Dying for Good Health Care in Russia

This morning's Los Angeles Times ran part two of the paper's series on Russia's demographic crisis, "The Vanishing Russians."

In my earlier entry on part one of the series ("Russia' s Dying Population"), I remarked how dramatically fast Russia had fallen from the ranks of the great powers. There's some triumphalism here, on my part, for the Soviets were the United States' mortal enemy during the post-World War II era, and the end of the Cold War was seen as ushering in a "New World Order" of superpower cooperation amid resurgent international institutionalism.

Today, however, in reading the second installment on the Russian health care crisis, I felt sadness, bitterness, and even a bit anger. For a country that was once a model for aspiring socialist political systems the world over, the health crisis of Russia's population is an embarrassing tragedy, with dire implications for the lives of the Russian people. No one should have to live like this, even citizens of our once great rival for world hegemony:

Russia's steep population decline in the 15 years since the collapse of the Soviet Union has many causes, but the end of the Soviet healthcare system and the debut of free-market medicine have added to the slide.

In the new Russia, millions are born sick. Many succumb to poisons in the air and water around them, or are slowly killed by alcohol, cigarettes or stress. Most are too poor to buy back their health.

The overwhelmed healthcare system can't help much. Although medical care still is nominally free, in practice all but the most basic services are available only to those able to pay hefty fees.

Bribes, the cost of superior treatment even in the Soviet era, are a feature of nearly every successful medical transaction. They can ensure that a patient will be admitted to a decent hospital and increase the chances that a doctor will be diligent.

For the well-off — mostly foreigners and those who struck it rich in Russia's transition from communism — there are gleaming "European medical centers" with modern equipment and foreign-trained physicians who charge $100 a visit. Everyone else is relegated to foul-smelling infirmaries with stained sheets, no food and a dearth of equipment as basic as a functioning X-ray machine. The doctors work for as little as $140 a month.

The Scientific Center of Children's Health, a branch of the Russian Academy of Medical Sciences, estimates that 45% of Russian children are born with "health deviations," including problems of the central nervous system, faulty hearts, malformed urinary tracts and low birth weight.

Heart disease and strokes among those younger than 40 have increased by as much as 36% in the last five years, said Yevgeny Chazov, who heads the Russian Cardiological Center in Moscow and was personal physician to most of the Soviet leaders since the Leonid I. Brezhnev era.

Russian President Vladimir V. Putin has responded to the problem, pushing healthcare to the top of the nation's priorities. This year, his government is spending $24.6 billion to more than quadruple some doctors' salaries, build hospitals, buy ambulances and equipment, pay for more surgeries, vaccinations and AIDS treatment, and subsidize medicines for children and pregnant women."

It finally took Putin himself to understand what was happening," said Murray Feshbach of the Woodrow Wilson International Center for Scholars in Washington, who has long studied health and demographics in Russia. "But it's very late."

This is an outstanding article, which deserves a close read. The health crisis in Russia is part of the larger "Russian problem" that will face the world in coming decades -- the situation of a pseudo-democratic state, rife with corruption and oligarchic power, with a crumbling military infrastructure (especially in the realm of strategic nuclear weapons), combined with a destablilizing nationalities problems and terrorist threats. These Russian developmental challenges are often forgotten amid other world crises on the international agenda, but how they unfold will have dramatic implications for global security.

Be sure as well to check out the article's photo gallery slide show, especially the pictures from Karabash, the industrial region about 1000 miles east of Moscow known as the world's most polluted location during the 1990s.

Karabash is a poster-town for the tremendous environmental costs associated with the Soviet Union's classic surge model of industrialization, which relied on massive inputs of natural resources, grinding human labor, and little concern for ecological ramifications. In Karabash today, deaths exceed births by 3.5 to 1 (statistically aligned, of course, with the entire country's demographic free fall). As one Karabash residents noted:

"No one in this town isn't sick. Not a single one. If they don't have bronchitis, they have problems with their stomach. If it's not the stomach, it's the heart," said Alevtina Nazarova, 40. "It's all because of the gas. You walk in the street, you come home and you cough like a madman."