Demographic crisis in Russia — страница 3

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structure compensated for the long-term trend toward lower fertility. The average age of the population was relatively young, and many women were of childbearing age. Beginning in the 1990s, however, this is no longer the case. The age structure is now such that it will promote a population decrease rather than an increase. Continued low fertility will only accelerate this effect. The Epidemiological Situation: Deteriorating Russian Health Perhaps the only genuine crisis aspect of current Russian demographic trends appears in increased rates of mortality, which have been especially dramatic among working-age men. In 1992, there was a sharp increase in deaths from nonnatural causes. By 1994, mortality rates for males between ages 15 and 64 were about twice as high as they had been

in 1986. Rising alcoholism and related conditions have figured prominently in this trend. In the mid-1980s, an anti-alcohol campaign championed by Mikhail Gorbachev was responsible for a brief reversal in the mortality trend, but the increase resumed after the campaign was abandoned in the late 1980s. Growing alcohol consumption is not the only explanation of increased mortality. Deaths from violence, injuries, and other nonnatural causes have contributed heavily to the latest rise. Russia's rates of homicide and suicide are among the highest in the world. In addition, deaths from illness and chronic and degenerative diseases, such as cancer, respiratory failure, and circulatory and cardiovascular diseases, have increased sharply. It is interesting to note that environmental

problems, generally given a large share of blame for Russia's health woes, are in fact not among the main culprits. Environmental problems cannot explain the increases in accidents, homicides, and suicides or the much greater increases in mortality for working-age males compared with other population subgroups. Mirroring the increase in mortality rates, life expectancy in Russia has dropped. However, like the fertility trend, the current pattern is not new. In the mid-1960s, after decades of increase, life expectancy began to decline. This trend was reversed briefly in the mid-1980s due, many believe, to the success of the anti-alcohol campaign between 1985 and 1987. However, by 1993, life expectancy fell again. Russia now has the lowest life expectancy for males in a developed

country (58 years) and the largest disparity in the world between male and female life expectancy (13.5 years). The Failing Health-Care System The increase in deaths from preventable causes points to problems in Russia's health-care system. Again, these problems are not a recent phenomenon. They have accumulated over many years. One characteristic of the Soviet period was a lack of incentives to improve medical services. When changes in the health of the population occurred--such as a decrease of infectious disease and a rise in "civilized" ills, such as alcoholism, smoking, traffic accidents, and pollution, in the mid-1960s--the health-care system failed to adapt appropriately. Excessive reliance on ideology led to ineffectual goals and an emphasis on activities that

addressed neither the medical problems at hand, the level of national development, existing medical capabilities, nor public demand. In the 1980s, the system finally made attempts to cope with the changing health environment, but the strategy was poorly implemented and lacked necessary investments in facilities and equipment. Although these problems were not created by the current socioeconomic crisis, they have been aggravated by the breakdown of the old social system. In the Soviet era, virtually all health care was provided free by the state, whose system emphasized the quantity of medical personnel and facilities, overlooking the quality of services, and pursued goals set on the basis of political ambitions rather than on objective medical needs and economic capabilities. As

the command economy crumbled, the public-health sector plunged into a financial crisis. The system found itself in an emerging market environment without the capacity to function successfully in it. Left without proper funding, health-care facilities were forced to abandon new construction, renovation, and other basic investments. Cost cutting necessitated switching to cheaper technologies, which proved insufficient to maintain needed levels of care. Available funds were frequently diverted to current needs. As a result, the health status of the Russian population is deteriorating, and diseases long thought to be eliminated or controlled--such as diphtheria--are now spreading again. Reviving an effective health-care system in its current form presents a near-impossible task. Many