Saturday, October 6, 2018

In Putin’s Russia, the Health and Well-Being of the Individual Comes Last, Inozemtsev Says

Paul Goble

            Staunton, October 6 – No counry, Vladislav Inozemtsev argues in an important new book, can be considered contemporary unless it puts the well-being of each of its citizens “above abstract ‘national interests.’”  Using that standard, he argues, Putin’s Russia must be considered anything but contemporary.

            His book, An Anything but Contemporary Country. Russia in the World of the 21st Century (in Russian, Moscow, 2018), surveys the entire range of the ways in which well-being of the individual comes last in Russia today from health care to environmental protection and the defense of human rights.

            For a variety of historical and economic reasons “from the positioning of the state in relation to its own people to the raw materials character of the economy which doesn’t require ‘excess’ population,” Russia has “traditionally left in the shadow the problems of the quality of life,” including health care.

            As a result, health care in Russia “remains and is even becoming ever less contemporary. Developed countries spend from 11 to 17 percent of GDP on health care, while Russia spends only 7.1 percent. In fact, the US spends 50 percent more on health care alone than the entire Russian GDP.

            A major reason for this, the economist argues, is that medicine remains a largely government-controlled sector and is viewed by the powers that be as a budgetary burden rather than as an opportunity to improve the lives of people.

            Evidence of this includes the fact that Russia has not developed its own production of medical equipment or even medicines. At present, Russia imports 79.8 percent of medical equipment and 72.7 percent of the medicines uses in the country. And it pays its doctors a tiny fraction of what they are paid abroad.

            There is to be sure some commercial medicine, Inozemtsev acknowledges, but he points out that it is concentrated in the major cities: At present, 39 percent of all paid medical services in Russia are to be found in Moscow and St. Petersburg alone. Those who extrapolate from the situation in the capitals are thus making a profound mistake.

            The Russian governmenthas concluded that it cannot even maintain the level of Soviet medical care. “Between 2000 and 2016,” the economist says, 7500 hospitals and polyclinics were closed in Russia.” Most of those shuttered were in rural areas, and today, “more than 17,500 population points do not have any medical facilities at all.”

                The remaining hospitals do far fewer operations, 15 to 25 times fewer than the US even though Russia has almost half the population, needed to maintain contemporary standards of health care.  But even more unfortunately, far fewer Russians are examined regularly and therefore diseases are discovered only later when they are harder or impossible to cure.

            In Russia, 39.6 percent of all those found to have cancer are diagnosed only in the third or fourth stages, while in the US, only 14 percent are diagnosed so late and only 6.5 percent in Japan. Not surprisingly, survival rates for cancer victims are far worse in Russia than they are elsewhere, “the result of the consistent underfinancing of Russian medicine.”

            Spending on health care exceeds spending on defense by 2.9 times in the US and 7.3 times in Germany; but in Russia, the situation is reversed. There, the government spends four times as much on its military than it does on the health of the Russian people, all too often to counter “imaginary threats.”
            Three other areas where Russian health care is anything but contemporary are the stratification of access by wealth, the lack of study of epidemiological problems, and the failure to work to integrate those with disabilities into the workforce and the broader society, Inozemtsev continues.

            The wealthiest and most powerful do have access to good health care either in special clinics or by going abroad, but the rest of the Russian people don’t. Indeed, the situation in that regard is if anything worse now than it was in Soviet times.

            Moreover, Moscow fails to conduct the kind of epidemiological studies any truly contemporary country must.  As a result, it has not focused on the rise of the number of HIV infected. Instead, Russia is the only “advanced” country where such infections are on the rise to the tune of 85,000 to 120,000 new cases each year.

            There are between 1.11 and more than two million HIV cases in Russia, and the fact that no one can be more specific is itself a failure on the part of the Russian government.  In some cities, from 2.5 to 8 percent of men in their 30s or 40s are infected; but officials “seriously suppose that the majority of infected are guilty” rather than viewing this as a societal problem.

            “However much we curse ‘the wild 1990s,’” Inozemtsev says, “the number of deaths from HIV-AIDS in [Russia] today exceeds by a significant number those of that ‘wild’ time and will grow further.” 

            But perhaps the worst sector of all is the Russian approach to persons with disabilities.  A Stephen Hosking wouldn’t have survived let alone flourished in Russia, Inozemtsev points out.  Russia spends vastly less on each of them than do other countries, and today “not a single major domestic company corresponds to the standards of an equal opportunity employer.” 

            Russia doesn’t even take good care of those who have served their country in the military and suffered disabilities as a result.  The United States does. Indeed, the US spends on the health care of veterans a sum that is 4.3 times that of the entire Russian military budget, Inozemtsev continues.

            There are many things other countries are doing in health care that Russia could copy, he says; but the government isn’t doing that, and so the population will continue to decline not only because Russians will die far earlier than they would otherwise but also because the lack of good health care is one of the reasons Russia is anything but a magnet for immigrants.

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