Health and Healthcare in Russia - Implication and Responses
Authors: Simpson J.G. 
Published: December 2007

Abstract
This paper (1) provides an impression of Russian health and healthcare, (2) discusses some of the more significant implication of that health and healthcare for companies operating in Russian, especially those involved in oil and gas exploration and production, and (3) presents examples of responses based on these implications.

Introduction
The Russian people have endured dramatic changes in their political, economic and social infrastructures in the last several years. Health and healthcare have been caught up in these paradigm shifts. In spite of the admirable Russian quality of making the best of any situation, maintaining an acceptable level of health and providing adequate healthcare has become more and more difficult. Health and healthcare have not been at the level hoped for by the Russian medical community or the Russian people. For example, the average life expectancy of Russian men has fallen from 65 years in 1987, to 59 years in 1993 and below 58 years by 1995.
Health and healthcare in Russia is in need of substantial improvements and a well-managed effort over a significant period of time (years) will be required to bring about these improvements. The costs will be considerable. For example. an estimate for a five-year plan to improve health and healthcare in one far eastern Russia oblast was U.S. $350,000,000 in 1991. Obstacles to improvement include the traditional health systems and practices. competing priorities for scarce resources and the general political, economic and social environments in which health and healthcare must operate. The current health and healthcare conditions are partly the results of decades of a lack of emphasis. and therefore funding, relative to a worldwide ambitious political agenda. a successful space program and a well-respected military establishment. The predictable outcomes of inadequate medical facilities, equipment and supplies are present.

Health
The most significant health concern is acute trauma including violence and accidents, As encouraging as the sidewalk merchants and the related crowds (Figs. 1 and 2) are in terms of democracy and free-market enterprise, crime which involves personal injury is a very real threat. Deteriorating economic conditions have been a major contributing factor which was aggravated by occurrences such as merchants demanding hard currency, i.e. cash other than Russian rubles, during the tumultuous socioeconomic upheavals of the late 80's and early 90's. Understandable resentment of anyone, especially foreigners who appeared to be relatively well-off compared to many Russians, exacerbated the situation.
Equally threatening are injuries from accidents, especially due to unsafe conditions, some of which are obvious and some, not so obvious. Stretched public budgets have made sidewalk and street maintenance and repair difficult with open manholes and deteriorating conditions common place (Figs 3 and 4). As obvious as this hazard may he, a dark night without adequate street lights or a covering layer of ice and snow create a potential risk for serious injury.
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