The adoption of the law "About foundations of population health care in the Russian Federation" in absence of concept of health care development determining the major targets and tasks of the sector gives rise in citizen incomprehension and rejection of innovations of health policy. To determine the vector of development of Russian health care as compared with Soviet system of health care the analysis of particular positions of the Federal law "On foundations of population health care" (2011) and the USSR law "On approval of foundations of legislation of USSR and Union republics on health care" (1969) is made.
The main principles of the concept of the "decrease of harm", realized in many countries of the world, are presented and the expediency of using this concept in Russia is substantiated. The beginning of the realization of the Project "Decrease of Harm: the Russian Federation", aimed at training specialists capable of carrying out prophylactic work among users of intravenous drugs (UID), is demonstrated. The principles of the selection of the groups of trainees are shown: the groups are made up of physicians working at AIDS centres, specialists in narcology and representatives of non-governmental organizations. The course of training provides the basic information on the strategy of the prophylaxis of HIV infection among UID, including evaluation and study, outreach, change of syringes and needles, replacement therapy, the program of the treatment of drug addiction. At the present moment 46 specialists from 18 regions of Russia are taking the course of training.
Russia has always been at an intersection of Western and Eastern cultures, with its dozens of ethnic groups and different religions. The federal structure of the country also encompasses a variety of differences in socioeconomic status across its regions. This diversity yields complexity in aging research; aging people in Russia differ in terms of nationality, religion, political beliefs, social and economic status, access to health care, income, living conditions, etc. Thus, it is difficult to control for all these factors or to draw a picture of an "average" Russian older adult. Nevertheless, there is a great deal of research on aging in Russia, mainly focusing on biomedical and social aspects of aging. Most such research is based in the Central and Western regions, whereas the Siberian and Far East regions are underrepresented. There is also a lack of secondary databases and representative nationwide studies. Social policy and legislation address the needs of older adults by providing social services, support, and protection. The retirement system in Russia enables adults to retire at relatively young ages-55 and 60 years for women and men, respectively-but also to maintain the option of continuing their professional career or re-establishing a career after a "vocation" period. Though in recent years the government has faced a range of political issues, affecting the country's economy in general, budget funds for support of aging people have been maintained.
Male life expectancy in the Russian Federation, at 60 years, is the lowest in Europe. Several factors contribute to this situation, but hazardous consumption of alcohol is especially a key factor.
We undertook a stakeholder analysis in a typical Russian region located on the western side of the Urals. Organizations with a stake in alcohol policy in the region were identified by snowball sampling and information on their position and influence on alcohol policy was elicited from interviews with key informants. Their interests and influence were mapped and their relationships plotted.
Twenty-nine stakeholder organizations were identified and 43 interviews were conducted with their staff. The most influential actors were the Federal and regional governments, large beer producers and manufacturers of strong alcohols. However, the majority of organizations that might be expected to play a role in developing or implementing alcohol control policies were almost entirely disengaged and fragmented. No evidence was found of an existing or emerging multi-sectoral coalition for developing alcohol policy to improve health. Organizations that might be expected to contribute to tackling hazardous drinking had little understanding of what might be effective.
While stakeholders with an interest in maintaining or increasing alcohol consumption are engaged and influential, those who might seek to reduce it either take a very narrow perspective or are disengaged from the policy agenda. There is a need to mobilize actors who might contribute to effective policies while challenging those who can block them.
Cites: Health Policy Plan. 2000 Sep;15(3):239-4611012397
Cites: Lancet. 2001 Mar 24;357(9260):917-2111289348
Evidence for alcohol-price policy relies heavily on aggregate econometric studies for the United States. Prior reviews of prices and alcohol-related harms include only a few studies based on natural experiments. This study provides a comprehensive review of natural experiments for a wide variety of harms from studies published during 2003 to 2015. We examine policy changes that importantly affected alcohol taxes and prices, and related changes in availability.
Forty-five studies met inclusion criteria, covering nine countries: Australia, Denmark, Finland, Hong Kong, Iceland, Russia, Sweden, Switzerland, and United States. Some studies cover more than one harm or country, and there are 69 outcomes for review. Summaries are provided for five outcome groups: alcohol-related mortality and hospitalizations; assaults and other crime; drink-driving; intoxication; and survey-indexes for dependency. The review notes both positive/mixed results and negative/null results.
Findings indicate that changes in taxes and prices have selective effects on harms. Mortality outcomes are positive for liver disease and older persons, especially in Finland and Russia. Mostly null results for assaults and drink-driving are found for five countries. Intoxication results for Nordic countries are mixed for selective subpopulations. Results for survey indexes are mixed, with no strong pattern of outcomes within or across countries.
Prior reviews stress taxes as a comprehensive and cost-effective intervention for addressing alcohol-related harms. A review of natural experiments indicates the confidence placed on this measure is too high, and natural experiments in alcohol policy had selective effects on various subpopulations.
Responding to problematic drug use in Russia, the government promotes a policy of "zero tolerance" for drug use and "social pressure" against people who use drugs (PWUD), rejecting effective drug treatment and harm reduction measures.
In order to assess Russian drug policy against the UN Convention Against Torture and the International Covenant on Economic, Social, and Cultural Rights, we reviewed published data from government and non-governmental organizations, scientific publications, media reports, and interviews with PWUD.
Drug-dependent people (DDP) are the most vulnerable group of PWUD. The state strictly controls all aspects of drug dependence. Against this background, the state promotes hatred towards PWUD via state-controlled media, corroding public perception of PWUD and of their entitlement to human rights. This vilification of PWUD is accompanied by their widespread ill-treatment in health care facilities, police detention, and prisons.
In practice, zero tolerance for drug use translates to zero tolerance for PWUD. Through drug policy, the government deliberately amplifies harms associated with drug use by causing PWUD (especially DDP) additional pain and suffering. It exploits the particular vulnerability of DDP, subjecting them to unscientific and ideologically driven methods of drug prevention and treatment and denying access to essential medicines and services. State policy is to legitimize and encourage societal ill-treatment of PWUD.
The government intentionally subjects approximately 1.7 million people to pain, suffering, and humiliation. Aimed at punishing people for using drugs and coercing people into abstinence, the official drug policy disregards the chronic nature of drug dependence. It also ignores the ineffectiveness of punitive measures in achieving the purposes for which they are officially used, that is, public safety and public health. Simultaneously, the government impedes measures that would eliminate the pain and suffering of DDP, prevent infectious diseases, and lower mortality, which amount to systematic violations of Russia's human rights obligations.
BACKGROUND: The official statistics of persons with mental disorders who are granted disability pension (DP) in Russia and Norway indicate large differences between the countries. METHODS: This qualitative explorative hypothesis-generating study is based on text analysis of the laws, regulations and guidelines, and qualitative interviews of informants representing all the organisational elements of the DP systems in both countries. RESULTS: The DP application process is initiated much later in Norway than in Russia, where a 3 year occupational rehabilitation and adequate treatment is mandatory before DP is granted. In Russia, two instances are responsible for preparing of the medical certification for DP, a patients medical doctor (PD) and a clinical expert commission (CEC) while there is one in Norway (PD). In Russia, the Bureau of Medical-Social Expertise is responsible for evaluation and granting of DP. In Norway, the local social insurance offices (SIO) are responsible for the DP application. Decisions are taken collectively in Russia, while the Norwegian PD and SIO officer often take decisions alone. In Russia, the medical criterion is the decisive one, while rehabilitation and treatment criteria are given priority in Norway. The size of the DP in Norway is enough to cover of subsistences expenditure, while the Russian DP is less than the level required for minimum subsistence. CONCLUSION: There were noteworthy differences in the time frame, organisation model and process leading to a DP in the two countries. These differences may explain why so few patients with less severe mental disorders receive a DP in Russia. This fact, in combination with the size of the DP, may hamper reforms of the mental health care system in Russia.