The Impact of Globalization on Infectious Disease Emergence and Control Exploring the Consequences and Opportunities: Workshop Summary (2006) / Chapter Skim
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Appendix D Social Aspects of Public Health Challenges in Period of Globalization: The Case of Russia
Appendix D Social Aspects of Public Health Challenges in Period of Globalization: The Case of Russia
Pages 206-228
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The research methodology includes monitoring of public health and social security and relevant socioeconomic aspects, including activities implemented by the Russian Public Health Association, and comparative analysis of socioeconomic aspects of public health challenges. Some of the research materials were obtained by means of direct contacts with public health officials and experts and political scientists.3 A search of available publications, including those on the Internet, was followed by structuring and analysis of the collected information and data.
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They are supported by the governments of the countries leading globalization, and indirectly by international trade and financial organizations dominated by these countries (Matveevskiy) Economic activity becomes increasingly independent from the state, which loses the ability to manage its own economic and social affairs.
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. Public health challenges become a basic element in the stability of international political systems.
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However, a political model of globalization should serve the broader interests of the global community, primarily those related to environmental, social security, and public health challenges. Global policy and governance in the interests of all states and nations, based on relevant institutional and legal components, is needed in the era of global interdependence, when "Everyone is responsible to everyone for everything."6 It should be noted that post-Soviet Russia emerged at the peak of a political, socioeconomic, and public heath crisis, and since then has been an object rather than a subject of globalization (Dakhin, 2001)
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On that basis, the system of national interests and their hierarchy according to political and economic realities should be developed, ideologically based, and protected if Russia is to secure a sound place in the changing world, including participation in the development of new approaches for a global world order, public health policy, and governance. PUBLIC HEALTH THEORY AND PRACTICE IN RUSSIA Analysis of the development of public health theory and practice in Russia, closely related to the political, economic, and social changes in the country, is also important for understanding the country's public health challenges and response.
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However, a "class approach" was practiced in the training of medical professionals.7 Soviet social hygiene claimed that diseases and premature mortality are the product of a "sick" capitalist social system, social habits, and institutions, and that population health would be improved with the advent of "healthy" socialism and ultimately communism through the transformation of society and the education of the population. From the late 1920s, Soviet social hygiene was suppressed by the ruling political elite.
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By the mid-1960s, Russia's public health profile was comparable to that of many Western countries. The comprehensive health and social security of the Soviet citizen was considered by many to be an international "yardstick." However, public health theory and practice failed to prevent the decline of many public health indicators, experienced in Soviet Russia after 1964, with a short period of relative improvement in 1985–1987 with the advent of "perestroika." This decline can be explained largely by the sacrificing of social to military concerns during the cold war (Field and Twigg, 2000)
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Health information was declassified in 1993; modern research became possible, international collaboration began to develop, and activities of international players in Russia commenced. Attempts to modernize public health theory and practice according to Western approaches began.
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Among major public health challenges in Russia are depopulation, high mortality, low birth rates, intensive migration (including illegal) , increasing morbidity, and the rise of infectious diseases such as tuberculosis (TB)
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Only 10 percent of children finishing school are healthy, and only one-third of conscripts are fit for military service. The role of infectious disease in declining living standards and other social factors, especially poverty, is rising.
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POLITICAL, ECONOMIC, AND SOCIAL FACTORS RELATED TO PUBLIC HEALTH CHALLENGES IN RUSSIA In Soviet Russia, state social programs were the sole provider of safety nets for the population. These programs, as well as the economy and industry, were fueled until 1992 largely by state exports of natural resources, not manufacturing.
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. Public health challenges develop in parallel with, though lag behind, changes in the economy and social security.
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State and social control of alcohol use deteriorated in 1987 after the anti-alcohol campaign ended. The state alcohol monopoly was abolished in post-Soviet Russia at the end of 1991 by neoliberal ministers, sacrificing public health and state tax income to market interests.
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It is obvious that the hasty opening of the country to globalization processes during a crisis in social development has been one of the key factors in public health changes. Examples of these agents of change are 16Basic educational enrollment (as the percentage of the 7–15 age group)
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The world center of illegal drugs has moved closer to Russia, to Afghanistan. ROLE OF VARIOUS POLITICAL ACTORS IN PUBLIC HEALTH Four actors shape public health policy in the era of globalization: the state, private enterprises, civil society, and international players.
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Drug supplies and access to expensive quality health care became a matter for public concern. The response to public health challenges, even the depopulation threat, was inadequate.
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The second approach is to prevent premature mortality by means of health promotion and disease prevention. However, if this approach is to succeed, the social security system and informal safety nets, already strained in Russia, need to be strengthened to serve the increased numbers of aged with poor health that would survive.
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There has been strikingly little political protest, despite the considerable social costs of change. The political stability is explained by the legacy of the USSR regime, such as the absence of large inequalities and long-term poverty, the provision of welfare services, and compromised trade unions, as well as by the structural and institutional consequences of the neoliberal measures implemented, including increased unemployment, a decline in trade union membership, growth of the private sector, an increase in employment insecurity, and the opportunity to protest by voting the government out.
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The availability of natural resources and an educated population and opening up to globalization processes cannot guarantee a country's integration into the global economy or its internal social stability if social security and public health are not a priority in global and national political, social, and economic changes. Social security and public health can decline very rapidly if their importance is underestimated by the ruling elite, with profound repercussions for national security, the economy, and survival at the national level and beyond, to the regional and global levels.
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Russia could play a leading role in the prevention and control of HIV/AIDS and other infectious diseases in the Commonwealth of Independent States and Eastern Europe. Russian experts
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2000. Chapter 5: The social costs and consequences of the transformation pro cess.
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1999. Global public health: Revisiting healthy public policy at the global level.
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