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Addressing the epidemiologic transition in the former Soviet Union: Strategies for health system and public health reform in Russia


  • Tulchinsky, T.H.
  • Varavikova, E.A.


Objectives. This paper reviews Russia's health crisis, financing, and organization and public health reform needs. Methods. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. Results. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. Conclusions. The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

Suggested Citation

  • Tulchinsky, T.H. & Varavikova, E.A., 1996. "Addressing the epidemiologic transition in the former Soviet Union: Strategies for health system and public health reform in Russia," American Journal of Public Health, American Public Health Association, vol. 86(3), pages 313-320.
  • Handle: RePEc:aph:ajpbhl:1996:86:3:313-320_7

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    Cited by:

    1. Brainerd, Elizabeth, 2010. "Reassessing the Standard of Living in the Soviet Union: An Analysis Using Archival and Anthropometric Data," The Journal of Economic History, Cambridge University Press, vol. 70(1), pages 83-117, March.
    2. Atun, Rifat A. & McKee, Martin & Coker, Richard & Gurol-Urganci, Ipek, 2008. "Health systems' responses to 25 years of HIV in Europe: Inequities persist and challenges remain," Health Policy, Elsevier, vol. 86(2-3), pages 181-194, May.
    3. World Bank, 2014. "Kyrgyz Republic Public Expenditure Review Policy Notes : Health," World Bank Other Operational Studies 19313, The World Bank.
    4. Kim, Sang-Weon & Pridemore, William Alex, 2005. "Social support and homicide in transitional Russia," Journal of Criminal Justice, Elsevier, vol. 33(6), pages 561-572.
    5. Natalia Gavrilova & Victoria Semyonova & Elena Dubrovina & Galina Evdokushkina & Alla Ivanova & Leonid Gavrilov, 2008. "Russian Mortality Crisis and the Quality of Vital Statistics," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 27(5), pages 551-574, October.
    6. Butzlaff, Iris, 2016. "BMI Growth Rates and the Nutrition Transition: The Role of Income, Inequality and Income Growth in Russia," GlobalFood Discussion Papers 232914, Georg-August-Universitaet Goettingen, GlobalFood, Department of Agricultural Economics and Rural Development.
    7. A. J. Mercer & B. Jacobs & S. Moon & J. Kynch, 2003. "Prisons and the tuberculosis epidemic in Russia," Journal of International Development, John Wiley & Sons, Ltd., vol. 15(5), pages 559-574.

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