Commentary / World

Serious challenges hamper ambitious Russia

by Cesar Chelala

As the new economic crisis threatens to engulf countries involved in world trade, Russia still has to confront several challenges such as youth emigration, demographic, public health and economic issues that hinder the country’s development.

Growing economic difficulties and lack of job opportunities and professional development entice many young people to emigrate, particularly to Europe and to the United States. It is estimated that between 2000 and 2010 more than 1.25 million Russians emigrated, an even greater number than those who left after the collapse of the Soviet Union .

During the past two decades, an aging demographic turn and its effect on Russian society has been the focus of debate. Russia is experiencing a rapidly aging population with steadily declining birth rates. However, while people living in most industrialized countries have increased life expectancy, Russian inhabitants have a relatively low health status.

These factors, in addition to restrictive immigration policies and low fertility rates (below two children per woman, which is considered the population replacement rate), have led Russia to a constant process of depopulation. Between 1993 and 2015 Russian population decreased from approximately 149 to 144 million people. If current trends continue, there will be between 100-107 million Russians in 2050.

Serious health problems among Russians derive from high rates of smoking and alcohol consumption. Mortality among Russian men rose by 60 percent since 1991, four or five times higher than the European average, mostly from preventable causes (alcohol poisoning, smoking, cardiovascular diseases, traffic accidents and violent crime.)

According to the World Health Organization, heart disease, aggravated by alcohol and tobacco, is responsible for over 1.2 million deaths each year. Estimates of annual fatalities derived from smoking-related diseases range from 350,000 to 400,000. In the U.S., with more than twice the population of Russia, cigarette smoking causes more than 480,000 deaths annually.

HIV/AIDS is still a serious problem, particularly because 80 percent of those infected with HIV are under 30, and the epidemic is closely associated with high levels of intravenous drug use. More than two million men are considered to be HIV positive, and the epidemic doesn’t show any signs of abating.

Tuberculosis still affects many Russians. Even more seriously, the country is experiencing a high burden of multidrug-resistant tuberculosis (MDR), a variety of the disease impervious to isoniazid and rifampicin, the two most effective first-line anti-TB drugs. Treatment of MDR TB requires treatment with drugs that are less potent and more toxic that those used to treat drug-susceptible TB.

The prevalence of diabetes is rapidly increasing in Russia, where four million people have been diagnosed with the disease and almost six million people are unaware they have it. The annual cost of caring for diabetic patients in Russia is over $12.5 billion.

In addition, a still inadequate health care system, lacking in resources and with attention focused on the country’s main cities, affects mental health care. In 2012, there were 277 outpatients clinics devoted to the primary care of people with mental disorders compared to 318 such clinics in 2005. At the same time, there is a reduction in the number and quality of medications for patients with psychiatric illnesses.

Trying to cope with such problems diverts resources from an economy under strain because of international sanctions and the low price of oil. The energy sector is a motor for the country’s economic growth, and there is a close correlation between oil prices and the country’s GDP. More than two-thirds of export earnings come from energy. However, the current global oversupply of oil and lower demand because of the economic crisis doesn’t augur well for the country’s economy.

The economic outlook is negatively affected by widespread corruption. Independent experts name law enforcement agencies as the most corrupt institutions, followed by health care, education, housing and communal services. While some experts maintain that corruption consumes as much as 25 percent of Russia GDP, the World Bank puts this figure at 48 percent. Transparency International ranks Russia 136th in its Corruption Perception Index.

The economic downturn affects all sectors, from big corporations to small and medium enterprises, many of which have gone bankrupt. A considerable number of small businesses that do well in prosperous times such as boutiques, small restaurants and several kinds of service stores have closed down.

Some recent cuts in health care and education will not solve the problems affecting the Russian economy. They are at most palliative measures.

Although the problems highlighted are not the only ones affecting Russia, they need to be effectively addressed if the country aims to develop at the rate that its considerable resources allow.

Cesar Chelala, a medical doctor who serves as a global health consultant, writes extensively on foreign policy and human rights issues.

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