Health and Demographics in Russia and the Consequences for Russian Society and Policy

On October 6, 2004, the Kennan Institute commemorated the 75th birthday of Wilson Center Senior Scholar Murray Feshbach with a seminar on the public health problems confronting Russian society—including HIV/AIDS and population decline—and the policy implications for Russia's leaders. Panelists Peter Hartsock of the National Institutes of Health, Judyth Twigg of Virginia Commonwealth University, John Hardt of the Congressional Research Service, and Harley Balzer of Georgetown University emphasized that Feshbach, throughout over 40 years of study of Russia and the Soviet Union, has been very effective in making sense out of limited and often distorted Soviet and Russian data sources in order to identify and track demographic and health concerns in the region. He has also played a vital role in encouraging Russian and U.S. policymakers to address these problems.

Peter Hartsock praised Feshbach's skill in uncovering demographic trends in the Soviet Union and Russia and in accurately predicting the health crises that are occurring today, and his perseverance in the face of Russian and Western critics who have claimed that his predictions were exaggerated. Hartsock explained that he had worked extensively with Feshbach on issues of Russia's HIV/AIDS epidemic. According to Hartsock, HIV arrived in the Soviet Union nearly a decade after it was first identified in the United States, but the Soviet government refused to admit that AIDS could become a serious problem, claiming that the disease was a result of capitalist excesses and immorality. The Russian government has continued this attitude of denial and has invested very few resources in the prevention and treatment of AIDS. The U.S. government, Hartsock added, also failed to provide assistance in combating HIV/AIDS in Russia during the 1990s, although it did finance prevention and treatment programs in Africa and Asia. Only recently, he argued, have Russian and U.S. leaders recognized how serious a threat the disease represents for Russia, and this acknowledgement is the result of dedicated work by people such as Feshbach.

Judyth Twigg described the recent reforms in Russia's healthcare system, which are intended to help Russia confront the threat presented by HIV/AIDS and many other diseases. According to Twigg, Russia uses its healthcare budget inefficiently, and the system is fraught with corruption as it labors under unclear and often contradictory legislation. Several attempts at reforming the system during the 1990s have been unsuccessful. The most recent set of reforms, expected to become active in 2008, are directed at increasing regional contributions to the national health insurance fund and providing consistency. However, Twigg argued that although these reforms may result in increased spending on healthcare, they will probably not provide higher-quality or more equitable healthcare.

John Hardt described how health and demography—and Feshbach's analyses of these factors—have affected public policy in the Soviet Union and Russia. He noted that Feshbach and other outside researchers were able to analyze data on issues such as infectious disease, infant mortality, alcoholism, and the health consequences of environmental degradation that were ignored or suppressed inside the Soviet Union. Soviet economists and demographers have credited Feshbach's work on infant mortality with saving thousands of infant lives in the Soviet Union, Hardt added. Russia's demographic and health situation continued to decline in the post-Soviet period, but the government did little to address the underlying problems. Hardt argued that only under current president Vladimir Putin has the Russian government started to recognize the seriousness of the country's health and demographic problems and to direct funding into programs that may help resolve them.

Harley Balzer warned that the scope of Russia's current health and demographic problems is huge and that the government is not likely to have the will or ability to deal with these problems effectively. He argued that Russia will soon have too few healthy adults to staff its military, fill its universities, and maintain the workforce in the state and private sectors. The government can address demographic problems by implementing policies that improve health and life expectancy indicators, increase the birthrate, or facilitate immigration. Balzer explained that all of these policies are complicated to implement in practice, and it is unlikely that Russian leaders will take the initiative to address complex public health problems, especially while high energy prices provide a false sense of economic security. The most likely answer to Russia's demographic crisis, he argued, will be mass immigration. However, he warned that immigration can create its own problems, particularly by fueling nationalist sentiment in Russia.