THL, Kansainvälisten asiain yksikkö, Dmitry Titkov1 SIHLWA North-West Russia Stakeholder Analysis Tentative summary of project findings Dmitry Titkov, project manager

THL, Kansainvälisten asiain yksikkö, Dmitry Titkov2 Project’s overall objective To improve the health and wellbeing of the population in the partner countries through providing all interested partner countries

THL, Kansainvälisten asiain yksikkö, Dmitry Titkov3 Project’s purpose To provide up-to-date info about key stakeholders/expert organisations/other actors within the project area related to: - alcohol, - adolescent health and socially rewarding lifestyles, and updated info on workability To identify most crucial programmes/projects related to these areas to improve networking and exchange of data and know-how To take up ideas for further co-operation

Geographically

Thematically two focuses: Alcohol Adolescent health and socially rewarding lifestyles THL, Kansainvälisten asiain yksikkö, Anne Vienonen5

Personnel: Project manager, local experts in the pilot areas (totally 5), plus advise as needed from SIHLWA EG (chairperson, ITA) THL, Kansainvälisten asiain yksikkö, Anne Vienonen6

Technically: Stage 1: Local experts recruited, ToRs Stage 2: Review of documentation collected at STAKES IDC/web search with emphasis on European/federal/national policies, strategies, plans/programmes related to the themes of investigation Stage 3: Collection of data (relevant international/regional policies/plans/programmes/projects and interviewing of stakeholders personally or by /phone) by local experts and project manager (field trips) Stage 4: Analysis of data collected and report writing; details clarification (currently ongoing) THL, Kansainvälisten asiain yksikkö, Anne Vienonen7

Policies, alcohol No specific alcohol-related laws, policies or strategies available Several laws prohibit: sale of alcohol products to those under 18 yo; drink-driving; limits on advertising of alcohol products in mass media; limits on public places where alcohol may be consumed as well as may appear being drunk Regional laws may further restrict time for sales of above 15%-proof alcohol (effective in St-Petersburg, Leningrad Region, Karelia Republic) Problems with the implementation of those few laws in force THL, Kansainvälisten asiain yksikkö, Anne Vienonen8

Policies, health promotion Russian National Priority Project “Health” /Zdorovje/, where health promotion is a new key area of activity ( ) with accent on tobacco smoking and alcohol use Concept of Russia's demography policy to year A major task of the demography policy is establishment of conditions and development of motivation towards healthy lifestyle among the population Concept of Russian healthcare development up to One of the ultimate goals is to increase life expectancy rate in Russia to 75 years and build up healthy lifestyles among the population, particularly through reduction of alcohol use and tobacco smoking Strategy of Physical Culture and Sports Development in Russia (draft) – focus on physical activity, particularly among children Problems with funding of the programmes/policies

Regional policies on alcohol and health relation In many ways the region-level policies/strategies/plans follow the nationally initiated and accepted documents, with few exceptions The laws/policies in regions are targeted at: production and turnover of alcohol products (licensing/where/when/to whom/quality/illegal alcohol), demography development, prevention of juvenile delinquency, social support to families and children, youth programmes, prevention of socially related diseases The primary reason to follow the federal legislation is centralisation (national priority projects) and money available for federal plans and programmes, while for regional initiatives regional resources may be used

Overview of stakeholders on alcohol arena tax policyFederal government, finance ministry, tax authority illegal trafficking, qualityLaw enforcement authorities and Rospotrebnadzor (Consumer Rights and Human Welfare Agency), alcohol industry offences/crimes in intoxication stateLaw enforcement agencies, social services and NGOs (e.g. victims of domestic violence) treatment/rehab/sec.preventionNarcology services, psychiatric services, NGOs primary special preventionMedical prevention services, narcology services, social care centres, mass media, NGOs non-specific preventionYouth authorities, social authorities, educational authorities, culture authorities, mass media, NGOs

Alcohol related key stakeholders in Russia Narcology/Addictions Service (narkologicheskij dispanser) (subordinate to healthcare authorities) – therapies, rehabilitation, secondary prevention Medical Prevention Service (tsentr meditsinskoj profilaktiki) (subordinate to healthcare authorities) – special primary prevention targeted at risk factors Youth Committees, Social Policy Committees, Education Committees, Culture Committees – general (non-specific) prevention, vulnerable groups, particularly families, young people and children NGOs, associations – mostly in general prevention, secondary prevention, working with at-risk groups

Healthy and socially rewarding lifestyles related stakeholders in Russia Regional medical prevention centres (through healthcare authorities) – responsible for specific prevention focused at risk factors and at health promotion Youth committees at regional/city level – deal with general (non- specific prevention), promotion of socially rewarding and healthy lifestyles through thematic actions, campaigns, programmes, contests Educational authorities – deal with promotion of health and socially rewarding lifestyles at educational institutions (through the school healthcare system and collaboration with other relevant actors) Social welfare/policy authorities – deal with vulnerable population groups (young people, families, children)

Structure of the medical prevention services in Russia departments/offices of medical prevention at healthcare settings

Centre of Medical Prevention as a basic institution in special prevention activity and health promotion Centre of Medical Prevention (tsentr meditsinskoj profilaktiti) is responsible for: organization and conduct of evidence-based actions aimed at primary and secondary prevention of non-communicable diseases, health education, dissemination of health information and knowledge, and assistance to other structures and institutions in implementation of such actions analysis of casual relations between public health and lifestyles, level of healthcare services and environmental situation; based on this, development of specific measures of disease prevention provision of health-related information to professionals and population groups THL, Kansainvälisten asiain yksikkö, Anne Vienonen15

Structure of narcologic service in Russia National Narcology Research Centre (methodical and scientific guidance) Regional/city addictions clinics (narkologicheskij dispanser) Regional/city addictions hospitals (narkologicheskaja bolnitsa) Narcologic departments (narkologicheskoje otdelenije) at narcologic, psychiatric and general inpatient institutions

Narcology/Addictions Clinic as a basic institution in alcohol-related activity Narcology (Addictions) Clinic (narkologitcheskij dispanser) is responsible for: early detection and putting on records of patients with chronic alcoholism, drug addiction or substance abuse therapeutic and preventive, counseling and psycho-preventive assistance to such patients in inpatient and outpatient settings surveying of incidence rates related to chronic alcoholism, drug addiction and substance addiction participation in anti-alcohol and anti-drug measures along with other agencies, organizations and institutions making therapeutic and preventive plans for patients with alcoholism, drug addiction and other addictions THL, Kansainvälisten asiain yksikkö, Anne Vienonen17

Young person Medical prevention centres Narcologic/addiction clinics Youth authorities Educational authorities Culture authorities Law enforcement agencies Mass media Alcohol industry Social welfare authorities FAMILY PEERS, FRIENDS, COLLEAGUES Actors of impact NGOs

Key stakeholders, summary Through regional/city health authorities to regional addictions/narcologic clinics Through regional/city healthcare authorities to regional/city centres of medical prevention Youth committees at regional/city level Educational authorities at regional/city level Social welfare/policy authorities at regional/city level Regional branches of the Rospotrebnadzor NGOs

Key problems, alcohol Fragmental inexplicit legislation related to alcohol and lifestyles Supervision of implementation of existing laws Price policy (beer price – vodka price ratio) Lobbying from alcohol industry High public tolerance towards alcohol consumption, including medical community Early initiation of alcohol consumption, often at families Increasing number of girls starting alcohol consumption Beer alcoholism Low detection rate, particularly at early stages, of alcohol-related problems Statistics for alcohol-caused disorders and alcohol consumption – official figures are a peak of the iceberg

Key problems, healthy and socially rewarding lifestyles Economic challenges do not allow either the government or people to concentrate adequate attention/time to own health Low responsibility for own health in general Lack of community-based initiatives Poor coordination/consolidation of efforts from various relevant actors Health promotion activity not systematised Scarce resources, infrastructure, trained personnel Mass media poorly involved High mortality rate and low life expectancy rate among working-age males

Possible areas of cooperation, alcohol Tax and price policies in Western countries/EU Control of alcohol sales to the under-aged Reporting, statistics, information exchange, surveying Early identification and brief intervention/motivational interviewing techniques Piloting of a system of primary and secondary prevention of psychoactive substance use in outpatient setting Development and copying of educational/informational materials Working with at-risk groups

Possible areas of cooperation, healthy and socially rewarding lifestyles Arrangement of promotion of healthy and socially rewarding lifestyles Key risk factors and how they are dealt with Experiences of health promotion among young people at practical level Building up a responsible attitude towards own’s health Joint youth initiatives, actions, camps

International projects, St-Petersburg, alcohol WHO Collaborative Project on Identification and Management of Alcohol-Related Problems in Primary Health Care, Phase IV; pilot in St- Petersburg for development and application of country-wide strategies for the widespread, routine and enduring implementation of early identification and brief intervention within primary healthcare, ; MAPS (St- Petersburg)/Know How fund (GB) EIBI Early Identification and Brief Intervention for harmful and hazardous alcohol consumption; feasibility study of EIBI applicability with possible further programming of EIBI implementation projects in the NW Russia, 2008; MAPS (St-Petersburg)/STAKES (Finland) Alcohol and drug abuse prevention among youth in St. Petersburg; to influence risk-behaviour of young people towards responsible, sustainable relationship with alcohol, and towards abstinence vis-à-vis drugs, to develop preventive programs based on peer-to-peer methods and “Health Councils” in schools; training for volunteers; interactive public actions; media seminars; seminars for local decision makers, ; Information and Analyses Centre for Social and Health NGOs, “Stellit”, “Look to the Future”, Drug abuse prevention centre, Mechnikov Academy/National Public Health Institute (Finland), A-Clinic Foundation, Nordic Council of Ministers

International projects, St-Petersburg, lifestyles Youth Peer Education in the Krasnogvardeisky and Nevsky raions in St.Petersburg; the project trained 50 Peer Natural Leaders (PNL), who would arrange workshops for minimum 3000 youths in the project period. Intensive communicational training was provided for the PNL. The project also did workshops at summer camps for youths at risk. The main area of work was collaboration with the 30 youth clubs affiliated to the Nevsky Raion; 2004; administrations of the raions/The Petrinax Group (Norway) Process and contract; the project´s aim was to combat the increasing drug abuse among young people in the districts of Admiraltejskij and Primorsky in St- Petersburg. The Swedish partner worked together with the Admiraltejskij district and Gertzen University against drug abuse through education, raising awareness and changing attitudes and opinion towards drugs; ; Norrbottens Basketbollförbund/Gertzen Pedagogical University, administration of Admiraltejskij raion Prevention of social isolation and mental disorders through environmental and nature-based education (Syrjäytymisen ja mielenterveysongelmien ehkäiseminen ympäristö- ja luontokasvatuksen avulla); to support children’s and youth’s welfare and prevent their isolation by environmental education means. Isolation is the worst problem, which eventually may lead to further social risks. Being close to nature and growing in nature is one of the preventive methods. The project developed and tested innovative education and development sets of methods to work with children and young people; ; Rantasalmi Environmental Education Institute

International projects, Leningrad Region, alcohol EIBI Early Identification and Brief Intervention for harmful and hazardous alcohol consumption (see above)

International projects, Leningrad Region, lifestyles New Life Scenarios for Russian Youth; to build the capacity of youth NGOs in St Petersburg and Leningrad Oblast by establishing a set of services responding to current local needs designed to improve levels of youth employability and providing conditions for effective cross-sector partnership; to transfer to youth NGOs and groups of St-Petersburg and Leningrad Region training manual "Enhancing Competitiveness at Labour Market" intended for young people of 16 to 25 years old; establishment at some youth NGOs of "Career Counseling Centres" based on studies and adaptation of international experiences; ; St. Petersburg Non- Governmental Organisation "The NGO Development Center", St- Petersburg Committee on Youth Policy, Leningrad Regional Committee on Sports and Youth / Prince of Wales International Business Leaders Forum (UK)

International projects, Murmansk Region, alcohol Support New Beginning, to build up strong NGO-aided alcoholism rehabilitation activities, particularly for indigenous people, 2004-now on; "Sami Mission" (Sigfred Giskegjerde)/"New Beginning" NGO (Ms Natalia Vetsko) Competence building for prevention and rehabilitation of children and youth with drug- and alcohol problems; to provide knowledge and experience, consultations and follow-up of the existing and prospective activities for children and youngsters who abuse drug/alcohol in the Murmansk Region, to contribute to the re- integration of children who abuse drug/alcohol into society, to involve civil society into the problems of children who are drug/alcohol abusers; , SOS-barnebyer Norge / Murmansk Regional Administration THL, Kansainvälisten asiain yksikkö, Anne Vienonen28

International projects, Murmansk Region, lifestyles Prevention, diagnosis and treatment of COPD in the Murmansk region , Phases I and II; the objective is to improve health in the Murmansk region by reducing morbidity and mortality of COPD, ; Filha (Finland) / Healthcare Committee of Murmansk The development and research project of the psychosocial wellbeing of children and youth of the Arctic; to strengthen cross- national cooperation (Finland, Sweden, Norway, Russia) between doers related to psychosocial wellbeing in the fields of university- and polytechnics-, young people and families by developing a model that supports the psychosocial wellbeing of young people and children in the Barents area; ; Murmansk Institute of Humanistic Sciences, Murmansk Pedagogical Institute, University of Lapland Arctic Children II; Development of a multifunctional model of co- operation aimed at health care and preventing exclusion from the social environment. The project description and results are available at , partners from Murmansk, Finland, Sweden and Norwaywww.arctichildren.net THL, Kansainvälisten asiain yksikkö, Anne Vienonen29

International Projects, Karelia Republic, alcohol Together against tobacco and alcohol – a community programme to prevent alcohol consumption and smoking among youth; the purpose of the project is to increase knowledge on alcohol related social pressure among youth and educate adolescents the skills to refrain from smoking and alcohol consumption, ; National Institute of Public Health (Finland) / Pitkäranta District Administration Strategies to Tackle Alcohol and Drug Abuse in the Workplace; The overall objective of the project is to establish and encourage local preparedness to deal effectively with problems related to alcohol and drug abuse in the workplace in Karelia through formulation of alcohol and drug abuse policy for Petrozavodsk City Administration, Onego Tractor Plant and other stakeholders. The services provided include workplace and public policies, stakeholder networking, occupational health and treatment perspectives, Prime for life lifestyle risk reduction model, gender and family aspects, information and education as prevention methods; 2004-now on; Scanagri Sweden AB / Petrozavodsk City Administration, Onego Tractor Plant THL, Kansainvälisten asiain yksikkö, Anne Vienonen30

International Projects, Karelia Republic, lifestyles Promoting of healthy life style and social wellbeing of young people in the Republic of Karelia; to prevent abuse of drugs, alcohol and tobacco among adolescents, to promote healthy lifestyle of young people and their concern of their own welfare. Furthermore, to support children, young people and families at risk, which are under the pressure to be excluded, ; STAKES (Finland) / Karelian Health and Social Development Ministry, Centre of Medical Prevention Health promotion through physical training classes in Karelia schools; to support health and development of children and adolescents through physical training classes and health promotion activity. The ultimate purpose of the project is to build school health promotion teams which would guide schoolchildren and teachers in health promotion actions in pilot schools; ; Liikunnan ja Terveystiedon Opettajat ry (Finland) / Karelian Pedagogical University THL, Kansainvälisten asiain yksikkö, Anne Vienonen31

Few conclusions about international activity 1) If all the projects are categorized into research and development, then alcohol-related projects are basically research ones, i.e. psychopharmacology- oriented, 2) Out of development projects only few ones were targeted at only alcohol problems, and most projects concerned a wider range of problems, where alcohol was just one problem on the list. 3) The most common themes of a project are: prevention of psycho-active substance use (drugs, alcohol, tobacco), promotion of healthy lifestyles, support actions for vulnerable groups of population. 4) The Russian counterparts in projects represent both the governmental and non-governmental sector. Formal commitment from governmental bodies is preferable regardless to who the implementing parties of a project are from the Russian side. 5) The most active international actors in the regions in question are from Finland. Swedish and Norwegian organizations concentrate their project activity in Murmansk Region with few exceptions in St-Petersburg (and outside the coverage of the given project) THL, Kansainvälisten asiain yksikkö, Anne Vienonen32