1. Inequity and Inequality in a Healthy City Profile of Moscow Part II Irina Campbell, PhD, MPH ivm1@columbia.edu www.CampbellHealthAssociates.com

2. TABLE : Economic Indicators in Russia, City of Moscow, City of St. Petersburg, 1990-1995 Click for whole Table

3. A 1992-1994 analysis of health profiles from 47 cities across Europe, which were members of the WHO Healthy Cities Project, indicated that cities, as coherent collective wholes, have population distributions with characteristics distinct from the sum of its individual members.

4. To orient health policy priorities to resolve inequities, it is important to distinguish between identifying intervening individual risk factors (like secondary smoke or drinking and driving) or addressing fundamental social conditions (like the lack of education, a civic community, or employment).

5. Health policy which seeks to eliminate only the intervening mechanisms or individual factors in health inequality will neither eliminate inequity nor the relationship between the disease and fundamental social conditions (Fiscella, 1997).

6. Social conditions and access to resources are very different in urban and rural regions, particularly in large, diverse multi-ethnic, multi- lingual nations like Russia.

7. Cities in Eastern Europe and Russia have a younger population structure, but a lower life expectancy than western and northern European cities. St. Petersburg, Russia, had the highest SMR of 14 cities, and twice of Nancy, France.

8. TABLE: Social Capital Indicators in Russia, City of Moscow, City of St. Petersburg, 1990-1995 Click for whole Table

9. A city health profile of Moscow is specific to its historical and geographical context. Moscow is the capital and chief city in the central region of Russia.

10. Moscow, which celebrated its 850 th anniversary in 1997, has always been Russia’s seminal city, the seat of the Tsars and the bureaucratic elite, which controlled national resources and wealth.

11. Inequality and poverty in the general population of Moscow were regulated to some extent by the socialist state, which attempted to control most aspects of community life by urban planning of housing, services, and economic infrastructure.

12. Moscow also has a large aging population of older women. In 1995, Moscow women were an average 5 years older than men (40.7 years and 35.5 years, respectively) and 31.1% were pensioners, older than working age, as compared to 14.1% of men.

13. TABLE 4 : Cause-specific death rates in Russia, City of Moscow, City of St. Petersburg, 1989-1997 (per 100,000) Click for whole Table

14. It was an alarming indicator of a compromised quality of life when, overall, more inhabitants died in Moscow than were born at the close of Perestroika.

15. FIGURE 3 : City of Moscow projected death rates, 1993-2010: actual rates, average rates, pessimistic high rates, optimistic low rates Click for the Figure

16. Although cardiovascular diseases still contribute the largest segment to decreasing life expectancy in Moscow, deaths from unexplained external and other causes account for a substantial proportion of total mortality (Table 5).(Table 5).

17. Adequate mortality statistics are not yet readily available openly for independent verification of government sponsored research by any western researchers requesting such data, the accessibility to which is still strictly controlled.

18. Although some attempts at linking alcohol consumption and cardiovascular disease mortality have been made for Russia to account for the mortality gap, the effects of stress, inequality, and social determinants have been shown to have a greater impact than individual levels of drinking in western countries (Chenet et al., 1998a, 1998b; Bloom and Malaney, 1998).

19. Morbidity in Moscow has been reported by the Mayor’s office as being 15-20% higher than the average in the Russian Federation in the first half of 1999.

20. 21% of all morbidity among Moscow adults, in 1998, was due to respiratory illness, 40% among adolescents, and 60% among children.

21. With the transfer of government property into private ownership, there has been a concomitant increase in breach of the Moscow city sanitation code by industries and firms, from 82.6% in 1995 to 85.2% in 1997, especially among small businesses.

22. Adult heart disease was 70% higher in 1997 in Moscow than Russia (220 vs. 125.4/100,000 respectively), and infectious respiratory diseases and sexually transmitted diseases remain a major public health threat (State of the Environment in Moscow, www.mos.ru, 1999). www.mos.ru

23. Morbidity was officially published in Moscow for only a limited number of conditions before 1990, but has been available annually for Russia as a whole since the last census of 1988-1989 (Vishnevsky, 1995; Goskomstat, 1996).

24. Moscow, as the primary urban center in the Russian Federation, clearly exhibits the health risks of a variety of factors which accompany any megalopolis of over 8 million inhabitants.

25. In 1991, Moscow did not have any registered cases of congenital syphilis, while in 1997, this increased to 34 cases.

26. The uneven variation of risk factors and health status was noted by the 1997 Mayor’s Report, pointing to the existence of specific neighborhood pockets of poor health.

27. In 1992, the southwestern district had the highest overall prevalence of infectious and parasitic diseases. Although morbidity rates were influenced by the location of specific health facilities which report official data, as was likely in the northwestern district, urban areas varied by important health risks.

28. Housing was a major employment benefit before 1992, and an important measure of personal wealth with the spread of privatization and purchase of apartments after 1992.

29. The Urban Institute survey estimated that the richest one-fifth of Moscow residents owned about half the wealth, including most real property (Lee, 1996).

30. The contrasts of the quality of life within Moscow’s 33 raiyons were amplified with time and the allocation of services and housing through employing institutions, a dominant mechanism of controlling perks and access to material resources.

31. The Moscow raiyons, both before and after rezoning have had specific social neighborhood characteristics reported by the city census and statistical agency. The Moscow neighborhood, thus, may be incorporated into a multilevel model of health-related quality of life.

32. Further, the hierarchical linear model can take into consideration multiple factors and their interactions, which can clarify the independent association between area and distribution of various measures of the quality of life.