Comment re: Times (UK) article on Russian Healthcare (JRL 2020-126)[, “Russia’s Health System is Dying on Its Feet”]

Medical Symbol with Pole, Serpents, Wings, adapted from image at lanl.gov

Subject: Comment re: Times (UK) article on Russian Healthcare (JRL 2020-126)
Date: Wed, 15 Jul 2020
From: Rudra Sil <rudysil@gmail.com>

Yesterday’s JRL (2020-#126) included Mark Bennetts’ article, “Russia’s Health System is Dying on Its Feet,” originally published in The Times (UK) on February 6, 2020. I missed this article when it first came out, so I am very glad to have had the chance to read it now. The piece deserves credit for shining the spotlight on the many challenges Russians can face when it comes to receiving or providing adequate healthcare in the provinces. By focusing on a single state hospital in Bogdanovich, a small town in the Urals of fewer than 30,000 people, the author was able to offer a close-up look at some of the vexing problems faced by those dwelling in distant provinces. Unfortunately, rather than stopping there, the author went on to generalize about the overall state of “Russia’s Health System,” making the leap by throwing in some “macro” data about the healthcare situation in Russia. And this is where the story (and the headline) goes off the rails. Here are two glaring examples:

(1) The author mentions that Russia’s death rate is similar to that of the Central African Republic – a statement intended to suggest that things are falling apart (or, as the headline suggests, “Russia’s health system is dying on its feet”). The data on crude death rate is indeed correct (although the latest figures provided by the World Bank put the crude death rate for two countries at 12 – not 13 – deaths per 1000 people). The author fails to note, however, that the death rates in both countries have been declining since the early 2000s. Russia, in fact, had a crude death rate of 16.4 in 2003, before seeing a steady, sustained reduction in the figure over the next fifteen years. The picture gets even more interesting when we consider that Germany also has a crude death rate of 12 per 1000, and that many post-communist countries that are now EU members have higher death rates than does Russia (for example, Romania and Lithuania are at 14, while Bulgaria and Latvia are at 15). These observations do not imply that Russia’s healthcare system is doing fine; they do, however, suggest the need for a very different headline and more nuanced interpretation of the data. At a minimum, a comprehensive narrative needs to acknowledge the downward trend in Russia’s death rate while also taking into account comparative referents that go beyond a single African country (with a total population that is one-third that of Moscow!)

(2) The author also tries to make hay of Russia’s supposedly inadequate $524 per capita expenditures in healthcare, noting that Britain spends eight times that amount ($4,356). There are several problems with using this data to make the point the author seems to want to make. First, healthcare is one of those sectors where it would be more appropriate to use figures based on the principle of purchasing power parity (PPP), which adjusts for the cost of typical goods and services in a given country. Adjusting for PPP, Russia’s figure for per capita health expenditures rises to $1400, while Britain’s figure remains around $4300. The ratio drops from 1:8 to 1:3. In any case, it is far from clear that more spending is intrinsically a good thing: the United States spends over $10,000 per capita – three times the average for the European Union – but I doubt many global health experts will conclude from this that the quality of healthcare in the U.S. is three times better than that in the EU! Also important is the lack of attention to historical trends. Even sticking with current dollars (not adjusted for PPP), Russia currently spends six times as much on healthcare per capita than it did in 2000. During this time, China and India have also made steady gains in healthcare expenditures per capita, and yet Russia’s current figure is higher than the combined per capita total for the two Asian giants. Again, this does not imply that all is well with the healthcare system in Russia; but a more open-ended and systematic consideration of the data points to a much more nuanced story than the one captured in the headline.

Let me repeat that I was happy to learn from the author about the special difficulties that provincial healthcare in Russia creates for both the local population and healthcare providers. But, if we want to then offer sweeping assessments for the entire country’s healthcare system, there needs to be a more balanced effort to collect and interpret the relevant (and quite easily accessible) data.

Rudy Sil
University of Pennsylvania
Department of Political Science
SAS Director of Huntsman Program in International Studies & Business