Human and financial resources:
Essential foundations for action
Since the disintegration of the Soviet Union in 1991, the public health system in that region has collapsed because of a lack of human and financial resources. The transition from a socialist to a market-based economy has been accompanied by a severe economic crisis as state-owned industries have been sold or closed down, thus creating mass unemployment. An estimated 40 000 of these former state enterprises are now in the hands of criminals, resulting in widespread tax evasion. This denies governments the billions of dollars needed to run hospitals, pay schoolteachers and provide for public health needs. The result has been the return of epidemics of diseases such as diphtheria, polio, syphilis, and exponential growth in AIDS, TB, alcoholism, drug use and suicide. Between 1991 and 1996, there was a 126 per cent increase in premature deaths among men. This has caused a decline in male life expectancy from 65 years in 1970 to 59 years in 2000. The Russian population also began to decline in 1992. By 1999 only 1.2 million babies were born, while 2.1 million people died.
Nowhere is the public health crisis highlighted more than in Russian prisons. An escalating crime rate has caused acute overcrowding, creating conditions for the emergence of new strains of multi-drug resistant TB among one in five prisoners. The prison population was estimated at 1 million in 2003. During the Soviet era all citizens were compelled to have an annual X-ray. Any infected individuals were sent to sanatoria for months. Now there is no centralised public health system to impose screening and treatment, so TB control measures have disintegrated. The lack of finances has led to the deterioration of TB-related equipment and facilities, while the