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Russian Federation

Are all medical procedures, drugs good for the patient?

Patricio V. Marquez's picture

Also available in: РусскийPatients waiting at health center in Angola (credit: UN/Evan Schneider).

When healthcare professionals take the Hippocratic Oath, they promise to prescribe patients regimens based on their “ability and judgment” and to “never do harm to anyone”.

Although extraordinary progress in medical knowledge during the last 50 years, coupled with the development of new technologies, drugs and procedures, has improved health conditions and quality of life, it has also created an ever-growing quandary regarding which drugs, medical procedures, tests and treatments work best.

And for policy makers, administrators and health economists, the unrestrained acquisition and use of new medical technologies and procedures (e.g., open heart surgery to replace clogged arteries, ultrasound technology scanners to aid in the detection of heart disease, and life-saving antiretroviral drugs for HIV/AIDS) is increasing health expenditures in an era of fiscal deficits.

In many countries, I’ve see how ensuring value for money in a limited-resources environment is not only difficult but requires careful selection and funding of procedures and drugs. It also comes with serious political, economic and ethical implications—and with new drugs and technologies appearing every day, this challenge isn’t going away. What should countries do?

Making a public health case for safer roads

Patricio V. Marquez's picture

Also available in: Русский

ARA0171UZB World Bank

On recent visits to Moscow and Tbilisi, and driving from Baku to the Sheki and Agdash regions in Azerbaijan, I observed challenges and progress in making roads safer. Why should this matter to public health folks? Or should this be only the concern of engineers?

If one of the goals of development is to improve health outcomes by reducing premature mortality, injuries and disability, then unsafe roads are a key public health challenge.

In Eastern Europe and Central Asia (ECA) the problem is acute. Road traffic deaths rank among the ten leading causes of death: people are 2-3 times more likely to die from road injuries than people in Western Europe. For every death, many more people have injuries that require medical care.

What is causing this problem? For sure, more people are driving because the number of cars has increased significantly due to rising incomes—the traffic jams in some ECA cities vividly reflect this change. Poor road conditions and spotty enforcement of speeding, drunk driving, and seatbelt and helmet laws are leading culprits. “Distracted driving,” due to the growing use of cell phones and texting, is also resulting in more car crashes.

The clock is ticking: attaining the HIV/TB MDG targets in the former Soviet Union countries

Patricio V. Marquez's picture

Some countries of the former Soviet Union, the so-called CIS countries, are facing difficult challenges to achieve the HIV/tuberculosis-related Millennium Development Goal (MDG 6) by 2015. The continuing growth of new HIV cases, insufficient access to prevention services and treatment for people living with HIV, combined with the severity of region’s tuberculosis (TB) epidemic (particularly multi-drug resistant TB) are major challenges.

On October 10-12, 2011, the Russian government, along with UNAIDS, the Global Fund, and the World Bank, is hosting in Moscow a high-level forum to discuss these challenges and ways to reach MDG 6 in the CIS. (Click here for a video, a presentation, and more from the forum.)

Unless concerted action is taken, sustained political commitment mobilized, new public/private and civil society partnerships established, and a sharp improvement in the effectiveness of HIV and TB programs realized, MDG 6 risks not being achieved. So, what to do?

Taking Advantage of Russia’s Resource Windfall

Grzegorz W. Kolodko's picture

If the nation which has bestowed to the civilization such giants as Tchaikovsky and Shostakovich, Tolstoy and Bulgakov could manage its economy as splendidly and robustly as its culture, Russia would be doing just great! Unfortunately, it’s not the case. The resource curse is affecting the economy in a negative way and even more seriously than certain counterproductive habits and mental inertia from the old times of statist, centrally planned economy.  

I’m afraid there is not much time left for Russia. If it wants to catch up with the advanced world – and become a true member of the G8 group of developed countries –  it must use wisely for investment in restructuring and diversification of its economy the windfall revenue from exploitation of vast natural resources. Otherwise, the process of deindustrialization without offsetting by the nowadays service sector will continue and this great country – with huge potential for fast, durable, and sustainable development – will miss the chance to become one of the leaders of world economy. This decade will decide the fate of Russia for the whole 21st century. And the time runs fast. 

Russia’s Migration Reforms – Learning to look at the Glass Half Full

Sudharshan Canagarajah's picture

The more I work on migration issues, I have come to realize the uniqueness of the CIS region migration phenomena. Migration in what is currently called the CIS region (the former Soviet Union) includes both migration within the region and external migration. Although the CIS countries are now nation states, they were earlier part of one country. The migration phenomena, therefore, existed for more than 70 years before the fall of Soviet Union in 1991. Despite being ethnically different, almost all speak Russians (although the fluency in Russian is declining over time, especially in the younger generation). There is substantial movement of goods and services and trade integration across the region.

Russian wildfires: No winners from climate change

Alan Miller's picture

A commonly heard comment in climate change discussions has been that the benefits of climate change – milder winters, increased agricultural productivity -- also have to be acknowledged. Russia and Canada, it has often been argued, could be economic “winners” from climate change due to easier access to ocean shipping routes, longer growing seasons, and the space and water necessary to increase agricultural production. A 2008 report of the U.S. National Intelligence Council notes that Russia “has the potential to gain the most from increasingly temperate weather”, citing easier access to Siberian energy reserves and an Arctic waterway. This idea was popular with some Russian scientists and politicians, who as recently as the past year questioned whether reductions in greenhouse gas emissions were necessary.

 

While consideration of benefits is appropriately included in economic studies of climate change, the recent heat waves and wildfires in Russia illustrate the limitations in thinking this way. The July heat wave – the worst in the
130 year record -- brought Moscow temperatures in excess of 100 degrees, destroyed crops on an estimated 25 million acres (about the size of Iceland), and led to intense fires across the country wiping out entire villages. Burning peat fields darkened the skies and filled the air with high levels of pollution. Breathing the outside air for an hour in Moscow is now reported to be equivalent to smoking two packs of cigarettes. In response to this, and other climate-related production declines in the EU and Canada, grain prices have risen 90 %. In order to protect domestic markets, Russia has banned grain exports.

WikiLeaks: “The Intelligence Agency Of The People”

Naniette Coleman's picture

I am not sure if I stumbled upon a tool for fighting corruption or a conspiracy theorist’s dream. Either way, I will report and leave the judgments and interpretations to you, the reader. Before you begin reading this particular blog post, I would recommend that you close your door, pull down the shades and close all other browser windows; after all, you never know who could be watching.

WikiLeaks says they have a “history of breaking major stories in every major media outlet and robustly protecting sources and press freedoms.” They claim that “no source has ever been exposed and no material has ever been censored since their formation in 2007.”  WikiLeaks claims they have been “victorious over every legal (and illegal) attack, including those from the Pentagon, the Chinese Public Security Bureau, the Former president of Kenya, the Premier of Bermuda, Scientology, the Catholic & Mormon Church, the largest Swiss private bank, and Russian companies.” And, as if that is not enough of a soap box on which to stand, WikiLeaks claims to have “released more classified intelligence documents than the rest of the world press combined.” If you do not believe WikiLeaks, perhaps you might trust another source, Time Magazine who suggests that WikiLeaks “...could become as important a journalistic tool as the Freedom of Information Act.”

Murder and Impunity

Anne-Katrin Arnold's picture

The issues of journalism and a free press come to mind these days. With a significant number of journalists attacked in, among other countries, Russia, just in the past few months, we clearly see the dependence of the media system on the political environment in a country. Journalism training is the major form of media development - how to use new technologies, how to write a good feature, how to sniff out a corruption scandal - but is anyone thinking about what happens to reporters in countries where the rule of law is weak? This year alone, 16 journalists have been killed in the line of duty, as the Committee  to Protect Journalists (CPJ) reports. Last year: 71. Since 1992, more than 800 journalists have been murdered as a direct consequence of their reporting. Iraq, the Philippines, Algeria, and Russia are the four deadliest countries for journalists.

Migrant remittances and private capital flows - Which is what?

Sanket Mohapatra's picture

The Uganda Daily Monitor reported recently that according to the World Bank’s latest Global Economic Prospects report, “remittances to developing countries is forecasted [sic] to recover modestly from $454 billion in 2009 to $771 billion by 2012, which still stands below the 2007 $1.2 trillion.” Since we produce the global remittances data and estimates (which incidentally show that remittance flows to developing countries

Photo © Curt Carnemark /  World Bank
reached $316 billion in 2009 and are forecast to grow by 6.2 percent to $335 billion in 2010 (see Migration and Development brief 12), the numbers in the Uganda Monitor made little or no sense to us. Until our colleague Andrew Burns, the lead author of the GEP 2010, pointed out that the Uganda Monitor has likely mistaken overall private capital flows to developing countries as remittances.

The issue of migrant remittances being confused with private capital flows (and even aid flows) is not new. Central banks all around the world have been struggling with this issue for several years now. A global survey of central banks that we conducted during 2008-09 suggests that central banks find it challenging to separate migrant remittances from other small-value transfers such as trade payments, small investments, and even transfers by/to non-governmental organizations and embassies.

Is Russia the second-largest sender of remittances? Or is it Saudi Arabia?

Ani Silwal's picture

Saudi Arabia was the second largest sender of remittances (after the United States) from 1988 to 2006. In 2007 and 2008, it was displaced by Russia as the second largest sender of remittances (figure 1). Flows from Russia have increased rapidly in recent years, reaching $26.1 billions in 2008. However, this rapid growth was interrupted in 2009, when remittance outflows fell by 29% to $18.6 billions in 2009. We don't have 2009 outflows data for Saudi Arabia yet but based on inflows data from Bangladesh, Pakistan, and the Philippines, Saudi Arabia's remittances outflows have not fallen much. Saudi Arabia was likely the second largest sender of remittances in 2009.

There are two possible explanations for why remittances from Saudi Arabia have been more stable than those from Russia (see Migration and Development Brief 12 for details). First, oil prices are more closely related to economic activity (thus, better employment prospects for migrants) in Russia than in Saudi Arabia. As major oil-exporters, both countries benefited from the surge in oil prices in the last few years. But only in Russia did remittance outflows move closely with oil prices (figure 2). This was not the case in Saudi Arabia, which has had ambitious development plans for a while and an aggressive counter-cyclical fiscal policy. Second, Russia’s borders with its neighbors are much more porous than those of Saudi Arabia, which enforces immigration quotas strictly. Russia’s porous borders have allowed migrants from neighboring countries to move in an out in response to changes in labor demand.


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