Public Health: Challenges of Our Time. St. Petersburg International Economic Forum 2022
A sub-forum entitled “Public Health: Challenges of Our Time” was held in St. Petersburg as part of the annual St. Petersburg International Economic Forum. The panellists discussed difficulties in establishing a common strategy in overcoming those challenges, as well as global experiences in that area.
Public health is mentioned in a number of core documents and federal projects, including the Demographics National Project (the Public Health Initiative) and two federal projects (Public Health Promotion and Healthy Lifestyle, Healthy Diet and No Bad Habits Initiative). The Healthy Cities, Regions and Villages Association, which is the Russian chapter of the WHO European Healthy Cities Network, has been active promoting public health and well-being for over ten years. However, despite their vigorous efforts, close collaboration with regional and municipal authorities and generally good performance, its workers still face certain challenges. The participants of the sub-forum discussed those challenges in detail.
Aleksey Raskhodchikov, Chairman of the Moscow Center of Urban Studies “City” Foundation and moderator of the discussion, started by venturing a definition of public health. “The pandemic has amply demonstrated that public healthcare system in its classic form is not always capable of dealing with emergencies,” he said. “Sometimes people just don’t want to do anything about their health, and doctors cannot help that. This is when public health has to play center stage, and by public health I mean everything including healthy lifestyle but excluding emergency medical aid.”
“This is something like group immunity,” he added. “It shows us how healthy our children, working-age adults and elderly people really are. It defines our sustainability in modern society and our capability to meet challenges and common threats.”
In Soviet times, the traditional disease prevention system, which included mandatory physical check-ups, a network of preventative clinics and resort facilities as well as at-work sports activities promotion programs financed by the government, was considered instrumental in strengthening the immune system of working-class citizens.
Viktor Cherepov, Executive Vice President of the Russian Union of Industrialists and Entrepreneurs, talked about the newest trends in that area.
“I’m pleased that all stakeholders in society, from executive branch agencies to civic organizations, have begun to realize that public healthcare system should be considered a sector of economy,” he said. He also emphasized that in the US, one dollar invested in public health brings five dollars in return on investment. In Russia, it is ten to fifteen rubles for one ruble invested, due to increased productivity and life expectancy, improved health and decreased costs of treating preventable diseases.
Viktor Cherepov also noted that the Covid pandemic made the Russian authorities focus on health promotion and revert to certain traditional medical care services for the working population.
The Russian Union of Industrialists and Entrepreneurs created a coordinated council for healthcare, which includes representatives of small and medium-sized businesses, officials of the Russian Ministry of Labor and Social Protection, Russian Federal State Agency for Health and Consumer Rights and Russian Federal Service for Supervision in Healthcare as well as representatives of major holding companies, dominant in the regions where they operate and employing tens of thousands of people.
Viktor Cherepov also talked about the FosAgro company, which set a good example of assisting the working population. Early in 2020, before the start of the mass vaccination campaign, it invested around 2 million rubles in the procurement of vaccines, transport, hot meals and financial incentives for health professionals working in Covid hospitals.
“Heads of major companies started talking of reverting to traditional preventative routines, such as medical check-ups for new employees and preventative vaccination according to the national vaccination calendar,” he said. “We think of reestablishing medical care facilities on premises and resuming health resorts programs, since Covid has dangerous long-term complications, such as strokes, heart attacks and thrombosis, usually five to six months after recovery. That is why all post-Covid patients need to be supervised by a physician.”
He also lamented the fact that numerous employees of small and medium-sized businesses, who often have to operate in poor working conditions, such as vibration, noise or poor ventilation, are usually sidelined. It is not easy to arrange regular check-ups and other preventative services in such working environment.
“Regular medical screenings require the amounts of money small business just don’t have. And small or medium-sized businesses employ over 60% of the working population,” he added.
The Russian Union of Industrialists and Entrepreneurs has recently established the Commission for Medical Industry and the Commission for Physical Culture and Sports, both aimed at health promotion among the working population. To that end, it signed a cooperation agreement with the Healthy Cities, Regions and Villages Association.
“We will work together to improve the health of workers of Russian enterprises, to promote healthy lifestyle and to educate municipal officials,” Viktor Cherepov promised.
Irina Ilyina, Head of the Institute for Regional Studies and Urban Planning of the Higher School of Economics, cited the results of a research conducted by her team. Using the statistics provided by local medical centers, they had attempted to figure out the cause of increased morbidity in a certain administrative okrug of Moscow. There was no traceable correlation with noise or air pollution levels, since the local environmental situation was much better than that of other okrugs. It turned out that the okrug had a higher rate of industrial facilities that made their employees undergo regular health screenings. There was also a higher number of healthcare centers that provided such services to local residents.
“That is what caused the increased level of morbidity among the residents. But in most cases, the diseases were diagnosed at an earlier stage and were quite treatable. This is why prevention check-ups are crucial,” she said.
She also spoke about the experiences of her team working for the Institute of Public Health, which is part of the Higher School of Economics. They had studied factors that affect human health. WHO divides those factors into three groups: genetic, hereditary and environmental (the latter includes quality of life and personal lifestyle).
“We can influence about 70% of those factors, first of all, quality of life and environment,” she noted.
In light of the government’s recent decision to intensify import substitution, observing sanitary-hygienic zone rules will be a must, since industries are likely to be back to cities, at least partly.
“There are multiple industrial factors that affect human health. Noise, electromagnetic radiation, in some cases even nuclear radiation, to name but a few. We have to pay close attention to the planning of residential areas. New apartment blocks need to be placed at a sufficient distance from sources of noise, including supermarkets, which usually carry out loading and unloading operations in the night,” she specified.
Irina Ilyina also said that wind patterns must be observed when designing new neighborhoods, as well as safe distances from industrial facilities, recommended sizes of yards and heights of buildings.
“If we regard all city-planning decisions in the light of health regulations, we will be able to reach our goal within the foreseeable future,” she concluded. “We need to be very clear about the sanitary protection zone regulations. Industrial facilities that can affect human health in a negative way have no place in densely populated cities.”
Sergey Rybalchenko, Head of the Public Evaluation Institute, talked about the joint efforts of the Civic Chamber and the Healthy Cities, Regions and Villages Association towards studying factors that affect life expectancy. The purpose of the research is to determine and combat negative factors that reduce life expectancy and thus harm economy.
“There must be return on investments in preventative medicine, and we need to learn to calculate it,” he said.
And so, the Public Health Navigator was born. Its purpose is to get non-commercial organizations and socially minded citizens interested in creating local healthcare initiatives and in implementing national health promotion projects. Potential years of life lost are calculated, and roadmaps for reducing mortality rate and improving public health are developed. The project is now being implemented in several “pilot” regions and municipalities of Russia, including Vologda Oblast, Ulyanovsk Oblast, Bashkortostan, Yakutia and Sevastopol.
“We calculate the index of years of life lost according to a formula developed by WHO. Those are the years before 70 that an average person loses, the age of active involvement in economic relations,” he explained. “In Finland, for example, this index is calculated in each municipality and is the basis for public health investment policies.”
In Vologda Oblast, it has been experimentally confirmed that injuries, home accidents, car accidents, water accidents etc. are in the top three main exopathic causes for the loss of potential years of life. And this can be changed. In Yakutia, for instance, municipal authorities have been able to decrease the unusually high alcohol-related mortality rate to the country’s average by implementing the Territory of Abstinence project.
“In Yakutia, we managed to gain a two-years increase in the average life expectancy in only one year of hard work. It is a unique result,” Sergey Rybalchenko said.
He also told that after a series of workshops conducted by the Healthy Cities, Regions and Villages Association, municipal authorities introduced a new performance evaluation system for heads of districts, which includes the index of citizens’ potential years of life lost if deaths are due to accidents or other external causes.
“From now on, heads of districts will report not only on the number of beds in local clinics, quality of street lighting, equipment of pedestrian crossings at the intersections where people are the most frequently hit with cars and of lifeboat station in places where people are the most likely to drown, but also on what they do about preventing deaths due to external causes. When we match our calculations with the regional gross domestic product, we can see the economic effect of our programs. Though good results can only be reached by cooperation,” he added.
Anastasia Tanicheva, Executive Director of Russian Society of Cardiology, talked about the ways non-commercial organizations can work with municipal authorities, businesses and state-financed institutions.
Russian Society of Cardiology brings together doctors to implement preventative medicine projects, such as the Health Museum. Its establishment, according to Anastasia Tanicheva, is a perfect example of synergy between non-commercial organizations and municipal authorities. The administration of St. Petersburg handed over for free use a building in the downtown; several pharmaceutical companies helped with necessary repairs, anonymously. When promoting the new museum, Russian Society of Cardiology decided to raise awareness about healthy sleep and problems that lack of sleep might cause. Vladimir Almazov National Medical Research Center supported the idea and granted them access to several of its sleep research laboratories. Several commercial companies gave the museum samples of their “sound sleep devises”, such as pillows, sleep glasses and masks.
“We invited the St. Petersburg Kunstkamera to take part in our exhibition, recorded lullabies in the languages of various national groups of Russia and prepared an ethnic-themed interactive presentation on the phases of sleep. The admission was free. People got interested and more people came. They listened to lectures and had an opportunity to get a doctor consultation. Thanks to the promotion campaign we attracted a lot of elderly people who liked the idea of a free medical examination as well as students who were interested in testing sleeping glasses,” she said.
Last year, at St. Petersburg International Economic Forum 2021, Russian Society of Cardiology signed a trilateral agreement with Vladimir Almazov National Medical Research Center and Amgen, a major biotech company, on developing and upscaling a career guidance program for high school students.
“We have developed it on the basis of the Skolkovo Atlas for Jobs of the Future and selected several ones such as cyberprosthetist or tech consultant. We prepared an educational program, obtained necessary materials, including a free app for solving genetic puzzles. Experts of Almazov Research Center helped us to develop instructional guidelines,” Anastasia Tanicheva told.
According to her, it is one more example of seamless cooperation among businesses that donate money, research centers that give information support and non-commercial organizations that implement social projects, such as this one that provides career guidance to high school students and helps them decide if they are prepared to continue their education in that field.
Russian Society of Cardiology plans to go on with their awareness-building program together with the Healthy Cities, Regions and Villages Association and supported by the St. Petersburg authorities. They have recently signed an agreement on creating a health-themed area in the Udelny Park.
Elena Mikhailova, Councilor to the Director General of the Russian Public Opinion Research Center, talked about the difficulties sociologists face when making calculations in that area, since the term “public health” is vague and there is no precise interpretation that everybody accepts.
“Doctors usually refer to the theory by Nikolai Semashko, psychologists and sociologists talk about public mental health, whereas architects emphasize the importance of architectural features that give people a feeling of comfort and thus make their lives better,” she explained.
Form her perspective, one of the highest-priority tasks in public health is finding a clear definition of the term.
“We need a clear matrix that would help a head of a region or a business see weak spots in their municipality or company and understand what kind of work needs to be done to remedy that,” she added.
According to Elena Mikhailova’s observations, the lack of such matrix is the reason why large groups of people are overlooked and major issues remain unaddressed, although, at the same time, some things are done over and over again. For instance, there can be five foundations assisting people with disabilities in a city, including non-commercial ones, but no one cares about the troubled situation around immigration policy. That lowers the efficiency of local institutions and the goals are not being fully achieved.
All in all, she thinks that there definitely is positive momentum. The younger people care more about their health, healthy lifestyle is getting increasingly popular, and even the elderly people pay more attention to annual physical check-ups.
Tatiana Shestakova, Executive Director of the Healthy Cities, Regions and Villages Association, supported her colleague by stating that there is indeed no common understanding as to what public health means, and so there is no clear definition to be introduced in related legislative acts.
“Public health and well-being are something that any region or municipality should work for. Generally speaking, it is our national idea and common goal,” she said.
Analyzing the presentations of other speakers, Tatiana Shestakova agreed that what they discussed was indeed the synergy of scientific theory and practice where every participant contributed to common cause.
“Unfortunately, we don’t have a centralized public health promotion system here in Russia. There are some cities that show outstanding results, but all in all, we will have to build such system together. That is our unique way,” she said.
Tatiana Shestakova compared public health government to a car control system — a car will not start if it is not there. The same is with a public health government system. It needs to be developed in close collaboration with municipalities. The process is on track; the parties discuss relevant technologies, indices and success criteria.
She emphasized the magnitude of the problem — globally, the whole European Healthy Cities, Regions and Villages Association network deals with it as well as its Indian, Australian, Japanese and Chinese chapters. The collaboration dynamics show that the foreign counterparts are more than happy to work together with the Russian branch and sometimes even learn from its experience.
“Public health and well-being are the principal value of any country. We work together to achieve them, and everyone’s contribution is equally important,” she added.
According to her, partnership arrangements and best practices must be written down clearly and then digitalized and distributed among colleagues. A great thing would also be to include them into state and municipal legal acts and regulations. There is no shortage of such practices in Russia. The Moscow Center of Urban Studies “City” Foundation helps the Healthy Cities, Regions and Villages Association to analyze the experience of its municipalities.
It is also absolutely necessary to define the term “public health” and incorporate it into the Federal Act No. 131 On general principles for the organization of local government in the Russian Federation as well as into other related acts.
Sergey Rybalchenko added that, aside from the clear definition of the term, the acts must contain indices and calculations that cannot be easily manipulated or tampered with.
“You can manipulate life expectancy, but you cannot manipulate years of potential life lost, since it is a clear index and it is directly related to mortality rates and causes of death. Mortality rate is a fact you can work with,” he said.
He also believes that Russian specialists need expert support. The Finnish public health expert program is the best in the world; it has been on track since 1970. It promotes healthy diet and physical exercise and includes a large-scale awareness campaign aimed at reducing people’s daily rates of fat, salt and sugar intake.
“Our Public Health National Project is in fact a replica of the Finnish program. It is a common practice; WHO declared their program a model one,” he explained. “Indeed, the Finnish government managed to increase the life expectancy of citizens by 13 years and to reduce the mortality from cardiovascular diseases by 80%. And here in Karelia, in the same climate zone, male mortality from cardiovascular diseases is the highest in the world.”
He emphasized that just giving orders to municipal authorities was not enough. It is crucial to find local committees that are actively involved in promoting public health on an everyday basis and cooperate with them, giving them as much governmental support as they need.
Closing the discussion, Aleksey Raskhodchikov reminded everybody that pulling strings in an office was not what governing truly meant. When creating a new public health government system, it is important to respond to grass-roots initiatives, of which there are many. The society is ready to take systematic care of individual health to the next level. Half-empty smoking rooms attest to this, and they used to be filled with people just a couple of years ago.
“Public health is our common problem. The time has come for us to see that reaching high levels of public health is our common goal, a goal we need to work towards together with the Healthy Cities, Regions and Villages Association,” he summarized.
- Viktor Cherepov, Executive Vice President of the Russian Union of Industrialists and Entrepreneurs;
- Irina Ilyina, Head of the Institute for Regional Studies and Urban Planning of the Higher School of Economics, Professor of the Urban and Regional Development Department of Vysokovsky Higher School of Urban Studies;
- Anastasia Tanicheva, Executive Director of Russian Society of Cardiology;
- Elena Mikhailova, Councilor to the Director General of the Russian Public Opinion Research Center;
- Sergey Rybalchenko, Head of the Public Evaluation Institute, Chairman of the Commission on Demography, Protection of Family, Children and Traditional Family Values of the Civic Chamber of the Russian Federation;
- Tatiana Shestakova, Executive Director of the Healthy Cities, Regions and Villages Association.
Aleksey Raskhodchikov, Chairman of the Moscow Center of Urban Studies “City” Foundation