National CVD Prevention Coordinator for Russia:
Professor, MD, PhD
National Research Center for Preventive Medicine of the Ministry of Healthcare of Russian Federation
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Healthcare in the Russian Federation is predominantly free of charge according to the Federal Law and the program of the state guarantee free medical care provision for citizens.
Russia has formed a three-tier system of healthcare.
- First level: Medical organisations near residences, work or study place that provide care for common diseases
- Second level: Inter-municipal or district health organisations primarily for urgent and scheduled specialised care for major causes of mortality
- The third level: Regional, oblast, republic hospitals and centres that provide specialised and high-tech medical services for the full spectrum of pathology
Despite the fact that in the last decade there was a decrease of mortality from cardiovascular diseases (CVD), CVD mortality data for 2013 remained high (745.9 in men and 476.4 in women per 100,000 inhabitants).
In the past 10 years the prevalence of smoking has declined for men to 44%, but has increased for women up to 14%. Slightly over one third of the population has insufficient physical activity.
The incidence of obesity (BMI ≥30 kg/m2) has increased significantly in recent years: about one-third of women and one quarter of men are obese.
During those years, the frequency of arterial hypertension (AH) in men also significantly increased which lead to increase of overall prevalence of AH in population from 40% in 2003-2004 to 44% in 2013. More than half of the Russian population has high cholesterol.
Prevention methods and main actors
Russia has recently adopted legislation which prioritises prevention in healthcare and has ratified international agreements including the WHO Framework Convention on Tobacco Control.
Primary health care (PHC) provides 60% of all medical services. All PHC organisations have prevention units or offices for prevention and assistance with smoking cessation. In 2009-2010 health centres (HC) were created to promote healthy lifestyle and prevent chronic non-communicable diseases (NCDs).
The country has a number of professional medical societies, such as the Russian Society of Cardiology (RSC), the Russian National Society of Preventive Cardiology (RNSPC), and the Russian Society for Prevention of Non-communicable Diseases (RSPND).
In the 1990’s the Russian National Research Centre for Preventive Medicine (NRCPM) has been designated as a WHO Collaborating Centre for the development and implementation of NCDs prevention policy and programs.
Since 1997, the journal "Preventive Medicine" has been published on a regular basis to highlight the problems of health promotion, prevention and treatment of NCDs and injuries.
Joint Russian-European schools for physicians on cardiovascular prevention and rehabilitation were held in Russia’s large cities.
Over the last 15 years NRCPM has been teaching courses for decision-makers regarding planning, implementation and evaluation of regional programs for prevention, as well as long distance training of PHC physicians on primary and secondary NCDs prevention and promotion of healthy lifestyles.
In 2014 the Russian government approved the State Program "Development of Healthcare" which included 11 sub-programs. The first is titled "Disease Prevention and Promotion of Healthy Lifestyle. Development of Primary Healthcare". Programs for NCDs prevention and promotion of healthy lifestyle have been developed for all administrative entities and are currently being implemented.
In 2012 the Russian Ministry of Healthcare stipulated procedures for the organisation of medical rehabilitation. Rehabilitation system for patients after myocardial infarction (MI) or cardiac surgery is carried out in three phases by multidisciplinary teams led by cardiologists and is covered by the Fund of Obligatory Medical Insurance.The goal of the Russian Ministry of Healthcare is to provide cardiac rehabilitation for 25% of those in need by the end of 2015 with subsequent expansion by 10-15% annually, which is a rise from the 15% at present.
Aims for the future
The key actions for the next 5 years:
- Promotion of healthy lifestyle: creation of inter-sectorial commissions in all regions of the country; routine training of decision makers and the development of inter-sectorial roadmaps for interagency cooperation in promotion of healthy lifestyle.
- Risk factors: reaching targets recommended by the WHO in reduction of prevalence of risk factors.
- Smoking: ensure complete elimination of tobacco use in all health organisations.
- Counselling and management: increasing the proportion of people receiving intensive counselling on healthy lifestyle. Provide medical correction of risk factors within a system of drug insurance
- Cardiac rehabilitation: organising cardiac rehabilitation programmes in all major hospitals and clinics, as well as establishing specialised centres in the major cities.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology