Manning, N. and Tikhonova, N. ( eds .) Health and Health Care in the New Russia . Farnham : Ashgate , 2009 £65.00 xvii + 314 pp . ISBN 978-0-7546-7427-6 ( hbk )
There have been many quantitative surveys of health and wellbeing as well as numerous epidemiological studies seeking to explain the Russian ‘mortality crisis’ since the collapse of the Soviet Union in 1991. The research presented in this book represents a very useful and interesting addition to the field as it does not seek to explain the Russian health crisis per se, but instead provides the essential backdrop to those studies which do seek to explain the phenomenon. Similarly it does not seek to explain how the Russian health care system works (either in theory or practice) but it highlights how the system is variously utilized, or not, by households with different levels of social and financial capital. This household-level study effectively contextualises these studies, elucidating both the distal and proximal causes of the stark fluctuations in Russian life expectancy (particularly male life expectancy) throughout the 1990s.
This book is the main academic output of a long-term collaboration between researchers based in both the UK and Russia, who have sought to explore the changing nature of poverty in post-Soviet Russia over the country’s social, political and economic transformation. This book, focussing on health, poverty and employment, is the third of a trilogy from this collaboration which began in 1993. It uses the cross-cutting theme of disability – both in terms of working with a disability or illness and the significance of acquiring formal disabled status as a means of coping with economic hardship. This adds value to the study as disability in the post-Soviet space remains an under-researched area.
The authors use an in-depth longitudinal set of interview data from a panel of over 80 households living in three contrasting Russian cities (Moscow, Voronezh and Kazan). The Russian academics in this collaboration have also recently been involved with the Russian Longitudinal Monitoring Survey (RLMS) and another pan-Russian Representative Survey on social reforms (conducted in 2006). This has enabled the team to triangulate findings and explore some of the points raised in the household interviews by incorporating appropriate questions in these nationally representative surveys.
The book is divided into three parts, namely: Health beliefs in the new Russia; Health and social structure; and Health and social action. Personally, I felt it was the third part which really got to grips with the most interesting issues arising from the data as these go to the heart of both health and health care in post-Soviet Russia. In particular Chapter 10 provides us with a thorough exploration of the relationship between gender, health and poverty. The examination of the complexities of accessing health services through informal channels in preference to formal ones given in Chapter 8 was also an instructive analysis that speaks to a growing body of literature examining the importance of social networks and social capital in accessing health services.
The real strength of this book lies in its analysis of life stories as the essential narratives to explain the impact of social and economic transformation on health. At various points in the book these interview data are ‘quantified’ in tables which is probably inappropriate given the sample size and how it was selected. This group of households encompass a wide variety of experiences, but they were in essence a convenience sample which has evolved over time with the shifting focus of the research collaboration. It is the breadth of experience uncovered by these data which is potentially more instructive than the commonalities between households. There were also some points in the text which were a little hard to follow. For example, where the findings from the household panel interviews were compared with the findings from nationwide representative surveys it was not always immediately clear which data set was being discussed in every instance. However, these are relatively minor problems which relate to the presentation of the findings rather than their validity.
This work would be of interest to any researcher working on health or health care in post-Soviet Russia as it provides a setting for current research which is rooted in real life experiences. It would also benefit scholars engaged in research on sociological accounts of health care utilization in the post-Soviet region. However, the findings and personal accounts reported in this book probably act most strongly as a reminder that transition is not a single ‘one-off’ event or merely a social experiment ripe for observation: it is an ongoing lived experience which has been both liberating and traumatic for the populations involved.