Russia – Public Health, Public Policy and How the Gaps Do Harm

J0182630TORONTO, ONTARIO – Anyone who has been a reader here for any length of time has noticed the fact that I have been highly critical of the way the Administration has violated the American trust in the FDA by the Plan B fiasco.  It is a text book example of public policy formulated by politicians based on politics. 

Yet the bedrock of public health is evidence-based decision making.  The Bush Administration instead has engaged in faith-based decision making.  While politically expedient, such forays are disastrous to public health. 

But the Administration is not alone.  Many other governments do it too.  Russia, for instance.

Russia had an enormous luxury that it has squandered.  There were years before the HIV epidemic really took root in Russia and that country could have learned and benefited from fathoms of information, as well as mistakes, in the United States that made the epidemic worse.

Because the United States, again because of politics and not evidenced based decision making, largely rejected needle exchange when it would have save countless lives of men, women and children.  "Right to life" apparently had no meaning when it met with needle exchange.

The United States denied needle exchange at the very time when it could have saved thousands of lives.  Today, Russia is doing the same thing.  Yet Russia is one of the countries in the world that has the fastest growing HIV populations in the world.  Not the biggest.  But one of the fastest growing.  Why?  Because of intravenous drug use. 


My family is Russian.  I understand their stubbornness and their xenophobia.  Still, this is just the perfect example of why politics, whether regarding something like Plan B or needle exchange or methadone treatment, should not interfere with public health.  Politics – hello – you don’t know much about public health.  And when you make policy decisions based on politics, you cost people their lives.  That is not a right to life.   

Who knew that Russia and the U.S. had so much in common?  This is why politics should not interfere with evidenced based public health interventions.  It has bad health results, even if it is good politics.

Greetings from Toronto – a most civilized city!

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1 Response to Russia – Public Health, Public Policy and How the Gaps Do Harm

  1. Mark, I always thought Russia and the United States had a lot in common. Two vast territories filled with multi-national populations for one thing… The scale of the two states affects the scale of problems both countries have. It simply takes a lot more people, a lot more infrastructure and effort to get anything done. Any procrastination or nonsense in political decision making leads to years of consequences, because the implementation costs are always high.
    However, none of this is a valid excuse for politics based on political support rather than reality. In retrospect, it turns out that Russia had preserved itself from a lot of nasty problems by having the “iron curtain” around for decades. But once “the wall” was down, the effect was similar to the one experienced by Cherokee encountering Europeans. There were no mechanisms in the system to deal with issues that didn’t exist, and AIDS was one of those unknown “capitalist” problems that came at the time when food on the table was a much bigger issue in Russia.
    It’s a miracle the country didn’t die within a year as the above mentioned tribe did… While I don’t disagree with the point you are making in your post, I feel that some additional clarification for the suggested comparison is necessary.

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