Prison health in Russia: the larger picture.

Russia, despite recent legal reforms, still has one of the highest rates of imprisonment in the world. There are many reports of the adverse conditions in Russian prisons, often highlighting the consequences for health, in particular, risks of HIV, tuberculosis, and other infectious diseases. However, there are no reviews of the broader health issues in the Russian penal system. This paper reviews the available information on the health of the imprisoned population in Russia and the factors underlying it. It was undertaken by means of a search of Russian and international literature, including unpublished sources, supplemented by in-depth interviews with 27 key informants from the Ministry of Justice, prison administration, and non-governmental organizations. Published and unpublished data from the ministries of health and justice were used to describe the demographic characteristics of the imprisoned population and compare it with the general population. Although convicts are drawn disproportionately from disadvantaged groups in society and are detained in adverse physical conditions, the standardized mortality ratio from all causes is slightly over one-third of that in the overall Russian male population. This is mainly explained by an eight-fold lower mortality from external causes and a more than two-fold lower mortality from cardiovascular disease. These far outweigh the increased mortality from infectious diseases. The chances of survival of young men in Russia may actually be improved by being in prison, highlighting the need for policies that reduce the overall level of violence and other external risks, such as dangerous driving habits, in Russian society. Yet while conditions are improving in Russian prisons, with death rates falling, there are still many avoidable deaths and high levels of mental illness and infectious disease. There is also much that is not known about the health of Russian convicts, with what is available reflecting what is measured rather than what is important.

Environmental and social factors as determinants of respiratory dysfunction in junior schoolchildren in Moscow.

BACKGROUND: The process of industrialization of the USSR has left a legacy of widespread and often poorly controlled pollution which is widely believed to have adverse implications for health, in particular for respiratory disease among children. OBJECTIVES: To assess the relationship between area of residence and respiratory function in junior schoolchildren in different districts of Moscow. METHODS: A survey was conducted of 539 children aged 6-12 years who attend school and live in one of three districts of Moscow with varying ambient pollution levels. Spirometry [forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)] was assessed at school by trained school health staff. Parents of the children completed a questionnaire asking about respiratory function and factors potentially associated with it, as well as about social and other factors that could influence respiratory development and the health status of their children. RESULTS: There was appreciable difference in the characteristics of the children from the three districts. Children from the lower pollutant districts were generally younger, had higher parental income, and were less frequently exposed to cigarette smoke at home. They were also less likely to report heavy lorry traffic in the streets outside their homes. After adjustment for age, gender and height the FVC was 7.6 per cent (3.6-11.5 per cent) lower in children from the medium pollution district and 9.9 per cent [95 per cent confidence interval (CI) 5.6-14.0 per cent] lower in children from the high pollution district compared with those in the least polluted district (p < 0.001 for trend). These differences were little affected by further adjustment for household income or exposure to household smoking. In contrast, FEV1 showed comparatively little variation across districts. The odds of a forced expiratory ratio (FER) <75 per cent were substantially lower in the high pollution compared with the low pollution district (odds ratio 0.10, 95per cent CI 0.03-0.32 after adjustment for age, gender and height), and there was clear evidence of a trend across pollution categories (p < 0.001). The frequency of reported allergy was also lower in the high pollution district. FVC increased, and the probability of a low FER decreased, with household income. CONCLUSION: Children from areas of high environmental pollution had lower lung capacity but also smaller risk of a low FER compared with those from cleaner areas. The extent to which these differences can be attributed to environmental pollution is unclear without more detailed study. However, socio-economic deprivation, which was associated with pollution, appears to be an important determinant of respiratory function although it was associated with a lower risk of an obstructive pattern of lung function tests.