style="font-size:15px;"> A separate issue that requires solution within health inequity is marginalized groups that are to be found in any country and in any society. Unfavorable working conditions that potentially exacerbate the impact of environmental risk factors are mostly typical of marginalized groups, such as refugees and migrants even though they could pose a problem for people with a low level of education. The concept of “unfavorable working conditions” may embrace such types as working with no contract signed, child labor, as well as forced and coerced (as a pay for a debt) labor. Working with no contract signed is the major source of inequity in relation to the environment and health, as well as violation of regulations for national labor safety, working hygiene, and working conditions, which involves various negative effects on the health of the employees.
In Hungary, for instance, 15 % of Gypsy settlements (Roma) were located within 1 kilometer from illegal dumps, and 11 % – within 1 km from the places for destroying dead animals (Gyorgy et al., 2005). In Serbia similar settlements had a 2–3 times lower water supply and hygienic facilities (Sepkowitz, 2006).
Therefore health inequity has along historical context; this issue is determined by many factors and is found anywhere regardless of the socio-economic level of development of the country as a whole. Yet, in view of ethical, legal, economic, and medical-social implications this issue requires urgent response at all levels, from local to global.
Health inequity in Russian Federation: state of things
The issue of inequity in income distribution in the post-socialist area has been a subject for wide discussion both in our country and abroad. This point has always been the focus of researchers and politicians, from time to time giving raise to acute socio-political debate. Russia is no exception here given the significant changes it has undergone in the latest decade. Quite a tough issue is developing human potential under rapidly progressing market conditions and similarly rapidly disappearing social benefits for the disadvantaged. In view if this, experts define two types of challenges: on the one hand the country is facing typical of poor countries troubles like spread of communicable diseases, regions with stagnating poverty (still present in Russia), undeveloped infrastructure and high death rate. On the other hand the country is suffering from healthcare and education crisis, and such issues are common for advanced post-industrial countries as well.
Poverty profile in Russia
Poverty in Russia has a number of typical features. For instance, most vulnerable are families with children and, therefore, children themselves, who are under 16. Note to be made though that this issue is not common for most countries. As for retirees they are under lower risks of being affected by poverty because most of them work and the social benefit system is oriented, first of all, at the elderly.
Special mention should be made of the fact that working population is the larger part of the poor group even despite of salary growth. In order to reduce the number of poor people among the working population the minimum salary should be at least 150 % of the minimum cost of living. In the April of 2009 25 % or the working population received their salaries below this minimum. 70 % of them had children. 37,4 % of the working population received salaries below 200 % of the minimum cost of living.
This level of pay for labor is sufficient for meeting the minimum needs of one employee and one child. Therefore, even in a situation where two parents are employed such salaries cannot be enough to support two children at the minimum level.
The largest share of the poor population is accounted for by the people who are able to work, especially youth. Countrymen are more vulnerable to poverty than urban population. Besides, the maximum poverty risk affects the unemployed population, economically inactive groups, as well as those living on social and disability benefits.
Level of poverty and inequity
The dynamics of poverty and inequity is determined by the consumption share for the 20 % of poorest against the total volume of consumption. Up until 2000 this index was about 5,8–6,1 %. Later on the share of the poorest 20 % has gone down, which serves perfect evidence of the fact that the poor have got no access to the results of economic growth.
(The World Bank in Russia Russian Economic Report, No. 21, March 2010, http://siteresources.worldbank.org/INTRUSSIANFEDERATION/Resources/305499-1245838520910/6238985-1269435660465/RER21rus.pdf).
The liberal economic reforms went along with a significant fall in the standard of living and an increase in the socio-economic differentiation. The growing economic inequity has become a serious challenge both for the people and for the government. Our country now has significant inequity in terms of health and accessible medical assistance due to polarization of income and opportunities, which means limited and clearly deficient current social policy carried out in our society. The recent research findings have provided quite a clear demonstration of significant differences in people’s opportunities at birth, during the preschool and school period, in terms of getting access to higher education, housing, transportation, shopping, recreation and fun activities, relationships with the state, access to medical services, life expectancy, maintaining health status and healthy lifestyles, religious affiliation, funeral services, inheritance, etc. Just 20–25 years ago when the disproportion was not so extreme some specialists in social hygiene and healthcare arrangement even talked about potential homogenous conditionality of health in our country.
We must admit that health inequity is a new and, obviously, a long-term issue in Russia. Even though there have always been differences in people’s health status this point never got so much attention. One of the sources of social tension in any country is the gap between people’s welfare, in the level of their prosperity. The level of prosperity is determined by two factors:
1) the size of (any kind of) property possessed by individuals;
2) the size of the individuals” income (Дашкевич П. Р., 1995; Денисов П. Р., 1997).
One of the criteria of civilization in any country’s social sphere is maintaining the respective appropriate living standard for the groups (families) that for some reasons cannot meet even the minimum standards and customs (food, clothing, leisure, etc.). One of the most urgent social issues in Russia that came into being because of economic changes is unprecedented inequity in income. According to the Russian Statistics Agency (Rosstat), by 2006 the income of the most prosperous groups was 16 times the share of the least prosperous ones (Российский статистический ежегодник, Россия в цифрах, 2006). However, if we take into account that the official statistics often underestimates the socio-economic differentiation in Russia not taking into view the shadow economy, then the true gap in question may be much larger. According to the data provided by T. Zaslavskaya (2005) the inequity gap between the 10 % at the extremities is 30–40 times. As noted at the Report on Poverty Evaluation made by the World Bank (2004), this fast growth of income inequity in Russia was close to a record – Russia here is very much different from other countries including Central and East Europe, where they also had a transfer to the market economy. Experts say that socio-economic differentiation similar to Russian should be looked for in Latin America rather than in European societies (Murphy, Bobak, Nicholson, Rose and Marmot, 2006). The social stratification trend in our country that became especially obvious in the 1990-s is still there under the rather long process of economic growth noticed in the recent years – income differentiation was detected in 2007 as well (Щербакова Е. М., 2008).
The high rate of economic and socio-structural changes in Russia that were ahead of most people’s adjustment capacity brought to many increased levels of chronic stress, loss of control over life circumstances, and resulted in prevalence of behaviors related to health risks, first of all high alcohol consumption (Cockerham, 2000; Bobak, Pikhart, Rose, Hertzman,
