A significant proportion of the EU budget is spent on research grants to encourage research and innovation across Europe. Although this funding is vital, there is Michael Galsworthy argues a substantial East-West divide which is encouraging a ‘brain drain’ from Eastern Europe.

Within the European Union there is an East-West gap, in health and innovation. The gap is widening because eastern European member states (such as Poland, Romania, Latvia, Hungary and Slovakia) are winning a tiny proportion of science grants from European central funding.

Scientist salaries and jobs have hit rock-bottom following austerity measures, not only in eastern Europe but also in many southern member states. Scientists are fleeing westward, fleeing out of the EU, or just out of science. Although the main funding body European Commission is now working to help, its current policies on salaries may be causing a brain drain.

As the EC prepares its research and innovation pot of €71bn to be awarded competitively under the “Horizon 2020” programme, it is also preparing additional programs to help struggling regions restructure to be more competitive for that money. However, the most powerful medicine for the recent cocktail of grim circumstances may be a simple principle: Equal pay for equal work.

Eastern Europe has huge scientific potential, but getting there from where we are now will require smart actions at the EC, national government and grassroots levels.

How bad is the situation? With regard to winning a share of central funds, the EC’s own impact assessment of health-related research found that the 12 newest member states participated on only about 6% of projects. Worse, they took home only 2.5% of the total funds collectively. Compare this with the original 15 member states with 78% participation and 85% of funds (the rest of the funds went to participants outside the EU). To put this in context; the original 15 member states had received 34 times more health research funding, a difference that cannot be explained by their 3.8 times larger population nor even their 12.8 times greater contribution to the EU budget. Other areas of science show similar patterns.

So what is in place to help poorer member states under Horizon 2020? Unfortunately, acknowledgement of a crisis and plans to tackle it are largely missing in the standard documentation. You have to call up the right people in the EC and connect the dots. (more…)

Photo: Vladimir Morozov CC-BY-ND

Russia experienced an extreme spike in death rates in the immediate aftermath of the break-up of the Soviet Union. Jay Bhattacharya, Christina Gathmann and Grant Miller  write that while this has typically been explained using political and economic arguments, the real cause of Russia’s mortality crisis may have been the end of Mikhail Gorbachev’s anti-alcohol campaign.

Following the demise of the Soviet Union, Russia experienced a 40 per cent surge in deaths between 1990 and 1994. As a consequence, life expectancy for men declined by 6.6 years from 64.2 to 57.6 years. The magnitude of this surge in deaths – coupled with the Soviet Union’s international prominence – has prompted observers to term this demographic catastrophe the ‘Russian Mortality Crisis.’

What caused this dramatic increase in mortality? Many people attribute the Russian mortality crisis to political and economic turmoil that followed the collapse of the Soviet Union, and to restructuring and reforms during the 1990s. We develop an alternative explanation for the observed pattern: the demise of the reputedly successful 1985-1988 Gorbachev Anti-Alcohol Campaign.

The Gorbachev Anti-Alcohol Campaign was unprecedented in scale and scope – and it operated through both supply and demand-side channels, simultaneously raising the effective price of drinking and subsidising substitutes for alcohol consumption. At the height of the campaign, official alcohol sales had fallen by as much as two-thirds (Russians responded by increasing home-production of alcohol called samogon – although our estimates suggest not by nearly enough to offset the reduction in state supply). In practice the campaign lasted beyond its official end – restarting state alcohol production required time, and elevated alcohol prices lingered.

Figure 1 illustrates our basic logic. Age-adjusted Russian death rates had been increasing linearly between 1960 and 1984, plummeted abruptly with the start of the campaign in 1985, remained below the campaign trend throughout the latter 1980s, rose again rapidly during the early 1990s to a temporary peak in 1994, and then largely reverted back to Russia’s long-run trend.

Figure 1: Age-adjusted death rates in Russia (1960-2005)

NoteData available from The Human Mortality Project. Pre-campaign linear trend estimated using ordinary least squares regression of mortality per 1,000 population on pre-campaign year.

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Re-reading Bulgakov leads health researcher and guest contributor Erica Richardson to some sharp realisations about primary healthcare in the former Soviet Union

Photo: Vladmir Menkov via Wikicommons

I have now reached an age when I can go back to novels I read twenty years ago, reread them with fresh eyes and experience the joy of new discoveries.  Most recently, this has involved revisiting A Country Doctor’s Notebook by Mikhail Bulgakov, a collection of short stories based on his experience as a newly qualified doctor sent to a remote region for his first job practicing medicine.  I sincerely believe it is essential reading for all new doctors and cannot recommend it highly enough.  In the 1990s, I was struck by how little had changed in the rural Russian landscape despite the electrification and mechanisation drives under Stalin.  In 2012, I was struck by the way in which different members of the clinical team were presented.

Maybe this is because I’ve recently returned from Minsk, Belarus where I was representing the European Observatory on Health Systems and Policies at a sub-regional policy dialogue on human resources in countries of the former Soviet Union.  As an aside to discussions about skill-mix and task shifting, a fascinating discussion developed around the concept of a ‘nurse’ and in the post-Soviet context, and where ‘feldshers’ fit into the picture. Nurses have their distinct heritage and philosophy which is focused on ‘care’, while the doctors are more focused on providing ‘treatment’.  So what’s a feldsher? (more…)