Comparison of Healthcare Systems: Russia and the US

Comparison of Healthcare Systems: Russia and the US Joel Adewuyi Madalyn Arnott Stephanie Armstrong Lauren Ball Russian federation has 17 million km2 of land surface area, making it the largest country in the world. The country has major deposits of coal, timber, oil, and assorted minerals and is thus perceived by many as a rich country who can provide universal healthcare to her citizens. Today, the healthcare system in Russia unlike in the United States is universal but has been plagued with poor quality and deficient services and thus in the process of being reformed by the Russian government. It is a universal system only in theory but the poor quality has made many Russians result to paying under the counter-bribes in order to get their necessary treatments (Russian, 2017). Recent government reforms, and measures to increase efficiency such as increase in funding have begun to address the ongoing problem in the healthcare sector. However, even with the new reforms in place, since the 1990s, there has been no significant improvement in the healthcare system (Russian 2017). The biggest problem confronting this system has been attributed to lack of funding by the government. Historical Perspectives The end of the Soviet Union gave birth to the Russian Federation in 1991 and since then the health status of the Russian population has been on a dramatic decline. Rates of medical conditions like cancer, heart disease, and tuberculosis are the highest compared to any other industrialized country. Government spending on healthcare which was 7% of Gross National Product (GNP) in the 1960s before Soviet Unions breakup was reduced to 3% after the breakup (site wide, 2017). Most of the government funding started going to industrial and military developments and lesser priority given to the healthcare system and by the end of 1995 less than 1 percent of Russias budget was allocated to public health in comparison to more than 12 percent in the United States (site wide 2017). With this, the public health delivery system in Russia went into the crisis with poorly trained medical personnel, lack of modernized equipment, poor payments for the medical personnel, poor personal hygiene and diet, lack of exercise, virtually nonexistent preventive medicine etc. The lack of accessibility to national health system facilities, with most patients standing in line at clinics for an entire day before receiving treatments coupled with non-affordability prescriptions drugs, has encouraged them resulting into unorthodox alternatives such as herbal medicine, mysticism, and faith healings. Russian Healthcare System Today There are several issues that can be observed in the modern Russian healthcare system. For example; there is limited access to healthcare facilities, and the sanitation in the facilities is below United States standards. The Healthcare system in the United States is often viewed as the best in the world, but it has several flaws as well. There is limited access for veterans and several hospitals charge as much as three times what others charge. There are also several benefits to the United States healthcare. Virtually on every corner of any town in the U.S there is access to a hospital or an emergency room. Also in the U.S., there are several payment plans individuals can use. In the Russian healthcare system one of the main problems is limited access to healthcare facilities. Only four percent pay their doctors when they have a medical procedure (Allianz, 2009 p 5). This causes a shortage of medical professionals. The lack of medical professionals causes individuals to rely on themselves for medical treatment. Several problems arise when individuals rely on their own knowledge. Another major issue with this system is the unsanitary working conditions of medical practices and medical professionals themselves. The lack of sanitation in facilities causes individuals to be more susceptible to diseases and other types of infections (Antonova, 2016 p3). The Russian healthcare system has several flaws that we do not have in the United States healthcare system. In the United States, there are hospitals around every corner. This allows individuals to have access to healthcare no matter where they live, but this can have some repercussions. Although hospitals are easy to find some individuals cannot afford this care. In 2010 the Affordable Care Act was signed so everyone has access to healthcare, but individuals need to have insurance for this Act to apply to them. This although seems beneficial to all, some individuals feel that they are forced to buy insurance. One positive aspect of the United States healthcare system is the amount of insurance options available. Most individuals use insurance through their employer, and some have medical cards. One negative aspect of the healthcare system is there is little to no coverage to for veterans. Tricare only covers veterans when they are in active duty, once they retire the insurance no longer covers them. Future of Healthcare System in Russia The Russian healthcare system for sure needs improvements due to many problems. Russias population is more than 6 million lower than it was nearly two decades ago (public health, 2015). Sadly, birth rates are lower and mortality rates are higher. Over half of the deaths are due to cardiovascular disease. Other problems include cancer and external causes such as accidents and traumas. However, since 2005 the Russian healthcare system have been trying to turn things around positively. In 2006, the Russian government launched the National Priority Project (NPP) to try and change the system for the better (public health 2015). The budget for this project was over than 400 billion rubles (Russian dollars) which was granted between 2006 to 2009 (public health 2015). Many activities have been planned and accomplished through the NPP. The NPP has increased salaries of primary and emergency care physicians, purchased more primary care equipment, provided more vaccination programs, providing free medical examinations to the public, increased the promotion of fertility, and made more high-tech centers for tertiary care. These activities have increased the quality of the system and bettered it for the citizens of Russia. There have recently been very bad financial troubles in Russia yet the NPP has managed to improve the system through these ways. Fertility rates are higher, mortality rates are lower, and life expectancy for both women and men have risen. However, not all the healthcare problems have been addressed. Basic healthcare is still unfunded, there are many problems with Russias healthcare insurance, and there is little effort to face and fix the population health behavior. Until the Russian citizens take these problems into their own hands the future of Russias health will be a problem. The citizens need to stop smoking, binge drinking, and bad habits in order to enjoy better health. The Russian public needs to be able to provide healthy air, water, better food quality, safer roads, and safer work environments. Until these problems are addressed, the health challenges that Russia faces will not be fixed and will follow to the years ahead. Russias health care system has taken a turn for the worst. Consequences of a failing healthcare system have fed to declining health among the Russian population. Inefficient funds have led to cost cuts, this already damaging a weak system. Numerous medical staff had to be laid off because of this, when healthcare workers were already at a minimal amount. At this point in time Russia suffers from a high death rate, low birth rate, and low life expectancy. The total population is decreasing by 700,000 people each year (Aarva 2009). The average life span for a male is statistically shown to only reach 59 years old (Aarva, 2009). Compared to the United States, a typical average life span for men is 78 years old (Aarva, 2009). Women in Russia overall only average to 72 years old (Aarva, 2009). The fertility rates in Russia cannot meet the declining rate of population. The decline in health statistically shows to only get worse within the next 50 years, declining by 30 percent (Aarva 2009) . In Russia, the number one leading cause of death is cardiovascular disease, this is followed by alcoholism and tobacco use. The World Health Organization accounts for more than 1.2 million deaths per year from these. A growing health issue in Russia is disease, such as HIV/AIDS, a little over 1 percent of Russias population test positive (Aarva, 2009). Lancet 2012 study showed that 57 percent of those affected acquired this from drug use (Aarva, 2009). Although over looked, Russias health care system has led them to have a lot in common with 3rd world countries. Numerous factors have led to Russias health care decline; however, many believe lack of education is the number one reason for the decline. Public health policies and information is less easy to access in Russia then the United States. Russia is also lacking in resources such as a lack in medication. Russias health care doesnt have the ability to give the citizens proper health care, if this situation continues their population will significantly continue to decline. In conclusion and in fairness to the Russia federation, the truth is that despite the relatively poor health statistics and healthcare situations, Russia is not dependent on any international assistance for her healthcare funding and is nondependent on any of the developed countries. Even though, they are independent, the governments duty of a guaranteed full range of free healthcare services to her citizens has not experienced any setback, but rather has been confirmed through the newly implemented Russian constitution and the new healthcare financing laws. References Russian health care: A healthy future? (n.d.). Retrieved February 22, 2017. Site-wide navigation. (n.d.). Retrieved February 23, 2017. Public Health: Russia is Sick. The Globalist. N.p., 04 Oct. 2015. Web. 23 Feb. 2017. Landed, S. J. (2014, May 04). Overview. Retrieved February 22, 2017. Allianz. (2017). Healthcare in Russia support. Retrieved February 23, 2017. Aarva, P., Ilchenko, I., Gorobets, P., Rogacheva, A. (2009). Formal and informal payments in health care facilities in two Russian cities, Tyumen and Lipetsk. Health Policy and Planning, 24(5), 395-405. doi:10.1093/heapol/czp029 Antonova, N. (2016). Access to Healthcare in Russia: A Pilot Study in Ekaterinburg. Central European Journal of Public Health, 24(2), 152-155. doi:10.21101/cejph.a3942 O. (n.d.). Weve Got You Covered. Retrieved February 23, 2017. Dairy Products: Physio-chemicals and Microbiology Dairy Products: Physio-chemicals and Microbiology Agriculture is the single largest sector in the Pakistan, contributing 21. 8 to the gross domestic product and employing approximately 44. 7 of the workforce. Livestock is playing a vital role in the economy of Pakistan and account for 51. 8 % of the agriculture value added and 11. 3% of the national Gross Domestic Product. The milk production in country increased by 35. 6% from 1996 to 2007 (Anonymous, 2008). Pakistan dairy sector is producing 41. 3 million tons milk and is the fifith largest milk producing country in the world. Its massive herd of 60. 8 million cows and buffaloes produced 40. 76 million tons of milk in the year 2007-2008. while 56. 70 million goats produced 0. 70 million ton (Anonymous, 2008). The role of livestock sector in the rural economy of Pakistan is important as 30-35 million rural population of the country derive their livelihood from livestock production as a primary or secondary activity (Anonymous, 2008), Milk is defined as the whole, fresh, clean, lacteal secretion obtained by the complete milking of one or more healthy milk animals excluding that obtained within fifteen days before or five days after the calving or such period as may be necessary to render the milk practically colostrums free and containing the minimum prescribed percentage of milk fat and sold not fat (Goff and Griffth, 2006). Milk is a dynamically balanced mixture and is also a perishable food. It is one of few foods consumed in the natural form throught the world. Milk contain 87% water 3. 9% fat, 3. 3% protein, 5% lactose and 0. 7% ash. Milk supply body building protein, bone forming minerals, health giving vitamin and energy giving lactose and milk fat. Besides providing certain essential fatty acids it contain all essential amino acid. All the properties of milk make it an important food for growing children, adults, adolescents, invalid, convalescents and patients (Khan et al., 2005). There is a great potential for dairy industry but the sector operates mostly in the informal economy and needs a constituents effort to formalize and be able to contribute better to the national economy. There are nearly 5. 5 million small scale rural units owing less than 6 dairy herds. These small dairy holders produce 65% of all buffalos and cows milk. Out of total milk produced, 97% is in the informal sector (i. e. loose milk consumed in the village and or sold in the cities through Gawalas in unhygienic condition and without any quality standard). The small scale milk collector collect 200-400 kg milk per day from different villages. Medium scale milk collectors collect 400-800 kg milk per day in a manner similar to the small milk collectors, but on a large scale, Large scale milk collectos collect 5-to 10 tons milk per day and supply milk the dairy factories (Garcia et al, 2003). There are hardly 15 milk processing plant (mainly UHT fluid milk, milk powder and yoghurt in Pakist an). Only about 3 % milk is being processed and 97% is consumed as a raw milk (Malik, 2008). Milk and milk products are one of the most important food products with livestock origin which enjoy special significance in terms of its various nutritional properties such as protein, lactose, fat, minerals and vitamins. Many studies have been made on its constituents and physiochemical characteristics (Walstra et al,  1999). Adulteration of milk and dairy products is one of the most serious issues in the dairy industry and causes economic losses and major health problem to consumers. Due to the limited number of large dairy farms, milk handling process in the traditional system are unhygienic and there is insufficient enforcement of standards, resulting in poor quality of milk products. In order to keep the milk safe, middleman add ice to the milk, in addition microbiological contamination occur due to addition of ice in the milk. The middleman increases the milk quality by adding water, vegitable oil, whey powder and other ingredients to increase the soilds of milk. Antibiotics and Hydrogen peroxide are often used as a preservatives (Garcia et al,   2003). The adulterants in milk include water, starch, whey poxder, vegetable oil and hazourds substance such as antibiotics, caustic soda, urea, formaline, detergents and other chemicals preservatives. Adulteration in milk is a very serious issues in Pakistan. Keeping in view these facts, the present will be planned. Objectives: To study the Physio-chemicals and microbiological quality of dairy products. To determine the adulterants and residues in the dairy products. To determine the relationship of physio-chemical parameters with adulterants. To make recommendation to the Govt of Punjab in the control of adulterants in milk and other food products. Review of Literature: A study conducted on physiochemical quality of UHT milk produced from whole milk powder and stored at 4 °C and 25 °C for 48 hours. They observed that non protein nitrogen content of UHT milk increased while pH decreased with storage and the rate of change being greater at higher storage temperature. Sediment increased with longer storage period, but independent of storage temperature. With longer storage at both 3+-1 C and 25-+ 1 °C, greater sediment and lower pH were observed in UHT milk processed from older milk powder. The development of off flavors increased in UHT milk with a prolong storage period (Ernani et al, 1997). Kuo et al. 2001 studied the effect of heat treatments on the meltability of cheese. They studied cheddar cheese of different composition and low-moisture. Cheese samples were heated to 60 °C and held for 0, 10 and 20 min before allowing the melted cheese to flow. Mean meltabilities, over all ages of both Cheddar and Mozrella cheeses decreased significantly as holding time increased. Meltability of young cheese was scarcely affected by the holding time, in contrast to that of the old cheese where increasing the holding time greately reduced meltability. Khan (2004) studied the physio-chemicals changes in UHT bottled milk and found that effect of treatments and storage on sedimentation, fat, pH, acidity and SNF was highly significant. Maaximum sedimentation was observed after 12 weeks of storage, pH gradually decreased and minimum value were found after 12 weeks. Maximum acidity was found after 12 weeks and minimum was noted in the first week. Kumar and Mishara (2004), studied the effect of stabilizer addition on physiochemical, sensory, textural properties and stater culture counts of mango soy milk fortified yoghurt (MSFY). Three stabilizer namely gelatin, pectin and sodium alginate were used. The addition rate of stabilizer was 0. 2%, 0. 4% and 0. 6% w/w. Significant effect of type and addition rate on acidity, msture content and total solids ofMSFY were observed. Syneresis and acetaldehyde content of MSFY was reduced significantly. Lightness and yellowness of MSFY increased with gelatin and decreased with pectin and sodium alginate. Gelatin gave better effect on appearance and color, body and texture, flavor and overall acceptability in comparision with other stabilizer at 0. 4 % addition rate. Hardness, cohesiveness and adhesiveness of MSFY increased up to 0. 4 % stabilizer addition, while springiness and gumminess did not follow any trend. There was a significant effect of stabilizer addition on Streptococcus thermop hillus and lactobacillus delbrueckii subsp. bulgaricus counts. Griffiths et al 1988, manufactured low heat skim milk powder from raw farm bulk tank and creamery silo milk which had been stored at 2 °C for 24 and 72 hours. During the storage period psychrotroph count increased by about 1log cycle after 24 hour aand 2 log cycle after 72 hours. There was no increase in thermoduric or spore counts of the milk under these storage condition. The powder manufactured from these milk was good bacteriological quality and conformed to ADMI recommendations regarding moisture content, titratable acidity and solubility. They concluded that storage of raw milk at 2 C had no deterintal effect on the heat stability of the powder manufactured from it when reconstituted to both 9 and 22% total solid concentrations. Molska et al 2003 studied the microbiological quality of kefir (61 samples) and yoghurt (92 samples) purchased in retail network in Warsaw. The total number of bacteria in at least 90% of yoghurt and 73% of kefir was in the range of 10(7)-10(9) cfu/g. The domestic group of bacteria in kefir were mesophilic lactic acid streptococci and in yoghurt S. thermophillus. The number of L. delbrueckii in 40 % of sample was less than 10(7) cfu/g. More than 86 % of kefir and 97 % of yoghurt analysed were free from coliform bacteria., B. cereus, mould and yeast. About 48 % of kefir samples did not fulfilled the FAO/WHO requirements concerning the number of yeast. Kessel et al 2004, determine the test for standard plate count (SPC) and fecal coliforms in the bulk tank milk in the inited state. As part of the 2002 survey, 861 bulk tank milk sample were collected from farms in 21 states, coliform were detected in 95 % samples. There were no apparent relationship between SPC and incidence of salmonella or L. monocytogenes. Although the prevalence of L. monocytogenes and salmonella was low, these pathogens represent a potential risk to consumers of raw milk and raw milk products. Nero et al 2004 condcted a study to avaluate the microbiological quality and the presence of Listeria monocytogenes and Salmonella spp. In the raw milk produced in 210 small and medium farms located in four important milk producing Brazilian states. In 66% of the selected farms the milkng was manual. In 33 % of them, the milking was semi-automatic and only 1 % were equipped wit hfully automatic milking systems. All raw milk samples were negative for L. monocytogenes and salmonella spp. Mesophilic aerobes counts were higher than 10^5 CFU /ml in 75. 7% of the samples. In 80. 4%, coliforms were over 10^2CFU /ml. Escherichia coli were detected in 36. 8% of the samples. Aygun et al 2005 purchased 50 randomly selected samples of Carra cheese, raw milk cheese, from different retail markets in the Antakya region and were investigated for microbiological quality and some chemical analyses. In their samples, the number of microorganisms were found as follows : Staphylococcus aureus 2. 51* 10^3 cfu/g, coliform 1. 02*10^4 cfu/g, E. coli 4. 27*10^3 cfu/g, Salmonella were not detected in any of the samples. Mean moisture, salt and fat content of Carra cheese were found as 41. 26%, 7. 82% and 26. 77% respectively. The pH value of the samples varied b/w 4. 53 and 6. 32 with the mean of 5. 24. The microbiological finding showed the presence of high counts of microorganisms investigated and the poor hygienic quality of Carra cheese. Little et al 2008 determined the microbiological quality of two retail fresh ripened and semi hard cheeses made from raw, thermized or pasteurized milk. Raw or thermized milk cheeses were of unsatisfactory quality due to level of Staphylococcus aureus st 10^4 cfu/g, E. coli at 10^5 cfu/g, whereas pasteurized milk cheeses were of unsatisfactory quality due to S. aureus at 10^3 cfu/g and E. coli at 10^3 cfu/g. Salmonella was not detected in any samples. They emphasize the need for applying and maintaining good hygeinc practices throught the food chain to prevent contamination and bacterial growth. Labelling of cheeses with clear information on whether the cheese was prepared from raw milk also requires improvement. Sheppard et al 1985 demonstrated the application of various analytical methods to the detection, identification and quantitation of vegetable oil adulteration o ice cream. Total fat content, sterol, long and chain fatty acid, vit E, Reichert à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Meissle values and Polenske values were measured in ice cream. All method except total fat determination were capable of detecting vegetable oil adulteration. Sterol determination was the most effective and versatile measurement because it provided information not only on the detection and extent of adulteration but also on the possible identity of the adulterant. Fox et al 1988, described a test for routine screening of Mozzarrella Cheese and butter for vegetable fat adulteration. Fat is extracted and sponified. The potassium salts of the fatty acids are measured through direct gas chromatographic analysis. A ratio, calculated from the concentration of butyric acid and oleic acid is used to avaluate the puroty of the samples. The test offers good precision and can detect less than 10% partially hydrogenated vegetable fat. Kumar et al 2002, reported that adulteration in milk and milk products has reached an alarming stage. Milk fat is being mixed or replaced with cheaper vegetable oil. Therefore, often more than one test has to be employed to confirm the purity of milk fat. The various method for the detection of adulteration in milk at is based on the physical properties, chemical properties and presence or absence of specific constituents of either milk fat or adulterant fats. Jha and Matsuoka 2004, conducted a study on the adulteration of natural milk by synthetic milk, prepared by mixing appropriate amount of vegetable oil, urea, detergent powder /shampoo, caustic soda, sugar /salt and skim milk powder to water. Detection of adulterants is difficult by a single method and sometimes more than two methods are required to confirm the presence. The potential of near-infrared spectroscopy were investigated (NIRS) in the wavelength range of 700-1124. 8 nm. Material And Methods: Collection of Samples: The dairy products samples will be collected from the market and then analysis will be performed at Dairy Laboratory, National Institute of Food Science Technology, University of Agriculture, Faisalabad. Butter: Butter samples of three different brand namely Gourmet, haleeb and Nurpur Dairies will be collected. Three samples from each brand will be collected. Youghurt: Yoghurt samples of three different brands namely Gourmet, haleeb and Nurpur Dairies will be collected. Three samples from each brand will be collected. Cheese: Cheese samples of three different brands namely Adams, Military dairy Factory and Nurpur Dairies will be collected. Three samples from each brand will be collected. Milk Powder: Milk Powder samples of three different brands namely Gourmet, haleeb and Nurpur Dairies will be collected. Three samples from each brand will be collected. UHT milk: UHT milk samples of three different brands namely Gourmet, haleeb and Nurpur Dairies will be collected. Three samples from each brand will be collected. Sampling Procedure: Dairy product samples will be collected in clean sterilized container and put in ice chest, whereas milk powder will be collected in zip polyethylene bag. These samples will be transported for analysis to the Dairy Laboratory, National Institute of Food Science Technology, University of Agriculture, Faisalabad. Sterilization: All glassware like pipette, test tubes, petri dishes, beaker and flasks will be thoroughly cleaned and sterilized in an oven at 180 C for 2 hours. All media and solution will be prepared in distilled water and autoclaved at 121 C at 15 Ib pressure for 15 min using the procedure of AOAC (2000). Physiochemical Test: The samples will be subjected to different physic-chemical test which are detailed as under. Melting Resistance and Melting Quality: Melting Resistance and Melting Quality will be determined by the method as prescribed by Bhadari(2001). Fat: Fat will be determined by using Gerber method as described by the Kirk and sawyer (1991). pH The pH of all the treatments will be determined according to AOAC (2000) method no. 981. 12. Moisture and ash All the treatments will be analyzed for moisture and ash according to their respective methods mentioned in AOAC (2000). Total solids Total solids called percent residues will be determined by drying the sample in hot air oven according to method described in AOAC (2000). Protein: Protein content will be determined by using Kjeldhal method as described by AOAC (2000). Microbiological Test: Dairy products samples will be tested for total plate counts, Coliform counts, Staphyloccus aureus and Yeast and Mould count by the method prescribed by AOAC (2000). 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