The poor’s focus is shifted towards negative evaluation of the reality, pessimism, and despair. They are often unable to build proper relations within their families – high voice in the family, mutual reprimands, obscene words and abusive language become a common thing. Such conditions develop a special lifestyle and a value system, which could be described by restraint and voluntary isolation, economic and social dependency, lack of clear behavior role models, separation and political passivity, absence of future plans and self-confidence; increased disposition to conflicts in family relations (rude talks, quarrels between parents and children, frequent divorces) (Кислицина О. А., 2005).

Other reasons responsible for acute aggravation of health inequity in Russia during the transition period include:

1. Actual shift in healthcare from caring for health to clinical medicine, i.e. from mass recreational and preventive measures to individual treatment.

2. Increased share of paid services, development of new relationships with patients, which destroy the basics of medical ethics, and which make it possible to view the patient as another source of income; chronic deficit of funding with a large number of various sources of that, which never contributes to financial transparency.

3. Sharp increase in inequity in terms of people’s access to medical services, while the majority of these people are socially disadvantaged.

4. Prominent inequity in doctors” incomes.

5. Unequal access to medical services for certain groups of people: homeless people, neglected children, migrants, and just financially vulnerable people.

4. Continuing practice of increasing the share of costly and expensive medicine, a huge gap between the quality and quantity of medical assistance in cities and in the provincial areas, and the gap between the assistance provided to rural and to urban residents is increasing.

5. Obvious and neglected mismatch between people need for preventive medicine, treatment and rehabilitation, and the funding allocated to the area. All this makes medicine spontaneous, paid, creates new issues and even power abuse, which may result in undermining the entire structure of the system. Since recently, instead of improving medical assistance, managers in healthcare have started talking about lifestyles, thus trying to avoid responsibility for current state of things in medicine and shifting it onto people who abuse tobacco, alcohol, stick to unhealthy diets and just do not take care of their own health, even though, actually, all this is one of the tasks for the system of healthcare.

6. Overly complexity of the very system of healthcare and, as a result, its poor controllability and efficiency (Комаров Ю. М., 2010).

Thus, we believe that in order to reduce the urgency of health inequity it takes comprehensive intersectoral measures, which should be initiated by the public health sector, while all the municipal agencies and public groups should be involved as equal partners.

Measures for reducing health inequity

Health inequity determinants lie within areas of public life other than healthcare alone; then it is obvious that there is a need for a policy in all these areas aiming at assessing their impact on health, especially on the health of the most vulnerable groups, which would allow coordinating the policy respectively.

From the viewpoint of social policy, first of all there is a need to realize the scale of the issue. This is why the top aim for a social policy in this area should be activity for, at least, limiting the impact of poverty and income inequity on people’s health.

The Committee for socio-economic determinants recommends the following

– to carry out a quantitative assessment of potential effects on the health of different groups of the population due to particular risk factors;

– to detect the risk factors (including social determinants) whose effect could be prevented;

– to carry out a differentiated analysis of the impact on health that competing risk factors have, e.g. such as tobacco smoking and diet;

– to detect and carry out a deeper analysis of the cumulative effect of multiple impacts;

– to investigate additional and synergetic (or, which is less likely, antagonistic) interaction between socio-economic factors and the negative environmental factors;

– to get to deeper understanding of the nature and gender differences in the vulnerability of children, older people and the elderly to negative environmental effects (CSDH, 2009).

The countries looking for counter-measures in order to reduce social and environmental inequities should take into account their driving forces and the underlying reasons. No doubt, there are no easy ways to eliminate the inequities, proof to that being the social processes that have been going on in the latest decades. The key to success of the strategies that are being implemented is a clear division between short– and long-term objectives, and reducing socially determined environmental issues takes various approaches.

?In the long-term outlook disadvantaged groups will gain the maximum benefit from interventions aiming at creating a safer environment just because these groups are more often subject to negative environmental impact.

?The long-term measures that should be part of the local, national, and international agenda must include special events and campaigns aiming at serving the groups with the detected risk of the most serious or specific unfavorable effects of environmental inequity.

Since poverty is one of the key factors determining health inequity, this inequity cannot be resolved unless this key issue is resolved.

The major stream in overcoming absolute poverty is ensuring productive employment, increasing labor efficiency, creating conditions allowing the working population earning more thus supporting themselves and their families.

In this case the size of the salary comes out as the major guarantee against poverty. The role of the state here implies establishing market conditions for increased competitive capacity in the national economy through increased competitive capacity of the Russian enterprises – implementing the required industrial policy, proper adjustment of the system for staff training, introducing measures for supporting the national manufacturer.

Higher selectivity in offering social assistance, application-based priority, and individual social benefits – all these make up an efficient way of eliminating poverty.

When selecting socially vulnerable groups there is a need to match the officially established poverty line with their income, the officially established minimum property standard with the property that they possess. Special attention should be paid here to the issue of homelessness, neglected children, and children in crisis families.

An important task for social policy is detecting the obstacles on the way to obtaining social support and benefits.

The current system for revealing and supporting poor families and people providing them with various benefits, advantages, sand other types of assistance is far from being perfect and needs adjustment to market economy. The funding allocated nowadays to provide social support to the poor is not efficiently distributed and will often go to the families that are poor indeed. As a result the truly poorest population remains even in worse condition.

The international practice includes the following measures to combat poverty:

– Redistribution of income.

First of all there should be measures for the development of an efficient labor market. This issue implies resolving two key tasks:

– Measures for reducing the number of low-paid employees;

In the major measures aiming at the reduction of the number of low-paid employees the following can be defined:

– Increased salaries for public employees through bringing up the expenses for remuneration of labor;

– Implementing a policy aiming at reducing illegal types of labor remuneration, which contributes to impoverishment of the working population (delayed pay, payment in kind). Such a policy must include economic and administrative measures targeting, first of all, the employer;

– Encouraging employment for those who want and can work, new workplace establishment. To ensure prompt the establishment of new workplaces takes stimulating the priority in the development of the economic areas that can provide new workplaces with minimum investment. This is, first of all, small– and middle-scale business.

– measures for reducing income inequity at the expense of social transfers and increased minimum guarantees in social security sphere;

– introducing a progressive income tax for individuals. Officially the gap between the 10 % of the poorest and the richest is 15 times (CSDH, 2009).

No doubt, apart from solving general healthcare issues, the measures for reforming the national healthcare system should also contribute to reducing health inequity in Russia. Such organizational measures include:

1. A multifunctional network of healthcare institutions with its internal and external connections, which would allow calling this network a healthcare system.

2. A rather branchy system of medical examinations, check-ups and measures. There should be extensive work to offer general public training in self-help in certain cases (in case of trauma, bleeding, etc.) and self-examination (regular examination and palpation of breast, taking the pulse, blood pressure, etc.); this will take circulation of special literature.

Besides, the tasks for healthcare both in general and locally (by health criteria) include:

– bringing closer to densely populated areas shopping malls offering everyday goods, pharmacies, institutions for primary medical assistance, recreational institutions, schools and preschool institutions, places of everyday use, public transport, etc.;

– Improved facilities, reduced environment pollution, improved quality of water, air, and soil;

– Improved local environment, planting of greenery, establishing recreational areas;

– Improved structure and quality of food, efficient control of food safety;

– Increased level of culture and education, encouraging involvement of children and adolescents into activities based on their interests, organizing their spare time and creating conditions for public physical activities (stadia, swimming pools, skating rinks, skiing paths, sport gyms, etc.);

– Strengthening the value of family, crime prevention;

– Activating the movement for health and mobile lifestyles;

– Eliminating drug abuse, tobacco smoking, alcohol consumption, preventive work with children, youth and adolescents;

– Sanitary education of the general public, increasing the level of sanitary literacy and culture, teaching simplest ways of primary self-help and mutual assistance;

– Combating prostitution, STDs, and AIDS;

– Vaccination and immunization;

– Establishing paramedical and nurse respite service, integrated medical support at home (day-time or day-and-night), establishment of municipal or neighborhood nursing homes or hospices;

– Health and working capacity recovery, establishment of rehabilitation centers;

– Conducting preventive, special periodic medical check-ups, early diseases detection, primary medical assistance;

– Detecting socially vulnerable groups and providing them with the individual required support;

– Working and living conditions. Since health inequity is often related to unequal living or working conditions then reducing the inequities should imply eliminating the underlying causes. Some public policies aiming at the establishment of proper and safe residence, increased standards of professional health and accident prevention, even though they were developed to help people in general, still may prove most efficient for those employed and living under the worst conditions, through increasing their physical and social environment standards;

– Choice of lifestyle. The state policy here should be aiming at offering people equal opportunities in choosing healthy lifestyles. Recreational institutions and sport facilities, for instance, should be accessible both by their location and price, while shopping mall chains should guarantee cheap and nutritional food supplies. At the same time the advertisement and promotion of products that have a negative effect on health should be restricted (Комаров Ю. М., 2010).

The areas of social policy that could have the most efficient contribution into improving people’s health include the following ones (CSDH, 2009; Final report by Commission on Social Determinants, WHO, 2010):

– Intervention into early life.

More and more research support the role of the environment where a child lives in the early childhood, which has an impact on the child’s future behavior, academic performance, and health for his/her entire life. People whose childhood included residing in families suffering from financial issues were more prone to various diseases in adulthood. Therefore, offering equal opportunities requires the earliest intervention possible. It is common knowledge that mother’s nutrition during pregnancy will impact not only the child’s health in the first year, yet for the entire life. Therefore, a woman’s weight prior to pregnancy is a good predictor of the child’s weight at birth; a lower weight, in turn, is related to a higher risk of coronary heart disease, hypertension, and diabetes in the future life. This means that investing into policies reducing negative early effects may prove profitable not only in the present, yet in the future generations as well (Gilmore. G., 2009).

The role of the population in the system is extremely important and may reveal itself in municipal volunteers and activists involved in all the aspects of healthcare and in solving all the issues. It is becoming more and more popular to join patients in groups of self-training (with some professionals involved as well), teaching them how to make the best of their living and working with some particular chronic disease or after overcoming some dependency (alcohol, tobacco, drugs). Here we can also mention the currently popular in Russia so-called schools of people with diabetes, hypertension, asthma, osteochondrosis, osteoarthrosis, etc., anonymous alcoholics groups and so on. Involving people from the most disadvantaged groups into common work will give them a chance to become part of political processes and define measures for inequity reduction, which would allow better detection and elimination of the most relevant inequities. Based on the data analyzed we can make a preliminary conclusion that breaking the vicious circle of increasing poverty and poor health, even under scarce resources, is mostly about their mobilization in three areas: successful employment (improved conditions based on involvement that may bring satisfaction); strengthening social connections, development of a stable communication circle for people who are related and who share similar ideas; consistent and economical disease prevention, which includes a wide range of issues (proper nutrition, absence of negative behaviors, general activity, maintaining social connections, positive emotions, etc.). (Комаров Ю. М., 2010).