Preventive measures for public health in Russian Federation

Non-communicable diseases (NCDs), cardiovascular diseases (CVDs), cancer, pulmonary disease, and diabetes are the main causes (more than 75%) of death in Russia. Cardiovascular diseases are a leading cause of a premature death both in men and in women. In 2010, the mortality rate of Russian men aged between 25 and 64 years was two times higher than that of European men in the same age, mainly due to CVD mortality. In Russia, as well as in the other European countries, the leading causes of death and disability are directly associated with main risk factors: elevated blood pressure, hypercholesterolaemia, smoking, poor nutrition (low level of vegetable and fruit consumption, excessive salt and fat consumption), physical inactivity, overweight/obesity, and alcohol abuse. In 2013, national guidelines for the prevention of NCDs were developed and published by National Research Center for Preventive Medicine and the Russian National Association of the Cardiologists. Main strategies of preventions were elaborated concerning primary prevention, based on two approaches: the population approach and high-risk one. Inter-sectoral collaboration was declared as an essential part of the population approach. For this purpose, in 2012, the Governmental Committee on health protection was established in the Russian Federation headed by the Primary Ministry. The Committee includes different ministers of Russian Government. The main aim of the Committee is the co-ordination of actions of all federal ministries, involving them in the programmes on health protection. The same inter-sectoral committees were established in all Russian regions in 2012. In 2012, the Russian Ministry of Health elaborated the State programme of healthcare development till 2020 according to the objectives and indicators of the WHO Action plan for the prevention and control of NCD 2013-20. This programme consists of several subprogrammes. First of them is the subprogramme on disease prevention, health promotion, and primary care development. Specific indicators related to the main risk factors were also established. Following the Federal document, the regional programmes on healthcare development, including the subprogrammes of disease prevention and health promotion and primary care development, were elaborated in all 83 regions of Russia in 2012-13. Given the large occurrence of the population of individuals at high risk (up to 25% on the scale of SCORE, and up to 20% of individuals with clinical manifestations of atherosclerosis), a high-risk strategy was also taken in account in the Russian Federation. In 2013, a systematic work started to implement the high-risk strategy, assuming screening at outpatient clinics to detect the patients with NCD and risk factors.