The democratization of Russia has led to an extraordinary teaming of
Russian and U.S. officials to improve the lives of citizens in both nations. Created by
President Clinton and Russian President Yeltsin after their 1993 summit meeting, the
U.S.-Russia Joint Commission on Economic and Technological Cooperation (JCETC) advances
bilateral cooperation on many global issues, including health.
Also known as the Gore-Cherno-myrdin Commission for the cochairs, Vice
President Al Gore and Prime Minister Victor Chernomyrdin, the commission conducts its work
through eight committees on health, space, business and investment development, energy,
defense conversion, science and technology, environment, and agriculture. Numerous
cooperative ventures and programs have resulted, many supported by technology, especially
the information superhighway.
Directing the globalization of public health is the Health Committee
cochaired by Secretary of Health and Human Services Donna E. Shalala and A.D.
Tsaregorodtsev, Minister of Health and Medical Industry of the Russian Federation. A key
vehicle in the committee's exchange of information for improving health of citizens in
both countries is the Internet. Indeed, the committee has a World Wide Web site
(http://odphp. osophs.dhhs.gov/russia) with text in both English and Russian.1
The Health Committee, which has met four times since its formation in
late 1994, seeks to have a practical impact on the health status of both Americans and
Russians through cooperative activities. The primary tool for achieving this goal is the
exchange of information using all types of communication vehicles. This includes the
Internet and e-mail as well as traditional printed materials, exchange visits, and
face-to-face technical assistance. Collaborations and discussions among government
officials and scientists, training, and public-private partnerships are also being
pursued.
Indeed, one of the most far-reaching achievements to date has been U.S.-Russian and public-private cooperation. This cooperation is seen within agency departments, across agencies, and between governments and industry at the local, State, and national levels. Members also work with other committees, particularly those concerning business development and the environment.
The Health Committee has identified eight priority areas-diabetes,
health education and promotion, prevention and control of infectious disease,
strengthening primary care practice, tuberculosis treatment and control, maternal and
child health, health reform and policy dialogue, and environmental health. The committee
is also focussing on two interdisciplinary or crosscutting areas: trade and investment and
telecommunications.
Telecommunications is one of two crosscutting aspects of the Health Committee as well as the commission as a whole, especially with the use of the World Wide Web and e-mail for both personal communication and database access. Electronic communication also has the advantage of facilitating data analysis and strengthening surveillance. This crosscutting priority encompasses demonstrations of the potential of computers in the field of health.
The second crosscutting area, health sector trade and investment, covers
the supply of high-quality health products, such as pharmaceuticals and medical devices
(some specific to the health sector and others with a broader effect). Co-led by
representatives of the U.S. Department of Commerce and the Food and Drug Administration,
the working group is investigating existing barriers to trade and investment in the health
sector and has issued memoranda of understanding on medical devices and pharmaceuticals.
The groups working in each of the eight priority areas have specific objectives, accomplishments to be proud of, and upcoming deliverables.
Diabetes. The objectives are threefold: to establish an effective, nationwide surveillance system for diabetes in Russia, to initiate clinical training programs to facilitate improved diabetes professional education, and to support the establishment of a professional diabetes association similar to the American Diabetes Association. Thus far, Russian diabetes specialists have visited the United States to develop plans for a diabetes prevention initiative; others have received clinical training; and electronic communications have been established so that U.S. and Russian diabetes researchers can share data. Also of particular importance is the work with pharmaceutical companies (insulin producers Eli Lilly and Novo-Nordisk) and major diabetes-related industries in the United States. The Centers for Disease Control and Prevention's Division of Diabetes Translation will cosponsor a major health promotion conference in Russia later this year.
Health Education and Promotion. Here the initial emphasis
is on development of strategies to promote better health of children and adolescents,
principally through school health education and other health programs. At the committee's
January 1996 meeting, cochairs Shalala and Tsaregorodtsev declared in a joint statement,
"The children of our nations are our most precious national treasures, and assuring
their present and future growth is one of our most essential obligations." The
cochairs called for making "health education a priority for our educational systems,
defining health education broadly to engage families, communities, and educational and
health institutions in the transmission of essential information about life sciences and
risks to health, as well as in provision of opportunities to engage in health-supporting
activities and to live their childhoods in health-sustaining environments."
The declaration was just the beginning. Within months, priority group members were putting
together a Joint Exhibition on Health Education and Health Promotion and a Conference on
Health Education and Health Promotion for Children and Youth as part of the Third
International "Medicine for You" exhibition in Moscow in June 1996. Russian and
U.S. working groups were successful in obtaining participation by government,
corporations, and academic health centers. In addition to formal events, Russian and U.S.
health officials have discussed committee-related matters as occasions have presented
themselves: for example, at the May World Health Assembly in Switzerland. Even before the
declaration, grass-roots efforts were underway through the School Linkage Program, a
reciprocal high school exchange involving 1,400 students in 179 Russian schools and 1,400
American counterparts. For example, students from Volgograd have visited a Medford,
Oregon, high school to develop a joint curriculum on healthy lifestyles. (See Spotlight.)
Prevention and Control of Infectious Diseases. Seeking to enhance training, epidemiological studies, and applied research in infectious diseases, the committee is focusing on bilateral exchange of scientists, other experts, and know-how (for example, computer software programs). One important aim is to strengthen Russian efforts to control the ongoing diphtheria epidemic (see box on page 2). Teams of epidemiologists have reviewed surveillance data and identified increased risks among adult women and lower levels of vaccine coverage in the highest risk group. Now underway or planned are vaccine coverage assessments, studies of diphtheria isolates, and assistance to Russian collaborators in defining and implementing improved control strategies. The Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report has published in English and in Russian "Profile of Infectious Diseases: Russian Federation and U.S.A., 1994," which covers diphtheria as well as hepatitis, measles, and poliomyelitis.
Another U.S. agency participating in this priority area is the Food and Drug Administration (FDA). FDA representatives have provided technical assistance in food safety and conducted workshops on foodborne pathogens, labeling, and other topics. FDA has also established a World Wide Web page to provide multilingual versions, including Russian, of food safety publications: http://www.cfsan.fda.gov/~mow/select1.html.
Strengthening Primary Care Practice. This priority area involves strengthening current primary care practice and developing family medicine physician training and nurse training for primary health services in Russia. Recent accomplishments include a study tour and plans for satellite conferences with key Russian and U.S. primary care leaders.
Tuberculosis (TB) Treatment and Control. TB has shown a resurgence in the United States and continues to be a serious problem in Russia. The focus in this area is the assessment of short-course ambulatory therapy in Russia, the development and use of computerized systems for surveillance of the disease and case management, and the exchange of information and expertise on common problems of TB in each country. Of particular note is a public-private partnership, with U.S. pharmaceutical manufacturer Marion Merrill Dow providing drugs for a demonstration project for the therapy.
Maternal and Child Health. With maternal and infant mortality continuing to be public health problems in both countries, this group is sponsoring seminars on modern contraceptive technologies, training of trainers, and exchanges of experts and information on case management and major childhood diseases. These and other activities are a part of the Women's Health Program of the U.S. Agency for International Development (USAID).
Health Reform and Policy Dialogue. Both nations are exchanging information on issues facing federal health authorities on decentralized health systems, including quality assurance of cost-effective health services. The working group has lauded the National Center for Health Statistics (NCHS) and the MedSoc-EconInform Institute for their Russian-language translation of Vital and Health Statistics: Russian Federation and United States, Selected Years 1980-93, considered a landmark joint effort by both countries to help establish an agenda for action. (See NCHS in Resources.)
Environmental Health. Focusing on strengthening
environmental science and epidemiology, applying risk assessment, and improving risk
communication (see http://nhic-nt.health.org/prevrep.htm), this group's first activity was
an interagency conference in Moscow on environmental lead exposure and child health.
Experts from the Department of Health and Human Services, the U.S. Environmental
Protection Agency, and nongovernment organizations met with more than 50 Russian
researchers and policymakers. A joint report on cooperation in lead-related health
research and policy is planned for release near the end of this year.
Working groups in each priority area have targets tied to the overall mission, as well as to specific meetings of the Gore-Chernomyrdin Commission. The most recent meeting of the Health Committee was held July 15-16.
1 By its very existence, the committee helps promote the benefits of
international networked health information, the topic of the previous issue of Prevention
Report. For an online version, see the National Health Information Center's World Wide
Web site: http://nhic-nt.health.org/. For transcripts of the recently conducted 1996
Partnerships for Networked Consumer Health Information conference, see this World Wide Web
site: http://odphp.osophs. dhhs.gov/confrnce/partnr96/.
Diphtheria: An Epidemic in Russia |
Through a mutual exchange of knowledge and information, the Health Committee of the U.S.-Russia Joint Commission on Economic and Technological Cooperation seeks to be more than a humanitarian effort. As U.S. health professionals and scientists work with their Russian counterparts on prevention, treatment, and control strategies, both nations will benefit. Diphtheria serves as an example. Years ago in the United States, diphtheria was a widespread and greatly feared disease, striking about 150,000 people annually and killing about one in ten. Today, only a few cases occur each year. The contrast with diphtheria-related morbidity and mortality in Russia is considerable and indeed was cause for alarm recently upon the increase in Russian immigration to the United States. Diphtheria constitutes an epidemic in Russia and the number of cases continues to rise. Of the persons who died in 1994, 95 percent had never been vaccinated. According to the Centers for Disease Control and Prevention, the current rarity of diphtheria in the United States is due primarily to the high level of appropriate immunization in children and to an apparent reduction in the poison-carrying strains of the bacteria. However, the increasing percentage of diphtheria cases in adults suggests that many adults may not be protected against diphtheria because they do not receive boosters every 10 years as recommended. |
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