title: Health and health systems in the Commonwealth of  Independent States.
abstract: The countries of the Commonwealth of Independent States differ substantially in their post-Soviet economic development but face many of the same challenges to health and health systems. Life expectancies dropped steeply in the 1990s, and several countries have yet to recover the levels noted before the dissolution of the Soviet Union. Cardiovascular disease is a much bigger killer in the Commonwealth of Independent States than in western Europe because of hazardous alcohol consumption and high smoking rates in men, the breakdown of social safety nets, rising social inequality, and inadequate health services. These former Soviet countries have embarked on reforms to their health systems, often aiming to strengthen primary care, scale back hospital capacities, reform mechanisms for paying providers and pooling funds, and address the overall shortage of public funding for health. However, major challenges remain, such as frequent private out-of-pocket payments for health care and underdeveloped systems for improvement of quality of care.
authors.affiliation: European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK. bernd.rechel@lshtm.ac.uk
authors.forename: Bernd
authors.initials: B
authors.lastname: Rechel
authors.forename: Bayard
authors.initials: B
authors.lastname: Roberts
authors.forename: Erica
authors.initials: E
authors.lastname: Richardson
authors.forename: Sergey
authors.initials: S
authors.lastname: Shishkin
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Shkolnikov
authors.forename: David A
authors.initials: DA
authors.lastname: Leon
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.forename: Marina
authors.initials: M
authors.lastname: Karanikolos
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D000328:Adult; D000368:Aged; D017517:Commonwealth of Independent States; D018672:Community Health Planning; D003431:Cross-Cultural Comparison; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006305:Health Status Indicators; D019456:Health Transition; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011156:Population Density; D011634:Public Health