At 32, Sergei Boyarsky is the youngest dean in the history of the Moscow Medical Academy named for Sechenov. There he heads the Academy’s Faculty of Health Care Management—the only faculty of its kind among the 47 medical institutes in Russia. Boyarsky lectures on public health, the basics of management, economics and the sociology of public health and health care legislation. His students are ministers and heads of health care services from all around the Russian Federation, chief-doctors of hospitals and employees of the medical insurance funds. Over the past six years, some one thousand people have undergone training in Boyarsky’s department.
“The nation’s health is above all an economic issue,” Boyarsky said. “Human resources, individuals’ physical and moral health—all of this relates to the country’s national security. One way or another, our not-so-rich health care is being financed. But the fact is that we don’t really know how much funding we need. And to have 600,000 doctors—isn’t it too much?” Boyarsky said he believes that Russia’s present health care system is plagued by an absence of management, hence the chaos which has gripped it.
A graduate of the Preventive Health Care Faculty at the Sechenov Academy, Boyarsky never wanted to become a practicing doctor. He was always more interested in general issues, such as the philosophy of health care, its socio-economic and ethical problems. These topics became the focus of his work as a student, which attracted the attention of experts. Then followed post-graduate work in the department of Social Health Care and Health Care Management. Having successfully defended his graduate dissertation, Boyarsky is now working on his doctoral dissertation, on Public Health Management and New Policies in Public Health Care.
On top of a rather impressive scientific publishing record (over 20 articles), Boyarsky has vast expertise in management and developing international relations in public health. He trained at the School of Public Health and Tropical Medicine at Tulane University, New Orleans and was instrumental in the establishment of the Association of Educational Programs in Public Health Management, which unites such partners as the Moscow Sechenov Academy, the Novosibirsk State Academy of Economics and Management, and the Far-Eastern State Medical University with universities in New Orleans, Minnesota, Seattle and Kentucky. He is now the association’s executive director.
“The health of the nation must be the concern of all state structures and of the entire society,” Boyarsky said. “Yet, according to recent data, in the hierarchy of values, public health ranked only 14th in the Russian government, and 8th in the State Duma. We must remedy this situation quickly. The whole world is looking for ways to preserve national public health. It is very important to learn from someone else’s expertise, but we don’t need to be simply copying—American or any other country’s expertise won’t save us. A health care system must reflect a country’s national values and traditions. Russia has a rich tradition of wise, zemskaya medicine [a zemsky vrach —a rural doctor—was one who worked alone, covering a huge region]. It had doctor-enlighteners who served as role models for a healthy lifestyle.
“I have just returned from London’s Imperial College. Our British colleagues have deep respect for the system of public health created in the last century by Russian Academician Nikolai Semashko ... Yet time calls for changes. Great Britain is drastically reforming its public health system, just as many other countries are carrying out reforms in keeping with the current socio-economic situation. Yet this is not the case with Russia. People responsible for political decisions have no idea how to extract us from the disastrous situation surrounding the health of Russians.” In Russia, the mortality rate exceeds the birth rate by 70%; the average life expectancy is just 65 years, whereas in the US it is 77.
Boyarsky does have ideas. His credo is to follow common sense in everything. “One must make health a priority in all walks of life,” he said. “Doctors cannot save everyone, no matter how much they want to. One must focus on: developing branches of public health in preventive medicine; better organizing first aid systems, especially developing the network of family doctors; taking good care of women during pregnancy; recreating the virtually nonexistent system of rural health care. And, of course, we need to create a cohesive system of public health management, which at present lacks coordination between its different units.”
Sound too business-like for such a young Russian doctor? But then Sergei Boyarsky comes from the new generation of no-nonsense Russians. Tired of endless, empty small talk around the kitchen table about “Who is to blame?” they instead prefer to answer the timeless question, “What is to be done?” As to his youth, Russian folk wisdom sums it up well: this is a shortcoming which passes quickly.
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