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Income inequality is surging, and there are few countries where it is rising faster than the United States. The distance between rich and poor is greater in America than nearly all other developed countries, making the US a leader in a trend that economists warn has dire consequences. GlobalPost sets out on a reporting journey to get at the ‘ground truth’ of inequality through the lenses of education, race, immigration, health care, government, labor and natural resources. The hope is to hold a mirror up to the US to see how it compares to countries around the world.

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Galina Nikolaeva (left), 65, thanks Nadezhda Gracheva of Sisters of Mercy at Saint Alexei Hospital in Moscow. (Yuri Kozyrev/GlobalPost)

Health care disparity reveals Russia's income inequality crisis

When citizens become patients, the country's growing economic divide is painfully evident.

Comparing the Divide: Income dictates access to health care in the capital cities of Russia and the United States, where lawmakers debate policy mere miles from some of the country’s most underserved communities. Russia’s Gini coefficient, at 0.420, is actually better than that of Washington, D.C. at 0.435.

MOSCOW — Pensioner Galina Nikolaeva, 65, cries with affection when she recalls how she was looked after when she suffered a seizure on New Year’s Eve.

“If I hadn’t made it to this hospital, I wouldn’t be alive anymore. I’m sure of this. I believe the Lord sent me here,” says Nikolaeva, whose 8000-ruble ($264) monthly pension does not allow her to afford even low-budget state care.

Nikolaeva was admitted to Saint Alexei, a respected Moscow hospital financed by the state and the Russian Orthodox Church that provides free medical care. She doesn’t think she would have survived her latest run of bad health without what she calls the “dedication” and “love” of the medical staff.

“This isn’t empty praise,” Nikolaeva says. “I am just saying what it is like. And I am in a position to judge — I’ve been in and out of hospitals for the last 25 years.”

“If you want to be healthy, then you have to pay.”
~Elena Prikhodova

Russia's Constitution guarantees free health care for everyone, but many Russians say the reality is not so egalitarian. They say that health care is divided into two camps: those who can afford private clinics or paid state treatment; and those who must queue for crowded and second-rate care if they cannot draw together the necessary funds.

Since the Soviet collapse, years of unbridled western-style capitalism driven by high oil prices have transformed Russia, still the world’s largest energy exporter, but many believe it has mostly enriched the wealthiest slice of society while the majority remains little better off. Though in Soviet times personal wealth was kept well out of sight, Russia today is rife with ostentatious displays of personal riches.

The disparity in health care access reflects what analysts call a widening gulf between the rich and the poor in a country with a minimum wage of $170 a month but which has almost a hundred ‘dollar billionaires.’ Those billionaires own 30 percent of all the country's personal assets, according to the Credit Suisse Global Wealth Report.

A volunteer dries Galina Nikolaeva's hair at Saint Alexei Hospital in Moscow.
(Yuri Kozyrev/GlobalPost)

Russia’s Gini coefficient — the standard measure of income inequality — ranks Russia as more equal than the United States and the four other BRICS countries. But Russia performs well on this ranking in part because the government handed citizens their apartments in a mass privatization effort after the Soviet Union’s collapse.

In the last two decades, trust in Russia’s free health care has plummeted, spurring the rise of private clinics, some of which are world-class and have attracted foreign investors — tens and even hundreds of millions of dollars at a time.

But millions of Russians like Nikolaeva have never set foot in such a clinic.

Fearing they are left with no real safety net, poor sections of society like pensioners are thankful for charity organizations like the Sisters of Mercy who contribute staff to the Saint Alexei hospital.

They know how lucky they are to get in the door.

Sisters of Mercy 

The Sisters are an international religious movement that sprung up in the mid-1800s. But in Russia they are thought of primarily as the Orthodox Tsarist-era nurses who treated the wounded during the Crimean War, later morphing into a national movement that saw communities helping the poor, homeless and sick across the country.

These communities went underground in atheist Soviet Russia, but they have returned after the Soviet collapse just over two decades ago and operate a number of programs to treat the poor.

Their nurses, who once again wear traditional nurses’ head scarves, elicit glowing praise from patients in Saint Alexei, many of them Orthodox Christian pensioners. Svetlana Prokofeva, 74, who is recovering from stomach poisoning and pneumonia, says the hospital’s dedicated care has made her feel like “she has made it into heaven.”

But for every patient receiving top care in a reputable Moscow hospital, there are thousands facing long queues, sub-standard treatment, outdated medical equipment in the regions or not able to afford treatment at all.