This book on health and health care is the third in a series of books on the impact of social change in Russia since the fall of communism. The two earlier books focused on poverty and employment. They all draw on a lengthy research programme funded by INTAS, a European Union scheme starting in 1993. INTAS aims to support research by Russian scientists through collaboration with European scholars to encourage knowledge transfer. The projects are managed by a co-coordinator, in this case from the UK.

Researching in Russia is challenging. The size and diversity of the country inhibit generalisation; there are gaps in official statistics and responsibility for some health functions such as the new national health insurance scheme, have been devolved to the regional level. Some UK-based Russian specialists, such as Bowring and Figes, suggest that recently access to archives for foreigners has become more restricted. Then, there are the barriers brought by language and culture. It is an achievement to have completed a complex research project with a number of publications and to have done so against a background of considerable political and economic turbulence. Between 1991 and 1997, the boundaries around the Russian Federation were redrawn; the state withdrew from providing a number of centralised welfare services and large sectors of the economy were privatised. By the mid 1990s, GDP had fallen by 50 per cent, unemployment was widespread and a third of the population lived below the official subsistence minimum.

In an introductory chapter, the editors give a brief overview of the policies of the Putin years when, around 2000, the economy began to grow but state services remain minimal. The events of the past decade have had a particularly catastrophic effect on the health status of Russians. Life expectancy, particularly for men, has fallen dramatically. The latter part of the chapter gives a summary of the research findings.

Research design and methods are, of course, critical to the validity and credibility of the findings. These are explained in an appendix, but it would have been helpful to have had a fuller summary of the methods and the socio-demographic characteristics of the sites chosen for fieldwork in the first chapter to provide a context for the individually authored chapters. The study drew on three major sources: national government statistics, data from the regular pan-Russian representative, quantitative, questionnaire-based surveys undertaken by the Russian Academy of Sciences and a longitudinal panel study of a structured sample of 87 persons in three regions: Moscow, Voronezh and Kazan. This consisted of both pre-coded and open-ended questions. Data were collected on two occasions between 1996 and 2005 in face-to-face interviews. The aim was to chart individual circumstances and coping mechanisms over time. Until fairly recently, social science research relied on questionnaire-based data, so the qualitative research was innovative.

The book contains a wealth of detailed information with chapters written by different authors. Part I covers health beliefs, measuring and understanding health; Part II, health inequalities, poverty, employment and health; Part III access to health care, gender and health. A final chapter presents selected life stories of how people have coped with illness and disability over time. Contributors analyse data using a variety of concepts and theories from the sociology and psychology of health and illness literature available in English: such as help-seeking behaviour, internal and external locus of control and social capital. Standard measures used in Europe, such as the General Health Questionnaire, are also used to compare the health of Russians with other European countries. Factors contributing to the high mortality rates, such as alcoholism and poverty are discussed in a number of chapters as are the growing inequalities in health status by income group, gender and region.

The qualitative data are used to illustrate quantitative data and to provide new insights. For example, it is suggested that the Russian language lacks nomenclature for states of health. Illness is accepted unless activity is severely restricted and self-care is widespread to compensate a shrinking service. The qualitative data suggest that Russians are stoical in the face of adversity and the social and economic resources of family and social networks remain vital to getting by. If read from cover to cover, the wealth of detail, multiple concepts and theories, and the repetition of information related to cross-cutting themes make the book difficult to digest, particularly in the absence of summary conclusions in some chapters. It is probably best read selectively by those with a specialist interest. The chapters by Davidova on poverty and health stand out as presenting a clear argument and suggestions for how a strategy for preventing ill health could be developed.

Overall, the book is more about health than health care services or policy. The reader is left with many questions about what policy is, how it is made and the gap between policy intent and implementation. The first chapter gives a very general overview of the reforms of the Putin era. The chapters following make occasional references to the health insurance reforms and to a new framework of central decision-making institutions, but the effect of these changes for service accessibility and availability is not spelt out. Perhaps such information is not available. This brings us back to the point that externally sponsored researchers face particular difficulties in giving a convincing account of health policy in Russia.