SOCIAL PATTERNING OF ILL HEALTH IN HELSINKI AND MOSCOW Results from a comparative survey in 1991 HANNELE PALOSUO, 1 * ANTTI UUTELA, 2 IRINA ZHURAVLEVA 3 and NINA LAKOMOVA 3 1 Department of Public Health, University of Helsinki, Box 41, 00014 University of Helsinki, Helsinki, Finland, 2 Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland and 3 Institute of Sociology, Russian Academy of Science, Krzhizhanovsky St. 24/35, Block 5, 117259 Moscow, Russia AbstractÐSocial inequalities in health are widely documented in the western countries including Fin- land, but research on Russia has so far been scarce. This article compares self-reported ill health of men and women and its social patterning in Helsinki and Moscow on the basis of a survey. The data (Helsinki N = 824, Moscow N = 545) were collected by mailed questionnaires in 1991. The Muscovites fared more poorly on perceived and psychological health, but the dierences in self-reported morbidity (prevalence of chronic illnesses) between the cities were quite small. The sex dierentials were greater in Moscow and Muscovite women had the poorest health of all. Education, family income and occupation had the most consistent associations with perceived health and morbidity among Helsinki women and the weakest among Muscovite women. With few exceptions, men of both cities fell between these groups. The dierences in health between the cities were smaller in groups with low education. Thus, the role of education as a protective resource was more pronounced in Helsinki, and more notably among women. The possibility of a dierent impact of social strati®cation on health in a transitional socialist society compared to a western market economy is discussed. # 1998 Elsevier Science Ltd. All rights reserved Key wordsÐRussia, Finland, sex dierences, strati®cation, inequality INTRODUCTION Social class dierentials in morbidity are repeatedly found in Finland, as in other west European countries (Kunst et al., 1992; Lahelma et al., 1993; Huuhka et al., 1996). Social dierences during the past two or three decades have somewhat dimin- ished in Finland and subjective health generally improved. At the same time sex dierences have been quite small, women reporting slightly more ill- ness (Lahelma and Karisto, 1993, Huuhka et al., 1996, Lahelma et al., 1997). Also social dierences in mortality persist in Finland as in other European countries (Valkonen et al., 1993; Valkonen, 1994; Kunst and Mackenbach, 1994a,b). In contrast to morbidity, social dierentials in mortality seem to have increased, although mortality itself has decreased (Valkonen et al., 1993). There have been indications of a somewhat greater inequality in both morbidity and mortality in Finland as com- pared to other Nordic countries (Karisto, 1984; Lahelma and Valkonen, 1990; Lahelma et al., 1993; Lahelma and Karisto, 1993; Kunst and Mackenbach, 1994a), even if economically and socially Finland had by the 1980s essentially attained the same welfare state characteristics as the other Scandinavian countries (Allardt, 1976; Alestalo et al., 1985). Health inequalities have been shown to exist also in Eastern Europe (Valkonen, 1987; Anderson and Silver, 1989; Wnuk-Lipinski and Illsley, 1990; Makara, 1994), although under socialism inequality was not an ideologically acceptable topic of study, notably in the Soviet Union (see e.g. Cooper and Schatzkin, 1982). However, there were also some Soviet reports on dierences in mortality by edu- cation (Virganskaja, 1990; K zdorovoj Rossii, 1994). In one study (Molchanova, 1990) especially mother's but also father's low level of education contributed to the risk of ill health of the family. Recent reports from Russia refer to a drastic impairment of the health of the population. The in- itially bene®cial development of the health of the Soviet population was reversed in the 1960s when mortality, especially of men in the working ages, started to increase (Blum and Monnier, 1989; Anderson and Silver, 1989, 1990; Mezentseva and Rimachevskaya, 1990). In the 1980's mortality tem- porarily went down, but in the 1990's the rates of cardiovascular mortality, mortality from diseases of Soc. Sci. Med. Vol. 46, No. 9, pp. 1121±1136, 1998 # 1998 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0277-9536/98 $19.00 + 0.00 PII: S0277-9536(97)10043-0 *Author for correspondence. 1121