A multilevel city health profile of Moscow.

This report describes a multilevel city-wide profile of physical health in Moscow, examining individual and urban level factors. Objectives of the paper were to: (1) identify macro and micro risk factors for poor physical health in Moscow;(2) assess the effect of two dimensions of micro determinants--personal health habits and social connectivity, such as social cohesion, social support, and social networks; (3) examine the hypothesis that relative social inequality is a significant structural condition at the community level which influences the physical health of individuals, as a main and as a joint effect with psychosocial behaviors. A random sample of Moscow adults, with household telephones (N = 2000), was collected 17-19 September, 1991, and had a completed interview rate of 81.8%. The questionnaire replicated items from the California Alameda Study and the US Health Interview Survey. Respondents' urban area of residence was linked to macro measures of inequality derived from the Moscow census. This report describes the baseline survey of a prospective study design. Results of this study demonstrate that the social context in a community affects the health of people living there independently from the effects of individual health lifestyle or social connectivity. The structural conditions in Moscow which significantly increased the vulnerability of specific social groups for poor physical health were identified in a hierarchical linear regression: relative social inequality in the form of income inequality; urban area poverty risks; and mean level of alcohol consumption in urban areas. The psychosocial conditions included poor diet, lack of social cohesion and social support, involvement in formal social networks in the form of professional groups. A multilevel theoretical perspective is important for defining the targets of preventive health policy by identifying the structural conditions which increase the health disadvantage of some social groups. Further research is needed in refining the concept of relative social inequality, as well as investigating whether psychosocial factors, such as social cohesion, are mediating links between sick societies and their sick citizens.