Vyugovskaya E. V., Malkova E. E. Access barriers to health care: A comparative analysis of Russia’s urban and rural areas // The Russian Peasant Studies. 2026. V.11. №2. P. 191-207.

EDN: UHVRPS

Annotation

The article considers the subjective perception of healthcare accessibility in Russia, focusing on two key dimensions of inequality — type of settlement and age group, is based on the survey conducted in April 2025 as part of the annual monitoring “Social Position and Behavior of Population in Current Conditions” (N=1623, 18+, All-Russian sample, telephone survey) and supplemented with narratives from telephone interviews. The results show persistent territorial polarization: while 51% of residents in large cities (with population over 100,000) assess the quality of healthcare positively, only 40% do so in small towns and rural areas. In major urban centers, the primary access barrier is long wait, while in smaller settlements — a shortage of highly specialized specialists, geographic remoteness of medical institutions, and financial constraints associated with transportation costs. The authors pay special attention to the 55+ group with significantly lower estimates of healthcare quality compared to younger respondents (18–34-year-olds), which can be explained by the elders’ higher need for medical services and, as a result, more critical and frequent contact with the healthcare system. The most vulnerable group are residents of small settlements with family members in need of constant care: 62% negatively assess healthcare accessibility. Interview narratives confirm and illustrate these findings, highlighting such structural problems as staff shortage, logistical and financial difficulties for patients, especially those with limited mobility and the elderly.

Keywords

Accessibility of health care, territorial differences, rural health care, age groups, access barriers, shortage of specialists, remoteness of medical facilities, financial constraints.  

About the authors

Elena V. Vyugovskaya, Researcher, Field Research Laboratory, Center “Institute for Social Analysis and Forecasting”, Russian Presidential Academy of National Economy and Public Administration. Prechistenskaya Nab., 11, bldg. 1, Moscow, 119034, Russia.
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Evgeniya E. Malkova, Junior Researcher, Field Research Laboratory, Center “Institute for Social Analysis and Forecasting”, Russian Presidential Academy of National Economy and Public Administration. Prechistenskaya Nab., 11, bldg. 1, Moscow, 119034, Russia.
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Rogozin D.M., Vyugovskaya E.V. Autoethnography of the rural house in the Russian North // The Russian Peasant Studies. 2019. V.4. №1. P. 98-122.

DOI: 10.22394/2500-1809-2019-4-1-98-122

Annotation

The authors use the ethnographic weak description, i.e. the introspection of personal feelings and impressions, to turn personal reflections into a complete story supplemented with the fragments of narrators’ direct speech and linguistic means that allow to express emotions in words and phrases; thus, the authors reconstruct the concept of the Russian northern rural house and archetypical representations of the traditional rural lifestyle. The article is based on conversations and observations in Siniki, the village in the Ustyansky district of the Arkhangelsk Region, in which the structure of respondents’ houses, their appearances, history of construction and of families were discussed. The distinctive features of the old northern house are determined not only by its architectural forms, organization of everyday-life space (hut) and farm outbuildings but also by its owners’ biographies and destinies for the house reflects cultural identities, family values and memories, and intergenerational connections. The internal structure of the house determined primarily by natural conditions, economic needs and pragmatics of everyday life allows to identify four types of northern rural houses: a hut, a five-wall house, a no-name house and a duplex house. The latter two types represent the most recent housing characterized by functionality, comfort, compactness and the loss of the previously important wide economic multifunctional spaces. Today the new forms of management and organization of the living place and transformations of the rural house by the contemporary villagers (mainly the elderly) are the basis of the rural revival.

Keywords

autoethnography, participant observation, rural house, rural revival, weak description, rural lifestyle

About the authors

Dmitry М. Rogozin, PhD (Sociology), Head of the Laboratory for Social Research Methodology, Institute of Social Analysis and Forecasting, Russian Presidential Academy of National Economy and Public Administration. 119034, Moscow, nab. Prechistenskaya, 1.
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Elena V. Vyugovskaya, Researcher, Laboratory for Social Research Methodology, Institute of Social Analysis and Forecasting, Russian Presidential Academy of National Economy and Public Administration. 119034, Moscow, nab. Prechistenskaya, 1.
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