Georgia
How Free-Market Ideologues Dismantled Health Care in Post-Soviet Georgia
No sooner was the Soviet state created at the end of 1922 than its authorities had to deal with a series of epidemics. Reports at the time indicated seven million cases of typhus and 2.8 million cases of tuberculosis or syphilis — not to mention cholera, malaria, smallpox, scarlet fever, and typhoid.
These plagues all had severe biological consequences. But the Soviet government also recognized that poverty was the cause of many illnesses. Its representatives believed that to treat and prevent disease, a new society must address social and biological ills in combination, and the collective should bear responsibility for health outcomes. Soviet authorities could see how modern industry was spreading illnesses in new ways. In Georgia, in the Russian Empire’s southern reaches, workers suffered appalling conditions in factories, while the main river in its biggest city, Tbilisi, was polluted from the dumping of toxic waste from manufacturing. Workers slept outside in mining towns during summer — and in the mines themselves during winter.
The first architect of Soviet health care and the commissariat of health was Nikolai Aleksandrovich Semashko. He, along with others, worked tirelessly to first halt the epidemics and then put in place a policy of preventive medicine. More broadly, health care was seen as something that could never be a source of revenue but a social necessity.
This preventive Semashko model was implemented through a multitiered health care system that included a referral system of service providers — ranging from district physicians providing primary care to regional and federal hospitals providing specialized care. It also emphasized occupational diseases, with factories integrated into the health care system. Workers received regular compulsory checks in the factory, and their health information was also sent to occupational illness specialists, who tracked which occupations caused which diseases. At every level, there was access to health care, which meant diseases, infections, cancer, and so on could be caught early.
Physical therapy, exercise, and diet were given notable emphasis, while diagnostic lab and X-ray examinations received less attention. The state also built a large network of short-stay rest homes for people who needed a break from work, as well as spas and similar resorts for short stays. The focus on facilities and stays in hospitals, sanatoriums, and rest homes was based on giving a lot of time and space for recovery — and indeed, the presupposition that the private home might not provide all these things.
The Semashko model, built a full century ago in a war-ravaged Soviet Union, is surely not the last word on community health care models. But what’s not debatable is the need for a holistic approach that includes social determinants, an emphasis on prevention, and collective responsibility without regard to the need to make money off health care. The Semashko model enabled the integration of activities from other medical services and provided an economically efficient solution in the Soviet Union, especially in periods when it was fully funded, a low-cost, universal health care coverage that was made available to everyone at no cost. The results of this approach were a significant increase in life expectancy, a decrease in mortality, a decrease in morbidity, an increase in health care workers per population, an increase in hospital beds, an increase in the utilization of health care, the establishment of labor medicine, and the prevention of occupational diseases.
So, what happened in Georgia after the demise of the Soviet Union, when the country gained its independence? For all the hopes raised in this period, the results for health care were dismal.
Within just a few years, Georgia experienced a drop to almost zero financial support for public and animal health infrastructure, limiting its ability to control illness. If in 1990, the equivalent of $130 a year was spent on health care per person, in 1994 this had fallen to $1. Almost 90 percent of health care costs had to be covered by citizens out of pocket. Instead of the Semashko model’s integrated view of social determinants, free and universal health care delivery, and collective responsibility, the Georgian government got a revolving door of experts operating under sets of policies known as the “Washington Consensus” at a time when people in Georgia needed health care the most due to declining social and economic conditions and disease outbreaks. Individual responsibility took the place of collective responsibility, and the social determinants of health were separated from health care.
Many general indicators show the rate of decline. As of 2019, the number of hospital beds in Georgia stood at only 43 percent of 1990 levels. While this number is today again growing, at the current rate it will only return to Soviet-era levels in the year 2045. The average number of qualified health care workers by population — which increased from 26 per 10,000 in 1940 to 82.4 in 1965 and 115 in the early 1980s — would fall by half over the course of the 1990s. This isn’t just about provision, but the outcomes. The post-Soviet decades have seen a 1.5 percent increase in the average death rate and a 2.3-fold increase in morbidity levels. In 2017–19, the rate of tuberculosis morbidity was 1.98 times higher than the rate in 1988–99.
Not only did the health care system suffer, but many social determinants were made worse by the lack of electricity, hot water, heating, access to food, and the use of dangerous heating substitutes. This led to outbreaks of diseases like tuberculosis, diphtheria, hepatitis, and so on.
In Georgia, the neoliberal state now bore only limited responsibility for communicable diseases, while noncommunicable diseases were left to the responsibility of individuals. The assumption that health care should not be profitable was replaced by a total commitment to profit-oriented health care and privatization. This ideology was neatly summed up by Kakha Bendukidze, an oligarch who made his millions in Russia and a major architect of Georgian neoliberalism in his 2000s roles in the finance and economic reforms ministries. For him, “To ask the government for help is like trusting a drunk to do surgery on your brain.”
This offloading of government responsibilities has had severe consequences. Hospital care has been replaced with an emphasis on outpatient care, which has only increased the burden on women’s unpaid care work; sanatoriums and spas have either been left to rot, given to refugees from separatist Abkhazia, as temporary housing, or else sold to corporations, making hotels completely out of reach for most people. Universal free access was replaced by out-of-pocket expenses for most, with limited subsidies to “targeted” groups. On top of that, the World Bank “reformers” exported the terms “optimization” and “rationalization,” which refer to reducing the health care infrastructure to fit better with a free-market system.
Georgia was one of the first countries in the former Soviet Union to receive technical and financial support from Western donors for health sector reforms and other infrastructure and civil-society development programs. The international organizations proposed an immediate transition from a planned economy to a market economy. Yet, due to the nature of public health services, where pandemics are always a possibility, liberalizing mechanisms were moderated in order to maintain the government’s role in public health. Uncontrolled diseases like tuberculosis, HIV, and other communicable diseases could put the country, region, and even the wider world at risk. Thus, the World Bank and the World Health Organization collaborated to reform the Soviet Georgian health system into a market one with little room for public health. There are many reasons for these undoubtedly negative trends, but one of the main ones is the almost ninefold fall in the number of preventive examinations, which ensure the detection of diseases at an early stage and relatively easy treatment. Going to the doctor is now associated with high costs and navigating a complex and predatory web of health care providers.
Most health workers also lost out from the changes over the past three decades, and real income decreased. Before 1990, there were 2.2-2.3 nurses for every doctor, and accordingly, 30 percent of the medical staff were doctors, and 70 percent were nurses and other specialists with secondary qualifications. As of 2019, there are an average of 0.6 nurses per doctor. This would demand that the number of nurses be increased by at least 3.6 times to restore the optimal proportion of medical staff with high- and mid-level qualifications.
The reason for this problem is very simple: the education system also works on market principles. Doctoral diplomas are in demand in society, and the education system supplies the appropriate products to the “market.” However, despite the fact that training doctors alone does not ensure the full functioning of the health care system, there is no market demand for a nursing degree. On top of the lack of demand, the worsening economic conditions drive many nurses to migrate to the European Union or elsewhere; some are even recruited by foreign agencies, which further destabilizes Georgian health care and puts it at risk.
In a recent study, “Social Consequences of Privatization of Healthcare,” we divided the government approaches since independence into three stages: The first stage is “Toying with neoliberalism,” where the international experts were in the driver’s seat since the governments had no knowledge of how markets worked and put their fate in the hands of international financial organizations.
This was followed by a second phase, militant neoliberalism, with the government of Mikheil Saakashvili taking the lead and frequently going above and beyond international recommendations and directives for austerity and liberalization. The current Georgian government, which we have categorized as “neoliberal without conviction” (the third stage) continued the legacy of total deregulation albeit without having committed ideologues within its ranks. It came to power and won people’s support because it promised single-payer insurance.
In 2013, it implemented universal insurance, but this was quickly reformed to targeted insurance, as the costs of financing an unregulated health care market in which virtually all hospitals and clinics are private were deemed too high for the state. Last year, the government also implemented a minimum wage for health care workers — the only minimum wage that exists in the whole country — and started to discuss the need for public clinics to “compete with private ones.” Even if this is a huge step compared to early 2000s militant neoliberalism, it’s a drop in the ocean considering the needs of the population.
The future of the few remaining public hospitals remains in jeopardy. In the 1990s, during the first stage of collapse, Georgians would not go to the neighborhood outpatient center (polyclinic) for preventive health care because they did not have the money to do so — they only went to the hospital in an emergency. Then as privatization increased, preventive health care was considered unprofitable and was thus sidelined, as it remains to this day. Without the guidance of the polyclinic, the individual Georgian is now left to confront the oversaturated clinic health care system, which profits from their sickness and relies on asymmetrical information.
While most outside observers marvel how doctors and nurses continued to work in the hospitals without pay during the worst times in the 1990s when there was barely any power and gas, many of these selfless and devoted health workers were often “repaid” with being laid off and fired. When the lights came back on, their hospitals closed. Just when the people of Georgia needed help the most after experiencing the shock of the collapse of their social structure, they were subjected to unimaginable austerity imposed by international organizations’ experts and fanatical domestic reformers. The current government has offered only little relief.
Georgia
A Georgia Wildlife Haven Forged by Fire and Peat Nears UNESCO Recognition – Inside Climate News
FOLKSTON, Ga.—The world’s smallest heron hops from blade to blade in a patch of tall grass, testing its footing above the dark water as it searches for an evening meal.
“This was already worth the trip out today,” Joshua Howard said earlier this month from a gray flat-bottomed tour boat just a few yards away. The tiny creatures, called Least Bitterns, are secretive birds, not easy to spot.
With one quick movement of its neck, which seems to take up most of its body, the tiny heron plunges into the water and comes up with a fish. Howard and his guide continue down the swamp between walls of Spanish moss-adorned cypress trees and alligators, hoping to find more of the birds and wildlife that call the Okefenokee National Wildlife Refuge home.
By July, the vast swamp Howard has visited since childhood and still tries to reach at least once a week could be internationally recognized as a United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage Site.
The Okefenokee, on the Florida border in southeast Georgia, hosts the largest blackwater swamp in North America, a slow-moving wilderness roughly five times the size of Atlanta. It began forming hundreds of thousands of years ago, as the Atlantic Ocean retreated and left behind Trail Ridge, a long, low fossilized beach dune, and a shallow depression that trapped water between the ridge and higher uplands to the west.
The Okefenokee is a blackwater swamp, meaning its dark waters are stained by tannins released from decaying vegetation and cypress trees. Beneath the dense canopy, the water takes on the color of steeped tea, reflecting cypress trunks and drifting lily pads like dark glass.
The refuge was established in 1937 by President Franklin D. Roosevelt, following a series of visits from Cornell biologist Francis Harper. Harper had come to admire both the swamp’s landscape and its people, but it was his wife—who had once tutored Roosevelt’s children—who ultimately helped push the president toward protecting the land.
The refuge’s latest conservation effort now depends partly on another layer of federal and international politics. The Okefenokee’s UNESCO nomination comes amid renewed uncertainty over the United States’ relationship with the organization.
Earlier this year, President Donald Trump moved to again withdraw the United States from UNESCO, though the withdrawal would not take effect until December—months after a decision on the Okefenokee nomination is expected. The United States also remains part of the World Heritage Convention, the international agreement governing World Heritage Sites.
In addition, World Heritage designations have continued in the United States during previous periods when the country was formally withdrawn from UNESCO, including under both Trump and President Ronald Reagan. The Okefenokee effort has also received support from prominent Republicans, including Secretary of State Marco Rubio and former Georgia Gov. Sonny Perdue, who served as Trump’s agriculture secretary.
Still, regardless of shifting politics around UNESCO, the landscape at the center of the nomination remains largely unchanged.
Today, the Okefenokee stands as a protected wilderness of blackwater channels, peat and dense wetland forests, supporting a rich array of wildlife and plant life.
A great blue heron and a barred owl perch among Spanish moss in the Okefenokee National Wildlife Refuge. Credit: Ryan Krugman/Inside Climate News
As Howard floated through the swamp at the refuge’s eastern entrance for about an hour and a half, he saw nearly 200 alligators, owl fledglings, hawks, herons and more. What he somewhat incredulously called an “above average” number of encounters was partly driven by drought conditions that pushed animals toward remaining water, though abundant wildlife sightings are far from unusual.
Across the swamp, an estimated 15,000 alligators inhabit the blackwater alongside almost 250 bird and 64 reptile species. Black bears and bobcats move through the uplands, and there are rumors of Florida panthers wandering the refuge. It is also a stronghold for endangered species, including red-cockaded woodpeckers, wood storks and eastern indigo snakes.
To fully experience the Okefenokee, visitors often paddle deep into the backcountry by canoe or kayak, traveling through areas inaccessible to motorboats. Along the way, they pass open prairies filled with lilies, wildflowers and carnivorous plants, including the Okefenokee giant pitcher plant, which can grow more than four feet tall and traps insects inside its tubular leaves.
Some visitors spend nights on raised wooden platforms scattered throughout the swamp, with multi-day trips carrying paddlers far into the blackwater wilderness. Yet even with those routes, only about 5 percent of the Okefenokee is currently accessible to humans.
Despite being one of the best-preserved wetlands in North America, and especially on the eastern seaboard, the Okefenokee has repeatedly faced pressure from industry and development. Before it became a wildlife refuge and federally designated wilderness area nearly a century ago, logging companies cut through vast cypress forests, disrupting habitats and the natural systems that shaped the swamp.
Later, the Suwanee Canal Company attempted to drain the Okefenokee to clear the way for development. The company planned to carve a canal through Trail Ridge and connect the swamp to the Suwannee River, but water repeatedly flowed back into the basin. The project ultimately collapsed, driving the company into bankruptcy before the canal could be completed.
More recently, the Okefenokee has faced renewed pressure from a high-profile mining dispute near Trail Ridge and continued development across the Florida border. Yet the swamp’s beauty and biodiversity continue to draw roughly 800,000 visitors each year—and now the attention of UNESCO.
The Okefenokee was first placed on the United States’ tentative UNESCO World Heritage list in 1981, but the nomination stalled for decades. In 2023, the Department of the Interior authorized work on a formal nomination, a push driven in large part by advocates including Kim Bednarek, executive director of Okefenokee Swamp Park.
The nonprofit, which runs tours and educational programs near and in the refuge, helped lead the campaign and raise money for the years-long nomination process. To qualify, researchers and advocates had to demonstrate the swamp’s “outstanding universal value,” the central standard for World Heritage designation.
The nomination was formally submitted in January 2025. Later that year, scientists with the International Union for Conservation of Nature, which advises UNESCO on natural sites, visited the swamp as part of the evaluation process. Advocates are now awaiting a recommendation from the organization ahead of a final decision expected this July at the UNESCO World Heritage Committee meeting in Busan, South Korea.
UNESCO’s standard of “outstanding universal value” is reserved for places considered significant not just to one country, but to humanity. Advocates and scientists argue the Okefenokee qualifies because of its biodiversity and the remarkable condition of its peatlands, which have remained largely intact for thousands of years and are a natural carbon sink.
Peatlands form when organic material builds up faster than it decomposes. In the Okefenokee, still blackwater, low oxygen levels and acidic conditions—created largely by tannins from cypress trees—slow decay enough for layers of plant matter to accumulate over thousands of years.
“We do not have a similar peatland in the world in the subtropics,” said Hans Joosten, one of the world’s leading peatland experts. According to Joosten, the swamp’s location—sandwiched between the Gulf of Mexico and the Atlantic—provides the humidity and rainfall needed to sustain this rare subtropical peatland.
An inch of peat can take more than 50 years to form. In parts of the Okefenokee, those layers reach more than 15 feet deep, storing an estimated 124 million tons of carbon and forming one of North America’s most significant peat systems.
Many of the estimated 15,000 Alligators in the Okefenokee are tagged as part of research initiatives. Credit: Ryan Krugman
The swamp’s Muscogee Creek name, often translated as “land of the trembling earth,” reflects what lies beneath its surface. Deep peat can shift, swell and occasionally rise toward the top, where visitors may see methane bubbles break through the blackwater or floating mats of peat drifting at the surface. Those peat mats can become platforms for new plant growth, reshaping the swamp as they move and settle.
The biodiversity hotspot is supported by another cycle, one much faster than peat formation. The swamp is frequently reshaped and renewed through natural wildfires. The fires clear dense vegetation and invasive species, return nutrients to the soil, and maintain the open conditions needed for fire-dependent ecosystems like the longleaf pine, one of the most endangered forest types in North America.
“To be put on the same list as places like the Grand Canyon and Yellowstone would just be amazing,” Howard said with a Southern drawl as he floated along the remnants of the Suwannee Canal.
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Howard, tall and broad with silvering hair and an easy smile, had arrived at the swamp after a long day working as a school administrator in Charlton County. “You want to know why I think this place deserves to be on that list?” he asked. “Because when I got here this evening, I was stressed and now I am not.”
Howard has been coming to the swamp for almost 50 years and has spent the last seven serving as president of Friends of the Okefenokee National Wildlife Refuge, a nonprofit that helps raise money for its preservation. While the group is not directly involved in the UNESCO bid, Howard said its members strongly support the designation.
If approved in July, the designation would make the Okefenokee Georgia’s first UNESCO World Heritage Site and the first national wildlife refuge in the country to receive the status.
For Bednarek, the recognition would do more than honor the swamp’s ecology. It could fundamentally change how the Okefenokee is seen internationally. National wildlife refuges typically operate with far less tourism, funding and global visibility than national parks.
“They have this iconic brand that refuges don’t,” Bednarek said. UNESCO World Heritage status, she said, functions differently. “It’s a global brand that people travel far and wide to see.”
For now, though, the Okefenokee remains what it has long been: a slow-moving wilderness of blackwater, peat and cypress.
As dusk settled over the swamp, Howard’s guide cut the boat motor and the sounds of insects and distant birds filled the blackwater again. Methane bubbles continued rising quietly to the surface, signs of the trembling earth beneath the water.
In July, delegates in South Korea will decide whether the Okefenokee receives World Heritage status. But the swamp itself will keep moving at its own pace.
About This Story
Perhaps you noticed: This story, like all the news we publish, is free to read. That’s because Inside Climate News is a 501c3 nonprofit organization. We do not charge a subscription fee, lock our news behind a paywall, or clutter our website with ads. We make our news on climate and the environment freely available to you and anyone who wants it.
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Two of us launched ICN in 2007. Six years later we earned a Pulitzer Prize for National Reporting, and now we run the oldest and largest dedicated climate newsroom in the nation. We tell the story in all its complexity. We hold polluters accountable. We expose environmental injustice. We debunk misinformation. We scrutinize solutions and inspire action.
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Ryan Krugman
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Ryan Krugman is a recent graduate of Columbia University’s Climate School focusing on climate change reporting and communications. He also holds a Bachelor’s degree from St. Lawrence University where he studied Environmental Science and Sociology. As a former Inside Climate News fellow, he is now reporting on climate and environmental issues in New England and Georgia.
Live updates from Athens, Georgia as the Bulldogs take on Liberty in game two of the Athens Regional.
The Georgia Bulldogs are back in action this afternoon as they are set to take on the Liberty Flames for game two of the Athens regional. The Dawgs are coming off a dominant victory over Long Island =, in a game that concluded earlier this morning following a rain delay.
With a win, the Bulldogs will advance to face the winner of a matchup between Liberty and the victor of Boston College and Long Island. First pitch for that game is scheduled to take place this Sunday at 5 p.m. As action continues in Athens, stay tuned with Bulldogs on SI for more updates from today’s game.
Georgia Bulldogs vs Liberty Flames Live Updates:
Editor’s Note**: This article will be updated periodically as action continues throughout today’s game
Top of the First (UGA at Bat)
- Tre Phelps singles to left center field for his first hit of the afternoon.
- Daniel Jackson homers to right center field. Georgia leads 2-0.
- Rylan Lujo flies out to right field.
- Brennan Hudson is walked on a 3-1 count.
- Kenny Ishikawa flies out to right field.
- Ryan Wynn grounds out to second base to retire the side. Georgia leads 2-0.
Bottom of the First (Liberty at Bat)
- Tanner Marsh singles to the pitcher.
- Riley DeCandido strikes out swinging.
- Tanner Marsh steals second to put a runner in scoring position.
- Jordan Jaffe singles to right center field. Tanner Marsh scores. Georgia leads 2-1.
- Jaxon Sorenson is walked on a full count. Jaffe advances to second.
- Nick Barone reaches first on a fielder’s choice. Sorenson is tagged out at second. Jaffe advances to third and scores on a throwing error. Game is tied 2-2.
- Nick Barone is tagged out trying to steal second to retire the side. Game is tied 2-2.
Top of the Second (UGA at Bat)
- Jack Arcamone flies out to right field.
- Kolby Branch is walked on a full count.
- Ryan Black fouled out to the catcher.
- Tre Phelps is walked on a full count. Branch advances to second.
- Daniel Jackson is walked. Tre Phelps advances to second. Kolby Branch advances.
- Rylan Lujo grounds out to third to retire the side. Game is tied 2-2.
Bottom of the Second (Liberty at Bat)
- Easton Swofford grounds out to shortstop.
- Landon Scilley is walked on a 3-1 count.
- Kyle Hvidsten is walked on a 3-0 count. Scilley advances to second.
- Josh Campos lines out to right field.
- Tanner Marsh strikes out swinging to retire the side. Game is tied 2-2.
Top of the Third (UGA at Bat)
- Brennan Hudson flies out to right field.
- Kenny Ishikawa homers to right field. Georgia leads 3-2.
- Ryan Wynn homers to center field. Georgia leads 4-2.
- Nick Arcamone singles to right field.
- Kolby Branch pops up to shortstop.
- Ryan Black flies out to right field.
Bottom of the Third (Liberty at Bat)
- Riley DeCandido flies out to left field
- Jordan Jaffe grounds out to the pitcher.
- Jaxon Sorenson flies out to center field to retire the side. Georgia leads 4-2.
Top of the Fourth (UGA at Bat)
- Tre Phelps grounds out to shortstop.
- Daniel Jackson strikes out swinging on a full count.
- Rylan Lujo singles to left field.
- Brennan Hudson singles through the right side. Lujo advances to second.
- Kenny Ishikawa is walked on a full count. Hudson advances to second, Lujo advances to third.
- Ryan Wynn reaches first on a fielder’s choice. Ishikawa is tagged out at second to retire the side. Georgia leads 4-2.
Bottom of the Fourth (Liberty at Bat)
- Nick Barone grounds out to shortstop.
- Easton Swofford strikes out swinging.
- Landon Scilley grounds out to shortstop to retire the side. Georgia leads 4-2.
Top of the Fifth (UGA at Bat)
- Nick Arcamone strikes out swinging.
- Kolby Branch strikes out looking on a 1-2 count.
- Ryan Black singles to first base.
- Tre Phelps grounds out to third base to retire the side. Georgia leads 4-2.
Bottom of the Fifth (Liberty at Bat)
Top of the Sixth (UGA at Bat)
Bottom of the Sixth (Liberty at Bat)
Top of the Seventh (UGA at Bat)
Bottom of the Seventh (Liberty at Bat)
Top of the Eighth (UGA at Bat)
Bottom of the Eighth (Liberty at Bat)
Top of the Ninth (UGA at Bat)
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JACKSONVILLE, Fla. – Storm activity is expected to fire up around midday, starting inland from the Gulf sea breeze. From there, storms will track eastward at 20-25 mph, and that faster movement is actually good news for flooding concerns.
Some minor, temporary flooding is possible through tonight, especially in low-lying areas and spots that typically flood during heavy rain events.
The best chances for stronger storms and heavier rainfall will be north and near I-10 during the afternoon and evening hours.
The Weather Prediction Center has placed roughly the northern two-thirds of the area under a marginal risk of excessive rainfall.
What to expect through the night
Rain chances will stay elevated into the evening but should taper off after midnight. However, inland Northeast Florida could see a late round of showers or storms develop due to enhanced west coast sea breeze.
Gusty winds and frequent lightning can’t be ruled out. Always have your indoor plan ready to go for shelter access.
Cooler temperatures, patchy fog round out the forecast
High temperatures will run below average, topping out in the mid-to-upper 80s. Overnight lows will range from the upper 60s to near 70 degrees across inland Southeast Georgia, with mid-70s expected closer to the Atlantic coast.
Patchy fog is expected early this morning and again Sunday morning. Brief periods of dense fog are possible, so drivers should use caution on the roads during those early morning hours.
Copyright 2026 by WJXT News4JAX – All rights reserved.
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