The distribution of factors, such as social inequality, changes at the community level, and may take distinctive forms in various communities. This has health consequences for the social groups and individuals within communities. Since it is a prime objective of the social science perspective in medicine or public health to assess the context in which macro and micro units change, greater insight into causal processes are possible when including the complex nesting of individuals in groups, within neighborhoods, within cities or rural environments, and within societies and nations (Rose, 1995). Social inequality is included in the Moscow health profile as a community context which has important health consequences for individuals. Social inequality may be altered by public policy and modifying such community conditions has also been effective in changing individual health, without “blaming the victim” (McKeehan, 1995).

This is the first multilevel study of urban health in Russia. Multilevel studies have not been published previously because most health research in the Soviet and post-Soviet period concentrated either on macro or micro level data. However, social contexts, geographic and environmental variables in Russia have been implicated in differentially affecting psychosocial processes which impact on individuals’ health.