In sum, Moscow, appears to have an overall health profile distinct from the Russian Federation mean. Although the wealthiest region, it is by no means the healthiest. The infant mortality rate, a traditionally sensitive indicator of deprivation, was higher in Moscow than in other regions; birth and death ratios are substantially greater than in the Russian Federation; congenital anomalies at birth were greater; the highest life expectancy in the Russian Federation dropped to Russia’s mean after macro economic reforms began in 1992; chronic disease morbidity is higher than the mean for Russia, especially for cardiovascular diseases; and almost a decade after Perestroika collapsed, post-Soviet Moscow is the STD/HIV capital of Russia. Between 1991 – 1997, syphilis increased by a factor of ten; there were 16,986 new cases registered.