The roots of the health crisis in the Russian Federation are not entirely, or even primarily, in the state of the health care system. High levels of mortality and morbidity, particularly among working-age males, reflect many other factors that transcend the health system as they are related to the aging of the population, growing urbanization, lifestyles and risky behaviours. Spending more money on healthcare, while necessary, will not be sufficient to improve Russia's health outcomes on a sustainable basis. A multisectoral strategy is required, coupled with increased health expenditures and structural reforms to improve the efficiency and effectiveness of healthcare organization, financing and service delivery. However, it should be clear that improving health outcomes is a complex, medium- to long-term undertaking that should be addressed forcefully by the government at the federal and regional levels as a priority social objective.