Russia, the sick man of Europe

Public Interest, Wntr, 2005 by Nicholas Eberstadt

Russia's upswing in mortality was especially concentrated among its working-age population, and here the upsurge in death rates was utterly breathtaking. Over the three decades between 1970-71 and 2001, for example, every female cohort between the ages of 20 and 59 suffered at least a 30 percent increase in death rates; for men between the ages of 40 and 59, the corresponding figures uniformly reached, and some cases exceeded, 60 percent.

What accounted for this peacetime collapse in public health standards? To go by Russia's (admittedly less than perfect) cause-of-death statistics, nearly all of the increase in mortality rates for men--and absolutely all of the increase for women--can be traced to an explosion in deaths attributed to cardiovascular disease (CVD--heart disease plus strokes) and injuries. Between the mid 1960s and the end of the twentieth century, CVD mortality rates in Japan, Western Europe, and North America fell sharply. Russia, by contrast, suffered an explosion of cardiovascular death over the same period. Between 1965 and 2001, Russia's age-standardized death rate for CVD surged by 25 percent for women--and it soared by 65 percent for men. Today, CVD-related mortality in Russia is four times higher than in Ireland, five times higher than in Germany, and eight times higher than in France.

As for mortality attributed to injury--murder, suicide, traffic, poisoning, and other violent causes--age-adjusted levels for Russian men and women alike more than doubled between 1965 and 2001. Among contemporary societies at peace, Russia's level of violent deaths places the country practically in a category of its own. For men under 65 years of age, Russia's death rate from injury and poisoning is currently over four times as high as Finland's, the nation with the worst rate in the EU. Russia's violent death rate for men under 65 is nearly six times as high as Belgium's, over nine times as high as Israel's, and over a dozen times that of the United Kingdom. As is well known, men are more likely than women to die violent deaths--but in a gruesome crossover, these death rates for Russian women are now higher than for most western European men.

Russia's dismal health record can be explained in terms of a multiplicity of unfavorable social, behavioral, and policy tendencies: pervasive smoking; poor diets; sedentary life styles; increasing social atomization and anomie; the special economic stresses of Russia's "transition"; the unimpressive capabilities of the Soviet medical system and the limited coverage of its successor. At the end of the day, however, it is impossible to overlook the deadly contribution of the Russian love of vodka.

From the sixteenth century--when vodka was first introduced to a receptive public--up to the present day, Russians have always demonstrated a predilection to drink heavy spirits in astonishing excess--a fact remarked upon by visiting foreigners for centuries. Russia's thirst for hard liquor seems to have reached dizzying new heights in the late Soviet era, and then again in the early post-Communist era. By 1984, according to some estimates, the per capita level of alcohol intake in Russia was roughly three times as high as in 1913 (that pre-revolutionary era not exactly being remembered as a time of temperance). By the mid 1990s, Russian per capita alcohol intake may have even slightly surpassed its previous, Communist-era, zenith. In 1994, for example, the estimate of pure alcohol consumed by the population aged 15 and older amounted to 18.5 liters per capita annually--the equivalent of 125 cc. of vodka for everyone, every day.