Russia, the sick man of Europe

Public Interest, Wntr, 2005 by Nicholas Eberstadt

The "negative momentum" apparent in Russia's modern-day mortality trends makes the objective of broad, sustained improvements in public health especially unlikely in the years ahead. And this analysis, it is worth noting, has yet to take into account the possibility of additional new health troubles on the horizon. Yet such problems are, quite plainly, gathering today. Foremost among them may be Russia's still-mounting epidemic of HIV/AIDS. As we have already seen, curable STIs are now rampant in Russia--and generally speaking, epidemic levels of curable STIs seem to serve as a leading indicator for the spread of HIV.

Russian authorities have registered a cumulative total of just under 300,000 cases of HIV, while the U.N. Joint Programme on HIV/AIDS (UNAIDS) estimates that over 800,000 Russians were living with HIV as of 2003 (with an upper estimate of 1.4 million). The U.S. National Intelligence Council (NIC) suggests that the true number as of 2002 could have been as high as 2 million. If the UNAIDS central estimate were accurate, Russia's adult HIV prevalence rate would be over 2 percent; by the NIC's 2002 estimates, it could already have been as high as 2.5 percent in 2002. The future course of Russia's HIV epidemic is likewise clouded in uncertainty. Clearly, though, HIV has the potential to cancel any prospective health progress in Russia over the coming generation.

Progress is, of course, to be prayed for--and under the right circumstances, some progress may be achieved. But major reductions in Russia's awful toll of excess mortality do not look to be in the cards any time soon.

The tightening demographic straitjacket

Russia's demographic trends have unambiguously negative implications for Russian development and security. The ramifications are manifold and far-reaching, some of them complex--but the basic outlines of the more important considerations can be briefly and simply adduced.

Russia's lingering health and mortality crisis promises to be a brake on rapid economic development. In the modern era, the wealth of nations is represented, increasingly, in human rather than natural resources--and the richer the country, the more pronounced the tendency for "human capital" to overshadow or replace physical capital in the production process. Human health figures importantly in the overall composition of human capital, and thus the correspondence between human health and economic productivity has been fairly robust. In recent years, to judge by U.N. and World Bank data, an additional year of male life expectancy at birth has been associated with an increment of GNP per capita of about 8 percent.

The relationship between health and economic productivity, to be sure, is multidimensional and simultaneous--improved wealth also makes for better health, and does so through a variety of avenues. But it is difficult to see how Russia can expect, in some imagined future, to maintain a western standard of living if its work force suffers from a third-world schedule of survival--or worse.