Life Expectancy In Russia Research Articles

Alcohol and Russian mortality: a continuing crisis

Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007, male life expectancy at birth was 61 years, while for females it was 74 years. Alcohol is implicated particularly in deaths among working-age men. To review the current state of knowledge about the contribution of alcohol to the continuing very high mortality seen among Russian adults Conservative estimates attribute 31-43% of deaths among working-age men to alcohol. This latter estimate would imply a minimum of 170 000 excess deaths due to hazardous alcohol consumption in Russia per year. Men drink appreciably more than women in Russia. Hazardous drinking is most prevalent among people with low levels of education and those who are economically disadvantaged, partly because some of the available sources of ethanol are very cheap and easy to obtain. The best estimates available suggest that per capita consumption among adults is 15-18 litres of pure ethanol per year. However, reliable estimation of the total volume of alcohol consumed per capita in Russia is very difficult because of the diversity of sources of ethanol that are available, for many of which data do not exist. These include both illegal spirits, as well as legal non-beverage alcohols (such as medicinal tinctures). In 2006 regulations were introduced aimed at reducing the production and sale of non-beverage alcohols that are commonly drunk. These appear to have been only partially successful. There is convincing evidence that alcohol plays an important role in explaining high mortality in Russia, in particular among working age men. However, there remain important uncertainties about the precise scale of the problem and about the health effects of the distinctive pattern of alcohol consumption that is prevalent in Russia today. While there is a need for further research, enough is known to justify the development of a comprehensive inter-sectoral alcohol control strategy. The recent fall in life expectancy in Russia should give a renewed urgency to attempts to move the policy agenda forward.

Commentary: Russia's mortality crisis, alcohol and social transformation

After the fall of communism in Eastern Europe in the late 1980s and early 1990s, it was generally believed that the poor state of public health in this region would improve. Instead, in many countries it became even worse. In Russia for instance, life expectancy fell by an unprecedented 6 years between 1987 and 1994. In relation to this, more than 10 years ago, Leon and his colleagues suggested that a very high level of alcohol consumption together with a habit of drinking in binges was resulting in circulatory deaths among middle aged people and accordingly, was the most important factor underpinning the dramatic fall in life expectancy in Russia. Leon et al.’s work has subsequently become a classic in the field. They were among the first to suggest that the sharply increasing mortality rates were not just an artefact resulting from changes in classification practices or inadequate population estimates. Instead, they pioneered the idea that binge drinking might be an important determinant of circulatory death. It is against this background that another timely, and important addition to the literature has been produced, which again suggests that alcohol is the main contributor to the post-communist public health crisis in Russia. The so-called ‘alcohol hypothesis’ has not gone unchallenged. The social and economic changes that occurred during the early 1990s were huge and for a majority of Russians life certainly changed for the worse. The introduction of ‘shock therapy’ in 1992 was followed by falling real wages, mass unemployment, hyper inflation with many Russians becoming impoverished. This suggests that if we want to gain a full understanding of the public health crisis and people’s behaviours during this period, we have to look at the wider social, economic and political context. By doing this, it does not mean that the role of alcohol is in any way diminished, rather, it means that sociological factors are important for the explanation of both health and lifestyles. Making use of detailed data from across time, Zaridze et al.’s article not only contributes to our understanding of the aetiology of the Russian mortality crisis, but importantly, it also highlights the argument that social factors are vital for our understanding when it comes to alcohol and alcohol-related problems. For example, earlier research has suggested that there may be a close connection between economic factors and alcohol consumption in Russia as heavy alcohol consumption is particularly common among men who are likely to have lost out during the transition, while poor men in Russia are simultaneously more likely to binge drink and abstain from alcohol than are those men in a better economic position. Russia is a ‘wet’ drinking culture and the answer to the question why people drink goes deep both into its history and to the present social transition. The need for more ‘joinedup’ research that links the epidemiological with the sociological also emanates from the disadvantages specific to each approach i.e. the use of indirect measures of alcohol behaviours, such as deaths from liver cirrhosis, alcohol poisoning, heart disease and, perhaps, a lack of social context in epidemiological studies; while the sociological or survey approach can often suffer from problems of non-response, underreporting and or difficulties arising from using a cross-sectional design. Working in conjunction with one another, however, these approaches can help us to gain not only a better understanding of the public health crisis in Russia, but also of health and health related behaviours in general.

What targets for international development policies are appropriate for improving health in Russia?

The OECD countries and the United Nations have agreed to co-ordinate their work around a series of International Development Targets. The targets for health are based on improvements in infant, child and maternal mortality. Progress towards these goals will be used to assess the effectiveness of development policies. To assess the potential impact of achievement of the International Development Targets on health in Russia, and to identify possible alternatives that may be more relevant to transition countries. The study covered the population of the Russian Federation from 1995-99. The effects of reducing infant, child and maternal mortality on Russian life expectancy at birth were modelled using construction of life tables. Three scenarios were modelled, reducing rates to those of the best performing regions in Russia, those required to achieve the International Development Targets and current UK rates. The results were compared with the effect on life expectancy at birth of policies to reduce adult mortality in different ways. Achieving the International Development Targets for infant, child and maternal mortality (66.7 and 75% reductions) will contribute very little to improving life expectancy in Russia (0.96 years). In contrast, even a 20% reduction in adult mortality would give rise to an increase in male life expectancy at birth of 1.86 years. Targets for health improvement in transition countries such as Russia should take account of adult mortality as well as the indicators contained in the International Development Targets.

Family effects on self-reported health among Russian wives and husbands

Alcohol abuse and a transition to the market economy are often blamed for high mortality and low life expectancy in Russia, but little is known about proximate influences on individual health. This study estimates family influences on the self-reported health of Russian wives and husbands. Predicting gender differences in the determinants of health status, hypotheses are presented for the effects on spouses’ self-reported health of five family characteristics: economic status, household division of labor, family decision-making, presence of young children, and housing conditions. Controls are included for age, education, sensitivity, alcohol use, job-related time, and urban–rural location. Data from a 1996 sample of couples ( n=925) from Moscow and two rural regions of Russia are analyzed using logistic regression. The findings provide mixed support for the hypotheses, though they do show the important role of family characteristics on spouses’ health. Family economic standing is important to both spouses’ self-reported health, though young children in the home is not. Family decision-making does influence spouses’ health: when Russian wives are the primary decision makers in the family, their own health suffers, though their husbands’ health is better. And support is found for the combined effects of job-related time and household labor but only for wives’ health. When wife's household labor is low, the probability of her having poor health increases, the more time she devotes to her job. However, when she does substantially more domestic labor than her husband, her job-related time has the opposite effect, reducing the chances of poor health, the more time she spends on job activities. This study is important both in helping to account for poor health of Russians during the current economic and social transition and in identifying aspects of family life that affect men's and women's health cross-nationally.

Changes in life expectancy in Russia in the mid-1990s

Between 1987 and 1994, life expectancy in Russia declined substantially. Between 1994 and 1998, this trend reversed, and mortality rates returned to those of the early 1980s. Although the decline in life expectancy has been examined previously, much less is known about the subsequent improvement in mortality rates. We used recently published cause-specific mortality data up to 1998 to clarify this issue. Changes in cause-specific death rates at ages 15-74 years were examined. Rates for 1998 were compared with those for 1994 (the year of lowest life expectancy) and for 1991 (the year the Soviet Union broke up). Death rates among children fell steadily throughout the 1990s, and those in elderly people changed little. The reduction in mortality since 1994 was mainly due to a decrease in the death rate among middle-aged adults, which had increased until 1994. Deaths among those aged 15-30 years, which rose during 1991-94, remained high. Some causes of death, such as stomach cancer and road-traffic accidents, declined throughout the 1990s, whereas others, such as breast and prostate cancers and tuberculosis, increased. The decline in mortality since 1994 was, however, mainly due to a reduction in the rate of deaths from a group of causes associated with alcohol consumption. The changing life expectancy in Russia is a consequence of a complex pattern of trends in different causes of death, some of which have their origins long in the past, and others that result from contemporary circumstances. This study provides further support for the view that alcohol has played an important part in the fluctuations in life expectancy in Russia in the 1990s, although there remains a need for a much better understanding of the factors underlying these continuing changes.

Macroeconomic consequences of the Russian mortality crisis

This paper examines macroeconomic consequences of the Russian mortality crisis. Life expectancy in Russia decreased from 70 to 65 years during the first half of the 1990s, which we estimate accounts for approximately 1.6 million excess deaths during 1990–1995. Coupled with its disproportionate impact on working age males, the large number of excess deaths suggests the crisis may have had a significant negative impact on the level and growth of Russia's per capita income. We estimate the economic cost of the crisis using two alternative approaches. First, we estimate the capitalized value of the income forgone due to the crisis, which represents between 1.8 and 2.7% of Russia's 1990 GDP. There are, however, both theoretical and empirical problems with this approach to estimating the cost of the crisis. Second, we estimate the parameters of a macroeconomic growth model and use it to calculate the effect of the crisis on Russia's rate of economic growth. Our calculations suggest that the net effect of the drop in life expectancy, the decline in the rate of total population growth, and the even larger decline in the rate of growth of the working age population have been to lower the annual rate of growth of income per capita in Russia by roughly one-third of one percentage point. Given that Russia's per capita income fell at an average annual rate of 9% during 1990–1995, we conclude that the mortality crisis — which has unquestionably been catastrophic in human terms — has been at most a small contributor to Russia's poor macroeconomic performance. The paper also discusses the effects of the crisis on other macroeconomic variables such as income inequality and the fiscal balance of the pension system. The paper concludes with a discussion of possible new approaches to modeling the two-way linkages between health status and economic growth.

Economic change, crime, and mortality crisis in Russia: regional analysis

Objective: To identify which aspects of socioeconomic change were associated with the steep decline in life expectancy in Russia between 1990 and 1994. Design: Regression analysis of regional data, with...

The Social Determinants of the Decline of Life Expectancy in Russia and Eastern Europe: A Lifestyle Explanation

This paper examines the social origins of the rise in adult mortality in Russia and selected Eastern European countries. Three explanations for this trend are considered: (1) Soviet health policy, (2) social stress, and (3) health lifestyles. The socialist states were generally characterized by a persistently poor mortality performance as part of a long-term process of deterioration, with particularly negative outcomes for the life expectancy of middle-aged, male manual workers. Soviet-style health policy was ineffective in dealing with the crisis, and stress per se does not seem to be the primary cause of the rise in mortality. Although more research is needed, the suggestion is made that poor health lifestyles--reflected especially in heavy alcohol consumption, and also in smoking, lack of exercise, and high-fat diets--are the major social determinant of the upturn in deaths.

Life expectancy in Russia falls

The life expectancy of Russian men has plunged to just 59 years, the lowest level since the 1960s, according to new government statistics. Coupled with signs of a fall in the birth rate, the figures have prompted fears among commentators here that the Russian nation is literally dying out. The provisional data from the State Statistics Committee prepared for Prime Minister Viktor Chernomyrdin show that the average lifespan of Russian males in 1993 was three years shorter than that in the previous year. Russian women, too, are living shorter lives, although the drop for them over the 12 months was more modest, from 73.8 to 73.2 years. It takes overall life expectancy in the country to 65.8 years, which puts Russia on the …