Over the past decade, Russia has seen the rise of a number of unfavorable demographic trends. Among the most significant are the drop in life expectancy for both men and women and the rising number of deaths among the male population. In the second of a two-part series on Russian health care, RFE/RL looks at the reasons behind the alarming demographic shifts.
Moscow, 5 July 2002 (RFE/RL) -- Life expectancy is a mirror that reflects the current state of affairs in any given country, from health care to living standards to psychological stress.
In Russia, the mirror reflects an alarming image: In less than a decade, average life expectancy dropped by an astonishing six years, from 70.1 in 1986-87 to 64 years in 1994. On a list of life-expectancy rankings worldwide, Russia now occupies the 100th spot.
Moreover, life expectancy for men has dropped even further. According to the United Nations Development Program (UNDP), between 1998 and 2000, the average life expectancy for Russian men dropped from 61.3 to 59 years. Female life expectancy also saw a slight drop in the same period, from 72.9 to 72.2 years. But the resulting gap means Russian women now outlive men by more than 13 years, one of the widest life-expectancy divides in the world, where the average gap is seven years.
Yevgenii Andreev is the head of the Laboratory for Analysis and Prognosis of Population Mortality at the Moscow Center of Demography and Human Ecology. He explained why Russian men are dying younger, and in greater numbers. "I would say that there are three main reasons. First, men lead a less rational way of life: They abuse alcohol more than women [abuse alcohol]. Second, men are the ones who are sent to war zones and have to fight [and] also often work in ecologically dangerous places. And finally, the third reason is a general biological one, the male body," Andreev said.
Andreev said males are biologically more susceptible to illness and disease than women. In Russia, this tendency is exacerbated by the male predilection for drinking and smoking. According to a report by the U.S. RAND think tank, life expectancy for Russian males reached its highest levels after Mikhail Gorbachev launched a sweeping antialcohol campaign in the mid-1980s and alcohol consumption plunged. Once the campaign ended, male life expectancy again began to drop.
Smoking, too, is on the rise in Russia. In 1985, 53 percent of Russian males smoked. That figure rose to 67 percent in 1992 -- more than twice the percentage of adult male smokers in the United States.
Many observers link the drop in life expectancy to the financial and social disruption caused by the breakup of the Soviet Union in 1991. But Andreev said the trend has been several decades in the making. "Life expectancy in Russia has been decreasing since 1965. The trend began during the so-called stagnation period [of Leonid Brezhnev], which is now considered by many people as not such a bad period in our history. Undoubtedly, the economic crisis [of the 1990s] increased mortality trends in Russia, but that isn't the most important [reason]. The Russian lifestyle and attitude toward life and death, as it has been shaped over the course of the 20th century, had a great impact on the issue," Andreev said.
In the 1960s, as Soviet family incomes increased, the Russian daily diet began to include more red meat and dairy products and fewer grains and cereal. The consequences of this shift, according to the RAND report, can be seen now in the higher number of deaths from coronary heart disease.
Another part of the equation is Russia's poor health-care record. Andreev said sophisticated medical care was never a priority in the Soviet period, and noted that when the Soviet Union was created, the average life expectancy was 40 years and medical efforts concentrated primarily on reducing infectious diseases and epidemics. "The health-care system has never been very developed in Russia. It was designed to solve simple problems like fighting infections and mass epidemics. But when these problems were solved in the mid-1960s, Russia should have created a new, sophisticated health-care system to fight diseases like heart disease and cancer," Andreev said.
Failing to adapt health-care systems to address a new range of post-war medical concerns, Russia quickly saw mortality rates decrease but life expectancy stagnate. Men and women in Russia can now expect to live between six and 14 years less than their counterparts in the West.
Experts say the transition from communism to capitalism has also contributed to the drop in life expectancy and a general decline in health. For example, over the past 10 years, Russia has found itself facing health problems thought to be eradicated -- like tuberculosis -- as well as new health crises, like HIV/AIDS.
The return of tuberculosis (TB) infections began in the early 1990s and continues to gain momentum. According to the UNDP, TB cases rose 160 percent between 1991 and 2000, with more than 90 cases registered per every 100,000 people, a rate not seen in Russia since the mid-1970s. More than half of those infected are men, and many of them are inmates in Russia's notoriously overcrowded prisons, where TB rates are estimated to be nearly 50 times higher than in the civilian sector.
Yuliya Mikhailova is a deputy director at the Russian Health Ministry's Central Research Institute for Health-Care Organization and Information. Mikhailova, who has been working with TB patients for 20 years, said the growing incidence of TB has prompted the country to adopt better control and treatment strategies. "Thank God, the last two years (2001-2002) have seen the [number of TB infections] decrease. First of all, this is because infected patients who were in prison were given amnesty, [slowing the spread of TB among prison inmates]. Second, TB treatment programs have improved. [If in the 1990s] there was no money for medicine to treat TB, now we have all the medicine we need, and I believe the next report [on TB rates] will be more positive," Mikhailova said.
Mikhailova said the sharp political shifts of the 1990s played a role in the rapid spread of HIV/AIDS infections. If during the Soviet era the country was closed to foreigners and drug abuse was uncommon, the fall of the Soviet Union has seen borders opened and drug use growing. Over the past decade, Mikhailova said, "young people, both out of curiosity and also because of the deep identity crisis they were undergoing," have begun to use drugs more and more often.
According to a new report issued by UNAIDS, the agency that coordinates the United Nations AIDS programs, new reported cases of HIV/AIDS in Russia have almost doubled since 1998. There are now officially estimated to be nearly 200,000 Russians living with HIV/AIDS, the vast majority of whom are men who contracted the virus through intravenous drug use. Some experts believe the number of infections is actually far higher and blame the government for continuing to put the disease low on its list of priorities.
Urban Weber is the UN technical adviser on HIV/AIDS programs on preventing intravenous drug use in Russia. He said that while the government is aware of the spread of infections, the problem remains largely invisible. "Those who are infected are an invisible problem at this very moment, because from the HIV infection to the development of [full-blown] AIDS, it takes, on average, between seven or 10 years. Meaning that those who are infected now will not enter hospitals for another four years, more or less. Out of the 200,000 infections we have now, 95 percent were infected during the last three years. This means that the first wave of patients entering the hospitals with AIDS-related diseases will show up in hospitals no earlier than 2005, 2006, 2007. So the problem in Russia is still largely invisible," Weber said.
Weber said the challenge now is to see whether the Russian health-care system is capable of coping with the wave of AIDS patients it can expect to see in the next few years. "HIV affects a country in transition whose health-care system is not in its best shape. So it's a question of whether the health-care system can be ready to respond to this epidemic without a clear preparation for that, a preparation that will take a number of years. The health-care system [in Russia] still has time, because the HIV epidemic will need time to develop into an AIDS epidemic. So the Russian health-care system still has three years' time to get prepared on that. However, it is time now to prepare oneself in order to be ready to respond to the needs of these HIV-infected patients," Weber said.
The UNDP has urged Russia to fight both TB and HIV/AIDS by drumming up active support from government institutions and nongovernmental organizations.
(This is Part 2 in a two-part series.)