The Times (UK), September 23, 2004
Russia Doomed to Be the Sick
Man of Europe
MOST Europeans today take the steady improvement
of health conditions in their countries as
a given, almost as if this were a rule of Nature.
Unfortunately, Europe's largest country -the
Russian Federation, with its population of
nearly 145 million -stands as a terrible exception.
Russia is in the midst of a severe health crisis,
an astonishing problem for a developed, literate
and urbanised society. The magnitude of the
crisis is captured by a single statistic: life
expectancy at birth is lower today than it
was 40 years ago during the Khrushchev era.
The dimensions of Russia's health crisis are
best illustrated by mortality trends.
Between 1965 and 2002, after correcting for changes
due purely to shifts in age structure, Russia's
mortality rate for males shot up by an appalling
43 per cent.
The deterioration was not as dramatic for females,
but the 16 per cent rise was nonetheless a
movement badly in the wrong direction. By comparison,
the UK's age-standardised death rate for men
fell by 33 per cent and by 36 per cent for
women between 1965 and 1999.
Russia is heading down the path to steep depopulation.
Since the end of communism, nearly ten million
more people have died in Russia than have been
born. The country's population will continue
to decrease by at least 0.3 per cent per annum
for the next decade -and quite possibly the
decline will be significantly faster.
The upsurge in death rates predominantly affects
the working-age population - exactly those
who should be the drivers of economic growth.
Why are Russia's demographic patterns so desperately
unfavorable these days? Cause-of-death statistics
help to answer the question: Russia has suffered
parallel explosions of mortality from cardiovascular
diseases and from injuries such as drowning,
poisoning, homicide and suicide. Between 1965
and 2001, while cardiovascular mortality was
falling in Western Europe, age-standardised
rates skyrocketed by 65 per cent for men, and
jumped by 25 per cent for women. As for deaths
from injuries in Russia, these have more than
doubled for men and women alike.
However, the underlying causes of this health
crisis are harder to pinpoint. We can mention
a number of plausible factors: poor diet, lack
of exercise, heavy smoking and social stress.
Russia's deadly love affair with the vodka
bottle remains legendary and is another significant
factor. And we cannot ignore the woeful state
of the public health system: the old Soviet-era
network of primary facilities has disintegrated
and little has taken its place.
At this point, it would be an impressive accomplishment
for Russian adults simply to reattain the health
levels of their parents. Yet if Russian men
were to regain their fathers' health levels,
in other words those of 1970, male life expectancy
at birth in the country today would be a mere
63 years -lower than for men in India.
And that does not take into account the gathering
storm of infectious diseases sweeping across
Russia: drug-resistant tuberculosis and HIV-Aids
According to the 2003 estimates by Unaids some
860,000 Russians (and possibly as many as 1.4
million Russians) were infected with HIV, mainly
through drug use, and heterosexual transmission
is picking up significantly.
If those numbers are roughly accurate, national
mortality levels will look even worse in a
few years. And Moscow is doing surprisingly
little to avert an Aids explosion despite considerable
international lobbying efforts and offers of
financial support. For example, the Russian
public health ministry's unit on sexually transmitted
disease employs only three people who specialise
in HIV Aids.
Access to antiretroviral treatment is still minimal,
only reaching a few thousand patients each
A Russian HIV "success story" --the
effort in and around the Siberian city of Irkutsk
-is a perfect example of how limited local
efforts are. The Irkutsk programme offers about
200,000 clean syringes a year, whereas the
corresponding initiative in Zurich -for a much
smaller at risk population -was processing
about 4.4 million clean needles a year at the
peak of the Swiss fight against the spread
of HIV-Aids in 1993.
Russia's continuing health crisis is more than
just a humanitarian catastrophe.
These health problems also act as a straitjacket
on the Russian economy, stifling productivity
and development. President Putin has set the
goal of doubling Russia's GDP over the course
of a decade.
Russia has enjoyed positive economic growth over
the past few years, but most of this has been
generated by its limited oil and gas enclaves.
How can the country hope to have a vibrant
modern economy with a dwindling and debilitated
In the modern world, the state of a country's
health is an essential element of its overall
economic potential. In Russia today, life expectancy
is 12 years shorter than in Western Europe;
per capita output in Russia -even with generous
purchasing power adjustments -is not much more
than a third of the Western European levels.
Simply put, Russia has little chance of narrowing
the income gap with the EU unless it also closes
the yawning health gap that separates Russians
from the rest of Europe.
Nicholas Eberstadt holds the Henry Wendt Chair
in Political Economy at the American Enterprise
Hans Groth has served as Pfizer Global Health
Fellow on an HIV-Aids harm reduction epidemiology
project in Russia
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