Date: Sat, 31 Oct 1998 22:52:11 -0000 Subject: THE RUSSIAN MORTALITY CRISIS From: Ray Thomas <r.thomas at open.ac.uk> To: Russian-Studies list <russian-studies at mailbase.ac.uk>
Radical Statistics THE RUSSIAN MORTALITY CRISIS by Ray Thomas
The average male expectancy of life in Russia declined from 65 years in 1986 to 57.5 years in 1994. A fall of this magnitude must be unprecedented in world history for any country capable of maintaining a statistical system capable of measuring such a decline with any accuracy. Irrespective of matters of accuracy a decline of such magnitude must also be unprecedented in that it was not the product of famine or from some kind of plague. The only major epidemic suffered by Russia in this period has been the outbreak of capitalism.
Russian pundits and journalists reports put the decline down to demoralisation. Millions of men in Russia have lost their work and their purpose in life. The ILO unemployment rate is only 10%, but that conceals massive underemployment and massive wage arrears.
This decline has not yet been the subject of investigation by social scientists. But Professor Martin McKee gave a paper in September that dealt with the medical aspects (as part of a programme of public seminars held by the International Centre for Health & Society at UCL). McKee is the leader of a research group at the European Centre on Health of Societies at the London School of Hygiene and Tropical Medicine which has reported extensively on Russia's mortality experience - which is parallel to that of many other former soviet countries. A copy of McKee's references is given at the end of this article.
There were only two items of good news in McKee's lecture. One was that the team did not find anything wrong with the statistics. Any major errors or fiddling, McKee argued would reveal inconsistencies. But no inconsistencies were found.
The other positive point was that there was a sharp rise in the male expectation of life of nearly three years over the period 1984 to 1987. This is attributed to Gorbachov's anti-alcohol campaign and the vigilance of the KGB in regulating the market for alcohol. After 1987, illicit brewing of alcohol is believed to have become widespread and much of it is said to be of such poor quality as to be a special danger to health.
Commentators in and outside Russia have long attributed that low male expectation of life to drinking vodka. Russian sources estimate that Russian men drink nine times as much as Russian women, and this must go some way to explaining the large difference between the expectation of life for men and for women. Russian women have an expectation of life ten years greater than that for men - a difference greater than that in any other country in the world.
But relating consumption of alcohol to the statistics on cause of death is another matter. If alcohol is the cause, it is well disguised. The number of deaths from accidents, injuries, drownings, murders and suicide are all high - but alcohol is not included in the statistics as a contributory factor for these categories. The big medical puzzle, as McKee explained, is that the major cause of death among men is diseases of the circulatory system including heart disease - that are not usually associated with heavy alcohol consumption.
The theory developed by McKee's team is that the pattern of drinking in Russia is different from that in other countries. High alcohol consumption in the west is usually associated with regular drinking. But in Russia, McKee asserted. The pattern is one of binge drinking. The Russians do not sip wine with every meal, but on the occasion gulp down lots of vodka. The statistical evidence supporting this conclusion flashed on the screen in a chart showing deaths by day of week. The peak day for deaths is Sunday. The number of deaths per day declines through the week until Thursday, and then starts to climb again.
Another chart, presumably from the Walberg article cited below, showed a close correlation between the rate of labour turnover and the increase in the death rate over the period 1987 to 1994. I suspect that this chart is just the beginning of the important story. Bingeing on vodka may be part of the Russian male soul, but a large increase in bingeing that may help to explain the massive increase in the death rate over the period 1987 to 1994 has to be attributed to social and economic factors.
The obvious sets of factors are the economic disasters associated with the transition to capitalism. Russia has suffered from all the problems of Thatcherism writ large. Privatisation there has produced what was described a few years ago as a million millionaires and 149 millions living in poverty. The economic crisis of 1998 seems likely to give a new lease of life to that description.
Martin McKee's suggested reading -
Leon D, Chenet L, Shkolnikov VM, Zakharov S, Shapiro J, Rakhmanova G, Vassin S, McKee M. Huge variation in Russian mortality rates 1984-1994: artefact, alcohol, or what? Lancet 1997; 350: 383-8.
McKee M, Zatoqski W. How the cardiovascular burden of illness is changing in Eastern Europe. Evidence-based Cardiovascular Medicine 1998; 2: 39-41.
McKee M, Bobak M, Rose R, Shkolnikov V, Chenet L, Leon D. Patterns of smoking in Russia. Tobacco Control 1998; 7: 22-26.
Chenet L, Leon D, McKee M, Vassin S. Death from alcohol and violence in Moscow: Socio-economic determinants. Eur J Population 1998; 14: 19-37.
Walberg P, McKee M, Shkolnikov V, Chenet L, Leon DA. Economic change, crime, and mortality crisis in Russia: a regional analysis. BMJ 1998; 317: 312-8.
McKee M, Britton A. The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms. Roy Soc Med 1998; 91: 402-7.