Why It's Unhealthy to Be a Man in Russia: Looming Crises in Health Care and Demographics
Death became a way of life in 20th century Russia. An estimated 23 million Russians died during World War II. Joseph Stalin's gulags killed an estimated 20 million more.
Today's Russia, for all of its economic advances, seems unable to shake that ghastly legacy. The country is mired in a demographic crisis brought on by a combination of low birthrates and premature deaths. On top of that, Russians spend more of their lives sick than their peers in the United States, Western Europe and Japan. "Russia combines the most problematic demographic trends of a developed and developing country," says Bill Tompson, an economist and Russia specialist at the Paris-based Organization of Economic Co-operation and Development (OECD). "Russians are getting richer, yet the indicators of human welfare aren't moving very much."
If current trends don't reverse, Russia's population will drop to about 100 million from its current level of about 143 million by 2050, according to the World Bank. If that happens, the country's growth could be choked off by a shortage of workers. By simply addressing preventable deaths and raising life expectancy to the average level of Western Europe, Russia could give its gross domestic product a huge boost, the World Bank said in a report issued in late 2005 entitled, "Dying Too Young."
"Russia's population is aging at a fast rate," says Serguei Netessine, a Wharton professor of operations and information management, and a native of the country. "The politicians are trying to encourage immigration to bring younger workers in, but that's meeting with resistance. In the U.S., the immigrants are much younger than the average population, and that's [building] a new work force."
Disease, bad habits and pollution have collided to create the bleak situation that Russia faces. The health care system, though lately improving, fell into a shambles after the dissolution of the Soviet Union, says David Woodruff, a lecturer in comparative politics at the London School of Economics. "Health care was desperately underfunded for over a decade," he points out. "It wasn't perfect in the Soviet system, but it was comprehensive. It has really decayed." Weakened hospitals and clinics have been unable to control epidemics of AIDS and tuberculosis, and careless administration of antibiotics has contributed to the emergence of drug-resistant TB.
Corruption undermines a health care system that's already weak, adds Murray Fesbach, a demographer at the Woodrow Wilson International Center for Scholars of the Smithsonian Institution in Washington, D.C. "Funds that are designated for medical care and medical technology get diverted," he points out.
Unhealthy lifestyles are killing people prematurely, too. Russia has high levels of alcoholism and smoking, especially among men, which leads to significant heart disease and cancer, says Mary Collins, acting head of the World Health Organization's office in Moscow. The country has one of the world's highest rates of cardiovascular disease deaths -- 994 deaths per 100,000 people in 2002. The United States reported 317 deaths per 100,000 that year, while Brazil reported 225.
Drunkenness also contributes to fatal car accidents and to shootings, stabbings and other violent deaths. The rate of fatal traffic accidents in Russia is nearly twice that of the other countries in the Group of Eight, an international forum that also includes the U.S., the United Kingdom and Japan. Dangerous roads and little-enforced traffic laws play a role as well. "Driving in Moscow is insane," Fesbach says.
As if that litany weren't grim enough, pollution left over from the Soviet era likely contributes to high levels of cancers. According to a study by the Blacksmith Institute, a New York environmental group, three of the world's 10 most polluted sites are in Russia. After studying 300 polluted locales around the world, Blacksmith named the Russian city of Dzerzhinsk, former home of a Cold War-era chemical-weapons plant, as the world's most contaminated spot.
Vodka at Lunch
Russia's problems are seen most acutely among its men, who die far younger than their counterparts in Western Europe, Japan and the U.S. "They live 16 years less on average than men in Western Europe and 14 years less than Russian women," the World Bank study noted. Russian men, on average, survive to about age 58, compared with about 72 for Russian women.
Male life expectancy was longer under the Soviet system but dropped rapidly in the 1990s. "The decline in male life expectancy has been the largest ever outside of wartime," notes Andrew Spicer, a professor of international business at the University of South Carolina. "My opinion is that it's a response to the pain of the transition. There's a sense of anomie that leads to alcoholism and suicide, combined with poor medical care." Many men lost their livelihoods when the Soviet Union collapsed, leading to increased alcoholism rates.
Collins, of the World Health Organization, predicts that Russian drinking habits won't change unless the government invests substantially in educating young people about the perils of overconsumption, and makes liquor, wine and beer less accessible. "Beer's not considered alcohol, and you can drink everywhere," she says. "You see teenagers drinking it. So the problem is young people starting with beer and moving to vodka. Vodka is so much part of the culture. People drink it at lunchtime."
Poor health care and bad habits also mean that Russians enjoy fewer healthy years than their peers in the rest of the developed world. "If you don't live in good health, you can't be productive," Collins points out. Russian women don't beat men as much on this measure as they do on life expectancy. They average 64 years of healthy life, compared with 53 years for men. "That's low for females," Collins says. In the most developed countries in Europe, women average 72 years of healthy life. Adds the OECD's Tompson: "The cliché in Russia is, 'What breaks the men bends the women.'"
President Putin's administration acknowledges Russia's demographic crisis and is taking steps to stem it, according to some analysts. The President has even suggested paying women to have children. In a state-of-the-nation address, he laid out a program that would provide cash payments and additional medical benefits for people who have children and guarantee that mothers would be paid at least 40% of their prior earnings while on maternity leave.
Dmitri Trenin, deputy director of the Carnegie Endowment for International Peace's Moscow Center, doubts that Putin's proposals will make much difference. "People don't bear children based on how much they are helped by the government," he says.
Trenin is more optimistic about another Putin initiative, an attempt to reform the country's health care system, which is one of four national projects that Putin announced in 2005. (The other three are improvements in education, agriculture and housing.) Putin has earmarked money from the government's stabilization fund, which contains about $80 billion in oil revenue, for the projects.
Specifically, he committed to spend $3 billion to raise salaries of primary care doctors, better equip ambulances and clinics, build rural medical centers and restore the national system of communicable disease prevention, which was one of the successes of Soviet-era health care.
"The government is trying to have every person in Russia go through regular comprehensive checkups so people can find out if they have some kind of health problem at the beginning when they can more easily deal with it," explains Vladimir Pantyushin, an economist with Renaissance Capital, a Moscow investment bank. That, combined with more money for doctors and medical equipment, will begin to alleviate some of the country's health problems, though the results may not be obvious for five to 10 years, he says.
Putin's program is a key first step, but much remains to be done, according to the World Bank. "Policies for controlling excessive alcohol consumption, enforcement of existing policies for smoke-free worksites and public places, and targeted taxes would help prevent [noncommunicable diseases] in Russia," the bank says. The bank also recommends public campaigns to promote wearing seat belts and driving sober as well as national and regional pushes to improve road safety.
Perhaps the best cure for Russia's demographic ills would be continued economic growth paired with some relaxation of rules that make it tough for immigrants to work in the country. Simply put, rich countries are healthier on average than poor ones, even if affluence, in some places, brings a few problems of its own such as obesity and diabetes. "There's no single key to unlocking the demographic crisis," says OECD's Tompson. "Lifestyles, violence, road and traffic safety, environmental problems. It's about improving all of those things. There's no silver bullet."