THE RELIGIOUS CONSULTATION
on population, reproductive health & ethics

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 in particular.

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 year.

A Russian HIV "success story" --the foreign-supported "harm-reduction" 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 workforce?

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 Institute.

Hans Groth has served as Pfizer Global Health Fellow on an HIV-Aids harm reduction epidemiology project in Russia

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