iStockphoto/Björn Kindler

Ever since the days of the British political economist Thomas Robert Malthus [1766-1834], demographic commentators have been faulted for excessive despondency, for being overly ready to find ubiquitous "population problems" in virtually every new demographic development. Be that as it may, serious or even disastrous population problems can still threaten real existing countries--even today. In fact, we are currently witnessing a demographic crisis of historic proportions right before our very eyes. 

The crisis, however, is not ravaging an illiterate and impoverished Third World country. Instead, it is unfolding in a modern, highly-educated nation that sent the first cosmonaut into space: the Russian Federation. Russia is in the grip of startling and anomalous demographic tendencies, trends whose humanitarian and economic consequences are not only self-evidently adverse, but, quite arguably, dire.

Russia today is a society at peace. But judging by vital statistics alone, it looks like a country trapped in a prolonged and devastating war. Since the end of the Communist era, in late 1991, the country's birth rates have collapsed while its death rates have soared. Over the post-Communist era as a whole, Russia has reported three deaths for every two births. The year 2008 was a "good" one for modern Russia: it registered "only" five deaths for every four births.  

Since the beginning of 1992, Russia has recorded nearly 13 million more deaths than births, and the country's population has dropped by about 7 million; only a net influx of migrants prevented an even steeper drop. The magnitude of Russia's ongoing population decline (to date) is overshadowed in our post-war epoch only by China's terrible population decline in the immediate wake of Mao's disastrous "Great Leap Forward." China's population decline abated, however, as soon as Beijing's fanatical policies were reversed. Russia's depopulation, on the other hand, shows no signs of a genuine turnaround.

One major component of the "demographic shock" that Russia has been experiencing was a sudden, radical reduction in fertility. In the late Soviet era--the Perestroika period--the Russian Federation's childbearing patterns held more or less at the levels required for long-term population replacement. By contrast, in the early years of the 21st Century, Russia's fertility rates have been almost 40 percent below the replacement level. Although the Kremlin unveiled an ambitious and expensive pro-natal population program several years ago, this seems to have elicited only a modest increase in births. According to official Russian reports, birth totals in the first four months of 2009 were up, albeit slightly, on a year-to-year basis--but death rates remained substantially higher than birth rates.

Low sub-replacement fertility can be expected to accelerate the "graying" of a society and to hasten the shrinkage of its working age population--tendencies that can impede efforts to enhance economic growth and prosperity. Russia's circumstances, in this case, are not so different from the rest of Europe. But while low birth rates in Western Europe may constitute a challenge, few voters or policymakers would describe their fertility picture as a crisis, much less a disaster. 

What distinguishes modern-day Russia's demography from the rest of Europe's is not its fertility trends, however, but rather its patterns of mortality and survival, which can be described as shocking--or even disastrous. In the post-war era, the modern world has been all but exploding with health. According to the UN's Population Division, for the planet as a whole, life expectancy at birth jumped by about twenty years between the early 1950s and the early 2000s. Russia has been an exception to this global rule: according to those same UN estimates, the country's life expectancy was actually two years lower in 2000-2005 than in the late 1950s. Though there has been some recovery since 2005, life expectancy for both males and females in the Russian Federation is lower now than it was four decades ago.

The country's worsening public health conditions have caused a catastrophic loss of life and a corresponding severe depletion of "human capital." Health conditions were far from ideal during the Gorbachev era and before. Yet when measured against the country's survival schedules from the late 1980s, post-Communist Russia has, thus far, suffered a toll of nearly 7 million "excess deaths."

Examined more closely, the details of Russia's upsurge in death rates are nothing short of terrifying. For men in their 30s and 40s, Russia's death rates are roughly twice as high as they were 40 years ago. Scarcely less appalling are the death rates for females in their 40s, now 50 percent higher now than they were four decades ago. 

Cardiovascular disease--heart attacks, strokes and the like--kill four times as many people in Russia as in Western Europe, even after adjusting for population size and age. Furthermore, Russia's death levels from injury--accidents, suicide, murder, and so on--are positively "Fourth World." The only other spots on the planet sustaining such radical losses are the conflict- and post-conflict societies of sub-Saharan Africa, such as Angola and Sierra Leone. 

We should not assume that Russia's health situation could not worsen any further. The country faces looming risks from infectious disease such as HIV/AIDS and drug-resistant tuberculosis (XDR TB). Current international estimates indicate that nearly one million Russians are now living with HIV and virulent new strains of XDR TB.  Thus far, Russia's alarming health trends have been primarily due to non-communicable causes. But unexpected virulent epidemics/pandemics could exact their own grim toll on the country in the years ahead.

Russia's continuing health crisis is without doubt more than just a humanitarian catastrophe. These health problems also act as an economic straitjacket, stifling the nation's productivity and obstructing its goal of developing into a prosperous 21st century society. Life expectancy in Russia today is a full 12 years shorter than in Western Europe. Its per capita output--even with generous purchasing power adjustments--is still not much more than a third of 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.

True, Russia is burdened by the legacy of generations of Communist rule and has suffered travails in its "transition" away from Soviet-style socialism. But it is not unique in this regard; the entire former Soviet Bloc faced the same daunting situation. And the record of the past two decades demonstrates that substantial, even dramatic health progress is possible for any given post-Communist European population.

The most remarkable example is the former German Democratic Republic. Life expectancy in Eastern Germany has soared since reunification. In the 16 years from 1990-2006, overall life expectancy in East Germany is estimated to have risen by over eight years--over 3.5 days for every passing week! Despite four decades of Communist-era disadvantage, life expectancy at birth for the population in Eastern Germany has converged with that of Western Germany; today it stands within just a few months of the Western German level.

This tremendous accomplishment is a consequence of broadly-based improvements arising from a still ongoing transformation of East Germany's population with increased wealth, freedom of mobility, unrestricted access to high-quality healthcare, and hence improved health and levels of happiness. Such factors have led to significant improvements in survival prospects for men and women of all ages, not just selected groups of beneficiaries. This accomplishment looks all the more breathtaking when we compare the life expectancy trajectories of East Germany and the United States over the past two decades: In 1985, overall life expectancy at birth was two years higher in the USA than in Eastern Germany; by 2005 overall life expectancy was one full year higher in Eastern Germany than in America.

East Germany may offer the most spectacular example of post-Communist health progress, but it is hardly an isolated case. As highlighted by cross-national analyses provided by researchers at the Human Mortality Database (HMD), substantial health improvements have been enjoyed by a number of other post-Communist populations in Europe since the revolutions of 1989. Since then, overall life expectancy has risen by nearly five years in the Czech Republic, and similar gains have been made in Slovenia. Even Hungary, a notorious health laggard under Communism from the 1960s onward, has seen a turnaround: overall life expectancy is a full four years over the 1989-2006 period.

Is there cause for hope for Russia? Some would say there is indeed--and would point to President Dmitri Medvedev's own words. Writing in Early September 2009, Medvedev declared, negative demographic trends must be slowed and stopped. We need to improve the quality of medical care, promote fertility, ensure safety on the road and in the workplace, combat the pandemic of alcoholism and develop physical culture and mass sport. This requires both a strategic approach and making such things the everyday tasks of the government.

Stirring words, some would say--but unfortunately we have heard much the same before, during the Putin Presidency. Over those eight years, apart from the aforementioned "baby bonus" scheme, the Russian government's commitment to addressing the country's multi-dimenional human resource crisis proved to extend scarcely beyond rhetorical flourishes. Unfortunately, there is scant reason to be confident that the Kremlin will change course, and back its words with action, this time around.

Russia's ongoing health crisis may justify an air of gloom, but it must not encourage fatalism. There are good reasons for hope, and they all begin with the frank acknowledgment of the realities of the situation, followed by a firm determination to act. Improving population health and economic prosperity is more than a statistical accomplishment. It is about a sense of humanity preparing a nation to move up the ladder of growth. 

Nicholas Eberstadt is the Henry Wendt Scholar in Political Economy at AEI. Hans Groth is a member of the board of directors for Pfizer-Switzerland AG and a Pfizer Global Health Fellow.