Too Sick to Grow and Prosper

Most Europeans today take the steady improvements in health conditions in their countries as a given–almost as if this were a rule of nature. Unfortunately, Europe’s largest neighbouring country–Russia with a 145 million population–stands as a terrible exception to any such presumed “Rule of steadily improving health.”

The Russian Federation is in the midst of a severe ongoing health crisis, which is astonishing for a developed, literate and urbanized society. The magnitude of the health crisis can be captured by one single statistic: Life expectancy. For men and women alike, life expectancy at birth in Russia is lower today than it was 40 years ago during the Khrushchev era! Moreover, the prognosis for the immediate future is hardly encouraging.

The dimensions and components of Russia’s ongoing health crisis are best illustrated by the country’s 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 percent. The deterioration was not as dramatic for females, but the 16 percent rise was nonetheless a movement badly in the wrong direction. By comparison over the time period 1969 and 2000, Switzerland’s age-standardized death rate for men fell by 59 percent and for women by 55 percent.

With death rates soaring and the attendant slump in birth rates–at the moment Russia tallies 160 deaths for every 100 births–Russia is headed down the path to steep depopulation.

Since the end of Communism, nearly 10 million more people have died in Russia than have been born. After correcting for confounding factors, such as immigration, the country’s population will continue to decrease by at least 0.3% per annum for the next decade–and quite possibly the decline will be significantly faster if an additional emerging threat becomes reality: The HIV/AIDS pandemic.

Upon closer look, the country’s upsurge in death rates predominantly affects the “working age population”–exactly those who could be the drivers of economic growth towards a modern, wealthy–and economically equal–Russia. Between 1970 and 2001, death rates for women in the age groups 20 to 59 have shot up by more than 30 percent and those for males between the ages of 40 and 64 have soared by 60 percent or more. According to the WHO 2000’s survival schedules about 9 percent of Swiss women would not make it from age 20 to age 65; for Russia the corresponding figure was 22 percent. As for men, about 15 percent Swiss aged 20 would not reach their 65th birthday–whereas in Russia, the proportion was a staggering 54 percent.

Why are Russia’s demographic patterns so desperately unfavorable these days? In a proximate sense, cause-of-death statistics 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-standardized rates skyrocketed by 65 percent for men–and jumped by 25 percent for women. As for deaths from injuries in Russia, these have more than doubled on an age-adjusted basis for men and women alike.

The underlying causes of this ongoing health crisis are harder to pinpoint, but 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. Estimated average alcohol consumption continues to be huge and peaked in 1993 with more 15 liters of pure alcohol per year per person. And we cannot ignore the woeful state of the public health system: while the old Soviet era network of primary facilities has disintegrated, lack of political commitment on the part of post-Soviet leadership has meant that nothing systematic has taken its place.

At this point, it would be an impressive accomplishment for Russian adults simply to re-attain the health levels of their parents. Yet if Russian men were to regain their fathers’ health levels–i.e. the patterns of 1970–male life expectancy at birth in the country today would be a mere 63 years: lower than for men in India today!

And that does not take into account the gathering storm of infectious diseases sweeping across Russia: drug-resistant tuberculosis (TB) and HIV/AIDS in particular. According to the latest estimates by UNAIDS, as of yearend 2003 some 860,000 Russians and possibly as many as 1.4 million Russians were infected with HIV, mainly through drug abuse, 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 financial support offers by the World Bank, the Global Fund for AIDS, Tuberculosis, and Malaria, and others. For example the Russian Ministry of Public Health has exactly three employees charged with HIV/AIDS in its unit for confronting a sexually transmitted disease. Access to antiretroviral treatment is still minimal–only reaching a few thousand patients each year–and in those few cases who receive treatment international treatment regimen are rarely followed. 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 current Irkutsk program offers about 200,000 clean syringes per year, whereas the corresponding initiative in Zurich–for a much smaller “at risk” population–has been processing about 4.4 million clean needles a year at the peak of the Swiss fight against HIV spread 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 several years, but most of this has been generated by its limited oil and gas enclaves. How can Russia hope to be a vibrant modern economy with a dwindling and debilitated workforce?

In our modern world, a country’s health profile is an essential element of its overall economic potential. In Russia today, life expectancy is a full twelve 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 served in 2003 as Pfizer Global Health Fellow for Doctors of the World on a HIV/AIDS harm reduction epidemiology project in Russia, Ukraine, and Central Asia.