#14 - JRL 7023
St. Petersburg Times
January 17, 2003
Russian Life Expectancy on Downward Trend
By Irina Titova
Just last month of weeks ago, unemployed engineer Nikolai Medvedyev, 52, buried his cousin Alexander, who died of a heart attack at the age of 59. The funeral was the second Medvedyev attended for a male relative this year as another cousin, only 45 years old, also died from heart disease in August.
Medvedyev's terrible year is an all-too-common story in Russia, where a variety of factors combine to create life-expectancy numbers well below Western levels, particularly for men.
According to the most recent data compiled by the State Statistics Committee, the average life expectancy for Russian men is less than 59 years - 58 years and 11 months - while that for Russian women is 72 years. The combined figure is 65 years and three months.
By comparison, the average life span for men in the United States is 73 years and for women 79 years. Male life expectancy in France and Germany is 74 years, while for women it is 82 and 80 years respectively.
Not only are the numbers for men bad, they are getting worse. Since 2000, the average life expectancy for Russian men has fallen by 15 days, while the number for women has increased by almost two months.
Demographic and health-care experts say that the chief factors behind the poor figures are alcohol abuse, psychological stress caused by economic uncertainty, widespread smoking, poor personal-safety practices, an unhealthy diet and a general lack of exercise.
"The basis for the unprecedented growth of early mortality in Russia is the result of the worsened quality of life for the majority of the population," Nikolai Gerasimenko, the head of the State Duma Health Committee, said in a Duma report in 2001. "It is the result of a lingering social and economic crisis, characterized by the rise in unemployment; chronic delays in paying salaries, pensions and social aid; worsening nutrition; a decrease in access to medical care and medicines; and the stress generated by people's lack of confidence in their futures and those of their children."
Official statistics give the two leading causes of death in Russia as heart disease - accounting for about 60 percent of all deaths - and accidents, followed by cancer, drug abuse and suicide.
According to Murray Feshbach, a research professor at Georgetown University in Washington, who specializes in demographic trends in Russia and other countries of the former Soviet Union, the rate of deaths from cancer and heart disease are much higher than other developed countries.
"As to causes, no single explanation will suffice," Feshbach wrote in an email interview. "Deaths related to stress, smoking, alcoholism and TB are incredibly high, and soon, probably deaths from AIDS will also rise."
Yevgeny Andreyev, a demography expert with the Institute of National Economic Forecasting in Moscow, says that average life-expectancy fell steadily between 1965 and 1980, but the statistic has followed a roller-coaster path in the last twenty years. Average life expectancy rose in the mid 1980s, fluctuated through the 1990s, and has remained relatively stable over the last few years.
Andreev agrees that part of the cause of the recent drop in the figure stems from stresses associated with the fall of the Soviet Union.
"In the Soviet Union, no one was afraid of losing their jobs - work was guaranteed by the state," Andreev said. "In modern, capitalist Russia, you have to be good at your job and work hard in order to keep it."
Vladimir Khavinson, the director of St. Petersburg Institute of Bioregulation and Gerontology, confirmed that, in his opinion, Russia's tragic life-expectancy statistics are, in large part, explainable by social factors.
"Life expectancy differs for various social groups in all countries," Khavinson said. " Thus, a homeless American would live about as long as a homeless Russian, just as a Western drug-addict's life would be, on average, about as long as that of a Russian drug addict."
He said that people's financial situation has a direct bearing on life expectancy. Better-off people are able to afford better-quality food, better medicine and doctors, as well as fitness-club memberships and more relaxation time, Khavinson said.
"The cause of the problem is clear: The majority of Russian population is poor," he said.
Alexander Markovich, a doctor at the American Medical Clinic in St. Petersburg, said that the problem is particularly economic for the elderly, whose state pension is to low for many of them to be able to afford the medicine they need.
"Therefore, many of them just live circulating between their home and a hospital, where they end up repeatedly because they lack the essential, but expensive, medicine they should be taking at home," Markovich said.
But not all of the explanations for the negative figures are related to recent developments. Demographers and health-care experts agree that one traditional Russian problem - high rates of alcohol consumption - is also to blame for the low life-expectancy figures. As evidence, they cite a jump in the rates in 1986 and 1987 prompted by an anti-alcohol campaign initiated by then Soviet Premier Mikhail Gorbachev in 1985. Whereas male life expectancy had been 61.7 years in 1984 - its lowest point since the 1960s - the figure for men reached 65 years in 1987, with the overall rate climbing above 70.
Health experts say that the campaign likely saved the lives of at least 1 million people, who would otherwise have died as a result of illnesses related to alcohol abuse.
Experts say that another factor underlying the negative figures for Russia - deaths due to accidents - is, itself, partially the result of high levels of alcohol consumption.
"Half of the accidents happen, again, as the result of alcohol," Andreev says, "But Russians, in general, seem to be less aware of and pay less attention to regular safety measures. They are more likely to fall from buildings; drown in rivers; get run over by cars; or die in car accidents because they weren't wearing seatbelts."
"A look at European countries reveals tiny details that speak of their concern for safety," he said. "They tend to produce children's clothes with fluorescent stripes. In Germany, children are even forbidden from rollerblading on bicycle paths, and 10 year-old children are required to pass exams on bicycle safety. Nothing like this happens in Russia."
"It seems that life isn't valued as highly in Russia as it is in other countries in the West, where both the people and the governments realize that health is the guarantee of their ability to work and earn an income," Andreyev said.
According to Markovich, Russians in general tend to take less care of their health compared to Westerners.
"From my professional experience, most Western patients visit a doctor when they see the first signs of something wrong, while Russian people often wait until the last moment, when their illness is so bad that they can no longer work or live normally," he said.
Andreyev adds that the same lack of concern for personal health issues is also present in relation to personal-health practices, listing smoking and lack of exercise as two main problems. In 1985, 53 percent of Russian males smoked. The figure rose to 67 percent in 1992 - more than twice the percentage of adult male smokers in the United States - and has remained steady since. At least one third of Russian women also smoke.
The number of reported cases of lung cancer has increased by 63 percent over the last ten years, with smoking cited as the main cause for 52 percent of all cancer cases, Gerasimenko, who smoked for 30 years before quitting, wrote in his report.
With regard to exercise, only 6 percent of Russians take part regularly in some sort of sport or fitness-related activities, according to data from the Russian State Statistics Committee.
Feshbach said that the problem with life-expectancy rates has been complicated by the increase in the incidence of old as well as new diseases in Russia.
The number of reported cases of tuberculosis has risen by 70 percent over the last five years, with 2.3 million cases registered in 2001, the last year for which statistics are available.
The spread of AIDS is also a minor contributor, with Russia trailing only certain African countries in the spread of HIV infection in recent years. Although the official figure for the number of HIV-infected Russians is 220,000, many experts say that the real figure is likely five times higher, said Alla Davydova, a doctor at the St. Petersburg AIDS Center.
Most of those infected are from 15 to 25 years old, with about 90 percent of them being intravenous-drug users.
Andreyev says that the poor state of Russia's health-care system remains one of the biggest causes of the problem.
"Russian medicine is in need of financial reform," he said. "It's not effective when an ambulance takes half an hour or more to arrive and the doctors working with the ambulances lack essential tools for saving people's lives."