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Drinking and violence are obvious culprits. But neither appears to hold up on close examination. In fact, there's some evidence that the heavier drinkers live longer - about which more in a moment. Nor do infectious diseases or mortality due to smoking or pollution. The one big obvious culprit is cardiovascular disease: heart attacks and stroke. But even here Russians don't seem to do the things normally associated with heart disease more than other national populations which fare much better.
And then there's the other big culprit: accidents. Of almost every sort. Falls. Poisonings. Car wrecks. Everything. Everything you can imagine from carelessness, recklessness, drunkenness. And after all that, on closer inspection, the evidence of demographic collapse doesn't start with the fall of the fall of the Soviet Union. It actually goes back decades, deep into the Soviet era.
The punch line is that the best explanation appears to be psychological - a culture beset by grim hopelessness, depression and the bodily stresses which accompany both. Drinking may turn out to be an adaptive coping strategy more than a driver of bad health outcomes in itself. That seems like more of a poetic explanation than one grounded in public health data. But by process of elimination and other suggestive data it appears the most plausible one. It's a fascinating piece.
Late Update: A number of readers have flagged this article in Forbes which suggests that the demographic realities in Russia aren't as bad as Gessen suggests. Some of the points - about improvements in the last few years - Gessen alludes to but does not emphasize. But this piece presents overall a very different picture.