Dying Russia

In the seventeen years between 1992 and 2009, the Russian population declined by almost seven million people, or nearly 5 percent—a rate of loss unheard of in Europe since World War II. Moreover, much of this appears to be caused by rising mortality. By the mid-1990s, the average St. Petersburg man lived for seven fewer years than he did at the end of the Communist period; in Moscow, the dip was even greater, with death coming nearly eight years sooner.

This is one paragraph from Masha Gessen’s story in The New York Review of Books on ‘The Dying Russians’. I knew that in the bleak years just after the collapse of the Soviet Union that Russian mortality rates had spiked dramatically – a mix of profound economic dislocation, hopelessness about the future, poor health both driving and being driven by these factors. What I did realize is that this pattern has continued unabated ever since.

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.