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Los Angeles Times
May 19, 1999

A Grim Diagnosis: Russia's a Sick and Dying Country


WASHINGTON--Watch as stiff, puffy, slow-moving, weak-voiced Russian President Boris N. Yeltsin fires another of his prime ministers these days, and you are seeing much more than a very sick man.

You're seeing the personification of a desperately unhealthy nation.

Rarely do the sciences of health statistics and demography play a role in international affairs. With Russia, they do. The Russian population of 147 million has become so remarkably unhealthy that its decrepitude could affect the country's role in the world for decades to come.

Things were bad enough in the last decades under the Soviet Union. For years, an American researcher, Georgetown University professor Murray Feshbach, chronicled the progressive decay of the Soviet health system.

But since the breakup of the old Soviet empire in 1991, the statistics show, Russia's death rates have increased as new stresses have compounded the earlier health problems.

In a provocative essay in the coming issue of Policy Review, Harvard University demographer Nicholas Eberstadt writes that Russia's crisis in public health "is historically unprecedented: No industrialized country has ever before suffered such a severe and prolonged deterioration during peacetime."

Eberstadt points out that this phenomenon has important political, economic and even military implications. Russian health problems, he says, could contribute to its relative economic decline for another generation. 

And poor health, he says, could well become a "significant constraint upon Moscow's prospects for reattaining Great Power status."

How bad is it in Russia today?

Every year, 700,000 more Russians die than are born. The population is in steady decline for the first time since World War II.

Russia's death rate was 40% higher in 1994 than the annual average during the three years from 1989 to 1991 (the last three years of the Soviet Union). Death rates have stabilized since then, but at high levels: In the first half of 1998, they were still 30% higher than at the time of the Soviet breakup.

Russians are dying at younger ages than in most comparable countries. The result, Eberstadt says, is that "Russia's health profile no longer remotely resembles that of a developed country. In fact, it is worse in a variety of respects than those of many 'Third World' countries."

Russia's life expectancy--68 as of 1997--fell short not only of America's 78 but also of Mexico's 73, according to Eberstadt. And for Russian men, life expectancy is now only 61. Experts debate what's causing Russians to die at such alarming rates.

Feshbach points to the country's environmental problems. In a recent issue of the Atlantic Monthly, he pointed out that bad water gives Russians high rates of dysentery, hepatitis and cholera, while bad air, lead emissions and radioactive and chemical contamination account for a variety of other ailments.

Eberstadt suggests that the root causes lie elsewhere. The cause-of-death statistics, he notes, show that Russia has experienced striking increases in two categories: first, cardiovascular diseases, such as heart attacks and strokes; and second, deadly injuries, including accidents, suicides and homicides.

"If cause-of-death statistics are to be believed, the world has never before seen anything like the epidemic of heart disease that rages in Russia today," he writes.

Bad diet, lack of exercise and heavy smoking all contribute to this epidemic. But above all, Eberstadt says, is alcohol abuse. Not only does it contribute to high rates of heart disease, but it is also a key factor
underlying the car crashes, industrial accidents, murders and suicides that make deadly injuries so prevalent in Russia.

Russia's alcohol consumption is difficult for Americans to imagine. "In 1996, over 35,000 Russians died from accidental alcohol poisoning," writes Eberstadt. "America is hardly a country of teetotalers, yet in the United States, a country with almost twice Russia's population, the corresponding figure averages about 300 persons a year."

A few other countries have experienced spikes in mortality rates comparable to Russia's today. But they were all in the midst of war or civil war: Germany and Japan at the end of World War II, Spain in the late 1930s and South Korea in the early 1950s. In these countries, war itself was followed by outbreaks of communicable diseases, such as pneumonia and influenza, but recovery was only a few years away.

By contrast, Eberstadt says, Russia will probably not be able to turn things around. Based on current trends, he says, Russia's overall life expectancy 20 years from now will be lower than the regional averages for either Asia or Latin America.

During the next two decades, Russia's economy, now the world's 13th largest, will slip as low as No. 20. And its military will find it ever harder to modernize or to project power across its borders.

In Moscow, politicians come and go. But the statistics tell a more enduring story. Russia's modern-day time of troubles won't go away any time soon.

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