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
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
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
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
"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.