Health care and life expectancy: A letter from Russia (original) (raw)
Related papers
The Recent Mortality Decline in Russia: Beginning of the Cardiovascular Revolution?
Population and Development Review
The health situation in Russia has often been characterized as a long-running crisis. From the 1960s until the beginning of the 2000s, the declining life expectancy trend was substantially interrupted only twice: once in the mid-1980s as a result of Gorbachev's anti-alcohol campaign, and again at the end of the 1990s as a result of the “rebound” effect following the dramatic rise in mortality associated with the acute socioeconomic crisis. In both cases, the progress made proved to be short-lived. A third mortality decline in Russia began in 2003 and is still ongoing. We investigate the components and driving forces of this new development, in particular the role played by cardiovascular diseases. Using cause-specific mortality data, we identify the main features of the recent improvements and compare these features with those observed in selected European countries, specifically France, Poland, and Estonia. Our aim is to gauge whether the features of the improvements in these c...
The evolving pattern of avoidable mortality in Russia
2003
Life expectancy at birth in Russia is now over 12 years less than in western Europe. 1 The reasons for this difference are complex, reflecting the impact of factors acting at different levels and different points over the life course. One perspective is provided by the health field concept, which identifies four inputs to health: genetic predisposition; environmental circumstances; individual behaviour and lifestyle; and health services. 2 Although a combination of environmental and lifestyle factors, in particular the social consequences of rapid transition and excessive alcohol consumption, superimposed on high rates of smoking and poor nutrition, are the major determinants of the burden of disease afflicting the countries of the former Soviet Union, 3 it is also likely that timely and effective health care could ameliorate their effects.
Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what
Background According to published data, between 1984 and 1994 mortality rates in Russia initially underwent a rapid decline followed by an even steeper increase. In 1994, male life expectancy at birth was 57•6 years, having fallen by 6.2 years since 1990. There has been concern that such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated. Methods We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed mortality series for Russia so that we could examine the plausibility of various explanations for the mortality trends. Findings All major causes of death, with the exception of neoplasms, showed declines in mortality between 1984 and 1987 and increases between 1987 and 1994. In relative terms, these tended to be largest for the age-group 40–50 years; surprisingly, they were of the same magnitude among women and men. The largest declines and subsequent increases in proportional terms were observed for alcoholrelated deaths and accidents and violence. However, pronounced effects were also seen for deaths from infections, circulatory disease, and respiratory disease. No substantial variations were seen for neoplasms. Interpretation The stability of mortality from neoplasms in contrast to other causes over the period 1984–94 largely precludes the possibility that the changes in life expectancy are mainly an artefact, particularly one due to underestimation of the population. Although factors such as nutrition and health services may be involved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the mortality fluctuations observed. These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns within and between many other countries.
European journal of epidemiology, 2003
Since the beginning of the 1990s the public health situation in Russia has been characterized by an extremely high mortality and a significant reduction in life expectancy. Cardiovascular diseases remained the major cause of death. Only a few large population studies were conducted in Russia during this period. A total of 1968 men and 1737 women aged 18-75 years participated in a health survey in Arkhangelsk, Russia, over the period 1999-2000. Investigation included assessment of classic cardiovascular risk factors (family history, smoking, blood pressure, and blood lipids) along with general health variables. The paper presents sex specific data on risk factors for coronary heart disease. Though the cardiovascular mortality is high in Russia, the calculated risk for coronary heart disease (the Framingham risk score and the Norwegian risk score) was lower in all age groups of men and women in Arkhangelsk compared with studies from the Western Europe and USA. Our data suggest that hi...
Some aspects of alcohol-related mortality in Russia
Population and Economics, 2021
The aim of this communication is to comment on certain statements and conclusions presented in the paper on alcohol-related mortality by P.O. Kuznetsova from the medical viewpoint, summarizing and updating at the same time the preceding papers. The author refers to some evidence showing positive tendencies in Russia, namely, a decline in both the heavy binge drinking and total alcohol consumption, and claims that exaggerating the alcohol consumption problem indirectly shifts the responsibility for the relatively short life expectancy onto the excessive alcohol consumption, thus camouflaging shortcomings of the healthcare and public assistance.
Causes of the Russian mortality crisis: Evidence and interpretations
World Development, 1998
During 1992-94 life expectancy at birth in Russia dropped by 6.1 years for men and by 3.3 years for women. Very little individual-level evidence linking mortality experience with social conditions and behaviors is available. This article puts together evidence from analysis of routinely collected data on changes in Russian mortality. These data suggest that the mortality upsurge cannot be attributed to absolute deprivation, collapse of the health system or environmental pollution. Instead, psychological stress caused by the shock of an abrupt and severe economic transition is likely to have played a major role mediated in part by the adverse health effects of excessive alcohol consumption.
Mortality from external causes in Russia over half a century
Демографическое обозрение
The article discusses long-term mortality trends (since 1956) from external causes of death in Russia. Russia has long lagged behind developed countries in this domain. The level of mortality from external causes of death remains high and its structure is still archaic with large contribution of homicides, alcohol poisoning and injuries of undetermined intent. Excess number of deaths from life tables of Russia and Western European countries is compared. It is shown that in Russia the greatest excess losses are associated with mortality from poisonings among both sexes, suicide among men and homicide among women. Mortality from external causes, along with mortality from diseases of the circulatory system, has had a significant impact on life expectancy. In general, over the period 1956-2012 the increase in mortality from external causes in the 15-64 age group reduced life expectancy by 2.6 years for males and 0.7 years for females. The decline, starting in 2003, of mortality from ext...
MORTALITY IN RUSSIA: THE SECOND EPIDEMIOLOGICAL REVOLUTION THAT NEVER WAS* ANATOLY VISHNEVSKY
Demographic Review, English selection, 2015
The article looks at different approaches to the conceptualization of the modern stage of mortality reduction (the "new stages" of the epidemiological transition, "the second epidemiological revolution", the "health transition"). During this stage, which has lasted for at least half a century, revolutionary changes have taken place in most developed countries. These changes manifest themselves in the drastic expansion of the degree of control over non-infectious causes of death-particularly over diseases of the circulatory system, neoplasms, and other non-communicable diseases, as well as over external causes of death. As a consequence of these changes, there has been a rapid shift of deaths from the abovementioned causes to older ages, an increase in the mean age of death from these causes, and, ultimately, a significant rise in life expectancy. Russia, unfortunately, is watching this revolution from the outside, without taking any part in it. The age distribution of deaths from major classes of causes of death in Russia has not changed over the past half-century, life expectancy has stagnated, and Russia has increasingly lagged behind the majority of developed countries with respect to this indicator. Thus, the "second epidemiological revolution" has yet to occur in Russia.