There are few more shocking trips one can take in Russia than to the general wards of a major hospital. Despite the well-publicized problems of the Russian health care system, it is not the hospitals themselves, or their staffs, that give alarm: it is almost always the age of the patients and their condition.
“Lung disease, heart attack, cancer, alcohol poisoning, high blood pressure.” Tanya Rodinova, a 20-year-old nurse at this city's Hospital Number 4, reeled off the afflictions of five men, none of them yet 50. “The usual stuff. They are all going to die.”
It may sound dismissive, but it is certainly true. Russian men are dying in middle age at a rate unparalleled in modern history: from too much smoking, too much vodka, horrid diets, little exercise and the enormous stress of rapid economic change and social dislocation since the dissolution of the Soviet Union. Suicides are on the rise, so are murders, and some Russians wonder if yet another less tangible factor should be added: the gloomy Russian psyche. It is not the first time the question has been raised.
“It is the indifference toward everything that is vital -- toward the truth of life, everything that nourishes life and generates health,” Fyodor Dostoyevsky wrote in 1876, complaining of what seemed to be the incurable darkness of the Russian soul. “In our day this indifference -- compared, let us say, with the outlook of other, European nations -- is almost a Russian disease.”
It is not clear that such pessimism over the future and the health of the nation was justified 100 years ago. There can be no doubt that it is now. An astonishing drop in life expectancy for Russian men over the past decade, combined with one of the lowest birthrates on earth, has turned this country into a demographic freak show.
There is almost no current demographic fact about Russia that would fail to shock: per capita alcohol consumption is the highest in the world, nearly double the danger level drawn by the World Health Organization; a wider gap has developed in life expectancy between men (59) and women (73) than in any other country; the mortality rate of 15.1 deaths per 1,000 people puts Russia ahead of only Afghanistan and Cambodia among the countries of Europe, Asia and America (the rate for the United States is 8.8); the death rate among working-age Russians today is higher than a century ago. And there is much more.
“The current death rates present the clearest possible threat to the national security of Russia,” a special report to President Boris N. Yeltsin recently concluded. “Only extreme measures will help us out of this demographic crisis.”
Yet the health crisis has received little top-level attention and almost no money. The Government spends less than 2.6 percent of the gross national product on health care, far below the levels of other industrial nations. For the most part, it has been nationalist politicians and health care advocates who have led the debate on the mortality issue, casting it as “genocide” for the Russian people.
“I don't think when you are killing off half a million able-bodied men every year, it is unfair to call that genocide,” said Aleksandr Prokhanov, the extremist editor of the newspaper Zavtra and the intellectual leader of the nationalist opposition. To him and his allies, the figures reflect the economic changes of the Yeltsin era.
“How many have to die before we realize what is going on here?” he said.
Most demographers say the slide in health began long ago and was covered up by inconsistent and contradictory statistics. Whatever the reasons, the figures for the past five years are worse than ever: the mortality rate for Russian men age 40 to 49 was 16.3 per 1,000 in 1995, 77 percent higher than in 1990, when it was 9.2.
Even the good news is hard to take: Life expectancy for men may actually have risen slightly in 1996 from the previous year -- simply because the most vulnerable young people have already died. The raw number of sick children, appallingly high by any standard, appears lower this year only because so few children have been born over the past several years.
“It has become an issue of ethics, of morality and of politics,” said Dr. Valery Yelizarov, a demographer at Moscow State University. “No society can survive such patterns for long. What bothers me most is how people assume it is inevitable, part of the Russian male mentality. Russian men have always had an indifference to their health. But it has to stop or the consequences will be too awful to predict.”
Soon after Dostoyevsky noted the “Russian disease,” demographers carried out the nation's first major census and projected that by this time the population would be 400 million. Instead, it is 147.5 million, and the most recent report to Mr. Yeltsin suggests that if new health and education initiatives are not adopted soon the population of Russia will decrease by as much as 30 million in the next 50 years.
The implications of such change are stark. Of the 3.5 million people under age 60 who died in Russia over the past five years -- a figure with parallels in modern history only during vast famines or prolonged wars -- most have been working-age people desperately needed to help lift Russia from its depression.
In 1940, working-age people accounted for 40 percent of the population and the elderly 8 percent. Now the figure for the elderly is triple that proportion, nearly 24 percent, while that for working-age people has been cut in half.
No Confidence, No Children
And there is no sign of relief. Despite a slight rise in life expectancy, the Russian population fell by 480,000 last year, the steepest such decline in any year since World War II, according to state statistics.
“You do have to ask yourself how long can this go on?” said Carl Haub, a demographer with the Population Reference Bureau in Washington. Russia's low birthrate -- only Italy and Spain have lower ones -- is a clear reflection, he said, of a lack of optimism for the future among Russians.
“You keep expecting it to turn around and it doesn't,” he said. “Obviously there are very significant long-term implications to all this. People often focus on the death rate. And in Russia, of course, it is bad. But the birthrate and the health of children who are born play a much larger role than the death rate. They are the future of the country.”
Photo: A gloomy spirit oppresses Russian men. Poor diet and too much smoking and drinking don't help. (Stif Stasig/2Maj/Impact Visuals) Graph: “Mortal Coils” shows deaths in Russia for men aged 16 to 59 and women 16 to 54. Figures reflect data from 1990 and 1995. (Source: Russian Federal Statistics)