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.”
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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.”
Societal Suicide
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)
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