December 25, 2004

Those Disappearing Russians

Power and Population in Asia by Nicholas Eberstadt - Policy Review, No. 123
The most radical and dramatic shift in the relative population weight between major countries in the region, however, involves Pakistan and Russia. In 1975, Russia’s population was nearly twice as large as Pakistan’s (134 million vs. 70 million). By 2025, under medium variant projections, the situation will be virtually reversed: Pakistan will be just over twice as populous as Russia (250 million vs. 124 million).

The most conspicuous — indeed, startling — health and mortality setback in contemporary Eurasia is, of course, the one currently underway in the Russian Federation. Modern Russia has given the lie to the ameliorative presumption that literate, industrialized societies cannot suffer long-term health declines during times of peace. According to Moscow’s official calculations, the country’s life expectancy was lower in 2001 than it had been in 1961-62, four decades earlier. For Russia’s men, life expectancy had dropped by almost five years over that interim — but female life expectancy was also slightly down over that period. This anomalous circumstance could not be entirely attributed to the deformities of communist rule, for both male and female life expectancy were lower in 2001 than in 1991, the last year of Soviet power.

In absolute arithmetic terms, this Russian mortality crisis qualifies as a catastrophe of historic proportions. Over the extended period between 1965 and 2001, age-standardized mortality for Russia’s men rose by over 40 percent. Perhaps even more surprising, it also increased for Russia’s women by over 15 percent. Against the hardly exemplary health patterns of Gorbachev-era Soviet socialism, Russia has suffered a surfeit of “excess male mortality” since 1991 on the order of 3.5 million deaths — the equivalent, for Russia, of twice the deaths suffered in World War i. (Add “excess female mortality” and the post-1991 death toll rises by almost another million.)

Russia’s mortality crisis is concentrated on the population traditionally construed as “of working age.” For Russian men in every age grouping within the 20–64 spectrum, age-specific death rates in 2001 were at least 40 percent higher than they had been three decades before. In some cases (viz., men 45–54), they were over 60 percent higher. As for women between the ages of 20 and 59, their death rates were at least 30 percent higher in 2001 than in 1970-71. Russia’s cause-of-death statistics are far from perfect, but if overall reports can be trusted, the proximate explanations for these dismal trends were an explosion of deaths from cardiovascular disease (cvd) and injuries.

Reversing Russia’s long-term deterioration in public health will be a more difficult task than might at first be supposed. Throughout low-income Asia after World War ii, significant health advances were achieved through new, inexpensive, and relatively easy interventions to control infectious disease (e.g., sulfa drugs, ddt). Russia’s burden of illness today, however, is not primarily communicable and infectious, but instead overwhelmingly chronic and/or behavioral — the sorts of problems that are seldom susceptible to quick, cheap medical fixes. Moreover, death from such chronic illnesses as cvd tends to be due to an accumulation of offenses against the physiological system over the course of decades — and, to judge by mortality statistics, today’s Russian adults have been more assiduous than their parents in accumulating those offenses. Indeed, in 2001 Russian men in their late 20s had higher death rates than did men in their early 30s three decades earlier; men in their late 30s suffered nearly the same mortality rates as men in their late 40s from that earlier generation; and so on. At any given age, in other words, today’s Russians are more likely to succumb to fatal risk than their parents.

For broad segments of the current Russian population, simply returning to the health patterns of the early 1970s would be a formidable public health challenge. If Russian men in their early 40s were to reattain, by their late 40s, the same survival chances their fathers faced at that age, they would have to improve on the mortality rates of today’s 45–49 year olds by over 40 percent — and they would have to reduce their own future mortality rates to just five-sixths the level they currently experience. From today’s vantage point, that is a pretty imposing task. Success in that quest, moreover, should be evaluated in context: Male life expectancy in the Russian Federation in the early 1970s, after all, was just over 63 years — about the same as in India today.

According to unpd estimates, male life expectancy is lower today for the Russian Federation than for the world’s less developed regions. The unpd envisions that Russian male life expectancy will catch up with the less developed world’s levels by 2020-2025 — but for reasons just reviewed, such projections may prove too optimistic. It is hard to see how Russia can hope to develop a First World economy on the backs of a work force with a Third World health profile, and a Third World health profile is almost certainly Russia’s lot for the foreseeable demographic future. Consequently, it may not be too much to suggest that unfavorable mortality trends constitute a tangible factor that will constantly impede Russia’s recovery of economic potential, and restoration of influence on the world stage, in the decades just ahead.

Furthermore, Russia’s health future may look rather worse than we have so far suggested, for our analysis has as yet taken no measure of the possible impact of hiv/aids. hiv/aids has already made major inroads in Russia and could turn out to be a major cause of death nationwide in the years to come. Reliable estimates of hiv prevalence in Russia today are lacking — but in October 2002 a study by the U.S. National Intelligence Council (nic) suggested that as many as 1 million to 2 million Russians might be hiv-positive, and in May 2003, Dr. Vadim Pokrovsky, head of the Russian Federal aids Center, indicated that Russia’s hiv population might be as large as 1.5 million. By such figures, as many as 2 to 3 percent of Russian adults aged 15–49 could already be infected with hiv. Our limited understanding of hiv/aids means that we have no terribly accurate methods for predicting the future trajectories of the pandemic — but for what it is worth, the nic study suggested that adult hiv prevalence might reach 6 to 11 percent by the year 2010. Even presuming a less virulent spread of hiv through Russia, however, the impact of aids would be utterly devastating. A demographic-epidemiological modeling exercise for hiv in Russia undertaken by the author indicated that even with an epidemic stabilized by 2025 at 2 percent adult prevalence — a level possibly lower than Russia’s actual existing burden of hiv infection — life expectancy progress in Russia might be cancelled for the next decade. If hiv prevalence ends up closer to 6 percent, Russia’s life expectancy in 2025 would be a decade lower than otherwise anticipated — meaning it would be distinctly lower than today — lower even than at the time of Stalin’s death. And a 10 percent hiv prevalence rate would knock 16 years off Russia’s prospective 2025 life expectancy, pushing it into essentially sub-Saharan coordinates.
This is an intersting factoid.
To be sure, there are historical instances in which the shift of demographic weight between national actors seems to have been invested with real strategic significance. In the “struggle for mastery” in modern Europe, one thinks of the role of population in the ascendance of Germany over France during the nineteenth century. (The nineteenth century commenced with 11 French for every 10 Germans and ended with about 15 Germans for every 10 French.)