Demography II – Out of the Death Spiral

As we covered in the previous instalment, Demographics I: The Russian Cross Reversed?, fertility rates are not abnormally low by European standards and are likely to rise further in the future. The same cannot be said of mortality rates – a ‘quiet crisis‘ that has been a ‘catastrophe of historic proportions’.

Take life expectancy. As of 2007, the average age of death in Russia was 65.9 years. This is way below First World levels (United States – 78.0; EU – 78.7; Japan – 82.0) and even many developing country standards (Mexico – 75.6; China – 72.9; Egypt – 71.6; India – 68.6). Note: this figure was actually 67.7 years in 2007 (the CIA relies on its own projections to estimate demographic data), but the general point stands.

Even compared to other post-Soviet countries, Russia’s mortality stats are far from impressive – as you can see from the graphs in that link, total life expectancy, male life expectancy and death rates for both sexes all hovered near the worst levels. Nor is so-called healthy life expectancy anything to write home about (in 2002, it stood at 53 years and 64 years for men and women respectively, compared with 55/64 for Ukraine, 63/68 in Poland and 67/71 in the US).

Russia’s infant mortality rate, at 10.8 / 1000 people in 2008, is respectable compared to countries of roughly similar income levels (Mexico – 19.0; Latvia – 9.0; Poland – 6.9) and far better than most developing countries. Nor is Russia’s female life expectancy all that bad compared with the typical Asian or Latin American country. The same cannot be said of male life expectancy. According to CIA estimates, in 2008 it stands at a meagre 59.2 years – the US (75.3), Poland (71.4), India (66.9), Ukraine (62.2) and even Bangladesh (63.2) score higher, while Russia’s neighbors in this area are the likes of Madagascar (60.6) and Ghana (58.7). The main reason is amazingly high mortality rates for middle-aged Russian men, which by Rosstat calculations are somewhat higher today than they were in 1897.

Age specific mortality rates / 1000
Left: men; right: women.

As you can see from the graph above, by far the biggest change between 1897 and 2005 occured in a massive reduction in infant mortality, from 233 / 1000 to just 12.5, as well as in children and teens. This was in large part due to basic and fairly cheap to implement advances in vaccinations and basic obstetrics (the latter of which has practically eliminated maternal mortality as a major cause of death amongst women). Female mortality has improved all around, although not to the same extent as in European countries. Yet male mortality has remained stagnant, comparable to old Tsarist and modern African levels.

This is best illustrated by a measure called “Probability of dying (per 1 000 population) between 15 and 60 years”. For Russian women in 2005, this was 17% – not much worse than, say, Egypt. Yet almost half of Russian men, at 47%, died before reaching retirement age. This compared with 9% in Japan, 14% in Finland and the US, 16% in China, 21% in Poland, 28-33% in the Baltic countries and 40% in the Ukraine. In fact, it was worse than in many African countries, e.g. Ghana (36%) and Ethiopia (41%). The only states to have the dubious distinction of beating Russia in this sphere were those with mass AIDS epidemics, like South Africa (60%) and Botswana (76%).

Eberstadt’s Russia: Too Sick to Matter? is as relevant to mortality today as when it was written in 1999. To quote it in extenso:

For every subsidiary age group from 15 to 65, death rates for Russian men today are frighteningly high. Youth may be the prime of life — but Russian men in their late teens and early 20s currently suffer higher death rates than American men 20 years their senior.13 For their part, Russian men in their 40s and 50s are dying at a pace that may never have been witnessed during peacetime in a society distinguished by urbanization and mass education. Death rates for men in their late 40s and early 50s, for example, are over three times higher today in Russia than in Mexico. To approximate the current mortality schedule for Russian middle-aged men, one has to look to India — the India, that is, of the early 1970s, rather than the much healthier India that we know today.14

It is beyond doubt that Russia’s healthcare system has improved in the last one hundred years, and despite its flaws, it is light-years ahead of countries like Ethipia or India, as measured by infant mortality rates, health spending per capita or immunization rates. So how come mortality, especially amongst middle-aged men, is so astoundingly high? To answer the question, it is instructive to look at the historical trends.

Russia life expectancy 1890-2000
Note how overall improvements in life expectancy for men were exclusively
due to the removal of childhood illnesses as a major cause of death.

In 1897, life expectancy in the Russian Empire was extremely low (31 years for males, 33 for females), lagging behind Western Europe and the US by around 15 years. The 1920’s and the period from 1945 to 1965 saw the introduction of mass elementary healthcare, raising life expectancy to 64 years for men and 72 years for women. Since then, the latter has stagnated while the latter went into slow but steady decline, in constrast to First World nations where life expectancy continued rising (see graphs below).

Life expectancy in Russia and other countries 1950-2000
Note how Russia trailed Japan up until 1965.

From the first graph on my Demographics I post, we can see that from the mid-1960’s mortality in Russia embarked on its merciless upwards trajectory (thus reflecting life expectancy trends). Notice how despite the dips (late 1980’s, late 1990’s, 2007?) and troughs (early 1990’s, early 2000’s), it follows a remarkably straight line. Rapid improvements, in which Russia followed Japan’s trajectory, stalled in the mid 1960’s and have been in stagnation ever since. (The Soviet Slavic and Baltic states followed a similar pattern, e.g. see stats and discussion on Ukrainian historical mortality here).

As of 2006, the vast majority of Russians died from cardio-vascular diseases (CVD’s) and injuries/violence. Some 8.6 / 1000 Russians passed away due to CVD’s, which is more than the America’s entire death rate (8.3 / 1000). In contrast, 2.8 / 1000 of Americans died from CVD’s. Russia’s deaths from external causes (DEC’s) were 2.0 / 1000, about four times higher than in the US. Of these, 23 / 100,000 were from alcohol poisoning, 30 / 100,000 from suicide and 20 / 100,000 from murder. On the other hand, cancers did not kill a significantly higher amount of people than in the West, while deaths from infectitious diseases are quantitavely insignificant. So it is clear than any solution of the mortality crisis will have to focus on reducing deaths from CVD’s and injuries / violence.

Historically, it can be seen below that deaths from diseases of the circulatory system have almost doubled since 1970. Forty years ago about an equal percentage of people died from circulatory diseases in both Russia and Europe (although even then, we should point out that this was not a good indicator, since Russians were substantially younger than Europeans then); today, they are separated by a factor of 4, as can be seen in the graph below. Deaths from injuries / violence have followed roughly similar trends.

1970-80 linear projection is mine by Rosstat data

Finally, life expectancy and mortality rates vary by geographical region and socio-economic factors. Siberia, the Far East and the North fare worse in relation to the Volga and the South – in particular, regions like Daghestan and Ingushetia with burgeoning populations of young Muslims were completely immune to the soaring post-1965 mortality rates in Russia proper. In Russia proper, the poor report worse health than the rich (see p.68) and rising mortality has mostly affected those who are poorly-educated (‘The well-documented mortality increases seen in Russia after 1990 have predominantly affected less-educated men and women, whereas the mortality of persons with university education has improved, resulting in a sharp increase in educational-level mortality differentials’).

Having outlined the situation, we can now ask ourselves several questions.

Why have Russia’s mortality rates, especially amongst less well-educated ethnic Russian men, soared since 1965 in such stark contrast to trends in the First World?

Веселие Руси есть пити [The joy of Russia is to drink]. – attr. Vladimir the Great, 988 AD, upon rejecting Islam as Russia’s future religion.

At its core, the mortality crisis is an alcohol crisis. Russia has had a long and rich relationship with alcohol from the times of Kievan Rus. From the earliest days excessive drinking was remarked upon in foreign travellers’ accounts. Ownership or regulation of vodka production has been a major source of state revenue since Ivan IV created a chain of taverns in all major cities through to the USSR, when in the 1970’s receipts from alcohol constituted a third of government revenue. Furthermore, Russian drinking is characterized by the zapoi, long binge sessions involving hard spirits. Nonetheless, until the country became industrialized, excessive regular drinking was circumscribed both by limited incomes (in the 17th century, a keg (12 liters) of bread wine was estimated to cost as much as one and a half or two cows) as well as traditionalist mores and folk wisdom.

Perhaps it was the beginning of the breakdown in social morale that had become endemic by the 1980’s. Perhaps it was linked to a tipping point in the level of development (half of Russians were living in cities by the 1950’s). Perhaps it was the after-effects of Red Army soldiers who had been given daily 100ml vodka rations during the Great Patriotic War (1941-45), became alcoholics and started dying in ever increasing numbers 20 years later. In any case, mortality rates began to increase dramatically since 1965, reaching epidemic proportions by the 1980’s. To quote Alcohol in Russia by Martin McKee in extenso:

Potentially more reliable figures have been generated outside the USSR by, for example, surveys of emigrants, especially to Israel, although these are problematic as there is evidence that Soviet Jews drank rather less than their Slavic neighbours. Nonetheless, one of the most rigorous studies, although again likely to be an underestimate because it did not include that large volume of alcohol now known to be stolen each year, suggests that consumption more than doubled between 1955 and 1979 to 15.2 litres per person (Treml, 1975). This figure is higher than that recorded for any OECD country (France was highest at 12.7 litres in 1990, although most other countries were in the range 5–9 litres), where data are largely derived from validated surveys of consumption (World Drink Trends, 1992). Also note that Russians tend to binge on hard spirits, while the French consume red wine in frequent moderate doses. Of course, this figure relates to the entire USSR and, for religious and other reasons, there are marked regional variations so levels in the Russian heartland are likely to have been much higher. Other studies of emigré families suggested that alcohol consumption accounted for 15–20% of disposable household incomes. Studies by dissidents and others supported the impression that alcohol consumption was increasing at alarming levels, suggesting, for example, that alcohol accounted for 15% of total retail trade (Krasikov, 1981).

Under Gorbachev, official statistics on a wide variety of topics slowly reappeared, although it was still not possible to undertake or publish research on topics such as alcoholism and social breakdown (Korolenko et al., 1994). The available data included figures on official production of absolute alcohol equivalent which was reported to have increased from 2.2 litres per capita in 1940 to 7.2 in 1985, a rather greater increase than had been assumed in the earlier estimates by Western observers.

However, the level of consumption is only one part of the picture. It is also important to know whether the frequency of drinking and the social context within which it takes place are different from those in other countries. Here, the information is even more fragmentary. Various reports suggest that, by the 1980s, the age at which people began to drink had fallen, that increasing numbers of women and children were heavy drinkers, and in some cities the average consumption among working adults was a bottle of vodka each day (White, 1996).

This pattern is reflected in the extensive evidence, reviewed by White (1996), from newspapers and from local surveys that alcohol consumption was becoming a major social problem. This included reports from a chemical plant that 3.5% of the workforce were confirmed alcoholics, 2.2% showed early signs of addiction, and a further 18.8% were alcohol ‘abusers’, with only 1.4% abstainers. Between 75% and 90% of absences from work were attributed to alcohol. It was suggested that loss of productivity associated with alcohol was the main reason for the failure to achieve the Soviet Union’s 5-year plan in the early 1980s, with estimates that the loss of productiv-ity due to alcohol was up to 20%. There were many letters to newspapers complaining of a lack of government action to tackle excessive consumption.

Refer to the male life expectancy chart above. Notice the slight uptick around 1982, and the much larger improvement from 1985-89? It is not a coincidence. In 1982 ‘action was initiated under Andropov and Chernenko under the general heading of reducing anti-social behaviour’, and three years later a wide range of specific action against alcohol abuse was undertaken – the banning of drinking at workplaces, banning sales before 2pm and in trains and restricting sales to off-licenses and over 21’s. Vodka production was cut and alcohol was banned at official functions (interestingly enough, today, there is noise but no action). Alas, initial successes were undermined by black market moonshine (read: more dangerous) production, while the new climate of perestroika decreased the risks of minor lawbreaking. The project was abandoned in 1988. From 1990 to 1994, the price of alcohol in relation to food fell by a factor of more than 3.
Predictably enough, alcohol consumption soared. Life expectancy plummeted.

Alcohol consumption estimates in litres per year
Look at the mortality trends of the first graph here and notice the remarkable
correlation between alcohol consumption and mortality rates.

Furthermore, we noted in this post that mortality rates were 1) geographically not uniform (lowest in the South and Volga) and were worst amongst 2) less well-educated 3) men. Guess what?

Nine per cent of men and 35% of women reported not drinking alcohol at all. Only 10% of men and 2% of women reported drinking several times per week, but 31% of men and 3% of women would drink at least 25 cl of vodka at one go at least once a month, and 3) 11% of men and 1% of women would drink at least 50 cl of vodka in one session at least once per month. There were large geographical differences, 1) with lowest rates of heavy drinking in the Volga and Caucasus regions and highest in the Urals….Unemployment was strongly associated with heavy drinking.

According to a NOBUS survey in 2003 (see pg.68), more than 50% amongst the poorest quintile of Russians consumed hard alcohol daily, compared with little more than 10% of the richest quintile. Since the poor tend to be less well educated, that’s 2) met.

Since 2002, alcohol consumption has remained extremely high. In 2006, it was an ‘estimated 15.2 litres of pure alcohol per capita each year for over-15s’ (no difference from 2002). Another study found that 44% of male deaths and 20% of female deaths can be attributed to alcohol in those aged 25 to 54, including 72% of homicides, 42% of suicides and 23% of CVD’s – in total, 32% of aggregate mortality, compared with 1-4% in all sampled West European countries. Even in Finland, well known as a nation of hard drinkers, the figure was just 4%.

On the other hand, there have been some positive developments, especially since 2005. The mortality rate fell from 16.1 / 1000 to 14.7 / 1000 by 2007. Death rates from CVD’s fell from 9.1%% to 8.3%% and death from external caused tumbled from 2.2 / 1000 to 1.8 / 1000. Perhaps most crucially, deaths from alcohol poisonings halved, while homicides fell by 30%.

What could have accounted for this? Recent times have seen a rise in national morale, documented here. Burgeoning economic growth has seen real incomes nearly triple in the last eight years and the poverty rate halved. The population, or at least its more connected members, has become more exposed to information on healthy lifestyles. During Putin’s second term, there have been more social investments, like the National Priority Projects (one of which is health), and this trend looks set to intensify under Medvedev. Finally, as we’ve noticed here, younger people are turning to beer – ‘beer consumption has risen from 20 litres per person a year to nearly 80 litres’. Considering that total alcohol consumption under Putin has remained about constant, this means that vodka’s 70% share of Russia’s alcohol consumption in 2001 must have fallen since.

In conclusion, it’s safe to say that alcohol is by far the biggest contributor to Russia’s mortality crisis. On the other hand, Russia, and more particularly working Russian men, pursue lifestyles that are practically optimized for ending them. In 2004, 61% of Russian men (and 15% of women) smoked – one of the highest rates in the world and little changed from Soviet times. (Mass smoking began during and immediately after the Second World War, while mortality began to rise 20 years later). Men smoked an average of 16 cigarettes per day. The Russian diet is ‘characterized by a diet high in animal fat and salt, and low in fruits and vegetables’ and many Russians suffer from high blood pressure and excessive blood cholesterol levels. Most Russians lead a sedentary lifestyle – ‘from 2000 to 2002, 73-81% of surveyed men and 73-86% of women aged 25-64 reported having low-levels of physical activity (CINDI 2004)’. Finally, the healthcare system suffers from a legacy of underfunding (real public health expenditure only overtook late Soviet figures in 2007) and inefficiency.

The general population is aware of the problems. Putin is not too impressed either, as he made clear in his state of the nation address in 2005.

I am deeply convinced that the success of our policy in all spheres of life is closely linked to the solution of our most acute demographic problems. We cannot reconcile ourselves to the fact that the life expectancy of Russian women is nearly 10 years and of men nearly 16 years shorter than in Western Europe. Many of the current mortality factors can be remedied, and without particular expense. In Russia nearly 100 people a day die in road accidents. The reasons are well known. And we should implement a whole range of measures to overcome this dreadful situation.

I would like to dwell on another subject which is difficult for our society – the consequences of alcoholism and drug addiction. Every year in Russia, about 40,000 people die from alcohol poisoning alone, caused first of all by alcohol substitutes. Mainly they are young men, breadwinners. However, this problem cannot be resolved through prohibition. Our work must result in the young generation recognizing the need for a healthy lifestyle and physical exercise. Each young person
must realize that a healthy lifestyle means success, his or her personal success.

Which is why the state has set itself the task of stopping negative natural population growth by 2011 and raising life expectancy to 75 by 2020. The billion dollar question is: will they succeed?

How and to what extent can Russia solve its mortality crisis?

The pessimistic demographers are skeptical of Russia’s ability to solve the mortality crisis any time soon. For instance, according to Eberstadt, achieving rapid improvements in mortality from CVD’s is unrealistic:

With heart disease, in a real sense, today’s “bills” cover “debts” accumulated over long periods in the past. For this reason, trends in deaths from heart disease in any country can never turn on a dime. Even with sensible, well-funded medical policies and wholesale popular embrace of a more “heart-healthy” lifestyle — none of which conditions obtain in today’s Russia — the control and reduction of CVD death rates tends to be a relatively gradual affair.

Furthermore, Russia suffers from ‘negative mometum’ in mortality. Working age life expectancy has been decreasing for forty years straight. In a sense, young Russians today are much ‘older’ than their peers of the same age a generation ago. Two assumptions are made. Firstly, as today’s young people are less healthy than their equivalents forty years back (who are now dying at already very high rates), this implies that when they reach their forties, fifties and sixties, their mortality will be even higher. Secondly, the population continues to get older, as the post-war boomers reach pension age. This creates the conditions for a demographic double wammy that, everything else remaining equal, will further depress life expectancy and massively inflate mortality levels even further. An example of these simplistic trend extrapolation can be seen in this model, according to which male life expectancy will fall to as low as 49 years by 2050. This is what we’d call a Stagnation scenario.

If this ‘debt model’ of national health is correct, and if societal attitudes remain stuck in the past, then Russia should indeed reconcile itself to continuing increases in the death rate and accelerating population decline. Fortunately, there is evidence that the first of the above assumptions is flawed.

Generational mortality for men 1981-2006
Indicates mortality levels for each age group for a given year. Lowest line
correspondsto the 40-44 age group, second lowest to the 45-49 age group in 2006, etc.
Colors track out a particular generation’s demographic history,
e.g. pink is the generation who were 60-64 years old as of 2006.

Take a look the above graph. Firstly, notice how mortality amongst all age groups rise and fall with each other. This implies that that in Russia, the factors leading to high mortality affect all age groups about equally. (If it hadn’t – if for example heavy drinking had only been increasing in the younger generations – then the lines above would have overlapped, or at least gotten closer together, as the younger generations started dying more relatively to the older). This puts into question Eberstadt’s whole ticking time-bomb thesis.

But more importantly, notice how mortality amongst all age groups declined from 2001 to 2006. Let us also note that this period came before the health National Priority Project. Nor did alcohol consumption decline, as we noted (although young people started drinking more beer – but we’re talking about middle-aged people here, and the fall in mortality amongst those in their sixties was if anything greater than in other age groups). There was a small drop in cigarette smoking rates, but benefits from that come with at least a few years’ lag. Yet a tipping point seems to have come at around 2005. Remember the 47% male “probability of dying” rates from 15-60 years in 2005? Well, according to Rosstat, in 2006 they fell to 43%, and fell further in 2007 (judging from the fact male life expectancy increased from 58.9 in 2005 to 60.4 in 2006 and 61.5 in 2007).

There is, however, a factor which explains flunctuations in Russia’s life expectancy much better than any other theory. That is the ratio of alcohol to food prices, as shown below. Notice how all price spikes and dips were associated with troughts and crests in life expectancy, especially pronounced amongst men.

Alcohol / food price ratios and life expectancy

Which takes us to the next part of the discussion. What is the government doing to promote healthy lifestyles, and what should it do?

For that, it is sufficient to look at a typical issue of the bi-weekly Russian demographic journal Demoscope Russia section – plans to raise pensions from 30-35% to 60-65% of wages, general increase in welfare, raising the alcohol-buying age to 21 and banning alcohol and tobacco adverts on transport. Increasing numbers of patients are getting access to hi-tech medical care. Even La Russophobe noticed these efforts, which must mean Russia is doing something right. In other words, all the things done in the West since the 1970’s and which the USSR tried to do in the 1980’s but gave up on.

In 1990, “probability of dying” rates for Russian and Estonian men were similar (32% and 30%, respectively), and both soared by 1995 (47% and 40%, respectively). In the next ten years, however, Estonia’s figure plummeted to 28%, while Russia in 2005 remained at 47%, falling only slightly in the interval. As we’ve noted, however, by 2007 this figure was probably already below 40%. Contrary to Eberstadt’s protestations to the contrary, rapid improvements in mortality stats are possible, and at no great expense if the ‘population-based and high-risk prevention strategies’ recommended here are pursued. The example of Karelia in Finland is illustrative:

The North Karelia Project in Finland shows that major changes in mortality from NCDs can be achieved through dietary changes, increased physical activity, and reduced smoking, serum cholesterol, and blood pressure. Coronary heart disease(CHD) in adults aged 65 years and less fell by about 73 percent between 1970 and 1995. In a recent 10-year period, mortality from coronary heart disease declined by about 8 percent a year. Mortality from lung cancer declined more than 70 percent, mostly due to consistent declines in the proportion of men who smoked (from 52 percent in 1972 to 31 percent in 1997). Data on the risk factors from ischemic heart disease and mortality in Finland suggest that the changes in the main coronary risk factors (serum cholesterol concentration, blood pressure, and smoking) can explain most of the decline in mortality from that disease.

As a result of targeting important high-risk factors for NCDs, all causes of mortality in North Karelia declined by about 45 percent during 1970–95. In the 1980s, these favorable changes began to develop all over Finland, improving life expectancy by 7 years for men and 6 for women. The largest decline in age-specific mortality was reaped by the 35- to 44-year-olds: men in this age group saw an 87 percent decline in mortality from CHD between 1971 and 1995. Men 35–64 saw age-adjusted mortality rates decline from about 700 per 100,000 populationin 1971 to about 110 per 100,000 in 2001. This rate for all of Finland among men in the same age group was about 470 per 100,000 and fell 75 percent. These improvements in life expectancy are correlated with significant declines in the amount of saturated fats consumed, coming mainly from milk products and fatty meat (saturated fatconsumption dropped from about 50 gr/day in 1972 to about 15 gr/day in 1992) and significant reductions in blood cholesterol levels (from about 7mmol/L in 1972 to about 5.6 mmol/L in 1997).

…Data from North Karelia reveal that results from preventionefforts may appear in years rather thandecade—improvements occur some 2-7 years after the elimination of the exposure to a risk factor, and that they are beneficial even for people in older age groups.

This suggests that if the trends explained above continue and people continue jumping up income classes, health improvements are sustainable. There’s a handy chart below showing the effects of decreasing different types of mortality on life expectancy.

Even if the only Improvements were a 40% drop in deaths from circulatory diseases and external causes, average life expectancy in Russia would rise to a respectable 72 years (in line with what happened in Estonia, where life expectancy grew from 67.8 years in 1995 to 73.0 years in 2005). On the one hand, Karelia was just one region; on the other, today’s medical technology is much more advanced than even a decade ago. As such, I think the idea of raising life expectancy to 75 years by 2020 is fulfillable, and that is not even taking into account the emerging technologies of life extension – which should be zealously pursued for both its financial (acturial escape velocity) and more tangible everyday benefits (like being able to live as long as you want).

Talking of which, we now move on to the fun bit – the Transformation scenario. This is an event or series of events which would induce a demographic paradigm shift. In the previous post, we’ve identified the artificial womb as a revolutionary concept for supply-side demographics, which will make the ‘birth rate’ independent of sociological factors. What would be revolutionary for the demographic depreciation rate (death rates)? Continuous and exponential growth in life expectancy. How could that be achieved?

Well, to an extent that is the case already.

Life Expectancy in England & Wales, both sexes, 1541-1998
Life expectancy at birth of male landowners in England between 1200 and 1450 AD,
so not strictly comparable with later, more detailed stats.

As you can see, from a historical perspective life expectancy before the Industrial Revolution was essentially stagnant. There were macro-trends associated with pressure on the earth’s carrying capacity, which drove down life expectancy in the 1200’s and 1550-1750, as well as sudden dips due to chaotic factors (the Black Death in the middle of the 14th century, fluctuations from 1500-1800 due to random climate changes impacting on food production), but on the whole it stayed flat. However, around 1750, there was a turning point, coinciding in time with the Agricultural Revolution. The 19th century saw considerable improvement, while in the 20th century it shot upwards.

Granted, the 1900-1960 growth spurt was mainly due to massive reductions in infant mortality rather than adult longevity increases per se. On the other hand, the former stopped playing a substantial role by 1960, and improvements in life expectancy occured mainly through the lowering of adult mortality rates. Since then, the sum of Western lifestyle and healthcare changes decreased adult mortality and pushed life expectancy up. (In the USSR, as we’ve noticed, healthcare remained stagnant and lifestyles worsened, so life expectancy sloped down).

However, now Russia has rejoined the mainstream of world development and as we’ve pointed out here and here, rapid economic convergence with the First World is likely. In the latter, life expectancy has been rising by around 0.3% per annum since 1970. Serious interest and research is already under way, such as the Methuselah Mouse Prize and Aubrey de Grey’s work on strategies for engineered negligible senescence (SENS).

The seven sisters that Dr de Grey wishes to slaughter with SENS are cell loss, apoptosis-resistance (the tendency of cells to refuse to die when they are supposed to), gene mutations in the cell nucleus, gene mutations in the mitochondria (the cell’s power-packs), the accumulation of junk inside cells, the accumulation of junk outside cells and the accumulation of inappropriate chemical links in the material that supports cells.

For more information, read the above Economist article, the wiki entry and a related collection of articles. Unfortunately, however, these technologies are not going to be making a truly revolutionary impact demographically any sooner than in about three decades (10 years to perfect them in animal experiments; another 10 to conduct the necessary human experiments; the final 10 to bring them into mass usage).

Nonetheless, the potential already exists today to radically prolong life expectancy.

Improvements in lowering rates of mortality attributable to alcohol to decent levels will reduce them by maybe 25%. Lowering tobacco usage to normal Western levels of 20-25% and environmental measures could reduce it by another 10%, while better healthcare could account for another 20%. This would lower Russia’s mortality rate from 14.7 / 100,000 to 8.9 / 100,000, which is comparable to the US (a country whose median age is about the same as Russia’s).

The Myth of Economic Collapse due to Ageing Population

According to a Stagnation (extrapolation of today’s fertility and age-specific mortality trends, which sees Russia’s population falling by 12% to 2025), the proportion of population aged 65+ will increase from 12% to 18% – but the latter figure is actually equal to Estonia’s percentage today, whose main problems today are purely macroeconomic (big CA deficit) rather than entitlements. The World Bank’s 15th Russian Economy Report itself admits this:

But growing older does not have to mean growing slower. Aging is not a stop sign for growth – if Russia enacts policy reforms that sustain productivity growth. Changes in labor markets are not immutably determined by demographic legacies. Productivity improvements are the core predictor of growth, so measures to improve labor productivity would swamp any “quantity” effects of a smaller labor force. In fact, in recent years, growth decomposition exercises show that in Russia labor productivity growth has been the single greatest contributor to increases in per capita income.

Considering that the gap between (high) human capital and (low) GDP per capita is so great in Russia, productivity growth should continue to be buoyant for the foreseeable future. Furthermore, considering that in the future older Russians will be both healthier and more educated, an ageing workforce could be counteracted by increased labor participation of the older cohorts in the economy.

Is Russia facing an AIDS Catastrophe?

According to Eberstadt’s ‘Intermediate Epidemic’ scenario in The Future of AIDS, there will be a cumulative total of 13mn AIDS cases in Russia by 2025, 9mn would have died and life expectancy will be down to just 63 years. Other media have also homed in on the apocalyptic dimensions of Russia’s AIDS crisis.

According to government figures, the number of new cases peaked in 2001 at 87,000, but has since stabilized at around 40,000-50,000 per year from 2003 on. As of 2007, there were 402,000 cumulative AIDS cases. However, although Russia’s AIDS epidemic was at first concentrated amongst injecting drug users (IDU’s), ‘HIV-infection is starting to spread more intensively heterosexually’. The share of women diagnosed with HIV every year increased from 20% in 2001, to 38% in 2004 and 44% in 2006. However, other assessments of the share of Russia’s HIV prevalence are usually about three times higher than official figures. HIV prevalence among pregnant women in Russia was 0.3% in 2004 and 0.4% in 2005 and 2006.

But there are good points too. Since 2006, the federal government has started spending huge amounts on the problem. Syphilis and hepatitis B have fallen sharply from their respective 1997 and 1999 peaks. The incidence of tuberculosis peaked in 2001 at around 95 / 100,000, although the fall hasn’t been as dramatic (82 / 100,000 in 2007). According to official sources, AIDS monitoring coverage in Russia consists of 20% of the population, including all the high-risk groups, so perhaps official figures aren’t such big underestimates after all.

The reality is that I simply don’t know enough about this to make a judgement either way, but then again, it is not even known why AIDS exploded in sub-Saharan Africa but remained contained everywhere else. If readers can point to more concrete information on this topic (AIDS in Russia) it would be much appreciated.

Now for Demographics III – Face of the Future


  1. Oleg Nevestin says:

    stalker, please tread carefully here. If you come up with anything that says that Russia is not about to disappear within 20 years, you’ll get a lot of Russophobes staring into abyss of underemployment, and hordes of Russophobes’ children unable to come up with soaring college tuition. Be sensitive. US stock market is about to break on the downside, and you surely don’t want to multiply American misery, or do you? Demography is all these people have left to lie about. Please, remember that.

  2. To be fair, objectively, things on the mortality front actually are quite dire. So perhaps our beloved Russophobes will indeed be saved from the gutter…just.

  3. Anonymous says:

    Stalker,I was reading the table regarding migration to the Russian Federation. The last year was 2006. Due to the incentives being offered by the Russian goverment for immigration and the increasing economic separation between Russia, UKR,BLR,KAZ and Baltics is their any indication that immigration is increasing in 2007 and 2008? I would expect an acceleration in immigration soon.DJP

  4. Anonymous says:

    Stalker,I am sure you have read Leonid Fedun’s comments about Russian oil production. If not here is the link: needs to gradually scale down to about 5-7 million barrels a day. Placing money in the reserve fund is wasting it. This money is in a paper currencey which is declining. Russia may never even get to spend this money! I hope this wakes up Russia in regards to the energy situation and the goverment mobilizes to conserve precisous black gold for the future. DJP

  5. Anonymous says:

    Stalker A question and answer with Andrey Parshev. Probably one of the most interesting interviews I have read in years.

  6. Anonymous says:
  7. @djp,240,000 net immigrants arrived in Russia in 2007, compared with 150,000 in 2006. ( This is substantially larger than in recent years, although lower than in the early and mid-90’s, when many Russians from the “Near Abroad” returned.I doubt it will rise substantially in the near future, however, since the government has capped migration at between 180,000 and 300,000 people per year, IIRC.@all,If you multiple post, please keep on topic (in this case, demographics). I greatly appreciate input on other matters but can you please do it by email (darussophileATyandexDOTru) or in a relevant post.

  8. Fedia Kriukov says:

    Very informative and interesting. A small nit to pick:”many Russians suffer from high blood pressure, excessive blood cholesterol levels and hypertension” ==> hypertension is in fact high blood pressure.As an additional note, when I used to engage in arguments about the effects of alcohol consumption on demographics (believe it or not, many Russians simply refuse to accept the reality), I also used a comparison between predominantly Muslim republics and Slavic oblasts. If you compare infant mortality, which is often used to represent the overall quality of the medical system, you will find that it is significantly higher in poorer Muslim regions. But if you compare male life expectancy, you will find that Muslim men live much longer. That’s despite the apparently inferior medical care. Why? Because Muslims traditionally don’t drink.Another piece of evidence is detailed statistics of improved life expectancy during Gorbachev’s anti-alcohol campaign. The more alcohol a certain group consumed, the greater rise in life expectancy it experienced. So Slavic men benefited the most (3 years, if I’m not mistaken), Slavic women significantly less, and there was almost no effect in Central Asian (once again, Muslim) republics.

  9. Fedia Kriukov says:

    Another thing: where you have “less 2)” in the text, it should be “2) less”

  10. Oleg Nevestin says:

    stalker, yesterday I stubmled upon a brief in, I believe, which was recycling ITAR-TASS info on life expectancy in Russia. Tried to find it today to post a link here, but was unable to do so. Anyway, it said that Russian life expectancy at the end of 2007 was 67.7 yrs ( men at 61.5, or pretty damn close), up from 65-something in 2005. As I have said before, CIA data is often innacurate, outdated, or outright manipulated (US public debt for example went from 64.70% of GDP in 2005 to 36.80% in 2007, even though US had borrowed massively in between, impossible feat), and should be taken with a grain of salt, with requisite independent verification. Their Fact Book is incredibly sloppy for an organization with a budget as big as France’s total defence outlays. Otherwise, you continue to impress.

  11. Fedia Kriukov says:

    Oleg, the CIA fact book is not wrong. They include only debt held by the public and exclude intragovernmental holdings in their calculation. They did not do that in the past.Debt held by the public is thus $5.6 trln, while total debt is $9.4 trln.

  12. Oleg Nevestin says:

    fedia, with all due respect, public debt is debt OWED by the public (e.g. GOVERNMENT) , not held by the public. Who holds it is absolutely irrelevant. Debt is still a debt. No? If CIA people are starting to parse it that way, the’ve got to be really desperate to make situation look better than it really is. Whichever way one is to look at it, it’s beyond pathetic.

  13. Thanks for the tips/corrections all.@fedia,True. The evidence linking Russia’s high mortality rates to alcohol consumption is enormous.@oleg,That’s true, I was suspicious of the CIA’s data to be fair but couldn’t find anything better for 2007. Anyway, you’re figures helped and I’ve found some sites confirming those stats (e.g. this is certainly taking far longer than I thought. It certainly will be finished off by tomorrow. I hope.

  14. Oleg Nevestin says:

    stalker, you also gave too much credit to Poles for male life expectancy – CIA says it’s 71.42 yrs, not 75.41(this number includes both sexes). 10 yrs difference with Russia, not 16.

  15. Oleg Nevestin says:

    Let’s hope our anonymous American friend had commited suicide right after expressing his delusional self. If not, and he keeps hijacking the comment section, we may all be in trouble. My condolences, stalker.

  16. @anonymous,I’m not enthusiastic about deleting posts, since that could lead to accusations of censorship. On the other hand your’s was quite clearly copied and pasted spam, which you didn’t even bother making unique for my blog (e.g. see here for a copy of the comment As such I think I’m justified in deleting it so as not to hopelessly clutter discussion.@oleg,Thx. Poland = fixed. Twas’ a typo.

  17. Fedia Kriukov says:

    Don’t think anyone would accuse you of censorship if you deleted that spam. I always delete that guy without warning or guilt in my blog.Anyway, I just thought that your article would actually be of more use to Russians. Maybe you should consider translating it and posting it in Runet?

  18. Anonymous says:

    Stalker,I believe it is also justified to criticize the Putin goverment for torpidity in correcting the problems that you have mentioned: smoking,highway safety,alcoholism and diet. Good legislation and intelligent funding can go a long way in correcting these problems. What is taking so long? Money is not question.DJP

  19. Fedia Kriukov says:

    DJP:Do you know what the one reform that Gorbachev is hated the most for was? It was the anti-alcohol campaign.Was he right? Without a doubt. For the short period that it lasted, it probably saved hundreds of thousands of lives. But it was also one of biggest contributors to the collapse of the country, since people completely lost trust in the authorities and were in fact quite angry with what they saw as interference in the natural right to drink themselves to death.So it’s not an issue of money, and it’s not a matter of political will at the top either. What is necessary is general awareness on the part of the population that right now is doing its best to kill itself early and often, that things cannot go on like this, that something needs to change. Only then will the people support restrictive measures on the part of the government. Otherwise, there will be social unrest once again.And that’s why I’m recommending to Stalker that this article needs to be in Russian.

  20. Fedia Kriukov says:

    Also forgot another big piece of evidence that points to alcohol as one of the main culprits in Russian mortality.Remember the excise tax stamp screwup a couple of years ago, when alcohol products disappeared from store shelves for a month or so? Check mortality statistics for that period. They simply took a nosedive.Stalker, seriously, if you could expand the section on proving that alcohol is the main factor in Russian mortality, and then translate it all into Russian, you would actually be contributing to alleviating the situation, rather than simply talking about it. 🙂

  21. Fedia Kriukov says:

    Oleg, the other part of debt is intragovernmental. It’s the debt that the gov’t owes to itself. What it means in reality is that it consists mostly of social security obligations, which are definitely not the same as the gov’t debt on T-bills, T-notes, and T-bonds. It’s a much lower level of obligation.The main point, though, is that the data provided by the CIA fact book for various countries must be compatible. It is correct to include the entire debt, even intragovernmental one, only if for other countries their own gov’t pension plans are included as part of the public debt. If they are not (and I believe they are not), then it would make US data incompatible with the rest. So the change in methodology was justified.

  22. Anonymous says:

    Fedia,wasn’t the cause of alcoholism during soviet and immediate post-soviet times due to idolness? That is: no work or no incentive to work, or even no perspective to improve one’s circumstances. Hasn’t that changed during the economic boom? Hence Stalker’s info regarding the mortality of educated professionals being lower than the rest of the population.DJP

  23. Oleg Nevestin says:

    fedia, good point, although the very fact of metodical inconsistency from one year to another may itself serve as a subject for critique, if not lack of trust. And if you reread my original post I never said that CIA data is “wrong”, but rather inaccurate (which may be “slightly off but generally in a ballpark”), outdated, and/or manipulated. Debt data clearly falls under “manipulated” category (one year we calculate it this way, next that way, go figure), while demographic data would easily fit as “inaccurate” and “outdated”. How else could you explain that they project for 2008 life expectancy in Russia full 2 years lower than was already achieved in 2007, even though all headlines coming out of that country continue to point to rapidly falling mortality? Is it Inertia? Laziness? Wishful Thinking? Pure Lies? I don’t know. All I know is that the data is corrupted. It’s even more disconcerning if you realize that all these geniuses have to do is google and read Russian stats. Those aren’t top secret anymore.

  24. Finished second post. Got far longer than I ever expected.Anyway the third (and last!) one will be much shorter, as its just a series of graphs I generated with various inputs.@fedia,Stalker, seriously, if you could expand the section on proving that alcohol is the main factor in Russian mortality, and then translate it all into Russian, you would actually be contributing to alleviating the situation, rather than simply talking about it.Great idea! I’ll do that within the month.To be fair I’ve got quite a few online things on hand right now, not limited to DR. For instance, building a website 🙂 (which I’ll link to when it’s put up).

  25. Btw, do any of you have any detailed info/projections/etc on AIDS in Russia, apart from the media soundbytes that half the country will die from it in a few years?

  26. Oleg Nevestin says:

    stalker, fedia, DJP, – I’d never try to minimize an impact of alcohol and other unhealthy habits on Russian life expectancy, but aren’t we overblowing them just a bit? Let’s see. Russian men and Russian women aren’t eating radically different food (and, oh, yeah, women boast higher rates of obesity) and yet former die 14 years earlier than the latter. So food can’t explain it, considering also that Russian and Polish cuisine aren’t radically different. So, it must be smoking then! It well may be, but not to that degree. Japanese are prodigious smokers, Chinese also and have air quality magnitudes worse than Russians to top it off – yet both live significantly longer. Alcohol, it’s got to be the alcohol!!! Well, alcohol consumption levels in Russia are way overblown. More than 30% of the population (data from my memory, might be inexact) don’t drink at all, similar numbers drink very little, and total per capita consumption is approximately on par with France, and less than UK. So if anything, it may be quality of alcohol, not quantity, and even that should not be overestimated. These days Russians are switching fast from hard spirits to wine and beer. People on the street don’t look any more hung over than most Westerners. Stress, maybe? Japanese are the most stressed people on the planet, yet outlive Italians who stress only when deprived of gelato. Poverty? Mexicans are poorer. Wheather? Iceland is not much better, yet Icelandic lifespan is tops. I’ll volunteer the suggestion that Russian men die early simply because they are lost, dispirited, defeated, and deprived of meaningful purpose – or to put it simply, fucked up in the head by the communist experiment gone awry. In USSR, they ate shit, drank like there was no tomorrow (which was true), smoked like chimneys – BUT LIVED LONGER! Why? Sense of purpose, that’s why. Will to live. Feeling of belonging to a community. Belief in the future, however misplaced. All of these served to dumpen self-destructive impulses so evident in Russian men today. Speaking od self-destructive impulses, I think we fail to appreciate the devastating impact of violent crime and traffic accidents on Russian male population. 70000 people die annually in both, bulk of them young men. Almost 5 million lives snuffed out over an average lifespan. That’s where I see the biggest problem. And women? Why do they live so much longer? Because women are far more adaptable to changing circumstances, and in the wrenching transition that Russia had to go through, adaptability is everything. Today, as Russia is on a mend, I am not at all surprised to see Russian life expectancy rebounding sharply. I’m going to go on record and predict that it will continue for decades, and quite possibly will even accelerate. stalker, can’t help you with AIDS picture, sorry. Numbers are all over the place, and all are taken out of thin air.

  27. @oleg,I am afraid your argument contains the seed of its own destruction. You make the following comparisons:Diet – Russia = PolandSmoking – Russia = Japan, ChinaAlcohol – Russia = France/ (but ignoring the fact that in general Russians binge on hard spirits while French consume red wine moderately every day. I’d also dispute your observation that ‘people on the street don’t look any more hung over than most Westerners’. Take a walk in the morning in Moscow and you’ll almost inevitably find a passed out alkie).Stress = JapanPoverty = MexicoClimate = IcelandOh, and national demoralization to boot.In other words, what you’re saying is that in many areas (diet, alcohol, smoking, environment, stress, poverty, climate) Russia is near the bottom. Even though it might not be lowest on any one of those (although I’d argue that it is at least on alcohol), on average it is at rock bottom, and this is reflected in the mortality stats.The whole is greater than the sum of its parts.

  28. Oleg Nevestin says:

    stalker, I thought it could be misconstrued that way, but, again, what I implied is that since Russian men are subject to the same everyday factors of life as Russian women, yet live so much less, then something beyond these factors must be at work. There are not enough vodka and cigarettes in this world to achieve such a discrepancy in the length of life. From my point of view, it’s the collapse of Russia itself that led to self-destructiveness of Russian men. Women live for their children, men live for their country. Take men’s pride away, and you don’t need to kill them anymore, they’ll kill themselves. Not necessarily by putting a gun to their head, but by simply not attaching any value to their own lives – and adopting a corresponding lifestyle. That’s what happened in 1990s. I do agree that lousy high-calorie, low-nutrition food, and excessive smoking/drinking add to the plight of Russian men, but clearly these phenomena can’t explain it away. All of this was plenty present in USSR, when men lived 8 years longer on average.

  29. Anonymous says:

    Stalker,I am in agreement with Oleg. It is obvious to me as a foreigner that it was the collapse of society that led to the early deaths of many. Alcoholism and smoking are just manifestations of this not the cause. As society becomes stronger people will turn away naturally, but good goverment policy can help.DJP

  30. @oleg,In the RSFSR since 1959, male life expectancy ranged 61-65 years. In the RF has it has ranged 57-62 years. So the gap isn’t 8 years as you say, but about 4. Note also that the only times Russia achieved the mid-60’s figure after the alcohol epidemic took off was in 1986-88 (period of anti-alcohol campaign).Women life longer than men by 5-8 years in every industrial nation. The fact that in Russia this differential is more like 12-14 years is due to the fact that in Russia, about 60% of men smoke compared to about 10% of women, and drinking rates are much higher as well – i.e. relative to average Russian women, average Russian men life more unhealthily than the average American man to the average American woman.Collapse in morale does not necessarily have to result in decreasing life expectancy. LE in 1930’s America and 1980’s Latin America continued increasing regardless of economic depression. On the other hand in the Russian case liberalization led to massive drops in alcohol prices, which encouraged consumption, which as I’ve written here is very closely correlated to mortality in Russia, especially amongst ethnic Russian men.I dispute your assertion that women life for children and men for their country. The former trumps the latter by far for pretty much everyone I’ve ever met of both sexes.@djp,As above. Few people die from being depressed or pessimistic, they die from heart attacks, cancer and accidents caused by bad lifestyles.

  31. BTW, yet more proof for cheap vodka = more mortality causation.As you all probably know food prices globally have been increasing rapidly since around mid-2007. In Russia, the increase has been about 2x greater in food than in vodka, and by now the food/alcohol price ratio is now comparable to its all time low in 1994, and maybe even lower.Guess what? Jan-Feb 2008, compared with the same period last yet, 14,600 more people died, a rise of 2.6%. And that’s despite continuing healthcare improvements and shifting patterns of alcohol consumption (to beer).

  32. Oleg Nevestin says:

    stalker, your numbers seem to confirm my point. If in RSFSR male lifespan reached 65 yrs, then collapsed to 57 in RF, that’s exactly 8 yrs. I wasn’t talking about today, but about the differnce between zenith of RSFSR and nadir of RF.