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Hours after his inauguration last May, President Vladimir Putin signed a decree ordering his government to increase Russian life expectancy to 74 years by 2018, reflecting urgency in the effort to keep the world’s largest country filled with enough people to sustain it.
Last year, life expectancy here was 66.5 years, according to estimates by the CIA World Factbook — 60.1 for men and 73.2 for women — compared with 78.5 years in the United States and 79.8 in the European Union. More people are dying than are being born. Russians bear a staggering load of risk factors for disease, with 60 percent of men smoking and each citizen consuming, on average, more than four gallons of pure alcohol a year. Half the population is overweight.
Two big steps are in the works to
change some of the dynamics. Russia’s lower house of parliament
overwhelmingly passed a bill forbidding smoking in public places,
which the upper house approved Wednesday and is expected to be
signed quickly by Putin.
And a law that went into effect Jan. 1 has designated beer as
an alcoholic beverage instead of a food, prohibiting its sale
in ubiquitous street-corner kiosks.
But advocates for better health, leading
to longer lives, say Russia needs to do far more.
“Cigarettes are incredibly cheap,” said Dmitri Yanin,
chairman of the Conference of Consumer Protection Societies. “I
think we can change consumer behavior eventually, but it won’t
be quick because the law doesn’t include economic measures.”
Poor demographic trends have troubled
Russia since the collapse of the Soviet Union, with a population
of 148 million 20 years ago reduced to about 143 million now.
In 2006, Putin ordered subsidies for women who give birth, calling
the demographic situation “Russia’s most acute problem
today.” Last year he said the population could decline to
107 million by 2050 if trends are not reversed.
The latest government health figures suggest the difficulty ahead:
Last year, 2,500 more people died than were born, and the infant
mortality rate rose to 8.7 deaths per 1,000 births from 7.1 in
2011 after a dozen years of dramatic decline.
“Men, especially, are dying at a productive age,” said
Luigi Migliorini, the World Health Organization’s special
representative to Russia. “They’re dying when they can
be useful to their country and their family. That’s why the
fight against tobacco and alcohol is so important.”
About 400,000 Russians die from tobacco-related diseases every
year, Putin has said. Health officials say perhaps 300,000 die
from causes linked to alcohol, though its effect on mortality
is more debated.
About 20 billion packs of cigarettes a year are bought by Russians, while the United States, with a population of 314 million, buys about 16 billion packs. Popular cigarette brands sell in Russia for about $1 a pack, with taxes making up 30 cents of the price.
Migliorini and other health experts
say more far-reaching measures will also be necessary to turn
the tide against non-communicable ailments such as lung cancer,
stroke and cardiovascular disease, which exploded as the health-care
system fell apart with the collapse of the Soviet Union.
A provision of the new smoking ban that would have allowed the
government to set a minimum price was deleted after intense industry
lobbying. While alcohol use contributes to a high rate of road
accidents, so does lax adherence to seat-belt laws — many
men here spend more effort carefully arranging a seat belt to
make police think it’s buckled than it would take to actually
buckle it.
Volunteer groups are needed to help people understand the importance
of a healthy lifestyle and encourage changes in behavior, health
experts say. They call for steps that would go beyond laws and
decrees to include pay increases, new equipment and training across
the health-care system, along with improvements in the distribution
of medicine, which is often prone to interruption.
“Whether their goals can be achieved by 2020 is unclear,”
Migliorini said, “but setting ambitious targets moves the
whole system forward.”
But don’t forget Russian fatalism.
“I am ready to acknowledge that tobacco and smoking are not
mankind’s healthiest habits,” said Andrei Loskutov,
executive director of the All-Russia Movement for the Rights of
Smokers. But, he said, a hermit who has lived isolated and free
of tobacco in the Siberian taiga now is dying of cancer.
“Churchill smoked,” he said triumphantly, “and
he lived to 91.”
