Russia is one of the few developed countries where life expectancy has fallen in recent years.1 Russia's total life expectancy of 66 years lags behind that of Japan by 16 years, the European Union by 14 years, and the United States by 12 years. High mortality and morbidity from non-communicable diseases, along with a low birth rate, mean that Russia's overall population is rapidly becoming smaller and sicker. Reporting recently for the World Bank, Marquez and colleagues emphasise the gravity of Russia's health problems and argue that the crisis represents a “new pattern of the epidemiological transition that deviates from that experienced by a number of western countries where age-specific NCD [non-communicable disease] rates declined and life expectancy grew.”^w1

Russia's population declined from 149 million in 1992 to 143 million in 2003, and in the next 50 years it could fall by 30% to 100 million. Compounded by rapid ageing of the population, this fall is increasing the dependency ratio (the ratio of the economically dependent part of the population–mainly those too young or too old to work–to the productive part) and producing an economic burden that Russia may not be able to …