Low life expectancy and huge health problems

The enormous health problems facing Russia have been recognised for several decades. Life expectancy in Russia has been falling since the 1960s, in contrast to the steady rise in western Europe (figure⇓). One statistic that caused widespread concern was the sharp rise in mortality in the late 1980s and early 1990s. While this was interpreted as a consequence of Russian drinking habits it is now understood as a temporary phenomenon related to the political crisis and accompanying disorganisation of social life, life habits, and health care.3 4 Some other problems are long lasting and they are still unclear.

The mortality pattern is unusual as the death rate is high in middle age. Many deaths in this age group are related to trauma, alcohol, and smoking. More than 60% of men in Russia smoke compared with less than 25% in the UK.5 Chronic diseases have all increased over the past 20 years, and the incidence of cardiovascular diseases and cancer has doubled since 1990. Population ageing is creating additional challenges.

Russia is also facing developing epidemics of HIV and tuberculosis (fig 2 …