Alcoholism and rising mortality in the Russian FederationBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6995.1668g (Published 24 June 1995) Cite this as: BMJ 1995;310:1668
- Martin McKee,
- Laurent Chenet
- Senior lecturer Research fellow Department of Public Health and Policy, Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
EDITOR,—Michael Ryan's article1 and the press coverage that followed it highlight how little is known in the West about the human tragedy currently unfolding in Russia. Although the non-Islamic republics of the former Soviet Union have a long tradition of high alcohol consumption, until recently epidemiological research on it was suppressed as this was the reponsibility of the Ministry of Internal Affairs.2 This latter factor may explain the remarkable absence of references to alcohol in major Western reports on health in the former Soviet Union.
Ryan notes that if the change in life expectancy coinciding with Gorbachev's antialcohol campaign had been seen in a Western country it would seem improbable and some might be inclined to dismiss it as propaganda. We have also experienced disbelief in the magnitude of this effect, but considerable evidence supports it. This includes the observation that similar changes took place in all the European republics of the former Soviet Union (figure). Each experienced a dramatic increase between 1985 and 1986, typically of the order of two years. Since then the direction of change has reversed dramatically in all republics. Studies in the Russian literature of experience at local level also report quite large reductions in rates of admission to hospital and death rates (in both cases over 30%), due in large part to a reduction in violence related to alcohol.3
There can now be little doubt that the campaign in 1985, described indetail by Tarschys,2 was extraordinarily effective. It involved a range of approaches, including reducing access through the closure of outlets and restricting sales to after 2 pm, increasing prices, police action, media campaigns, and the creation of antialcohol movements. Detailed analysis of consumption patterns, with allowance being made for illicit production, shows a considerable, if short lived, fall in consumption.4 This is all the more amazing given the strong vested interests, not least in the Ministry of Finance, that opposed it.2
Although alcohol consumption began to increase again in the late 1980s, especially as a result of illicit production and diversion from state trading organisations, alcohol is unlikely to explain all the recent deterioration in life expectancy.5 As Ryan notes, much high quality epidemiological research is now being undertaken in the former Soviet Union, although there is little evidence that it is being acted on by policymakers either there or in the West. What is needed is a mechanism for bringing this work to a wider audience in both regions.