Russians are dying at an unprecedented rate. Between 1990 and 1994 the country's
death rate increased by 40 percent, from 11.2 to 15.7 deaths per 1,000 people.
Male life expectancy fell from 63.8 years to 57.7 years, and female life
expectancy from 74.3 to 71.3 years. According to Elizabeth Brainerd, a graduate
student in economics, "Declines in life expectancy of this magnitude
in only four years are unparalleled in the twentieth century among countries
at peace and in the absence of major famines or epidemics." She is
now researching the causes of the precipitous rise in the death rate in
conjunction with Stone professor of international trade Jeffrey Sachs '76,
Ph.D. '80, director of the Harvard Institute for International Development
(HIID), and HIID's deputy director, David Bloom.
The mortality crisis has coincided with the introduction of market reforms
in Russia, leading Brainerd to ask whether there is any correlation. To
answer the question, she is studying Russian mortality data as well as fluctuations
in price and wage indexes from 1958 to 1994.
Data show that working-age men (those aged 18 to 59) account for most of
the death increase for the 1990-1994 period. In particular, males aged 40
to 44 represent a disproportionate share of the total. Women in the 20 to
54 age group also showed a significant rise in mortality. Surprisingly,
children and the elderly, traditionally vulnerable populations, show no
change in death rates.
"A large part of the 'excess mortality' is stress related," Brainerd
explains. "The leading cause of death is cardiovascular disease, which
is a proxy for stress. The second largest category is death due to external
causes, including accidents, suicides, and homicides. These deaths increased
sharply in the 1990-1993 period, up 70.5 percent. Alcohol use may account
for some of these deaths-alcohol-related deaths have tripled in the last
four years." This isn't casual drinking, Brainerd says. "Typically,
men down shots of vodka after work or polish off entire bottles. Then they
pass out in the middle of the road and get hit by cars. In colder, more
desolate climates like Siberia, they freeze to death." In addition,
she reports, the male suicide rate is up and, since the dissolution of the
Soviet Union, Russia's murder rate has risen to three times that of the
United States.
Brainerd believes that older working men are doing poorly because they no
longer have the skills necessary to support their families; many older workers
have been unable to retrain themselves for new jobs. "There have been
increases in unemployment and wage inequality since the introduction of
market reforms," she notes. At the same time, decontrolling prices
has diminished incentives for individuals to invest in health: the relative
price of alcohol has gone down, while food and health care have become more
expensive.
Because women haven't experienced the same sudden devaluation in the marketplace,
Brainerd suggests they are handling the stress better and show lower rates
of death from heart disease. Social prohibitions against vodka consumption
also buffer women from some of the alcohol-related problems.
The stresses of Russia's ragged transition to a market economy do not fully
exp
lain the increased mortality, however. Statistics from other formerly socialist
countries vary. Ukraine and Latvia saw large increases in mortality (up
22.4 percent and 23.8 percent, respectively, between 1989 and 1993), for
reasons still unknown. Despite high unemployment rates, Poland (up only
2 percent in 1989-93), and the Czech Republic (down 6.5 percent for 1990-93),
have had better mortality outcomes. The differentiating factor, according
to Brainerd, appears to be the government's decisiveness in implementing
market reforms. Countries where reforms are quick and clear seem to fare
better than those (like Russia) where policies have been erratic.
Brainerd acknowledges the limits of her economic, rather than epidemiological,
method, and explains that HIID is working on expanding the mortality research.
If funded, a three-year, multidisciplinary project will include epidemiologists,
public-health researchers, and environmental specialists. They will sample
hospital records from Russia's 77 regions and conduct a comparative survey
of other formerly socialist countries. Until such information becomes available,
it's difficult to develop recommendations to ameliorate Russia's mortality
crisis. At this point, Brainerd's only advice is a hefty alcohol tax: an
economist's version of "Just say Nyet."
