Russian mortality fluctuations since 1980

In March 2001 my colleagues and I published a paper in the Lancet (Shkolnikov et al. 2001) summarizing the fluctuations in mortality that had occurred in Russia between 1991 and 1998. Our main interest was in looking at whether the causes of death that had increased so rapidly in the period 1991-94 were also the ones that declined in the subsequent period up to 1998, when life expectancy at birth showed a steady improvement. In general they were. While we were aware that the 1999 data showed increases in mortality from a broad range of causes, none of us anticipated that mortality would continue to increase up until the present time. However, this is what has happened. As can be seen in Figure 1 life expectancy at birth in males and females has fallen each year from 1998 to 2002. In 2002 for males it was 58.5 years and for females 72.0 (Evgueny Andreev, personal communication). Provisional estimates based on mortality in the first part of 2003 suggest that life expectancy has fallen further (Evgueny Andreev, personal communication). The increase in mortality rates that followed the financial collapse in August 1998 was perhaps to be anticipated. However, it was thought that this would be a transient effect, particularly as from 1999 onwards the macro-economic indicators (such as GDP per capita) showed evidence of steady improvement. This was in sharp contrast to the years 1991-94, in which the enormous upheavals and changes brought about by the collapse of the Soviet Union were accompanied by worsening of the macroeconomic situation. The extended decline in life expectancy since 1998 cannot therefore be simply explained by reference to macro-economic indicators. This paper provides a summary of key aspects of what is currently known about the mortality fluctuations in Russia since the mid-1970s. It then considers some of the issues about the biology of disease processes that may help us understand some features of the complex Russian mortality dynamics, paying particular attention to the proximal role of alcohol. Finally, it suggests that some features of the mortality fluctuations could be best explained by hypothesizing the existence of a sub-group of the Russian population who have a set of social, psychological and biological vulnerabilities that make them particularly sensitive to major shocks and upheavals such as the collapse of communism and the 1998 financial crisis. If this is the case, this has important implications for social policy both in terms of protecting the vulnerable as well as taking steps to ameliorate the social process that appears to be continually generating this vulnerable sub-group.