Russia’s Life Expectancy Plunge Called a Type of National Suicide

In the deepening dusk, a young man comes weaving up a snow-covered street.

It is a gloomy street of shambling wooden buildings long untouched by paint, of small windows and little light. As the man steps unsteadily out of the shadows, his face comes into focus: It is round, the hair pulled back into a ponytail, the mouth formed into a sneer.

A cigarette dangles from one hand. His breath smells of tobacco and alcohol. He gives his name as Andrei, his age as 30.

“I smoke,” he says defiantly. “Smoking is not a problem for me. I always smoke when I drink.”

He takes a short, hard drag and glares.

“Frankly speaking, I did not smoke for two months,” he says. “Then I lost my job. Well, now I have nothing to do but drink and smoke.”

Once a railroad worker, Andrei sits home in this formerly Finnish city--Russian since World War II--and watches rock music videos, vodka and cigarette in hand. As far as he can see, there isn’t much else to do.

His health is a distant concern, as distant as the brightly lit streets and graceful modern architecture on the other side of the border in Finland--short in miles, remote in reality.

“The only thing I care about is finding a job,” he says, his voice rising in exasperation. “I’m a young man! I don’t want to be supported by my mother and father!”

Andrei may be young, but if he conforms to Russian averages, his life is more than half over.

After more than two decades of slow decline, life expectancy in Russia plummeted in the first half of the 1990s--a drop so swift, so steep, that the Lancet, a respected British medical journal, said it was “without parallel in the modern era.”

Throughout Russia, men are dying so young that, as a grim joke puts it, there is a silver lining: They no longer have to worry about retirement.

For the last five years, a group of Finnish public health experts has been working with Russian doctors in Pitkyaranta, trying desperately to reverse a public health disaster.

The Finns have valuable experience to offer. Twenty-five years ago, Finland had the world’s highest rate of cardiovascular disease. Finns smoked a lot, drank a lot, consumed a dairy-land diet high in fat and cholesterol, and were too often sedentary.

A mammoth public education campaign, which began in Finnish Karelia, just over the border from Russia, has been a huge success in getting Finns to adopt healthier habits. Between 1970 and 1990, the overall mortality rate in Finnish Karelia dropped by nearly 40%; improvements in the rate of cardiovascular disease and lung cancer were especially impressive.

The effort to duplicate that experience in Russia is still in its early stages. So far, what it has mainly demonstrated is that it will be a very difficult task.

“Unlike Finland, where they got very good results, we haven’t yet gotten good results,” concedes Dr. Mikhail Uhanov, head of the local hospital in Pitkyaranta (peet-kuh-ran-tah), about 60 miles from the border.

“Living conditions in Russia are becoming worse and worse with every passing year,” he continues. “Some scientists believe that 70% or 80% of Russians feel some kind of stress. Well, they face a lot of problems. . . . In such conditions, it’s very difficult to solve the medical problems.”

There are few places in the world that offer a sharper contrast than the borderland between Finland and Russia.

True, the natural landscape is mostly the same: a sea of fir and birch set in an archipelago of lakes, blue-green in summer, ice white in winter. It is a place of great natural beauty.

The human contrast, however, can best be expressed in black and white, and it is not a thing of beauty.

Step across the border from Finland and, if you are a man, your average life expectancy drops by 14 years, from 72 to 58.

Step across the border and, if you are a woman, your prospects of a healthy pregnancy and trouble-free birth plummet to almost nil. Your life expectancy drops by nine years, from 80 in Finland to 71 in Russia.

Step across the border and you enter a world where well-meaning doctors struggle against losing odds in ill-equipped hospitals; where people eat poorly, smoke and drink heavily and rarely exercise; where disease runs rampant and death occurs almost routinely by accident or violence.

This is the world that Dr. Olga Nikitina enters every day when she goes to work in the maternity ward of the Pitkyaranta hospital.

A young woman with a direct and open manner, her short, straight blond hair neatly cut in layers, she stands in a dim hallway painted institutional pinkish-brown and smelling strongly of disinfectant. Only one in every four ceiling lights is working.

Nearby, mothers and newborn babies rest in spare green rooms, on plain iron beds that suggest an American or Western European hospital in the 1940s. There is no television.

There is no electronic monitoring equipment. Before babies are born, their fetal heartbeats are monitored with a wooden instrument that looks like a plain pine candlestick flared on either end.

It is hard to believe the hospital is only 17 years old.

“I cannot tell you anything good about the health of women and children,” Nikitina says ruefully. “Maybe it is connected to the problems of the economy and our hard life, and our ecological problems.

“There are very few women--mothers--who are healthy,” she says. “Even young women who are going to give birth cannot be called healthy.” That’s why “there are very few babies who are healthy. We are worried.”

Not so far away, across the border in the prosperous, tidy city of Joensuu, Finland, nurse-midwife Mustaniemi Katilo shows visitors through the newly refurbished maternity ward of Joensuu Central Hospital.

Bright, cheerful murals cover the walls. The ward has its own cafe-style dining room for patients and a homey lounge where nursing mothers can relax in rocking chairs and chat or watch TV.

At the main nursing station, a computerized panel tells nurses and doctors at a glance who is in each bed and the sex of each child. It lights up when a patient requests assistance.

Patient rooms are electronically integrated, with up-to-date monitoring equipment, power-driven hospital beds, televisions with remote control.

But the differences are not merely architectural. Pregnant women and mothers in Joensuu are inundated with the latest information about prenatal and infant health. Their diets are likely to be good; their overall health is typically excellent. They are encouraged to breast-feed their babies, a strong contributor to child health. In Pitkyaranta, babies are typically bottle-fed from birth.

“At the Pitkyaranta hospital, in those conditions, they are working very well,” Katilo says. Still, she adds, “I think it’s better here. Because of our equipment, there will be no infections. And . . . our public health system is quite good.”

Statistics bear her out. The infant mortality rate in Pitkyaranta, about 17 deaths for every 1,000 live births, is roughly triple what it is in Joensuu.

But then, on the whole, the statistics for health in Pitkyaranta--and for Russia as a whole--are dismal.

One of the great accomplishments of the Soviet Union was a socialized medical system that brought universal health care to the country and yanked its standards out of the 19th century.

Life expectancy for men in the Soviet Union peaked at 65 in the mid-1960s--a tremendous accomplishment which, at the time, brought the country in line with the standards of the industrialized world.

From then on, it was all downhill, except for a sharp improvement in the mid-’80s during Soviet leader Mikhail Gorbachev’s widely reviled anti-alcohol campaign. In the 1990s, Russian life expectancy went into free fall.

Things have improved a bit since bottoming out in 1994--one demographer predicts life expectancy for men will reach 60 when the 1997 figures are calculated--but remain dreadful by world standards.

Even when you include Russian women, with their superior health habits, life expectancy in Russia still ranks lower than any European country, the United States, Canada, the Middle East and most of Asia and Latin America.

As a region, only Africa is significantly worse.

It is not an overstatement to call what has happened in Russia in the last few years a kind of national suicide, says Murray Feshbach, a professor at Georgetown University who is one of the foremost experts on Russian health.

“Yes, in a sense, that’s probably more correct than I want it to be,” he says. “I’ve become more pessimistic than I used to be. . . . But I ask my Russian friends: Tell me where I’m wrong?”

The reasons for the decline are still being debated, but probably are multifold. Some argue that the Soviet health care system was simply too inefficient and reached a point of diminishing returns. In recent years, too, investment in health has declined.

Meanwhile, Russia has one of the world’s highest rates of cigarette smoking, a habit further encouraged by Western tobacco companies now operating here. And drinking, ever this country’s scourge, has gotten worse.

While the World Health Organization calculates that smoking causes one-third of all male deaths in Russia, a new body of evidence suggests alcohol may be the country’s No. 1 killer.

After cardiovascular disease, which is linked to both smoking and heavy drinking, the second-ranking cause of death in Russia now is “other,” a category that encompasses accidents, poisonings, homicides and suicides--all strongly related to drink.

Between 1990 and 1995, “other” deaths nearly tripled in Russian Karelia, the region that includes Pitkyaranta.

In 1996, Pitkyaranta--a town of 20,000 people--recorded seven deaths by alcohol poisoning and 24 suicides and drownings. Most of the drownings were of drunken fishermen in nearby Lake Ladoga.

So far, the public health program that the Finns have helped establish has focused mostly on smoking, not drinking. Its results--still in their early stages--have been modest, at best.

With advice from Finnish experts, Uhanov, the hospital chief, and his assistants have launched a “Quit and Win” campaign that offers information about the hazards of smoking and prizes to those who quit.

But it is up against a frightening trend: Russian women, whose relatively modest smoking and drinking habits have been one of the bright spots on the Russian health scene, are smoking in ever-increasing numbers.

So in Pitkyaranta, surveys have found that for every man who has quit smoking, a woman has begun.

Among those who have not yet quit: Uhanov, the head of the program. “I will quit next Monday,” he says with an impish smile.

Uhanov is a big man who brims with infectious enthusiasm and pride in all things Russian, especially the Russian people’s ability to weather hard times.

“No other nation could resist these difficulties which we are facing now,” he says one night over a dinner at which both cholesterol and alcohol flow freely.

But even Uhanov questions how much he can do without financial help from the federal government. Last year, his 260-bed hospital received only 61% of its paltry $1.8-million budget.

For that matter, he questions just how much “propaganda” can change people’s lives.

“Tradition is very strong in the life of the Russian people,” he says. “And so if a man is used to eating fat pork, he will be on the verge of dying, but he’ll still eat fat pork.”

The same might have been said in Finland 30 years ago. Today, walk into a home in Joensuu and you meet people like Aino and Hannu Mannerkoski. She is a nurse, he is a college professor, and they seem to have adopted the principles of good health so thoroughly that they hardly give them a thought.

They have transformed their diet--no butter, no sausage; lots of fresh fruits and vegetables. They don’t smoke. They drink rarely.

Exercise? “Not so much,” Hannu says.

Which, upon further prompting, means that he regularly walks their dog, cross-country skis and rides a bicycle to work. And that Aino goes to the gym twice a week for hourlong workouts. And that they favor vacations filled with strenuous activities, such as hiking or skiing.

He is 53, she is 50, and like many people in Finland, they seem to live a happy and satisfied life. Asked if they are optimistic about their future, Hannu thinks for a moment, then nods. “Yes, I would say so.”

In Pitkyaranta, you might meet any number of men like Andrei, the young drunk. Or, on the same snowy street, someone such as Alexander Sirenko.

Sirenko is 52, a joiner at the local pulp mill, which has been struggling since its privatization several years ago. He is probably as healthy a man his age as can be found in Pitkyaranta today.

He did smoke, but he quit 10 years ago when he began having problems with his lungs. He does drink, but only on special occasions. He doesn’t exercise, but, out of necessity, he does walk to work. He doesn’t necessarily watch his diet, but he does grow fresh vegetables in the summer.

But life is hard for Sirenko, a lean man with dark bushy eyebrows and graying hair.

“The problem is that the companies here in Pitkyaranta don’t work, so we don’t get any money,” he says.

His monthly pay, when he gets it, is only 100 new rubles--the equivalent of $17--”so, practically speaking, I’m not paid.” He fully understands what drives many people to drink.

“They drink because their life is not easy,” he says. “The people who have no jobs have nothing to do but drink.”

Like the Mannerkoskis in Finland, he is asked if he is optimistic about the future. He stands there in the dying light, huddled in an old jacket, hat pulled over his ears, and laughs.

“Hope dies last,” he says. “We live only on such hopes.”

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The State of Ill Health in Russia

Some statistics on Russian health:

* Cardiovascular disease death rate for Russian men is five to six times higher than in the West, Health Ministry says. Among men ages 45-74, the mortality rate is 1,343 per 100,000, contrasted with 330 in France and 453 in Italy.

* Russian population of about 147 million shrank by about 475,000 in 1996, State Statistics Committee says. For at least the next several years, it is expected to continue shrinking by about 500,000 annually.

* 53% of the deaths are caused by heart disease, 20% by cancer. World Health Organization estimates that smoking causes 32% of all male deaths, 5% of female deaths.

* In 1995, the average life expectancy was 58 for men, 72 for women, contrasted with 74 and 81 in the European Union. Latest estimates from WHO say Russian life expectancy for both sexes is now 64--the same as Pakistan and Guyana, but worse than Vietnam, Mexico, Guatemala, Mongolia and Algeria.

* A 20-year-old Russian man has just one chance in two of living to age 60, says Dr. David Leon of the London School of Hygiene and Tropical Medicine. In Britain or France, nine of 10 will live to 60.