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."
~ M. Elaine Mar Elizabeth Brainerd may be e-mailed at [email protected]
