Staunton, December 24 – When they address Russia’s demographic dilemmas, Vladimir Putin and other Russian leaders focus almost exclusively on boosting birthrates and rarely mention Russia’s extraordinarily high mortality rates, even though reducing them to anything like European levels would dramatically change Russia’s demographic future.
The reason that the number of Russians is declining is that the number of deaths exceeds the number of births. On both sides of the equation, the changing age structure of the population has an impact, reducing the number of women in prime child-bearing cohorts and increasing the number of elderly who have higher death rates that younger age groups.
But Russia’s high mortality rates, currently among “the highest in the world,” Eurasianet’s Alena Lapteva reports, reflect not just age structure but, in the opinion of Russian experts, serious problems that Moscow is doing little to address and in some cases is making worse (russian.eurasianet.org/россия-причины-высокой-смертности).
These include inadequate medical care, overuse of alcohol and tobacco, lack of exercise, poor nutrition, and pollution and other problems with the environment. Addressing such problems is not only expensive but requires a systemic approach that means solutions would be possible only if powerful interests were overcome.
For example, experts say that 118,000 Russians die prematurely because of environmental contamination (krizis-kopilka.ru/archives/71053); but doing anything about tht would require addressing Moscow’s industrial policy, something the Kremlin has been unwilling to do.
A major problem in addressing mortality is knowing what the real causes are. The authorities have a list topped by circulatory diseases, cancers and accidents, but healthcare experts like Larisa Popovich of the Higher School of Economics say that these numbers can’t be relied upon (rbc.ru/society/21/12/2018/5c13be709a794763085f768c).
In many cases, she says, doctors and other officials report as causes of death something from the approved list arising from Putin’s 2012 May decrees. As a result, no one can be certain what the real causes are or what the ranking is. Accidents, suicides and deaths from environmental pollution may be far higher than are now being recorded.
The doctors have good reason to change their diagnoses, Lev Kaktursky of the Russian Society of Pathologists says. The amount of money their hospitals receive depends on their reported figures being within the officially approved range whatever the realities in fact are. Those who report honestly will thus lose money.
That is one problem but far from the most serious, Lapteva continues. Access to medical care which has been reduced by Putin’s health “optimization” program also pushes up premature deaths. Further, Russians overconsume alcohol and tobacco, with the former boosting death rates by 17 percent and the latter by 10 percent, even the health ministry says.
Fewer than a quarter of all Russians exercise even a few times a month, and more than half have what officials describe as an unhealthy and inadequate diet. Indeed, two out of three Russians now have to choose between quality foods and clothing. Not surprisingly, many choose the latter, even though that choice means premature death.
And finally, Lapteva says, there is environmental pollution. The two capitals with a total population exceeding 18 million people are the most contaminated, the population is aware and angry, but nothing is done and death rates are higher as a result. In Russia as a whole, established norms of air and water quality are often exceeded by orders of magnitude.
Unfortunately, activists like Greenpeace Russia say, many Russians and certainly the Russian authorities don’t know just how bad things are because officials keep raising the levels of permissible contamination and don’t have at present a system to collect and report adequate data even on that.