March 26: Carel de Rooy urges policy makers to pay more attention to life expectancy in Russia
Life Expectancy as a Government Performance Measure in Russia Lately several announcements have been made in the media both optimistic and critical about the evolution of the fertility rate in Russia and its relationship to population decline. This issue attracts a lot of attention and deserves to be assessed from different perspectives. The 2002 census established Russia’s population at 145.8 million. By April 2007, it had declined to 142.1 million. If this trend continues, with a net loss of almost 700,000 people each year, it is estimated that by 2050 the population could fall to 104 million. President Putin underscored the severity of Russia’s demographic situation in his May 10, 2006 annual address to the Federal Assembly, proposing concrete actions to tackle this problem. The latter comprised a series of additional financial transfers to families with children. However, international experience suggests that while such transfers are helpful they are not sufficient to enhance fertility rates. Better housing, well paid and flexible female employment, affordable and high quality day care centers are among the complementary measures required to positively impact fertility rates . The key parameters defining Russia’s demographic situation are a low birth rate and a high mortality rate, especially among working age men. Furthermore, Russia’s demographic situation is characterized by a contradicting trend: while infant, child and maternal mortality ratios are gradually declining, life expectancy at birth has remained comparatively low, at 65.87 years (2007). The average Russian male and female live to 59 and 73 years respectively. This gender disparity is among the largest in the world. Particularly alarming is that the life expectancy of Russian men at age 30 years has not changed since the late 1940s despite significant achievements in modern medicine during this time. Comparison of Russia’s 2007 life expectancy with that of other European countries for the same year highlights the severity of the problem: Norway at 79.78 years; the United Kingdom at 78.7 years; Italy at 79.94 years; and Poland at 75.19 years . The greatest impact on population levels is the overall mortality rate. In the 1960s and 1970s, the mortality rate began a steady rise, from 7.4 deaths per thousand in 1960, to 11 deaths per thousand by the end of the 1970s. Throughout the 1980s, that figure hovered around 11. After 1992, it rose sharply, reaching 15.7 deaths per thousand in 1994. This figure has remained stable at 16.1 deaths per thousand (2005 ). The main causes of death in Russia are: 1) cardio-vascular diseases (almost 60%); 2) accidents; and 3) cancer. In 1993, death by accidents overtook cancer to occupy second place. For working age males, the single most frequent cause of death is accidents, with half of these deaths being alcohol-related . Rates of alcoholism and drug addiction have increased, especially among young people. Two-thirds of Russian males currently smoke, more than twice the proportion in the USA, and one third of Russian females also smoke. Lung cancer has increased by almost 63% since the mid-1990s. Only 6% of Russians undertake regular exercise. In the third periodic report on the Russian Federation’s implementation of the Convention of the Rights of the Child, which was discussed in Geneva among Government officials and the Committee on the Rights of the Child at the end of 2005, the Government highlighted the acute problem of increasing trends of smoking, drinking, substance abuse and unsafe sex among young people which, if not effectively addressed, could cause Russia’s life-expectancy trends to deteriorate further. According to research Russia as of the beginning of 2005 ranked 122nd in the world for male mortality In the above figure Russia’s life-expectancy trend over the past 100 years depicts a dramatic history. Four major troughs can be found all of which are linked to crises. The first coincides with World War I and the Bolshevik Revolution (1914-1917). The second in the early 1930s relates to the collectivization of agriculture which led to widespread famine, especially in the Ukraine. The third corresponds to World War II in the early 1940s, and the last in the 1990s occurred after the breakup of the Soviet Union. Russia’s life expectancy evolution over the last century could be divided into two distinct phases, the first half of the 20th century which was extremely dramatic with three very critical phases of approximately equal magnitude and, the post World War II phase with a very rapid progress during the first 20 years followed by stagnation. The latter is surprising because it follows very tangible gains made basically under the same leadership (Stalin) which had provoked the collectivization and famine crisis of the 1930s. This underlines the impact government policies can have on life-expectancy. It also suggests that questionable policies can have as negative an impact as major wars. After very tangible gains were achieved on life-expectancy between the mid-1940s and 1960, presumably through universal vaccination, improved water supply, sanitation and hygiene, improved nutrition, better access to medicines and health care, and better access to education, over 40 years of stagnation followed. It is surprising that this stagnation occurred at the same time that many developing countries throughout the world gained independence and made rapid progress in life expectancy, though that progress was initiated from a much lower level than the Soviet Union had already achieved by that time. But other industrialized countries in Europe, North America and Asia also continued to make substantial progress. Even Cuba, another socialist country, but under tough economic sanctions for almost 50 years, had achieved by 2007 a male life-expectancy of 77.08, eighteen years higher than that of the Russian Federation, and even higher than that of many middle-income countries such as Chile, Slovenia, Czech Republic, Argentina, Uruguay, Poland, Serbia, Slovakia and Croatia. Cuba ranks as 38th worldwide, 84 countries above the Russian Federation . What could be done to change this situation? First of all, given the strategic and economic importance of addressing the demographic situation in Russia today the Government could consider using life expectancy as one of its main indicators to measure progress in the social sector. This implies effective coordination between the Ministries of Finance, Economic Development and Trade, Regional Development, Health and Social Development, Education and Science, Information, and the Youth Commission. It also implies provision of relevant but age appropriate information and facilities in schools for children to better protect themselves against risks to their health and development and to adopt healthy life-styles. Specifically in the health sector it implies greater attention to preventive health including prevention of HIV, expansion of adequate health and counseling services to adolescents and youth, promotion of iodized salt use, breastfeeding and better parenting, to provide children with the best possible start in life, anaemia prevention, especially among women, where necessary with supplementation of iron/folic acid, provision of vitamin A where required as these interventions are inexpensive and highly effective to enhance health standards. Higher taxes could be considered for sales of cigarettes and alcohol, possibly to fund the simultaneous crackdown on the manufacture of illegal alcohol. Much tougher regulations could be implemented regarding the advertising and marketing of alcohol and cigarettes. Effective promotion of safe driving and a better understanding and response to causes of cancer would also be helpful. While the current government cannot be held accountable for what happened in the past century it definitely has the opportunity to positively influence Russia’s life expectancy in the future. Carel de Rooy
|
