Adult ill-health in the Russian Federation

Marc Suhrcke, Lorenzo Rocco, Martin McKee, Stefano Mazzuco, Dieter Urban, Alfred Steinherr, 2007

The Russian Federation is one of only a few countries where life expectancy is falling. However, the situation in the Russian Federation and its ex-Soviet neighbours differs from some other countries where life expectancy is also falling, such as in sub-Saharan Africa, where the declines have been driven by the HIV/AIDS epidemic. In the former, both the recent declines and the current low level of life expectancy were driven largely by increasing mortality among people of working age, with the greatest contribution from NCD and injuries (Shkolnikov et al. 2004; Nolte, McKee and Gilmore 2005). As a consequence, the global development agenda, driven by the pursuit of the Millennium Development Goals (MDGs), may not be perfectly appropriate for the Russian case (and for most other eastern European countries). A recent World Bank report showed how reducing mortality from CVD and injury would have a much greater impact on life expectancy than achieving thehealth-related MDGs (child and maternal mortality, reductions in HIV/AIDS and tuberculosis (TB)) (Lock et al. 2002; Rechel, Shapo and McKee 2004).

Although male life expectancy at birth in the Russian Federation is about two years less than in Brazil or Poland, the probability that a 15-year-old Russian boy will die before he reaches 60 is over 40%, about 16 percentage points higher than in Brazil, double the rate of Turkey, and quadruple that of the United Kingdom.

A major determinant of a population’s health is its country’s level of economic development. However, even if we take income differences into account, Russian male mortality rates are still substantially higher than those of other countries with a similar level of per-capita income. The only countries that are on a still higher trajectory than the Russian Federation are those that have suffered some of the worst HIV/AIDS crises (e.g. Botswana, South Africa, Namibia, Swaziland).

The social consequences of this high toll of avoidable mortality are bound to be significant. The widely held view that NCDs exclusively strike people that have passed retirement age is mistaken. In the Russian Federation the young and the middle-aged are by far more affected than in Western Europe.

The difference between the Russian Federation and Western Europe is even greater when their morbidity rates are compared. An analysis of healthy life expectancy – i.e. life expectancy augmented by a morbidity component – demonstrates the less well-recognized phenomenon of a high level of ill-health among women, in particular those of working age. Indeed, the difference in healthy life expectancy between the Russian Federation and Western Europe is even higher than that for life expectancy alone. This confirms that morbidity data contain important information not captured by mortality/life expectancy data. If the Russian health crisis is not merely a health crisis of men, as these findings very strongly suggest, then the economic costs of ill-health are most likely also felt among women.

In sum, this chapter shows that the health challenges facing the Russian Federation affect not only the retired, but also working-age people – and very much so. Moreover, in contrast to what mortality data alone tell us, women’s health has been seriously affected, too…

© World Health Organization 2007, on behalf of the European Observatory on Health Systems and Policies

Source: www.euro.who.int