Are more Russian men dying from alcoholism because the government finds sozzled citizens easier to control? Zhores Medvedev reports on a country awash with alcohol.

In 1988 1.57 million people died in the Russian Federation. In 1992 1.8 million people died. In 1994 2.3 million people died. By the beginning of 1996 the population of Russia had fallen to 148.1 million. In the past similar losses were experienced only as a result of the famine of 1932-1933 and during the 1937-8 Stalinist terror.

The artificiality of this demographic catastrophe is demonstrated by the fact that the greatest increase in Russian mortality has occurred not among children or elderly people, which is what usually happens when there is a sharp fall in living standards (whether for economic reasons or in the wake of natural catastrophe), but among men of working age.

The average life expectancy for men has decreased from 64.8 to 58.9 years. On the index of average male life expectancy, Russia no longer belongs to the economically developed countries (the group in which it had previously occupied the last place) - it falls below practically all the countries of Europe, Asia, North and South America. Only in Africa are there countries where the average male expectancy of life at birth is as low as it is in Russia.

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This high male mortality rate cannot be wholly explained by economics. After the disintegration of the USSR the economic situation in Kazakhstan, Ukraine or Belarus was far worse than in Russia. Yet in Kazakhstan the average expectation of life at birth for men decreased from 64.7 to 61.3 years between 1988 and1993. In Belarus it declined from 67.0 to 63.8, whereas in Ukraine it only declined from 66.6 to 65.0 years.

The transition from a socialist to a market economy using "shock therapy" caused a fall in the standard of living and a sharp decrease in public spending throughout East and Central Europe, with a concomitant fall in health indices for both men and women. However, the decline in the average male life expectancy at birth in most countries from 1989 to 1993 was measured in months, not years. In Hungary, which experienced the most precipitous fall in Europe after Russia, average male life expectancy at birth declined from 65.5 to 64.5, that is, by one year. The fall in gross national product in Hungary in that period was more than 50 per cent.

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Why has Hungary "paid" for the transition period with only one year of its men's lives and Belarus with three years, when Russia has paid six years?

There is no direct connection between the economy of a country and the health of its population, although in rich countries people live longer on the whole than they do in poor countries. Climate, national dietary habits and lifestyle all affect health. In Europe, for example, the highest average male life expectancy of 75.5 years is in Greece - the poorest European Union country leads in longevity. Switzerland and Sweden, the richest European countries, have the same expectation of life as Greece for newborn males, but the life expectancy of Swiss and Swedish males of more advanced years lags behind the life expectancy of older Greek males. Spanish men live longer than German, Danish or British males, although Spain is twice as poor as all three countries. Gerontologists explain the difference by the propitious Mediterranean weather, the Greek and Spanish tradition of using olive oil rather than butter, and the healthy southern habit of the siesta.

Africa is, without doubt, the demographic disaster zone of the planet. The national income of most African countries, from $110 to $500 a person per year, is at a level of extreme poverty. In Nigeria, the largest African country, with a population of about 100 million, the average expectation of life in 1993 was only 53.5 years for men and 55.9 years for women. In Asia the position is worst in Bangladesh and best in Japan. In 1993 the average life expectancy at birth in Japan was 76.5 years for men and 83.1 years for women. Yet despite the comparability of per capita GNP, the Japanese standard of living is lower than the American or western European because a larger proportion of profits is invested or saved in Japan. Moreover, Japanese workers receive small pensions, work a six-day week and get only two weeks paid holiday a year (compared with six weeks in Germany). The Japanese spend a third as much per capita on health care as the Americans. One doctor serves 570 people in Japan, 390 people in the United States and 225 people in Russia. Nevertheless, Japanese men live an average of 4.3 years longer than American men. Japan's advantages are the absence of unemployment, an ethnically homogeneous population and a diet in which fish predominates over meat. Japanese people also smoke less than Americans and drink very little alcohol.

The Russian press is unanimous in attributing the high mortality rate of Russian men to excessive alcohol consumption. It is true that by level of consumption of pure alcohol per head of population, 14.5 litres in 1994, Russia now holds first place in the world. In the 1970s, the consumption of alcohol, in the form of wine, was higher in France and Italy and at the time France and Italy had the highest mortality rate in Europe from cirrhosis of the liver.

However, international statistics do not confirm a direct link between the level of alcohol consumption and average life expectancy. On its own a growth in the consumption of alcohol per head of population usually reflects an increase in a country's economic prosperity. Expenditure on alcohol is higher in countries where the population has more surplus income after satisfying its basic needs of life. In the 1970s the number of registered alcoholics was highest in the richest country at that time, the US, where it reached 5.4 million people (with a level of consumption of pure alcohol equal to 11 litres per head of population per year).

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At various periods from 1980 to 1991 the records of Russian health centres have shown from 2.5 to 2.9 million diagnosed alcoholics, a relatively lower level than in America or France. But in western countries the recognition that alcoholism was hazardous to health provoked a campaign against it; the sales tax on alcoholic drinks was raised systematically and duties were levied on imported wine and vodka. As a result, the price of alcoholic drinks rose steadily and always exceeded the rate of inflation. In the USSR the growth in the consumption of alcohol from 1970 to 1982 was also connected to a systematic rise in the population's income. But in 1985 Gorbachev, rather than using the well-tried means of lowering consumption by increasing prices, adopted measures to curtail the production and sale of vodka, wine and even beer. Predictably, the result was a rise in the illegal production of home brew that already exceeded the production of vodka in state distilleries in 1987. The rate of alcohol poisoning began to rise correspondingly.

The reform period in 1992-3 was vastly different from this. In those two years, and to a lesser extent in 1994-5, the consumption of alcohol rose rapidly even though incomes and most people's standard of living fell sharply. The incomes of approximately half the families in Russia declined to below the minimum subsistence level, but at the same time alcohol consumption increased steeply. There was also a rise in the consumption of tobacco products.

There is an absurd theory (which the press tends to support) that Russians have a proclivity to misuse alcohol. This is untrue. Any nation will drink too much if state policy encourages it. The steep rise in alcoholism in Russia in recent years can be linked quite directly to government policy. At the beginning of 1992 the president signed two decrees. One abolished the state monopoly of vodka production and the second removed all controls on the sale of alcoholic drinks. Dozens of new types of vodka of unknown origin appeared; sold from boxes on the pavements and alongside the roads. No other country in the world has ever experienced such freedom in the sale of alcohol. At the same time, the uncontrolled import of duty-free alcohol was permitted and numerous organisations that had previously had nothing to do with the sale of spirits (sports, veteran and invalid organisations) were given special licenses to import this duty-free alcohol. A vast stream of cheap, duty-free foreign drink arrived in Russia.

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As a result, vodka became extremely cheap (around US$1 a bottle). The government seemed to be making a conscious effort to stimulate the consumption of alcohol by making vodka accessible even to those who had least money. This "opium for the masses" perhaps explains how Russian state property could be redistributed and state enterprises transferred into private ownership so rapidly without provoking any serious social unrest. Ukraine, Belarus and Kazakhstan fell far behind Russia in effecting this transformation. But they also fell behind Russia in the number of cases of poisoning, suicide, homicide, and heart and blood vessel diseases. Russia reached the top place in the world in the number of fatal alcohol poison cases (48,342 men and 14,555 women in 1992). In the number of homicides Russia overtook the US not only in relative figures (per 100,000 of population), but also in absolute numbers. In 1993 there were 45,060 homicides in Russia, whereas in the US there were only 26,254.

But the reduction in average life expectancy in Russia cannot be attributed to alcohol alone. During 1992-1994 mortality from infectious diseases rose steeply in Russia. Approximately 20,000 people are dying at present annually from tuberculosis - the result of poverty and the collapse of the health and epidemiological services. The huge increase in the number of suicides, particularly among men, from 26,796 in 1988 to 46,016 men in 1993, can also partly be linked to alcoholism.

In 1995, when the most acute phase of the reform and redistribution of property ended, the Russian government tried to bring some order back to the anarchy in the production, import and sale of alcohol. Customs duties were imposed on imported alcohol. Controls were introduced on the quality and sale of alcohol. One must hope that as this process gradually takes place, the nation's health will be restored.

Zhores Medvedev is the author of Soviet Science, Nuclear Disaster in the Urals and The Legacy of Chernobyl.

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LIFE EXPECTANCY FOR MALES 1992-1993

At birth At age 15 Japan 76.5 62.1 Greece 75.0 60.9 France 73.8 59.6 United Kingdom 73.7 59.4 Russia 58.9 45.9 Nigeria 53.5 n/a