“How could a literate European country with a traditionally strong technical and scientific base gradually but inexorably retrogress toward a Third World mortal- ity profile?” The Enigma of Russian Mortality NICHOLAS EBERSTADT ussia today is in the grip of an eerie, far- exports facilitated a spurt of sustained rapid reaching, and in some respects historically growth, the nation’s demographic and public R unprecedented population crisis. Since the health problems were temporarily obscured, at end of the Soviet era, the population of the Russian least to many outside observers. Today, in the Federation has fallen by nearly 7 million. Apart from wake of a global economic downturn and contin- China’s paroxysm in the wake of Mao’s catastrophic ued weakness in the Russian economy, they are Great Leap Forward, this is the largest single epi- once more inescapably exposed. sode of depopulation yet reg- Demographic istered in the postwar era. THE SICK MAN OF EUROPE Dilemmas Russia is hardly the only Russia’s acute and continuing health crisis Second in a series country to register popu- presents the world not only with a humanitarian lation decline nowadays. tragedy, but also with something of an analytical Many other post-Soviet societies in Europe have mystery. The spectacle of such stagnation and smaller populations today than at the end of the even deterioration in health conditions would Soviet era. Moreover, a shrinking population is an seem to challenge some of our most fundamental increasingly common characteristic of contempo- precepts about social development and public rary societies, including affluent democratic soci- policy in industrial societies. How could a literate eties. Germany, Japan, and Italy have either started European country with a traditionally strong tech- population decline or are on the cusp of it. nical and scientific base gradually but inexorably Yet there is a profound difference between those retrogress toward a Third World mortality profile? three countries and Russia. Germany, Japan, and The enigma is even more puzzling when we Italy confront the prospect of declining population examine the past decade of the Russian experi- in the context of robust and steadily improving lev- ence. From the eve of the new century until the els of public health. Russia, by contrast, has been recent global financial crisis, the nation’s per seized by an extended mortality crisis—an afflic- capita income grew vigorously, reportedly almost tion of historic and truly tragic dimensions. doubling. Yet mortality levels between 1998 and For males and females together, life expectancy 2007–08 barely budged. at birth in Russia looks to be lower today than As in the urbanized and literate societies of it was four decades ago. By the critical measure Western Europe, North America, East Asia, and of life expectancy, in fact, the country appears to Oceania, the overwhelming majority of deaths in have suffered almost half a century of health stag- urbanized, literate Russia today accrue not from nation or decline—this in a world where overall infectious but rather chronic, non-communicable health levels have been constantly improving. diseases: heart disease, cancers, stroke-inducing During the decade-long economic boom from cerebrovascular disease, and the like. But this is 1999 to 2008, when Russia’s natural resource where the similarity ends. In all those other plac- es, death rates from chronic diseases are low, rela- tively stable, and declining regularly over time. NICHOLAS EBERSTADT is a political economist at the In Russia, overall mortality levels from chronic American Enterprise Institute. His books include Russia’s Peacetime Demographic Crisis: Dimensions, Causes, Impli- diseases are astonishingly high—indeed, they cations (National Bureau of Asian Research, 2010). look impossibly high. To make matters worse, the 288 The Enigma of Russian Mortality • 289 country’s death rates from chronic diseases have depopulation is, by contrast, proceeding gradu- been manifestly unstable, oscillating wildly and ally and routinely. This time, there is no obvious erratically. And Russia’s chronic mortality levels and grievous adverse application of state force to have been generally rising, not falling, since the be relieved in hopes of reversing the population end of communism. decline. In 2009, for the first time in over a decade Something terrible and new is happening in and a half, Russia’s population did not drop (tal- contemporary Russia. The nation is pioneering lying instead a meager official increase of about strange modern pathways to bad health, generat- 15,000 persons). But it is impossible to predict ing overall levels of premature mortality much when—or even if—the current depopulation will like those in impoverished developing countries, come to an end. but in a society with a far higher level of material Russia’s population trajectory is of course shaped attainment. For most of humanity, health levels not only by death rates, but also by birth rates. The have progressively improved over recent decades. country’s fertility level has dropped dramatically In Russia, the new technical and scientific oppor- since the collapse of communism, partly because tunities of our era have somehow been harnessed of changing patterns of family formation and child- to a nationwide formula for preventing health bearing. Marital unions in today’s Russia appear to progress—indeed, for driving life expectancy be less stable than in the past, the Soviet Union’s down. The country in effect has modernized the notoriously high divorce rate notwithstanding. For “achievement” of high death rates and woefully whatever reason, the country’s total fertility rate, at poor public health. 1.54 births per woman as of 2009, though higher Admittedly, Russia has experienced popula- than a decade ago, is nonetheless far below replace- tion decline before. The country suffered repeat- ment levels. (Given current mortality patterns, ed bouts of depopulation Russia would require about during the first half of the 2.14 births per woman for twentieth century, an epoch The Kremlin’s optimistic prognosis long-term population stabil- punctuated by war, revolu- regarding population prospects flies ity.) tion, famine, and political All the same, increas- upheaval. But the current in the face of some obvious and ing family instability and depopulation differs from irreversible demographic realities. reduced fertility are perva- previous episodes in three sive modern trends, encom- important respects. First, passing the rest of Europe, this is already by far the longest period of popula- as well as many affluent Western societies out- tion decline in modern Russian history. The post- side Europe. To be sure, Russia’s single parents Soviet depopulation has persisted for over twice must raise their children on far lower incomes as long as the population decline that followed the than their counterparts in Western Europe or Bolshevik Revolution, and well over three times North America. And, unlike Western Europeans as long as the terrifying depopulation during and or Americans, they can count on precious little immediately after World War II. support from the government’s social welfare Second, unlike all of Russia’s previous depopu- apparatus if they are in need. lations, this one has been taking place under basi- Even so, it is Russia’s morbidity crisis—not its cally orderly—and peaceable—social and political low fertility rate—that most drastically sets the circumstances. Whatever else may be said of the country apart demographically. The nation’s pub- end of the Soviet Union and the post-Soviet transi- lic health losses today are of a scale akin to what tion, they were attended by very little bloodshed. might be expected from a devastating and unend- Terror and war are not the engines for the depopu- ing general war. Since the end of the communist lation that the country is experiencing today. era, “excess mortality” has cost the country hun- This second difference highlights a third: dreds of thousands of lives year after year. Whereas Russia’s previous depopulations were wild and awful paroxysms, they were also tempo- LOWER EXPECTATIONS rary. In each of those earlier episodes, one could Russia’s health woes did not erupt suddenly expect with some confidence that the popula- with the collapse of the Soviet state. Rather, they tion decline would cease more or less as soon represent the latest culmination of trends darkly as orderly conditions were restored. The current evident on Russian soil for almost half a century. 290 • CURRENT HISTORY • October 2010 Rising death rates came to define the life chances of By 2006, life expectancy for the country as a a steadily expanding proportion of Soviet Russia’s whole under then-President Vladimir Putin was population in the late 1960s, and eventually char- over three years lower than it had been in 1964. acterized public health circumstances for the coun- Female life expectancy was slightly lower than it try as a whole. By the late Soviet era it was clear that had been 42 years earlier, and male life expectancy the nation’s health trajectory was veering off badly was down by over four and a half years. Since from the rest of the postwar world’s general trends then, life expectancy has once again been edging of pervasive, incremental, annual improvements. upward. In 2009, according to Russia’s official sta- Yet Russia’s health patterns did not correct tistics, overall life expectancy was 68.67 years— course with the collapse of the Soviet Union. To 74.67 years for females, and 62.77 for males. But the contrary: While the end of the USSR marked this would still be lower than the country’s esti- one the most momentous political changes of mated life expectancy for the year 1961. the twentieth century, that transition has been attended by a gruesome continuity in adverse EXCESSIVE MORTALITY health trends for the country’s population.