Drink of choice
Aspecter is haunting Russia today. It is not the specter of Communism—that ghost has been chained in the attic of the past—but rather of depopulation—a relentless, unremitting, and perhaps unstoppable depopulation. The mass deaths associated with the Communist era may be history, but another sort of mass death may have only just begun, as Russians practice what amounts to an ethnic self-cleansing.
Since 1992, Russia’s human numbers have been progressively dwindling. This slow motion process now taking place in the country carries with it grim and potentially disastrous implications that threaten to recast the contours of life and society in Russia, to diminish the prospects for Russian economic development, and to affect Russia’s potential influence on the world stage in the years ahead.
Russia has faced this problem at other times during the last century. The first bout of depopulation lasted from 1917 to 1923, and was caused by the upheavals that transformed the Russian Empire into the Soviet Union. The next drop took place between 1933 and 1934, when the country’s population fell by nearly 2 million—or almost 2 percent—as a result of Stalin’s war against the “kulaks” in his forced collectivization of Soviet agriculture. And then, between 1941 and 1946, Russia’s population plummeted by more than 13 million through the cataclysms and catastrophes of World War II.
The current Russian depopulation—which began in 1992 and shows no signs of abating—was, like the previous episodes, also precipitated by events of momentous political significance: the final dissolution of the Soviet Union and the end of Communist Party rule. But it differs in three important respects. First, it is by far the longest period of population decline in modern Russian history, having persisted for over twice as long as the decline that followed the Bolshevik Revolution, and well over three times as long as the terrifying depopulation Russia experienced during and immediately after World War II.
Second, unlike all the previous depopulations in Russia, this one has been taking place under what are, within the Russian context, basically orderly social and political circumstances. Terror and war are not the engines for the depopulation Russia is experiencing today, as they have been in the past.
And finally, whereas Russia’s previous depopulations resulted from wild and terrible social paroxysms, they were also clearly temporary in nature. The current crisis, on the other hand, is proceeding gradually and routinely, and thus it is impossible to predict when, or whether, it will finally come to an end.
A comparison dramatizes what is happening in Russia. Between 1976 and 1991, the last sixteen years of Soviet power, the country recorded 36 million births. In the sixteen post-Communist years of 1992–2007, there were just 22.3 million, a drop in childbearing of nearly 40 percent from one era to the next. On the other side of the life cycle, a total of 24.6 million deaths were recorded between 1976 and 1991, while in the first sixteen years of the post-Communist period the Russian Federation tallied 34.7 million deaths, a rise of just over 40 percent. The symmetry is striking: in the last sixteen years of the Communist era, births exceeded deaths in Russia by 11.4 million; in the first sixteen years of the post-Soviet era, deaths exceeded births by 12.4 million.
The Russian Federation is by no means the only country to have registered population decline during the past two decades. In fact, 11 of the 19 countries making up Western Europe reported some annual population declines during the Cold War era. On the whole, however, these population dips tended to be brief and slight in magnitude. (Italy’s “depopulation,” for example, was limited to just one year—1986—and entailed a decline of fewer than 4,000 persons.) Moreover, the population declines in these cases were primarily a consequence of migration trends: either emigration abroad in search of opportunity (Ireland, Portugal), or release of foreign “guest workers” during recessions or cyclical downturns in the domestic economy (most of the rest). Only in a few Western European countries (Austria, Denmark, Germany, the United Kingdom) did negative natural increase ever feature as a contributing factor in a year-on-year population decline. In all but Germany, such bouts of negative natural increase proved to be temporary and relatively muffled.
So where, given these daunting facts, is the Russian Federation headed demographically in the years and decades ahead? Two of the world’s leading demographic institutions—the United Nations Population Division (UNPD) and the U.S. Bureau of the Census—have tried to answer this question by a series of projections based upon what their analysts believe to be plausible assumptions about Russia’s future fertility, mortality, and migration patterns.
Both organizations’ projections trace a continuing downward course for the Russian Federation’s population over the generation ahead. As of mid-year 2005, Russia’s estimated population was around 143 million. UNPD projections for the year 2025 range from a high of about 136 million to a low of about 121 million; for the year 2030, they range from 133 million to 115 million. The Census Bureau’s projections for the Russian Federation’s population in 2025 and 2030 are 128 million and 124 million, respectively.
If these projections turn out to be relatively accurate—admittedly, a big “if” for any long-range demographic projection—the Russian Federation will have experienced over thirty years of continuous demographic decline by 2025, and the better part of four decades of depopulation by 2030. Russia’s population would then have dropped by about 20 million between 1990 and 2025, and Russia would have fallen from the world’s sixth to the twelfth most populous country. In relative terms, that would amount to almost as dramatic a demographic drop as the one Russia suffered during World War II. In absolute terms, it would actually be somewhat greater in magnitude.
Strikingly, and perhaps paradoxically, Moscow’s leadership is advancing into this uncertain terrain not only with insouciance but with highly ambitious goals. In late 2007, for example, the Kremlin outlined the objective of achieving and maintaining an average annual pace of economic growth in the decades ahead on the order of nearly 7 percent a year: on this path, according to Russian officials, GDP will quadruple in the next two decades, and the Russian Federation will emerge as the world’s fifth largest economy by 2020.
But history offers no examples of a society that has demonstrated sustained material advance in the face of long-term population decline. It seems highly unlikely that such an ambitious agenda can be achieved in the face of Russia’s current demographic crisis. Sooner or later, Russian leadership will have to acknowledge that these daunting long-term developments are shrinking their country’s social and political potential.
Marxist theory famously envisioned the “withering away” of the state upon the full attainment of Communism. That utopia never arrived in the USSR (or anywhere else for that matter). But with the collapse of Soviet rule, Russia has seen a pervasive and profound change in childbearing patterns and living arrangements—what might be described as a “withering away” of the family itself.
In the postwar Soviet era, Russia’s so-called “total fertility rate” (TFR), which calculates the number of births a typical woman would be expected to have during childbearing years, exceeded 2.0—and in the early years of the Gorbachev era, Russia’s total fertility rate temporarily exceeded 2.2. After 1989, though, it fell far below 2.0 with no signs as yet of any recovery. Russia’s post-Communist TFR hit its low—perhaps we should say its low to date—in 1999, when it was 1.17. By 2005, the total fertility rate in the Russian Federation was up to about 1.3—but this still represented a collapse of about two-fifths from the peak level in the Gorbachev years.
In the late 1980s, near the end of the Communist era, there were just a handful of European countries (most of them under Communist rule) with higher fertility rates than Russia’s. By 2005, the last year for which authoritative data is available, there were only a few European societies (perhaps ironically, most of them ex-Communist) with lower rates.
What accounts for the Russian Federation’s low levels of fertility? Some observers point to poor health conditions. And indeed, as we will see, Russia’s overall health situation today is truly woeful. This is especially true of its reproductive health.
A consortium headed by the World Health Organization estimated that for 2005 a woman’s risk of death in childbirth in Russia was over six times higher than in Germany or Switzerland. Moreover, mortality levels for women in their twenties (the decade in which childbearing is concentrated in contemporary Russia) have been rising, not falling, in recent decades.
But Russia’s low fertility patterns are not due to any extraordinary inability of Russian women to conceive, but rather to the strong and growing tendency among childbearing women to have no more than two children—and perhaps increasingly not more than one. The new evident limits on family size in Russia, in turn, suggest a sea change in the country’s norms concerning family formation.
In 1980, fewer than one Russian newborn in nine was reportedly born out of wedlock. By 2005, the country’s illegitimacy ratio was approaching 30 percent—almost a tripling in just twenty years. Marriage is not only less common in Russia today than in the recent past; it is also markedly less stable. In 2005, the total number of marriages celebrated in Russia was down by nearly one-fourth from 1980 (a fairly typical Brezhnev-period year for marriages). On the other hand, the total number of divorces recognized in Russia has been on an erratic rise over the past generation, from under 400 divorces per 1,000 marriages in 1980 to a peak of over 800 in 2002.
In 1990, the end of the Gorbachev era, marriage was still the norm, and while divorce was very common, a distinct majority of Russian Federation women (60 percent) could expect to have entered into a first marriage and still remain in that marriage by age 50. A few years later, in 1996, the picture was already radically different: barely a third of Russia’s women (34 percent) were getting married and staying in that same marriage until age 50.
Since the end of the Soviet era, young women in Russia are opting for cohabitation before and, to a striking extent, instead of marriage. In the early 1980s, about 15 percent of women had been in consensual unions by age 25; twenty years later, the proportion was 45 percent. Many fewer of those once-cohabiting young women, moreover, seem to be moving into marital unions nowadays. Whereas roughly a generation earlier, fully half of cohabiters were married within a year, today less than a third are.
Is Russia’s post-Communist plunge in births the consequence of a “demographic shock,” or the result of what some Russian experts call a “quiet revolution” in patterns of family formation? At the moment, it is possible to see elements of both in the Russian Federation’s unfolding fertility trends. Demographic shocks tend by nature to be transient; demographic transitions or “revolutions,” considerably less so. But this much is clear: to date, no European society that has embarked upon the same demographic transition as Russia’s—declining marriage rates with rising divorce; the spread of cohabitation as alternative to marriage; delayed age at marriage and sub-replacement fertility regimens—has reverted to more “traditional” family patterns and higher levels of completed family size. There is no reason to think that in Russia it will be any different.
There are many ramifications of the dramatic decline in population in Russia, but three in particular bear heavily on the country’s prospective development and national security.
First, when Western European nations reached the level of 30 percent illegitimate births that Russia has now attained, their levels of per capita output were all dramatically higher—three times higher in France, Austria, and Britain, and higher than that in countries such as Germany, Ireland, and the Netherlands.
This means that Russia’s mothers and their children will be afforded far fewer of the social protections that their counterparts could count on in Western Europe’s more generous welfare states.
A second and related point pertains to “investment” in children. According to prevailing tenets of Western economic thought, a decline in fertility—to the extent that it occurs under conditions of orderly progress, and as a consequence of parental volition—should mean a better material environment for newborns and children because a shift to smaller desired family size, all else being equal, signifies an increase in parents’ expected commitments to each child’s education, nutrition, health care, and the like.
Yet in post-Communist Russia, there are unambiguous indications of a worsening of social well-being for a significant proportion of the country’s children—in effect, a disinvestment in children in the face of a pronounced downward shift in national fertility patterns.
School enrollment is sharply lower for primary-school-age children—99 percent in 1991 versus 91 percent in 2004. And the number of abandoned children is sharply higher. According to official statistics, as of 2004 over 400,000 Russian children below 18 years of age were in “residential care.” This means that roughly 1 child in 70 was in a children’s home, orphanage, or state boarding school. Russia is also home to a large and possibly growing contingent of street children whose numbers could well exceed those under institutional care. According to Human Rights Watch, over 100,000 children in Russia have been abandoned by their parents each year since 1996. If accurate, this number, compared to the annual tally of births for the Russian Federation, which averaged about 1.4 million a year for the 1996–2007 period, would suggest that in excess of 7 percent of Russia’s children are being discarded by their parents in this new era of steep sub-replacement fertility.
A third implication of the past decade and a half of sharply lower birth levels in Russia will be a drop-off in the country’s working-age population, and an acceleration of the tempo of population aging in the period immediately ahead. Barring only a steady and massive in-migration, Russia’s potential labor pool will shrink markedly over the coming decade and a half and continue to diminish thereafter.
In addition to its daunting fertility decline, Russia’s public health losses today are of a scale akin to what might be expected from a devastating war. Since the end of the Communist era, in fact, “excess mortality” has cost Russia hundreds of thousands of lives every year.
The 1960s and 1970s witnessed an increase in mortality rates for key elements of the Soviet population. But Russia’s health patterns did not correct course with the collapse of the USSR, as many experts assumed they would. In fact, in the first decade and a half of its post-Communist history the country’s health conditions actually became worse. Life expectancy in the Russian Federation is actually lower today than it was a half century ago in the late 1950s. In fact, the country has pioneered a unique new profile of mass debilitation and foreshortened life previously unknown in all of human history.
Like the urbanized and literate societies in Western Europe, North America, and elsewhere, the overwhelming majority of deaths in Russia today accrue from chronic rather than infectious diseases: heart disease, cancers, strokes, and the like. But in the rest of the developed world, death rates from these chronic diseases are low, relatively stable, and declining regularly over time. In the Russian Federation, by contrast, overall mortality levels are high, manifestly unstable, and rising.
The single clearest and most comprehensible summary measure of a population’s mortality prospects is its estimated expectation of life at birth. Russia’s trends in the late 1950s and early 1960s were rising briskly. In the five years between 1959 and 1964, for instance, life expectancy increased by more than two years. But then, inexplicably, overall health progress in Russia came to a sudden and spectacular halt. Over that 18-year period that roughly coincides with the Brezhnev era, Russia’s life expectancy not only stagnated, but actually fell by about a year and a half.
These losses were recovered during the Gorbachev period, but even at its pinnacle in 1986 and 1987, overall life expectancy for Russia was only marginally higher than it had been in 1964, never actually managing to cross the symbolic 70-year threshold. With the end of Communism, moreover, life expectancy went into erratic decline, plummeting a frightful four years between 1992 and 1994, recovering somewhat through 1998, but then again spiraling downward. In 2006—the most recent year for which we have such data—overall Russian life expectancy at birth was over three years lower than it had been in 1964.
The situation for Russian males has been particularly woeful. In the immediate postwar era, life expectancy for men was somewhat lower than in other developed countries—but this differential might partly be attributed to the special hardships of World War II and the evils of Stalinism. By the early 1960s, the male life expectancy gap between Russia and the more developed regions narrowed somewhat—but then life expectancy for Russian men entered into a prolonged and agonizing decline, while continued improvements characterized most of the rest of the world. By 2005, male life expectancy at birth was fully fifteen years lower in the Russian Federation than in Western Europe. It was also five years below the global average for male life expectancy, and three years below the average for the less developed regions (whose levels it had exceeded, in the early 1950s, by fully two decades). Put another way, male life expectancy in 2006 was about two and a half years lower under Putin than it had been in 1959, under Khrushchev.
According to the U.S. Census Bureau International Data Base for 2007, Russia ranked 164 out of 226 globally in overall life expectancy. Russia is below Bolivia, South America’s poorest (and least healthy) country and lower than Iraq and India, but somewhat higher than Pakistan. For females, the Russian Federation life expectancy will not be as high as in Nicaragua, Morocco, or Egypt. For males, it will be in the same league as that of Cambodia, Ghana, and Eritrea.
In the face of today’s exceptionally elevated mortality levels for Russia’s young adults, it is no wonder that an unspecified proportion of the country’s would-be mothers and fathers respond by opting for fewer offspring than they would otherwise desire. To a degree not generally appreciated, Russia’s current fertility crisis is a consequence of its mortality crisis.
How did Russia’s mortality level, which was nearly 38 percent higher than Western Europe’s in 1980, skyrocket to an astonishing 135 percent higher in 2006? What role did communicable and infectious disease play in this fateful health regression and mortality deterioration?
By any reading, the situation in Russia today sounds awful. The Russian Federation is afflicted with a serious HIV/AIDS epidemic; according to UNAIDS, as of 2008 somewhere around 1 million Russians were living with the virus. (Russia’s HIV nexus appears to be closely associated with a burgeoning phenomenon of local drug use, with sex trafficking and other forms of prostitution or “commercial sex,” and with other practices and mores relating to extramarital sex.) Russia also faces a related and evidently growing burden of tuberculosis. As of 2008, according to World Health Organization estimates, Russia was experiencing about 150,000 new TB infections a year. To make matters worse, almost half of Russia’s treated tubercular cases over the past decade have been the variant known as extreme drug-resistant tuberculosis (XDR-TB).
Yet, dismaying as these statistics are, the picture looks even worse when we consider cardiovascular disease (CVD) mortality trends.
By the late 1960s, the epidemic upsurge of CVD mortality in Western industrial societies that immediately followed World War II had peaked. From the mid-1970s onward, age-standardized death rates from diseases of the circulatory system steadily declined in Western Europe. In Russia, by stark contrast, CVD mortality in 1980 was well over 50 percent higher than it had been in “old” EU states as of 1970, and the Russian population may well have been suffering the very highest incidence of mortality from diseases of the circulatory system that had ever been visited on a national population in the entire course of human history.
Over the subsequent decades, unfortunately, the level of CVD mortality in the Russian Federation veered even further upward. By 2006, Russia’s CVD mortality rate, standardizing for population structure, was an almost unbelievable 3.8 times higher than the population-weighted level reported for Western Europe.
Scarcely less alarming was Russia’s mortality rate from “external causes”—non-communicable deaths from injuries of various origins. The tale here is broadly similar to the story of CVD: impossibly high levels of death in a society that otherwise does not exhibit signs of backwardness.
In Western Europe, age-standardized mortality from injury and poisoning, as tabulated by the World Health Organization, fell by almost half between 1970 and 2006. In Russia, on the other hand, deaths from injuries and poisoning, which had been 2.5 times higher than in Western Europe in 1980, were up to 5.3 times higher as of 2006.
A broadly negative relationship was evident between mortality from injuries and per capita income. In other Western countries in 2002, an increase of 10 percent in per capita GDP was associated with a drop of about 2 points in injury deaths per 100,000 population. Yet Russia’s toll of deaths is nearly three times higher than would be predicted by its GDP. No literate and urban society in the modern world faces a risk of deaths from injuries comparable to the one that Russia experiences.
Russia’s patterns of death from injury and violence (by whatever provenance) are so extreme and brutal that they invite comparison only with the most tormented spots on the face of the planet today. The five places estimated to be roughly in the same league as Russia as of 2002 were Angola, Burundi, Congo, Liberia, and Sierra Leone. To go by its level of mortality injury alone, Russia looks not like an emerging middle-income market economy at peace, but rather like an impoverished sub-Saharan conflict or post-conflict society.
Taken together, then, deaths from cardiovascular disease and from injuries and poisoning have evidently been the main drivers of modern Russia’s strange upsurge in premature mortality and its broad, prolonged retrogression in public health conditions. One final factor that is intimately associated with both of these causes of mortality is alcohol abuse.
Unlike drinking patterns prevalent in, say, Mediterranean regions—where wine is regarded as an elixir for enhancing conversation over meals and other social gatherings, and where public drunkenness carries an embarrassing stigma—mind-numbing, stupefying binge drinking of hard spirits is an accepted norm in Russia and greatly increases the danger of fatal injury through falls, traffic accidents, violent confrontations, homicide, suicide, and so on. Further, extreme binge drinking (especially of hard spirits) is associated with stress on the cardiovascular system and heightened risk of CVD mortality.
How many Russians are actually drinkers, and how heavily do they actually drink? Officially, Russia classifies some 7 million out of roughly 120 million persons over 15 years of age, or roughly 6 percent of its adult population, as heavy drinkers. But the numbers are surely higher than this. According to data compiled by the World Health Organization, as of 2003 Russia was Europe’s heaviest per capita spirits consumer; its reported hard liquor consumption was over four times as high as Portugal’s, three times that of Germany or Spain, and over two and a half times higher than that of France.
Yet even these numbers may substantially understate hard spirit use in Russia, since the WHO figures follow only the retail sale of hard liquor. But samogon—home-brew, or “moonshine”—is, according to some Russian researchers, a huge component of the country’s overall intake. Professor Alexander Nemstov, perhaps Russia’s leading specialist in this area, argues that Russia’s adult population—women as well as men—puts down the equivalent of a bottle of vodka per week.
From the epidemiological standpoint, local-level studies have offered fairly chilling proof that alcohol is a direct factor in premature mortality. One forensic investigation of blood alcohol content by a medical examiner’s office in a city in the Urals, for example, indicated that over 40 percent of the younger male decedents evaluated had probably been alcohol-impaired or severely intoxicated at the time of death—including one quarter of the deaths from heart disease and over half of those from accidents or injuries. But medical and epidemiological studies have also demonstrated that, in addition to its many deaths from consumption of ordinary alcohol, Russia also suffers a grisly toll from alcohol poisoning, as the country’s drinkers, in their desperate quest for intoxication, down not only sometimes severely impure samogon, but also perfumes, alcohol-based medicines, cleaning solutions, and other deadly liquids. Death rates from such alcohol poisoning appear to be at least one hundred times higher in Russia than the United States—this despite the fact that the retail price in Russia today is lower for a liter of vodka than a liter of milk.
Josef Stalin is said to have coldly joked that one death was a tragedy, while one million deaths was just a statistic. This comment seems to apply to post-Communist Russia as well to Stalin’s own deranged regime. For the better part of a generation, Russia has suffered something akin to wartime population losses during year after year of peacetime political order. In the United Nations Development Program’s annually tabulated “Human Development Index,” which uses health as well as economic data to measure a country’s living standards as they affect quality of life, Russia was number 73 out of 179. A country of virtually universal literacy and quite respectable general educational attainment, with a scientific cadre that mastered nuclear fission over half a century ago and launches orbital spacecraft and interplanetary probes today, finds itself ranked on this metric between Mauritius and Ecuador.
In the modern era, population decline itself need not be a cause for acute economic alarm. Italy, Germany, and Japan are among the societies where signs of incipient population decline are being registered nowadays: all of these are affluent countries, and all can anticipate continuing improvements in their respective levels of prosperity (albeit at a slower tempo than some might prefer). Depopulation with Russian characteristics—population decline powered by an explosive upsurge of illness and mortality—is altogether more forbidding in its economic implications, not only forcing down popular well-being today, but also placing unforgiving constraints on economic productivity and growth for tomorrow.
As we have already seen, it is Russia’s death crisis that accounts for the entirety of the country’s population decline over the past decade and a half. The upsurge of illness and mortality, furthermore, has been disproportionately concentrated among men and women of working age—meaning that Russia’s labor force has been shrinking more rapidly than the population overall.
Health is a critical and central element in the complex quantity that economists have termed “human capital.” In the contemporary international economy, one additional year of life expectancy at birth is associated with an increase in per capita output of about 8 percent. A decade of lost life expectancy improvement would correspond to the loss of a doubling of per capita income. By this standard, Russia’s economic as well as its demographic future is in jeopardy.
It is not obvious that Russia will be able to recover rapidly from its health katastroika. There is an enormous amount of “negative health momentum” in the Russian situation today: with younger brothers facing worse survival prospects than older brothers, older brothers facing worse survival prospects than their fathers, and so on. Severely foreshortened adult life spans can shift the cost-benefit calculus for investments in training and higher education dramatically. On today’s mortality patterns, a Swiss man at 20 has about an 87 percent chance of making it to a notional retirement age of 65. His Russian counterpart at age 20 has less than even odds of reaching 65. Harsh excess mortality levels impose real and powerful disincentives for the mass acquisition of the technical skills that are a key to wealth generation in the modern world. Thus Russia’s health crisis may be even more generally subversive of human capital, and more powerfully corrosive of human resources, than might appear to be the case at first glance.
Putin’s Kremlin made a fateful bet that natural resources—oil, gas, and other extractive saleable commodities—would be the springboard for the restoration of Moscow’s influence as a great power on the world stage. In this gamble, Russian authorities have mainly ignored the nation’s human resource crisis. During the boom years—Russia’s per capita income roughly doubled between 1998 and 2007—the country’s death rate barely budged. Very much worse may lie ahead. How Russia’s still-unfolding demographic disaster will affect the country’s domestic political situation—and its international security posture—are questions that remain to be answered.
This article has been revised from the print version.
Nicholas Eberstadt holds the Henry Wendt Chair in Political Economy at the American Enterprise Institute and is Senior Adviser to the National Bureau of Asian Research.