Vodka, capitalism and Russia's "mortality crisis"

When communism ended in Russia, death rates shot up: but how much of that was actually due to economic turmoil?

Via Tim Worstall, a new NBER paper argues that the massive surge in deaths after the end of communism in Russia may have a simple, single cause: "the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign."

There is no doubt that the period between 1990 and 1994 was one of extraordinary turbulence in Russia. The country experienced, in just four years, a rapid and wholesale transition from an almost entirely centralised economy to one of the freest markets in the world. The opportunism of the change was given as an archetypal example of the "Shock Doctrine" by Naomi Klein, in her book of the same name.

One of the key stats cited to prove the upheaval is the astonishing leap in mortality. As the authors of the paper, Jay Bhattacharya, Christina Gathmann, and Grant Miller (of Stanford university) write:

Crude death rates in Russia soared by 40% between 1990 and 1994, climbing from 11 to nearly 15.5 per thousand. By 2009 standards, the decline in male life expectancy at birth (by nearly 7 years, to 57.6) would tie Russian men with their counterparts in Bangladesh, falling short of male longevity in less-developed countries with troubled population health histories (Botswana, Haiti, North Korea, and Yemen, for example). The magnitude of this surge in deaths – coupled with the Soviet Union’s international prominence – has prompted observers to term this demographic catastrophe “the Russian Mortality Crisis.”

The immediate cause of the surge in deaths isn't economic transition, but a massive rise in alcohol consumption; the types of deaths that increased most were those related to alcoholism, like alcohol poisoning, violent deaths, heart attacks and strokes. Additionally, the deaths were concentrated amongst working age men.

What the authors argue is that, while alcoholism can of course be the result of societal factors, it also suggests that factors more directly related to drinking be examined. Their key prompt comes in the form of the following chart:

 

While the post 1990 spike is very real, the corresponding pre-1990 dip is under-explained by narratives which focus on economic upheaval. But it is potentially explained by the success, and then demise, of the USSR's "Measures to Overcome Drunkenness and Alcoholism", which "ushered in the country’s most stringent anti-alcohol policies since its 1919- 1925 prohibition".

The actual measures are fascinating, especially in the context of today's debate around minimum pricing. They addressed both supply and demand, by:

  • Reducing production of alcohol;
  • Restricting alcohol sales on business days, raising the drinking age, and banning restaurants from selling spirits;
  • Raising prices by around a quarter, then a half;
  • Introducing new sanctions for alcohol related crimes;
  • (and on the demand side) subsidising substitute activities like parks and sports clubs;
  • Propoganda and a ban on glamorous depictions of drinking;
  • And improved treatment of alcoholism.

These measures had a huge success; although the official statistics probably overstate the effect, due to the difficulty of accounting for moonshine production, they show a drop in sales of 50 per cent. That led to a continued decrease in death rates:

 

Importantly, the authors argue that the measures would take a while to unwind once the program ended in 1988, explaining the lag in time between its end and the beginning of the mortality spike.

Not every extra death is explicable by this factor; but the authors estimate that 2.15 million people in the mortality crisis died, not as a result of the larger crisis, but due to these measures being repealed.

Drink responsibly, people.

Boris Yeltsin sips some Vodka. Photograph: Getty Images

Alex Hern is a technology reporter for the Guardian. He was formerly staff writer at the New Statesman. You should follow Alex on Twitter.

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For a mayor who will help make Londoners healthier, vote for Tessa Jowell

The surgeon, former Labour health minister and chairman of the London Health Commission, Ara Darzi, backs Tessa Jowell to be Labour's candidate for London mayor.

London’s mayor matters. As the world’s preeminent city, London possesses an enormous wealth of assets: energetic and enterprising people, successful businesses, a strong public sector, good infrastructure and more parks and green spaces than any other capital city.

Yet these aren’t put to work to promote the health of Londoners. Indeed, quite the opposite: right now, London faces a public health emergency.

More than a million Londoners still smoke tobacco, with 67 children lighting up for the first time every day. London’s air quality is silently killing us. We have the dirtiest air in Europe, causing more than 4,000 premature deaths every year.

Nearly four million Londoners are obese or overweight – and just 13% of us walk or cycle to school or work, despite half of us living close enough to do so. All Londoners should be ashamed that we have the highest rate of childhood obesity of any major global city.

It’s often been said that we don’t value our health until we lose it. As a cancer surgeon, I am certain that is true. And I know that London can do better. 

For that reason, twice in the past decade, I’ve led movements of Londoners working together to improve health and to improve the NHS. Healthcare for London gave our prescription for a better NHS in the capital. And Better Health for London showed how Londoners could be helped to better health, as well as better healthcare.

In my time championing health in London, I’ve never met a politician more committed to doing the right thing for Londoners’ health than Tessa Jowell. That’s why I’m backing her as Labour’s choice for mayor. We need a mayor who will deliver real change, and Tessa will be that mayor.  

When she invited me to discuss Better Health for London, she had the courage to commit to doing what is right, no matter how hard the politics. Above all, she wanted to know how many lives would be saved or improved, and what she could do to help.

In Tessa, I see extraordinary passion, boundless energy and unwavering determination to help others.

For all Londoners, the healthiest choice isn’t always easy and isn’t always obvious. Every day, we make hundreds of choices that affect our health – how we get to and from school or work, what we choose to eat, how we spend our free time.

As mayor, Tessa Jowell will help Londoners by making each of those individual decisions that bit easier. And in that difference is everything: making small changes individually will make a huge difference collectively.  

Tessa is committed to helping London’s children in their early years – just as she did in government by delivering Sure Start. Tessa will tackle London’s childhood obesity epidemic by getting children moving just as she did with the Olympics. Tessa will make London a walking city – helping all of us to healthier lifestyles.

And yes, she’s got the guts to make our parks and public places smoke free, helping adults to choose to stop smoking and preventing children from starting.   

The real test of leadership is not to dream up great ideas or make grand speeches. It is to build coalitions to make change happen. It is to deliver real improvements to daily life. Only Tessa has the track record of delivery – from the Olympics to Sure Start.   

Like many in our capital, I am a Londoner by choice. I am here because I believe that London is the greatest city in the world – and is bursting with potential to be even greater.

The Labour party now has a crucial choice to make. London needs Labour to choose Tessa, to give Londoners the chance to choose better health.