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.

Getty
Show Hide image

Wrists, knees, terrible rages – I felt overwhelmed when Barry came to see me

I teach my registrars to be aware how a consultation is making them feel: that can give valuable clues to the patient’s own emotional state.

To begin with, it seemed that Barry’s wrists were the problem. He told me about the pain he was experiencing, the pins and needles that came and went in his hands. I started to examine him. His palms were calloused, his fingers thick and stubby, veterans of the heavy work he’d undertaken throughout his 57 years. Even as I assessed this first problem, he mentioned his knees. I moved on to look at those. Then it was his back. I couldn’t get to grips with one thing before he veered to the next.

I teach my registrars to be aware how a consultation is making them feel: that can give valuable clues to the patient’s own emotional state. Barry was making me feel overwhelmed, the more so as I learned that he’d been experiencing all these problems for years.

“Why are you coming to see me about them now,” I asked, “rather than six months ago – or in six months’ time?”

“I need some time off, doc.”

There was something about the way he wouldn’t meet my gaze. And again, that feeling of being overwhelmed.

“What’s going on at work?” I asked him.

His tone hardened as he told me how he’d lost his temper a couple of days earlier. How one of the others had been winding him up, and something inside him had snapped, and he’d taken a swing at his workmate and landed a punch.

Barry had walked out and hadn’t been back. I tried to find out if he’d heard from his boss about the incident, if he knew what was likely to happen next.

He told me he didn’t care.

We talked some more. I learned that he’d been uncharacteristically short-tempered for months; his partner was fed up with being shouted at. Sleep had gone to pot, and Barry had taken to drinking heavily to knock himself out at night. He was smoking twice his usual amount. Men like Barry often don’t experience depression as classic low mood and tearfulness; they become filled with rage and turn in on themselves, repelling those closest to them in the process.

Depression is a complex condition, with roots that can frequently be traced right back to childhood experiences, but bouts are often precipitated by problems with relationships, work, money, or health. In Barry’s case, the main factor turned out to be his job. He’d been an HGV driver but at the start of the year his company had lost its operator’s licence. To keep the business afloat, his boss had diversified. Barry hated what he now had to do. He was now a “catcher”.

I didn’t know what that meant. Getting up at the crack of dawn, he told me, driving to some factory farm somewhere, entering huge sheds and spending hours catching chickens, thousands upon thousands of them, shoving them into crates, stashing the crates on a lorry, working under relentless pressure to get the sheds cleared and the birds off to the next stage of the food production chain.

“It’s a young man’s game,” he told me. “It’s crippling me, all that bending and catching.”

It wasn’t really his joints, though. Men like Barry can find it hard to talk about difficult emotion, but it was there in his eyes. I had a sudden understanding: Barry, capturing bird after panicking bird, stuffing them into the transport containers, the air full of alarmed clucking and dislodged feathers. Hour after hour of it. It was traumatising him, but he couldn’t admit anything so poncey.

“I just want to get back to driving.”

That would mean landing a new job, and he doubted he would be able to do so, not at his age. He couldn’t take just any old work, either: he had to earn a decent wage to keep up with a still sizeable mortgage.

We talked about how antidepressants might improve his symptoms, and made a plan to tackle the alcohol. I signed him off to give him some respite and a chance to look for new work – the one thing that was going to resolve his depression. But in the meantime, he felt as trapped as the chickens that he cornered, day after soul-destroying day.

Phil Whitaker’s novel “Sister Sebastian’s Library” will be published by Salt in September

This article first appeared in the 21 July 2016 issue of the New Statesman, The English Revolt