I concluded my previous column with a promise to share with you a “startling and personal finding” to do with my “Russian twin”. Many of you asked what it is. Time now to end the suspense!
I am an Indian male, born on January 15, 1970. If I were still living in India, with an average lifestyle and access to health services, I would have an estimated 28 years of life left. But my Russian counterpart, also born on January 15, 1970 but in Russia, can expect to live only 23.5 more years. In other words, my “Russian twin” is expected to die 4.5 years earlier than me. Startling, isn’t it?
You can enter your own birth dates and compare how long you will live in any other country through this nifty website created by World Data Lab.
So, why is life expectancy in Russia is low? Before we get to the bad news, let’s first recognize the good news. Life expectancy in Russia has been increasing in recent times –– from 65.3 years in 2000 to 72.7 years today. This is mostly due to a drop in the number of deaths caused by non-communicable diseases (i.e. diseases that are not infectious or contagious such as heart attacks and stroke) and external causes (such as road accidents and homicides).
Moreover, these gains appear to be more sustainable than those in two previous waves. The first was during the mid-1980s when Secretary Gorbachev launched an anti-alcohol campaign. The second was in the mid-1990s, in the aftermath of the fall of the USSR, when life expectancy plunged to 63.9 years in 1994 – its lowest point, and the only way left was up.
However, both these waves were short-lived. The anti-alcohol campaign effort of the mid-1980s lost steam because of its top-down and small-scale nature. And the post-1994 gains were rudely reversed because of the 1998 macro crisis –– which underscores the importance of macro-stability and economic conditions in increasing life expectancy.
It is also worth pointing out that mortality rates for both adults and particularly children have been decreasing since the 2000s. This is good news, indeed. Even more recently, infant mortality decreased by 36 percent from 2011 to 2017, and maternal mortality decreased by 49 percent in the same period. These are gains that Russians ought to be proud of!
What then is the bad news, you may ask?
Nikolai Gogol, in his tour de force Dead Souls, wrote: “Ah, our peasant of Russia. Never do you welcome death when it comes.” But sadly, it seems that the average Russian must “welcome” death sooner than expected. At 72 years, life expectancy in Russia is just around the global average, and far below that of Brazil and China (both 76 years) –– countries with much lower per capita incomes than Russia’s. Secondly, male life expectancy is only 67.6 years compared to 77.6 for females –– a 10-year difference. Strikingly, since the 1950s, male life expectancy has gone up by only 12 years in Russia compared to 32 years in China and 21 years in Brazil. And thirdly, national figures hide huge variations in Russian regions.
While life expectancy in urban Moscow city is 77.1 years, it is only 64.4 years in far-flung Chukotka –– more than a 14-year difference. These sub-optimal health outcomes also affect economic outcomes: one estimate suggests that Russia could have reversed two-thirds of its recent working-age population decline if deaths were delayed to a later age.
So, what can be done? The underlying causes of low life expectancy in Russia remain the prevalence of non-communicable diseases mentioned above. In broad terms, actions to address these causes fall under two categories: reducing demand for addictive, harmful items such as tobacco and alcohol, and increasing supply of health service provision.
Let’s start with the demand side. While there are many ways of sapping demand for addictive and harmful items that reduce life expectancy (from awareness campaigns to outright bans), the most sustainable and effective means to influence behavior remains increasing prices. Raising prices of alcohol or tobacco through excise taxes, often referred to as “sin” taxes, are simple and they work: increase price, reduce consumption.
To its credit, the Russian government has been gradually increasing sin (and related) taxes. Thanks to these measures, alcohol consumption has fallen from 12 liters per person in 2012 to 10 liters per person in 2017. Smoking prevalence among adults has also fallen from almost 40 percent in 2009 to 31 percent in 2016.
However, tobacco taxes remain below those of countries such as Israel and Slovakia where, according to recent World Health Organization estimates, over 80 percent of the total price of a pack of cigarettes is due to taxes (compared to about 50 percent in Russia).
Now, let’s look at the supply side. It is important to recognize Russia’s 2006 National Priority Health Project and the Health Care Modernization Program. Over the period 2011-2017, these initiatives led to more than 300 new polyclinics and 1,800 feldsher-midwife units being built in Russian regions. And over 600 special centers for providing modern emergency care to patients with stroke and acute coronary syndrome have also been established.
However, public health spending in Russia remains relatively low. At around 3.6 percent of GDP in 2016, it is well below the EU average of 7.2 percent of GDP and 6.5 percent for OECD countries. Compared to the BRIC countries, Russia’s public health spending only exceeds health expenditures in China (3.1 percent of GDP) and India (1.4 percent of GDP). Russians have to make up for this low public spending on health by incurring high private, out of pocket expenditures instead.
In addition, Russia’s health care spending is inefficiently allocated. The current configuration of health care provision emphasizes high-cost hospital and specialist care. Indeed, despite a reduction of hospital capacity in the last decade, the number of hospital beds per 1,000 people in Russia is 1.6 times higher than the EU average, and the average length of stay is 1.5 times longer! Admittedly, some of this might be due to Russia’s country size and low population density vis-à-vis other EU countries. But the point is while additional resources are needed, they need to be accompanied by reforms to increase the value for money spent.
Health is less like wealth and more like money: Both are necessary but do not guarantee happiness. And like money, health provides the basis for equal opportunity. I remain cautiously optimistic that through managing these demand and supply challenges, higher life expectancy is indeed an attainable goal for Russia. If not me, perhaps my 10-year-old son (with whom I coincidentally share the same birthday) and his “Russian twin” can share more in common on this journey of life...