Medical University Of Sofia

Demographics of Russia

Firat GULLU
Faculty No: 5139
Group:39

This publication tries to debunk some popular, but misguided, views on demographic trends
in today's Russia. These consist of the perception that Russia is in a demographic "death
spiral" that dooms it to national decline (Biden, Eberstadt, NIC, CIA, Stratfor, etc). Some
extreme pessimists even predict that ethnic Russians - ravaged by AIDS, infertility and
alcoholism - will die out as an ethnicity, displaced by Islamist hordes and Chinese settlers
(Steyn, Collard).
The Myth of Russia's Demographic Apocalypse
Think again. While it is true that Russia's current demographic situation is nothing to write
home about, most of the demographic trends that matter are highly positive - and there is
compelling evidence that Russia can still return to a healthy, longterm pattern of sustainable
population replacement.
1. MYTH: Russia is losing 750,000 of its population per year and will become
depopulated within decades.
REALITY: In 1992, for the first time since the Great Patriotic War, deaths exceeded births in
Russia, forming the so-called "Russian Cross". Since then the population fell from 149mn to
142mn souls.However, the rate of depopulation has slowed massively in recent years.
As of 2008, there were 362,000 more deaths than births in Russia, down from 847,000 in
2005. Furthermore, adding in migration would give a total population loss of just 105,000
people in 2008, equivalent to -0.07% of the population, which is a massive improvement
from the 721,000 fall in 2005. The situation continued improving in 2009, despite
the economic crisis, with Russia seeing positive natural increase in August and
September for the first time in 15 years.

[Source: Rosstat; analyzed & published by Sergey Slobodyan @ Sublime Oblivion].

Though this is still far from demographic salubrity, the situation today more resembles the
stagnation seen in Central Europe than the catastrophic collapse of the transition era, and
the trends remain positive. As such, pessimistic predictions of imminent demographic
apocalypse are becoming increasingly untenable.
2. MYTH: Granted, Russia's crude birth rates have risen in recent years. But this was
all due to the big size of the 1980's female cohort, which reached childbearing age in
the 2000's; since the 1990's cohort is about 40% smaller, birth rates will tumble again.

[Source: Rosstat; edited by Anatoly Karlin].

REALITY: From 1999-2007, only 37% of the increase in the crude birth rate was due to an
increase in the size of the childbearing age segment of the population (only 10% in 2007
itself). The rest came from an increase in the total fertility rate (TFR), the average number of
children a woman can be expected to have over a lifetime, irrespective of the structure of the
age pyramid.
Speaking of which, Russia's TFR has risen from a nadir of 1.16 children per women in
1999, to 1.49 children in 2008 (and thus also breaking the "lowest-low" fertility hypothesis
that states that no society has ever recovered from a fertility collapse to below 1.30 children).
The figures for 2009 will almost certainly show a TFR above 1.50.
This is not to say that the coming reduction in the fertility contribution of the 1980's "youth
bulge" will not exert a growing downwards pressure on Russian birth rates in the next two
decades. However, a growing TFR will be able to partially, or even fully, counteract these
adverse trends.
3. MYTH: The recent rise in fertility is small and fragile, based on the temporary effects
of new maternity benefits and pro-natality propaganda. It will shatter as soon as the
first economic crisis interrupts Russia's petro-fueled swagger.
REALITY: It is true that Russia's current TFR, at 1.5 children per woman, is well below the
2.1 needed for long-term population stability. That said, there are compelling reasons to
believe that we seeing an incipient fertility reversal in Russia.
First, fertility expectations today are little different from those of the late Soviet era
when the TFR was near replacement level. According to numerous surveys since the early
1990's, Russians consistently say they want to have an average of 2.5 children. This is
broadly similar to respondents from the British Isles, France and Scandinavia, who have
relatively healthy TFR's of around 1.7-2.1. This suggests Russia's post-Soviet fertility
collapse was caused by "transition shock" rather than a "values realignment" to middleEuropean norms, where people only want 1.7-1.8 children.
Second, a major problem with the TFR is that it ignores the effects of birth timing. A more
accurate measure of long-term fertility is the average birth sequence (ABS), which gives the
mean order of all newborn children. If in one fine year all women in a previously childless
country decide to give birth for some reason, the TFR will soar to an absurdly high level but
the ABS will equal exactly one.

[Source: Demoscope; edited by Anatoly Karlin].

In Russia the ABS remained steady at 1.6 children per woman from 1992-2006, little
changed from the 1.8 of Soviet times, even though the TFR plummeted well below this
number. This indicates thatmany women were postponing children until they settled into
careers and improved their material wellbeing -- a hypothesis attested to by the rising age
of mothers at childbirth since 1993. As such, it is not unreasonable to expect a
compensatory fertility boom in the 2010's.

[Source: Demoscope; edited by Anatoly Karlin].

Though this may be a false positive if many women remain childless, the 2002 Census
indicated that only 6-7% of women did not have any children by the end of their reproductive
years. This indicates that childlessness is not in vogue and worries about widespread
abortion-induced sterility are overblown.
Third, a new, confident conservatism has recently taken hold in Russian society. After
two decades of disillusionment, at the end of 2006 consistently more Russians began to
believe the nation was moving in a positive than in a negative direction. The state began to
reconstruct an ideological basisfor belief in Russia's future, which included the
aforementioned maternal benefits and pro-natality campaigns - and contrary to pessimist
assertions, the examples of France and Sweden indicate that such efforts tend to be
successful at incubating longterm improvements in TFR. Can it really be the case that the
genesis of Russia's rediscovery of belief in itself, and of consistent improvements in its
demography, were a matter of mere coincidence?
Fourth, the cohort now entering the workforce will probably enjoy greater job opportunities
and higher wages because of the imminent shrinking of Russia's labor force. This may
provide incentives to marry earlier and have more children, which would compensate for this
cohort's smaller size. Nor are they likely to be subjected to taxes high enough to discourage
family formation; relative to continental Europe, Russia is still a younger nation and can be
expected to enjoy high energy revenues in the post-peak oil age.
Finally, the economic crisis has come and gone - and in stark contrast to popular
predictions of arenewed fertility collapse and higher deaths from alcoholism (which I
challenged in the face ofheavy opposition), Russia saw its first two months of natural
population growth for the last 15 years in August and September 2009. So the notion
that Russia's demographic recovery is built on quicksand has been objectively refuted.

4. MYTH: Russia's main demographic problem is not the fertility rate, but a dismally
low life expectancy, especially for middle-aged men.
REALITY: It is true that Russia's life expectancy is exceptionally bad by industrialized-world
standards. Death rates for middle-aged men today are, amazingly, no different from those of
late Tsarism -- a phenomenon Nicholas Eberstadt termed "hypermortality". This tragic
development is almost entirely attributable to the extreme prevalence of binge drinking of
hard spirits, which accounts for 32% of Russia's aggregate mortality (compared to 1-4% in
West European nations)
However, not all demographic indicators are created equal. High mortality rates only
have a direct impact on the replacement-level TFR when significant numbers of women die
before or during childbearing age, as in Third World countries. Russia's infant mortality rate
of 8.5 / 1000 in 2008 is close to developed-country levels and not statistically significant.
Though tragic and unnecessary, its "hypermortality" crisis mainly affects older men and
as such has negligible direct effects on fertility.
That said, mortality rates must be curbed if Russia is to avoid significant population decline in
the coming decades. Contrary to prevailing opinion, plans to raise life expectancy to 75 years
by 2020 or 2025 are feasible if approached seriously. From 1970-1995 in Finnish Karelia,
better healthcare and lifestyle reforms reduced incidences of heart disease, Russia's main
cause of death, by over 70%. Considering the sheer size of the gap between Russia and the
advanced industrial world, even modest improvements will have a big impact.
These modest improvements are now coming about. Russia is now installing new
equipment in oncology centers, aims to increase access to hi-tech medical services from
25% to 80% by 2012, and is becoming more serious about implementing anti-smoking, antialcohol and safety measures. In 2008, Russia's life expectancy, as well as deaths from
accidents (including alcohol poisoning, violence, and suicide), have improved past the
(pre-transition) levels of 1992 - and the recovery continues into 2009.
5. MYTH: There is an unrivaled panoply of social ills in Russia, such as sky-high rates
of abortion, alcoholism and accidents. These will induce Russians to disinvest in the
future, which will result in low economic growth and a perpetuation of its death spiral
into oblivion.
REALITY: Quite apart from this being a "mystical" explanation for national decline, and
hence unscientific, this assertion is not backed up by the historical record. All these social ills
first manifested themselves in the USSR from around 1965 (accompanied by sky-rocketing
male mortality rates), yet nonetheless, that did not preclude Russia from maintaining a near
replacement level TFR until the Soviet Union's dissolution - and ultimately, that is all that
matters for maintaining longterm population stability.
The Russian abortion rate was nearly twice as high during the Soviet period relative to
today, but today's prevalent fears of widespread infertility as a byproduct somehow never
materialized - the 2002 Census indicated that only 6-7% of women did not have any children
by the end of their reproductive years. Today, abortions continue on their longterm
decline, even in the aftermath of the late-2008 economic crisis (and despite
the hysterical predictions to the contrary).

[Source: Demoscope; edited by Anatoly Karlin].

Similarly, excessive alcohol consumption - the major cause of "hypermortality" amongst
middle-aged Russian men - set in long before the post-Soviet demographic collapse.
(Observe how closely Russia's historical mortality trends correlate to Nemtsov's estimates
of alcohol consumption in the graph below). Yet as mentioned above, high middle-aged
male mortality rates have no direct impact on fertility rates. Furthermore, since there is
no major discrepancy between the numbers of men and women until the age of 40, women
have no physical problem in finding mates (though it is true that high mortality and alcoholism
amongst males has a suppressing effect on new couple formation, the late Soviet experience
suggests that it does not altogether preclude a healthy TFR).

[Source: Rosstat, V. Treml & A. Nemtsov; note that the official Goskomstat (Rosstat)
figures ought to be discarded because they do not account for moonshine, which may
constitute as much as half of Russia's alcohol consumption].
The demographer Eberstadt asserts that Russia's high mortality rates preclude human
capital formation through education because men facing elevated mortality risks
(supposedly) discount its future value; consequently, this dims the prospects for longterm
economic growth. This hypothesisdoesn't stand up to the evidence. The late Soviet Union
had one of the world's highest tertiary enrollment rates, and more than 70% of today's
Russians get a higher education. This should not be surprising due to human psychological
factors - "deaths from heart disease and accidents only happen to other people"; and
besides, even if a Russian man assumes he'll die in his 50's or 60's, he'd still rather live
comfortably, avoid the military draft, etc, than sweep the streets. So this argument is flawed
on many, many levels.
It is true that poor health lowers economic productivity. However, one should note the
caveats that 1) hypermortality disproportionately effects poorer, lower-educated people, 2) in
the post-agrarian society, the main driver of productivity improvements is education - not
health, and 3) there is a silver lining in that by curbing aging, a low life expectancy also
relieves pressure on pensions. Finally, drunkenness by itself cannot check the growth of a
vital civilization -- after all, America was known as the Alcoholic Republic during the
early 19th century.
6. MYTH: The ruling elite's criminal neglect of Russia's growing AIDS crisis will soon
result in hundreds of thousands of annual deaths, further accelerating its
demographic collapse.

REALITY: Institutions like the World Bank were predicting hundreds of thousands of
deaths by 2010, yet the death toll for 2008 was only 12,800. Further, the percentage of
pregnant women testing HIV positive plateaued in 2002, suggesting the epidemic
remains essentially contained among injecting drug users.

[Source: 2008 Russian AIDS Progress Report].

The problem with the "doomer" models used to predict apocalypse (Eberstadt, NIC, Ruhl et
al, etc) is that their projections of imminent mass deaths from AIDS unrealistically
assume heterosexual, sub-Saharan Africa transmission patterns, which is unbacked by
sociological analysis or surveillance data. A more rigorous model by the Knowledge for
Action in HIV/AIDS in Russia research program predicts a peak HIV prevalence rate of
under 1% of the total Russian population by around 2020. Thus far, it correlates with
reality.
Finally, following a period of real neglect of the problem until 2005, the Russian state has
sinceramped up spending on AIDS to an annual 0.5bn $. One can no longer speak of official
negligence.
7. MYTH: Faster-breeding Muslims will constitute the majority of the Russian
Federation's citizens by 2050, placing the dwindling Orthodox Russians under a brutal
dhimmitude.
REALITY: Ethnic Russians still make up nearly 80% of the population, whereas only 4-6%
of the population consider themselves to be Muslim in opinion polls. The fertility rates
of the biggest Muslim ethnicities, Tatars and Bashkirs, is little different from the national
average.
Even the Caucasian Muslim republics experienced a drastic fertility transition in the last
twenty years, as a result of which the only one to still have an above-replacement level TFR

is Chechnya. However, Chechnya's 1.2mn people constitute less than 1% of the Russian
total.

So the fact of the matter is that Russian Muslims simply do not have the demographic
base to become anywhere near the Federation's majority ethnicity in the foreseeable
future.

[Source: Rosstat; edited by Anatoly Karlin].

Furthermore, the main reason some people fear - or relish - the prospect of an Islamic
Russia is because they associate Russian Muslims with their less progressive co-religionists
in the Middle East. In reality, vodka has long since dissolved away the Koran in Russia. The
vast majority of Muslim Russians are loyal citizens, having made their peace with the
imperial Russian state long ago;imminent dhimmitude is a myth, the product of fevered
imaginations.
8. MYTH: The Chinese are taking over the depopulating Russian Far East by a stealth
demographic invasion; tempted by Siberian Lebensraum and vast mineral riches, they
will eventually seize it outright from a weakening Russia.
REALITY: There are no more than 0.4-0.5mn Chinese in Russia (and probably a good deal
less). The vast majority of them are temporary workers and seasonal traders who have no
long-term plans of settling in Russia. Even though the Russia Far East depopulated much
faster than the rest of Russia after the Soviet collapse, at more than 6mn today, Russian
citizens remain ethnically dominant.
Furthermore, the average Manchurian has no objective desire to migrate to Siberia and
squat illegally in a pre-industrial farm in a God-forsaken corner of the taiga. Alarmism on
this issue is a trifecta of ignorance, Russophobia, and Sinophobia (the "Yellow Peril").

Though the possibility that Malthusian pressures will eventually force China into aggressive
expansionism cannot be discounted, it would be suicidal to intrude on Russia because of its
vastnuclear arsenal.
9. MYTH: But all the demographic models indicate that Russia is going to depopulate
rapidly!
REALITY: Not all of them. I give an alternate range of scenarios that see Russia's
population change from today's 142mn, to 139mn-154mn by 2025, and 119mn-168mn
(medium -- 157mn) souls by 2050.
In the "Medium" scenario, life expectancy reaches 74 years by 2025 (today's Poland) and 81
years in 2050 (today's Canada); the TFR rises from 1.4 children per woman in 2006 to 2.0 by
2015, before gently descending to 1.7 from 2025 to 2050; and there is an annual influx of
300,000 net migrants. (These assumptions are plausible, based on a realistic knowledge of
the current situation (see above), and a modest amount of confidence in Russia's spiritual
regeneration and capability to sustain economic modernization). The resulting population
dynamics are reproduced below.

[Source: Anatoly Karlin @ Sublime Oblivion].

But even assuming Russia's TFR gets stuck at 1.5 children per woman in 2010 - i.e.
slightly lower than its level today, while retaining the aforementioned mortality and migration
trajectories, the population size will remain basically stagnant, going from 142mn to
143mn by 2023 before slowly slipping down to 138mn by 2050.

On the basis of this model, I made several falsifiable predictions back in July 2008, whose
fulfillment will confirm its validity (or not). The three most important predictions are the
following:
Russia's population will start growing again by 2010.
Natural population increase will resume by 2013.
Total life expectancy will exceed 70 years by 2012.
My results are somewhat similar to Rosstat forecasts which see the population growing
to 134mn-145mn (medium -- 140mn) by 2025. Furthermore, both of them are, at least thus
far, more in line with reality than the older "doomer" models, which by and large failed to
predict the recent demographic improvements.
10. MYTH: Okay then, the vast majority of models by respectable institutions - i.e., not
those of Kremlin mouthpieces like Rosstat or yourself - project that Russia's
population is going to plummet to 100mn or so people by 2050.
REALITY: First, appeal to authority & association fallacy. Second, you can check the
reliability of my model because my source code is open and accessible for all, which is
more than you can say for many of these "respectable institutions". Third, the problem with
the aforementioned "doomer" models is that they are all essentially based on linearly
extrapolating Russia's post-Soviet fertility and mortality situation into the far future,
assuming negligible improvements or even a deterioration (as in the models including the
imminent, but fortunately non-existent, African-style AIDS epidemic).
It is my belief that Russia's demographic "doomers" ignore the importance of the post-Soviet
resilience of Russia's fertility expectations, the evidence that Russia's post-Soviet
demographic collapse was just an aberration caused by its wrenching transition to a new
socio-political system, and the newly-emerging sociological trends that are returning
Russia's to its past-and-future Empire - trends that are restoring Russians' faith in the
future, reinforcing social conservatism, and creating the conditions, with the Kremlin's active
support, for a major demographic reversal out of the post-Soviet abyss.
I would be the first to admit that this interpretation of Russian society may be incorrect, and
consequently so are my "optimistic" demographic projections. Feel free to disagree with my
interpretation, but do note that 1) I accurately called the economic crisis as a non-event in
relation to Russia's demography and 2) made falsifiable, near-term predictions about
Russia's future demography, which few other crystal-ball gazers care to do.
Speaking of crystal balls, I would like to end this by noting that pretty much all demographic
projections beyond 20 years into the future - the approximate time needed for a new cohort
to reach reproductive age - are near-useless in practical terms. Any simplistic
extrapolation will eventually founder on the discontinuities inevitably produced by
complex human systems: for a past example, compare 20th century French and German
demographic history; regarding the future, note the profoundly disruptive potential of two
strong concurrent trends - limits to growth, and technological singularity - either of which
could so radically transform human life in the 21st century, as to render modern demographic
analysis meaningless as a scientific tool.
Anatoly Karlin is an independent blogger who writes about Russia, geopolitics, and global
trends at his blog Sublime Oblivion. He is currently working on a book about the "future
history" of the 21st century.

In 2010, 1,140,368, or 56% of all deaths in Russia were caused by cardiovascular disease.
The second leading cause of death was cancer which claimed 292,310 lives (14.3%).
External causes of death such as suicide (1.7%), road accidents (1.4%), murders (0.9%),
accidental alcohol poisoning (0.7%), and accidental drowning (0.5%), claimed 206,336 lives
in total (10.2%). Other major causes of death were diseases of the digestive system (4.5%),
respiratory disease (3.6%), infectious and parasitic diseases (1.6%), and tuberculosis (1.1%).
[50] The infant mortality rate in 2010 was 7.5 deaths per 1,000 (down from 8.2 in 2009 and
16.9 in 1999).[51][52]
As of 2010, the average life expectancy in Russia was 63.03 years for males and 74.87
years for females.[53] The average Russian life expectancy of 68.98 years at birth is nearly
10 years shorter than the overall average figure for the European Union, or the United
States.[54] The largest contributing factor to the relatively low life expectancy is high mortality
among working-age males due to preventable causes such as accidents, alcohol poisoning,
violent crimes, heart disease etc.[citation needed] Some infectious diseases are also
implicated, such as AIDS/HIV and tuberculosis, which became more widespread in Russia in
the 1990s because of the deterioration in the healthcare system. In the late 1950s, the USSR
had a higher life expectancy than the United States,[55] but the Soviet Union has lagged
behind Western countries in terms of mortality and life expectancy since the late 1960s. The
life expectancy was about 70 in 1986,[56] prior to the transition-induced disruption of the
healthcare system. The turmoil in the early 1990s caused life expectancy in Russia to
steadily decrease while it was steadily increasing in the rest of the world. Recently however,
Russian life expectancy has again begun to rise. Between 20052010 the male life
expectancy in Russia rose by over four years, increasing the overall life expectancy by nearly
4 years to 68.98.[53]

Abortions
In the 1980s only 810% of married Russian women of reproductive age used hormonal and
intrauterine contraception methods, compared to 2040% in developed countries. This led to
much higher abortion rates in Russia compared to developed countries: in the 1980s Russia
had a figure of 120 abortions per 1,000 women of reproductive age compared with only 20
per 1,000 in Western countries. However, after the dissolution of the Soviet Union many
changes took place, such as the demonopolization of the market for contraceptive drugs and
media liberalization, which lead to a rapid conversion to more efficient pregnancy control
practices. Abortion rates fell in the first half of the 1990s for the first time in Russia's history,
even despite declining fertility rates. From the early 1990s to 2006, the number of expected
abortions per women during her lifetime fell by nearly 2.5 times, from 3.4 to 1.2. As of 2004,
the share of women of reproductive age using hormonal or intrauterine birth control methods
was about 46% (29% intrauterine, 17% hormonal).[57]
Despite clear progress in family planning, the target of desired children at the desired time for
a large portion of Russian families has not yet been achieved. According to a 2004 study,
current pregnancies were termed "desired and timely" by 58% of respondents, while 23%
described them as "desired, but untimely", and 19% said they were "undesired". The share of
unexpected pregnancies remains much lower in countries with developed family planning
culture, such as the Netherlands, whose percentage of unwanted pregnancies 20 years ago
was half of that in Russia today.

Mortality
The social and economic crises that gripped Russia in the early 1990s are reflected in
increased mortality and declining life expectancy, especially among able-bodied males.
Contributing to Russia's long-term population decline is a projected mortality rate increase
from 11.3 per 1,000 population in 1985 to 15.9 per 1,000 in 2005. Russia's mortality rate
reached its lowest level, 10.4 per 1,000 population, in 1986 (for which a state anti-alcohol
campaign received substantial credit); then the figure rose steadily in the ensuing decade.
The largest jump was from 12.2 to 14.6 per 1,000 between 1992 and 1993; after having
reached 15.7 per 1,000 in 1995, the rate was projected to remain virtually flat over the next
decade.
According to 1994 statistics, the life expectancy for Russian males had reached 57.3 years
and for females 71.1 years. These are the lowest figures and the largest disparity by sex for
any country reporting to the World Health Organization, and they are a sharp decline from
the 1987 levels of 64.9 years for males and 74.6 years for females. In 1990 the Russian
Republic ranked only seventh in this statistic among the fifteen republics of the Soviet Union.
The lag in the average life expectancy of males was attributed to alcohol and tobacco abuse;
to unsafe conditions at work, on the road, and in the home; and to declining heath care.
Mortality rates are especially high for able-bodied males in rural areas. Served poorly by the
health care system and lacking basic sanitary facilities and conveniences, many farming
communities have been transformed into enclaves for the elderly, the indigent, and the sick.
Moreover, indigenous nationalities such as the Evenks and the Nenets have suffered
catastrophic declines in life expectancy and high rates of sickness and death that have
prompted speculation that some of those groups may become extinct. Geographically, the
lowest average life expectancy in Russia is in the Siberian Republic of Tyva, and the highest
figures are in the Caucasus Republic of Dagestan and in the Volga region. In the first half of
the 1990s, the imbalance between the birth and death rates was especially acute in major

cities. In Moscow and St. Petersburg, the number of deaths in 1992 was almost double the
number of births.
Since 1987 mortality from accidents, injuries, and poisonings has risen significantly, from 101
to 228 per 100,000 population. Contributing to that figure are an estimated 8,000 fatal
workplace accidents per year, largely the result of aging equipment, the proliferation of risky
jobs in the unofficial "shadow economy," and the deterioration of work discipline. For the
period between 1990 and 1994, the suicide rate rose by 57 percent to a total of nearly
62,000, putting Russia in third place among eighty-four developed countries. The stress of
the transition period is one explanation for this rising statistic. The homicide rate rose by
more than 50 percent in the same period. In 1994 Russia's 35,000 motor vehicle deaths
nearly equaled the 40,000 in the United States, although Russia has less than 1 percent as
many automobiles. Deteriorating roads and declining police discipline are the main causes of
that fatality statistic.
The chief natural cause of death is diseases of the circulatory system, which accounted for
769 deaths per 100,000 population in 1993. The next causes in order of frequency are
cancer and respiratory diseases. Among people of working age, 41 percent of deaths are
attributable to unnatural causes; the proportion of such deaths was highest in Leningrad
Oblast, the Permyak Autonomous Region, the Republic of Tyva, and the Evenk Autonomous
Region. The number of alcohol-related deaths also climbed in the mid-1990s; the 1994 figure
was 25 percent higher than the 1993 total. In some regions, alcoholism has assumed
epidemic proportions; in the Bikin Rayon of Khabarovsk Territory on the Pacific coast, nearly
half the deaths between 1991 and 1995 were alcohol related.
The overall aging of the population also is an important factor in the higher mortality rate.
Between 1959 and 1989, the percentage of retirees in the population and the percentage of
Russians eighty or older nearly doubled, although declining life expectancy already was
reducing the impact of that trend in the mid-1990s.

Healthcare in Russia
Russia has more physicians, hospitals, and health care workers than almost any other
country in the world on a per capita basis. However, since the collapse of the Soviet Union,
the health of the Russian population has declined considerably as a result of social,
economic, and lifestyle changes. After Vladimir Putin became president in 2000, there was
significant growth in spending for public healthcare[5] and in 2006 it exceed the pre-1991
level in real terms.[5] Also life expectancy increased from 1991-93 levels, infant mortality rate
dropped from 18.1 in 1995 to 8.4 in 2008. Russian Prime Minister Vladimir Putin announced
a large large-scale health-care reform in 2011 and pledged to allocate more than 300 billion
rubles ($10 billion) in the next few years to improve health care in the country.He also said
that obligatory medical insurance tax paid by companies for compulsory medical insurance
will increase from current 3.1% to 5.1% starting from 2011.
Common causes of death
In 2008, 1,185,993, or 57% of all deaths in Russia were caused by cardiovascular disease.
The second leading cause of death was cancer which claimed 289,257 lives (14%). External
causes of death such as suicide (1.8%), road accidents (1.7%), murders (1.1%), accidental
alcohol poisoning (1.1%), and accidental drowning (0.5%), claimed 244,463 lives in total
(11%). Other major causes of death were diseases of the digestive system (4.3%),
respiratory disease (3.8%), infectious and parasitic diseases (1.6%), and tuberculosis (1.2%).

The infant mortality rate in 2008 was 8.5 deaths per 1,000, down from 9.6 in 2007. Since the
Soviet collapse, there has been a dramatic rise in both cases of and deaths from
tuberculosis, with the disease being particularly widespread amongst prison inmates.
Smoking
Russia is the world leader in smoking. According to a survey reported in 2010 by Russias
Health and Social Development Ministry, 43.9 million adults in Russia are smokers. Among
Russians aged 19 to 44 years, 7 in 10 men smoke and 4 in 10 women smoke.[16] It is
estimated that 330,000-400,000 people die in Russia each year due to smoking-related
diseases.
Alcoholism in Russia
Alcohol consumption and Alcoholism are major problems in Russia. It is estimated that
Russians drink 15 litres (26 pints) of pure alcohol each year. This number is nearly 3 times as
much as it was in 1990.[17] In Moscow on September 24 of 2009, Russia's interior minister
Rashid Nurgaliyev cited the average intake at an estimated 18 liters a year; "In Russia, each
person, including babies, accounts for about 18 liters of spirits per year. In the opinion of
WHO experts, consumption of more than 8 liters per year poses a real threat to the health of
the nation. Russia has long exceeded this level".[18] It has even been reported that
excessive alcohol consumption is to blame for nearly half of all premature deaths in Russia.
[19] A recent study blamed alcohol for more than half the deaths (52%) among Russians
aged 15 to 54 from 1990 to 2001. For the same demographic, this compares to 4% of deaths
for the rest of the world.[20]
HIV/AIDS in Russia
HIV/AIDS, virtually non-existent in the Soviet era, rapidly spread following the collapse,
mainly through the explosive growth of intravenous drug use.According to a 2008 report by
UNAIDS, the HIV epidemic in Russia continues to grow, but at a slower pace than in the late
1990s. At the end of December 2007 the number of registered HIV cases in Russia was
416,113, with 42,770 new registered cases that year. The actual number of people living with
HIV in Russia is estimated to be about 940,000. In 2007, 83% of HIV infections in Russia
were registered among injecting drug users, 6% among sex workers, and 5% among
prisoners. However, there is clear evidence of a significant rise in heterosexual transmission.
In 2007, 93.19% of adults and children with advanced HIV infection were receiving
antiretroviral therapy.
The Russian Federation has demonstrated a high-level commitment in response to the AIDS
epidemic. In April 2006, the State Council met with the Russian President to set goals for
developing a strategy for responding to AIDS; improving coordination, through the creation of
a high-level multisectoral governmental commission on AIDS; and establishing a unified
monitoring and evaluation system. A new Federal AIDS Program for 2007 - 2011 was also
developed and adopted. Federal funding for the national AIDS response in 2006 had
increased more than twentyfold compared to 2005, and the 2007 budget doubled that of
2006, adding to the already substantial funds provided by the main donor organizations.
Coordination of activities in responding to AIDS remains a challenge for Russia, despite
increased efforts. In 2006, treatment for some patients was interrupted due to delays in

tender procedures and unexpected difficulties with customs. Additionally, lack of full
commitment to an in-depth program for education on sex and drugs in schools hinders
effective prevention programs for children.[24]
Suicide
In 2008, suicide claimed 38,406 lives in Russia. With a rate of 27.1 suicides per 100,000
people, Russia has one of the highest suicide rates in the world, although it has been
steadily decreasing since it peaked at around 40 per 100,000 in the mid-late 90s,including a
30% drop from 2001 to 2006. In 2007 about 22% of all suicides were committed by people
aged 4049, and almost six times as many Russian males commit suicide than females.
Heavy alcohol use is a significant factor in the suicide rate, with an estimated half of all
suicides a result of alcohol abuse. This is evident by the fact that Russia's suicide rate since
the mid-90s has declined along-side per capita alcohol consumption, despite the economic
crises since then; alcohol consumption is more of a factor than economic conditions.
Pre-reform health care
Pre-1990s Soviet Russia had a totally socialist model of health care with a centralised,
integrated, hierarchically organised with the government providing free health care to all
citizens. All health personnel were state employees. Control of communicable diseases had
priority over non-communicable ones. On the whole, the Soviet system tended to primary
care, and placed much emphasis on specialist and hospital care.
The integrated model achieved considerable success in dealing with infectious diseases
such as tuberculosis, typhoid fever and typhus. The effectiveness of the model declined with
underinvestment. Despite the fact that the quality of care began to decline by the early
1980s,medical care and health outcomes were on par with western standards. Despite a
doubling in the number of hospital beds and doctors per capita between 1950 and 1980, The
lack of money that had been going into health was patently obvious. Some of the smaller
hospitals had no radiology services, and few has inadequate heating or water. A 1989 survey
found that 3% of Russian hospitals did not have piped hot water and 1.2% did not even have
piped cold water.

Reform in 1991-1993
The new Russia has changed to a mixed model of health care with private financing and
provision running alongside state financing and provision. Article 41 of the 1993 constitution
confirmed a citizen's right to healthcare and medical assistance free of charge. This is
achieved through compulsory medical insurance (OMS) rather than just tax funding. This and
the introduction of new free market providers was intended to promote both efficiency and
patient choice. A purchaser-provider split was also expected to help facilitate the
restructuring of care, as resources would migrate to where there was greatest demand,
reduce the excess capacity in the hospital sector and stimulate the development of primary
care. Finally, it was intended that insurance contributions would supplement budget revenues
and thus help to maintain adequate levels of healthcare funding.

The OECD reported[citation needed] that unfortunately, none of this has worked out as
planned and the reforms have in many respects made the system worse. The populations
health has deteriorated on virtually every measure. Though this is by no means all due to the
changes in health care structures, the reforms have proven to be woefully indequate at
meeting the needs of the nation. Private health care delivery has not managed to make much
inroads and public provision of health care still predominates. The resulting system is overly
complex and very inefficient. It has little in common with the model envisaged by the
reformers. Although there are more than 300 private insurers and numerous public ones in
the market, real competition for patients is rare leaving most patients with little or no effective
choice of insurer, and in many places, no choice of health care provider either. The insurance
companies have failed to develop as active, informed purchasers of health care services.
Most are passive intermediaries, making money by simply channelling funds from regional
OMS funds to healthcare providers.