Alcohol is a major cause of unnecessary death among Russian men. That fact is unlikely to surprise even the most casual observer of Russia. But after crunching several years’ worth of data, a leading researcher expressed a sense of surprise over the extent of reckless drinking in Russia and its impact on heart disease.
In very detailed and clinical language, Dr. Martin McKee explained during a recent presentation at the Center for Strategic and International Studies in Washington, DC, how alcoholic behavior contributes to an extraordinarily high mortality rate among Russian men. McKee, a public health professor at the London School of Hygiene & Tropical Medicine, manages the largest team of researchers working on health issues in former Soviet bloc countries. Some contributed to these findings.
“We have had these remarkable fluctuations in life expectancy which really defy our understanding of the nature of disease in a population--generally outside wartime you do not get changes of the scale that we have seen,” McKee said during the presentation.
“To try to understand this phenomenon, we clearly need to understand what’s going on at all … levels,” McKee continued. “So, to put it another way, it’s not just enough to ask--if we are looking at alcohol--why do people die? We need to ask why do they drink? What do they drink? Why, when they drink to the extent that they do, do they fall down and why does no one pick them up?”
A major problem is that some Russians consume so much alcohol that they suffer from alcohol poisoning, McKee’s team found. The most dangerous form of drinking involves alcohol-based substances not meant for human consumption, including ethanol-based liquids and anti-freeze. Some Russians drink diluted forms of these toxic substances because they have twice the concentration of alcohol than spirits, and are taxed at only one-third the rate of hard liquor.
Another problem is the way Russians drink. There is a specific word in Russian – zapoi – to describe a phenomenon in which an individual goes on an alcoholic-bender that can last days, causing the drinker’s withdrawal from normal social life. This type of binge drinking is thought to lead to high rates of sudden heart failure from acute stress on cardiovascular muscles.
Moderate consumption of alcohol can have a protective effect against coronary artery disease. But such protective effects are negated when heavy, irregular drinking occurs. Binge drinkers are vulnerable to stroke from hypertension and sudden death from cardiac arrhythmia.
The large number of premature Russian alcohol-related deaths is due to chronic heavy drinking, binge drinking, and the drinking of potentially toxic substances containing high levels of alcohol. “The spectrum of cardiovascular disease is appreciably different in the former Soviet Union than it is in Western Europe,” McKee said.
Based on the research his team conducted in one Russian region from 2003-2005, McKee concluded that hazardous drinking — defined as heavy binge drinking, or the consumption of potentially toxic alcohol — accounted for 43 percent of deaths among working age (25-54) men in a typical Russian city. Applied to Russia as a whole, the data indicates that such phenomena cause an estimated 170,000 excess male deaths per year. A subsequent study in 2009 in Barnaul, a city in Siberia, indicated that more than half of all deaths of working-age males could be attributable to some form of alcoholism.
McKee’s findings have interesting policy implications. The scope of primary prevention needs to extend in Russia beyond the conventional “Western” model with its focus on smoking, diet and exercise, McKee asserted during his December 8 presentation in Washington. In addition to honing policies that provide for improved medical and psychological treatment, McKee advocated that Russian authorities consider legislative changes that discourage binge drinking. Authorities also need to redouble efforts to implement policies in Russia’s regions, he said.
McKee’s team confirmed that other factors contributed to high Russian death rates, including widespread cigarette smoking, poor diet, and the mistreatment of hypertension. McKee also noted that Russian life expectancy has been improving in recent years, due in part to government measures that have made alcohol-based products, not just spirits, more difficult to acquire. But as in the past, he emphasized, current conditions were prone to sudden shifts, meaning existing trends could quickly change.