Abstract and Introduction
Abstract
Aims: This study compared the level of alcohol mortality in tsarist and contemporary Russia.
Methods: Cross-sectional and annual time-series data from 1870 to 1894, 2008 and 2009 on the mortality rate from deaths due to 'drunkenness' were compared for men in the 50 provinces of tsarist 'European Russia': an area that today corresponds with the territory occupied by the Baltic countries, Belarus, Moldova, Ukraine and the Russian provinces to the west of the Ural Mountains.
Results: In 1870–1894, the male death rate from 'drunkenness' in the Russian provinces (15.9 per 100,000) was much higher than in the non-Russian provinces. However, the rate recorded in Russia in the contemporary period was even higher—23.3.
Conclusions: Russia has had high levels of alcohol mortality from at least the late 19th century onwards. While a dangerous drinking pattern and spirits consumption may underpin high alcohol mortality across time, the seemingly much higher levels in the contemporary period seem to be also driven by an unprecedented level of consumption, and also possibly, surrogate alcohol use. This study highlights the urgent need to reduce the level of alcohol consumption among the population in order to reduce high levels of alcohol mortality in contemporary Russia.
Introduction
Since the collapse of communism and the transition to a free market system, Russia has been experiencing a mortality crisis. The seriousness of this situation can be gauged by the fact that in 2009, life expectancy at birth was lower than it was in 1990 (Rosstat, 2010). It has been argued that alcohol is playing a central role in this rapid deterioration in population health (Leon et al., 2009). Since the second half of the 1990s, its role has become increasingly apparent (Leon et al., 1997). Recent research has suggested that alcohol may be responsible for >30% of all deaths in Russia (Nemtsov, 2005), with this figure being especially high for certain groups such as working-age men (up to age 54), where it has been estimated that between 43% and 59% of all deaths are due to alcohol (Leon et al., 2007; Zaridze et al., 2009a).
In terms of its negative consequences, it has recently been argued that 'the present magnitude of the alcoholization of society goes far beyond comparison with the magnitude in historical times past' (Zaigraev, 2010). These thoughts have also been echoed by the Russian authorities in a recent document which has suggested that the current alcohol situation is historically unique in terms of the high volume of alcohol being consumed, while highlighting the comparatively low levels of alcohol consumption in Russia in the past (Obshchestvennaya palata Rossiiskoi Federatsii, 2009). Support for this viewpoint comes from the fact that the current level of per capita alcohol consumption for the adult population aged 15+ is one of the highest in the world (15.7 l of pure alcohol in 2003–2005) (World Health Organization, 2011). Moreover, the current alcohol consumption figure does seem to exceed anything seen in the historical past as the highest recorded figure in tsarist Russia was 6.2 l of pure alcohol per person in the mid-1860s (Nemtsov, 2005).
Other evidence from both the historical and more recent past however, casts doubt on the uniqueness of the alcohol situation in post-Soviet Russia. Even in the 1970s, rates of mortality from alcohol-specific causes of death such as alcohol poisoning were extreme in Russia in comparative terms (Stickley et al., 2007), while Nemtsov has estimated that in 1984 (on the eve of the anti-alcohol campaign), 31.8% of all deaths (517,000 people) could be attributed to alcohol (Nemtsov, 2002). This high level of mortality also seems to have been underpinned by a high level of consumption as he has estimated that it was in excess of 14 l per capita at this time, i.e. as high as in post-Soviet Russia (Nemtsov, 2002). Historical data from much earlier periods also suggest that the current situation may not be unique. Not only were fluctuations in alcohol consumption in tsarist and Bolshevik Russia associated with rapid changes in mortality in much the same way as they have been in recent years (Stickley et al., 2009), but other practices which may have been important for mortality fluctuations, such as the drinking of surrogate alcohols, also occurred in both the present and the past (Leon et al., 2009; Stickley et al., 2009).
As yet, however, there has been no systematic attempt to compare the impact of alcohol on mortality in the historical past and the present. Therefore, the current study had two specific aims. First, to examine the level of alcohol mortality in the more distant historical past, i.e. in tsarist Russia. Specifically, we wanted to explore if the situation was as favourable in terms of the alcohol environment as has been suggested in recent publications; and secondly, to compare alcohol mortality in the present and the past. In the ongoing debate about whether it is possible to introduce alcohol policy that will help mitigate the current health crisis in Russia (Khaltourina and Korotayev, 2008), understanding the impact of alcohol on health across time may be important for policy in the present—especially as it has been argued that previous attempts to control alcohol consumption and its negative effects on the population's health in Russia over a prolonged period of time, have ultimately all been unsuccessful (Levintova, 2007).