ST. PETERSBURG, Russia—A 90-pound chunk of masonry breaks off the facade of a high-rise building and crushes a man on the sidewalk below. Another man, stumbling home from a late-night party, falls in the street, passes out and freezes to death. Two men break into a railroad yard and die after drinking several quarts of industrial solvent from a tanker car.
There are so many odd and horrible ways to die in Russia that it's almost no surprise that the average Russian man isn't expected to see his 59th birthday. Men in Bangladesh live longer.
"Normally only during wartime do we see the kind of decreases in men's longevity that we've seen recently in Russia," said Vladimir I. Simanenkov, the head of the department of internal diseases at the St. Petersburg Medical Academy and a senior official with the city's Public Health Committee.
Government statistics show that the average Russian man lives 58.6 years, compared with 73 years for the average Russian woman. In 1990, life expectancy for men was 63.4 years.
The reasons sound simple: Russian men drink too much, smoke too much, live with too much stress and go to the doctor too rarely.
The consequences are anything but simple, however. Russia's erupting men's health crisis could trigger major social or political unrest in a nation with huge stockpiles of nuclear, chemical and biological weapons.
Russia one day could even become incapable of patrolling its borders or policing vast expanses of rural emptiness, creating new havens for smugglers, terrorists and others. Military leaders already complain that most new draftees are so unfit, drug-addled or psychologically damaged that only about 10 percent are capable of withstanding boot camp.
Death rates are soaring for stroke, lung cancer, stomach cancer, TB and heart disease, the nation's No. 1 killer with a rate double that of American men.
Murray Feshbach, an expert on Russian health and demographics at the Smithsonian Institution's Woodrow Wilson International Center for Scholars in Washington, says the situation will grow worse.
He said the country's HIV/AIDS infection rates rival those of southern Africa, and that Russia is undercounting deaths from the disease by attributing many of them to secondary infections such as tuberculosis. By 2020, he said in a telephone interview, HIV/AIDS alone is projected to kill 250,000 to 648,000 Russians a year.
Hepatitis C, mostly caused by intravenous drug use, also is poised to explode, Feshbach said.
In the next 20 years, according to Goskomstat, the state statistics agency, the Russian National Security Council and the United Nations Population Division, Russia's population of 144 million could drop by a third.
Russian women would have to have almost twice as many children (2.4) as they're having now (1.3) just to keep the population from declining, but Russia has one of the world's highest abortion rates. Some surveys suggest that there are more abortions than births.
The health slide for Russian women isn't nearly so dramatic. While 40 percent of all Russian men now die between the ages of 16 and 59, the average life expectancy for Russian women has dropped only one year since 1990, when it was 74.
Georgey M. Manikhas, the chief of the St. Petersburg Oncology Clinic, said Russian women lived longer than men did because they got more and regular checkups, a habit that begins as they reach childbearing age. Also, women's clinics in Russia tend to be more efficient and welcoming.
Conversely, men's approach to health seems not to have changed all that much since Stalinist times, when Soviet propaganda films showed the dictator and his aides working through the night in the Kremlin, drinking heavily and filling all the ashtrays with cigarette butts.
Many doctors blame men's ill health partly on what they call "culture shock," the stress from the economic and social upheaval that followed the collapse of the Soviet Union in 1991. Factories closed, salaries went unpaid, food and medicines were scarce, and runaway inflation and a currency crisis wiped out most people's savings.
In St. Petersburg last year, 5,000 men needed heart surgery. But limited budgets and facilities allowed for just 500 operations, according to statistics provided by a medical administrator.
The issue is compounded today by a near total lack of public health awareness among Russian men and a similar lack of a coherent, coordinated campaign on the part of the government to persuade them otherwise.
"Our young guys dress well, they become top managers with wonderful skills, but they haven't developed their health skills," Manikhas said. "They think a fancy car and a beautiful woman on their arm are preventatives. This is their greatest mistake."
More than 60 percent of Russian men smoke regularly, and lung cancer is now the leading cause of cancer death in Russia.
"The Russian concept of health," Simanenkov said, "doesn't include not smoking."
Alcohol is another unchecked danger.
The importance of vodka to Russia's celebrations, traditions and social life cannot be overstated. The average Russian man drinks a bottle of vodka every other day, and that's not counting additional beers, wine, whiskey and cognac, according to the Health Ministry. Overindulging isn't seen as a "risk factor", simply part of being Russian.
Counterfeit alcohol—bottled and labeled like the real thing but highly impure and toxic—also has flooded the country. The result: Tens of thousands die from alcohol poisoning every year, so many that alcohol poisoning is a separate subcategory in government statistics tracking accidental deaths, along with traffic accidents and drowning.
"In rural villages, the degradation from alcohol is complete, and it runs through entire families," said Manikhas, who says he's seen it throughout the country. "This is a true disaster."
Soviet leader Mikhail Gorbachev tried to restrict the sale and production of alcohol starting in 1985. The long lines for vodka rations were derisively called "Gorbachev nooses."
Industrial production and longevity rates went up, but the resulting social tension and massive loss of tax revenues soon scotched the Soviet experiment with Prohibition.
Russian President Boris Yeltsin was notorious for his drinking during the 1990s, and a rumor that his chief aide was secretly watering down his vodka was widely believed.
The carefully crafted image of Vladimir Putin, Yeltsin's successor, is that of the Anti-Yeltsin. Putin is a judo champion and downhill skier who's fit, sober, serious and restrained. Public health officials think Putin could serve as a healthier role model for young Russian men.
"Let's hope so," said Manikhas. "He's the first (healthy leader) we've had.
"But we shouldn't be too proud. Putin shouldn't be an exception; he should be the norm. Russian leaders should be able to drink, to play sports and be athletic—and able to control themselves."
Putin has endorsed limits on public drinking, and the Russian parliament, the Duma, is considering laws restricting advertising of alcohol. But the beer and spirits industry is fighting those restrictions, and Russian law still allows open containers in cars. The legal limit for blood-alcohol content is twice as high as it is in most states in the United States.
Public health doctors and administrators complain that the government spends little on prevention and education.
Russia also has been unwilling to accept international help for some of its most pressing health problems. One example: Russia for years refused World Bank loans to treat drug-resistant TB, insisting that only Russian-made drugs could be used in the treatment program. The trouble was, Russia didn't make the drugs the treatment required.
Lee Reichman calls it "the Kursk Syndrome."
When the Kursk nuclear submarine sank in the Barents Sea in 2000, several countries were quick to offer help in rescuing some of the crewmembers trapped alive in the sub.
"But Russia delayed accepting foreign assistance until it was too late," said Reichman, the executive director of the National Tuberculosis Center at the New Jersey Medical School and a physician with extensive experience in Russia.
"It's the same with TB. ... TB is not going to go away without a major, major effort. It's shocking enough that young Russian men die of violence and trauma. But Russia should be able to treat infectious, preventable diseases."
(c) 2005, Knight Ridder/Tribune Information Services.
PHOTOS (from KRT Photo Service, 202-383-6099): RUSSIA-HEALTH
GRAPHIC (from KRT Graphics, 202-383-6064): 20050210 RUSSIA HEALTH
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