Two big steps are in the works to change some of the dynamics. Russia’s lower house of parliament overwhelmingly passed a bill forbidding smoking in public places, which the upper house approved Wednesday and is expected to be signed quickly by Putin.
And a law that went into effect Jan. 1 has designated beer as an alcoholic beverage instead of a food, prohibiting its sale in ubiquitous street-corner kiosks.
But advocates for better health, leading to longer lives, say Russia needs to do far more.
“Cigarettes are incredibly cheap,” said Dmitri Yanin, chairman of the Conference of Consumer Protection Societies. “I think we can change consumer behavior eventually, but it won’t be quick because the law doesn’t include economic measures.”
Poor demographic trends have troubled Russia since the collapse of the Soviet Union, with a population of 148 million 20 years ago reduced to about 143 million now. In 2006, Putin ordered subsidies for women who give birth, calling the demographic situation “Russia’s most acute problem today.” Last year he said the population could decline to 107 million by 2050 if trends are not reversed.
The latest government health figures suggest the difficulty ahead: Last year, 2,500 more people died than were born, and the infant mortality rate rose to 8.7 deaths per 1,000 births from 7.1 in 2011 after a dozen years of dramatic decline.
“Men, especially, are dying at a productive age,” said Luigi Migliorini, the World Health Organization’s special representative to Russia. “They’re dying when they can be useful to their country and their family. That’s why the fight against tobacco and alcohol is so important.”
About 400,000 Russians die from tobacco-related diseases every year, Putin has said. Health officials say perhaps 300,000 die from causes linked to alcohol, though its effect on mortality is more debated.
About 20 billion packs of cigarettes a year are bought by Russians, while the United States, with a population of 314 million, buys about 16 billion packs. Popular cigarette brands sell in Russia for about $1 a pack, with taxes making up 30 cents of the price.
Migliorini and other health experts say more far-reaching measures will also be necessary to turn the tide against non-communicable ailments such as lung cancer, stroke and cardiovascular disease, which exploded as the health-care system fell apart with the collapse of the Soviet Union.
A provision of the new smoking ban that would have allowed the government to set a minimum price was deleted after intense industry lobbying. While alcohol use contributes to a high rate of road accidents, so does lax adherence to seat-belt laws — many men here spend more effort carefully arranging a seat belt to make police think it’s buckled than it would take to actually buckle it.
Volunteer groups are needed to help people understand the importance of a healthy lifestyle and encourage changes in behavior, health experts say. They call for steps that would go beyond laws and decrees to include pay increases, new equipment and training across the health-care system, along with improvements in the distribution of medicine, which is often prone to interruption.
“Whether their goals can be achieved by 2020 is unclear,” Migliorini said, “but setting ambitious targets moves the whole system forward.”
But don’t forget Russian fatalism.
“I am ready to acknowledge that tobacco and smoking are not mankind’s healthiest habits,” said Andrei Loskutov, executive director of the All-Russia Movement for the Rights of Smokers. But, he said, a hermit who has lived isolated and free of tobacco in the Siberian taiga now is dying of cancer.
“Churchill smoked,” he said triumphantly, “and he lived to 91.”