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Case Not Closed

Sunday, November 14, 2004; Page B05

Forget who may be killing the great chefs of Europe. Here's a real-life mystery that's worth at least a book and maybe even a movie: What's killing off Russians, particularly men, in the prime of their lives? And why did they start dying in disquieting numbers in the years immediately after the collapse of Soviet communism?

The statistics are shocking and the reasons for the deaths are equally surprising, assert economists Elizabeth Brainerd of Williams College and David M. Cutler of Harvard University.

Between 1989 and 1994, life expectancy for Russian men fell by more than six years. In the slow-mo world of population demographics, that kind of movement is "almost unprecedented in its speed and scope," Brainerd and Cutler claim. Moreover, the Russian death rate increased most dramatically among middle-aged men and not the very young or the very old. Russian women also were dying younger, losing about three years in life expectancy during the same period, they found.

The rate hasn't improved much since then. The average Russian male born in 2002 will live to be 58.5 years old, a slight improvement from the 1994 figure of 57.6 years and down from 64 years in the mid-1980s. In terms of life expectancy, Russia ranks 122nd in the world, at the same level as Guyana and North Korea, these researchers reported.

Sobering data, to say the least. So what happened? To find out, the two professors analyzed data from a variety of sources, including studies conducted by the World Health Organization and the Russia Longitudinal Monitoring Survey, which collected data from tens of thousands of Russians between 1994 and 2002.

As in any good mystery, the three most likely suspects turned out to be innocent.

The researchers first considered the role of the state-run health care system, which had declined dramatically in the transition period between Soviet communism and Russian-style democracy. But as hard as they looked, "we find no evidence that this deterioration played a major role in the demographic disaster," they wrote in a new paper published by the National Bureau of Economic Research. For example, the maternal mortality rate, often a key indicator of the quality of a country's health care system, did not increase at the same time that men were dying in ever-increasing numbers.

Then they looked to see whether changes in diet, obesity or smoking might explain the drop in life expectancy. Nyet, they concluded. The proportion of Russians who were overweight or underweight hadn't changed much. Nor had the composition of their diets. And while Russian men do smoke like chimneys, per capita cigarette consumption had barely budged.

Unemployment soared after communism ended. Was that the culprit? Once again, close analysis pointed elsewhere. The best measures of material deprivation -- income levels, share of household income spent on food, whether families had to sell possessions to buy food -- appeared unrelated to the surge in mortality.

Then Brainerd and Cutler turned their attention to two less likely suspects: alcohol consumption and feelings of hopelessness. This time, they concluded, the evidence seemed solid.

They found that alcohol consumption soared by about 25 percent in the years following the fall of the Soviet Union -- an increase that all by itself would bump up mortality from heart disease by about 10 percent, they estimated. (Contrary to the stereotype, the average Russian typically drinks slightly less alcohol than other Europeans.)

They also determined that accidental alcohol poisoning represented about 7 percent of the increase in male mortality and 6 percent of female mortality -- "and may play a role in other violent deaths as well, either by instigating murder or suicide, or as a disguised cause of them," they wrote. Alcohol consumption explained about 25 percent of the decline in life expectancy after 1989, according to their estimates.

Then Brainerd and Cutler tracked down survey data measuring optimism about the future, a bold stroke worthy of the foxy old TV detective Columbo. "Greater despair or hopelessness among middle-aged men is associated with higher risk of heart disease and heart attack, as well as earlier onset of artery disease," even after controlling for alcohol consumption and smoking, they claimed.

One question in the Russian survey asked, "Do you think that in the next 12 months your family will live better than today, or worse?" They found the odds of dying were about "30 percent lower for men who have positive expectations about the future; for women the odds of dying are 50 percent lower." When analyzed with other data, they estimated that increases in levels of despair explained about 25 percent of the drop in mortality during the 1989-1994 period.

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