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Health crisis locks Russia in a downward spiral

WASHINGTON -- When Napoleon said war is one of two occupations (the other, he said, is prostitution) in which amateurs often perform better than professionals, he meant that normal intuitions are sometimes more useful than technical expertise. Recently, White House and State Department sophisticates are giving professionalism a bad name, not least in thinking about Russia in ways that reasonable amateurs recognize as unrealistic.

By encouraging Russia to act as NATO's mediator with Yugoslavia, and by worrying lest NATO's actions rekindle Cold War tensions with Russia, the Clinton administration seems eager to resuscitate Russia as a great power. Russia clearly is susceptible to such delusions of recovered grandeur.But reviving Russia probably is, for the foreseeable future, impossible. Russia is in a severe downward spiral, a spiral that cannot be quickly reversed because it is driven by a public health crisis without precedent since the Industrial Revolution.

So argues Nicholas Eberstadt in "Russia: Too Sick to Matter?" in Policy Review, published by The Heritage Foundation. Eberstadt, of the American Enterprise Institute in Washington and the Harvard Center for Population and Development Studies, reports, "Russia's health profile no longer remotely resembles that of a developed country."

In fact, "Russian men in their 40s and early 50s are dying at a pace that may never have been witnessed during peacetime in a society distinguished by urbanization and mass education." That is part of a pattern of mortality that has Russian deaths (approximately 2 million annually) exceeding births (approximately 1.3 million annually) by more than half.

Cumulatively, the catastrophe is akin to war. Measured against 1987, a relatively good year in the Soviet era, the recent "mortality shock" produced "excess mortality" during the four years 1992-95 that amounted to 1.8 million persons, more than the 1.7 million Russian soldiers killed in four years of World War I. In addition, there has been a sudden drop in fertility levels.

In 1997, life expectancy in Russia was, Eberstadt says, "somewhat under 67 years," which is "distinctly lower" than in Mauritius, Ecuador or Azerbaijan. Life expectancy for Russian males at birth is around 61, below current estimates for Egypt or Paraguay. This is not largely the result of respiratory and other illnesses resulting from Russia's environmental "ecocide." Russia cannot cope with communicable diseases routinely controlled in most regions -- typhus, typhoid, cholera, diphtheria, tuberculosis. Eberstadt says "the world has never seen anything like the epidemic of heart disease that rages in Russia," where the death rate from cardiovascular disease (heart attacks, strokes) alone "is higher than the death rate in the U.S. for all causes combined."

Russia has stunning levels of "accidents and adverse effects" (including suicides, murders and poisonings). These are often related to what clinicians call "psycho-social variables," such as attitudes, outlooks and stresses. These variables are not surprising in a Russia of rampant criminality and crumbling civil society.

Perhaps the most important causes of premature death are dietary habits and alcohol abuse. A national household survey -- self-reported, hence perhaps understated -- found that the more than 80 percent of Russian men who drink consume, on average, the alcohol equivalent of five bottles of vodka a week. In 1996 more than 35,000 Russians died from alcohol poisoning. America's annual toll is about 300. Given the "negative momentum" of Russian behaviors that are resistant to reform, Russia's population will continue to become more frail. In 20 years, probably only Bolivia, Haiti and Guatemala in the Western Hemisphere will have lower male life expectancies.

Today Russia's export revenues may not match Belgium's. Russia's 1997 per capita output was lower than Lebanon's and Peru's. Its GDP is approximately the size of the Netherlands'. In 20 years, Russia's economy, which now is approximately the 14th largest in the world, may be only the 20th largest.

Russia's health crisis is worsening as political-military power is becoming increasingly a function of "human capital" -- educated, disciplined populations managing information-intensive arrangements. Fifteen years ago a scholar warned against "delusions of Soviet weakness," saying: "Drunk (the Russians) defeated Napoleon, and drunk again they defeated Hitler's armies." Eberstadt replies: "Brave and regimented drunkards may have succeeded in marching on Paris and Berlin in the past, but they would fare rather less creditably today in, say, high-precision aerial combat."

In 1957 a beeping sound -- Sputnik: America had been beaten into space -- announced the Soviet Union's claim to ascendancy. Last week Russia announced that the space station Mir, the crowning achievement of the nation's space program, will be dismantled because of the economic crisis. That symbolically closed the parenthesis which was Russia's episode as a great power.

Washington Post Writers Group