DYING TOO YOUNG: CHALLENGES AND OPTIONS IN THE RUSSIAN FEDERATIONTHE WORLD BANK

Human Development Sector Unit Russia Country DepartmentEurope and Central Asia Region

Patricio Marquez December 2005

President Vladimir PutinState-of-the-Nation Address, Federal Assembly of the Russian Federation, April 25, 2005We cannot reconcile ourselves to the fact that the life expectancy of Russian women is nearly 10 years and of men nearly 16 years shorter than in Western Europe. Many of the current mortality factors can be remedied, and without particular expenseThe reasons are well known. And we should implement a whole range of measures to overcome this dreadful situation.

Presentation OverviewThe demographic decline and the health deficitDeterminants ConsequencesStrategies and interventions to prevent non-communicable diseases and injuries in RussiaActions to confront non-communicable diseases and injuriesExpected health improvements Potential economic benefitsConclusions and the way forward

Estimated Population Growth Rates, Russia, 198085 to 202025 Source: UN Population Projections, 2004 Revisions

Chart3

0.66

0.68

-0.02

-0.34

-0.57

-0.58

-0.6

-0.67

-0.73

Percent

Sheet6

Dependency Ratios

1995200020052010201520202025

Total50444037394449

Child32262018192020

Elderly18182018202429

Population 60+ and

Life Expectancy and Adult Mortality in Selected Countries, 20002001 Source: World Bank World Development Indicators

Mortality among the Working-Age Population in Russia Drives Fluctuations in Life Expectancy Source: WHO European Health for All Database

Life Expectancy at Birth: Russia and the EU, 19702000Source: WHO European Health for All Database

European Unionaverage

Russia

M+F combined

Healthy Life Expectancy (HALE) at Birth in Russia and Four European Countries, 2002 Source: WHO Health For All Database

Male Adult Mortality and Gross National Income per Capita in Selected Countries, 2000 Source: World Bank World Development Indicators. Note: PPP is purchasing power parity.

Chart1

5.3423342525.3423342526.0799331951

5.40717177155.40717177155.0434251169

5.56452040735.5645204073

5.94279937515.9427993751

5.29831736655.29831736656.1984787165

5.47646355195.47646355195.2094861528

5.03695260245.03695260245.2149357576

5.15905529925.1590552992

5.75574221365.75574221364.605170186

5.52146091795.52146091794.8283137373

5.68697535635.68697535635.5872486584

5.90263333345.90263333344.7874917428

5.81413053185.81413053185.5683445038

5.79301360845.79301360845.1929568509

5.65599181085.65599181084.8520302639

5.07517381525.07517381525.2983173665

5.78382518235.78382518235.9506425526

5.42053499935.4205349993

5.5606816315.5606816315.5909869805

6.05912319566.05912319565.5759491031

5.19295685095.19295685096.5553568918

5.37527840775.37527840775.5568280617

5.13579843715.13579843714.9698132996

5.6801726095.6801726096.3261494732

5.63764267225.63764267226.4738906964

5.89989735365.89989735365.9427993751

5.64190707095.64190707096.1903154059

6.07993319514.6151205168

5.04342511695.3471075307

6.429719478

6.19847871656.1070228877

5.20948615284.7858236857

5.21493575765.0172798368

5.081404365

4.6051701865.4722706737

4.82831373735.9427993751

5.58724865846.3473892097

4.78749174286.163314804

5.56834450384.8751973232

5.19295685096.3153580015

4.85203026394.9628446303

5.29831736654.7535901911

5.95064255264.8598124044

6.3801225369

5.59098698055.2094861528

5.57594910315.4553211154

6.55535689185.2933048247

5.55682806175.3471075307

4.96981329965.5214609179

6.32614947325.8260001074

6.47389069646.200509174

5.94279937516.3868793194

6.1903154059

4.61512051685.4806389233

5.34710753074.9698132996

4.9698132996

6.4297194785.1873858058

6.10702288775.9401712527

4.78582368575.9215784196

5.01727983684.836281907

5.0814043655.9375362051

5.47227067374.7361984484

5.9427993751

6.34738920975.3082676974

6.1633148045.022563865

4.87519732325.6559918108

6.31535800156.0684255882

4.96284463036.2045577626

4.75359019115.7004435734

4.85981240446.2614916843

6.38012253695.3981627015

5.20948615284.6221374248

5.45532111544.4426512565

5.29330482475.5214609179

5.34710753075.4475990693

5.52146091795.1357984371

5.82600010745.5529595849

6.2005091744.6821312271

6.3868793194

4.5951198501

5.48063892334.7004803658

4.96981329965.1298987149

4.96981329964.5849674787

5.18738580585.2933048247

5.94017125276.3595738687

5.92157841965.5947113796

4.8362819075.4722706737

5.93753620515.2257466737

4.73619844844.605170186

5.8721177895

5.30826769745.257495372

5.0225638656.5027900459

5.65599181086.1047932324

6.06842558825.3471075307

6.2045577626

5.70044357344.9052747784

6.26149168434.3870141762

5.39816270155.9532433343

4.62213742486.552507887

4.44265125655.3082676974

5.52146091795.429345629

5.44759906936.2499752423

5.13579843714.7095302013

5.55295958495.7104270174

4.68213122715.8777357818

5.429345629

4.5951198501

4.70048036585.1929568509

5.12989871495.4930614433

4.5849674787

5.29330482475.6347896032

6.35957386875.1590552992

5.59471137966.5132301109

5.47227067375.8377304472

5.22574667376.5439118456

4.6051701865.7493929859

5.87211778954.5538768916

5.2574953724.8828019226

6.50279004595.1873858058

6.10479323244.6821312271

5.34710753075.4161004022

6.1590953885

4.90527477846.09356977

4.3870141762

5.95324333434.6728288345

6.5525078875.2311086169

5.30826769745.3981627015

5.429345629

6.24997524234.9767337424

4.70953020135.8833223885

5.71042701745.1532915945

5.87773578185.2470240722

5.4293456295.5174528965

5.0998664278

5.19295685095.0159544556

5.49306144335.1532915945

6.5027900459

5.63478960325.4889377262

5.1590552992

6.51323011095.5947113796

5.83773044725.1984970313

6.54391184565.8721177895

5.74939298595.5909869805

4.55387689166.3750248198

4.88280192264.7361984484

5.18738580585.3981627015

4.68213122716.2461067655

5.41610040226.3403593037

6.15909538854.8040210447

6.093569775.4971682253

5.4930614433

4.67282883455.2430037208

5.23110861695.5053315359

5.39816270155.8318824773

5.4380793089

4.97673374246.4409465406

5.88332238854.5108595065

5.15329159454.5951198501

5.24702407225.1357984371

5.51745289656.3438804341

5.09986642785.5012582105

5.0159544556

5.15329159456.1312264895

6.50279004595.4205349993

5.48893772625.342334252

5.1298987149

5.59471137965.3844950628

5.19849703136.4248690239

5.87211778954.9628446303

5.59098698054.6913478822

6.37502481984.9904325868

4.73619844845.2203558251

5.39816270155.4806389233

6.24610676555.1817835503

6.34035930375.313205979

4.80402104474.6405373298

5.49716822535.0776706954

5.49306144335.6276211137

5.24300372086.5861716549

5.50533153596.4769723629

5.8318824773

5.4380793089

6.4409465406

4.5108595065

4.5951198501

5.1357984371

6.3438804341

5.5012582105

6.1312264895

5.4205349993

5.342334252

5.1298987149

5.3844950628

6.4248690239

4.9628446303

4.6913478822

4.9904325868

5.2203558251

5.4806389233

5.1817835503

5.313205979

4.6405373298

5.0776706954

5.6276211137

6.5861716549

6.4769723629

GNI per capita PPP 2000 (in log)

Male adult mortality 2000 (in log)

ALB

ARM

AZE

BLR

BGR

HRV

CZE

EST

GEO

HUN

KAZ

KGZ

LVA

LTU

MKD

MDA

POL

ROM

RUSSIA

SVK

SVN

TJK

TKM

UKR

UZB

WDI adult mortality

Adult male mortalityAdult female mortalityGNI pc PPPAdult male mortalityAdult female mortalityGNI pc PPPAdult male mortalityAdult female mortalityGNI pc PPPAdult male mortalityAdult female mortalityGNI pc PPP

Figure 1.10.Male Adult Mortality and Gross National Income per Capita in Selected Countries, 2000

Adult male mortalityAdult female mortalityGNI pc PPP

Country CodeCountry Name200020002000ln GNIpc 2000ln Adu Male Mort 2000ln GNIpc 2000ln Adu Female Mort 2000

ALBAlbania209954,180ALB8.33815.34238.33814.5539

ARMArmenia2231062,490ARM7.82005.40727.82004.6634

AZEAzerbaijan2611502,430AZE7.79565.56457.79565.0106

BLRBelarus3811334,810BLR8.47855.94288.47854.8903

BIHBosnia and Herzegovina20093BIH5.29834.5326

BGRBulgaria2391036,070BGR8.71115.47658.71114.6347Y=8.8118 - 0.3915X; R2=0.6517

HRVCroatia1541178,880HRV9.09165.03709.09164.7622

CZECzech Republic1747513,620CZE9.51935.15919.51934.3175

ESTEstonia3161149,870EST9.19735.75579.19734.7362

GEOGeorgia2501331,950GEO7.57565.52157.57564.8903

HUNHungary29512311,930HUN9.38685.68709.38684.8122

KAZKazakhstan3662014,310KAZ8.36875.90268.36875.3033

KGZKyrgyz Republic3352991,460KGZ7.28625.81417.28625.7004

LVALatvia3281227,640LVA8.94125.79308.94124.8040

LTULithuania2861068,570LTU9.05605.65609.05604.6634

MKDMacedonia, FYR160896,490MKD8.77805.07528.77804.4886

MDAMoldova3251651,350MDA7.20795.78387.20795.1059

POLPoland226889,850POL9.19525.42059.19524.4773

ROMRomania2601175,670ROM8.64295.56078.64294.7622

RUSRussian Federation4281567,050RUS8.86086.05918.86085.0499

YUGSerbia and Montenegro180100YUG5.19304.6052

SVKSlovak Republic2168311,250SVK9.32815.37539.32814.4188

SVNSlovenia1707616,640SVN9.71965.13589.71964.3307

TJKTajikistan293204760TJK6.63335.68026.63335.3181

TKMTurkmenistan280.8157.23,440TKM8.14325.63768.14325.0575

UKRUkraine3651353,980UKR8.28905.89998.28904.9053

UZBUzbekistan2821761,490UZB7.30655.64197.30655.1705

AFGAfghanistan4373766.07995.9296

DZAAlgeria1551195,1508.54685.04348.54684.7791

ASMAmerican Samoa

ADOAndorra

AGOAngola4923861,5907.37156.19857.37155.9558

ATGAntigua and Barbuda1831339,6709.17685.20959.17684.8903

ARGArgentina1849211,8209.37755.21499.37754.5218

ABWAruba

AUSAustralia1005425,43010.14374.605210.14373.9890

AUTAustria1256027,57010.22454.828310.22454.0943

BHSBahamas, The26716116,0809.68535.58729.68535.0814

BHRBahrain1209315,2209.63044.78759.63044.5326

BGDBangladesh2622521,6107.38405.56837.38405.5294

BRBBarbados18011514,8709.60715.19309.60714.7449

BELBelgium1286726,99010.20324.852010.20324.2047

BLZBelize2001245,1308.54295.29838.54294.8203

BENBenin3843289706.87735.95066.87735.7930

BMUBermuda

BTNBhutan2682225.59105.4027

BOLBolivia2642192,3207.74935.57597.74935.3891

BWABotswana7036697,0408.85946.55548.85946.5058

BRABrazil2591367,1708.87775.55688.87774.9127

BRNBrunei144944.96984.5433

BFABurkina Faso5595071,0106.91776.32616.91776.2285

BDIBurundi6486035906.38016.47396.38016.4019

KHMCambodia3813221,7707.47875.94287.47875.7746

CMRCameroon4884401,7507.46746.19037.46746.0868

CANCanada1015727,18010.21024.615110.21024.0431

CPVCape Verde2101214,6008.43385.34718.43384.7958

CYMCayman Islands

CAFCentral African Republic6205731,1507.04756.42977.04756.3509

TCDChad4493618606.75696.10706.75695.8889

CHIChannel Islands119.845.64.78583.8199

CHLChile151678,8909.09275.01739.09274.2047

CHNChina1611103,8108.24545.08148.24544.7005

COLColombia2381155,9608.69285.47238.69284.7449

COMComoros3813251,6307.39635.94287.39635.7838

ZARCongo, Dem. Rep.5714936406.46156.34746.46156.2005

COGCongo, Rep.4754066806.52216.16336.52216.0064

CRICosta Rica131788,2109.01314.87529.01314.3567

CIVCote d'Ivoire5534941,4807.29986.31547.29986.2025

CUBCuba143944.96284.5433

CYPCyprus1165917,0709.74514.75369.74514.0775

DNKDenmark1298228,72010.26534.859810.26534.4067

DJIDjibouti5905411,9807.59096.38017.59096.2934

DMADominica1831055,2608.56795.20958.56794.6540

DOMDominican Republic2341465,8308.67085.45538.67084.9836

ECUEcuador1991203,0608.02625.29338.02624.7875

EGYEgypt, Arab Rep.2101473,5808.18315.34718.18314.9904

SLVEl Salvador2501484,6108.43605.52158.43604.9972

GNQEquatorial Guinea3392805,6508.63945.82608.63945.6348

ERIEritrea4934419406.84596.20056.84596.0890

ETHEthiopia5945357006.55116.38696.55116.2823

FROFaeroe Islands

FJIFiji2401804,7908.47435.48068.47435.1930

FINFinland1446124,83010.11984.969810.11984.1109

FRAFrance1446125,53010.14764.969810.14764.1109

PYFFrench Polynesia17998.65.18744.5911

GABGabon3803305,2908.57365.94028.57365.7991

GMBGambia, The3733201,6607.41465.92167.41465.7683

DEUGermany1266025,95010.16394.836310.16394.0943

GHAGhana3793261,9107.55495.93757.55495.7869

GRCGreece1144716,8609.73274.73629.73273.8501

GRLGreenland

GRDGrenada2021596,8108.82615.30838.82615.0689

GUMGuam151.882.65.02264.4140

GTMGuatemala2861823,9208.27385.65608.27385.2040

GINGuinea4323661,9207.56016.06847.56015.9026

GNBGuinea-Bissau4954277506.62016.20466.62016.0568

GUYGuyana2992093,7608.23225.70048.23225.3423

HTIHaiti5243731,6607.41466.26157.41465.9216

HNDHonduras2211572,4507.80385.39827.80385.0562

HKGHong Kong, China101.711252.426,31010.17774.622110.17773.9589

ISLIceland855127,96010.23854.442710.23853.9318

INDIndia2501912,4007.78325.52157.78325.2523

IDNIndonesia232.2180.22,8407.95165.44767.95165.1941

IRNIran, Islamic Rep.1701395,9408.68955.13588.68954.9345

IRQIraq2582085.55305.3375

IRLIreland1086225,97010.16474.682110.16474.1271

IMYIsle of Man

ISRIsrael995619,4909.87774.59519.87774.0254

ITAItaly1105324,73010.11584.700510.11583.9703

JAMJamaica1691273,5108.16345.12998.16344.8442

JPNJapan984426,30010.17734.585010.17733.7842

JORJordan1991443,9108.27135.29338.27134.9698

KENKenya5785299906.89776.35966.89776.2710

KIRKiribati2692085.59475.3375

PRKKorea, Dem. Rep.2381925.47235.2575

KORKorea, Rep.1867115,1409.62515.22579.62514.2627

KWTKuwait1006818,6309.83254.60529.83254.2195

LAOLao PDR3552991,5107.31995.87217.31995.7004

LBNLebanon1921364,4508.40075.25758.40074.9127

LSOLesotho6676302,7307.91216.50287.91216.4457

LBRLiberia4483856.10485.9532

LBYLibya2101575.34715.0562

LIELiechtenstein

LUXLuxembourg1356450,94010.83844.905310.83844.1589

MACMacao, China80.451.619,1409.85954.38709.85953.9435

MDGMadagascar3853228106.69705.95326.69705.7746

MWIMalawi7016535906.38016.55256.38016.4816

MYSMalaysia2021138,2109.01315.30839.01314.7274

MDVMaldives2282265.42935.4205

MLIMali5184467306.59306.25006.59306.1003

MLTMalta1114617,3509.76134.70959.76133.8286

MHLMarshall Islands3022305.71045.4381

MRTMauritania3573021,6907.43255.87777.43255.7104

MUSMauritius2281099,5809.16745.42939.16744.6913

MYTMayotte

MEXMexico1801018,6909.06995.19309.06994.6151

FSMMicronesia, Fed. Sts.2431885.49315.2364

MCOMonaco

MNGMongolia2801991,6007.37785.63487.37785.2933

MARMorocco1741133,3908.12865.15918.12864.7274

MOZMozambique6746128206.70936.51326.70936.4167

MMRMyanmar3432455.83775.5013

NAMNamibia6956616,6208.79796.54398.79796.4938

NPLNepal3143141,3307.19295.74947.19295.7494

NLDNetherlands956427,34010.21614.553910.21614.1589

ANTNetherlands Antilles13266.84.88284.2017

NCLNew Caledonia17992.45.18744.5261

NZLNew Zealand1086918,7609.83954.68219.83954.2341

NICNicaragua2251612,3007.74075.41617.74075.0814

NERNiger4733087406.60676.15916.60675.7301

NGANigeria4433937906.67206.09366.67205.9738

MNPNorthern Mariana Islands

NORNorway1076134,79010.45714.672810.45714.1109

OMNOman18713512,0909.40015.23119.40014.9053

PAKPakistan2211981,8807.53905.39827.53905.2883

PLWPalau

PANPanama145935,9608.69284.97678.69284.5326

PNGPapua New Guinea3593292,3007.74075.88337.74075.7961

PRYParaguay1731294,6208.43815.15338.43814.8598

PERPeru1901394,6208.43815.24708.43814.9345

PHLPhilippines2491424,1708.33575.51758.33574.9558

PRTPortugal1646616,9309.73685.09999.73684.1897

PRIPuerto Rico150.85715,1309.62445.01609.62444.0431

QATQatar1731215.15334.7958

RWARwanda6675991,1007.00316.50287.00316.3953

WSMSamoa2421515,0908.53505.48898.53505.0173

SMRSan Marino

STPSao Tome and Principe2692265.59475.4205

SAUSaudi Arabia18111612,6109.44225.19859.44224.7536

SENSenegal3553031,4607.28625.87217.28625.7137

SYCSeychelles2681225.59104.8040

SLESierra Leone5875314506.10926.37506.10926.2748

SGPSingapore1146123,78010.07664.736210.07664.1109

SLBSolomon Islands2211541,8507.52295.39827.52295.0370

SOMSomalia5164526.24616.1137

ZAFSouth Africa5675029,2209.12916.34049.12916.2186

ESPSpain1224919,7609.89144.80409.89143.8918

LKASri Lanka2441243,4008.13155.49728.13154.8203

KNASt. Kitts and Nevis24314810,2809.23805.49319.23804.9972

LCASt. Lucia189.2376667117.31166675,2308.56225.24308.56224.7648

VCTSt. Vincent and the Grenadines2461654,9908.51525.50538.51525.1059

SDNSudan3412911,5607.35245.83197.35245.6733

SURSuriname2301385.43814.9273

SWZSwaziland6275874,5208.41636.44098.41636.3750

SWESweden9156.3333333324,34010.09994.510910.09994.0313

CHESwitzerland995830,91010.33884.595110.33884.0604

SYRSyrian Arab Republic1701323,1908.06785.13588.06784.8828

TZATanzania5695205106.23446.34396.23446.2538

THAThailand2451506,2708.74355.50138.74355.0106

TMPTimor-Leste

TGOTogo4604061,4007.24426.13127.24426.0064

TONTonga2261596,3408.75465.42058.75465.0689

TTOTrinidad and Tobago2091338,2909.02285.34239.02284.8903

TUNTunisia169995,9708.69455.12998.69454.5951

TURTurkey2181206,3008.74835.38458.74834.7875

UGAUganda6175671,2407.12296.42497.12296.3404

AREUnited Arab Emirates1439325,22010.13544.962810.13544.5326

GBRUnited Kingdom1096724,84010.12024.691310.12024.2047

USAUnited States1478434,69010.45424.990410.45424.4308

URYUruguay185898,7409.07575.22049.07574.4886

VUTVanuatu2401852,9407.98625.48067.98625.2204

VENVenezuela, RB178995,5808.62695.18188.62694.5951

VNMVietnam2031391,9907.59595.31327.59594.9345

VIRVirgin Islands (U.S.)103.6754.64054.3175

WBGWest Bank and Gaza160.41035.07774.6347

YEMYemen, Rep.2782267606.63335.62766.63335.4205

ZMBZambia7256877406.60676.58626.60676.5323

ZWEZimbabwe6506122,5007.82406.47707.82406.4167

&A

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GNI per capita PPP 2000 (in log)

Male adult mortality 2000 (in log)

UZB

UKR

TKM

TJK

SVN

SVK

RUSSIA

ROM

POL

MDA

MKD

LTU

LVA

KGZ

KAZ

HUN

GEO

EST

CZE

HRV

BGR

BLR

AZE

ARM

ALB

Is Economic Growth Sustainable in Russia without Good Health in Russia?Source: World Bank World Development Indicators 2005/WHO/ERO HFA Database 2005.Note: When calculating GNI in U.S. dollars from GNI reported in national currencies, the World Bank follows the Atlasconversion method, using a three-year average of exchange rates to smooth the effects of transitory exchange ratefluctuations.

The Russian Population Structure:2005 and 2020 Source: UN Population Projections, 2004 Revisions

Chart1

-5.3779463564.513527404

-5.21538878354.393605946

-5.9453926975.0063914184

-9.06408982817.7896234993

-8.92109937087.847607501

-7.98639332917.1755202087

-7.61762846566.7511827419

-6.95987236226.1199478144

-8.11884764747.5128816731

-8.77810891368.4406257001

-7.58903037427.6314853129

-5.81895902956.2266910902

-2.68671543393.2471040945

-4.75480899496.5192467351

-2.44137391253.8651608397

-2.72735482716.9567623842

Percentage

Russia 2005

Sheet6

Dependency Ratios

1995200020052010201520202025

Total50444037394449

Child32262018192020

Elderly18182018202429

Population 60+ and

Deaths and DALYs Lost Attributable to the 10 Leading Diseases and Injuries in Russia, 2002 Source: WHO/EURO Health Database

Cause-Specific Adult Mortality Rates, Age 1564Deaths per 100,000 populationSource: WHO Mortality Database

Deaths and DALYs Lost Attributable to 10 Leading Risk Factors in Russia, 2002 Source: WHO/EURO Health Database.

RankRisk factorTotal Deaths %RankRisk factorTotal DALYs %1High blood pressure35.51Alcohol16.52High cholesterol23.02High blood pressure16.33Tobacco17.13Tobacco13.44Low fruit and vegetable intake12.94High cholesterol12.35High BMI12.55High BMI8.56Alcohol11.96Low fruit and vegetable intake7.07Physical inactivity9.07Physical inactivity4.68Urban outdoor air pollution1.28Illicit drugs2.29Lead1.29Lead1.110Illicit drugs0.910Unsafe sex1.0

Non-Communicable Diseases and Injuries Are the Leading Causes of Death and Ill Health in RussiaCardiovascular Disease: CVD death rate in Russia (2002) = 994 per 100,000 population (United States = 317, Portugal = 363, Brazil = 225)Traffic Injuries: Mortality due to traffic injuries in Russia = 20.6 deaths per 100,000 population (G-8 rate = 11) Suicide: Russias suicide rate is much higher than that of EU countries (when it peaked in 1994, suicide rate for Russian men aged 5054 was over six times that in the United States) Alcohol Abuse: Adult per capita alcohol consumption in 1999 was 10.7 liters per adult in Russia versus 8.6 liters in the United States and 9.7 liters in the United Kingdom Violence: In 1999, close to 30,000 persons died from homicide in Russia. Alcoholism is closely related to crime; the proportion of crimes committed by men and women while intoxicated in 2002 was about 30 percent and 12 percent, respectively.

The Preventable Risk Factors for NCDs and InjuriesTobacco Consumption: Russia has one of the worlds highest rates of smoking among men. While smoking prevalence among men decreased slightly to 61 percent in 2004, the prevalence of smoking among women increased from 7.3 percent in 1992 to 15 percent in 2004. Drug Use: At the beginning of 2005, drugs users were estimated to number 500,000. High Cholesterol: About 60 percent of Russian adults have higher than recommended cholesterol levels, and about 20 percent are at high risk and in need of medical attention.Psychosocial Stress: Stress resulting from the economic transition and reduction in the social safety net manifests as depression and anxiety and can lead to incapacity, suicide, and other violence-related injuries.Low Socioeconomic Status: People of lower socioeconomic status have higher mortality and are more likely to report bad health than people of higher status.

Consequences of the Demographic Decline and The Health DeficitImpact on labor: Fewer workers; high absenteeism due to ill health; and job lossesDestabilization of families: The death of a household member affects other household members welfare and behavior, including alcohol abuseGrowing regional disparities: Disparities in life expectancy in different regions and among social and ethnic groups could exacerbate existing differences and may give rise to social and political challenges, especially in a country as vast as RussiaChronic illness has negatively affected household incomes, particularly during 19982002, when it is estimated that chronic illness contributed to an annual loss of 5.6 percent of per capita incomeHigh medical treatment costs on the economy

Impact Of NCDs and Injuries on Health Care Costs and the Economy Source: Frid 2005.

Distribution of Risk Factors in a PopulationSource: Rose 1992, as shown in North Karelia Project Presentation, National Public Health Institute, 2005

Strategies and Interventions to Prevent Non-communicable Diseases and Injuries Policies, Strategies, and Capacity-building at the Federal Level:Develop legal, policy, and strategy support for priority population-based subprogramsBuild institutional capacity to implement priority subprogramsAssure federal oversight and accountability

Priority Subprograms in the Regions:Population-based Primary Prevention Interventions: Alcohol, Tobacco, Changes in Diet, and Promotion of Physical ActivitySecondary Prevention: Hypertension, Cholesterol, Diabetes ControlRegional support subprograms for implementing the national mortality reduction programImproved road safety and emergency medical services

What Health Improvements Could Result from an Intensified Program of Action?Estimated Improvements in Life Expectancy if Mortality Rates Are Reduced by 20 and 40 Percent, Russian Males, 2000

Source: Authors calculations

What Health Improvements Could Result from an Intensified Program of Action?Estimated Improvements in Life Expectancy if Mortality Rates Are Reduced by 20 and 40 Percent, Russian Females, 2000

Source: Authors calculations

Main FindingsThe static economic benefits of gradually bringing the adult NCD- and injury-mortality rates down to the European Union (EU-15) rates by 2025 are estimated at 3.6 to 7.1 percent of the 2002 Russian GDP When a broader concept than GDP per capita is considered, the welfare benefits from achieving EU-15 rates by 2025 are estimated to be as high as 29 percent of the 2002 Russian GDP The impact of improving adult health on economic growth rates is significant and grows over time: while in 2005 the difference in the per capita GDP between the status quo scenario and the most optimistic scenario is US$105$324, by 2025 this difference grows to US$2,856$9,243

What Are the Potential Economic Benefits of Mortality Reduction in Russia? Russian GDP per Capita Forecasts in the Three Scenarios1996 constant U.S. dollarsSource: Suhrcke at al. 2005

ConclusionsRussia is experiencing a major and complex demographic and health crisis characterized by premature mortality; ill health and disability among young adults; and a reduction in population size, coupled with the aging of its population. Poor adult health negatively affects economic well-being at the individual and household level; if effective action were taken in Russia, improved health would play an important role in economic growthMost non-communicable diseases and injuries could be prevented and controlled through a comprehensive national program operating at the federal, regional, and municipal levels, adapting best practices that have proven effective internationally The time has come to acknowledge the breadth of social and economic factors that affect health, including the responsibility of individuals for their own health and government responsibility for creating an enabling environment for its population to make healthier choices