How Russian lifestyles are affecting the nation's healthcare

The truth about current-day Russians and their lifestyles is complicated. In some ways they are in somewhat better shape than their American and European counterparts, but in others their habits are dangerously unhealthy.

Stories about Russians' alcohol consumption are legendary. In one travelogue, chef Anthony Bourdain warns: “No matter how good a drinker you might think you are, don't forget that the Russians – any Russian – can drink you under the table.” 

In 2009 the World Health Organization (WHO) said that alcohol consumption in Russia is more than double the 'critical level' – the amount that poses a threat to a nation's health. The WHO reported that each person in Russia, including babies, accounts for 18 litres (L) of spirits per year, while more than 8L per year is considered the 'critical level'. Around the same time, The Lancet published a study that found drinking caused more than half of all deaths among Russians aged 15 to 54 in the era following the collapse of the Soviet Union.

As a response, then-Prime Minister Vladimir Putin approved a campaign to fight alcohol abuse and cut Russia's alcohol consumption in half by 2020. The first phase, which ends this year, is to cut alcohol consumption by 15 per cent per capita; the second phase seeks to eliminate the illegal alcohol market and to reduce consumption by 55 per cent. The law also for the first time classifies beer as an alcoholic drink (it is considered a 'soft drink' – although Russia's famous kvas is still safe from being labelled as alcohol).

We assessed data from the 2011 National Health and Wellness Survey (NHWS), a cross-sectional, representative, self-administered survey of adults in urban Russia (cities with more than 100,000 people), to see how they self-report their alcohol consumption. In the survey, 76 per cent of urban Russians say they consume alcohol, which is consistent with 76 per cent in the EU and only slightly more than 64 per cent in the US. In fact, six in 10 Russian adults who drink alcohol say they do so three times a month or less.

Russians also reported the size and type of the alcoholic drinks they typically consume. Adult urban Russians say the size of the typical 'soft drink' (such as beer) they consume is about 1.8L, although men are drinking much more beer than women (more than 2L versus about 1L). Men younger than 40 years say they typically consume nearly 3L of beer in a sitting.

Women's drink of choice appears to be wine, with Russian women drinking an average of around 1.5L of wine in a sitting, compared with 0.9L for men. Older women in particular are drinking large amounts of wine, with women over 50 saying they typically drink about 2L of wine.

Perhaps unsurprisingly, Russian men report drinking staggering amounts of hard liquor, such as vodka and cognac. Men say the size of their typical serving of hard alcohol is around 150 ml. In contrast, women's typical size of a serving of hard alcohol is 35 ml. Hard alcohol consumption is highest among men aged 40-49 (at 200 ml). Consumption of hard alcohol seems to drop as men age, although men 65 and older still report drinking a typical serving of more than 100 ml.

Up in smoke
Russia has the highest prevalence of smoking in the world. Similar to alcohol consumption, Russia's government is taking steps to try to rein in the smoking epidemic. In 2010 the Russian Ministry of Health and Social Development started requiring all packs of cigarettes to carry an antismoking message. In addition, the government wants to ban advertising and promotion of cigarettes as well as smoking in enclosed spaces.

According to the NHWS, 61 per cent of Russians say they have smoked at some point, compared with 59 per cent of the EU adults and 48 per cent of Americans. However, the number of men who report having ever smoked in Russia is staggering: over three in four, much higher than seen in the EU and the US (approximately 66 per cent in the EU and about 50 per cent in the US).

More worryingly, a third of the Russian adult population currently smokes, compared with 25 per cent in the EU and 19 per cent in the US. Again, men make up the majority of the smoking population in Russia, with 46 per cent of Russian men saying they smoke compared with 23 per cent of women.

Over half of the male population between the ages of 30 and 49 currently smoke, compared with about 30 per cent of the EU's five biggest countries (5EU) men and 25 per cent of American men. While the smoking rate drops as the population ages, it is still much higher among Russian men, eg 26 per cent of Russian men 65 and older still smoke vs. 15 per cent of 5EU and 11 per cent of Americans. However, many Russians are trying to quit. Eighteen percent of Russian men are trying to quit smoking, and another 2 per cent say they are in the process of quitting. These proportions are much higher than they are in either the US (11 per cent of men are trying to quit; 2 per cent are in the process of quitting) or 5EU (9 per cent are trying to quit; 1.5 per cent are in the process of quitting).

The rate of smoking among Russian women is comparable to that of women in 5EU, although it is higher than the rate in the U.S. (23 per cent of Russians versus 25 per cent of 5EU and 17 per cent of US). While smoking rates are higher among younger Russian women, fewer older women are smoking in Russia compared with American and especially 5EU women (eg among women 65 and older 6 per cent of Russians currently smoke, compared with 10 per cent in the US and 16 per cent in 5EU). Based on these self-reported data, Russia is still far away from alleviating the smoking epidemic.

Weighty issues
Obesity is a health problem in Russia, as it is around the world. According to NHWS, 51 per cent of Russian urban adults are overweight or obese, and the mean body mass index (BMI) is 25.7, which is slightly lower than 5EU (52 per cent overweight/obese; mean BMI 26.1) and much lower than in the US (66 per cent overweight/obese; mean BMI 28.6). Similar to patients in 5EU, the proportion of obese patients is much lower than the proportion of overweight (eg 18.1 per cent of Russians are obese and 32.9 per cent overweight, versus 17.8 per cent of 5EU are obese and 34.5 per cent are overweight). This contrasts with the US, where the obese population (34.1 per cent) slightly outnumbers the overweight (31.5 per cent).

In Russia obesity and being overweight increase as the population ages, with nearly 70 per cent of those aged 65 and older being classified as overweight/obese, which is similar to the levels seen in the US. However, there are striking differences in the younger age group (adults under 30), where 26 per cent of Russians are overweight/obese compared with 48 per cent of young Americans.

Findings from NHWS suggest another weight problem at the opposite end of the spectrum, particularly in young women. Overall, 6 per cent of Russians are underweight, compared with 4 per cent in 5EU and 3 per cent of Americans. However, in Russia the proportion of women aged 18-29 who are underweight is 22.4 per cent (mean BMI is 22.0), which is much higher than seen in 5EU or the US (underweight population in young women is 13.0 per cent in 5EU, for an average BMI of 23.5, and 8.5 per cent in the US, for an average BMI of 26.6). As Russian women age, the proportion who are underweight declines to around 2 per cent, consistent with 5EU and the US. Among Russian men, the proportion who are underweight is much lower than among women but is still higher than for 5EU and American men across all age groups.

An assessment of exercise habits suggests considerable diversity among Russians. There are a greater number of people in Russia who say they never exercise, 46 per cent of the population compared with 40 per cent in 5EU and 37 per cent of Americans. This finding is consistent across all age groups, with about 40 per cent of Russians younger than 40 reporting they never exercise, versus about 35 per cent in 5EU and 30 per cent of Americans. However, about 22 per cent of Russians say they exercise vigorously at least every other day, compared with 25 per cent in the US and 18 per cent in 5EU.

Are the health reforms working?
The Russian government is taking aggressive steps toward promoting healthier living through its recent and upcoming restrictions on alcohol consumption and smoking. There is some evidence that the reforms are working, with the WHO estimating that alcohol consumption is now 12L per capita. Similarly, there is more awareness of the health risks of tobacco use, and polls have shown that 60 per cent of the population would support a 100 per cent workplace smoking ban.

However, NHWS self-report data suggests that these steps may not yet be reflected in the current behaviour of many Russians as alcohol consumption and smoking rates remain high. In addition, other lifestyle factors are also negatively impacting the health of Russians, including the increasing obesity in the older population and the widespread lack of exercise.

Russia has lower life expectancies than other industrialised countries, with men expected to live to just 62 years old on average. In order to increase life expectancy and improve quality of life, Russia's people must embrace these lifestyle changes.