The decline in health is attributable in part to such environmental and social factors as air and water pollution, contamination (largely from nuclear accidents or improper disposal of radioactive materials), overcrowded living conditions, inadequate nutrition, alcoholism, and smoking, and in part to a lack of modern medical equipment and technology. In 1991 life expectancy in Russia was 74.3 years for females and 63.5 years for males. By 1994 the figure for males was 57.3 years. The male-to-female ratio in the population reflects the higher male mortality rate and the enduring impact of losing millions more males than females in World War II. (In all age-groups below thirty-five, there are more males than females.) In 1993 the overall ratio was 884 males per 1,000 females, and experts predicted that the figure for males would decline to around 875 by the year 2005 (see Demographic Conditions, ch. 3).
By the mid-1990s, Russia's death rate had reached its highest peacetime level in the twentieth century. Curable infectious diseases such as diphtheria and measles have reached epidemic levels unseen since the Bolshevik Revolution, and the rates of tuberculosis, cancer, and heart disease are the highest of any industrialized country.
In 1993 the incidence of a number of infectious diseases increased significantly over the previous year: tuberculosis by 1.25 times, brucellosis by 1.9 times, diphtheria by 3.9 times, and syphilis by 2.6 times (see table 14, Appendix). In 1995 the Russian health system was overwhelmed by the return of epidemic diseases such as cholera and typhoid fever, even as it faced chronic staff and equipment shortages. In the winter of 1995-96, Russia suffered its most severe epidemic of influenza in decades. An estimated 1 million people were infected in Moscow alone, and numerous schools and public institutions were closed to prevent the spread of the disease. Experts attributed the virulence of the epidemic to the generally low level of resistance of much of the Russian population, the result of poor overall health care and stressful economic conditions. Other causes were the uneven availability of influenza shots and the population's general belief that injections enhance rather than decrease an individual's chances of becoming ill.
Between 1980 and 1989, cancer and its complications increased from 15 percent to 18 percent among causes of death. In 1990 the most common types of cancer were breast cancer, cancer of the stomach and liver, and skin cancer. In the last years of the Soviet Union, about 680,000 new cases were diagnosed annually. The causes of cancer are varied and complex, but contributing factors in Russia are heavy smoking, radiation exposure, and contact with pervasive toxic emissions and chemicals in soil, food, and water. According to the deputy minister of environmental protection and natural resources, about 50 percent of all cancer-related illnesses can be attributed to environmental factors. Heavy-manufacturing regions show especially high rates; in Noril'sk, the metallurgical center located above the Arctic Circle, the incidence of lung cancer among males is the highest in the world (see Environmental Conditions, ch. 3).
Russia's birthrate has shown an increasingly steep decline in the 1990s, amounting to what one commentator calls "the quiet suicide of a nation." For example, the annual birthrate for the first six months of 1992 was 11.2 per 1,000 population--a 12 percent decline from the same period in the previous year. In some areas, the rate was even lower, for instance, 9.2 in St. Petersburg and 8.2 in the Moscow region.
Russia's Ministry of Health reported in June 1991 that the country had a negative rate of population change for the first time since records have been kept. The declining number of births is attributed in part to a drop in fertility, which presumably stems from a combination of physiological and environmental factors, and in part to women's reluctance to bear children in a time of economic uncertainty.