Общероссийское движение «трезвая россия» международная славянская академия союз борьбы за народную трезвость
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THE IMPACT OF ALCOHOL ON MORTALITY OVER TWO CENTURIES: THE EXPERIENCE OF EUROPEAN RUSSIA In the early 1930s the Soviet authorities decided to prevent the publication of data pertaining to alcohol consumption, abuse and alcoholism. Although there were a few attempts to estimate the impact of alcohol on mortality subsequently, for most of the Soviet era little was known about the effects of alcohol on population health in Russia and other Eastern European countries. By the end of the Gorbachev era, some official data on alcohol again became available, but it is only in recent years that alcohol has become a focus of public health researchers working in this region, reflecting emerging evidence that it is playing a major role in the rise in mortality in Russia in the post-Soviet period. This evidence suggests that alcohol has been either directly or indirectly responsible for over 30%of all deaths including deaths from external causes as well as cardiovascular deaths [7]. The impact of alcohol on mortality and morbidity is however, not confined to Russia in the modern period but stretches across both time and space. It has been suggested that alcohol may be responsible for almost 20% of male mortality in contemporary Eastern Europe [4]. Moreover, the rapid fluctuations in alcohol-related mortality that were observed during Gorbachev’s 1985 anti-alcohol campaign have been seen in much earlier periods of Russian history. Between 1923 and 1928 the number of alcohol-related deaths increased by nearly 15 times in Moscow while the alcoholism mortality rate in Leningrad climbed from 1.6 to 25.9 cases per 100.000 during the same period [6]. The rise in mortality accelerated after 1925 when the Bolshevik’s ongoing attempts to impose partial prohibition formally ended. Following the reintroduction of the sale of 40% vodka, the consequences for both health and crime attracted considerable contemporary attention even though detailed data on alcohol-related mortality across the USSR were lacking. The effects that alcohol was having on the population’s health were, however, recognized even earlier, with on alcohol-related mortality beginning to appear in the 1830 and 1840s [2]. These early works were augmented by the later descriptions of forensic-medical doctors working in the Russian regions, especially in the pages of the journal “Archives of Forensic Medicine”. These increased concerns about the effects of alcohol during the last quarter of the nineteenth century culminated in the introduction of a state monopoly on the sale of spirits in 1894 as well the decision, at about the same time, by the decision, at about the same time, by the Society for the Protection of Public Health to form a “Commission for the Study of Alcoholism and the Means of Combating It” [9]. The period between the 1905 Revolution and First World War saw increased efforts by anti-alcohol activists, including the staging of the “first All-Russian Congress on the Fight against Drunknness” in St. Petersburg between December 1909 and January 1910. Yet throughout this period alcohol consumption grew, as did the number of fatal alcohol poisonings recorded in the forensic-medical statistics [8]. This evidence indicates that alcohol has played an important role in Russian mortality from at least the nineteenth century onwards. However, contemporary writers on alcohol in Russia have, entirely reasonably, focused on more recent trends. To the best of our knowledge, the phenomenon of alcohol-related mortality in tsarist Russia has not been systematically studied so far and, specifically, it is not clear how it compared with what is happening in Russia now. In exploring these issues the present study thus builds on a recent work that has examined the impact of alcohol poisoning in Russia and other countries in Eastern Europe between the later-Soviet and post-Soviet period. It asks the following questions:
Data and Methods The study covers the region known as “European Russia”. During the tsarist period this region contained those fifty provinces that today comprise Estonia, Latvia, Moldova (Bessarabia in 1870), Ukraine and the part of Russia located to the West of the Ural Mountains. It considers only one element of alcohol-related mortality, alcohol poisoning. Although this captures only a small portion of overall alcohol-related causes of deaths, such as cardiovascular disease and injuries, also have other causes. Furthermore, analyses of more recent data show that it mirrors trends in other deaths of hazardous drinking in Russia. For the earlier period data relating to alcohol poisoning is drawn from an official state publication the “Statistical Almanac of the Russian Empire”. A five-year average was calculated by dividing by five the number of deaths from alcohol in the years 1970-1974 to give the numerator, with official population data from 1970 being used as the denominator. For the contemporary period information on alcohol poisonings for the years 2001-2002 was obtained from official state statistical agencies and subsequently standardized. Results The most striking finding in 1970-1974 is the very high mortality from alcohol poisoning in Russia when compared with the other countries. This results principally from the high rates among Russian men compared either to Russian women or to men elsewhere. Male mortality, at 19.4 per 100.000 was 7.5 times higher than that for Ukrainian men (2.6 per 100.000), who were in second place among the countries studied (Table). Rates among women were much lower than among men in all countries, although the male-female ratio varied, from 11.4:1 in Russia to 2.7:1 in Bessarabia/Moldova, while no female alcohol-poisoning deaths were recorded among the Baltic countries. The situation in 2001-02 was quite different, with high rates now extending beyond Russian men to men and women in most of the other countries. The rate among Russian and Ukraine were even greater, bringing them closer to the Russian rater. The largest increase, among men, was in the Baltic States, but this was from a, relatively, very low level in 1870. It was, however, among women that the greatest increases were seen, with a striking 50 fold increase in Belarus and a high rate observed amongst women in the Baltic States where previously there had been an absence of this form of mortality. As a result of these changes, rates in 2011-02 were much more similar in Russia, Ukraine, and Belarus than those recorded earlier. In summary, over a period when overall mortality has declined considerably, the death rate from alcohol poisoning in this region has increased among men and, especially, women everywhere. What was once a phenomenon concentrated among Russian men is now a much widespread problem. Discussion In 1870 the combined alcohol poisoning death rate across the 49 provinces of European Russia was 7.0 per 100.000. However, this combined rate masked large differences between the individual countries. The rate in Russia proper (10.6) was 6.5 times higher than that in the next nearest country, Ukraine. The male and female poisoning rates were also higher in Russia than in the second-placed countries (Ukraine and Bessarabia, by 7.5 and 2.8 times respectively). However, all the countries experienced a rise in their alcohol poisoning rates across the period 1970 to 2002 although this rise was much larger in those countries such as the Baltic States that had very low rates in the earlier period. Despite experienced a much smaller proportionate increase over this period, Russia had the highest overall alcohol poisoning mortality rate in 1870 and 2002 among both men and women. What factors might explain the different country and sex-specific rates in the earlier period and the changes over time? In broad terms, the higher the level of alcohol consumption in society, the more detrimental its effects on both morbidity and mortality. This is likely to account for some of the increase observed in alcohol poisoning rates across the period, as more alcohol consumed in the post-Soviet period than in 1870, with consumption having increased in countries like Russia in recent years. However, differences in overall amounts consumed are not a sufficient explanation for the variation among countries. Thus, the combined estimate of recorded and unrecorded per capita consumption of pure alcohol by adults aged 15 and above in Russia in 1998 was 16.4 litres [7]. While the corresponding figure for Moldova, where the alcohol poisoning rate was over six times lower than in Russia, was 29.4 litres. This emphasized the need to look to other explanations. This is also supported by evidence from the earlier period. It is known, that the level of alcohol consumption in 1870 was lower in European Russia than in many other European countries [9]. This comparatively low level continued throughout the later-tsarist and early-Soviet period with consumption figures not starting to rise sharply until the early 1950s. Yet the level of alcohol-related mortality, including the alcohol poisoning rate, was considerably higher in Russia than in other European countries during the tsarist period. Moreover, researchers from the tsarist period were unable to find the expected relationship between regional levels of alcohol consumption and acute alcohol mortality which led one of them to argue that ‘this circumstance indicate clearly that other factors also exists, influencing alcohol mortality” [2]. Contemporary alcohol researchers have echoed this finding by suggesting that both the level of alcohol consumption and the way the alcohol is consumed i.e. the drinking pattern, impact on mortality [1]. In particular, in our study region, research has focused on the contribution of episodic heavy drinking (or binge drinking) to the incredibly high alcohol poisoning mortality rates observed in the post-Soviet period, where in 2001 the Russian rate was over 120 times the European average [9]. This pattern of alcohol consumption was also common in the nineteenth century however, as Russia moved from what Christian has termed a “traditional” to “modern” pattern of drinking with the spread of the tavern, which many people used to drink with the aim of becoming intoxicated [5]. It is possible nonetheless that this was more of a Russian drinking pattern in the nineteenth century that has subsequently spread throughout the region. It is also possible that other factors such as what is being drunk exacerbate the effect of a harmful drinking pattern. In contemporary Russia, although the consumption of beer is growing, spirits continue to be the drink of choice as they were in the late nineteenth century. In contrast, beer is preferred beverage in the Baltic countries, where it was also drunk in large quantities, in addition to vodka, in the earlier period [4]. As spirits have been shown to associate with more closely with mortality in this region than other forms of alcohol the difference in what and still is drunk may explain the gradation in mortality that runs down from the Slavic countries (spirits) through to the Baltic countries (beer) and Moldova (wine) at both points in time. This difference may have been further compounded by the poor quality of much of the spirit-based alcohol being drunk. Recent research has highlighted the growth in samogon and surrogate use in Russia the post-Soviet period and of how many of these surrogates contain ethanol in exceptionally high concentrations [9]. However, in the nineteenth century there were worries about the potentially harmful effects to health of even legally produced alcohol. These concerned the impurities such as fusel oil that were by-products of the vodka distilling process as well as additive intended to change the look or taste of vodka that could range from such things as copper and soap through to cupric acid. Although there is some evidence that the quality of vodka may have improved in the second-half of the nineteenth century and especially after the introduction of a spirits monopoly in 1894, even as late as the 1880s it was argued that most retailed alcohol contained up to 3% impurities with fusel oil accounting for 0.2-0.3% with potentially lethal effects [5]. Moreover, as the quality of vodka was generally poor in the Great Russian provinces this might partly explain the regional differences in acute alcohol mortality during the late nineteenth century. It is also possible, that increasingly poor quality of surrogate and illegal alcohol products may also explain the higher mortality rates in other countries in the region in the modern period. Finally, it is noticible that the male alcohol poisoning rate is between 3-4 times higher than the female rate in the contemporary period. This finding accords with recent research that has shown much higher levels of male alcohol-related mortality in Russia and other Eastern European countries in the post-Soviet period. Given that the men in this region abstain from drinking less often, drink more alcohol more frequently, and engage in the episodic heavy drinking of spirits to a much greater degree than women, this results is not unexpected [4]. However, it is also noticeable that with the exception of Moldova, female alcohol poisoning rates have risen more sharply than males in all women did drink alcohol in the tsarist period they were generally considered to consume relatively little, as was highlighted by the male-female alcohol-mortality ratio of 10:1 in the late-nineteenth century. Indeed, it was not until the late 1970s that drinking was regarded as having spread to women. This may have been connected with their growing participation in the labor force which has been used to explain higher female alcohol consumption in other countries in recent years. However, as the male-to-female alcohol poisoning rate ratio has decreased even in the post-Soviet period other factors may also be important. For example, in Russia, a falling marriage rate, a growing divorce rate and a lower number of births have seemingly coincided with the greater acceptance of women’s drinking in recent years. In turn, this may have resulted in more female (problem) drinking, especially against a background of the deteriorating social and economic position of women in post-Soviet Russia, where it has been argued that a growing “feminization of poverty” has occurred [3,10]. Alternatively, the economic hardship that has affected both men and women in contemporary Russia may have encouraged both male and female drinking where female problem drinking id possibly a function of heavy male drinking as has been previously seen amongst women in the United States [3]. As yet, little direct research has been undertaken on hazardous alcohol consumption amongst females in this region although it is possible that the same factors that underpin this type of drinking among men – low education and unemployment will also be relevant for women. At the end of the nineteenth century in his monograph on alcohol and its effects, the eminent psychiatrist Ivan Sikorskii described alcohol as “the great killer”. As the present study has shown, this was in the past but also in the present, as the rate of alcohol poisoning in this region continues to be exceptionally high in comparative terms. In relation to this, it is highly significant that many of the factors that underpinned high alcohol mortality in tsarist Russia such as the harmful drinking pattern, the overwhelming consumption of spirits and the poor quality of the alcohol being consumed continue to be relevant when explaining the high alcohol poisoning death rates in this area in the contemporary period [7]. However, some important changes have also occurred. If earlier consumption figures are reliable, it indicates that the region has become much “wetter” across the period as there has been a large rise in the level of alcohol consumed. Moreover, whereas alcohol poisoning was very much a Russian phenomenon in the early period, by 2002 high rates were observed in the other countries in the region which suggests that there may have been some diffusion of the Russian drinking pattern and its harmful effects during the Soviet period. Further, women are now dying comparatively more often from the harmful ingestion of alcohol which may signify their changing, but also deteriorating position in these countries in the post-Soviet period. Taken together, these findings highlight how difficult it will be to effect a change in the drinking culture in the region but also that change is by no means impossible. Evidence already exists that the Baltic States may be beginning to diverge from the Slavic countries in terms of their alcohol poisoning rates in the post-Soviet period. Moreover, the growing popularity of beer in Russia, Ukraine and Belarus suggests that drinking habits in these countries are certainly not immutable. The countless number of alcohol-related fatalities that have occurred across the time frame of this study bear witness to the urgency of this task. |
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