All-Union Association of Voters of the Peoples of Russia (USSR). A small comparison of the USSR and Russia Mortality in the USSR

Information Bulletin of the Center for Human Demography and Ecology of the Institute of Economic Forecasting of the Russian Academy of Sciences

DEMOGRAPHY OF THE STALIN ERA

Anatoly VISHNEVSKY

In the mid-1920s, when Stalin took the first steps to consolidate his power, neither the USSR nor Russia had a well-established modern system of demographic statistics. Nevertheless, at that time quite rich information about all the main demographic processes was already collected and processed, albeit not everywhere, in 1926 one of the best Soviet population censuses was carried out, all available data were widely published and carefully analyzed, demographic forecasts were developed , demographic studies were on the rise. Next to demographers who gained fame even before the revolution (V. Mikhailovsky, P. Kurkin, S. Novoselsky), younger M. Ptukha, V. Paevsky, Yu. Korchak-Chepurkovsky, S. Tomilin, A. Khomenko and others worked. In the early 1930s, two research demographic institutes operated in the country - in Kyiv and Leningrad.

In 1953, after the death of the leader, the information field of demographic statistics and the research field of demography were a scorched desert.

Already in the early 1930s, the classification of demographic information was in full swing, gradually turning into its falsification. In particular, the population census of 1937 was declared "wrecking", and in 1939 a new census was carried out, the results of which were more suitable for the country's leadership. Both demographic institutions were liquidated - Leningrad in 1934, Kiev - in 1939. Demographic publications have almost disappeared. Brutal repression fell upon the demographers themselves.

V. Paevsky, the leading figure of the Leningrad Demographic Institute, died in 1934 at the age of 41 from a heart attack a few hours after the decision to close the institute was made. At the end of the 1930s, three successive heads of the state statistical service, V. Osinsky, I. Kraval, and I. Vermenichev, were arrested and shot in a short time. The execution ended the life of O. Kvitkin, head of the 1926 and 1937 population censuses, and Ukrainian demographer A. Khomenko. Another head of the census, 1937 L. Brangendler, died in the camp. M. Ptukha, Yu. Korchak-Chepurkovsky, B. Smulevich, M. Tratsevsky, A. Merkov, M. Kurman went through arrest, prisons and camps...

The concealment of information about demographic processes in the USSR has reached an unthinkable limit. Even the total population of the country was not known. Only in 1959 - 6 years after Stalin's death and 20 years after the census - of the population of 1939 - a new census was carried out, thanks to which the statisticians felt something like stable ground under their feet and were able to calculate the necessary demographic indicators. It is the results of the 1959 census and their comparison with the results of the 1926 census that make it possible to judge the demographic results of Stalin's rule. What are these results?

Fertility: the great turning point

At the beginning of the 20th century, Russia was a country with a very high birth rate. During the First World War and the Civil War, the birth rate, for obvious reasons, declined, but by the mid-1920s, the life of the population, then predominantly peasant, in Russia, Ukraine, and other regions of the USSR, returned to normal, and the pre-war high birth rate was restored. But this post-war rise did not last long, by the end of the 1920s a strong decline was already noticeable, which accelerated sharply after 1929 - Stalin's "year of the great turning point".

Having reached the maximum depth of decline in 1934, after a terrible famine, in 1935-1937 the birth rate in Russia increased slightly again, but never returned to the level that existed before 1933. In 1935, when Stalin uttered his famous words that “life has become happier” and “the birth rate is greater, and the net increase is incomparably greater,” the total fertility rate in Russia was almost 40% lower than in 1927. As for the natural increase, it was almost twice as low as in 1927 (11‰ versus 21‰).

The decline in the birth rate in a country that has embarked on the path of industrialization and urbanization is a natural process. What is striking about the Stalinist USSR is the enormous rate of decline in the birth rate. In order for the demographic behavior of entire generations to change almost instantly, people had to experience an incredible shock. Such a shock was the events of the late 1920s and early 1930s for the majority of the population of the USSR: forced collectivization, dispossession and famine. In a sense, this shock was much stronger than the shock of the First World War and the Civil War, the revolution and the post-revolutionary devastation. After they ended, the population quickly returned to the old norms of demographic and family behavior, while the shock of the early 1930s led to irreversible changes.

Rice. 1. Total fertility rate
in Russia and Ukraine

Frightened by this unexpected consequence of his economic and social policy, Stalin tried to extend the mechanism of repression to this area of ​​life of the citizens of the USSR. A few months after he announced with great fanfare, but without any foundation, that the population of the USSR "began to multiply much faster than in the old days," abortion was banned in the country.

Sources: Russia 1927 - 1940; 1950 - 1958 - assessment by Andreev and co-authors; Ukraine for 1925 - 1929 - calculation by M.V. Birds; Russia 2 - (1950 - 1958) and Ukraine for the same years - A. Blum's assessment.

The years immediately following the ban on abortion were marked by some rise in birth rates, but this was small and short-lived. The abortion ban did not bring the expected effect, and then the war caused a new sharp decline in the birth rate, and Stalin decided to tighten the screws even more. At the end of the war, in 1944, a decree was issued that raised the status of a registered marriage and made it more difficult to dissolve it. On the other hand, at the same time, an attempt was made to increase the prestige of motherhood by introducing government awards to mothers of large families and providing them with a number of benefits.

Judging by the fact that the measures taken could not stop the decline in the birth rate, the strengthening of the state presence in family affairs turned out to be an ineffective remedy. Moreover, it is precisely the countries that survived totalitarian regimes that tried to influence the family and demographic behavior of people (Germany, Italy, Spain, Russia, etc.) that are already demonstrating the deepest decline in fertility in our time. Perhaps this is due to the fact that state intervention in any form - both with the help of a stick and with the help of a carrot - does not increase the forces of family self-organization, but reduces them.

From 1925 to 2000, the total fertility rate in Russia decreased by 5.59 children per woman (from 6.80 to 1.21) (Fig. 2.). Of these, 3.97 children, or 71% of the total decline falls on the years 1925-1955 - the "Stalin era".

Mortality: no fracture

According to official estimates, the overall mortality rate for the USSR as a whole was 29.1‰ in 1913, 20.3‰ in 1926, and by 1930, according to Stalin's statement about a 36% reduction in mortality, fell to 18-19 ‰. Even greater successes were reported 5 years later, after the end of the terrible famine. In 1935, mortality was 56% of the 1913 level. 1 , that is, it has already decreased by 44%, or to about 16‰.

Rice. 2. Total fertility rate. Russia,
1897-2002

Many years had to pass for the researchers to get to the secret archives and, on the basis of all available data, came to the conclusion that the overall mortality rate of the population of the USSR in 1930 was not 18-19, but 27‰; and in 1935 its value was, accordingly, not 16, but about 21‰. Approximately the same as in the USSR was then the overall mortality rate in Russia (27.3‰ in 1930 and 23.6 in 1935) (Fig. 3).

Rice. 3. Crude death rate in Russia
and in the USSR. 1890-1960*

* Large dotted line - trend line 1890-1913

Sources: Population of the USSR 1987. Statistical collection. M., 1988, p. 127; Rashin A.G. Population of Russia for 100 years. M., 1956, p. 156; Andreev E., Darsky L., Kharkova T. Population of the Soviet Union. 1922-1991. M., 1993, p. 120; Andreev E., Darsky L., Kharkova T. Demographic history of Russia: 1927-1959. M., 1998, p. 164.

Now let's see how things stood with infant mortality, about which Stalin, speaking in 1930 at the 16th Congress of the All-Union Communist Party of Bolsheviks, said that it had decreased by 42.5%. If this were true, then by 1930 the infant mortality rate would have fallen to 155 per 1,000 newborns, which, according to later estimates by demographers, was 196 per 1,000 2 , that is, only 27% less than in 1913 - (then in the first year of life in Russia 269 died out of every thousand born). In Russia at that time, the rate was higher than the all-Union one and amounted to 227 per 1000.

According to calculations, it turns out that the mortality rate - both general and infant - in 1930 was indeed lower than in 1913. Why was Stalin not satisfied with the true assessment of these successes, albeit a more modest one? The answer is related to two circumstances.

Firstly, the death rate was already declining before the revolution, so its moderate decline could in no way be attributed to the merits of the Soviet government. Moreover, mortality rates in the 1930s were significantly higher than would be expected if pre-revolutionary trends persisted - all of them are above the trend line of 1890-1913 (see Fig. 3).

Secondly, although the indicators of 1930 were better than the pre-war ones, they were worse than those achieved in 1927-1928, before the start of the implementation of the main Stalinist projects.

Thus, already in 1930, the foundations were laid for that false mythology of the extraordinary successes of the Soviet government in protecting public health, which, it seems, has survived to this day.

Meanwhile, the dynamics of expected (average) life expectancy indicates an almost complete lack of progress "in the years of Stalin's five-year plans."

Rice. 4. Life expectancy at birth
and at the age of 30. Russia, 1897-2001

As E. Andreev showed (Fig. 4), even if we take only the most favorable, "crisis-free" years of the interwar period, women's life expectancy has risen noticeably higher than the pre-revolutionary level (by about 45 years), but men have no growth compared to the last practically non-existent in the pre-revolutionary years. The situation changed only after the war, and by 1953 the life expectancy of both men and women exceeded the best pre-war figures by about 20 years. However, this success was achieved mainly due to a decrease in mortality in childhood, which, in turn, was due to the emergence and mass introduction of antibiotics into practice. But the increase in life expectancy of the adult population was much more modest and short-lived, it stopped very soon, and for men it was even later replaced by a reduction in life expectancy.

Demographic catastrophes as the norm

Even those modest successes that actually took place refer only to the "normal" years, which in Stalin's time were constantly punctuated by catastrophic years.

Stalin's rule was marked by the largest military losses in the history of the country, primarily in the Second World War. Stalin did everything to hide their true scale.

The number of losses he named - "about seven million people" - was made public in February 1946, although, according to military historians, "at that time the country's leadership knew more accurate data - 15 million dead" 3 . But later these data turned out to be underestimated, and they had to be revised. According to the last Soviet official estimate given by M. Gorbachev in May 1990, the war took the lives of almost 27 million Soviet people. For the USSR, which had about 195 million people at the beginning of the war, this meant the loss of 14% of the pre-war population.

Stalin's assessment of the losses of the USSR in World War II was revised, but the mythology created by Stalin and his entourage of the inevitability of these losses persists to this day. And now it is considered good form to recall the heroism of the war years and hush up the question of the responsibility of the Generalissimo for the unpreparedness for war, for the mediocrity of military operations at its first stages, for the "expensive" method of obtaining victory at the cost of unimaginable human casualties.

Against the background of huge losses in World War II, 127 thousand irretrievable losses (and even 265 thousand wounded, shell-shocked, burned, frostbite, etc.) during the three and a half months of the war with Finland (December 1939 - March 1940) seem almost a trifle. But let's compare this trifle, which is also on Stalin's conscience, with, say, the losses in World War II of countries such as the United States (300-400 thousand according to various estimates) or England (350-450 thousand).

The second group of catastrophic demographic losses of the Stalin era is associated with famine. According to relatively recent estimates, in the USSR they amounted to 7-7.5 million, in Russia - 2.2 million people. But there was another famine, post-war. It was the result of the 1946 drought, began in December and continued until the 1947 harvest. According to some estimates, human losses as a result of this famine in the USSR amounted to about 1 million people.

The third source of catastrophic demographic losses, which has become almost a trademark of the entire Stalin era, is political repression.

The number of victims of repression, including the premature deaths caused by them, runs into the millions, but their exact number is still not known. A huge number of people were simply shot. According to the official information that once appeared, "in 1930-1953, on charges of counter-revolutionary, state crimes, judicial and all kinds of non-judicial bodies passed sentences and decisions against 3,778,234 people, of which 786,098 people were shot" 4 . At the same time, it is possible that this information underestimates the number of those executed.

"Besides, and we know this for sure, very many perished in camps and prisons without being sentenced to death" by a "court" 5 . The Gulag flourished in the 1930s, existed and replenished during the war years, and did not disappear even after it ended. Moreover, at the end of the war, mass repression intensified again and did not stop until 1953. The total number of prisoners in prisons, colonies and camps in the early 1950s approached 2.8 million people.

By this time, the first wave of mass Stalinist repressions had almost vanished - "kulak link". A new form of repression became deportation of peoples. The total number of Soviet citizens deported inside the USSR during the war and post-war years was approximately 2.75 million people.

It is known that the death rate in the camps, during the deportations, in the places of settlements of the deported was terribly high, so that the demographic losses here were much greater than from direct executions. According to D. Volkogonov, as a result of Stalinist repressions from 1929 to 1953, 21.5 million people died in the USSR. But so far this estimate can hardly be considered exhaustive or rigorously proven.

Years of wars, outbreaks of famine and the rise of mass repressions literally “flashed through” the “Stalin era”. Since 1929, there have been more of them than "normal", quiet years. Accordingly, it is not easy to separate the "normal" mortality, which can be discussed in terms of the successes of public health, sanitary hygiene, the achievements of medicine, etc., from the catastrophic mortality of people thrown back into almost primitive conditions. All this made itself felt later, when Stalin was no longer alive, there were no obvious demographic catastrophes, and the USSR and its core - Russia - stalled for a long time on the path along which other countries were triumphantly moving towards ever higher life expectancy. .

Demographic ruin

Falsifying demographic data is not an easy task. You can name any indicators of births or deaths and make them believe, but sooner or later they are subject to objective verification, because the population size depends on them, and hence the number of workers and eaters, soldiers and voters, schoolchildren and pensioners.

In the Stalinist USSR, this was possible. The population of the country has become a carefully guarded state secret, because its publication would immediately make obvious the many years of lies of the authorities and Stalin personally.

Before the veil of secrecy fell over the population, it was repeatedly falsified. In 1934, at the 17th Congress of the All-Union Communist Party of Bolsheviks, Stalin named a fake figure for the population of the USSR - 168 million people. Based on it, Soviet experts expected that the 1937 population census would record 170-172 million people in the country. But only 162 million 6 were taken into account. It is not surprising that the 1937 census was declared sabotage, and in 1939 a new census was carried out, and everything was done so that this time the census results confirmed the false statements of the country's leadership. The census was carried out in January 1939, and in March, even before its final results were received, speaking at the XVIII Congress of the CPSU (b), Stalin declared that 170 million people lived in the country. Naturally, the results published subsequently could not be less than this figure declared by the leader.

Subsequent historical events - the inclusion in 1939 of the USSR of the Baltic countries, Western Ukraine and Western Belarus, and then the war, pushed the question of the demographic results of the Soviet thirties into the background, and after the war, Stalin, apparently, given the not entirely successful experience of his pre-war falsifications, decided to stop publishing data on the population of the USSR altogether.

Even in the mid-1950s, numerous foreign researchers were still trying in vain to at least approximately estimate the number of inhabitants of one of the largest countries in the world. The French demographer A. Sauvy then gave a summary of such estimates from 213 to 220 million people in the middle of 1955. When, three years after Stalin's death, the official figure was first published, it turned out to be significantly lower than all available estimates: 200.2 million people in April 1956 7 .

Estimates of the demographic losses of the USSR by domestic specialists who gained access to archival materials became possible much later. According to these estimates, the number of excess deaths in 1927-1940 was 7 million, in 1941-1945 - 26-27 million 8 . But there were also direct losses from the famine of 1946-1947 (approximately 1 million people), as well as victims of the post-war Gulag. So the total direct losses of the Stalinist USSR are at least 35 million people, and, most likely, they are higher. And besides, one should take into account the significant reduction in the replenishment of the population due to children who were not born to prematurely dead.

Rice. 5. Population growth in Russia - actual and
in the absence of demographic catastrophes

If we imagine that there were no two main demographic catastrophes of the Stalin period - the famine of the early 30s and the Second World War, as well as other rises in mortality that reduced the growth rate of the population of Russia, then, starting from 1926, the population due to the balance birth and death rates would grow as shown in Fig. 5.

In 1926, when Stalin was just coming into power, the population of Russia was 93 million people.

Until 1941, the country did not know major wars, and its population could have grown to about 121 million people. In fact, in 1941 it was 9 million less - only 112 million. Only in 1935 was the population of 1930 restored - after the demographic failure of the times of collectivization and dispossession. Then a new terrible failure followed - the military one. The pre-war population of Russia was restored only in 1956 - 11 years after the end of the war and three years after Stalin's death.

Thus, for 15 years - more than half of the term of Stalin's rule - Russia lived in conditions of demographic losses that were not replenished even in comparison with the level already reached, i.e. being demographically pushed back.

By the time of Stalin's death, Russia's population was 107 million. If there were no excessive losses during the years of his reign, there could have been more than 40 million more Russians in 1953.

Anatoly VISHNEVSKY

LITERATURE.

1. Socialist construction in the USSR. Statistical Yearbook. M., 1936, p. 545.
2. Andreev E., Darsky L., Kharkova T. Population of the Soviet Union, p. 135.
3. Great Patriotic War 1941 - 1945. Military essays. Book 4. People and War. M., 1999, p. 282.
4. In the State Security Committee of the USSR. Izvestia, February 13, 1990.
5. Volkogonov D.A. Triumph and tragedy. October. M., 1988, p. 129.
6. Andreev E., Darsky L., Kharkova T. Population of the Soviet Union, p. 25.
7. A. Sauvy. La population de l'Union Sovietique. Situation, croissance et problemes actuels. Population, 1956, no. 3, p. 464.
8. Andreev E., Darsky L., Kharkova T. Population of the Soviet Union, p. 60, 77.

They aroused great interest and a number of reposts on history_russia And en_history.
In this regard, I decided to expand the data by years and somewhat deepen the analysis of the results. To do this, I had to turn to the Annual
statistics collections of Rosstat.

Added two more data series for 1975 and 1985. Unfortunately, Rosstat does not have annual data, but the five-year step also clarifies well
picture of the demographic development of the last twenty years of the Soviet period. For the post-Soviet period, we now have all the data up to 2011, which clearly adds details to the overall picture.

Let me remind you once again that these tables show the dynamics of male and female mortality by years for different age strata. I translated this data into a form that is digestible for assimilation of information. For the base, for 100%, the indicators of 1990 are taken. Figures for other years are based on 1990 and
show rise or fall.

First, let me turn my attention to the Soviet period. It shows two multidirectional trends: for young, young and middle ages up to 40 years, the trend is positive, with a decrease in mortality (1). After 1980, it becomes especially noticeable with a slight increase by 1990. For older, retirement ages, the trend is negative until 1980(2). After 1980, it changes to positive. This can be explained by the neglected state of affairs in the development of medicine under Brezhnev and the alcoholization of the life of a middle-aged urban inhabitant. But let me remind you once again that after 1980 the trend changes to a positive one. These data directly contradict the point of view of liberal demographers from the Higher School of Economics ala Vishnevsky that mortality in Soviet times was continuously growing from 1965 until the very end of the 80s and that the increase in mortality in the 90s is a continuation of the negative Soviet trends. This statement is false - mortality increased only until 1980, after which it stopped and a downward trend began to emerge. This is especially noticeable in children, young and middle ages up to 40 years.

Now let's move on to the post-Soviet period. A sharp increase in mortality (3) is immediately noticeable in all age groups, with the exception of children aged 5-9 years. There is even an increase in mortality in the 0-4 year group to the very zero. The neglected state of affairs in medicine under Yeltsin is having an effect. Among young and middle ages, the increase in mortality is almost doubling - the collapse of the economy, unemployment and crime. Mortality among pensioners is also growing one and a half times. Did not fit into the market - from small to large. After 1996, there is a decline in the increase in mortality. Then a new increase in mortality (5) after the 1998 default. Greetings to the authors of the default (Kiriyenko, Aleksashenko, etc.) - they have hundreds of thousands of lives on their account.
The only age group that has not suffered or suffered the least from the activities of the liberals are children aged 5-9. Which is logical - they are still under the close guardianship of their parents and the state influences them the least. The rest got it in full.
In 2002, there is a new, third surge (7) in the growth of mortality already under Putin. What was it? It's hard to understand. The collapse of the socio-economic system of the country at the lowest oil prices? 130th place in the world for health care? It is important that after that a gradual improvement of the situation began. First among young and old ages, then among adolescents (6) and the elderly (8).

Now the data for women:


Women are not much different from men, although there is less red in general, and this pleases and it is natural - women are stronger than men and lead more
healthy lifestyle. But they also got it hard - first to everyone, and then to the youngest and most capable at the age of 25-40 years (10). The only stratum that is most in line with the norm is also girls aged 5-9 years (9).

In recent years, the solution of the demographic problem in Russia has become one of the directions, without success in which it is impossible to ensure the survival of the Ethnos.

It seems important to look at the causes of the demographic decline. We have discussed one of the causes more than once - drunkenness. Thanks to Marina Rodionova, who did a lot of work on raising the topic of combating the demographic consequences of drunkenness.

Another reason, of course, is today's social conditions.

Today we are bringing up for discussion material almost 30 years ago. It is devoted to the POLITICAL REASONS FOR THE DEMOGRAPHIC SITUATION in the Soviet Union. The material is scientific. Based on open statistics. text that I would not have been able to find without his help.

DEMOGRAPHIC STATISTICS AND UNNATURAL MORTALITY IN THE USSR IN 1918-56

The pictures of repression witnessed in Solzhenitsyn's "Archipelago" suggested that violence of such magnitude could not but affect the population of the USSR, its growth, birth rate, mortality, the ratio of increases in the number of men and women, and other demographic indicators. The idea arose to estimate, using demographic analysis, the number of deaths from repression, deprivation, unpreparedness for war and the policy of achieving military goals at any cost. Unfortunately, professional demographers still evade their professional duty - to estimate the number of deaths in 1918-56.

In this work, I am only interested in the number of deaths, i.e. the excess of actual mortality over that which would have been under normal historical conditions: without civil war and World War II, without collectivization, without famine and camps. From a demographic point of view, the death toll can be defined as the difference between the total number of deaths and deaths from natural causes. This will be the number of unnatural deaths. The results of such a numerical analysis and a description of the estimation methods are given below.

Usually, demographic tables give the number of deaths per year per 1000 people of the population, i.e. in % (per mille), and this number is called the total mortality rate or - total mortality. Also, birth rate, infant mortality under one year old (per 1000 births) and other values ​​are given in %.
Official publications of demographic indicators for the period after 1918 are contained in the collections "The National Economy of the USSR in (such and such) year" (hereinafter "NX"), which have been published since 1956. Unofficial ones are scattered in small doses in different books. When all existing information is summarized in a table, it turns out that, unfortunately, for most of the period of interest to us, information is not available at all.
For 33 years - since 1917. to 1949 - population data exist only for 11 years, data on mortality, fertility, the number of men and women - exist only for 6 years. There is no demographic information for the periods 1929-36 and 1941-49. Censorship scissors cut out the years, where the death rate is too high and the birth rate is low. There is no distribution of the population by sex and age according to the 1937 census, and according to the census of January 17, 1939, it is given in total with an estimate of the 20 million population of the western regions that was not yet enumerated and not yet connected at that time (this is really the unwitting help of the West to demographic censorship).
It is not difficult to guess why these banknotes and mixtures were made: to make the population look ever-increasing (albeit not fast enough), the birth rate is gradually falling (the failures of the early 30s are removed), the death rate is at least marking time (20% in 1926 year, 18% - on average in 1937-40). Nevertheless, even from this meager, deliberately mutilated information, something can be learned.

The population of Russia in 1913 was 139 million people, the total mortality was 30.2%, the birth rate was 47%, the average annual increase for 1902-1912 was 3.7 million people. During the three years of the bloody World War I and 1917, the population increased by only 4.2 million people, that is, it increased by only 1.4 million people on average per year. Further - civil war and famine in the Volga region. In December 1922, the population was 136 million people, i.e., decreased by 7 million people, on average - by 1.4 million people a year. Where is the 1st World War!
Of course, population decline is not the number of deaths. If we take into account the data on fertility and mortality for 1913-23. in Russia, we get an excess of total mortality over natural. The number of deaths in 1918-23. - about 9 million people. Mortality in 1918 increased one and a half times compared to 1917 and remained so for three years, the birth rate barely covered mortality from natural causes.

The increase for 1923 amounted to 1.5 million (as in the "prosperous" years 1914-1917) - this is the first, still timid increase under the new government, and the population in 1924 was already 137.6 million.
From 1924 to 1929, a steady annual population growth of 3.1 to 3.3 million people is almost the pre-war level. Mortality in the "HX" tables is reported only for 1926 and 1928, and a slight, pre-storm increase is already visible over these two years. Further, official statistics fall silent from 1929 to 1937. Something went wrong.
If we divide the population difference between 1937 and 1929 by these 8 years, we get an average annual increase of 1.3 million people. The increase in peacetime (!) became less than during the First World War and 2.5 times less than in the years adjoining the period 1929-1936 "from above" and "from below". The population by 1937 amounted to 163.8 million people, while in the speeches of the leaders "170 million Soviet people" sounded from 1933.
The organizers of the 1937 census were shot, as is known, and the results of the census have not been published to this day.

In 1927-1928, about a million people died, in 1929-1936 - about 13 million people. These 13 million include those who died from the artificial famine of 1932-1933.
Let's go through these terrible years and go to 1937-40, which is not necessary to imagine. The denominations of 1929-36 are not surprising, but it is absolutely surprising that in "NH", starting from 1962, publications of annual full demo indicators for 1937-1940 flicker. That's just the gender and age structure of January 17, 1939 is carefully mixed with the still unattached population of the western regions. Apparently demostatisticians considered that the emptiness in the publications "below" 1937 and "above" 1949 is sufficient to obscure the death toll of the mid-30s.
However, comparison with the interpolation level of natural mortality, as well as with mortality in Poland and Finland, allows us to estimate the number of victims in 1937-40. 3.2 million people. This includes the military losses of the USSR in the shameful war with the "White Finns" (well, the term - as if there are Finns of other colors).

A few words about 1939 (within the boundaries of the Peace of Riga in 1923), when, finally, not in Stalin's speeches, but in statistical papers, "170 million Soviet people" appeared. Did the statistics of 1939 pull up this number under the sword of Damocles? Only the archives can answer this most serious question, and I will express my thoughts on this matter.

First. The "Damocles figure" hung over the demographers of 1939, but not over the demographers of the 1960s, who secretly analyzed the data of the 1937 and 1939 censuses. when preparing publications in "IH" and other publications, they could make the necessary adjustments. The demographers of the 60s were "threatened" by real, non-fictional control figures: the censuses of 1926, 1959, and a good population count before 1928 and after 1949 - everything is published. And they themselves could not fail to understand that any movement of the population of the 37-39s up or down can only "pump" the dead into neighboring periods - periods of famine-collectivization or World War II.

Second. If the demographers of the 60s, out of solidarity with their colleagues on the 39th, decided to bring 1939 up to 170.6 million, then they could do it only within narrow limits - by 2-3 million - the figure of 170 million was already 5 late - 6 years in a country with a then traditionally high birth rate, which, moreover, after 1935 and still certainly increased both due to the end of the artificial famine, and because of the ban on abortion in June 1936.

From 1941 to 1950, the population decreased by 18.2 million people, and there was also a considerable birth rate during the war, and in 1946-1949 it was almost at the level of 1950-1954. The birth rate in this period can be restored by analyzing persons of war years of birth in the 1959 census, by the number of students in grades 1-4 in the 50s (Urlanis), and the proportion of 1946-49s is directly published in the book "Women THE USSR". (Stat. sat. 1975 edition).
Knowing the level of natural mortality, population decline, analyzing the movement of age groups from the 1939 census to the 1959 census, we can estimate the number of deaths from the war and camps in 1941-1949: about 32 million people. The disastrous number of people of military age 1899 - 1926. birth can be estimated directly for the war years of 1941 - 1945: about 25 million people, of which 19 million are men.

Recall that the following were reported to us about the number of those killed in the war: 7 million (Stalin in 1946), 20 million (Khrushchev in 1961) and, finally, in one of the demographic books of 1975, V.I. Kozlov mentions that indirect losses from the war, where he includes the "increase in the death rate," amounted to another 21.4 million people.

Before giving final estimates of the number of deaths, let us consider additional indicators of high unnatural mortality in the USSR.

In 1924-28. born (rounded) 32 million children. By 1939, there were 22 million left to live. 10 million died, approximately one in three. In 1937-40s, the mortality rate for infants under one year of age remained at the level of 1926, despite an almost 8-fold increase in obstetric beds.

From 1922 to 1927, the increase in the number of men in the population was 1.1 million higher than the increase in women, and from 1927 to 1939, 2.9 million less. This means that in the "peaceful" time of artificial famine and repressions of 1937-38. 4-6 million more men disappeared than women.

In 1939, there were 39 million men born in 1899-1924 (this is part of the military age without 1925 and 1926). In 1959 there were 19 million fewer. There are 7 million fewer women of the same age.

I will now give the estimates of the dead, calculated from demographic data thinned out by censorship. In addition to direct losses, i.e. killed and ruined, I give an approximate value of population losses from a sharp decline in the birth rate - the result of inhuman living conditions.

In 1918 - 1923. FROM THE CIVIL WAR, TERROR, EPIDEMICS, HUNGER, DESTRUCTION, ABOUT 9 MILLION DIE. PERSON, INCLUDING INDIRECT LOSSES - MORE THAN 15 MILLION. HUMAN.

In 1927 - 1936. FROM 13 TO 15 MILLION DIE PERSON, INCLUDING INDIRECT LOSSES - FROM 15 TO 17 MILLION. HUMAN.

In 1937-40. SHOT, DIE IN THE CAMPS AND DURING THE FINNISH WAR FROM 3.0 TO 3.4 MILLION. HUMAN.
Of these, 1.2 million people in 1937-38, 1.8 million people in 1939-40.

In 1941-49. FROM WAR, DESTRUCTION AND REPRESSION, FROM 31 TO 34 MILLION DIE. HUMAN.
Of this number in the war of 1941-45. conscripts died 1899-1926 birth, from 24 to 26 million people died, including 19 million men and 5.5 million women.

DURING THE PERIOD 1950-54 FROM 300 TO 600 THOUSAND DIE IN THE CAMPS HUMAN.
This figure was obtained from the deficit in the growth of men documented in "NH", namely, the preponderance of the growth of men over the growth of women amounted to over the five years of 1950-54. only 300 thousand, while in each of the next four five years it was from 600 thousand to 900 thousand people.

IN TOTAL FOR 1918 - 1954, 56 MILLION. UP TO 62 MILLION HUMAN. OF THEM IN NON-WAR TIME FROM 17 MILLION. UP TO 19 MILLION HUMAN.

We must still mention the forces of life that oppose these demographic catastrophes. During the years of violence against the peasantry, although the birth rate was falling, it ensured a positive average annual population growth at the level of the 1st World War. Even during the years of the Patriotic War, the birth rate, decreasing at times by two or three times, relative to 1940, nevertheless, on average, 1.5 times covered mortality from natural causes, and by 1950 the population had restored to the level of 1941.

I would like to think that our demographers will fulfill their professional duty and one day publish all the data on the population of the 1918-1949s, extracted from special caches and caches.

The above estimates are based on updated figures from the old 1976-78 work of "Statists". Allow me, 13 years later, to name the people who provided me with invaluable help and support then: I.N. Khokhlushkin, A.P. Lovut, I.R. Shafarevich, A.I. Solzhenitsyn.
I.G.Dyadkin, Ph.D.

Mortality in Russia 15 years after the collapse of the USSR: facts and explanations

EAT. Andreev, Ph.D. n. YES. Zhdanov, Ph.D. n. V.M. Shkolnikov, Ph.D. n.
(Published in the magazine "SPERO" No. 6, spring-summer 2007, p. 115-142. Published with some author's clarifications)

INTRODUCTION

Term mortality reversal signifies a reversal or regression of mortality. It appeared in the world demographic literature in the 1990s. and was intended to emphasize the exceptional nature of the situation when the increase in the death rate in the country has been observed for a number of years. In the last decades of the 20th century, reversals in mortality were noted in a number of countries located in sub-Saharan Africa, as well as in almost all countries of Central and Eastern Europe and the former Soviet republics. The decline in life expectancy in some sub-Saharan African countries began 10 to 20 years ago as a result of the HIV/AIDS epidemic. The increase in adult male mortality began in the former socialist countries and republics of the USSR much earlier - approximately in the mid-1960s.

Table 1. Reduction in life expectancy for men aged 15 years ( e(15)) in some Eastern European countries

Countries	Start of decline		End of decline		decline
Bulgaria
Belarus
Former GDR
Slovakia

Sources: The Human Mortality Database (HMD), http://www.mortality.org/ and calculation based on the WHO Mortality Data Base http://www.who.int/whosis/en/ . The start year of growth is the last year in which life expectancy did not decrease, the end year of growth is the last year in which life expectancy decreased.
*For Belarus, Russia and Ukraine, the latest available year is taken.

It is important to emphasize that the increase in mortality in the former Soviet Union and Eastern Europe was observed mainly in men over the age of 15, while child mortality generally continued to decline.

In Belarus, Latvia, Russia, and Ukraine, this increase also extended to women, but the increase in female mortality was not as significant.

As follows from tab. 1, by the end of the 1990s. the once large group of countries with a regression in mortality has been reduced to three countries. In the remaining 9 presented in tab. 1 countries and regions, the increase in mortality has either been replaced by a rapid and steady decline (the former GDR, the Czech Republic, Poland, Slovakia), or the decrease is accompanied by some fluctuations in the level, or it is still not long enough to recognize it as final, but the increase in mortality has certainly stopped.

In this article, we make another attempt to explain the increase in mortality in Russia, and therefore our attention will be focused on the main problem of Russian mortality - adult mortality.

1. FACTS: TWO PERIODS OF GROWING MORTALITY

In Russia, as in other post-Soviet countries, the history of the increase in mortality falls into two periods - before and after 1985. Until 1985, the increase in mortality in Russia was almost uniform, sometimes accelerating somewhat during influenza epidemics, then slowing down briefly in response to attempts to limit alcohol consumption in the early 1970s and 1980s. (Fig. 1).

The anti-alcohol campaign, which began in May 1985, was accompanied by an unprecedented increase in life expectancy for both men and women. In 1986-1987 in Russia, the highest levels of life expectancy for men were recorded - 64.8 years, and in 1989 for women - 74.5 years. In 1988-1989 adult mortality has resumed.

Figure 1. Life expectancy for men and women at the age of 15 in Russia, Belarus, Hungary and Latvia after 1959

Note: The dotted lines on the graph are an extrapolation of the 1965-1984 trend, calculated based on these years using the standard TREND function (Excel 2003)

The period after the anti-alcohol campaign is different in that the increase in adult mortality took place against the background of its sharp fluctuations. Until 1992, it went slowly, just as in the 1980s, in 1992-1994. accelerated sharply, and in 1994 the lowest life expectancy after 1959 was recorded in Russia - 57.4 and 71.1 years for men and women, respectively. Then life expectancy increased again and in 1998 it was 61.2 and 73.1 years for men and women, respectively. Then there was a new drop: in 2003, life expectancy for men was 58.5 years, and for women - 71.8 years, and a new very small increase to 58.9 and 72.5 years in 2005. Let us note again that all these fluctuations took place against the background of a steady decline in child mortality and were entirely associated with the dynamics of mortality in ages over 15 years.

For comparison to rice. 1 presents trends in life expectancy at age 15 for three more countries in the same group, Belarus, Hungary and Latvia. Each of these countries is interesting in its own way for comparison with Russia. In the 1970s-1980s. mortality in Hungary was the highest among the countries of Eastern Europe that were not part of the USSR. Latvia had the highest mortality and the highest percentage of the Russian-speaking population among the Baltic countries. Finally, in Belarus, the mortality rate was the lowest among the countries of the former USSR. In 1985, a large-scale anti-alcohol campaign took place in Russia, Latvia and Belarus, but nothing like this happened in Hungary. At the same time, in the early 1990s, Hungary, Latvia, and Russia went through (with varying degrees of success) painful market transformations, and in Belarus, Soviet-style state paternalism continued to exist in many respects. From 1965 to 1984, the life expectancy of 15-year-old men in these countries decreased by 3.3-4.5 years, while in Western countries it increased by 2-3 years.

The first time the similarity between the four countries is broken in 1985, when in Russia, Belarus and Latvia the increase in mortality stopped, and life expectancy increased under the influence of anti-alcohol measures, and in Hungary the increase in mortality continued and continued for another 9 years.

The second violation of the similarity of dynamics occurred after 1991, since the deterioration of the situation in Belarus was noticeably less than in Latvia and Russia. In Belarus, the life expectancy of 15-year-old men fell in 1994 compared to 1990 by 2.8 years, and in Latvia and Russia by 5.4 and 6.4 years, respectively. Moreover, the previous increase in life expectancy during the period of the anti-alcohol campaign in Belarus was the same as in Latvia: the maximum increase compared to 1984 was 2.2 years, and in Russia more - 3.1 years. This suggests that the slower increase in mortality in Belarus in 1992-1994. can be attributed to the absence of cardinal socio-economic reforms that were taking place at that time in Latvia and Russia. But in Belarus, unlike Russia and Latvia, there was no significant increase in life expectancy in the mid-1990s.

In 1993, life expectancy began to increase in Hungary, and thus Belarus, Latvia, and Russia lagged behind Hungary and began to grow.

Finally, in 1998, new differences between countries appeared: while in Belarus and Russia the decline in life expectancy continued, in Latvia it began to increase after 1998. Thus, by the beginning of the 2000s. there are marked differences between Hungary and Latvia, on the one hand, and Belarus and Russia, on the other. The sad maxim of N.S. involuntarily comes to mind. Leskova: "From here, their fate began to differ greatly."

In Russia, despite the multidirectional dynamics of mortality, the overall results of changes for 1965-1984. and 1984-2005 very close (Table 2): from 1965 to 1984, life expectancy for men aged 15 fell by 3.29 years, and from 1984 to 2005 by 3.88 years. In women, from 1965 to 1984, life expectancy decreased by 0.91, and from 1984 to 2005 - by 1.42 years. In both cases, the second period turned out to be even less favorable than the first, resulting in an additional loss of 0.59 and 0.52 years of life expectancy for men and women, respectively. As seen from tab. 2, the main losses in life expectancy in both the first and second periods are associated with diseases of the circulatory system and external causes.

The main differences between the periods 1965-1984. and 1984-2005 associated with the dynamics of mortality from tuberculosis: if in 1965-1984. mortality was declining, then in 1984-2005. she grew rapidly. In the second period, losses from murders and intentional injuries, and especially from injuries without specifying their accidental or deliberate nature, also increased significantly. It is highly likely that a significant proportion of the latter are actually murders. If we divide deaths from injuries of an unknown nature proportionally between homicides and suicides, then the losses from homicides for men will be 0.69 years, and for women - 0.21 years. In addition, it turns out that the death rate of men from suicide has increased (loss of 0.2 years), while the death rate of women has not changed much.

Speaking about the reasons for the increase in the number of deaths, qualified as injuries without specifying their accidental or deliberate nature, it is appropriate to recall that already in the early 1990s. the pressure on physicians from the side of statistical bodies, seeking to minimize uncertain diagnoses, has significantly eased. It is not hard to see how consistently increased in the 1990s. the number of deaths with diagnoses of “other heart diseases”, “other respiratory diseases” and the already mentioned “injuries without specifying their accidental or intentional nature”. It should also be emphasized the imperfection of the Russian legislation, which imposes on the doctor the determination or, at least, the record in evidence of the so-called external cause in injuries and poisonings. Obviously, in many cases, only the investigating authorities or the court can determine whether the cause of death was intentional violence or an accident. Hence the increase in the number of unidentified damage.

It is also appropriate to recall that in 1999 serious changes took place in the system of recording the causes of death. Russian mortality statistics switched to the Tenth Revision International Nomenclature of Diseases, Injuries and Causes of Death (ICD-10). Since the beginning of 1999, the doctor who determined the cause of death not only made an entry on the medical certificate of death, but also coded the cause himself based on the full ICD-10 code. Thus, it became possible to encode the cause of death much more accurately. If before 1999 there were about 200 codes in use, then in 1999 more than 10,000 codes became available. Obviously, this in itself could not but increase the variety of diagnoses.

The same reasons led to a decrease in the contribution of coronary heart disease with a simultaneous increase in the contribution of other heart diseases. In 2005, Rosstat for the first time singled out the diagnosis “alcoholic cardiomyopathy” in the final tables of causes of death, it turned out that deaths from this cause account for 34% of male deaths from other diseases of the circulatory system and 19% of female deaths. Among all deaths from diseases of the circulatory system under the age of 60, alcoholic cardiomyopathy accounted for 12% of deaths in both men and women. Unfortunately, the number of deaths from alcoholic cardiomyopathy for 1999-2004 was not calculated, and before the introduction of the ICD-10 in 1999, it was not available at all.

Table 2. Decomposition of change in life expectancy at age 15 between 1965 and 1984 and 1984 and 2005 by main groups of causes of death (years)

	Men				Women
	1965-2005	1965-1984	1984-2005	Difference	1965-2005	1965-1984	1984-2005	Difference
All reasons
infectious diseases
including tuberculosis
Neoplasms
including malignant neoplasms stomach and intestines
trachea, bronchi, and lungs
other neoplasms
Diseases of the circulatory system (CK)
including hypertonic disease
cardiac ischemia
vascular lesions of the brain
other diseases of the
Respiratory diseases
including acute respiratory infections, influenza, pneumonia
Diseases of the digestive system
including liver cirrhosis
External causes
including motor vehicle accidents
suicide and self harm
murder and intentional injury
damage without specifying their accidental or intentional
Other reasons

Note: Calculation method, see [Andreev E.M. Component method in lifespan analysis // Bulletin of Statistics, 1982, No. 9. S. 42-48.], Data for 1999-2005. recalculated in accordance with the Brief Nomenclature of Causes of Death 1981, modified in 1988 (based on the 9th revision of the ICD). Deaths from other and unspecified causes of death, including old age without mention of psychosis and symptoms and ill-defined conditions, are proportionally distributed among all other causes of death [for more details, see Millet V., Shkolnikov V., Ertrish V. and Wallen J. 1996. Modern trends in mortality by cause of death in Russia 1965-1994. // M., 103 p.].

Previously, statistics took into account only four purely alcoholic causes of death: chronic alcoholism, acute alcoholic psychosis, alcoholic cirrhosis of the liver, and accidental alcohol poisoning. The loss of life expectancy for men due to increased mortality from these causes in the first and second periods was 0.32 and 0.29 years, respectively, and for women - 0.16 and 0.21 years. Since 2005, there have been 7 of them, and the above-mentioned alcoholic cardiomyopathy, degeneration of the nervous system caused by alcohol, and chronic pancreatitis of alcoholic etiology have been added. In 2005, the number of deaths from seven causes was 1.68 times more than from four, both for men and women, and accounted for 9% of all deaths. At the same time, as noted by many researchers, not all deaths caused by excessive alcohol consumption belong to headings that include the word "alcohol". The best-known example is cirrhosis of the liver, many deaths from alcoholic cirrhosis are recorded as deaths from other forms of cirrhosis, so in tab. 2 combined all forms of cirrhosis into one cause of death.

returning to tab. 2 note that in women (unlike men) the increase in mortality from cirrhosis in 1984-2005. was much more significant than in 1965-1984. In terms of the rate of increase in mortality from this cause, women overtook men.

On rice. 2 the age features of the increase in mortality in Russia are presented. As can be seen, the main increase in mortality is concentrated in the most active ages of 25-59 years. In this interval, the age intensity of mortality in men increased by more than 2 times, and in women - by 1.5 times.

Figure 2. Relative change in age-specific mortality rates from 1965 to 1984 and from 1984 to 2005 in percent

Another topic that comes up when comparing the rise in mortality before and after 1991 is the problem of growing inequality in the face of death. Unfortunately, in reality, we have only a few data on the differentiation of mortality in Russia. Moreover, these data in total give a rather contradictory picture. For example, differences in life expectancy between men and women consistently increased throughout the entire period of increasing mortality, differences in life expectancy between urban settlements and rural areas in men first increased markedly, and then decreased, while women grew evenly, and finally, interregional differences in life expectancy also increased (Table 3).

Table 3. Differences in life expectancy at age 15 by sex, place of residence and region

	1965	1984	2005	1984-1965	2005-1984
Gender difference
Difference between city and countryside
Interregional differences according to the Valkonen formula

* Estimated for 1969-1970.

Data on mortality in various social groups of the Russian population were obtained from the 1979 and 1989 population censuses. An analysis of these data is presented in the book Inequality and Mortality in Russia (2000). Later, unique data on occupational mortality by cause of death in the urban population of 17 regions of Russia in 1970 were found in the archive. Finally, we were able to estimate mortality by education in Russia in 1998, the last year when the registry offices recorded the education of the deceased.

Presented below tab. 4 shows the dynamics of life expectancy at the age of 20 in 17 regions of Russia for which data on mortality were developed depending on the nature of work in Russia (according to HMD), and an assessment of the contribution of individual socio-demographic groups to this dynamics.

The association between childhood adversity and mortality in later life is particularly strong for diseases such as stomach cancer, which are at increased risk from infection with the bacterium. Helicobacter pylori, which is more common in childhood. However, the influence of the life path is also seen in the case of lung cancer, the mortality from which is an indicator of the proportion of smokers in the population with a lag of 40 years between the start of smoking and the maximum risk of death from corresponding causes. A cohort analysis of mortality from lung cancer shows a high percentage of smokers among Russian men who came of age in the post-war period and, especially, during the war. The incidence of breast cancer today is partly explained by the history of fertility and breastfeeding. It is also possible that certain circumstances that played a role in early life determine the current rate of prostate cancer among adult men.

Contrary to the global trend, the number of people who smoke in the countries of the former USSR increased rapidly in the 1990s. Moreover, the content of harmful substances in cigarettes sold in Russia, as a rule, is higher than in Western samples. In the 1990s Russian borders opened for transnational tobacco companies. Paradoxically, their aggressive marketing policy has linked smoking to the Western way of life, while in reality there is an active anti-tobacco campaign in the West, and the level of smoking is half that in Russia. On the territory of Russia, tobacco production was significantly expanded, which is a significant factor in counteracting the anti-tobacco policy. As a result, the number of male smokers increased by the end of the 1990s. increased to 60-65%. But the most significant change of the last decade has been an increase in the number of women who smoke, which was previously traditionally low.

An analysis of male mortality in Izhevsk between the ages of 20 and 55 showed that high prevalence of smoking and the associated risk of cardiovascular disease increase the mortality rate in this group by 41%. Approximately the same result - 45% - was obtained by Peto et al. .

Thus, past smoking may cause a gradual increase in mortality from lung cancer and cardiovascular disease. Stability of mortality from lung cancer in the 1990s does not suggest that smoking may be the main cause of the increase in mortality in Russia and may explain the fluctuations in mortality after 1985 and, in particular, the sharp increase in the 1990s.

2.3. Alcohol

Even without taking into account the connection with mortality, it is impossible to deny the influence of alcohol on Russian society. There are descriptions of the consequences of drinking in Rus' as early as the 13th century. , and Russian politicians and hygienists of the late XIX - early XX century. discussed the problem of drunkenness as very disturbing .

There are many reasons why alcohol plays such a role in the life of Russia. These are the climatic conditions under which wheat is much more accessible than grapes, and, accordingly, the drinking culture is based on the consumption of strong alcoholic beverages, and not wine. Cold and long winters reduce social activity and bring alcohol to the fore. In this regard, Russia is not unique. All Nordic countries have experienced the same problems in the past.

But there are also factors related to government policy. In Tsarist Russia, the monopoly on the sale and production of vodka provided a third of all income. Obviously, no one wanted to interrupt this financial flow. For a short time, the situation changed from 1914 to 1926, when there was a ban on the production and sale of hard liquor. But the income from the sale of vodka was so attractive that Stalin, who needed funds for the industrialization of the country, lifted all restrictions in 1926. In a society that does not produce, in general, consumer goods, this turned out to be one of the few means of real circulation of money. This continued until the 1980s, when it became impossible to ignore the negative impact of alcohol on the country's economy and public health. Gorbachev, who came to power in 1985, along with glasnost and perestroika, introduced an anti-alcohol campaign.

Official statistics do not take into account illegal production, as well as the now completely legal home production of alcohol for one's own consumption, therefore it underestimates alcohol consumption. According to unofficial estimates, the true level is 12-15 liters of pure ethanol per year per person. Alcohol played an extremely important role in the sharp fluctuations in life expectancy during the period of the anti-alcohol campaign and after its termination, i.e. since 1985 .

The destructive effect of alcohol consumption in Russia is associated not only with quantitative characteristics, but also with the way of consumption. For example, residents of Mediterranean countries drink alcohol (wine) daily, usually with meals. In Russia, the same weekly amount of alcohol, but in the form of a drink of a much higher strength, is consumed at a time. This type of consumption in the English-language literature is called binge drinking or episodic heavy drinking, which means consumption during one feast (or other short period of time) of a significant amount of alcohol. This term is translated into Russian as consumption of shock doses of alcohol. According to one study conducted in Russia, 31% of men drink at least 250 g of vodka at a time at least once a month (and this estimate is most likely underestimated).

The latest classification of causes of death contains several dozen positions that are directly related to alcohol, in Russia only seven causes are taken into account , of these, three main causes make the largest contribution to the total number of deaths: alcohol poisoning - 1.8% (4.4% aged 50-59 years); alcoholic cardiomyopathy - 1.7% (4.0% at the age of 50-59 years) and alcoholic liver disease (cirrhosis) - 0.7% (1.6% at the age of 50-59 years). In addition, it is known that alcohol affects mortality from a number of chronic diseases, including heart disease, vascular lesions of the brain, etc. A special term has appeared in Russian medicine - chronic alcohol intoxication, which leads "to a specific development of a priori non-alcohol-related pathology" and makes the patient especially vulnerable, increasing the risk of death from diseases of the circulatory system or pneumonia at relatively young ages. This clinical finding is supported by the results of the anti-alcohol campaign, which suggest that the influence of alcohol consumption extends to the incidence of tuberculosis. Given the depressed immune system of alcoholics, this connection seems to be reliable.

Alcohol consumption increases the risk of death from external causes. In many cases, for example, when driving, intoxication creates an increased risk to others. In the study of homicide mortality by regions of Russia, a clear geographical relationship was traced between the increased number of homicides and alcohol consumption. About 70% of killers and their victims are under the influence of alcohol. In terms of mortality among working-age men, the Second Family Survey in Izhevsk found that hazardous alcohol abuse could be responsible for 4 out of 10 deaths among men aged 25-54.

The anti-alcohol campaign was accompanied by a significant decrease in mortality from diseases of the circulatory system. This fact contradicts the notion that alcohol reduces the risk of cardiovascular disease at any level of consumption. Careful research has shown that regular moderate consumption does have a protective effect. Excessive consumption of alcohol in shock doses has the opposite effect, which is associated with the different effects of alcohol on a number of physiological parameters, including lipid metabolism, blood coagulation and myocardial sensitivity. A similar effect has been found in other countries where one-time excessive alcohol consumption is common. Especially the risk increases with the consumption of alcohol surrogates and liquids with a high alcohol content. Apparently, therefore, the increase in mortality in 1992-1993. was especially intense: after the end of the anti-alcohol campaign, not only vodka, but also drinking alcohol with a concentration of pure ethanol above 70% went on free sale.

The suggestion that the association between alcohol consumption and cardiovascular mortality may be due to misclassification of deaths from alcohol poisoning is perhaps not unfounded, since relatives of the deceased would often prefer to see a different diagnosis on the death certificate. However, a study based on forensic data showed that although a significant proportion of men aged 20 to 55 in Udmurtia who died according to the official diagnosis of cardiovascular diseases had an elevated blood alcohol content, it, however, was clearly insufficient for alcohol poisoning.

Further work with the same data set made it possible to find evidence of an association between excessive one-time alcohol consumption and mortality from cardiovascular diseases already at the individual level.

Several epidemiological studies attempting to explain the high mortality from cardiovascular disease in the USSR and Russia by traditional risk factors such as cholesterol, smoking, and blood pressure have failed. The study found exceptionally high levels of gamma-glutamine transferase (a biomarker of alcohol consumption) in men and women aged 18-75. At the same time, 75% of men and 77% of women were classified as dangerously abusing alcohol according to the AUDIT criterion.

All of this underlines the importance of the unconventional findings of Britton and McKee (2000) on the association of alcohol shock and cardiovascular mortality, which is likely to be contributed by factors such as psychological stress and inadequate medical care.

So, alcohol directly and indirectly plays a major role in the fluctuations in mortality in Russia after 1984. Naturally, the question arises: why do people drink like that in Russia? This is a question for further discussion.

2.4. Nutrition

The lack of complete data on the nutrition of the population of the USSR in the post-war period, up to the mid-1980s. makes us think that information about the nutrition of the population of the USSR was even more closed than data on mortality. Most likely, the fact is that the problem of providing the population of the USSR with food remained acute until its collapse. Recall that in 1964 the USSR began to import grain, and the volume of imports increased systematically, and the last food program of the USSR for the period up to 1990 was adopted on May 24, 1982.

As in the case of alcohol, research in the former USSR has opened up new facets of the impact of nutrition on health. The relationship between dietary patterns (the proportion of proteins, fats and carbohydrates in foods consumed) and disease is well known. Lipids play a significant role in explaining the interindividual variation in cardiovascular disease. Diets high in fat and low in carbs are bad for the cardiovascular system. In Russia, the consumption of bread and potatoes decreased from the 1960s to the mid-1980s, while the consumption of meat, eggs and milk increased. By the end of the 1980s. fat intake was higher than the recommendations of the World Health Organization by 10-15%.

Price liberalization led to the fact that in the early 1990s. the consumption of more expensive meat and dairy products was partially replaced by potatoes and bread. However, by the mid-1990s the number of calories from fat returned to normal. During the 1990s, despite the increase in poverty, there was no serious shortage of total calorie intake.

Calorie intake and dietary patterns are only part of the problem. It is necessary to consider the entire energy balance, taking into account physical activity and energy expenditure. Insufficient mobility of Russians leads to an increase in the number of obese people.

The problem of food quality, the presence of trace elements and vitamins is especially highlighted. Thus, Prokhorov (2002) links the high level of anemia in children and pregnant women with insufficient consumption of fresh fruits and vegetables. Note that, according to the latest data, a high proportion of vegetables and fruits in the diet is a protective factor against cardiovascular disease and certain types of cancer.

The evidence collected suggests that malnutrition may have contributed to the baseline mortality rate, but is not a major contributor to the increase in the 1990s.

2.5. Insufficient medical care

Criticism of the Soviet health care system has already become common place in modern demographic literature, and there is no point in repeating what is known. We note only a few important points.

The system of medical care for the population created in the USSR turned out to be a fairly effective means of combating infectious and similar traditional diseases. Recall that the main successes in the fight against mortality were achieved after the Second World War and thanks to vaccination and the introduction of new medical methods of treatment. The beginning of progress was associated with the use of imported sulfonamides and antibiotics. Production of domestic analogues was started later . We note one more feature: in the West, the decline in mortality from most infections, including tuberculosis, occurred before the development of effective drugs for the treatment of diseases through improved nutrition and well-being.

Not free from shortcomings, the Soviet health care system allowed the entire population to have access to basic medical services. The Soviet system of primary health care in 1978 was even recognized as a model for developing countries at the conference of the World Health Organization held in Alma-Ata. But the weaknesses of the system began to emerge as early as the 1960s. and began to grow rapidly as a result of, first of all, insufficient funding, which decreased from 6% of GDP in the 1960s. up to 3% in the 1980s .

The system was a network of medical institutions with a hierarchical system of hospitals and specialized all-Union institutes in Moscow and several large cities. The main role was played by polyclinics and district doctors, who were responsible for districts with a population of about 1,700 adults or 1,200 children. In parallel, there were specialized outpatient dispensaries (tuberculosis, dermatovenerological, oncological, etc.), duplicating specialized departmental structures (polyclinics and hospitals of the ministries of defense, communications, etc.) and medical units of large enterprises. Gradually it turned out that the parallel structures were better funded and better equipped than the main medical network.

At the same time, the main network gradually became less and less efficient and unable to respond to the deteriorating health status of the population. By 1990, about half of hospitals, mostly small and located in settlements and small towns, were not provided with hot water and showers, and 15% did not have running water. The situation was especially unfavorable in rural areas. The salary of medical workers in the institutions of the Ministry of Health (mostly women) was 30% lower than the national average. Doctors were often forced to perform many elementary procedures due to a lack of nursing staff. Patient care was especially poorly organized, the number of nurses serving one patient was half that in the West.

While the Western healthcare system improved along with the development of pharmacology and technology, Soviet healthcare continued to struggle for existence. A large number of ineffective, but inexpensive methods of treatment were used, including radio-, electro- and light therapy. Truly effective technologies were hard to come by, partly because of the Western ban on the transfer of dual-use technology to the USSR. In the field of pharmacology, the country was entirely dependent on the import of medicines, mainly from Eastern Europe and India. The production of modern medical equipment and medicines within the country was poorly developed.

The milestone reached by the Soviet health care system in the 1980s was far behind the Western level, which can significantly reduce mortality from chronic diseases. Thus, the MONICA survey showed that in Russia the consequences of myocardial infarction are much more severe than anywhere else in developed countries.

From the mid 1960s. the number of deaths avoidable with effective and timely medical care has steadily declined in the West and remained consistently high in Russia and other Soviet republics. In the late 1990s these deaths explained up to 20% of Russia's lagging behind the West in terms of life expectancy for men and 25% for women.

The market reforms that began in 1991 made it theoretically possible to access modern medicines and medical technologies, but the economic crisis made them financially unaffordable for the majority of the population. In 1994 health spending was 10% lower than in 1990. Despite the relatively successful introduction of a new health care financing system based on compulsory health insurance, in the 1990s. every tenth Russian had no such insurance.

The proclaimed reform of the organization of the health care system was never completed, and with the existing levels of funding it was hardly possible at all. The result was a dramatic weakening of the system. It was at this time, against the backdrop of a continuing increase in the level of non-communicable diseases, that Russia faced new threats and challenges, such as antibiotic-resistant tuberculosis and HIV/AIDS. New threats are characterized by an unprecedented level of complexity. Chronic noncommunicable diseases, such as diabetes, which affect multiple systems, require the collaborative efforts of a range of health professionals. The same can be said about complex infectious diseases, such as AIDS or drug-resistant forms of tuberculosis. It is not yet clear how modern Russian healthcare will be able to respond to these threats.

In the early 2000s With energy prices soaring and Russia's financial position sharply improving, one could expect a significant improvement in the financing of the health care system. However, according to experts, public spending on health care in 2004 remained at the 1997 level. In conditions of insufficient state funding, the population's expenses for medical care are growing. The share of public funds in health financing increased from 11% in 1994 to 35% in 2004. In contrast to Western European countries, where the health insurance system covers the bulk of the cost of medicines, medicines in Russia for home treatment are almost entirely covered by on the population, and in recent years, the payment of medicines for treatment in a hospital is gradually shifted to the population. There is a very limited list of "life-saving and essential medicines, medical supplies and consumables" provided free of charge to hospital patients. It includes no more than 4% of medicines present on the market. But even with these medicines, hospital patients are not fully provided.

However, the situation of outpatients is much worse. In Russia, only certain categories of the population receive free medicines for outpatient treatment. In 2005, in the process of monetization of benefits, the number of holders of the right to free medicines, as well as the list of provided medicines, significantly decreased. It is striking that the monetization of benefits is presented as a liberal project and the equalizing cash payments in exchange for benefits (including free medicines) provided for by Federal Law No. 122-FZ of August 22, 2004, is regarded as a fair and market-based measure. According to the strange logic of the authors of the monetization project, Western health insurance itself, with its idea of ​​solidarity, can be considered wrong: of course, because everyone pays depending on income, but receives depending on needs.

Today, many hopes are associated with the national project "Health". As a matter of fact, the direction of the project “Providing the population with high-tech medical care” is exactly what, according to experts, the Russian healthcare system lacks today and which can have a real impact on the mortality of the population from diseases of the circulatory system. However, it seems that the scale of the project is clearly insufficient to solve the problem. Ultimately, 70% of the funds under the national project are supposed to be spent on the direction "Development of primary health care", i.e. essentially to patch up the existing system of primary care, the collapse of which we have already written above.

Compare the situation in Russia in the 1990s. with what was simultaneously happening in the countries of Eastern Europe. A detailed analysis of the decrease in mortality in the Czech Republic showed that a very important (if not decisive) role in it was played by a change in attitudes towards health and progress in healthcare. The decrease in mortality was mainly due to a decrease in mortality from cardiovascular diseases in middle and older ages. In time, this process coincides with a significant increase in spending on medicine from 5% of GDP in 1990 to 7.4% in 2001. Due to the growth of the Czech GDP itself and the increase in the share of spending on medicine, it became possible to dramatically increase the use of beta-blockers, calcium channel blockers, lipid-lowering drugs, and other modern drugs. Surgical treatment was intensified due to coronary artery bypass grafting, valve transplantation and angioplasty. Non-invasive methods of surgical treatment have been rapidly developed, significantly reducing the invasiveness of operations. At the same time, alcohol consumption and smoking increased slightly, and vegetable oil partially replaced animal fats in the diet. Thus, the lifestyle has not changed significantly, and progress in health care has become the most important component in reducing mortality in the Czech Republic.

It is very likely that a similar situation was observed in other countries of Eastern Europe, which experienced a sharp decline in mortality in the 1990s. In all these countries, the rate of death from cardiovascular diseases in people over the age of 65 has especially significantly decreased. At the same time, the scale of mortality reduction ranges from 20% in Hungary to 40% in Slovenia. And everywhere this happened against the backdrop of the introduction of new, more effective means of treating and preventing cardiovascular diseases and rising health care costs. By the beginning of the 2000s. in the Czech Republic, Hungary, Poland and Slovenia, health care expenditures were 6-9% of GDP, while in Russia they were only 2.9%.

Forty years of underfunding, and especially the last 15 years of development in a "wild" market, have largely undermined the Russian health care system, which, we recall once again, played a huge role in reducing mortality in Russia in the late 1940s and 1950s. It is difficult to quantify to what extent the state of medical care is responsible for the increase in mortality in Russia, but it is undoubtedly not insignificant.

2.6. Psychological stress as a reaction to communism and "shock" market transformations

Soviet ideology has always placed the interests of the state above the interests of the individual. The party called on people to sacrifice their lives to communism and competition with the West. The value of human life for the state was extremely low, and this was clearly reflected both in the priority of public health and in mortality trends. It would seem that the state took care of a person from birth to death, providing cheap food, housing, transportation, free medical care and education. The quality of these free goods, however, was not high. Although formally everything was affordable, obtaining many benefits was associated with long queues (in stores, medical institutions, at railway stations), and families stood in line for housing for years and decades. The latter circumstance, however, was to some extent smoothed over by the strict institution of propiska. State paternalism gave rise to passivity, people believed that the state would help in trouble. One of the consequences of such a policy is the emergence of the idea that a person himself can do little for his health.

In the 1950s-1960s. Gradually, a feeling of disappointment and an awareness of the utopian nature of the communist ideology grew, as evidenced by the events in Hungary (1956) and Czechoslovakia (1968). Eastern Europe, friend and ally, was not happy with real socialism. With the first cracks in the Iron Curtain in the 1960s and 1970s. Soviet people realized how much the standard of living in the USSR differs from the Western standard of living. Disillusionment with the communist system is growing and social norms and values ​​are being eroded during this time, according to unpublished polls. Okolsky, apparently one of the first in 1991, even before the collapse of the USSR, hypothesized that a simple comparison of life in the East and in the West and disappointment in the communist idea could in themselves cause serious psychological stress and, ultimately, an increase in mortality. Recall that the beginning of the increase in mortality in Russia coincided with the removal of N.S. Khrushchev and the rejection of the slogan of building communism in the USSR by 1980.

The disillusionment was exacerbated by the growth of corruption, which reached the level of the ruling elite, as a result of which people were increasingly alienated from the state and official institutions.

People were limited in many aspects of life. There was no legal opportunity to increase their income, and there was almost nowhere to spend the funds received. Official-bureaucratic organizations such as the Komsomol and Pioneers have taken the place of public organizations that are freely developing in the West. In general, people had few opportunities for self-realization. Gradually weakened the relationship between the work performed and the remuneration received, which also led to psychological stress. Men in the most active working age, especially unmarried men, turned out to be the most vulnerable group.

The weakness of many state institutions added to the growing uncertainty. The erosion of social norms and bonds, as well as law and order, was growing. One of the manifestations of this was a sharp increase in the number of murders. At the same time, the circle of social groups involved both as criminals and as their victims expanded. As a reaction to the surrounding chaos and uncertainty about the future, the number of drug addicts among young people grew.

By the end of the 1990s. Russia has developed a highly stratified society with a very small number of extremely rich people and a large number of people below the poverty line, at the bottom of the social pyramid.

Considering the time when there were especially sharp jumps in mortality - 1992 (after the start of reforms) and 1999 (after the financial crisis of 1998) - psychological stress as an explanation for what is happening seems very plausible. However, direct evidence for a link between stress and health is not yet particularly strong.

A study carried out in Russia by M. Bobak et al. based on a representative national sample, found a strong association between a low assessment of the ability to control one's own life and low self-assessment of health and poor physical status. However, it is not clear to what extent the self-assessment of the health of men of working age affects the risk of violent or sudden death, which determined both increases in mortality in the 1990s. Another study in Novosibirsk found a strong correlation between the work-earnings ratio and depression. A study in Taganrog revealed a relationship between increased alcohol consumption among men and the difficult financial situation of the family and family problems. Perhaps, however, feedback is more important. A study in Udmurtia showed a relationship between premature mortality in men aged 20-55 and some indicators of psychological stress. Unfortunately, information about the stress experienced by the deceased in this study was obtained from third parties and may be distorted.

According to Cockerham et al. Based on a recent study in Belarus, Kazakhstan, Russia and Ukraine, the impact of stress on mortality occurs primarily through behavioral responses. In women, in particular, major psychosocial distress does not lead to alcohol consumption. Due to the high level of social responsibility (the need to take care of the family, children, etc.), women usually limit themselves to smoking. On the contrary, in men, such shocks often lead to drunkenness.

In general, psychosocial stress may have contributed to the increase in mortality, but the magnitude of this contribution and the specific mechanisms of direct or indirect effects of stress on health and life expectancy remain to be explored.

2.7. Man-made pollution

The beginning of the increase in mortality in the USSR coincided with the period of intensive development of polymer chemistry, but even before that, the problem of environmental pollution was very acute. Most likely, the well-known review by Feshbach and Friendly is not without exaggeration, but the negative impact of industrial pollution on health and mortality is undeniable. There is an extensive literature on this topic, especially in relation to the population of certain areas with very high levels of pollution or workers in certain sectors of the economy. At the same time, it has become commonplace to assert that the increase in mortality in the 1990s. occurred against the backdrop of a decline in production and, consequently, in general, a significant reduction in emissions of harmful substances into the atmosphere and the environment. But, unfortunately, many types of pollution remain dangerous for quite a long time after the cessation of emissions.

And yet the fact of reducing industrial emissions in the 1990s. suggests that the so-called environmental factor was not the main cause of the increase in mortality. In addition, the increase in mortality did not affect children and, to a lesser extent, affected the elderly. Finally, the increase in mortality in the 1990s. was associated with such causes of death, in which it is rather difficult to see the environmental component.

3. CONCLUSIONS AND CONCLUSION

The decrease in life expectancy in the USSR began in 1965. At first, both statisticians and scientists assumed that this was a temporary phenomenon and that the situation would normalize in a year or two. When it became clear that the increase in mortality is a long-term phenomenon, the publication of statistical data on the mortality of the population of the USSR and the Union republics was banned. From 1973 to 1986, only total deaths and crude mortality rates were published. However, this did not prevent Western researchers from realizing that the epidemiological situation in the USSR was deteriorating. In essence, the population of the USSR was primarily protected from information about the increase in mortality.

In modern Russian society, there is a strange belief that before 1991 everything was fine in Russia and, despite extensive statistical publications, many scientists and politicians insist that the increase in mortality is a problem of the last fifteen years. This belief greatly facilitates both the explanation of the reasons for this growth and the choice of a way to overcome it. But, as we have seen, the problem is much deeper.

We have attempted to give a systematic description of mortality trends and to summarize the scientific explanations for the Russian health crisis that are currently known. At the level of facts, it can be seen that the main increase in mortality in Russia is associated with men of working age, with groups with a low educational level. At the level of causes of death, the greatest contribution to growth was made by cardiovascular diseases at older working ages, and external and alcoholic causes of death at younger ages. Mortality is most clearly associated with hazardous alcohol consumption and psychological stress, and these two factors may be closely related.

An attempt by M.S. Gorbachev to solve the alcohol problem in 1985 with one blow, for many reasons, could not be successful. But one cannot expect a decrease in mortality in Russia without an anti-alcohol policy. It would be ideal to understand and eliminate the very cause of drunkenness. Without this, the fight against alcohol will be, as doctors say, a symptomatic treatment that is used in emergency treatment until an accurate diagnosis is established and in some cases allows prolonging the patient's life until the underlying cause of the disease is established.

The 1998 Nobel Prize laureate in economics Amartya Sen called mortality a key criterion for the success of a country's development. Mortality is a reflection of society's ability to transform available economic resources into the most important product - the health of the nation. A simple indicator of mortality can often tell more about the level and direction of a society than complex macroeconomic indicators.

Following this logic, we can conclude that the socio-economic development of Russia in the second half of the 20th century. and in the first five years of the XXI was not successful. The root of the problem is that in the Russian communist and post-communist society, human health has an extremely low priority, which is reflected in the low level of spending on health care and other social needs, and in the government's apparent unpreparedness for a reasonable anti-alcohol and anti-tobacco policy.

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On this thread a couple of years ago. Now it's time to update it and supplement it with the information that I have accumulated during this time. And meet like this:

I warn you right away that I used for it only archival and official data from the Central Statistical Bureau of the USSR and Rosstat. There are no hypotheses from liberal demographers like Andreev, Darsky and Kharkova with their fantastic numbers.

Beginning from 1913. Data from 50 European provinces of the Republic of Ingushetia were used, i.e. these are the best scores. Before us is a characteristic demographic for a pre-industrial society with a huge birth and death rate and a life expectancy of people of 31-33 years. While in Europe the typical life expectancy was around 45-50 years. You can read a little more about this.

The coming to power of the Bolsheviks revolutionized everything, including demography. All of the 1920s and 1930s are characterized by a sharp and steady decrease in the mortality rate from the pre-revolutionary 35-30 per thousand to 18-20, which, coupled with the high birth rate of the still peasant population, gives a maximum population growth of 25.7 per thousand in 1928. It is also interesting to evaluate these achievements with pre-revolutionary demographic trends, which I have shown with dotted arrows on the graph.

Stalin's forced reforms, which began in the late 1920s, obviously affected demographic processes by a sharp and prolonged decline in the birth rate in the late 1920s and the first half of the 1930s. The famine of 1933 gave a local jump in mortality with a supermortality of 915 thousand people from the previous year. Throughout the USSR, about 2.5 million people died against the backdrop of famine. For comparison, the liberal Holodomor version gives a figure of 7 million people and a death rate of 70 per thousand for the USSR. I analyze in detail the issues of discrepancy between numbers here:,

Next comes the Great Patriotic War. For 1941-1945 no data available. Direct losses from it are estimated at 16 to 27 million people. I once attempted the mortality figures for 1941-45 with all the losses. The picture came out such that the highest mortality falls on 1943 and reaches the level of 69.5 ppm. Compare this figure with the fantasies of our famine liberals with their death rate of 70 per thousand in 1933. Now ask yourself: how did it happen that in the most difficult year of the war, the total mortality was less than the mortality of the much easier, peaceful year of 1933? In 1942, everything was in the country: bombing, evacuation, fighting, hunger, disease, the blockade of Leningrad. And the overall mortality turned out to be even less than in 1933, according to the Holodomorists, when in the country, and not all, but only in some 3-4 regions, there was only famine and nothing more?

The post-war period is characterized by an increase in the birth rate and a sharp decrease in mortality. The improvement of living conditions and the widespread introduction of medical advances (antiseptics and antibiotics) are affecting. There is a jump in mortality in 1947 from another crop failure, superimposed on the post-war devastation. This year's supermortality is about 400,000 compared to the previous year.

The Khrushchev period is characterized by the continuation of the trends of the Stalinist period until the beginning of the 3rd stage of the democratic transition with its sharp decline in the birth rate as a result of urbanization. If the Stalin period can be called a period of accelerated industrialization, then the Khrushchev period can be called a period of accelerated urbanization.

Under Brezhnev, a gradual increase in mortality from 1965 to 1980 is typical. I analyze the reasons for this growth in detail here: In the 80s, this process stopped and the mortality trend from 1980 to 1990 shows a decrease. The birth rate is generally characterized by an increase with a surge from the measures of the Gorbachev anti-alcohol campaign with a decrease in the late 80s. The people smelled the smell of fried during perestroika, and the second echo of the Great Patriotic War also affected.

The rule of liberals under Yeltsin and Putin is characterized by a rapid and catastrophic deterioration in all indicators for a long period since 1992. The official demographic decline for this period is 13 million 240 thousand people, and if we count from the USSR State Statistics Committee in 1991, then the decline is 19.4 million people for 2010. The decline consists of losses from the decline in the birth rate and supermortality. The latter is estimated according to different calculation methods from 4 to 14 million people over 20 years. According to my calculations, it is equal to 8-10 million people. One of the counting methods can be viewed.

I will dwell separately on the Putin period. Since 2006, there has been an overcoming of catastrophic trends in the demography of Russia. The birth rate is growing and the death rate is falling, which over the past couple of years has led to a small natural increase in the population of 0.1 and 0.2 per thousand. I consider in detail the reasons for the rise in the birth rate.