MARGARET WARNER: Moscow’s parks on weekends are filled with mothers pushing strollers, toddlers playing in sandboxes and on the slides.
The tragedy for Russia is, there aren’t enough of these young children to keep pace with the number of grownups who are dying. Funerals are outpacing births in most Russian cities, and an astonishing number of the graves hold men who died in the prime of their working lives.
Russia’s population now stands at 141 million, a drop of 12 million people, says the U.N., since the collapse of the Soviet Union 16 years ago.
KIRILL DANISHEVSKY, Chief Specialist, Open Health Institute: The mortality rates are two times higher than the birth rate, so you can call it a crisis, by all means.
MARGARET WARNER: Kirill Danishevsky, chief specialist at the private Open Health Institute, says the implications are immense: If something isn’t done, he predicts, Russia’s population could drop as low as 100 million within 20 years.
KIRILL DANISHEVSKY: A lot of the current dreams of Russia becoming superpower, super-economic — a super economy in the 21st century might not work out, because simply there will not be enough people to sustain this idea.
MARGARET WARNER: The average Russian man lives to barely 60, 15 years less than his American counterpart and 13 years less than Russian women. Cardiovascular disease is Russia’s number-one killer, just as in the U.S., but it’s three times more deadly here. The reason, it’s clear, is widespread overuse and abuse of alcohol and tobacco.
Official Russia was electrified last week when an international team of public health researchers, led by a Russian doctor, reported that drinking caused more than half of all Russian deaths in the post-Soviet years of the ’90s.
President Dmitry Medvedev reacted with alarm on Tuesday, saying, “We drink more now than in the 1990s,” and he called for a stepped-up campaign to turn that around.
Many Russians enjoy social drinking. The Karma Bar in Moscow on a Saturday night looks like any American watering hole.
But far too many Russians, especially men, end up like this.
Public health advocate Danishevsky said the problem is that both alcohol and tobacco are way too available and way too cheap, and he took us on a tour to see that.
Cheap vodka and dangerous myths
KIRILL DANISHEVSKY: So basically that's the place where I was able to get the cheapest cigarettes ever. Five rubles, that's -- that's about 15 cents.
MARGARET WARNER: So that blue box up there, that's 15 cents for a pack of cigarettes?
KIRILL DANISHEVSKY: Yes. Yes.
MARGARET WARNER: At a nearby train station, he scored some homemade vodka from an old woman. If we hadn't known what we were looking for, we would have missed it.
What did you get?
KIRILL DANISHEVSKY: It's vodka. Well, it's actually ethanol dissolved with a little bit of water. And since she didn't have change, she added a glass into the bottle, so it's 25 rubles for this bottle.
MARGARET WARNER: So that was like 80 cents?
KIRILL DANISHEVSKY: Yes, it's 80 cents. And that will get a male of an average size pretty drunk.
MARGARET WARNER: In addition to cheap prices, there are powerful social and cultural attitudes. From the novels of Tolstoy and Dostoevsky to Russian grocery store shelves today, vodka is deeply ingrained in Russian life.
KIRILL DANISHEVSKY: Russian people do not believe that alcohol is harmful to health. There are a lot of myths about alcohol being good for your health. So, for instance, if you have heart attack, it's considered a good practice to drink 100 grams of cognac. And if you headache, it's good to drink little bit of vodka.
MARGARET WARNER: In addition, Russian men are famously reluctant to seek medical attention.
TATIANA GOLIKOVA, Russian Minister of Health and Social Development (through translator): The problem is that, historically, men don't really like to look after their health and don't like going to the doctors.
MARGARET WARNER: Tatiana Golikova, Russia's minister of health, says younger Russians offer the best hope of turning these social factors around.
TATIANA GOLIKOVA (through translator): The generation that we are trying to bring up is a healthy one. It's a new generation that was born in Russia. We are working at schools, colleges. It's hard.
MARGARET WARNER: When Russians do seek medical attention, the care they find in public hospitals is too often substandard. But the hospital we were invited to see is one of the country's most advanced hospitals, the Pirogov Medical Surgical Center in Moscow.
The deputy director, Dr. Alexei Kuznetsov, acknowledges this place is a stand-out.
DR. ANDREI KUZNETSOV, National Pirogov Medical Surgical Center (through translator): We are offering the best, the most high-tech, and the most modern achievements in modern medical science. Our center is unique. There are quite a few problems still in our health care system, and not every medical center looks like ours. Russia needs more centers like this.
Attempts to boost health awareness
MARGARET WARNER: After a decade of under-funding health care, Minister Golikova said the government is going all-out to improve it.
TATIANA GOLIKOVA (through translator): In the last 10 years, we have been increasing the budget and the amount of health care financing. This is a scheme that does not bring results immediately; there is a delayed effect.
MARGARET WARNER: Public health advocates say there's one government step that would do more than any other to help: impose hefty taxes on alcohol and tobacco, as the U.S. and most other Western countries do.
The last short-lived attempt to do this by Soviet President Mikhail Gorbachev in the '80s did drive down drinking, but also his popularity.
KIRILL DANISHEVSKY: In order to deal with the demographic crisis and the health crisis in Russia, you don't need any money. All you need is political will. If we would harmonize our excise taxes with some South Asian countries or Northern African countries, we would get several years to the life expectancy.
MARGARET WARNER: And the current health minister says she doesn't expect this Russian government to try that again soon.
TATIANA GOLIKOVA (through translator): Increasing taxes for a sensitive product has to take into the account the social consequences, and such an increase must be done by stages. We are going to keep pushing that decision, but it won't happen momentarily.
MARGARET WARNER: Meanwhile, on the other end of the demographic seesaw, the government is also campaigning to encourage more births. The Moscow subway features posters like this one, advertising the joys of families. Some families with many kids received medals from President Medvedev last month.
And the government is giving baby bonuses worth $7,000 to $10,000 to families that have a second child.
But this young couple, walking in the park Saturday afternoon with their new 3-week-old baby, Maxim (ph), said financial incentives have nothing to do with their decision to start a family.
JULIA TYOMIN (through translator): Our child is very calm. He sleeps well. I'm happy with my husband and have enough of everything.
MARGARET WARNER: Russia just needs more couples like them.