Published: October 05, 2019DOI: https://doi.org/10.1016/S0140-6736(19)32265-2
Russians are officially drinking less and, as a consequence, are living longer than ever before: life expectancies reached an historic peak in 2018—almost 68 years for men and 78 years for women—according to a WHO report examining the effects of alcohol control measures on mortality and life expectancy in Russia. The document’s release, on Oct 1, coincided with a meeting in Prague (Czech Republic) of representatives from the 53 countries of the WHO European Region, who met to consider the levels of implementation of both the global strategy to reduce the harmful use of alcohol and the European Action Plan on Alcohol (EAPA).
Russia—historically considered one of the heaviest-drinking countries in the world—now stands as an example of how a long-term strategy using stringent policy reforms targeting both alcohol production and individual consumption can reverse the devastating effects of alcohol on a nation.
In the early 1990s, data showed that one in two men of working age would die prematurely because of alcohol, with life expectancy in men reaching an absolute low of 57 years in 1994. Total adult per capita alcohol consumption increased between 1991 and 2003: this rise coincided with the dissolution of the Soviet Union, in 1991, and a total liberalisation of alcohol prices. In 1995, the government slowly introduced alcohol production control measures, including Federal Law number 171, and restrictions on licensing and advertising, with limited success.
In 2003, Russia reached its all-time high: the total adult per capita alcohol consumption was 20·4 L. This peak coincided with almost half of all deaths in working-age men, in a typical Russian city, being attributed to hazardous drinking. However, from this time onwards, substantial drops in total adult per capita alcohol consumption—specifically because of reductions in drinking of spirits and so-called unrecorded beverages such as home brews and illegal drinks—occurred as a result of the staggered implementation of expanding government alcohol policies. Marketing restrictions, monitoring alcohol production, a ban on internet alcohol sales, and a 50% tax increase on ethyl alcohol were among several actions undertaken between 2004 and 2007.
Since 2011, Russia has taken an active role in implementing the recommendations of the EAPA to reduce the harmful use of alcohol by further increasing excise taxes, raising the minimum unit price of alcohol, and substantially reducing the availability of retail alcohol.
As a result of government actions, the period from 2003 to 2017 saw the prevalence of alcohol dependence in patients registered in state-run treatment services fall by 38%, the prevalence of harmful use of alcohol drop by 54%, and the prevalence of alcoholic psychosis reduce by 64%. Additionally, cardiovascular deaths, which are thought to mirror changes in per capita alcohol consumption, showed a decline of 48% in men and 52% in women during the same period. And homicides, suicides, and deaths from transport accidents—all further indirect indicators of the effects of alcohol consumption—decreased by 56% in both sexes during this time.
Success has been achieved with measures targeting price, availability, and the marketing of alcohol, operating at both the consumer and producer levels, as well as laws aiming to curb dangerous practices, such as drink-driving, and legislation promoting a healthy lifestyle. Other explanations—including stress associated with the transition from Soviet economies to capitalism, availability of food, smoking levels, and quality and provision of health and social care—have been mooted as being responsible for the fluctuations in life expectancy and mortality since 1990, says the report. Undoubtedly, these factors have to some extent contributed, but, the report concludes, it is alcohol that has played a central part in these dramatic changes.
Russians are still far from being teetotal: a pure ethanol per capita consumption of 11·7 L, reported in 2016, means consumption is still one of the highest worldwide, and efforts to reduce it further are required. Fortunately, it appears that Kremlin strategists are continuing to look at ways to build upon their achievements because in December, 2019, the minimum drinking age will be raised to 21 years. Russia’s sustained efforts to tackle high levels of alcohol consumption per capita over the past 30 years are to be welcomed and offer much for the countries in the WHO European region (and elsewhere) to learn from.