vodka, the elixir of life ….. and death cultural, economic and health aspects of alcohol use in...

Vodka, the Elixir of Life….. and Death

Cultural, economic and health aspects of alcohol use in Russia

April 27, 2010

Ellis L. Rolett, M.D.

Dartmouth Medical School

Smith & Christian, 1984


Churches, ikons, crosses, bells,Painted whores and garlic smells,

Vice and vodka every place –This is Moscow’s daily face

- Olearius, Travels, 1647

Christian, 1990


Without vodka the Russian people simply cannot live. It is their elixir of life, the living water, the universal cure.

- Y. Georg, 1858

Moscow News, №33 8/23/2007

Vodka - a cultural context (1)

“Russia's hard drinking is not a purely physiological phenomenon - it is, rather, psychological and social. Drinking to the Russians is something like Buddhism to the Indians or Confucianism to the Chinese. It is a kind of a national religion.”

- Aleksandr Zinovyev

Vodka - a cultural context (2)

“When the Russian is born, when he marries or dies, when he goes to court or is reconciled, when he makes a new acquaintance or parts from an old friend, when he negotiates a purchase or sale, realizes a profit or suffers a loss – every activity is copiously baptized with vodka….The Russian spends his entire life from cradle to grave, bathing and swimming in this drunken sea.”

– speaker at the All-Russian Congress on the Struggle against Alcoholism, 1914

Transchel, 2006

Negotiating a sale

Ukraine, 2008

Russia

Garrett, 2000; R. Room, Int J Epidemiol 2005

Alcohol - a cultural staple

Alcohol beverages were and are tightly interwoven into the fabric of Russian life.

Two Russian customs add to the problem of alcohol consumption:

a) a vodka bottle once opened, must be finished b) a shot glass of vodka must be downed in one gulp

Binge drinking is rampant. 40% of male drinkers and 11% of female drinkers consume ≥ 7 drinks on a typical drinking day.

Back in Time: Cultural History

Communal intoxication was a key social custom among ancient Slavic tribes.

Norsemen who conquered Kievan Rus in 9th C introduced a more violent drinking style.

Vodka became central to social interaction and the economy, especially among peasants.

Taverns and cheap vodka in late 19th C eroded communal control over individual drinking.

Drinking to get drunk became the norm.

Segal, 1990; Transchel, 2006

Liquor taxes (1)

Smith and Christian, 1984

Liquor taxes (2)

Smith and Christian, 1984

White, 1996; Herlihy, 2002

Early Twentieth Century History1900-1914 - 90% of alcohol consumed is vodka. Binge drinking is a common pattern

1905 - Battle of Tsushima, Russo-Japanese War“Who defeated the Russians? The Japanese did not conquer, but alcohol triumphed, alcohol, alcohol.” – German war correspondent.

1914 - Prohibition is instituted by the Czar to counter drunkenness in the military as Russia prepares for WW I. In part this contributes to the Bolshevik takeover in 1917: the loss of revenue from alcohol taxes makes it difficult for the government to feed Russian workers, and bread riots ensue.

Communist Takeover Engels argued that alcoholism resulted from economic exploitation

of workers.

Trotsky: “The very nearest future will be a period of a heroic struggle with alcohol. If we do not stamp out alcoholism, beginning with cities, then we will drink up socialism and drink up the October Revolution.”

Lenin: “Vodka and other narcotics will draw us back to capitalism, rather than forward to Communism.”

Stalin equated alcoholism with capitalism. With overthrow of capitalism, alcoholism was no longer regarded as a societal problem, rather as individual criminal behavior.

Segal, 1990; Transchel, 2006


A Change of Soviet Leadership!

1985 - General Secretary Chernenko dies of cirrhosis of the liver.

Mikhail Gorbachev takes his place.

Two months later Central Committee adopts resolution titled ‘On Measures to Overcome Drunkenness and Alcoholism’.

White, 1996

Official statistics on alcohol published after a lapse of 26 years

Younger onset of heavy drinking, average age 19.

Increase in heavy drinking among women and juveniles.

90% of women drinking regularly in 1984 => rising incidence of FAS.

Eight-fold increase in per capita alcohol consumption between 1940 and 1984.

White, 1996

Official statistics (continued)

Staggering consequences to the economy

– decreased productivity,

– decline in health of the population

– decreased military preparedness» at least half of the armed forces are heavy

drinkers or alcoholics


The Gorbachev Anti-Alcohol Campaign (1)

Nationwide anti-alcohol campaign launched in 1985.

Restrictions imposed on alcohol sales, many liquor stores are closed.

Official drinking age raised from 18 to 21. Government alcohol production is cut in half,

and prices are increased. Over 1 million private stills are destroyed.

White, 1996


“Waiting for opening time, 1988”



Compulsory treatment of alcoholics

Removal of alcohol abusers from public office and employment.

Expulsion of alcohol abusers from the Communist Party.

White, 1996; Nemtsov, 2005

The Gorbachev Anti-Alcohol Campaign: Positive Outcomes

♦Life expectancy rose 3 years for men, 1 year for women.

♦Overall mortality down 15% between 1984 and 1986.♦Accidental deaths down one-third.♦Heart disease deaths down 13%.♦Alcohol poisoning deaths down over 50%.♦Birth rate increased.♦Divorce rate decreased.♦Absenteeism and crime down 30%.

White, 1996

♦Drinkers find alternatives to alcohol: colognes, industrial spirits, etc.

♦Sugar sales skyrocket as homebrewing takes off.

The Gorbachev Campaign: Adverse Consequences

Garrett, 2000; Herlihy, 2002

The Gorbachev Campaign Ends

In October 1988, after three years, the Central Committee rescinds the reforms because of

– increased home brewing

– loss of government revenues

Alcohol in the Post-communist Transitional Economy

1991 - Boris Yeltsin is elected president of Russia

1992 - State monopoly on alcoholproduction is ended.

White, 1996

Alcohol in the Post-communist Transitional Economy (cont.)

1992 – Massive importation of foreign liquor.

1993 - Russia overtakes France as the world’s heaviest drinking nation.

– Average male consumes a bottle of vodka every 2 days

– Major adverse health and societal consequences

1994 - 50% of alcohol sales are illicit.

– 70% of alcohol sold by street traders is dangerous

Bootleg liquor sale on the street Ryan, 1995

Pravda, 11/9/2006; The Times, 4/13/2007

Magnitude of the Problem Estimated numbers of alcoholics in 2007

– 7 million men (official statistics), but may well be twice as high

– mainly men

Average per capita annual consumption of pure alcohol

– Russia: » 18 L (10 L legal, 8 L illegal) across entire population

» Equivalent to 60 bottles of spirits for every man, woman, and child

– WHO standard for dependency: 8 L

Estimates of alcohol related deaths and alcohol poisonings vary widely

White, 1996; Carlson, 2000; Leon, 2007; Denisova, 2010

Risk Factors for Alcohol Abuse

Disease of males. – Male coping strategy – Normative pattern of male socializing

Economic and social dislocation.– Lower economic strata– Unemployment– Lack of job satisfaction– Weak family structure

Less well educated Low self-esteem Geographic isolation and far northern location

Health Consequencesof binge drinking & acute intoxication

Poisonings– Illicit alcohol– Alcohol substitutes

Accidents and violence– Automobile and industrial accidents– Domestic violence– Suicide– Homicide

Cardiovascular– Arrhythmias– Acute myocardial infarction

Kristjanson, Alcohol Clin Exp Res, 31: 299, 2007

Alcohol and Pregnancy

Survey conducted 1999-2000, St. Petersburg. 88% of nonpregnant and 34% of pregnant women

had had alcohol within the preceding 30 days. 16% of nonpregnant and 2.5% of pregnant women

had “binged” at least once in the preceding 30 days. 60% reported drinking when they knew they were

pregnant. 75% of women who drank during pregnancy were

aware that alcohol consumption during pregnancy could cause birth defects.

Wine and beer were the preferred alcoholic beverages of both groups.

Rehm, Eur Addiction Research 2003

Global Distribution of Alcohol Consumption and Drinking Patterns

WHO Region Beverage Type Alcohol Consumption1

Heavy Drinkers%

Average Drinking Pattern2

Americas A(Canada, Cuba, USA)

> 50% beer, 25% spirits

9.3 11.2 2.0

Europe A(Germany, France, UK)

Wine & beer 12.9 15.7 1.3

Europe C(Russia, Ukraine)

Spirits 13.9 18.6 3.6

1Liters of pure alcohol per resident age 15 and above, annually2Range 1-4, with 4 being most detrimental

Type of Alcohol Consumed: 2000

NBER Oct 2004

Moscow Scene 2008

Alcohol Surrogates

Counterfeit Vodka Kills Russians by the ScoreMoscow, 1 Nov 2006, Reuters

“Thousands of Russians have been poisoned by counterfeit vodka laced with toxic household agents, and hundreds have died from acute liver failure.”

When Vodka is Your Poison (“Yellow Death”)By John Sweeney, March 10, 2007, BBC News, Russia

“Thousands of Russians may have been poisoned by bootleg alcohol containing a medical disinfectant (Extrasept) causing drinkers' skin to turn yellow because of acute toxic hepatitis.”

http://www.guardian.co.uk/world/2007/jun/15/russia.science

Alcohol Surrogates

United Nations Report 2008

Life expectancy among Russian males is 59 years, on a par with underdeveloped African countries.

Projected population decline is from current 142 M to 100 M by 2050.

Compared to countries with similar economic development, among working-age population mortality is 3-5 times higher for men and twice as high for women.

UN in Russia: Demographic Policy in Russia, 2008

United Nations Report 2008 (cont.)

Causes include alcoholism, smoking, industrial and automobile accidents, suicide, poor nutrition, and lack of health care.

Annual death estimates:- Alcohol 425,000- Smoking 330,000

- Industrial accidents 180,000- Traffic accidents 40,000

Alcohol-related deaths in Russia are 6 times higher for men and 5 times higher for women than in Europe.

UN in Russia: Demographic Policy in Russia, 2008

Demographics

Drunken Nation: Russia’s Depopulation BombNicholas Eberstadt, World Affairs, Spring 2009

In 2007, Russia ranked 164 of 226 nations in life expectancy. Major causes of premature mortality were cardiovascular disease (CVD) and accidental deaths.

♦ CVD mortality was almost 4 times higher than in Western Europe.

♦ Injuries and poisonings were over 5 times higher than in Western Europe.

♦ Alcohol abuse was a major contributor to both of the above, especially among younger males.

Eberstadt 2005

Dissolution of USSR

Eberstadt 2005

Male Life Expectancy

NBER Oct 2004

Eberstadt, 2005

Eberstadt, 2005Eberstadt, 2005

Eberstadt, 2005

Mortality men ages 35-39 (1980-2005)

http://demoscope.ru/weekly/2009/0363/img/l_graf03.gif

Russia

Latvia

Estonia

Hungary

Poland

Czech Republic

Ebe

rsta

dt, 2

005

D.A. Leon et al. (1997) The Lancet 350: 383

Life Expectancy: Summary

Substantial changes in alcohol consumption accounted for most of the changes in life expectancy in the Soviet Union and Russia during the 1980s and 1990s.

Summary (1)

Alcohol plays a highly symbolic role in Russian culture.

It functions as a means of social interaction, commemoration of significant events, and escape from unfulfilling existence.

Binge drinking is deeply ingrained in Russian society, especially among workers and those living in rural areas.

Summary (2)

Hazardous drinking patterns (binging, surrogates, illicit alcohol) are pervasive.

Russia is facing a demographic crisis.

It has the lowest male life expectancy in the developed world.

Alcohol abuse is a major contributor to both of the above.

New Anti-Alcohol Campaign

New Anti-Alcohol Campaign

Main features under consideration:

– Specialized life-improvement centers for alcoholics, smokers and obese persons

– Nationwide PR campaign

– Restriction of alcohol sales to youth

– Increase in price of vodka

– Crackdown on producers of illegal alcohol

Stay tuned!

Bibliography: “Vodka, the Elixir of Life…..and Death”

Brainerd, Elizabeth and David M. Cutler. Autopsy on an Empire: Understanding Mortality in Russia and the Former Soviet Union. National Bureau of Economic Research, 2004.

Carlson, Per. An Unhealthy Decade: A Sociological Study of the State of Public Health in Russia, 1990-1999. Stockholm: Almqvist & Wiksell International, 2000.

Christian, David. ‘Living Water’: Vodka and Russian Society on the Eve of Emancipation. Oxford; New York: Oxford University Press, 1990.

Cockerham, W.C. et al. “Psychological distress, gender, and health lifestyles in Belarus, Kazakhstan, Russia, and Ukraine.” Social Science & Medicine (2006) 63: 2381-2394.

DaVanzo, Julie S., and Clifford Grammich. Dire Demographics: Population Trends in the Russian Federation RAND, 2001.

Denisova, Irina. “Adult mortality in Russia.” Economics of Transition (2010) 18: 333-363.Eberstadt, Nicholas. “Drunken Nation: Russia’s Depopulation Bomb.” World Affairs (2009), Spring: 51-62.Eberstadt, Nicholas. Presentation to CSIS Global Aging Initiative, Washington, 2005.Herlihy, Patricia. The Alcoholic Empire: Vodka & Politics in Late Imperial Russia. Oxford; New York: Oxford

University Press, 2002.Jargin, Sergei. “On the causes of alcoholism in the Former Soviet Union.” Alcohol & Alcoholism (2010) 45: 104-5.Leon, David A., et al. “Huge variations in Russian mortality rates 1984-94: artifact, alcohol, or what?” Lancet

(1997) 350: 383-8.Leon, David A., et al. “Hazardous alcohol drinking and premature mortality in Russia: a population based case-

control study.” Lancet (2007) 369: 2001-9.National Research Council (U.S.). Committee on Population. Premature Death in the New Independent States.

Washington, D.C.: National Academy Press, 1997.

Bibliography (cont.) “Vodka, the Elixir of Life…..and Death”

Nemtsov, Alexander. “Russia: alcohol yesterday and today.” Addiction (2005) 100: 146-9.Philips, Laura L. Bolsheviks and the Bottle: Drink and Worker Culture in St. Petersburg, 1900-1929. DeKalb:

Northern Illinois University Press, 2000.Ryan, Michael. “Alcoholism and rising ;mortality in the Russian Federation.” BMJ (1995) 310: 646-8.Segal, B. M. The Drunken Society: Alcohol Abuse and Alcoholism in the Soviet Union. New York: Hippocrene

Books, 1990.Smith, R.E.F. and David Christian. Bread and salt. Cambridge: Cambridge University Press, 1984.Transchel, Kate. Under the Influence. Pittsburgh: University of Pittsburgh Press, 2006.White, Stephen. Russia Goes Dry: Alcohol, State, and Society. New York: Cambridge University Press, 1996.WHO Global Status Report on Alcohol 2004. The Russian Federation.

http://www.who.int/substance_abuse/publications/en/russian_federation.pdf (last viewed 23 Apr 2010)

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