The Gorbachev Anti-Alcohol Campaign and Russia's Mortality Crisis

The effects of alcohol sale bans on children: The case of Russia

Alcohol control policies are implemented to reduce alcoholism and related harms around the globe. This work examines the effects of a policy that restricted when alcohol could be purchased on child outcomes in Russia. To identify causal impacts, I exploit variation in the timing and severity of the restriction, which was implemented in Russian states between 2005 and 2010. Utilizing household survey data and a difference-in-differences estimation approach, I find that the policy has improved children's physical health, with younger children being more affected, and additionally has decreased a variety of risky behavior indicators. Potential mechanisms for these effects include alcohol consumption, parental employment, household income, family stability, and time use. This work demonstrates that policies controlling parental substance access can have important effects on child health.

Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania

BACKGROUND AND AIMS

The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population-level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population-level alcohol control policies on cirrhosis mortality rates in Lithuania - a high-income European Union country with high levels of alcohol consumption.

METHODS

Age-standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time-series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.

RESULTS

There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02-3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50-2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.

CONCLUSIONS

Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost-effective and aid in reducing the burden of liver disease.

God is in the rain: The impact of rainfall-induced early social distancing on COVID-19 outbreaks

We measure the benefit to society created by preventing COVID-19 deaths through a marginal increase in early social distancing. We exploit county-level rainfall on the last weekend before statewide lockdown in the early phase of the pandemic. After controlling for historical rainfall, temperature, and state fixed-effects, current rainfall is a plausibly exogenous instrument for social distancing. A one percent decrease in the population leaving home on the weekend before lockdown creates an average of 132 dollars of benefit per county resident within 2 weeks. The impacts of earlier distancing compound over time and mainly arise from lowering the risk of a major outbreak, yielding large but unevenly distributed social benefit.

Mortality in Russia Since the Fall of the Soviet Union

Adult mortality increased enormously in Russia and other countries of the former Soviet Union when the Soviet system collapsed 30 years ago. What has happened to mortality in Russia since the fall of the Soviet Union? What explains the wide swings of mortality over time? This paper documents changes in mortality in Russia since 1989, and reviews the research in the economics and public health literature on the causes of the changes. The focus is on the post-2000 period, and the possible role played in recent declining mortality rates by Russia's alcohol and tobacco control policies. The two themes that emerge are (1) that government policies are critical for understanding both rising and falling male mortality over this period, and (2) that the underlying causes of the mortality crisis and its reversal are difficult to clearly identify empirically and remain, at best, partially understood, leaving much scope for future research on this issue.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1057/s41294-021-00169-w.

Public Health, Democracy, and Transition: Global Evidence and Post-Communism

Democracy is generally associated with governmental accountability, better public policy choices and public health. However, there is limited evidence about how political regime transition impacts public health. We use two samples of the states around the world to trace the impact of regime transition on public health: the first sample comprises 29 post-communist states, along with 20 consolidated democracies, for the period of 1970-2014; the second sample is a subsample of the same 29 post-communist states but only for the period of transition, 1990-2014. We find that the post-communist states experienced some decline in life expectancy in the first few years of transition (1990-1995). Yet, with a steady increase in the measure of democracy from 1995 onwards, life expectancy significantly improved and infant mortality decreased. Therefore, in the long run, democratization has had a positive impact on both the life expectancy and infant mortality of citizens of the post-communist states.

The effect of alcohol sales restrictions on alcohol poisoning mortality: Evidence from Russia

This paper examines the tough anti-alcohol legislation recently introduced in Russia, which due to regional variation allows it to be used as a natural experiment. The effect of the restricted trading hours on alcoholic poisoning mortality is estimated. To establish a causal link, difference-in-differences and synthetic controls are used. The main conclusion is that the sales restrictions lead to higher alcohol poisoning mortality, which implies that more toxic alcohol surrogates serve as substitutes for commercially available alcohol.

Impact of alcohol on mortality in Eastern Europe: Trends and policy responses

Within the global context, Eastern Europe has been repeatedly identified as the area with the highest levels of alcohol-related health harms. Although the Berlin Wall fell in 1989, and the Soviet Union collapsed soon afterwards, alcohol-related mortality in Eastern Europe remains far higher than in Western Europe. However, despite the high burden of alcohol harm and mortality in Eastern Europe, with the partial exception of Russia, relatively little is known about the country-specific impact of alcohol on health and mortality and the various policy responses to it. In response to this, an international symposium was held in Vilnius, Lithuania in June 2017 entitled Persisting burden of alcohol in Central and Eastern Europe: recent evidence and measurement issues. This special section of Drug and Alcohol Review is based on a selection of the papers presented at this symposium, providing for the first time a broad overview of the problem of alcohol-related mortality in a diverse range of Eastern European countries linked to a description and analysis of alcohol control initiatives that have been developed. While there is strong evidence of the influence of history, culture and education across European countries having a profound and persistent effect on differences in drinking patterns and preferences, there is, nevertheless, evidence that effective policy responses have been mounted in a range of countries.

Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects

Issues.

The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign’s policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign’s end, the region faces diverse challenges in relation to alcohol.

Approach.

The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments.

Key Findings.

Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three ‘best buys’ put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries.

Implications.

In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions.

Conclusion.

Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.

The changing relation between alcohol and life expectancy in Russia in 1965–2017

Introduction and Aims

Design and Methods

Results

Discussion and Conclusions

Historical Persistence of Alcohol-Induced Mortality in the Russian Federations: Legacy of Early Industrialization

AIMS

The study aims to investigate insofar regional differences in alcohol-induced mortality in Russia, which emerged during the early industrialization of the country, persisted over a prolonged period of time (from late nineteenth to early twenty-first century), surviving fundamental political and social changes Russia experienced.

METHODS

Multivariate regression models with historical and contemporary data on alcohol-induced mortality in Russian regions were estimated to document the persistence of spatial patterns of mortality, as well as to identify the possible mediating variables. Numerous robustness checks were used to corroborate the results.

RESULTS

Alcohol-induced male mortality in Russian regions in 1880s-1890s is significantly and strongly correlated with male mortality due to accidental alcohol poisoning in Russian regions in 2010-2012. For female mortality, no robust correlation was established. The results for male mortality do not change if one controls for a variety of other determinants of alcohol-induced mortality and are not driven by outlier regions. Consumption of strong alcohol (in particular vodka) appears to be the mediator variable explaining this persistence.

CONCLUSIONS

Hazardous drinking behavioral patterns, once they emerge and crystalize during the periods of fragmentation of the traditional society and the early onsets of modernization and urbanization, can be extremely persistent. Even highly intrusive policy interventions at a later stage (like those of the Soviet government) may turn out to be insufficient to change the path-dependent outcomes.

Emigration and alcohol consumption among migrant household members staying behind: Evidence from Kyrgyzstan

Despite the growth of alcohol consumption and international migration in many developing countries, the links between the two remain underexplored. We study the relationship between emigration of household members, receiving remittances (migrant monetary transfers), and alcohol consumption of migrant household members staying behind in Kyrgyzstan, a poor post-socialist country that has recently witnessed both large-scale emigration and a rise in alcohol-related health problems. Using a large longitudinal survey, we find that, among the ethnic majority (Kyrgyz), an increase in migrant remittances is associated with a higher likelihood and frequency of consuming alcohol, as well as an increase in the consumption of beer. Among ethnic Russians, the emigration of family members who do not send remittances back home is associated with an increased likelihood and frequency of alcohol consumption. We discuss possible mechanisms through which emigration and remittances may affect the alcohol consumption of those staying behind, including the relaxation of budget constraints and psychological distress. Overall, our findings suggest that the emigration of household members contribute to a greater alcohol consumption among those staying behind, and highlight the role of remittances and cultural background in understanding the nuances in this relationship.

Political regimes, income and health: Evidence from sub-national comparative method

This paper investigates the effect of political regimes on healthcare outcomes with a novel approach. Instead of focusing on cross-country comparisons, like most studies do, we utilize the within-country variation of political regimes across individual regions. We use the case of the Russian Federation, where large sub-national differences exist in both health outcomes and political regimes in different provinces. General differences in sub-national politics in Russia have been subject of investigation of a large literature our paper adds to. The paper shows that the effect of political regimes on health is heterogeneous and depends on the type of health problems more salient for the region. More pluralist and competitive regimes are able to produce better results than the less competitive ones in rich regions, while in poor regions political pluralism and competition have an adverse impact on health.

Alcohol-attributed disease burden and alcohol policies in the BRICS-countries during the years 1990-2013

BACKGROUND

We aimed to assess alcohol consumption and alcohol-attributed disease burden by DALYs (disability adjusted life years) in the BRICS countries (Brazil, Russia, India, China and South Africa) between 1990 and 2013, and explore to what extent these countries have implemented evidence-based alcohol policies during the same time period.

METHODS

A comparative risk assessment approach and literature review, within a setting of the BRICS countries. Participants were the total populations (males and females combined) of each country. Levels of alcohol consumption, age-standardized alcohol-attributable DALYs per 100 000 and alcohol policy documents were measured.

RESULTS

The alcohol-attributed disease burden mirrors level of consumption in Brazil, Russia and India, to some extent in China, but not in South Africa. Between the years 1990-2013 DALYs per 100 000 decreased in Brazil (from 2124 to 1902), China (from 1719 to 1250) and South Africa (from 2926 to 2662). An increase was observed in Russia (from 4015 to 4719) and India (from 1574 to 1722). Policies were implemented in all of the BRICS countries and the most common were tax increases, drink-driving measures and restrictions on advertisement.

CONCLUSIONS

There was an overall decrease in alcohol-related DALYs in Brazil, China and South Africa, while an overall increase was observed in Russia and India. Most notably is the change in DALYs in Russia, where a distinct increase from 1990-2005 was followed by a steady decrease from 2005-2013. Even if assessment of causality cannot be done, policy changes were generally followed by changes in alcohol-attributed disease burden. This highlights the importance of more detailed research on this topic.

Protecting energy intakes against income shocks

Whether and how changes in economic circumstances or household income affect individuals' diet and nutritional intakes is of substantial interest for policy purposes. This paper exploits a period of substantial income volatility in Russia to examine the extent to which, as well as how individuals protect their energy intakes in the face of unanticipated shocks to household income. Using rich data from the Russia Longitudinal Monitoring Survey, our results suggest that households use substitution, disproportionally cutting back spending on non-foods to protect spending on foods, change the composition of the consumption basket, and increase the consumption of 'cheaper' calories. Taken together, however, we find that total energy intakes as well as the nutritional composition of the diet are almost fully protected against income shocks. Specifically, we find that 12-16% of the effect of permanent income shocks on food expenditures is transmitted to energy intakes, with 84-88% protected through insurance mechanisms.

Evidence for the effectiveness of minimum pricing of alcohol: a systematic review and assessment using the Bradford Hill criteria for causality

OBJECTIVES

To assess the evidence for price-based alcohol policy interventions to determine whether minimum unit pricing (MUP) is likely to be effective.

DESIGN

Systematic review and assessment of studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, against the Bradford Hill criteria for causality. Three electronic databases were searched from inception to February 2017. Additional articles were found through hand searching and grey literature searches.

CRITERIA FOR SELECTING STUDIES

We included any study design that reported on the effect of price-based interventions on alcohol consumption or alcohol-related morbidity, mortality and wider harms. Studies reporting on the effects of taxation or affordability and studies that only investigated price elasticity of demand were beyond the scope of this review. Studies with any conflict of interest were excluded. All studies were appraised for methodological quality.

RESULTS

Of 517 studies assessed, 33 studies were included: 26 peer-reviewed research studies and seven from the grey literature. All nine of the Bradford Hill criteria were met, although different types of study satisfied different criteria. For example, modelling studies complied with the consistency and specificity criteria, time series analyses demonstrated the temporality and experiment criteria, and the analogy criterion was fulfilled by comparing the findings with the wider literature on taxation and affordability.

CONCLUSIONS

Overall, the Bradford Hill criteria for causality were satisfied. There was very little evidence that minimum alcohol prices are not associated with consumption or subsequent harms. However the overall quality of the evidence was variable, a large proportion of the evidence base has been produced by a small number of research teams, and the quantitative uncertainty in many estimates or forecasts is often poorly communicated outside the academic literature. Nonetheless, price-based alcohol policy interventions such as MUP are likely to reduce alcohol consumption, alcohol-related morbidity and mortality.

Persistent threats to validity in single-group interrupted time series analysis with a cross over design

RATIONALE, AIMS AND OBJECTIVES

The basic single-group interrupted time series analysis (ITSA) design has been shown to be susceptible to the most common threat to validity-history-the possibility that some other event caused the observed effect in the time series. A single-group ITSA with a crossover design (in which the intervention is introduced and withdrawn 1 or more times) should be more robust. In this paper, we describe and empirically assess the susceptibility of this design to bias from history.

METHOD

Time series data from 2 natural experiments (the effect of multiple repeals and reinstatements of Louisiana's motorcycle helmet law on motorcycle fatalities and the association between the implementation and withdrawal of Gorbachev's antialcohol campaign with Russia's mortality crisis) are used to illustrate that history remains a threat to ITSA validity, even in a crossover design.

RESULTS

Both empirical examples reveal that the single-group ITSA with a crossover design may be biased because of history. In the case of motorcycle fatalities, helmet laws appeared effective in reducing mortality (while repealing the law increased mortality), but when a control group was added, it was shown that this trend was similar in both groups. In the case of Gorbachev's antialcohol campaign, only when contrasting the results against those of a control group was the withdrawal of the campaign found to be the more likely culprit in explaining the Russian mortality crisis than the collapse of the Soviet Union.

CONCLUSIONS

Even with a robust crossover design, single-group ITSA models remain susceptible to bias from history. Therefore, a comparable control group design should be included, whenever possible.

The Devil Is in the Details! On Regulating Cannabis Use in Canada Based on Public Health Criteria Comment on "Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts"

This commentary to the editorial of Hajizadeh argues that the economic, social and health consequences of legalizing cannabis in Canada will depend in large part on the exact stipulations (mainly from the federal government) and on the implementation, regulation and practice of the legalization act (on provincial and municipal levels). A strict regulatory framework is necessary to minimize the health burden attributable to cannabis use. This includes prominently control of production and sale of the legal cannabis including control of price and content with ban of marketing and advertisement. Regulation of medical marijuana should be part of such a framework as well.

Policy implications of marked reversals of population life expectancy caused by substance use

BACKGROUND

Life expectancy has been increasing steadily over the past century in most countries, with only a few exceptions such as during wartimes.

DISCUSSION

Marked reversal of life expectancy has been linked to substance use and related policies. Three such examples are discussed herein, namely the double reversal of life expectancy trends (first to positive, then to negative) associated with reducing alcohol supply in the then Union of Soviet Socialist Republics (USSR), followed by a rapid increase in availability; the impact of the rapid increase of prescription opioids on white non-Hispanics in the US; and the systemic impact of the violence accompanying the drug war in Mexico on the life expectancy of men. Alcohol policies were crucial to initiate the positive reversal in the USSR, and different substance use policies could have avoided the negative impacts on life expectancy of the described large groups or nations. Substance use policies can be responsible for abrupt negative changes in life expectancies. An orientation of such policies towards the goals of public health and societal well-being can help avoid such changes.

Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study

BACKGROUND

In the UK and USA, various jurisdictions have launched new approaches for managing alcohol-involved offenders that might have public health implications. These programmes require participants to abstain from alcohol and submit to frequent alcohol testing with swift, certain, and modest sanctions for violations, with the aim to reduce crime and keep alcohol-involved offenders in the community. In this study we examine whether the 24/7 Sobriety programme in South Dakota, USA-the largest such programme to date-is associated with reductions in mortality.

METHODS

With a differences-in-differences design, we used variation in the timing of 24/7 Sobriety implementation across South Dakota counties between 2005 and 2011 to estimate the association between programme introduction and county-level mortality. We used monthly, county-level, aggregate counts for mortality from January, 2000, to June, 2011. We assessed total deaths, and deaths due to external injuries, circulatory disorders, digestive disorders, and cancer (as a potential placebo).

FINDINGS

Between January, 2005, and June, 2011, 16 932 people (about 3% of the adult population) participated in the 24/7 Sobriety programme. The analysis was based on a sample size of 9 108 county-month observations (ie, 66 counties × 12 months × 11·5 years). Implementation of 24/7 Sobriety was associated with a 4·2% (95% CI 1·5-6·9) reduction in all-cause adult mortality, with the largest associations among women (8·0%, 95% CI 3·9-11·8) and individuals older than 40 years (4·3%, 95% CI 1·4-7·0). Associations were most evident among circulatory disorders.

INTERPRETATION

24/7 Sobriety might have public health benefits, which could extend beyond individuals directly enrolled in the programme. However, further research, including randomised controlled trials and analyses of individual-level data, is needed to corroborate the finding, reassess the size of these associations, and gain insight into causal mechanisms. Should a negative association be replicated, it might represent a substantial advance in our understanding of how criminal justice interventions could help shape public health.

FUNDING

National Institute on Alcohol Abuse and Alcoholism, US National Institutes of Health.

Russia-specific relative risks and their effects on the estimated alcohol-attributable burden of disease

Background

Alcohol consumption is a major risk factor for the burden of disease globally. This burden is estimated using Relative Risk (RR) functions for alcohol from meta-analyses that use data from all countries; however, for Russia and surrounding countries, country-specific risk data may need to be used. The objective of this paper is to compare the estimated burden of alcohol consumption calculated using Russia-specific alcohol RRs with the estimated burden of alcohol consumption calculated using alcohol RRs from meta-analyses.

Methods

Data for 2012 on drinking indicators were calculated based on the Global Information System on Alcohol and Health. Data for 2012 on mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years (DALYs) lost by cause were obtained by country from the World Health Organization. Alcohol Population-Attributable Fractions (PAFs) were calculated based on a risk modelling methodology from Russia. These PAFs were compared to PAFs calculated using methods applied for all other countries. The 95 % Uncertainty Intervals (UIs) for the alcohol PAFs were calculated using a Monte Carlo-like method.

Results

Using Russia-specific alcohol RR functions, in Russia in 2012 alcohol caused an estimated 231,900 deaths (95 % UI: 185,600 to 278,200) (70,800 deaths among women and 161,100 deaths among men) and 13,295,000 DALYs lost (95 % UI: 11,242,000 to 15,348,000) (3,670,000 DALYs lost among women and 9,625,000 DALYs lost among men) among people 0 to 64 years of age. This compares to an estimated 165,600 deaths (95 % UI: 97,200 to 228,100) (29,700 deaths among women and 135,900 deaths among men) and 10,623,000 DALYs lost (95 % UI: 7,265,000 to 13,754,000) (1,783,000 DALYs lost among women and 8,840,000 DALYs lost among men) among people 0 to 64 years of age caused by alcohol when non-Russia-specific alcohol RRs were used.

Conclusions

Results indicate that if the Russia-specific RRs are used when estimating the health burden attributable to alcohol consumption in Russia, then the total estimated burden will be more than if RRs from meta-analyses are used. Furthermore, additional research is needed to understand which aspects of the Russian style of drinking cause the most harm.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1818-y) contains supplementary material, which is available to authorized users.

How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.

Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

BACKGROUND

Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP.

METHODS

Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002-2005) included 16 812 men and 19 180 women aged 45-69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences.

RESULTS

Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators.

CONCLUSIONS

The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU.

The Gorbachev Anti-Alcohol Campaign and Russia's Mortality Crisis

Political and economic transition is often blamed for Russia's 40% surge in deaths between 1990 and 1994. Highlighting that increases in mortality occurred primarily among alcohol-related causes and among working-age men (the heaviest drinkers), this paper investigates an alternative explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. Using archival sources to build a new oblast-year data set spanning 1978-2000, we find a variety of evidence suggesting that the campaign's end explains a large share of the mortality crisis - implying that Russia's transition to capitalism and democracy was not as lethal as commonly suggested.