1. Mortality Crisis in Russia Revisited: Evidence from Cross-Regional Comparison Vladimir Popov, CEMI, Russian Academy of Sciences
Мор без  СПИДа и цунами. - "Эксперт", №19 (608), 12 мая 2008г.  - Mortality Crisis in Russia Revisited: Evidence from Cross-Regional  Comparison. - MPRA Paper No , March 2010; CEFIR and NES working paper #  157, January 2011.
Russia’s Mortality Crisis. WILL WE EVER LEARN? PONARS Eurasia Policy Memo No. 127, October 2010.
- Mortality in Transition: Study Protocol of PrivMort Project, a Multilevel Convenience Cohort Study. - Irdam et al. BMC Public Health, (2016) 16:672, (co-authored with 15 authors).

3. Life expectancy at birth in Russia and in the US in 1966-2013, total (years)

4. Life expectancy in transition economies in 2000 was 5 years higher than per capita GDP suggested
 LE2000 = logYcap + 5.1TRANS
(-2.8) (25.3) (4.9)
(N=147, R2 = 0.72, robust estimates, T-statistics in brackets)
LE – life expectancy in 2000, years
Ycap- PPP GDP per capita in 1999,
TRANS – dummy, equal to 1 if a country was communist in the past,

6. Mortality rate (per 1000, left scale) and average life expectancy (years, right scale)

7. Mortality and life expectancy in Russia since 1913

8. Nearly 80% of the increase in deaths in is due to mortality rise from cardio vascular diseases and external death causes

10. Totals may differ slightly from the sum of components due to rounding.
Table. Number of deaths from external causes per 100,000 inhabitants in 2002 – countries with highest rates
*Deaths due to unidentified external causes, wars, police operations, executions.
Totals may differ slightly from the sum of components due to rounding.
Source: WHO (

11. Fig Death rate from external causes (per 100,000 of inhabitants) - Russian Empire, RSFSR, RF, (log scale) Source: Demoscope, № August 27- Sept. 9, all external causes, accidents, 3- suicides, 4- murders, unknown, 6 – work related accidents.

12. Optimistic view – extremely fast recovery of the institutions Socialist heritage of strong state institutions cannot be ruined that easily

13. Post-communist mortality crisis - only a few analogues in history
One is the transition from Paleolithic to Neolithic age about 7000 to 3000 B.C., when the life expectancy fell by several years (Galor and Moav, 2004) – possibly due to the change in diet and lifestyle (transition from hunting and gathering to horticulture and husbandry).
Another comparable case – the increase in mortality during the Enclosure policy and Industrial Revolution in Britain, which is even better documented (– from the 16th to the 18th century life expectancy fell by about 10 years – from about 40 to slightly over 30 years (Wrigley and Schofield, 1981) due to changes in the lifestyle, increase in income inequalities and impoverishment of the masses.
Other cases of the reduction of life expectancy due to social changes – without wars, epidemics and natural disasters (say, for the black population of the American South after the abolition of slavery in 1865) – are very few and do not involve a fall of life expectancy by 6 years for the whole population of a large country (Cornia, 2004).

14. Mortality Rates and Life Expectancy (at birth) in the course of early urbanization: England

15. Mortality during recessions
During the Great Depression in the US life expectancy rose from 57.1 in 1929 to 63.3 years in 1932; the increase occurred for both men and women, and for whites and non-whites; mortality rates from all causes of death, except for suicides, fell (Granados, Roux, 2009).
Recent research on the link between mortality rates and economic conditions has identified a procyclical relationship. Ruhm (2000) who uses state-level data for the U.S. and a fixed-effect model and shows that a decrease in the unemployment rate leads to a sustained increase in the mortality rate.
Except for suicides and deaths from cancer, this procyclicality between unemployment and mortality rate is robust for ten other causes of mortality, especially for motor-vehicle accidents and heart diseases. Gerdtham, Ruhm, (2006) find similar evidence for the OECD countries.

16. Unemployment and mortality
Other researchers, however, found negative impact of recessions on mortality in developing countries and even in developed countries for particular groups of the population.
Reichmuth and Sarferaz (2008) show that young adults in the France, Japan and the US exhibit increased mortality in a recession, whereas most of the other age classes between childhood and old age react with lower mortality to increased unemployment or decreased GDP growth.
Using individual data records from Dutch registers of birth, marriage, and death certificates, covering the period , Van den Berg, Lindeboom, López (2006) demonstrate that recessions have the adverse impact on mortality, although not immediately, but later in life. Being born in a recession increases the mortality rate later in life for most of the population and especially for lower social classes.
Based on social security data for the US, Sullivan and von Wachter (2009) estimate that the increased mortality rate due to unemployment persists up to 20 years after the job loss and leads to an average loss of life expectancy from 1 to 1.5 years (see Figure).

17. Source: Sullivan and von Wachter (2009) cited in IMF, ILO (2010).

18. Mortality during recessions in developing countries
There is also evidence that in developing countries, unlike in developed countries, recessions have a strong adverse effect on social indicators, including life expectancy and infant mortality.
Conceição and Kim (2009) find that life expectancy for the sample of over 200 countries falls by over 4 years on average during growth decelerations episodes (defined roughly as 3 and more years of falling output) as compared to the periods of rapid growth, whereas infant mortality and under 5 years of age mortality nearly doubles – see table.

23. Countries with available 2009 mortality rate statistics (Oct. 6, 2010)

25. Suicides, murders, crime
During the Great Depression, the suicide rate increased about 20 percent, from 14 to 17 per 100,000 people. The Asian economic crisis in 1997 led to an estimated 10,400 additional suicides in Japan, Hong Kong and Korea, with suicides spiking more than 40 percent among some demographic groups.
The unemployed commit suicide at a rate two or three times the national average, researchers estimate. And in many cases, the longer the spell of unemployment, the higher the likelihood of suicide.
The suicide prevention hotlines also show signs of stress. In Jan. 2007, as the recession started, there were 13,423 calls to the National Suicide Prevention Lifeline, a nationwide toll-free hotline. A year later, there were 39,467. In Aug. 2009, the call volume peaked at 57,625. Last year, the government granted the group an extra $1 million to increase programs in places with high unemployment rates

33. Theories, explaining mortality crisis:
Third big mortality crisis in human history
Transition from Paleolithic to Neolithic Age
Enclosure policy in Britain (pre- industrialization)
Transition to market and democracy
Stress (The Mortality Crisis in Transitional Economies. Edited by Giovanni Andrea Cornia and Renato Paniccià. WIDER Studies in Development Economics, OUP, 2000).
Increase in
Unemployment
labor turnover
Migration
Divorces
Income inequalities
Increase in alcohol consumption + smoking
Fall in living standards (change in the diet)
Increase in mortality due to external causes of death (crime, suicides, accidents)
Deterioration in health care
Environment

34. Why stress kills? Japanese in California
Elder in their youth environment
40-50 year old men – crashed ambitions, life failure
Income inequalities in the US states are correlated with mortality
Women handle stress better than men

35. Literature review: stress versus alcohol
Daniel Treisman. Death and Prices: The Political Economy of Russia’s Alcohol Crisis (Economics of Transition, Vol. 18, Issue 2, pp , April 2010 ) Why have ever more Russians been drinking themselves to death? Some attribute this to despair in the face of painful economic change. I present evidence that, in fact, the surge in alcohol-related deaths – and premature deaths in general – was fuelled by a dramatic fall in the real price of vodka, which dropped 77 percent between December 1990 and December Variation in vodka prices – both over time and across Russia’s regions – closely matches variation in mortality. Although market competition and weak excise collection help explain the fall in prices, the main reason appears to be populist price regulation during inflationary periods.

36. Literature review: stress versus alcohol
Bhattacharya, Gathmann, Miller.The Gorbachev Anti-Alcohol Campaign and Russia’s Mortality Crisis, American Economic Journal: Applied Economics 2013, 5(2): 232–260
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 dataset 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.

41. Privatization and Life Expectancy
Source:
Lawrence King, David Stuckler and Patrick Hamm (2009) “Rapid Large-Scale Privatization and Death Rates in Ex-Communist Countries: an analysis of stress-related and health system mechanisms.” International Journal of Health Services. Volume 39 (3):  
Reference?

42. Privatization and Life Expectancy
Most of the burden falls on working age men
Reference?
Source:
Lawrence King, David Stuckler and Patrick Hamm (2009) “Rapid Large-Scale Privatization and Death Rates in Ex-Communist Countries: an analysis of stress-related and health system mechanisms.” International Journal of Health Services. Volume 39 (3):  

44. Literature review
Cross national evidence points at the crucial role of mass privatisation in the former USSR
See e.g.: Lawrence King, David Stuckler and Patrick Hamm (2009) “Rapid Large-Scale Privatization and Death Rates in Ex-Communist Countries: an analysis of stress-related and health system mechanisms.” International Journal of Health Services. Volume 39 (3):  
Replication studies find contrary evidence
See e.g. Earle, J. and S. Gehlbach “Correspondence on Stuckler, King and McKee’s ‘’Mass Privatization and the Post-Communist Mortality Crisis: A Cross-National Analysis’’’. The Lancet 375(9712):
the estimated correlation of privatization and mortality in country-level data is not robust to recomputing the mass-privatization measure, to assuming a short lag for economic policies to affect mortality, and to controlling for country-specific mortality trends. Further, in an analysis of the determinants of mortality in Russian regions, we find no evidence that privatization increased mortality during the early 1990s. Finally, we reanalyze the relationship between privatization and unemployment in postcommunist countries, showing that there is little support for the proposed mechanism by which privatization might have increased mortality.

45. Micro-level data is necessary for identifying channels of causality and distribution of impacts: Irina DENISOVA. Mortality in Russia: Microanalysis CEFIR Working Paper No 128, 2009
Twelve rounds of the Russian Longitudinal Monitoring Survey spanning the period of 14 years ( )
1,245 adult persons (5% of the adults in the sample) died, with 546 deaths in the age groups (3% of the adults of the age group).
importance of relative status measured in non-income terms
income-measured relative position is confirmed to be statistically insignificant
labor market behavior, and sectoral and occupational mobility in particular, on longevity.
smoking is found to be comparable to the role of excess alcohol consumption which is novel in the Russian context where the influence of smoking is downplayed in comparison to the alcoholism.
no micro evidence in support to the regional data result underlying Treisman (2008) political economy story.
Log of the lowest vodka price in the locality and relative price of vodka to bread in locality are NOT significant.

46. Economic indices (investment and income)
Popov, V. (2010). Mortality Crisis in Russia Revisited: Evidence from Cross-Regional Comparison. - MPRA Paper No , March 2010.
Over 80% of the regional variations in changes in life expectancy in are explained by:
Objective conditions (climate, urbanization, regional dummies for the Far East and Moscow)
Institutional capacity of the regional governments (share of employment at small enterprises, crime rate and murder rate)
Economic indices (investment and income)
Stress factors (labor turnover, migration, divorces, income inequalities, crime)
Health care system developments
Even without alcohol consumption indicators

47. Sales of alcohol, liters of pure alcohol per capita (left scale), death rates per 100,000 from alcohol poisoning, murders and suicides (right scale)

49. Alcohol consumption. (Nemtsov, 2002) attributes as much as 1/3 of total deaths in Russia to alcohol related causes (including indirect), which is much higher than official estimates (less than 4% deaths from causes directly related to alcohol consumption), a view widely held by Western experts. “Despite the improving situation, one-third of all deaths in Russia are directly or indirectly related to alcohol, requiring intervention at a variety of levels” (Pridemore, 2008). These are the highest available estimates that many experts question.
Official statistics reports that only 3% of all deaths are caused by alcohol (alcohol poisoning, liver cirrhosis, alcoholism, and alcoholic psychosis). Anatoly Vishnevsky (personal communications) attributes about 12% of all deaths to alcohol-related causes.

52. Increase in the consumption of alcohol is also driven by stress factors
VODKAincr = – 0.65VODKA POPdens UNEMPL03 +
(3.88) (-5.74) (2.90) (1.97)
+0.001MIGRgrINCR INEQincr LABmob POVERTYincr
(2.48) (1.66) (6.40) (1.69)
(N=75, R2 = 0.49, robust standard errors, t-statistics in brackets all coefficients significant at 10% level or less)

53. Not alcohol?
First, there is a controversy what is the impact of increase in the intake of alcohol on cardiovascular diseases. A recent study by Spanish researchers (Arriola et al., 2009) – 10 year survey of people aged 29-69, found that, compared with male non-drinkers, those that drank before but later quit drinking have 10% less chance of having heart problems, those that drink small amount (less than 0.5 gram everyday) have 35% less chance, those drinking moderately (5-30 gram everyday) has 54% less chance, and big drinkers (30-90 gram a day) and alcoholics (more than 90 gram a day) have 50% less chance of having heart problems.

54. Not alcohol?
Second, there are some periods, when per capita alcohol consumption and death rate were moving in opposite directions – in deaths rates from external causes, including murders, suicides, poisoning, were falling against the background of rising alcohol consumption. Similar inconsistencies exist for the period of the 1960s: from 1960 to 1970 alcohol consumption increased from 4.6 to 8.5 liters per capita according to official statistics (and from 9.8 to 12 liters according to alternative estimates), whereas life expectancy did not change much – 69 years in 1960, 70 in 1965, 69 in 1970.

55. Not alcohol?
And third, the levels of per capita alcohol consumption, according to official statistics and alternative estimates, in the 1990s were equal or lower than in the early 1980s, whereas death rate from external causes doubled and total death rate increased by half (compare figs. 1 and 4). It appears, therefore, that we observe a simultaneous increase in variables (total death rate and death rate from external causes, as well as alcohol consumption) that are all driven by another factor, which is very likely stress.

56. Доля водки в продажах алкогольной продукции падает

57. Mortality is related to vodka sales, but not necessarily caused by vodka consumption

58. Number of doctors matters only if the share of the rich is high or communists are in power

59. Pro-communist regions

60. Predicted (with and without stress) and actual changes in life expectancy in Russia's regions in , years

61. Privatization study 2011-16: Hypotheses
Privatization  UE  Stress Mortality
Privatization  Loss of firm provided medical care  Mortality
Privatization  Loss of firm provided social consumption  Stress  Mortality
Privatization  Firm failure  Stress  Mortality  Economic decline  Mortality
Privatization  Fiscal crisis/state failure  Stress  Mortality  Less health spending Mortality
Increased violence  Mortality
Privatization  Inequality  Status loss Mortality

62. Privatization study
By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary.
Mono-industrial towns were defined as where a single industrial enterprise provided employment for at least 7.5 % of the total population in 1991, while the second large industrial enterprise employed less than 2.5 % of the total population. The Russian towns were selected from those with 5,000–100,000 inhabitants in the European part of the country, excluding those that were within 50 km to Moscow and St. Petersburg (N = 539)
The Belorussian towns were selected from those with 5,000–100,000 inhabitants, excluding those within 50 km from Minsk (N = 96).
The Hungarian towns were selected from those with 5,000–100,000 inhabitants that were not located in Pest county (N = 110).
In Russia 10 mono-industrial towns with fast privatization were matched with 10 mono-industrial towns with slow privatization, (fast privatized towns are towns, where 90 or more per cent of state shares were privatized within two consecutive years, and slow privatized towns are towns in which less than 50 % of state shares were privatized within two consecutive years.)
After that, a matching control group of four multi-industrial towns with fast privatisation and one multi-industrial town with slow privatization were selected.
In Hungary 52 towns were selected at random from amongst the industrial towns (N = 83) in the original list of 110 towns. We chose this strategy mainly to address the far greater diversity of privatisation strategies applied in Hungary.
There are 11 mono-towns in Belarus in total, so all of them were included into the dataset. After that, 9 multislow towns in Belarus were matched to the 15 mono-fast towns selected in Russia

63. Privatization study- Larry King et al. – mono industrial towns
Model specification: Poisson regression, offset variable (time of exposure) is specified as a number of years a person lived in the exposure period ( ). Censured observations (i.e. those who died after 1998, or haven’t died yet) got a value of 8.
Dependent variable: 1-dead between 1992 and 1998, 0-still alive or died after this period
Independent variables: individual-level characteristics (age in 1992, education, drinking frequency, smoking, marital status, financial deprivation), and second-level characteristic: privatization speed x country.
Interpretation of independent variables coefficients: These are the estimated Poisson regression coefficients for the model. The dependent variable is a count variable, and Poisson regression models the log of the expected count as a function of the predictor variables. We can interpret the Poisson regression coefficient as follows: for a one unit change in the predictor variable, the difference in the logs of expected counts is expected to change by the respective regression coefficient, given the other predictor variables in the model are held constant.

64. Fast/slow privatization

65. Education, drinking, marital status, financial deprivation

66. Women
Similar results, only drinking and smoking is less significant

69. Pavel Grigoriev, Evgeny M. Andreev
Pavel Grigoriev, Evgeny M. Andreev. The Huge Reduction in Adult Male Mortality in Belarus and Russia: Is It Attributable to Anti-Alcohol Measures? PLOS ONE,September 16, 2015
To what extent the recent declines in adult mortality in Belarus and Russia are attributable to the anti-alcohol measures introduced in these two countries in the 2000s.
Cause-specific mortality series for the period 1980–2013, male population, only a limited number of causes of death which we label as being alcohol-related: accidental poisoning by alcohol, liver cirrhosis, ischemic heart diseases, stroke, transportation accidents, and other external causes.
Conclusion: The continuous reduction in adult male mortality seen in Belarus and Russia cannot be fully explained by the anti-alcohol policies implemented in these countries, although these policies likely contributed to the large mortality reductions observed in Belarus and Russia in 2005–2006 and in Belarus in 2012.
Antialcohol measures implemented in Belarus and Russia simply coincided with fluctuations in alcohol-related mortality which originated in the past. If these trends had not been underway already, these huge mortality effects would not have occurred.

71. Mortality is related to vodka sales, but not necessarily caused by vodka consumption

72. Conclusions
In the early 1980s vodka sales were over 200 mln dekalitres, but it did not lead to a sharp rise in mortality.
The stagnation and decline in life expectancy in , as well as the increase in alcohol consumption at that time, was caused by the loss of economic and social dynamism.
The decline in life expectancy in was caused by the stress of transition to the market.