1. Mortality in the former Soviet Union

2. Is it the vodka?

3. The short answer: Yes

4. The Longer Answer:

5. Mortality Rates n Have fluctuated significantly over the last 20 years n Decreased between 1984 and 1994, then sharply increased n Have since declined to 1984 levels.

6. Life expectancy European Union Whole European Region Central & E. Europe Former Soviet Union

7. Causes of death n Alcohol directly (e.g., acute alcohol poisoning) n Alcohol indirectly: –Homicide –Suicide –Accidents –Heart disease

8. Who is dying? n Somewhat surprisingly, mortality rates for the most vulnerable portions of the population, the elderly and children, have remained stable n The deaths are occurring in 20 -45 year old men and women.

10. Of what are they dying? n Pneumonias (alcohol related) n Sudden cardiac death (alcohol related) n Infectious diseases n Alcohol related diseases (cirrhosis and alcohol poisoning) n Accidents and violence (alcohol related) n Cancer of the female breast (alcohol related).

12. CCEE =Countries of Central & Eastern Europe EU=European Union NIS = newly independent states

13. Of what are they not dying? n Neoplasms n Lung cancer deaths have actually declined, in spite of heavy tobacco use

14. Vodka n Tends to be drunk in binges n Responsible for the deaths from acute alcohol poisoning n Mortality declined as consumption decreased in the mid 1980s as a result of Gorbachev’s reforms n Even though consumption of substitutes increased (perfume).

15. It’s not just what you drink, it’s how you drink it n Conventional wisdom held that alcohol had a cardioprotective effect, regardless of the level of consumption n Data from Russia shows that binge drinking is associated with sudden cardiac death n Supported by data from Scotland “I don’t like Mondays” n Patients with no Hx of CAD likely to die on week ends or Mondays.

16. Social problems n Interact with alcohol n For example, failure of regulatory bodies n Standards not enforced for building codes, so public safety is compromised n Significant deaths from drowning and fires (e.g., sprinklers do not work) n Enforcement of drunk driving laws lessened.

17. Crime n Significantly increased n Somewhat area dependent n Accounts for deaths directly and indirectly.

18. Poverty n Surprisingly, wealthier areas more affected n I.e., “the greatest declines in life expectancy are in those regions that were the wealthiest in 1990 and have subsequently experienced the smallest declines in household income” n Why? Perhaps due to previously high wages for hard manual labour jobs; in Russia the link between income and education was less than elsewhere.

20. Health Services n Age groups affected are those with the least contact with health services n Causes of death relatively insensitive to medical care.

21. Rapid Social Change n Has affected alcohol consumption n Is the associated despair also an independent factor?