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Keywords:

  • Russia;
  • gender;
  • life expectancy;
  • alcohol use

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

This paper examines the gender-related features of the health crisis in Russia which has produced the largest gender gap in life expectancy in the world. Stress and negative health lifestyles are the two most likely causes of the long-term adverse longevity pattern in Russia. However, this development cannot be clarified by a simple cause and effect explanation. This is because gender roles and gender-based normative behaviour, along with class influences, intervened to help shape outcomes. Men and women responded to the crisis along gender lines, with stress the best single explanation for a stunted longevity for females and negative health lifestyles accounting for much of the premature mortality among males.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

The decline in male life expectancy in Russia and the other former socialist states of Europe was one of the most significant and unexpected developments in world health during the latter part of the twentieth century. This calamity still continues in Russia, Ukraine, Belarus and Kazakhstan with its substantial Russian population. The epicenter of the crisis was in Russia where a huge gender gap in longevity appeared, as women outlived men 13.5 years on average as recently as 2005. The latest data available for 2009 show the gap standing at 12.1 years which is an improvement, but nevertheless extreme. Given this situation, it would be logical to rank the overall health of men in Russia as quite bad and that of the women quite good. Yet the life expectancy of neither gender can be considered positive when compared to longevity in Western Europe and to such former Soviet bloc nations as Poland, Hungary, eastern Germany and the Czech population.

The purpose of this review article is to examine the existing evidence in order to determine why this negative circumstance in Russia continued into the twenty first century during the country’s economic and social transition from state socialism to state corporate capitalism. The focus of this analysis is on gender differences in life expectancy − a topic that is under-analysed because females have not experienced early mortality at levels characteristic of males. Yet gender is a significant variable in this situation because the outcome for men and women has differed even though the health trajectories for both have been generally negative. Successive generations of men have been subject to premature death in middle age, while life expectancy for women has been mired in the low 70s for decades.

The wide gender gap in longevity is therefore due to male decline, not stagnation or small increases in the face of large female gains. Gender gaps typically result from the ‘male-female health-survival paradox’ which refers to the fact that women universally live longer than men, even though they report more sickness and worse health. This paradox has been explained in many ways, but the most influential explanation is that women really do experience more health problems − only these same problems tend to be more malignant and fatal sooner in men (Lawlor et al. 2001, Bird and Rieker 2008). The Russian situation is an extreme example of this paradox.

We know that the impact of purely biological factors on the survival advantage of women is limited to one or two years at most, including protective characteristics like estrogen for heart disease (Ram 1993, Lawlor et al. 2001, Luy 2003). Beyond this point, biology seems to reach its limits in explaining changes in longevity between men and women and gender gaps can narrow or widen through the gendered nature of risk behaviours, lifestyles, work, and social roles and relationships (Arber and Thomas 2005, Cockerham 2007, Bird and Rieker 2008). As Gorman and Read (2006: 96) point out, medical sociologists have long argued that biomedical research focusing on physiological male-female differences ‘ignores the manner in which gender as a social construct affects the physical health of men and women’.

Consequently, the focus of this paper will be on reviewing gender-specific patterns of social conditions and behaviour to explain the current gap in longevity between Russian men and women. We begin by comparing differences in life expectancy for over a century to show the unfolding of the gender gap over time and then review the health situation for men in order to better explain the circumstances of women.

The Russian gender gap in life expectancy

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

Table 1 shows life expectancy for Russian males and females, including the difference in years between the two genders, from 1896 to 2009. In 1896, the gender gap advantage for women was 2.1 years as they averaged 33.0 years of life expectancy compared to 30.9 years for men. Life expectancy is seen in Table 1 to rise consistently for both genders until 1965 at which time females averaged 72.1 years of life and males 64.0 years. The gender gap was 8.1 years. At this point, however, declining longevity for males first became evident, dropping a full year by 1970 to 63.0 years and falling further to 61.7 years by 1984. The gender gap increased to 11.3 years over this period. Although unrecognised at the time, the mid-1960s was the beginning of the long-term negative change in longevity that affected men and women differently.

Table 1. Life expectancy at birth in Russia, 1896−2009
YearFemalesMalesGender gap in years
189633.030.9 2.1
192644.839.9 5.5
193846.740.4 6.3
195869.261.9 7.3
196572.164.0 8.1
197073.463.010.4
198073.061.411.6
198473.061.711.3
198573.362.710.6
198674.364.810.6
198774.364.98.5
198874.464.89.6
198974.564.210.3
199074.363.810.3
199174.363.510.8
199273.862.011.8
199371.958.913.0
199471.257.613.6
199571.758.313.4
199672.559.812.7
199772.960.812.1
199872.861.811.0
199972.059.912.1
200072.359.013.3
200172.258.913.3
200271.958.713.2
200371.858.613.2
200472.358.913.4
200572.458.913.5
200673.260.312.9
200773.961.412.5
200874.261.912.3
200975.062.912.1

However, Table 1 shows male life expectancy actually increased from between 1984 and 1987 to an all-time high of 64.9 years, while the gender gap fell to 8.5 years. This temporary and surprising improvement appears entirely due to Mikhail Gorbachev’s 1985−1987 anti-alcohol campaign that significantly reduced vodka consumption by lowering production, raising taxes, and limiting availability in government stores and on the black market. Although some may seriously question whether this restriction in consumption could have such a powerful singular effect on male life expectancy, the evidence strongly supports it and highlights the key role of alcohol in this crisis (Leon et al. 1997, Shkolnikov and Nemstov 1997). There was virtually no other change in public health policy during this period, and once repealed in 1987 because of widespread unpopularity, the downward trend in male longevity rapidly resumed. By 1991, male life expectancy had fallen to 63.5 years and the decline accelerated through the years in which the former Soviet Union began its transition out of state socialism − reaching a modern low of 57.6 years in 1994.

With male longevity plunging, the gender gap in 1994 reached a high of 13.6 years in favour of women, even though female life expectancy had also fallen to a modern low at that time of 71.2 years. This illustrates just how negative the health situation had become for males, as the gender gap peaked at the point life expectancy for both men and women was the lowest in decades. While life expectancy for Russian women had slowly risen since 1965 from 72.1 years to 74.5 years in 1989; the stressful conditions associated with the implosion of state socialism found female longevity paralleling that of males in likewise turning downward. The decline was not as steep as that of males, but nonetheless mirrored the male experience during a time of stressful social change. According to Table 1, there was a temporary improvement for both genders during 1995−1998 with the gap shrinking to 11.0 years. In 1999, life expectancy for both again turned downward as the gender gap widened to 13.5 years in 2005. Women at this time averaged 72.4 years of life and men 58.9 years. As of 2009, the gender gap was 12.1 years as female longevity reached its highest level ever of 75.0 years and improved to 62.9 years for males.

A depiction of the fluctuations in life expectancy by gender and the continuing male disadvantage for 1965−2009 is shown in Figure 1. Does the promising recent gain for both genders shown in Figure 1 mean that the health crisis is finally over? It is too soon to tell whether or not this latest upturn marks the end, as there have been brief interludes of temporary improvement before. It may be that the population is not living longer on average; rather, once the susceptible people in an age cohort have died, longevity figures may be temporarily boosted by the survivors until the next cohort generates another wave of premature deaths. With this recent recovery, Russian males still averaged 1.1 fewer years of life in 2009 than they did in 1965. Females show a gain of 2.9 years between 1965 and 2009, but this advance is modest. French and American women, for example, added approximately 7.0 years of life expectancy and Polish women gained 6.6 years during this same time span. What is clear is that longevity for both genders in Russia has not been positive for decades.

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Figure 1. Male and female life expectancy in Russia, 1965–2009

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Males

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

The premature male deaths are primarily due to cardiovascular diseases and, to a lesser extent, alcohol-related accidents and poisonings. The ongoing cumulative effect of these deaths has significantly lowered overall male life expectancy through the years, even though there had been declines in mortality from some cancers, and infectious, respiratory, and digestive ailments (Leon et al. 2007, Mesléet al. 2003). There is strong evidence showing infectious diseases, environmental pollution, and medically avoidable deaths due to poor clinical care make only minor contributions to the rise in male deaths (Hertzman 1995, Shkolnikov et al. 1998, Cockerham 1999, Andreev et al. 2003). Consequently, the increased mortality rests solidly on cardiovascular and alcohol-related afflictions.

Although Soviet medicine had been relatively effective in dealing with communicable diseases, this was not the case with heart disease that requires individualised, long-term, and more expensive treatment regimens. As Field (2000) determined, the Soviet healthcare delivery system was not flexible enough to move effectively beyond the mass measures successful in combating infectious diseases to handling large-scale chronic health problems. Post-Soviet health policies and privatisation trends in healthcare delivery systems have yet to significantly alter the mortality pattern, although there have been efforts for individuals to take greater responsibility for their own health (Rivkin-Fish 2005). Soviet and subsequent health policy was undoubtedly a contributory factor for failing to prevent or reverse the increase in heart disease, but is not the cause of it.

In addition to gender, we know that age and class are highly relevant variables in that the rise in male mortality was most prevalent among middle-age, working-class men in manual occupations with lower levels of education, not older males age 60 and above as would be normally predicted or better-educated men working in tertiary sectors of the economy such as commerce, service, clerical, managerial, and professional positions (Abbott 2002, Andreev et al. 2009, Carlson and Hoffmann 2011). This latter and much smaller group was hardly affected; therefore, any search for social causes needs to focus on the stress and health lifestyles common to male blue-collar workers in mid-life (Carlson and Hoffmann 2011, Cockerham 1999, 2007).

Stress

The stress explanation has a logical appeal since stress has a well established connection with cardiovascular afflictions, as well as an important role in the promotion of alcohol use and smoking. It has been suggested that limitations on personal freedom and a repressive psychosocial environment under state socialism constrained innovation and life satisfaction (Bobak et al. 1998, Palosuo 2000, 2003). Stress at the societal level was intensified by the rise in unemployment and poverty, collapse of price controls for food and rent, reduced purchasing power and novel conditions of uncertainty in the immediate post-Soviet period (Shkolnikov et al. 1998). As Leon and Shkolnikov (1998) observed, the collapse of state socialism and the social, political, and economic change that followed created enormous stress for the population, especially workers who were officially favoured by Soviet political philosophy. Unfortunately, there is a lack of evidence documenting a direct relationship between stress and health outcomes in Russia at this time. Stress research was not sponsored by the Soviet state since it was not compatible with the official image of socialism and has been slow to develop during the post-Soviet period.

However, among the few existing relevant studies, males consistently show much lower levels of stress and depression than females (Bobak et al. 1998, Palosuo 2000, 2003, Pikhart et al. 2004, Cockerham et al. 2006b). The finding that Russian men are exceedingly less distressed than their female counterparts tends to undermine assertions that stress is the major cause of the curtailed male life span. We know, of course, that men tend to underreport stress in comparison to women. However, Cockerham et al. (2006a) found that men do acknowledge symptoms of psychological distress in the post-Soviet countries still experiencing the health crisis, just not as much as the women. Thus they are not averse to reporting stress symptoms, but either have less or what they have is mitigated by heavy drinking. Cockerham et al. (2006a) argue that the high level of alcohol consumption is a normative pattern of socialising for many Russian men that blunts stress. Additionally, studies that try to advance the stress explanation by focusing on the transition period when stress was endemic, usually overlook the fact that the health crisis for men began far earlier in the mid-1960s during a more stable period.

Health lifestyles

Health lifestyles are collective patterns of health-related behaviour based on choices from options available to people according to their life chances (Cockerham 2005). The term ‘life chances’ was introduced by Weber (1978/1922) to represent the chances or probabilities a person has in life to satisfy his or her wants or needs. Although people choose their lifestyle practices, their choices are either empowered or constrained by their chances in life and likely to be consistent with their capability to realise them. A person’s life chances are invariably shaped by the social structures (e.g. class, gender) in their lives that provide the norms for socially acceptable behaviour through socialisation and experience.

There is a critical reaction to the lifestyle explanation for the Russian health crisis that views it as a Western concept so closely linked with liberal economic assumptions about voluntary consumer behaviour that it cannot apply to the Russian context. Another possible criticism is that the lifestyle explanation is dwarfed by the phenomenon it seeks to explain and therefore the utility of the concept for depicting the origins of such a massive health crisis is questionable. Lifestyles, themselves, are collective patterns of ways of living associated not only with individuals, but with large-scale social entities, especially social classes and even nations, that reflect representative cultural practices. Traditions become norms and norms underlie lifestyle choices. A familiarity with current health lifestyle literature thus shows a focus on structural determinants, not voluntary consumer behaviour (Cockerham 2005, 2007). Furthermore, in the absence of any other model accounting for repetitive forms of living expressing group/class-based differences in behaviours, tastes, styles of living, and outlooks, the lifestyle model explains this social phenomenon best. At least this is the case according to Weber (1978/1922), Bourdieu (1984) and Giddens (1991). As Giddens (1991) points out, everyone has a lifestyle.

Under state socialism, life choices and chances were aligned with a dominant political ideology that officially de-emphasised the value of the individual in favour of the state and its goals (Kharkhordin 1999). The state assumed overall responsibility for healthcare and the belief was prevalent that a person’s health depended on the healthcare system, not the individual (Dmitrieva 2005). If people became sick, they expected the government to take care of them at no cost as a benefit of state socialism. There is evidence that this situation promoted a passive orientation toward taking care of one’s health that was reinforced by a lack of public health campaigns advocating healthy lifestyle habits (Cockerham et al. 2002). After the fall of the Soviet Union, the belief that the government is primarily responsible for the individual’s health apparently still prevails among some Russians (Pietilä and Rytkönen 2008).

Negative health lifestyles remained the norm for many people. Several studies have documented this lifestyle as a deep-rooted pattern of excessive alcohol consumption and binge drinking, accompanied by heavy smoking, along with high-fat diets and an absence of health-promoting leisure-time exercise (Cockerham 1997, 1999, 2000, Carlson and Vågerö 1998, Palosuo 2000, 2003, Perlman et al. 2003, Men et al. 2005, Cockerham et al. 2006a, Davidova et al. 2009). The origin of this lifestyle is found in peasant and later working class culture that extended into society as a whole (Cockerham 2007). Prior to the 1917 Russian Revolution, when much of the population lived in rural areas, widespread binge drinking and drunkenness among male peasants took place only on special occasions, usually at weddings, street parties, fairs, and the end of harvests, as well as on days off, such as Sundays and Russian Orthodox Church holidays (Shkolnikov and Nemstov 1997). Vodka with its high alcoholic content was the standard drink. Russian men in pre-Soviet times did not drink alcohol frequently, but when they drank, they tended to drink heavily.

During the Soviet period, however, heavy consumption became common throughout the year in both urban and rural areas, as the influence of the church was repressed and upper class norms eradicated. Many peasants moved into cities to become industrial workers and brought their drinking culture with them. Drinking was not only a form of socialising, but also a means to cope with the drab conditions of factory life and the disappearance of the supportive features of villages. Carlson and Hoffman (2011) investigated changes in the occupational structure of the labour force in the former socialist countries during the hyper-development of heavy industry and the corresponding stagnation/contraction of the service sector. Rises in male mortality were correlated with changes in the occupational structure. They note that the expansion of factory employment and the inability of the social environment to assimilate the influx of new workers led to unhealthy lifestyles and self-destructive behaviour.

Moreover, in the absence of a well-established middle class and its alternative norms of moderate social drinking, the peasant/working-class style of male drinking became the dominant style of consumption (Cockerham 2007). Shkolnikov and Nemtsov (1997) describe the Russian mode of drinking as part of a northern European practice involving rapid group consumption of large doses of vodka. Participants are expected to drink as long as they are able or until the supply of alcohol is gone. Little or no social stigma is attached to male drunkenness because it is not considered abnormal (Segal 1990).

This drinking practice has evolved through socialisation and experience to become an established disposition toward drinking that is customary for a large proportion of the male population, especially those in the working class and with less education (Cockerham 1999, 2000, 2007, Tomkins et al. 2006). It is reproduced over time and in subsequent generations, while proving to be difficult to change. As Palosuo (2003: 40) explains, ‘heavy drinking was habitual in Russia long before the recent upheavals and is not necessarily particularly stress related; on the contrary, drinking has been closely connected with Russian social life, rituals and celebrations’. Former Russian President Boris Yeltsin (2000) put this situation into perspective in his memoirs when he wrote that more than stress is involved in heavy drinking because the traditional Russian lifestyle dictates that it’s impossible not to drink at birthdays, weddings, and with co-workers. It is therefore not surprising that alcohol use continues to have a major role in the male health crisis (Cockerham 2007, Leon et al. 2007, 2009, Davidova et al. 2009, McKee et al. 2001).

Furthermore, it appears that the cardio-protective features of alcohol do not operate the same way in Russian society as in the West, most likely because of the habitual binge drinking style of consumption and strong preference for vodka with its high alcoholic content (Deev et al. 1998). Another difference from the West is seen in Russian studies showing that despite high rates of cardiovascular mortality, both Russian men and women exhibit lower levels of cholesterol than Western populations (Averina et al. 2003). This research suggests that the direct effects of episodic heavy drinking are more important in Russia for premature cardiovascular mortality than high cholesterol levels developing over time and clogging arteries (Leon et al. 2009).

Heavy drinking, as noted, may suppress stress for men. That is, heavy vodka users are not stressed because they drink heavily. Drinking heavily may, in fact, promote feelings of well-being and life satisfaction as seen in a Moscow study in which many male respondents reported that alcohol makes them feel more optimistic about life (Mustonen 1997). Other research finds Russian men reporting alcohol use is beneficial for their health (Abbott et al. 2006). Therefore, as suggested, stress may primarily operate indirectly by promoting negative health lifestyle practices like regular heavy drinking and smoking instead of provoking outright death. Yeltsin (2000: 318), for example, says that he learned ‘fairly early on … that alcohol was the only means to get rid of stress’. This outcome suggests that the normative demands of the Russian male lifestyle are a powerful influence promoting heavy male drinking. It is also important to note that alcohol use may not always be a stress response, but can indicate conformity to cultural norms or hedonistic desires (Horwitz 2002). This may be why Bobak et al. (1999) found alcohol consumption to be spread rather uniformly among males and not necessarily related to material deprivation, economic or political change, or ratings of the economic situation. While economic strain may promote binge drinking (Jukkala et al. 2008), the practice nevertheless appears to be so widespread over the course of the last century that it became normative regardless of Russia’s economy.

Heavy drinkers typically smoke and this is also the case in Russia. As Abbott et al. (2006: 235) put it: drinking and smoking is ‘seen as part of the normal way of life for men − deeply imbedded in taken-for-granted everyday practices’. Even though male smoking is extensive, it has not received the same level of attention from researchers as alcohol. Nevertheless, the existing literature is clear that smoking is considerably more common among males than females (McKee et al. 1998, Davidova et al. 2009, Nazarova 2009). Only a few studies have been carried out on diet and exercise. The Russian diet has changed since the 1960s and contains one of the highest levels of fat in the world. For a time, the proportion of fat in diets showed a steady decrease for adults, but in the last decade it has increased with a rise in the cost of high protein foods causing a shift to cheaper foodstuffs for many people (Nazarova 2009). The few data available on health-promoting leisure-time exercise show it to be minimal for both Russian men and women, as many adults do not engage in any physical exercise at all (Palosuo 2000, 2003, Nazarova 2009).

Overall, negative health lifestyle practices are far more characteristic of men than women and the powerful link between such lifestyles and the major causes of male deaths − heart disease and alcohol-related accidents and poisonings − lends support to the dominant role of lifestyles in the male health crisis. Age and class join gender as important lifestyle variables, since death rates have been highest, as noted, for middle-age, working-class males than any other segment of the population (Cockerham 1999, Tomkins et al. 2006, Andreev et al. 2009). While the lifestyle explanation is not the sole reason for the health crisis which is obviously complex, the evidence for males suggests for nearly half a century it is the primary cause relative to other causes.

Females

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

Whereas negative health lifestyles are the leading explanation for poor male longevity, the stress explanation seems to apply more fully to women. Soviet women were officially emancipated from household duties, given equality in education and employment, provided with childcare facilities when they were working, and abortions and divorces were relatively easy to obtain. Soviet women were workers who relied on the state, not men, for support as mothers and pensioners (Ashwin 2000). However, this did not create a stress-free situation. In reality, women had less authority and lower pay than men and were typically relegated to lower ranked jobs, including manual labour once reserved for males (Hosking 2001). Even with paid employment, women were not free from domestic responsibilities as many were either unmarried or had husbands unaccustomed to housework. They carried a double burden of work and family, by working full-time in a job and doing virtually all the shopping, cooking, cleaning, care-taking, and other measures necessary to support their household (Abbott et al. 2006).

The end of state socialism created unusually stressful conditions and uncertainty, as women faced disproportionately higher unemployment, loss of child care and maternity benefits, less purchasing power, and greater likelihood of living in poverty as single parents or elderly pensioners (Abbott 2002, Barrett and Buckley 2009). Rhein (1998: 351) referred to the lack of jobs and the high unemployment rates of women as ‘the feminisation of poverty’ in Russia. Those women who remained employed earned about 70 per cent less than men in the transitional economy and many worked in so-called ‘female’ occupations that were part of the system of job segregation held over from the old Soviet Union (Oglobin 1999, Kazakova 2007). Women not only fared significantly worse in wages than men with the same qualifications and at the same level of employment, they also had less upward mobility and were more likely to work less desirable job shifts (Gerber 2002). The incomes of employed women did rise during the transition along with the rise in wages generally from the artificially low pay standards of the former Soviet Union (Kazakova 2007). However, as wages rose, so did the costs of goods and services.

As Rose (2009) explains, the transformation of a Soviet into a post-Soviet society imposed stresses and created opportunities. The reality of the situation was a division of the new society into an elite that prospered under the new economic conditions and a large mass with minimal financial resources, which was especially the case for women. These conditions impacted strongly on family life, with rising rates of domestic violence and some 700,000 children living in orphanages who were either abandoned by their parents or removed by the state from dysfunctional families (Johnson 2001, Darmodekhin 2003, Levy 2010). The survival of the family in the post-Soviet period often depended upon the woman’s ability to find work and take over the responsibility as breadwinner when the husband did not or could not earn enough money (Kiblitskaya 2000). In such circumstances, women generally appear to have coped better with the transition than men (Burawoy et al. 2000, Kiblitskaya 2000).

Stress

There is general agreement that the initial period of the post-Soviet transition (1992–1994) was exceptionally stressful and continued to varying degrees over time (Leon and Shkolnikov 1998, Shkolnikov et al. 1998). It is also clear that Russian women report more stress, poorer physical health, and a higher incidence of chronic diseases that limit mobility, even though they live longer than the men (Abbott and Wallace 2007). Palosuo et al. (1998) and Palosuo (2000, 2003) found women in Moscow rated stress as the second most important cause of ill health, following heredity, which Palosuo (2003: 73) viewed ‘as a subjective reaction to hard conditions’. She also observed a more negative health lifestyle among Muscovites than residents of Helsinki and suggested that stress affected health indirectly through such lifestyles, rather than ending people’s lives more directly through stress-induced ailments.

Shreyn et al. (2003) determined that economic losses for Russian women caused increased psychological distress and decreased personal coping resources. Cockerham and colleagues (2006a) found significantly more psychological distress among females than males in Russia and other post-Soviet countries. The greater distress on the part of women in the Cockerham et al. (2006a) study did not promote alcohol use but was related to cigarette smoking. Hinote et al. (2009a) also found psychological distress to be stronger among Russian women than men, but only weakly associated with frequent drinking.

Hinote et al. (2009b) examined the relationship between psychological stress and diet in eight post-Soviet republics, including Russia, and determined that not only were women more distressed than men, but distressed persons had less healthy diets. Class was also an important variable in that higher socioeconomic status (SES) men and women tended to consume healthier and better balanced diets than those below them on the social scale. Hinote et al. suggest that food insecurity itself may be a source of distress as many people shifted the composition of their diets to cheaper food products with the removal of price controls from food, increased costs, and downturns in personal income. Women in this sample generally had healthier diets than men, but once distress was entered as an intervening variable, distressed persons of both genders showed less healthy diets.

A recent qualitative study based on a small sample of respondents in Moscow by Pietilä and Rytkönen (2008) found that stress was considered an ‘outside force’ arising largely from difficulties associated with the transition. The respondents thought men should be more stressed than women because of their traditional role as breadwinners and greater responsibilities in the labour market. Many blamed stress for deteriorating levels of physical health, but had difficulty providing concrete examples about people they actually knew. The authors concluded that the term ‘stress’ was largely used as a generic explanation to make sense of the impact of the transition on their lives.

Of course, women universally report more stress and rate their health less positively in comparison to men − but live longer (Desjarlais et al. 1995, Mirowsky and Ross 2003). However, if stress is the major cause of the Russian health crisis, then males should express more of it in the existing research − given their much greater mortality from cardiovascular diseases and alcohol abuse. What the existing literature suggests is that stress interdicts the lives of women more so than men and while it does not kill them outright, it promotes a burden of poor health impairing advances in their life expectancy.

Health lifestyles

It may be that biological advantages and healthier lifestyles promote female survivability in the face of adverse living situations in the former Soviet Union, while the more negative health lifestyles of men − especially their drinking habits − accelerate their mortality. Several studies, as noted, confirm that Russian males drink and smoke significantly more than the women in their society, regardless of the marked increase in smoking among young women (Bobak et al. 1999, Palosuo 2000, McKee et al. 2001, Gilmore et al. 2004, Van Gundy et al. 2005, Perlman et al. 2007, Boylan et al. 2009). The privatisation of Russian tobacco companies and penetration of Western brands of cigarettes into the transition market economy not only stimulated female smoking, but also a rise in the already high prevalence of smoking among males (Gilmore and McKee 2004, Perlman et al. 2007).

Not only do males drink and smoke more, they usually have less healthy diets than females. However, the female advantage in diet seems significant not because it is extraordinarily good, but because the male diet is so unhealthy. Palosuo (2000), for example, found in Moscow that only 24 per cent of the women in her sample consumed a healthy diet compared to 16 per cent of the men. Another survey in Moscow found that the risk of ailments from hardly ever eating fresh fruit and vegetables was five times higher for men than women (Kislitsyna 2009). The Russian diet generally is low in the consumption of fruits and vegetables and high in intakes of saturated fat, sugar, and complex carbohydrates (Boylan et al. 2009). Not surprisingly, obesity has risen in Russia with a higher prevalence among women than men (Jahns et al. 2003). Even though Russian men tend to have less body fat than women, their reduced body mass is linked to high levels of smoking which is not a positive outcome (Boylan et al. 2009). The benefits of a well-balanced diet, moreover, are undermined by the lack of leisure-time exercise on the part of both genders (Palosuo 2000, Kislitsyna 2009).

It is clear that women have healthier lifestyle practices than men overall, but this outcome seems largely due to the overwhelmingly greater alcohol consumption and smoking on the part of men. Although class is a critical variable with alcohol use and smoking possibly a universal trait of working class males, drinking and smoking by males takes place to a lesser extent throughout the class structure (Bobak et al. 1999, McKee et al. 2001). Moreover, there is evidence that being married has a protective effect from binge drinking for women but not men (Jukkala et al. 2008), that once again calls attention to the norms inherent in different gender roles. Men traditionally fill masculine roles as the primary breadwinner outside the home, while home duties and family caretaking, as noted, fall exclusively on women even if they are employed. As Van Gundy et al. (2005) conclude, the interaction of national drinking norms in Russia with traditional gender role orientations is a decisive factor in alcohol use patterns.

Gender roles are central to determining health lifestyle practices because such practices typically reflect socially acceptable gendered behaviour. Traditionally in Russian society, it is appropriate masculine − but not feminine − behaviour to drink alcohol (Segal 1990, Van Gundy et al. 2005). Thus social norms proscribe female drinking. Women also have social roles that carry the expectation of continuing on with daily life and caring for their families despite their personal strains and hassles, which may discourage disabling behaviour like drunkenness (Cockerham et al. 2006a). Other research shows that Russian women often put the needs of their families before their own and do what is necessary to take care of them rather than impair their caretaking role (Kiblitskaya 2000, Abbott et al. 2006, Abbott and Wallace 2007).

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

There is no universal model of the transition from socialism to capitalism that is equally valid for each of the post-socialist states (Kornai 2008), nor is there such a transition model for health and mortality outcomes. The post-socialist states adapted to capitalism in various forms and most showed continued advances in life expectancy through improvements in health-related lifestyles, standards of living, and quality of healthcare. This paper focused on Russia, which remains an exception, in that longevity has yet to consistently improve even though the past few years seem promising. Russia still stands as an example of how a transition state lags behind in advancing its health profile.

Stress and negative health lifestyles are likely to be the two major causes of the long-term adverse longevity pattern in Russia, although obviously the situation does not lend itself to simple cause and effect explanations. This is because gender roles and gender-based normative behaviour, along with class influences, help shape the outcome. Stress does not appear to act directly by causing an epidemic of outright stress-induced deaths (e.g. strokes, heart attacks); rather, its greatest effect on women seems to be that of promoting psychological distress that adds heavily to the burdens of their daily lives. While some women may have turned to alcohol and cigarettes in response, the majority seem to have continued with behaviour appropriate for their gender and role as family caretakers. The health outcome has limited upward movement in life expectancy for women and provided a nudge toward higher mortality when times are especially difficult, such as during the collapse of the Soviet Union and the immediate period of transition.

For men, especially middle-aged, working-class males who have experienced the brunt of the crisis in premature mortality, stress is thought to have advanced heavy drinking and smoking. However, the difficulty in assigning stress the dominant causal role for males in the crisis is that the masculine norm of binge drinking has become a well-established lifestyle practice inherent in male bonding, socialising, and hedonism regardless of stressful circumstances. Whereas stress seems a primary factor in the health of Russian women, it is less important for men who seem to subvert it with alcohol and cigarettes.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. The Russian gender gap in life expectancy
  5. Males
  6. Females
  7. Conclusion
  8. Acknowledgements
  9. References

This paper is a revision of an earlier paper presented to the Russia and Eurasia Program participants at the Center for Strategic and International Studies, Washington, DC, March 2011. I would like to expressly thank Judyth Twigg, Director of the Eurasia Health Project, and others at the presentation for their helpful comments.

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  7. Conclusion
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