Tag Archives: mortality

Shall we drink? Vodka, rational utility maximisers and the 1990s Russian mortality crisis

Covid has prompted a revisiting of the debate on the human (mortality/morbidity) costs of the 1990s in Russia. Scott Gehlbach reflects in a blog on how Covid pushed down hospital admissions in the US. From there he recalls the argument that economic collapse increases mortality – the most significant natural experiment being the transition in ex-communist countries in Eastern Europe. Gehlbach rejects this argument – perhaps the strongest proponent of which is Stuckler et al. in a 2009 Lancet article:

Clearly, rapid mass privatisation was not the only determinant of the mortality changes in countries in central and eastern Europe and those in the former Soviet Union; however, these results provide a major explanation of the ultimate determinants of cross-national differences, both within the former Soviet Union, and between countries formerly in the Soviet Union and other central and eastern European countries. Our findings also accord with a substantial body of research on mortality in the post-communist period, which has provided evidence for the effects of several factors, including acute psychosocial stress, reduced access to and decreasing quality of medical care (much provided at workplaces), impoverishment, rapid pace of transition, increased unemployment, rising social inequalities, social disorganisation, heightened corruption, and the erosion of social capital. Although a direct cause and effect relation cannot be ascertained and a detailed discussion of their roles is beyond the scope of this Article, all these findings can be linked, in some way, to mass privatisation programmes.

Gehlbach objects to these conclusions, saying that, roughly: long-term negative trends mean that any correlation with mass privatisation is weak, that mass privatization did not increase unemployment, and that in reality the mortality spike was due to the greater availability of alcohol and its reduction in price after 1991. I tweeted my misgivings about Gehlbach’s keenness to deflect from the impact of economic dispossession on the Russian population last week. I got some interesting replies.

Erica Richardson (who commented at the time of publication on the Lancet article) wrote to me: “It’s both [privatization, unemployment and vodka prices] – the proximal and distal causes are synergistic. It’s not just the price of course, this is just one indicator, alcohol policy is much broader than this – but don’t underestimate how harmful heavy drinking is for population health.” Of course she’s right. She links to a very comprehensive social harm study of alcohol in Russia from 2019 by the WHO. Alcohol policy is shown to have a very strong impact on mortality in Russia since 1990. Taxation and reducing availability were most important.

In an indication of how rashly tweeting one’s immediate reaction can nonetheless bring unforeseen rewards, I then received a link to an article by Michael Haynes from 2013 called “Social Inequality and the Continuing Russian Mortality Crisis”. Haynes argues that social epidemiologists can make a strong link between inequality and death in Russia, but that these should be traced back to significant problems before the transition in the 1990s. Material and psychological stresses result in ‘causation flows’, as do health behaviours – but all of them have social roots in advanced societies. To cut a long story short we should be asking why there is a prior problem in drinking that shows up so strongly in a social pattern. I can’t do full justice to Haynes’ argument, but he makes interesting points about pre-existing social divisions in Soviet society – that there was considerable inequality there and that transition intensified divisions. Further, restructuring ‘disrupted the social base of the economy’. What I like here is that Haynes challenges both the idea that the ‘USSR was unhealthily collectivist’ leading to psycho-social stress in adaptation, and he rejects the idea that Soviet society was full of atomized individuals. There were sources of social resilience and solidarity but these were quickly undercut in the early 1990s so that extremely negative socio-psychological effects (not of ‘culture’, but of transition) reinforced themselves overtime.  

In my own work, I’ve explored ‘socially harmful’ (itself a relative concept) drinking at length. Certainly, I situate propensities among men to engage in harmful drinking in the diminution of men’s social role, which became more and more accented – particularly for working-class men – as the 1990s went on. Nonetheless I find social scientists explanation of drinking as ‘escape response’ a bit too close to the rational choice theory of Gehlbach, where lower vodka prices supposedly maximized the utility for self-destruction. I use a more anthropological lens, and consider how drinking mediates social trauma, articulates social suffering and, ironically, becomes incorporated into a meaning of self (which is both defiant and morally recuperating).

This is how I ended the chapter on traumatic dispossession in my 2016 book: “Nearly 30 years ago Mary Douglas noted the inherent normative bias in attempting to label alcohol use as ‘problem drinking’ in other cultures. At the same time, drinking … continues to be culturally marked ‘as a rite of corporate identification’ (ibid: 6), with drinking, work, blue-collar identity, and sociality at the nexus of working-class masculinity. Others have noted the social pressure among working-class men towards drinking as an expression of ‘thriftlessness’ and a display of the ‘equality of interests’ among the marginalized (Mars 1987: 100). Chrzan notes that drinking sees linear time give way to ‘anti-time’—a focus on the event, the moment, ‘authenticity’ of self and social life (2013: 96). While this is perhaps a rather rosy view of hard drinking bouts in the Russian context, it does point to drinking as some form of dealing with contingency nonetheless. Bouts of hard drinking are not so much a badge of honour, as in some working-class communities (Mars 1987), but something almost tangible to hold onto given labour’s subaltern positioning. Drinking is not so much ‘compensation’, as conventionality; Lyova’s everyday way of enduring the present, his way of saying ‘it’s enough’. As inseparable from a sense of class, gender and sociality, drinking is also part of propertizing the self; it belongs to Lyova as part of his habitus, and forms part of his making of the traumatic present habitable.”