In the mid-1980s, life expectancy in Russia suddenly improved and then took a drop downward for the worse in the 1990s, leading many to believe that economic transition “kills people.” But researchers at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) are studying a little-examined phenomenon in that decade when Mikhail Gorbachev — then the general secretary of the Communist Party in Russia — launched a large public health campaign against alcohol abuse, which reduced alcohol production and imposed strict measures to limit its distribution.

“There was an increase in life expectancy between 1986 and 1988, especially among males, so we wanted to see if the drop in life expectancy in the early 1990s was actually related to rising alcohol consumption after the anti-alcohol campaign was renounced and not just economic transition,” explained Christina Gathmann, a postdoctoral fellow with the Stanford Center for Longevity, who is working with CHP/PCOR core faculty members Jay Bhattacharya and Grant Miller on the project. “The idea is to look at the antialcohol campaign and establish what the effect on life expectancy really is.”

While they have just secured data for a quantitative analysis, a few things seem immediately apparent: The effect is especially strong for males — though that is true of economic transitions as well — and the Russian population exhibits lower life expectancy even compared with other countries going though economic transition in the same period.

“Many countries in Central and Eastern Europe have experienced some decline in life expectancy during economic transition. But, the decline was most pronounced in the former Soviet Union where life expectancy among males fell by almost 10 years. There is a lot of evidence that alcohol plays an important role in this development,” Gathmann said. “A lot of the drinking in Russia and other countries of the former Soviet Union is heavy binge drinking — literally drink until you drop. From talking to Russians, they basically say that it’s such a common phenomenon that on weekends, many will go out and drink vodka until they faint, and if you do that enough, there is a good chance that you’ll drown or cause a deadly car accident. There are a lot of deaths related to binge drinking.” While previous research has examined this period using time-series data to understand the underlying context for the changes in aggregate mortality, none to date has been able to examine detailed regional variation in mortality within Russia.

“Russia is split up into about 85 regions (oblasts) and republics, and we’re trying to exploit the substantial regional variation in morality,” she explained. “Regions in the former Soviet Union differ substantially in their ethnic and religious composition as well as economic opportunities. Hence, it is no surprise that there are large variations in the amount of alcohol consumed in different areas.”

The challenge then is to figure out how much the campaign affected alcohol consumption in the different regions, but aside from a few journalistic pieces and political science discussions about the campaign, it is hard to find quantitative data on how the campaign was implemented in different parts of the country.

The anti-alcohol campaign essentially started as a top-down decision from Gorbachev, made famous when he started as the president, since he was always drinking water while his other government officials had a preference for other beverages, according to Gathmann.

Gorbachev felt the need to do something about the drinking culture, especially due to the high mortality rates in Russia.

“Since we can’t open some database and find how much restrictions on alcohol consumption and distribution were enforced region by region, we have to look for some indirect measure of what’s going on,” Gathmann said. “In particular, we want to exploit regional variation in the sales of alcohol in state stores, which were the only places that could sell alcohol at specified hours.”

Yet another indirect measure is the strength of the temperance movement that was active during the campaign: in particular, how many members were involved in the effort to convince people not to drink, hold community meetings on the issue, and spread information about the health risks of alcohol through leaflets and other materials.

“You would hope that the more people that are involved in a region, the more the campaign would take foot and the stronger the decline in alcohol consumption,” she said. The researchers hope that the regional data presents a cleaner view of how the campaign may have influenced drinking behavior and hence mortality. above: A selection of posters used during Mikhail Gorbachev’s anti-alcohol campaign. Left to right: Alcohol — E nemy of Production; Prisoner. Bottle reads ‘Samogon’; Profiteer is a worst enemy; This new outfit becomes me well. Label reads ‘Juice: natural.’

“Then, we could estimate how much of the increase in mortality since the late 1980s is a legacy of the past as opposed to the burden of economic transition alone,” Gathmann said.

She continued, “More generally, we can show whether policies to restrict the supply of alcohol are effective at all. This is interesting beyond the specific Russian context. The United States and other countries like Sweden have tried prohibition but you always have the problem that people are very creative in circumventing government regulations.”

The same happened in Russia. People began to start their own distilleries, forming a black market in the production of samogon, or moonshine.

“The main ingredient necessary for homemade alcohol is sugar,” Gathmann said. “When the sugar consumption increased dramatically during that time, it’s probably not that people wanted to eat more chocolate or something like that, but to produce their own alcohol. The legal alcohol production goes down by 30 to 40 percent, but once you take into account the illegal alcohol produced, alcohol consumption might go down by much less.”

Many also began resorting to alcohol in perfumes and other products, leading to a sharp rise in cases of alcohol poisoning.

These substitutions not only weaken the effect of the campaign, as some people will drink alcohol no matter what, but may also increase the health risks.

Gathmann explained, “The danger is that people then resort to alcohol that is often very poor quality, so the danger of drinking that kind of stuff is actually much higher than drinking legal alcohol.”

However, the main problem facing Gorbachev’s anti-alcohol campaign was financial. The government received more than 10 percent of its revenues from taxes on alcohol sales. Not only was the campaign extremely unpopular but the government also suffered from the sharp decline in revenues during the campaign.

Even though the anti-alcohol policy might have well been effective in increasing life expectancy, it was not itself sustainable.