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Wednesday, April 25, 2007

Russia's Broken Heart

Writing in the Moscow Times, Dr. Harald M. Lipman, the former senior medical adviser to Britain's Foreign and Commonwealth Office, who served as the regional medical adviser to the British Embassy in Moscow in 1983-1985 and 1987-1991, tells the tale of Russia's broken heart:

Heart disease and related circulatory illnesses like strokes are arguably the single largest threat to Russia's economic well-being and political future that the country will have to face in the 21st century. Fortunately, they are also problems that can, with appropriate measures, be controlled most easily. Cardiovascular disease is not a new problem. Deaths from heart disease in the Soviet Union doubled from 1965 to 1989.

Russia's population is declining at a rate of 700,000 people per year, and it fell by 6 million during the 10 years leading up to 2003. If present trends continue, it is estimated that the total population will have fallen by a further 40 million, to about 100 million by 2050.

Life expectancy for Russian men is currently 58 years, compared with 77 years in Britain and 74 years in France and Germany. Over half of all early deaths are caused by heart and circulatory illness, with 1.25 million Russian men below retirement age dying from heart disease every year.

Some of the factors that increase the risk and likelihood of developing heart and circulatory disease, such as genetic predisposition, severe stress and infections cannot be modified significantly. The good news is that many of the risk factors are related to lifestyle and potentially modifiable. These include diet, obesity and level of physical activity. Eating too much animal fat and dairy products, for example, raises blood-cholesterol levels and the likelihood of blockage of blood vessels. Too much salt increases the risk of developing high blood pressure, which is associated with increased risk of heart disease and stroke. Smoking constricts blood vessels and reduces blood supply to the heart and brain, while diabetes also increases risks. All of these factors can be modified. The excessive consumption of alcohol, and binge drinking in particular, has a direct toxic effect on heart muscle and is a major cause of sudden deaths in Russian men.

Ongoing studies in the United States over the last 60 years and in Finland since 1970 have shown convincingly that the modification of lifestyle risk factors significantly reduces illness and death due to heart and circulatory disease. Similar small-scale trials in Karelia, Chelayabinsk, Yekaterinburg Tver and other regions have confirmed these findings.

Early deaths often cause devastating family and social problems, contributing to increased individual stress, depression and alcoholism. By further fueling the problem, this is creating more widows, destabilizing families and reducing their incomes. It is a never-ending spiral.

At the national level the economy is already experiencing serious losses as a result of early deaths and illness -- at a rate of about $11 billion per year, or 1 percent of total gross domestic product. According to the World Bank, in the absence of successful measures to remedy the situation, this could rise to an annual loss of as much as $66 billion, or 5 percent of total GDP.

There will be increasing medical costs and worker absenteeism along with reductions in productivity, tax revenues, savings and healthy men to serve in the military. At a more general level, there will also be a greater risk of political instability.

President Vladimir Putin has publicly discussed the problem of Russia's declining population on numerous occasions and has initiated and financed measures to combat it. These have largely concentrated on increasing family size, improving standards of healthcare and reducing the imbalance between immigration and emigration. These measures are essential, but unless the numbers of men who die early can be significantly reduced, the population will continue to fall.

A team of British experts in medicine, public health and medical education will be launching a project in London on Wednesday titled "Reducing Early Mortality in the Russian Federation" with the aim of helping Russia combat this problem.

A holistic project has been devised to give postgraduate training to Russian polyclinic doctors and other healthcare workers in recognizing the causes of heart and circulatory disease, as well as diagnosing and treating it. Simultaneously, intensive long-term public education programs will be undertaken at the local level involving all levels of society -- families, schools, educational institutions, factories and workplaces -- with the objective of educating people about cardiovascular illnesses and their causes, prevention and treatment. This will be combined with the preventative use by those at risk of developing heart disease of small daily doses of aspirin to thin the blood and of a medication known as statins to reduce blood-cholesterol levels.

For this program to be implemented and succeed it will have to receive authorization from the federal and regional governments and be planned and implemented in conjunction with Russian cardiologists, preventive medicine specialists and medical educators. Our initial experiences lead us to believe that this initiative will be welcomed by the Russian authorities.

We are proposing to begin with a three-year pilot project in a region yet to be determined, with the objective of demonstrating the benefits of the program on the ground and modifying it where necessary. Subsequently, similar programs will be initiated in other regions, ultimately stretching to cover the entire country.

Funding for the pilot scheme will probably come largely from non-Russian sources, but due to the vast scope of the project and the need to continue it indefinitely, subsequent funding will have to come from Russian sources -- federal and regional governments, the corporate sector and individuals.

The benefits will be felt at the personal level as fathers, sons, brothers and uncles live longer and healthier lives, and at the national level in the form of a markedly improved economy. A 20 percent reduction in deaths from heart disease by 2025 will increase male life expectancy by six years and restore the anticipated 5 percent annual loss in GDP.

Changing long-established life styles will not be easy. But evidence from other projects show that it is not only possible, but can be highly successful. Many other healthcare problems will continue to exist, with those to combat infectious diseases, cancer and trauma to name just a few. But if this single project can save the lives of 250,000 men per year and improve the quality of life for many, many more, it must be implemented. For the sake of Russia's future and the future of its people such a program has to succeed.

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