Russia’s controversial involvement in the Ukrainian crisis in the last months has been labeled by many commentators as an attempt to take the attention of the Russian public away from the mounting internal problems of the country. One of the most serious of these problems has been since the last few decades the catastrophic health situation of the Russian population. Part 1 of the following report, prepared by a group of Public Health scholars at the London School of Hygiene and Tropical Medicine, analyses the health burden resulting from tobacco consumption in the Russian Federation. Part 2 will suggest actions that need to be taken by the Russian federal government in order to address this problem.
Anna Barr, Tamara Davies, Teresa Hall, Emilia Holland, Nazla Rafeeg, Silvia Segovia Chacon, Emilie Taymor, Mateusz Zatonski
Key messages of report
- Tobacco-related diseases are among the most significant contributors to Russia’s premature mortality burden, independently doubling the mortality risk in the Russian population.
- Smoking prevalence has been rising in Russia in the last decades, leading to worsening health and economic outcomes.
Rationale for action
- Tobacco death toll
Tobacco smoking has been shown to lead to numerous adverse, and frequently fatal, health outcomes. The most important broad categories of tobacco-related medical conditions are cancer, cardiovascular disease and respiratory conditions.
Tobacco smoking is the leading preventable cause of morbidity and mortality in the Russian Federation. Smoking accounts for 30% of the crude mortality rate in men and 4% in women. Smoking-related cancer mortality constitutes as much as 52% of all cancer mortality in men and 5% in women. The number of smoking-related deaths in Russia is estimated to be in the region of 400,000 per annum. Smoking has been found to independently double mortality risk in the Russian population.
- Rise of smoking rates
The highest smoking rates in Russia are found in men. Approximately 60% of men in Russia are smokers. This rate has increased from circa 45% in the mid-1980s. The cause of this increase was the combined effect of political transition and low levels of governmental tobacco control to combat the high levels of targeting by tobacco companies.
Rates of smoking in women and children are also increasing. The smoking prevalence in Russian women has more than doubled (from 10% to 21%) over the last 15 years. This rise has been accompanied by the increasingly aggressive targeting of women by transnational tobacco companies with brands such as ‘slim’ and ‘ultra-slim’.
The prevalence of smoking in Russian boys (13-15 years) is 30% and in Russian girls (13-15 years) it is 24%.
The highest smoking rates are found in the least educated segment of the population. Almost 10% of Russian adults do not believe that smoking causes significant disease and that it is addictive. Almost a quarter of young smokers (aged 15-18) do not believe that smoking is addictive.
Over 50% of Russians are exposed to second hand smoking in public places. Additionally, almost 30% of youth are exposed to second hand smoke at home.
- Soaring costs of smoking
Russia is one of the most important markets for transnational tobacco companies. The price of cigarettes is extremely low. Less than 2% of the cigarettes smoked in Russia are imported. However, 99% of the tobacco leaf used in the manufacture of cigarettes is imported with a cost to the Russian economy of approximately one billion US dollars in 2008. Less than 2% of the manufactured cigarettes are then exported leading to a large trade deficit.
World Bank estimated in 2003 that the cost of treating conditions related to smoking in Russia was 83 billion rubles for cardiovascular disease and 42 billion rubles for respiratory diseases. These costs were far higher than the revenue from the tax on tobacco which was 20 billion rubles.
Research shows that consumers who quit smoking would relocate their spending on groceries, recreation, housing and clothing. Stronger tobacco control policies would therefore aid the Russian economy as workers would be healthier and would be spending in other sectors of the economy.
- Insufficient tobacco control measures
In 2008 Russia acceded to the World Health Organization’s Framework Convention on Tobacco Control (FCTC). In September 2010, Prime Minister Vladimir Putin signed the ‘Concept of creation of a public policy to combat tobacco consumption from 2010-2015”. This was a first step to combat tobacco use bringing Russia into alignment with the FCTC.
Since then Russia has implemented stronger tobacco control measures. In early 2013, Russia has passed a comprehensive tobacco control law, which complies with many provisions of FCTC including health warnings, and adopted stronger smoke-free air laws and advertising restrictions. However, a simulation model (Russia SimSmoke) to examine the effects of tobacco control policies on past and future smoking prevalence and premature mortality in Russia shows that much remains to be done in order to meet the FCTC requirements. Russia also needs to strengthen its current tobacco control strategy in order to tackle the tobacco industry’s influences on policy processes and law.
Some suggested reading (for full bibliography contact us directly):
Perlman F, Bobak M. Socioeconomic and behavioral determinants of mortality in post-transition Russia: a prospective population study. Annals of epidemiology. 2008 Feb;18(2):92-100
Stickley A, Carlson P. The social and economic determinants of smoking in Moscow, Russia. Scand J Public Health. 2009; 37(6):632-9.
Holmes D. Smoking in Russia:will old habits die hard? The Lancet. 2011; 378(9795): 973-4.
K Danishevski, A Gilmore and M Mckee. Public attitudes towards smoking and tobacco control policy in Russia. Tob Control. 2008; 17:276-283.