Save the Russians!

In the seven years since Vladimir Putin came to power, Russia has sustained an utterly catastrophic toll of "excess mortality" among its population at large. Indeed, since 2000, approximately 3.9 million more Russians have died prematurely — 1 million women and nearly 3 million men — than would have if the hardly exemplary health conditions of the Gorbachev era still prevailed today. This toll amounts to more than twice the total wartime losses that the Russian Empire suffered under Nicholas II in World War I. Even more astonishing, on a per capita basis, the toll from "premature" mortality in Russia may now match — or exceed — sub-Saharan Africa’s death toll from HIV/AIDS. It’s grim proof that it is indeed possible for an urbanized, literate society to suffer long-term health declines during peacetime.

To its everlasting dishonor, Putin’s Kremlin has chosen to ignore the awful and continuing hemorrhaging of Russian life from this gaping national wound. But that doesn’t mean the rest of us should do the same.

Rallying to save millions of Russians over the coming decades would not be mere hyperbole: We know that relatively inexpensive policy interventions there could save hundreds of thousands of lives each year. Russia’s current death spiral circles principally around unnecessary and preventable mortality from heart disease and severe trauma (both closely related in Russia to severe excess drinking). Why not respond in force with, for example, preventive cardiovascular programs, alcohol education, road safety campaigns, and the establishment of emergency medical units in Russia’s urban centers?

A recent study by Johns Hopkins University indicates that intelligently crafted medical initiatives could be remarkably cost-effective in Russia: Traffic-safety measures could save lives for as little as $5 per year of life saved; cardio therapies involving aspirin and beta blockers can do the same for around $25; and the price of each death averted through urban emergency medical units with ambulances works out to less than $1,500. Such evidence suggests we could make major inroads against the current health disaster for perhaps as little as a few hundred million dollars a year.

As consequential as the purely humanitarian impact of an international campaign to save the Russians could be, important political dividends also stand to be reaped. At a time of increasing Russian isolation, such a campaign would be an important symbolic gesture to the Russian people that they have not been forgotten. Nor should we forget that the fates of demography and democracy may be more closely entwined than many appreciate. Modern history demonstrates a powerful connection between the nature of governance and the health of the governed. Limited constitutional democracies, given their principled respect for the lives of their citizens, are obliged to protect and care for the people in an entirely different manner than autocracies and dictatorships, where such efforts are always opportunistic and conditional. Treating human lives as though they matter — and catalyzing more political voice for that same sentiment within Russia — may be a first step in reviving that country’s democratic project.