Alcohol and Russian mortality: a continuing crisis David A. Leon 1 , Vladimir M. Shkolnikov 2 & Martin McKee 1 London School of Hygiene & Tropical Medicine, London, UK 1 and Max Planck Institute for Demographic Research, Rostock, Germany 2 ABSTRACT Background Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007, male life expectancy at birth was 61 years, while for females it was 74 years. Alcohol is implicated particularly in deaths among working-age men. Aims To review the current state of knowledge about the contribution of alcohol to the continuing very high mortality seen among Russian adults Results Conservative estimates attribute 31–43% of deaths among working-age men to alcohol. This latter estimate would imply a minimum of 170 000 excess deaths due to hazardous alcohol consumption in Russia per year. Men drink appreciably more than women in Russia. Hazardous drinking is most prevalent among people with low levels of education and those who are economically disadvantaged, partly because some of the available sources of ethanol are very cheap and easy to obtain.The best estimates available suggest that per capita consumption among adults is 15–18 litres of pure ethanol per year. However, reliable estimation of the total volume of alcohol consumed per capita in Russia is very difficult because of the diversity of sources of ethanol that are available, for many of which data do not exist.These include both illegal spirits, as well as legal non-beverage alcohols (such as medicinal tinctures). In 2006 regulations were introduced aimed at reducing the production and sale of non-beverage alcohols that are commonly drunk. These appear to have been only partially successful. Conclusion- There is convincing evidence that alcohol plays an important role in explaining high mortality in Russia, in par- ticular among working age men. However, there remain important uncertainties about the precise scale of the problem and about the health effects of the distinctive pattern of alcohol consumption that is prevalent in Russia today. While there is a need for further research, enough is known to justify the development of a comprehensive inter-sectoral alcohol control strategy. The recent fall in life expectancy in Russia should give a renewed urgency to attempts to move the policy agenda forward. Keywords Cardiovascular disease, mortality, public health, Russia. Correspondence to: David Leon, London School of Hygiene & Tropical Medicine, London, UK. E-mail: david.leon@lshtm.ac.uk Submitted 20 October 2008; initial review completed 17 December 2008; final version accepted 3 March 2009. INTRODUCTION Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007 male life expectancy at birth was 61 years, while for females it was 74 years. For males this is lower than life expectancy in 1970, and below that in many much poorer countries such as Bang- ladesh. Both the low level and the massive fluctuations of longevity across time since the mid-1980s are unique. The scale of these fluctuations is unprecedented in peacetime in any country with complete death registra- tion. Despite this, the full scale of the crisis is poorly appreciated or understood by the global public health and alcohol research community. This paper aims to summarize current knowledge and argues that far greater attention needs to be paid to this crisis. This is both because it is one of the most serious public health challenges facing any industrialized country, and also because it generates new insights of more general relevance. After an extended period of stagnation during the Brezhnev years (1964–1982), life expectancy in Russia rose sharply in 1985 with the implementation of an anti- alcohol campaign by Gorbachev [1–3]. However these gains were short-lived, and with the collapse of the Soviet Union life expectancy at birth fell dramatically: in males declining by 6 years between 1990 and 1994 [4]. At this low point, life expectancy was 57 years for males and 70 years for females. A brief recovery ensued, only to be reversed in 1998, coinciding with a foreign exchange REVIEW doi:10.1111/j.1360-0443.2009.02655.x © 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction Addiction, 104, 1630–1636