The group that has been hardest hit has been adult males of working age. In the period 1994–1995, which witnessed the largest mortality increases, cardiovascular disease and external causes and injuries were responsible for over 65% of the fall in life expectancy, and it is believed that alcohol (heavy consumption, binge drinking) played a decisive role in both these cases (16,17,18,33).

The role of alcohol and specifically the tradition of drinking vodka as a way for men to cope with stress could also help explain the very wide differential between female and male mortality. Women, in contrast to men, have assumed the role of providers of stability, strength and continuity (10,16). This does not mean that women were not affected by the crisis; they also experienced declining life expectancy, albeit to a much smaller degree.

The government of the Russian Federation clearly recognizes the urgency

of the health and demographic crises. The Minister of Health Y. L. Shevchenko

for instance, referred to the public health system as a significant factor in

“national security” of the nation. President Putin, in a speech to the State

Duma on 8 July 2000, stated that a persistence of recent demographic trends

would endanger the survival of the nation (5).