This paper provides evidence from cross-regional comparisons that the Russian mortality crisis (mortality rate increased from 1.0% to 1.6% in 1989-94 and stayed at a level of 1.4¬1.6% thereafter) was caused mostly by stress factors as:
and by the increase in unnatural deaths as:
but not so much by the increase in alcohol consumption (even though it also increased due to the same stress factors). Health infrastructure of a region had a positive impact on life expectancy only in regions with high income inequalities (large share of highest income group).
All indicators are taken from Goskomstat (Regiony Rossii), unless otherwise specified. Goskomstat database contains data on 89 regions, but not all data for each region are available. The increment indicators are for the period under investigation - 1990-2003. The method is to run cross-regional regressions to see, if this could shed light on the major causes of the increase in mortality.
To reiterate, Russian mortality crisis of the 1990s was caused by the shock-therapy type marketization of the economy that led to mass reallocation of labor in the course of industrial restructuring and to the dramatic rise of stress factors.
Deterioration of the health care facilities had only a modest impact on life expectancy and only in regions with low share of rich population and non-equitable political orientation. Hence, it is exactly the role of stress factors in mortality rise that makes the Russian case unique.