Politics could be bad for your health

It seems those who believe the state should take responsibility for most aspects of life also tend to eschew personal responsibility for taking care of themselves. As a result, they are more likely to engage in lifestyles hazardous to their health, including drinking to excess and not exercising.

The just-published research was conducted among Russians, comparing those who longed for a to return to the old-style Soviet system with those who preferred the free-market approach to the economy.

Personal interviews with almost 9,000 Russians found significant differences in how much they looked after their own health depending on where they placed themselves on the political spectrum.

The old divisions between socialists and capitalists may have largely disappeared in modern Britain but elsewhere in Europe, particularly in the old eastern bloc countries, the political conflict between socialists and capitalists remains. These countries have experienced unprecedented upheaval since the collapse of the old Soviet systems and it is still not clear to large sections of the electorate that abandoning the old centrally-planned economies has brought any real benefits yet.

But one of the key reasons Russia and eastern European countries are currently attracting the particular interest of health researchers is that one of the most striking developments in world health today is the recent dramatic decline in life expectancy in these parts of the world.

The situation is without precedent in modern history - nowhere else has health generally worsened among industrialised nations.

Russian male life expectancy stood at 64 years in 1965, but steadily decreased to around 62 years by 1980. Male longevity improved during Gorbachev’s brief (1984-87) anti-alcohol campaign, reaching almost 65 years in 1987, and then entered a period of accelerated decline - centred around the fall of the communist regime - in which life expectancy fell to a modern low of roughly 58 years in 1994. The most recent figures for 2000 show Russian males living 59 years, on average some five years less than in 1965.

Now only 76.2 per cent of Russian men and 91.3 per cent of women currently reach the age of 50 years.

This puzzling situation occurred even though Russia, the dominant state of the former Soviet Union, was not involved in a major war and was a military superpower with a stable government, industrial economy and free medical care.

Dr William Cockerham’s research, published in the Journal of Health and Social Behaviour, concludes it is unhealthy lifestyles that appear to be the primary determinant of the decline in life expectancy in the former socialist nations. This conclusion is partly based on the observation of a particularly strong relationship between recent increased alcohol consumption in former communist countries and declining male longevity.

Health lifestyle research on Russia specifically describes an endemic, entrenched pattern of excessive alcohol consumption, heavy smoking, high-fat diets and lack of health-promoting exercise. These lifestyle practices are especially characteristic of middle-age, working class males, whose high mortality rates from heart disease, alcohol poisoning and alcohol-related accidents seem largely responsible for the overall decline in male longevity.

Although the purchasing power of the average wage fell by nearly a half in 1992-93, relative to the price of vodka it increased three times, as the Russian government ended its monopoly on vodka production, allowing unrestricted sales from sources at home and abroad, with consumer costs dropping significantly.

As a result, by 1994, Russia had the highest per capita consumption of pure alcohol in the world - 14.5 litres per annum. Given that adult males consume 90 per cent of the alcohol in Russia yet comprise only 25 per cent of the population, it is obvious that the drinking practices of this group far exceed per capita consumption and reflect a tremendous concentration of drinking.

Cynics have even suggested that, in view of the country’s economic woes, low alcohol costs were a conscious attempt by the Yeltsin government to anaesthetise social discontent by making alcohol affordable by those in even the poorest social strata. But such centrally-planned economic strategy could perhaps have wider implications beyond mere short-term political ends - perhaps decades of such manipulation of the people has left a long-standing psychological imprint that influences an individual’s health choices.

Psychologists identify a common person-type found in Russia and known as homo soveticus - defined as a person with a collectivist orientation who does not like to assume any individual responsibilities.

If a socialist heritage negating individual health promotion is operative in Russian society as some suggest, it would be predicted that those in favour of returning to socialism would be especially passive with respect to healthy lifestyles.

The theory is that Soviet-style socialism eventually induces passivity toward health promotion in the population. After all, previously the state provided for personal needs and the individual in turn gave up personal reliance and freedom. The state was a shelter as it provided free health care and education, old-age pensions, low-cost housing plus food and guaranteed employment.

However, the totalitarian nature and paternalism of such centrally-planned economies has been viewed as responsible for the development and spread of a psychology of passivity and irresponsibility. If they got sick, people knew that the government would take care of them and so this situation was not likely to feature a strong sense of personal responsibility for health.

For example, one study found that, after surgery, almost all Russian cancer patients (94 per cent) had no plans to do anything themselves to promote their health; instead, they were going to rely solely on medical professionals.

This theory, that your political orientation could influence how much responsibility you took for your health, was recently tested by Dr Cockerham and colleagues by investigating the health practices of a national sample of Russians who wished for a return to socialism as it was before Gorbachev. They were compared with a group who favoured staying with a more free-market economy.

The data was collected through personal interviews by the Russian Longitudinal Monitoring Survey, a series of nationally representative surveys of the Russian Federation consisting of almost 9,000 adults.

The results were that pro-socialists are nearly one and half times more likely to be frequent drinkers than anti-socialists. Anti-socialists are also significantly more likely to take exercise, in fact, being pro-socialist decreased your chances of exercising regularly by almost 50 per cent. Furthermore, anti-socialists were almost 25 per cent more likely to go for preventive health check-ups compared to pro-socialists.

It is clear the Soviet government promoted neither individuality nor individual initiative in health matters. If, as it is argued, this heritage has indeed fostered a lack of responsibility for individual health promotion in Russia, then those persons wishing to return to this system would seem most likely to practice a negative health lifestyle. The data from this recent research suggests that this is indeed the case, as pro-socialist respondents generally demonstrated less positive health promoting activities than anti-socialists.

This new research is important because it suggests that a vital aspect of a nation’s health status has been neglected, and previously even not measured at all, which is how prevalent the culture of personal responsibility for health is. Self-reliance would seem to be something to be encouraged rather than a passive over-reliance on the state, as those who take more responsibility for their health seem to indeed be healthier as a direct result.

Anti-socialists in Dr Cockerham’s research not only had healthier lifestyles but they also rated themselves as generally more healthy than pro-socialists.

The dilemma in politics is that some kind of safety net for those unable to look after themselves seems desirable, yet if the net becomes too extensive it may act as a disincentive for fostering individual personal responsibility for looking after one’s own health.

Solving this dilemma is an urgent requirement of modern politics because it could even determine how long we live.

Dr Raj Persaud is a consultant psychiatrist and senior lecturer at the Maudsley Hospital in south London. He is the author of the best-selling self-help manifesto for looking after your own mental health, Staying Sane: How To Make Your Mind Work For You, published by Bantam Press.