WHO does not get tired of warning…
Why are men in Russia at high risk of chronic diseases?
The World Health Organization (WHO) warns that non-communicable diseases are the biggest threat to public health. And Russian men are subject to them to a much greater extent than women and the male population of Western European countries. Why? Director of the Russian State Research Center for Preventive Medicine Sergey Boytsov points to risk factors such as smoking, alcohol abuse, sedentary lifestyle and unhealthy diet. This has been talked about for many years, but the situation has not changed. Nikola Krastev talked to Professor Boytsov.
SB: In most countries of the world, and this applies not only to European, North American countries or, let's say, Westernized Asian countries, four groups of diseases, the so-called non-communicable diseases cause the absolute majority of deaths. This applies to most countries of the world. If we talk about the Russian Federation, about 75% of all deaths are associated with cardiovascular, oncological, chronic bronchopulmonary diseases and diabetes mellitus. The peculiarity of this group of diseases is also the fact that they all have a close, unified structure of risk factors that provoke their development.
These factors are largely associated with an unhealthy lifestyle, which are caused by the urbanization and industrialization of society. This is an excessive high-calorie diet with a large amount of refined carbohydrates, fatty components of food and salt. This is a decrease in physical activity, this is smoking, of course. Plus – alcohol abuse. The combination of these factors accelerates and enhances the development of secondary biological risk factors. These are arterial hypertension and elevated cholesterol levels. They, in turn, provoke the development of strokes, heart attacks, heart failure. And the same risk factors that I listed first, they provoke the development of cancer.
Smoking is a provocateur of chronic obstructive pulmonary disease. And these same risk factors provoke diabetes mellitus. This is, in fact, why chronic noncommunicable diseases are a global task, as defined by the World Health Organization in a special document called the "Global Action Plan to Combat Noncommunicable Diseases until 2020". WHO is now creating a global coordination mechanism to monitor the implementation of the plan at the country and regional levels.
NK: The report mentions about Russia that the probability of dying from non-communicable diseases among people aged 30 to 70 years is 30%. Compared to other countries, is this a high indicator or an average one?
SB: I would say that this is a high indicator. This is especially dramatic for our country – the high prevalence of risk factors and the high mortality rate among men aged 30 to 55 years. It is about twice as high as in other countries. This is one of our main goals to identify people who have these risk factors and correct them in a timely manner.
NK: The fact that the risk is twice as high for Russian men, what is the reason for this?
SB: This is mainly due to the higher prevalence of unhealthy lifestyle. As a matter of fact, the connection of lifestyle with the development of these diseases was assumed, perhaps, earlier. But the evidentiary, convincing base appeared on the border of the 50-60 years of the twentieth century. After that, significant measures were taken in many countries – first of all, it began in Europe and the USA – to control risk factors and thus influence mortality. This led quite quickly to a twofold and even more reduction in mortality.
The example of Finland is very well known, where there was a very high mortality rate, and then for literally 15 years it led to a fundamental decrease, and now Finland is at one of the lowest mortality rates.
Russia, or rather the Soviet Union, is just at the moment when coordinated interdepartmental efforts have begun, and they require solutions not only at the level of the healthcare system, but on condition of combining the efforts of a number of sectors of the economy, public organizations and government structures, because only in this way it is possible to provide conditions for a healthy lifestyle and motivation of people to him. So, in the Soviet Union, the perestroika processes just began, then the collapse of the country, and a sharp increase in mortality associated with very pronounced socio-economic destabilization.
That is, in other countries at that time there was a decrease in mortality, and in Russia, Ukraine, Belarus, Kazakhstan and other countries of the post-Soviet space, the opposite process was going on, due to socio-economic factors. Now, since 2003, we have also entered a phase of mortality reduction. Now the life expectancy in the country is slightly more than 71 years. And now, for a year and a half, the depopulation process has finally stopped, including due to a significant reduction in mortality.
NK: For quite a long period in Russia, there was a large gap in the average life expectancy of men and women. What is the reason for this?
SB: You are very correct, and this gap concerns not only the most important indicator – life expectancy – it also concerns the prevalence of risk factors, and, most importantly, the total value. For us, it is not only the individual factor itself that matters, but their combination. The frequency of high risk according to the totality of other components of risk factors among men in our country, especially under the age of 64, compared with women is five times higher. This is due to the fact that both the level of social responsibility and the level of motivation, the speed of consciousness change in women is much faster than in men. This temporary delta, which was formed in the mid-90s, has not yet been overcome for our men compared to women.
NK: It turns out that, in the natural plan, women are a more survivable, more tenacious component of the human species...?
SB: I'll interrupt you here. Firstly, the prevalence of smoking among women, the prevalence of abdominal obesity is significantly less than in men. The prevalence of arterial hypertension is not significant, but less than in men. Etc. Taken together, this makes such a difference. Although biological security also matters. Women before the menopausal period – up to the age of 50 and older – have very powerful hormonal protection. And men by this time are already, let's say, biologically poorly protected and exposed to risk factors.
NK: In Soviet times or after the collapse of the USSR, were comprehensive studies conducted on the possible effects of stress as a factor in the occurrence of non-communicable diseases?
SB: Of course, such studies were conducted, but, let's say, in accordance with the methods that are accepted and understandable today – such studies were conducted in Russia on the border of the 1990s-2000s, and there was also a very large project in the first decade of the XXI century. Recently, a large study was conducted – an epidemiological project studying the prevalence of risk factors in 12 cities and rural settlements of the Russian Federation, differing in climate, geography, demography, economy, and so on. So, it has already been shown that a high level of anxiety and secondary depression reflects the stress load on society. It was especially high just in that period, the late 1990s - early 2000s.
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