In Reply: Our objectives were
to describe as fully as possible the dimensions of the catastrophic
decline in life expectancy in Russia, to assess the major factors
behind the mortality increase, and to discuss data quality issues that
could affect the findings. We concluded that no single factor could be
identified as the underlying cause of the mortality increase, given the
evidence available and the complexity of developments in post-Soviet
Russia.
We discussed several factors that we believe worked together to account
for the rapid rise in Russian mortality, ie, economic and social
instability, consumption of alcohol and tobacco, nutrition, stress and
depression, and the health care system. One of those factors was the
increase in alcohol consumption, but we felt that other factors played
key roles as well, and their interaction was also important. We agree
with Dr Vlassov that stress and depression may have played a
significant role in both alcohol- and cardiovascular-related causes of
death, as we mentioned in our article. We also mentioned the possible
positive role of reduced stress and depression in reducing mortality
during the early years of the Gorbachev regime.