Mortality burden of ‘toxic masculinity’

Russia sets anti-record in gender mortality gap

Across the world, women tend to live longer than men — and Russia is no exception. The Russian Federal State Statistics Service (Rosstat) estimates life expectancy at birthAverage number of years the person is expected to live, assuming the mortality rates stay constant throughout their life (UN Definition). Constant mortality rates are a hypothetical condition, so the number should not be taken literally. However, it is a useful metric when comparing data across periods and regions. for women at 77.8 years compared to only 67.6 years for men in 2022. This difference is often referred to as the gender gap in mortality. Recent UN report suggests that it is greater in Russia than in any other country in the world.

Globally, the median gender gap is estimated at around 5 years. In the 20th century gender mortality gap has been driven by two main factors: ubiquitous smoking, which contributed to increased male mortality, and advances in hygiene and medicine leading to decline in maternal mortality, argues Marina Vergeles, expert on gender mortality in Russia and PhD student at Université Catholique de Louvain. 

Recently, however, the gender gap started to shrink: first in Northern and Western Europe in the late 1970s, then, sometimes with a significant delay, everywhere else.

In Russia the gender mortality gap began to decrease only in the 1980s, especially fast during the 1985–1987 prohibition. But immediately after the prohibition ended, male mortality went sharply upward. By 1994, male life expectancy had fallen to 57.4 years, and the gender mortality gap reached a record 13.7 years. In the same year, Russia passed the historical peak of alcohol consumption.

Stable and relatively rapid improvement in Russia began in the mid-2000s. But since Russian men took off from a very bad position, the gap with developed countries is still large.

Still, at the moment Russia is one of the top five countries with the largest gender mortality gap in the world, along with Armenia, Belarus, and Ukraine. In each of these countries women tend to live 9-10 years longer than men.
 

As a result, the gender ratioGender ratio is the ratio of males to females in population as a whole. Another useful measure for the purposes of demographic analysis is tertiary gender ratio. Tertiary (or adult) gender ratio is the ratio of males to females in reproductive age, in Russia tertiary gender ratio is close to 1. in Russia is one of the lowest in the world as well, measuring at 87 men per 100 women in 2021 (in Europe the median gender ratio is 93 men per 100 women). The skew is already visible in the 35–39 age group and only increases from there. Among Russians aged 40-44 years the ratio of men to women is 95 to 100, in the 60–64 age group it is already 73 to 100. Among 80–84-year-olds there are only 35 men per 100 women. 

Men die from external causes 5 times more often than women

Russian men over 25 tend to die much more often than women across all subsequent age groups. Age-specific mortality ratesNumber of deaths in a particular age group, divided by the average number of people in that age group in a year. start to even out only in the 85+ age group. Significant gender gap in mortality in the working-age population is not common for other countries, Marina Vergeles argues. "Well-studied factors that influence mortality rates, such as smoking, usually begin to take their toll only at older ages. That is, smokers who accumulated some health problems would start to face them at the age of 60 or even later. In Russia, the differences in mortality rates between men and women are already evident after the age of 25".

The reason is that the main cause of death in population of the working age are not diseases but so-called "external causes" — injuries from accidents, homicides, suicides, poisonings, etcExternal causes includes everything in groups XIX and XX in International Classification of Diseases and Related Health Problems (ICD-10).. In 2022 external causes accounted for 35% of all deaths of Russians in the 16–59 age group. Russian men are 5 times more likely to die from external causes than women.

Rosstat estimates that men commit suicide almost 7 times more often than women. Although suicides are more common in men than in women everywhere in the world, the male-to-female ratio of suicide rates is usually much lower at around 2 to 4 times. These figures are likely to be an underestimate since it is often hard to establish whether death was intentional. If it was, the authorities are also required to investigate whether the suicide was encouraged or assisted. For this reason, official statistics sometimes misclassify suicides as unintentional injuries. 

Young men are also more likely to be victims of road incidents: in 2021, approximately 92% of drivers, 66% of pedestrians and 55% of passengers who died in road accidents were male. The majority of them are in the 20–34 and 25–30 age groups and are 4–5 times more likely to die in road accidents than women of the same age. The significant gender difference in mortality is partly due to the fact that men constitute the majority of drivers. However, lack of official statistics makes it impossible to evaluate the significance of this factor.

Alcohol consumption contributes to mortality from external causes as well. Alcohol increases the likelihood of accidents, impulsive and aggressive behaviour, which in turn contributes to suicides, road accidents, homicides, and other causes of death in this group. According to demographer Alexey Raksha, up to 2/3 of deaths due to external causes are alcohol-related. 

Alcohol consumption is also more common in men. A 2010 study points out that Russian men prefer drinks with higher alcohol content and drink more often — 52% of men drink at least once a week, as opposed to only 9.5% of women. A 50% tax on vodka could prevent 30-50 thousand deaths a year, mostly among young Russian males, Professor of the New Economic School Yevgeny Yakovlev estimated.

Gender differences in chronic conditions show similar patterns

According to the Russian Fertility and Mortality database (RusFMD), among diseases, cardiovascular problems are the primary cause of death in Russian men of working age. Cancers rank second, followed by digestive and respiratory diseases. In all of these groups, male working-age mortality rates are around 2–3 times higher than female ones, except for cancer, which still causes 28% more deaths in men than in women. 

The risk of death from all these diseases is greatly increased due to several behavioural factors — primarily smoking, alcohol abuse and health neglect.

For example, the risk of death from tracheal or lung cancer for a smoker is 21.3 times higher than for someone who has never smoked. The chances of developing fatal bronchitis, emphysema and other chronic obstructive pulmonary diseases are 10.8 times higher. The risk of the condition causing most deaths, coronary heart disease, is also increased for smokers, especially in the 30–44 age group where it is 5.5 times higher.

Men tend to ignore symptoms of chronic diseases more often which exacerbates the problem. A 2014 study by Russian Ministry of Health revealed that almost every second Russian suffers from hypertension, but men know about the problem, measure their blood pressure and take medicine to reduce it much less frequently than women.

As Marina Vergeles explains, the gap in diagnosis makes a huge difference: "Hypertension, for example, significantly affects mortality from circulatory system diseases, but only when it is left unchecked. If a person is aware that they have hypertension and takes steps to keep their blood pressure under control, their risk of death from cardiovascular diseases is similar to the one of a person without hypertension. But in Russia there is a huge gap in diagnosis between men and women — men often do not know they have it, and when they do, they often leave it untreated".

"Post-Soviet masculinity" contributes to male mortality

Scientists put the causes of gender gap in life expectancy in two categories: biological and social. The first category includes, for example, higher level of estrogen in women protecting them from cardiovascular diseases. Behavioural factors, such as patterns of gender socialisation and associated concepts of masculinity and femininity, fall under the second category.

Research suggests that we do not fully understand how social and biological determinants of gender gap in life expectancy interact with each other. However, the literature shows that the contribution on the biological part is relatively modest, measuring at around two years.

Marina Vergeles emphasizes that the focus should be on social factors: "The biological gap has to do, among other things, with higher infant mortality in boys: they are more likely to have birth defects. But there is little we can do with these two years. We should try to eliminate social causes of male mortality, not biological ones".

Among social factors an important place holds the so-called "northern drinking pattern"The "northern pattern" involves drinking strong spirits in large quantities. In the "southern pattern", they tend to consume less alcohol, but more frequently, and mostly wine. . Historically, alcohol consumption has played an important role in various social practices, including gender socialization. In "Drinking toward Manhood: Masculinity and Alcohol in the Former USSR" Brian Hinote and Gretchen Webber argue that alcohol, tobacco and general disregard for health were significant attributes of Soviet masculinity. 

The authors suggest that after the collapse of the traditional patriarchal structure of imperial Russia, the manifestation of masculinity in the USSR by working-class men was channelled "into more permissible social environments like the tavern, where masculinities could be openly contested, challenged, and won or lost — often through drink and other masculinity challenges". 

This pattern where male body and health are used as instruments to establish masculinity is not unique to Russia. Hinote and Webber cite a discussion on working-class masculinity in Australia emphasizing that "physical destruction of the body (through labour, injury or environmental hazards) as the site of masculinity is actually one way to demonstrate and perpetuate masculinity itself." 

Similar idea is expressed in a study by William Courtenay on the United States, suggesting that "social practices that undermine men's health are often signifiers of masculinity", constructed in opposition to femininity which usually prescribes higher attention to personal health. 

"This culture is widespread in former Soviet countries — Belarus, Latvia, Lithuania, Estonia, Ukraine. Men do not care about their health, try to prove that they are the strongest and that they never fall ill, etc. This post-Soviet masculinity contributes to male mortality", concludes Marina Vergeles. 

What's next?

Until recently, the steady decrease in alcohol consumption and smoking in the last 20 years allowed to be optimistic about the dynamic of life expectancy and gender mortality gap. However, after the coronavirus pandemic, the gender gap in mortality stopped decreasing (see our article). 

At the same time, armed conflict in Ukraine is bound to have a negative impact as well. Conflicts have historically been shown to decrease life expectancy, not only through direct loss of life and injuries but also due to secondary effects on population as a whole. Rosstat has already reported that the share of those claiming to stick with a healthy lifestyle among Russian males had dropped from 60% to 45% compared to 2021. At the same time in women this indicator continued to increase which led some experts to believe that the decrease in men is due to the stress brought by mobilisation. 

In addition, experts anticipate an increase in crime levels in Russia after veterans return from the front. Considering that men most often die from violent causes, this will only increase the gender gap in life expectancy.

By Sergey Bondarkov

with the participation of NES professor Gerhard Toews and Maria Tsimbal

Infographic by Artyom Ivolgin and Ekaterina Burkova