"During the past decade we have been investigating reasons for the very high death rate among Russians," said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. "We have been looking in detail at men in Izhevsk, a city in central Russia. While we confirmed what we already knew, that a lot of vodka is drunk in Russia, we also found that ? a surprisingly large number of people ? seven percent ? were drinking substances containing alcohol but not meant to be drunk. We then decided to find out what was in these substances."
"History has shown us that alcohol plays an important role in life, health and death in Russia," added Vladimir M. Shkolnikov, laboratory chief at the Max Planck Institute for Demographic Research in Rostock, Germany. "For example, Mikhail Gorbachev's anti-alcohol campaign that was launched in May 1985; it included heavy reductions in alcohol production and sales, an increase in alcohol prices, a strengthening of mandatory treatment of alcoholism, and enforcement of measures against home production. Results were swift. From 1985 to 1987, life expectancy increased by 3.2 years for men, and 1.4 years for women, after two decades of a continuously slow decline."
In 1992, however, economic reforms led to a liberalization of alcohol prices and few, if any, restrictions on alcohol sales. "Hard liquor became available 24 hours a day," said Shkolnikov. "Consequently, from 1992 to 1994, life expectancy decreased by 4.7 years for men and 3.4 years for women, largely due to accidents and violence, alcohol-related causes, and cardiovascular deaths."
For the current study, researchers analyzed the surrogate products being consumed, dividing them into three broad groups: "samogon" (home-produced spirits, also known as "moonshine" in North America); medicinal compounds, essentially tinctures containing herbal remedies; and other spirits (mainly aftershave products and cleaning fluids). Commercially produced vodkas were used for content comparison.
The results indicate that a significant proportion of Russian men are drinking products that have either very high concentrations of ethanol, or contaminants known to be toxic.
"We found that home-made alcohol had about the same amount of alcohol as vodka, but also contained a number of more toxic alcohols that could cause damage to the heart and liver," said McKee. "The medicinal substances were about one and a half times as strong as vodka. The third group, including products such as aftershaves, was more than twice as strong as vodka."
Both McKee and Shkolnikov believe the study results are highly applicable to other regions in Russia.
"In the early 1980s," said Shkolnikov, "it was estimated that samogon constituted about one third of the total amount of alcohol consumed in Russia. Its production was largely concentrated in the countryside. Samogon consumption is, of course, in addition to other alcohol surrogates such as eau de colognes, aftershaves, and medicinal compounds."
"Our discussions with Russian colleagues suggest that [surrogate alcohols construe] a major issue," added McKee. "Samogon has been part of Russian life for centuries. The so-called aftershaves are sold in brightly coloured quarter-litre bottles and it seems very difficult to believe that those making them do not know that they are being drunk. The bottles seem to be produced in a few places and distributed widely across Russia. So although we need to do more work, we believe they are being drunk widely. It also seems very likely that these substances are playing an important role in the high level of alcohol-related deaths in Russia."
McKee said that he also suspects that the same types of substances are being consumed in many other parts of the world. "These are products that are often consumed by people living on the margins of society, who are difficult to conduct research upon," he said. "This is consistent with historical lessons which show that substance abuse is often widespread during periods of rapid transition, such as the industrial revolution."
Shkolnikov concurs. "When thinking about the Russian health crisis, one should not overlook certain societal forces operating in the post-Soviet era," he said. "These include a totalitarian legacy of neglect of individual values and interests, substantial poverty and underdevelopment, growing unemployment and income inequality, long-lasting underfunding of the social sector, and an insufficient health-care system. Alcohol is used as a means of escape from reality."
McKee is hopeful that the Russian government has become aware of the seriousness of the problem. "Following a meeting that we had with President Putin's advisors," he said, "the president specifically mentioned the need to tackle surrogate alcohols in his 2005 state-of-the-nation address."