Life span and disability in Sweden and Russia

Editor—Bobak et al in their paper on disability in Russia provide further evidence on the high level of morbidity in the Russian population, a finding that is consistent with our earlier reports using a similar method.¹,²,³ However, we disagree that these findings are consistent with the World Health Organization's healthy life expectancy project, which reported a male-female gap in healthy life expectancy of 11.5 years (52.8 years v 64.3 years).⁴ This figure, for healthy life expectancy at birth, would correspond to at least an 8-9 year gap between the sexes at age 20.

Figure 1.

Credit: PANOS PICTURES

Although Bobak et al do not report healthy life expectancy, their figures for the prevalence of good or fair health or good physical performance show no large gap between the sexes, again consistent with our findings. Computation of healthy life expectancy at age 20 from the table of age specific prevalence of poor health in the paper by Bobak et al produces figures of 34.5 years for men and 35.7 years for women. This is an even smaller gap than in our estimates of 36.7 for men and 40.6 years for women.³ We therefore believe that the main message relates to the plight of Russian women surviving into middle and old age, a group that, as we have previously noted, suffers from high levels of disability and a strong probability of widowhood. Their limited protection from the worst effects of political transition is now under threat from reform of the Russian social security system.⁵