Retesting Stress: An Indirect Cause?

Although stress likely contributes to the health crisis, the strongest evidence suggests that negative health lifestyles are the leading cause of cardiovascular and alcohol-related mortality in Russia. The question then becomes: what causes negative health lifestyles? Stress might not play a strong role at the secondary level, in the heart- and alcohol-related causes of death, but it might operate indirectly at the tertiary level by promoting heavy drinking and smoking. The problem with this assertion is that Russian women experience more stress yet do not turn to alcohol and cigarettes to alleviate this stress. In post-Soviet Russia, drinking alcohol and smoking cigarettes are generally appropriate masculine—but not feminine—behaviors. Although more young Russian women now smoke, this change has been attributed not to stress but to the desire to be fashionable and the advertising influence of Western tobacco companies. The trend is also largely restricted to major urban centers.

Among men, heavy drinking may suppress stress. Drinking heavily may, in fact, promote feelings of well-being and satisfaction, as demonstrated by a Moscow study in which many male respondents reported that alcohol makes them feel more optimistic about life. As Finnish sociologist Hannele Palosuo, who studied Moscow lifestyles, explains, “Heavy drinking was habitual in Russia long before the recent upheavals and is not necessarily particularly stress-related; on the contrary, drinking has been closely connected with Russian social life, rituals, and celebrations.” In his memoirs, Boris Yeltsin points out that he learned early that alcohol gets rid of stress and that stress alone has not motivated heavy drinking since: “The traditional Russian lifestyle dictates that it’s impossible not to drink at a birthday; it’s impossible not to drink at a friend’s wedding; it’s impossible not to drink with your co-workers.”

This circumstance suggests that the normative demands of the Russian male lifestyle exert an especially potent influence on heavy drinking. Heavy alcohol use is not always a stress response; it may be due to cultural norms or hedonism. Consequently, stress may not be closely related to health lifestyles. We must consider a stronger variable: the normative influences on health lifestyles that have their origins in a particular social class.

The Importance of Class

Social theorists have observed a close connection between class and lifestyle since the 19th century. Weber noted that certain strata served as “social carriers” of particular ways of living. These carrier strata were independent causal forces: they transmitted norms, values, and styles of living across generations and the boundaries of other classes. The working class appears to be the social carrier of the dominant male lifestyle in Russia, as its traditional form of drinking has spread across class lines. Historical sources indicate that before the 1917 Russian Revolution Russians did not consume as much alcohol per capita as French or Italians. Russian peasants and workers, however, were inclined toward periodic bouts of heavy vodka consumption. Accounts of village life in the late 1890s show widespread binge drinking and drunkenness among agricultural workers, especially at weddings, street parties, and fairs. Russian men typically drank only on their days off. In the Soviet era, however, this constraint disappeared and alcohol use became increasingly common throughout the year, fostering a male lifestyle characterized by consistent binge drinking.

The Russian mode of drinking involves rapid group consumption of large doses of vodka, with the participants expected to continue as long as they are able or until the supply of alcohol is consumed. Although alcoholism is socially stigmatized, little or no stigma is attached to drunkenness. Heavy consumption was most typical of Slavs, as Jews tended to drink moderately and Muslims not at all. Russian per capita annual consumption of pure alcohol may be as high as 15 liters or more—the highest in the world. Given that adult men, who constitute only 25 percent of the population, drink most of the alcohol, there is an enormous concentration of drinking among Slavic men.

My own research indicates that excessive alcohol use is a normative practice among working-class Russian men that has spread into the wider culture and is reproduced over time and in successive generations. The integration of a majority of peasants into a large urban working class under communism further established this drinking style as a working-class trait. Various studies indicate that the amount of alcohol one drinks drops as one’s education level rises. Given that the educational qualifications of most working-class Russians are not high (a secondary education and often less), heavy episodic drinkers are over-represented in this segment of the Russian social hierarchy. It is no coincidence that Russian demographer Vladimir Shkolnikov and his colleagues found mortality to be significantly higher among men in this group than among those with a university education.

Smoking in Russia has traditionally been a male practice and is common among males of all ages and classes, especially among urban workers. More than 60 percent of all males smoke. Reported smoking rates of almost 80 percent among men in some industrial areas link smoking to the normative framework of male working-class lifestyles. There is a lack of data about class distinctions concerning diet and exercise, but Russian diets generally have a high fat content and Russians engage in little health-promoting exercise.

The strongest evidence for the causal importance of class comes from patterns of drinking and smoking. Here it appears that the dominant health lifestyle largely reflects working class practices that have spread throughout the class structure. In Western society, the middle class, especially the upper-middle class, is the source of positive health lifestyles and transmits such lifestyles to the general population. The middle class has promoted anti-smoking campaigns, stigmatized drunkenness, and advocated healthy eating and exercise; all of these have become societal norms. The upper-middle and upper classes are also the first to learn of new health risks and, because of greater resources, are most likely to adopt and publicize new health strategies and practices.

Why has the middle class not performed the same function in Russia? The best answer is that a middle class similar to that in the West does not yet exist. During the transition to a market economy, fewer Russians have been upwardly mobile while more have been downwardly mobile in Russia’s class structure. Many people in the former middle strata in Soviet society, such as the intelligentsia and technical specialists, moved downward as the new Russian state abandoned Soviet efforts to promote those with working class and peasant origins. Studies of the stratification pattern in post-Soviet Russia show that displaced workers’ jobs in the new economy reflected their social origins more closely than their previous jobs did. Market reforms have conferred benefits upon and improved the social status of only a narrow segment of the population. Desirable jobs became far fewer in number, commanded much higher salaries, and usually went to people whose origins were among the former communist elite—the nomenclatura. They used their advantaged positions and connections to secure controlling interests in the privatization of state property. Their continuing unpopularity among the general public reduces their capacity for serving as role models for healthy living.