Russian sociologist Ludmila Beliaeva concludes: “In these years it has not yet been possible to establish a full-fledged modern middle class such as constitutes the nucleus of society in the developed countries.” Moreover, in the absence of independent economic activity and a fully democratic state providing individuals equal protection under the law, it is difficult for a Western-style middle class to emerge. People engaged in business in the new market economy must sometimes accommodate criminal organizations and corrupt state bureaucracies as the central government becomes increasingly authoritarian.

Therefore, as Russian economist Andrei Sitnikov points out, economic reforms in Russia have not yet fostered a middle class to serve as a potent force for change. In the West, a stable and resourceful middle class has served as a powerful social carrier of a positive health lifestyle. Although the level of participation in this lifestyle still differs across class boundaries, the West has not experienced Russia’s premature mortality and curtailed life expectancy for either men or women. Russia needs a civil society with a stable middle class that is health-conscious and able to create a culture based on a healthy lifestyle in order to change the current practices that have led Russia to this condition.