Abstract
          Communism is a political ideal that is often viewed  negatively by democratic societies. Since the fall of the Soviet Union in 1991,  the Russian Federation has experienced a rising mortality rate. It is clear  that the political turmoil of the country played a key role in the eventual  demographics of Russia. Coinciding with the onset of democracy a number of  factors including economics, lifestye, healthcare, and disease incidence have  contributed to the decline in population. The current demographic state,  underlying causes, and next steps will be explored within the paper
          Introduction
          The Russian Federation experienced a  surge in death rates of almost 40 percent since 1992, with numbers rising from  11 to 15.5 per thousand (Bhattacharya et al., 2011). The fall of the Soviet  Union in 1991 brought with it many social, political, and economic changes that  continue to affect Russia to this day. Although all countries progress along  the demographic transition model differently, general trends are shown.  Nonetheless, Russia appears to be experiencing a unique transition of its own.  Each country experiences population decline for varying reasons, such as  disease diffusion as experienced by Africa with the AIDS epidemic; others can  be caused by societal advancements that lead to lower fertility rates.  Population decline was evident in Russia since the fall of the Soviet Union,  which is why it serves as an interesting case study. On the surface it is  counterintuitive that the state of the country would worsen after the fall of  the communist party; however it is likely that political turmoil was  responsible for the onset of the demographic problem in Russia. A number of  factors including economic, lifestyle, health care, and disease incidence have  contributed to Russia’s decrease in population. The following discussion will  assess Russia’s current demographic state, identify the underlying causes, and suggest  logical next steps for Russia.  
          The Soviet Union
           The  Soviet Union refers to the joining of a number of different republics under  common rule. Communism was the former political system that governed these  joined regions and maintained rule from 1985-1991 (Barr & Field, 1996).  Gorbachev, the leader of the Communist party, imposed Glasnost, a new policy  that forced political openness. As a result, the negative aspects of life under  Soviet rule were exposed, such as poor housing, alcoholism, and poor technology.  In light of this negative exposure, the Soviet government as well as the  Communist party lost influence over its population due to reduced trust  (Matlock, 1995). Gorbachev also introduced perestroika, or economic  restructuring, which was not well received by the public (Stoner-Weiss &  McFaul, 2009). A number of factors contributed to the eventual demise of the  Soviet Union that began with the separation of Poland, and a domino effect of  states leaving the union continued (Stoner-Weiss & McFaul, 2009). A  combination of ethnic tension between the Soviet republics as well as growing  interest in independence led to the eventual dissolution of the Soviet Union in  the early 1990s (Anderson, 2002).
           Due  its large landscape of natural resources, such as timber and oil, the Russian  Federation was a key player in the global economy (Grigoriev, 2005). The  decisions that took place within its borders had an impact on other regions of  the world, such as creating a flux in oil prices (Grigoriev, 2005). Ever since  the fall of the Soviet Union, the population of Russia has been on a steady  decline (Anderson, 2002). The demographics of Russia continue to be one of the  most pressing issues facing the country; former president Putin even placed  dealing with it as a top priority (BBC, 2000). 
          Russia’s Current  Demographic State
           The  aging population of Russia outnumbers its working class due to population  decline (Nikitina, 2000). Russia’s total fertility rate prior to 1991 generally  fluctuated around the replacement level and remained well above it during the  1980s (Anderson, 2002). The Soviet Union’s government exercised a pro-natalist  stance and offered incentives for larger family sizes, which can help to  explain why populations appear to make a dramatic decrease after this  government structure collapsed (Anderson, 2002). The breaking up of the Soviet  Union brought with it economic hardships that influenced the fertility rate of  the nation by creating unfavourable conditions to bear a child (Kharkova &  Andreev, 2000). The GNP of Russia decreased by nearly one-half in 1995; when  combined with the relatively high cost of birthing and caring for a child, it  is clear that the declining fertility rate was a result of economic conditions  (Ranjan, 1999). 
           Russia’s  life expectancy in 2009 for men and women was 60 and 73 respectively, well  below other European countries’ averages that were as high as 77 in countries  such as Germany (Wong, 2009). Ironically, life expectancy was lower under the  Russian Federation than it was under a communist regime (roughly 58 for women  and 64 for men) (Notzon et al., 1998). These low numbers were attributed to a  high level of mortality among working class men as a result of lifestyle  choices, including alcoholism and smoking (Wong, 2009). About half of all  deaths of working age men could be related to hazardous binge drinking (Leon,  2007). Such lifestyle choices are commonly associated with depression, a  growing problem within Russia post Soviet times (Griffiths, 2005). The most  frequent cause of death in Russia was heart disease, which accounted for 56.7  percent of all deaths (RIANavosti, 2007)
 The  poor state of the health care system was one of the leading forces affecting  Russia in the past decade. Barr and Field (1996) found the post-Soviet health  care reform increased costs and limited access to health care, which likely  affected Russia’s life expectancy. It was not until Putin was elected as  president in 2000 that major reforms to the health care system took place  (Marquez, 2008). A poor health care system also affects the quality of disease  treatment and prevention. The HIV/AIDS epidemic is an issue plaguing Russia’s  youth; people aged between 15 and 29 make up 80 percent of infected persons.  The rapid spread of HIV/AIDS has been attributed to the massive amount of  intravenous drug users now present within the country (The World Bank, 2011). 
          Health Care 
           Under  Soviet governance, the health care system was socialized, and citizens were
            guaranteed full health protection  without charge. In the 1980s, there existed easily accessible clinics and first  aid facilities for public use (Curtis, 1996). The Soviet Union was also the  first country to have an equal ratio of hospital beds to citizens (Curtis,  1996). Despite the accessible nature of the Soviet health care system, there  still existed some inconsistencies amongst rural and urban areas as well as  severe need for advancements in practices and technologies (Curtis, 1996).  Although there was equal access to the health care system, Soviet facilities  lacked essentials. As a matter of fact, in 1990, 24 percent of hospitals did  not have adequate plumbing, 19 percent lacked central heat, 45 percent lacked  bathrooms or showers, 49 percent had no hot water, and 15 percent operated  without any water at all (Cassileth et al., 1995). 
           After  the fall of the Soviet Union, the already lacking health care system saw no  improvements and began to deteriorate exponentially (Notzon et al., 1998). Poor  medical care combined with high pollution from vehicles and factories as well  as dwindling resources lowered the health status of the people (Cassileth et  al, 1995). The health care system in Russia was in a crisis as a many  practicing doctors were under trained, lacked updated medical equipment, and  were poorly paid. Ultimately this led to a shortage of doctors, with the ratio  dropping to one for every 275 citizens (Curtis, 1996).
 The  distaste for the health care system was rooted in the underperformance of two  components of the system: polyclinics and hospitals (Brown & Rusinova,  1997). A polyclinic is a place that offers a wide range of health care  services. The medical system has produced a population of patients who “refuse  hospital admission, decline needed surgery, and only seek medical care after  their disease has progressed to advanced stages” (Petrov & Vovin, 1993).
 The  transition to a market system of health care was difficult on those accustomed  to Soviet-era practices (Brown & Rusinova, 1997). Accessibility to health  care resources decreased since free coverage was lost. It was common practice  for charges and fees to be applied for medical assistance, a luxury that many  low-income families cannot afford (Brown & Rusinova, 1997). 
          Economy
           There  were two significant economic crises that riveted Russia in the 1990s; the  first occurred in 1992, and the second in 1998. The first coincided with the  transition to a market economy following the fall of communism. The second  crisis involved the crash of the banking system (Gavrilova et al, 2001). Part  of this transition was the removal of price controls leading to a rise in  consumer prices of up to 140 percent, without a subsequent raise in living  wages 
            (Gavrilova et al, 2001; Kohler &  Kohler, 2002). The loss of controlled wages and incentives to maximize  employment paved the way to lowered levels of output and productivity; this  caused a decrease in productivity of the labour market that led to increased  poverty and inequality. A difference in earnings was exacerbated by this  effect, placing much of the population in poverty (Klugman & Braithwaite,  1998). 
           The  second economic crisis was characterized by increased violence and a sharp  increase in infectious disease-related mortality (Gavilova, 2001). Reduced  demand for labour meant increased layoffs and unemployment. Coinciding with  this was a decrease in overall income amongst Russian families. The number of  poor households, with 35 percent living below the official poverty line by  1995, rose shortly after the transition to democracy (Klugman &  Braithwaite, 1998). The concentration of households experiencing poverty was  most prevalent in ones with children and unemployed individuals (Klugman &  Braithwaite, 1998). 
 Poverty  had negative implications on population growth by inducing behavioural changes  within the population. The process of having a child, and subsequently  nurturing and raising it, was seen as an economic burden during trying times.  When there is concern regarding job security and unemployment, the likelihood  of reproduction is often reduced to reflect the unwanted burden associated with  children (Kohler & Kohler, 2002). The drop in total fertility in the  Russian Federation, by almost 35 percent, solidified the positive correlation  between poverty and lowered fertility.
          Suicide
          The World Health Organization (WHO)  found that suicide rates were on the rise globally; however Russia had one of  the highest suicide rates of all with 38 per 1000 people (WHO, 2007). The fall  of the Soviet Union brought with it political unrest, economic turmoil, as well  as increased stress on the population. With a number of people turning to  narcotics and alcohol to ease the pain, others took their lives as a last ditch  effort to escape. WHO found that people commit suicide when they feel there is  no other solution, whether it is financial or personal problems (WHO, 2007).  These feelings were in existence amongst the Russian population, and they were  exacerbated by the transition to a market economy. The rates of suicide can be  associated with a number of other factors that affect the demography of Russia,  e.g., alcoholism and job loss, are discussed herein. 
          Alcoholism 
           Russia  ranks amongst the world’s heaviest drinking countries (Vancouver Sun, 2011).  Prior to Soviet rule, alcohol consumption was steadily on the rise, with most  consumption in the form of binge drinking (McKee, 1999). Binge drinking leads  to an increase in deaths related to alcohol consumption, e.g., accidents,  violence, and alcohol poisoning (Chenet et al, 1998). Alcohol played a key role  in the mortality crisis experienced during the 1990s, especially a spike in  alcohol-related deaths in working age males (Pridemore, 2002). 
 The  Gorbachev anti-alcohol campaign was set in motion to reduce alcoholism in  Russia and was in place from 1985-1988 (Bhattacharya, 2011). Under the  Gorbachev policy, states were poised to develop strategies to reduce alcohol  consumption levels, including banning of alcohol in some regions, raising  prices, and reducing outlets for alcohol consumption (Mckee, 1999). During its  run, alcoholism declined significantly, and the crude death rate fell by nearly  12 percent (Mckee, 1999). A reduction of alcohol-related deaths lowered  mortality levels, suggesting the program had positive impacts. Unfortunately,  the Gorbachev campaign officially ended in 1988 due to its unpopularity and  loss of alcohol related revenue (Bhattacharya, 2011). 
 The  Russian Federation did not reach pre-Gorbachev levels of alcoholism until the  early 1990s, around the time of the dissolution of the Soviet Union, with  economic hardships and depression stated as the reasons behind it.  Subsequently, the death rate also climbed following the removal of the  Gorbachev policy (Bhattacharya, 2011). Furthermore, alcoholism was associated  with a number of adverse health risks, in particular an increased risk of  cardiovascular related problems (Chenet et al, 1998). As mentioned,  cardiovascular disease remained one of the leading causes of death and must be  addressed to reverse population decline (RiaNovosti, 2007).   
          HIV/AIDS
          The first documented case of HIV/AIDS  was documented in 1986; however it was not expected to become a widespread  health crisis. It was the lack of overlap between government practices and  reality that powered the spread of HIV (Feshback, 2005). In 1987, the diffusion  of AIDS was positively viewed under the notion it could eventually lead to the  demise of drug dealers and prostitutes (Feshback, 2005). Meanwhile, government  officials denounced the existence of HIV and related social problems within the  Soviet Union (Feshback, 2005). 
           After  the fall of the Soviet Union, the newly independent Russian Federation shifted  its focus to other political issues, and the once small issue of HIV/AIDS fell  to the wayside. According to the United Nations Program on HIV/AIDs (UNAIDS), approximately  1.1 percent of the Russian population, or 860,000 Russians, lived with HIV or  AIDS (UNAIDS, 2005). Since 1995, Russia experienced an exponential increase in  HIV/AIDS cases with the number of registered cases of HIV/AIDS reaching over  300,000 in 2005 as seen in Figure 1. The diffusion of AIDS throughout the  country was attributed to an increase in intravenous drug use with over 90  percent of registered HIV infections linked to it in the year 2000 (Holachek,  2006). Other affected populations included street children, sex workers,  prisoners, and children born to affected women (Roberts, 2010).
          Figure  1. Number of Registered Cases of HIV/AIDS in Russian Federation 1987-2005  
          
            Source: Holachek C. (2006). Russia’s  shrinking population and the Russian military’s HIV/AIDS problem. 
                      Infected families have a lowered life  expectancy and children born with the disease are prone to increased morbidity  (Rigbey, 2009). The increase in drug use, fueled by the illegal drug trade, was  one of the pressing issues facing Russian law enforcement. Deaths, related to  overdose and drug related complications, added to the already deteriorating  demographics of Russia. Nearly 65 percent of newly detected HIV cases were  linked to intravenous drug use (Rigbey, 2009). The population of Russia was  affected by the HIV/AIDS epidemic by adding to mortality and morbidity numbers  (Holochek, 2006). If Russia hopes to avoid the turmoil experienced by other  AIDS-ridden regions such as Africa, steps must be taken to avoid a larger  backlash in the future.  
          Next Steps and  Conclusion
           Russia  also plays an important role in international politics. Exploring the reasons  behind its declining population could affect its role in the world and could  result in changes in its relationship with North America. Russia’s depopulation  continues to be a great concern, because it will be difficult to sustain the  elderly population if it greatly outnumbers its workforce. It is important for  Russia to deal with the demographic imbalance properly to avoid a larger  catastrophe in the near future. After a wave of policies and incentives,  Russia’s population experienced its first increase in 2009 after over a decade  of decline (RIANovosti, 2010). The onset of this reversal suggests the policies  put in place are having some effect on the status of the population. The  prevalence of alcoholism needs to be addressed, and more policies must be put  in place to reduce alcohol consumption. Although steps are being taken to deal  with the ongoing HIV/AIDS epidemic, more needs to be done to ensure these  policies are implemented properly and proper procedures are being followed. In  terms of the economy, Russia needs to impose an economic restructuring plan  that addresses key holes in it’s workforce that need to be filled and find ways  to create meaningful and long-term employment for it’s citizens. Nonetheless  the future of Russia is very much up in the air, and time can only tell what  the future holds. 
           
          References
          
		  Anderson, B. (2002). Russia faces  depopulation? Dynamics of population decline. Population and environment. 23  (5). 437-464
          Barr, D., & Field, M. (1996). The  current state of health care in the former soviet union: Implications for  health care policy and reform. American Journal of Public Health. 86(3). 
          BBC News. (2000). Russian population in  steep decline. Retrieved from: http://news.bbc.co.uk/2/hi/europe/988723.stm
          Bhattacharya, J., Gathmann, C., &  Miller, G. (2011). The Gorbachev Anti-Alcohol Campaign and Russia’s Mortality  Crisis. 
          Brown, J., & Rusinova, N. (1997).  Russian meidcal care int he 1990s: A user’s perspective. Soc. Sci. Med 45 (8):  1265-1276.
   
            Cassileth, B., Vlassov, V., &  Chapman, C. (1995). Health care, emdical practice and medical ethics in Russia  today. The Journal of the American Medical Association. 273 (20): 1568-1573.
          Chenet, L., McKee, M., Leon, D.,  Shkolnikov, V., & Vassin, S. (1998). Alcohol and cardiovascular mortality  in Moscow; new evidence of a causal association. Journal of Epidemiology  Community Heath. 52: 772-774. 
          Curtis, G. (1996) Russia: A country  study. Washington: GPO for the library of congress. 
          Feshback, M. (2005). The early days of  the HIV/AIDS epidemic in the former Soviet Union. 
          Gavrilova,  N., & Evdokushkina, G., Semyonova, V., & Gavrilov, L. (2001). Economic  crises, stress and mortality in Russia. Paper presented  at The Population Association of American 2001Annual Meeting. 
          Griffiths, A.  (2005). Handbook of Federal Countries. (pp. 263-279). Quebec: Library  and Archives Canada.
          Grigoriev,  L. (2005). Russia’s place in the global economy. Russia in global affairs. Retrieve  from: http://eng.globalaffairs.ru/number/n_4959
          Holachek,  C. (2006). Russia’s shrinking population and the Russian military’s HIV/AIDS  problem. For the Atlantic Council of the United States. 
          Kharkova,  T., & Andreev, E. (2000). Did the ecnomic crisis cause the fertility  decline in Russia: Evidence from the 1994 microcensus.  European Journal of Population. 16: 211-233. 
          Kohler,  H., & Kohler, I. (2002). Fertility decline in Russia in the early and mid  1990s: The role of economic uncertainty and labour market crises. European  Journal of Population. 18: 233-262.
          Klugman,  J., & Braithwaite, J. (1998). Poverty in Russia during the transition: an  overview. The World Bank Research Observer. 13, 37-58. 
          Leon, D., Saburova,  L., Tomkins, S., Andreev, E., Kiryanov, N., McKee, M., & Shkolnikov, V.  (2007). Hazardous alcohol drinking and premature mortality in Russia:  population based case-control study. The Lancet, 369(9578),  2001-2009.
          Marquez,  P. (2008). Public spending for Russia for Health Care: Issues and options. Retrieved from: http://siteresources.worldbank.org/... on January 25, 2011
          Matlock,  J. (1995). Autopsy of an empire: The american ambassadors account of the  collapse. Random house. 
          McKee,  M. (1999). Alcohol in Russia. Oxford Journals; Alchohol and Alcoholism. 34;  824-829
          Nikitina,  S. (2000). Expert group meeting on policy responses to populatin ageing and  population decline. Department of Economic and Social Affairs. 
          Notzon,  F., Komarov, M., Ermakov, S., Sempos C., Marks, J., & Sempos, E. (1998).  Causes of declining life expectancy in Russia. The Journal of the American  Medical Association. 279(10):793-800. 
          Petrov,  M., & Vovin, N. (1993). Analysis of cases of late application for medical  care and refusal of hospitalization. Sov Zdravokhr. 1989; 10: 30-32
          Pridemore,  W. (2002). Vodka and violence: alcohol consumption and homicide rates in  Russia. American Journal of Public Health.  92 (12): 1921-1930. 
          Ranjan, P. (1999).  Fertility behaviour under income uncertainty . European Journal of Population, 15(1), 25-43.
          RIANovasti.  (2007). Heart disease kills 1.3 million annually in Russia-chief cardiologist  Retrieved from: http://en.rian.ru/russia/20070214/60721668.html on January 21, 2011. 
          RIANovasti.  (2010). Natural population decline in Russia down by 31% in 2009-Putin. Retrieved from: http://en.rian.ru/russia/20100216/157906438.html on January  21, 2011. 
          Rigbey,  E. (2009). Drug addiction: Not quite as simple as Russia v. the West. Open  democracy. Retrieved from: http://www.opendemocracy.net/content/drug-addiction-not-quite-as-simple-as-
          Roberts, A. (2010).  Policy Brief: Infectious diseases, HIV/AIDS in Russia. Jones & Bartlett  Learning, LLC. Retrieved from: samples.jbpub.com/9780763734213/34217_PBxx_InfectiousDiseasesRussia.doc
                      Stoner-Weiss, K, & McFaul, M  (2009). Domestic and international influences on the collapse of the Soviet  Union (1991) and Russia’s initial transition to democracy (1993). Center for  Democracy, Development, and The Rule of Law. Retrieved from: iis-db.stanford.edu/pubs/22468....pdf  on January 20, 2011. 
          UNAIDS. (2005). AIDS Epidemic Update:  December 2005. 
          UNAIDS. (2011). Russian federation.  Retrieved from: http://www.unaids.org/en/regionscountries/countries/russianfederation/ 
          Vancouver Sun. (2011). 15 top  alcohol-consuming countries in the world. The Vancouver Sun. Retrieved from http://www.vancouversun.com/health/alcohol+consuming+countries+world/4496427/story.html
          World Bank, The. (2011). HIV/AIDS in  the Russian federation. The World Bank. Retrieved from: http://web.worldbank.org/... 
          Wong, G. (2009). Russia’s bleak picture  of health. CNN. Vital Signs. Retrieved from: http://edition.cnn.com/2009/HEALTH/05/19/russia.health/index.html on January 21, 2011
          Wyon, J. (1996). Comment: Deteriorating  health in Russia- A place for community-based approaches. American Journal of  Public Health. 321 (3).