Center-peripheral differences in life expectancy in Russia: regional analysis
Elevated mortality (compared to the West) and significant spatial differences in life expectancy are serious challenges facing Russia. Improving Russians' health and increasing life expectancy by reducing inequality in mortality between regions and settlements are closely intertwined with the goals of spatial development of Russia, aimed at reducing interregional differences in the quality of life. This paper presents an assessment of the scope and dynamics of changes in mortality differences between the ‘center' and the ‘periphery' in 67 regions of Russia, which are home to three-quarters of the country's population. The selected research period - 2003-2018 - is characterized by a steady increase in life expectancy at birth (LE) in Russia. Using unpublished data from Rosstat for cities, we estimated life expectancy at birth in 67 regional centers and in the rest of the regions (‘periphery'). Depending on the magnitude of the differences in LE and the dynamics, we identified 6 types of regions. For the regions with the gap in LE between the center and the periphery larger than on average, the decomposition method was applied, which made it possible to determine the key age groups and causes of death responsible for such high differences. In 36 regions of Russia classified as types I-III, the center-peripheral gap exceeded the average Russian level, while only in six regions in 2003-18 there was a tendency to reduce the size of this gap. The decomposition results showed that elevated mortality of males in the periphery is due to a higher mortality rate at working age from external causes of death, especially from traffic accidents, homicides and suicides, as well as from ‘alcoholic' causes of death; females in the periphery suffer from higher mortality rate at older ages from chronic non-communicable diseases. Despite the seemingly ‘objective' nature of the mortality differences between the center and the periphery (the advantage of the former is due to the socio-demographic characteristics of its residents, the educational structure of the population, as well as selective migration), the positive experience of other countries shows that effective public health policies can significantly reduce the range of spatial inequality in mortality rates even if significant heterogeneity in the level of social-economic development of the territories persists.