The medical and demographic situation in Russia: long-term trends, prospects and improvement potential

Relevant trends for shaping state social policy, including public health protection, can only be formed relying on accurate assessment and forecast of changes in key medical and demographic indicators. Following the COVID-19 pandemic, which had both direct and indirect adverse effects on population mortality across the globe, interest in evaluating possible future changes in the medical and demographic situation has increased. According to the median projections by the United Nations Population Division and the Federal State Statistics Service, the population of the Russian Federation may decrease by 7.3-10 million people by the beginning of 2046. To reverse this negative trend, substantial efforts should be taken beyond migratory growth, including finding innovative mechanisms to stimulate birth rates and reduce mortality (increase life expectancy at birth) as the primary components influencing natural population growth and, consequently, population dynamics. The aim of this study is to identify long-term medical and demographic trends in the Russian Federation and explore the potential for increasing birth rates, life expectancy at birth, and reducing mortality. The research is based on data from Rosstat on population size, and age-sex structure, birth rates, mortality, and life expectancy at birth both in Russia as a whole and by regions, as well as data on deaths from Federal Register for Medical Death Documentation for the period 1970-2023 (with a forecast up to 2046). Observed current demographic trends in the Russian Federation align with global trends and are described by the demographic transition theory. However, significant regional heterogeneity is noted. Therefore it is challenging to develop a unified universal approach to transforming the healthcare system. Nonetheless, it is possible to identify relevant directions for all regions of the Russian Federation to strengthen demographic potential. The study identifies two priority areas for improving the medical and demographic situation in the country in terms of reducing mortality, each requiring different sets of measures: 1) increasing the average age of death from chronic non-communicable diseases that account for over 70 % of deaths both in Russia and other developed countries; 2) minimizing deaths from external causes (injuries, traffic accidents, suicide, poisoning, etc.) and infectious diseases.