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. Last Updated: 07/27/2016

Thick Scots and Russians

Russia has known colder winters than this, most recently 1978-1979. The real story about life -- and death -- in Russia today has to do with self-immolation, not snow.

Once upon a time, high mortality was a problem peculiar to the Third World. However, a more puzzling trend today is the dramatic deterioration of public health in what used to be seen as developed countries. Russia is the prime example. Over the last 20 years, average male life expectancy there has fallen from 65 years to below 60, compared with 75 in the United States.

And Russia is not alone. Take Belarus. Male life expectancy in parts of Minsk is down to 54. There has been a 350% rise in alcohol-related deaths in the last two decades. About 13,000 people die every year because of smoking-related diseases. More than a third of Belarus' 12-year-olds are overweight or clinically obese.

Actually, I've played a trick on you. None of those statistics relate to Belarus. They are all from Scotland, which in certain respects really is the Belarus of the West.

Why, after about a century of sustained improvements, is public health in some developed countries deteriorating?

The obvious answer is, of course, that Russians and Scots alike lead unhealthy lives. They smoke too much. They drink too much alcohol. They eat too much high-cholesterol food. And they do not exercise enough. The United States too has plenty of self-made invalids. The people of Kentucky are the nation's leading smokers, and few can beat North Dakotans when it comes to binge drinking.

But that doesn't really explain why people choose to shorten their own lives. It's certainly not enough to say "because they are poor." Compared with most Africans, even unemployed Glaswegians are well-off. Nor can one simply blame poor health education. The New Sick know that cigarettes cause cancer, that excessive alcohol consumption causes cirrhosis of the liver and that too much fast food causes obesity and heart disease.

People who knowingly undermine their own health are, in the language of economists, "discounting the future steeply." They are effectively saying: "The pleasure this cigarette/pint/Mars bar will give me right now is worth more to me than the pain and privation I may one day suffer from premature disease and death." An alternative interpretation is that individuals are simply miscalculating the probability of their dying young.

Either way, this can hardly be regarded as intelligent behavior. I would therefore like to suggest a new designation for these parts of the world where people are deliberately opting for ill health. To distinguish such places from the Third World, where people have maladies thrust upon them by nature and by poverty, I propose referring to them collectively as the Thick World -- as in thick-headed. (Note that the Thick World is also the Fat World, just as the Third World is also the Thin World.)

Now I have to confess my own sins. For I recognize only too well the Russian-Scottish-Dakotan traits. True, I don't smoke. I abjure illegal narcotics. I don't even eat Mars bars, deep fried or otherwise. Nevertheless, like a good many other writers and historians, I do abuse both caffeine and alcohol. So how can I possibly criticize those whose range of vices is merely wider than mine?

I used to say facetiously that people who die around the retirement age are behaving with admirable social responsibility, thereby helping to solve the impending pension crisis. Alas, the reality is that such people tend to die slowly and expensively, running up a substantial bill for taxpayers from the moment they first claim disability benefits until the day they finally expire.

So the growth of the Thick World poses a grave fiscal challenge for the First World. Worse, the rise of the self-made invalid is symptomatic of a more general decline of Western civilization, not unlike the fall of the European birthrate below the natural replacement rate. It is surely not without wider significance that by 2050, Russia's population is projected by the United Nations to be less than that of Egypt.

As the snow falls on Russia today, it is burying a society that is literally moribund. But Moscow is only the capital city of the Thick World. The disturbing thing is just how many northern European and North American towns are already headed in the same dumb, downward direction.

Niall Ferguson is a columnist for the Los Angeles Times, where this comment first appeared.