The Russian Constitution guarantees free, universal health care for all citizens.[162] In practice, however, free health care is partially restricted due to propiska regime.[163][164] While Russia has more physicians, hospitals, and health care workers than almost any other country in the world on a per capita basis,[165][166] since the collapse of the Soviet Union the health of the Russian population has declined considerably as a result of social, economic, and lifestyle changes.[167] As of 2007, the average life expectancy in Russia is 61.5 years for males and 73.9 years for females.[168] The combined average Russian life expectancy of 67.7 years at birth is 10.8 years shorter than the overall figure in the European Union.[169] The biggest factor contributing to this relatively low life expectancy for males is a high mortality rate among working-age males from preventable causes (e.g., alcohol poisoning, stress, smoking, traffic accidents, violent crimes). Mortality among Russian men rose by 60% since 1991, four to five times higher than in Europe.[170] As a result of the large difference in life expectancy between men and women and because of the lasting effect of World War II, where Russia lost more men than any other nation in the world, the gender imbalance remains to this day and there are 0.859 males to every female.[5]
A mobile clinic used to provide health care to people at remote railway stations.Heart diseases account for 56.7% of total deaths, with about 30% involving people still of working age. A study blamed alcohol for more than half the deaths (52%) among Russians aged 15 to 54 from 1990 to 2001. For the same demographic, this compares to 4% of deaths for the rest of the world.[171] About 16 million Russians suffer from cardiovascular diseases, placing Russia second in the world, after Ukraine, in this respect.[170] Death rates from homicide, suicide, and cancer are also especially high.[172] 52% of men and 15% of women smoke, more than 260,000 lives believed to be lost each year as a result of tobacco use.[173] HIV/AIDS, virtually non-existent in the Soviet era, rapidly spread following the collapse, mainly through the explosive growth of intravenous drug use.[174] According to official statistics, there are currently more than 364,000 people in Russia registered with HIV, but independent experts place the number significantly higher.[