The twenty-first century marked the beginning of rapid health improvements in Russia. In the late 2000s and the 2010s, there was already a moderate decrease in inter-oblast mortality disparities, with the exception of the growing life expectancy (LE) advantage of Moscow and Saint Petersburg. We have used newly available data to explore LE changes from 2003–2005 to 2015–2017 and determinants of LE differences across settlements of different types and population sizes. We distinguished between three major segments of the LE distribution: Moscow and Saint Petersburg at the top, large- and medium-sized cities in the middle, and smaller urban and rural areas lagging behind. The LE differences among these three groups increased, but the within-group differences decreased. The gaps between bigger cities and the “periphery” within oblasts grew, and this part of the total dispersion had increased substantially by 2015–2017. Education, together with population size, explained 62 percent (for females) and 67 percent (for males) of LE variation across 292 geographic units in 2015–2017. Our results suggest that slower health progress in small urban and rural areas is an important obstacle to further mortality reduction at the national level and is a matter of public health concern.
Published in a peer-reviewed journal of the Population Council.