Welcome to the Thick World, where the dumb seem determined to die young

And I complain about the weather in Boston! "Be thankful you're not here," a prospective student based in Russia told me last week. For conditions there are truly Arctic. In Moscow alone, more than 100 people have died of hypothermia this winter, with temperatures plummeting below -30C.

It would be nice to think that the Russian President, Vladimir Putin, is among those being kept awake by the sound of their own teeth chattering. Having threatened to cut off gas supplies to the Ukraine only a few weeks ago, the Russian government certainly had this coming to it. But something tells me that, while power is being rationed for ordinary Muscovites, Mr Putin's electric blanket is keeping him cosy all night long.

Russia is, of course, a tough place to live. When I took a boat trip on the River Volga near Kazan last summer, I struggled to imagine life on the island of Sviarshsk during the long winter months when the river freezes solid. Just looking at their rather flimsy wooden houses made me shiver. Yet this is hardly new. Russia has known colder winters, most recently in 1978-79. The real story about life - and death - in Russian today has nothing to do with the weather. This is not The Day After Tomorrow, more like the morning after the night before.

Once upon a time high and even rising mortality was a problem peculiar to the Third World. Even today, saintly Irish rock stars tend to direct their altruistic energies towards eradicating malaria or halting the spread of Aids in Africa.

There is, however, a more puzzling trend, and that is the dramatic deterioration of public health in what used to be seen as developed countries. Russia is the prime example. Over the past 20 years, average male life expectancy there has fallen from 65 to below 60, compared with 75 in the United States. The mortality rate for Russian men is four times what it is for their British counterparts.

And Russia is not alone. Take Belarus. Male life expectancy in parts of Minsk is down to 54. There has been a 350 per cent rise in drink-related deaths in the last two decades. Around 13,000 people die because of smoking related diseases every year. More than a third of Belarus's 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 from Scotland, which in certain respects really is - as I remarked here a few weeks ago - the Belarus of the West. So whatever became of Progress with a capital P? Why, after around 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 tobacco. They drink too much alcohol. They eat too much high-cholesterol food. (Do they have deep-fried Mars bars in Moscow? An enterprising Scot could make, er, a killing by exporting that particular delicacy.)

And they do not take enough exercise. Fat Bastard has his Russian counterpart, Tolsti Svoloch. America too has plenty of self-made invalids. The people of Kentucky are America's leading smokers and no one can beat the 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 poor Glaswegians are well-off. And their incomes in real terms are surely higher than their parents' were.

Nor can one simply blame inadequate health education. The New Sick know damn well that cigarettes cause cancer, that excessive alcohol consumption causes cirrhosis, and that too many deep-fried Mars bars cause obesity and heart disease. Still they consume all three like there's no tomorrow.

Well, that may be precisely the point. In acting "like there's no tomorrow", people who knowingly undermine their own health are, in the language of economists, "discounting the future steeply". They are effectively saying: "The pleasure this fag / dram / 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 they are simply miscalculating the probability of their dying young. It is well known that infantry men in the trenches during the First World War tended to underrate their vulnerability to enemy artillery. As the song says: The bells of hell go ting-a-ling-a-ling, For you but not for me; For me the angels sing-a-ling-a-ling, Death has no threats for me.

In the same way, perhaps, the compulsive smoker inhales in the belief that his life is somehow charmed; that he will not be among the eight out of every ten lung cancer victims who get the disease by smoking. Either way, this can hardly be regarded as intelligent behaviour.

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". (Note that the Thick World is also the Fat World, just as the Third World is also the Thin World.)

Now I do not mean to be censorious. I have castigated my mother country enough for one year; now it is time for me 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 raw. Nevertheless, like a good many other writers and historians, I do abuse both caffeine and alcohol.

The day begins with a pot of tea. By 11, I have an uncontrollable craving for a large latte, though I despise myself for it. And after lunch I need to restart my mental motor with an espresso. By 4pm it's time for more tea.

Then, at around 7 o'clock, I switch. First comes the nagging desire for a pint of beer. Then, when dinner is served, I absolutely must have a bottle of red wine - these days usually an Argentine Malbec - at my right hand. Gradually the caffeine level drops and the alcohol level rises. Dr Jekyll, toiling manically at his desk, mutates into Mr Hyde, holding forth belligerently at the table.

Is this lifestyle good for me? No. Can I stop it? Again, no. So how can I criticise those whose range of vices is merely wider than mine?

I used to say facetiously that people who die at around the retirement age are behaving with admirable social responsibility, thereby helping to solve the impending pensions crisis. Alas, the reality is that Fat Bastard tends to expire slowly and expensively, running up a substantial bill for the taxpayer from the moment he first claims invalidity benefit until the day he finally expires.

So the growth of the Thick World poses a grave fiscal challenge for the First World. Already payments to the New Sick in Britain must vastly exceed official aid to Africa. 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 to be less than Egypt's.

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

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