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PSKOV, Russia — Cardiologist Olga Kudryavtseva doesn't expect Vladimir Bragin to return to work at the welding factory.

The 40-year-old father has had two heart attacks, and pains in his chest suggest a third is imminent. Kudryavtseva says he's reaping the harvest of years of bad habits: two packs of cigarettes daily since age 15, no exercise, a diet of sausage and sour cream, and binge drinking of up to eight pints of vodka a day.

His heart is so damaged that only a bypass could repair it — far beyond his means. "He will be an invalid," Kudryavtseva said.

Bragin thinks differently. "I will work," he insists, in the hospital that has been his home for almost a month. "If I don't work, my family will not be able to survive."

Bragin's personal crisis is Russia's national disaster. Russian men in their 40s and 50s die at rates unheard of for a developed nation in peacetime. In 1999, outside of AIDS-swept Africa, only Haiti reported higher male mortality.

The life expectancy of Russian men is 59, shorter than that of men in three-fourths of the world's countries, including less prosperous nations such as Nicaragua and Vietnam.

The implications for Russia's place in the world could be profound; healthy nations tend to be more productive. Nicholas Eberstadt, a Russia expert with the American Enterprise Institute in Washington, says Russia's burden of disease is likely to cripple its economy, and its hopes of major power status, for decades.

"Russia's potential is seriously impaired by the woeful state of the population's health," he said.

The principal reason isn't poor medical care, though many hospitals are antiquated, and health-care spending is a fraction of that in the West. More significant is the risk-prone lifestyle of Russian men and the failure of doctors and government to stress prevention.

Almost two-thirds of Russian men smoke, compared with one-fourth of U.S. men. Some researchers estimate that the typical Russian man drinks a pint of pure alcohol every two days, compared with less than two pints a month for the average American man or woman. Only 6 percent of Russians exercise regularly. High-fat foods are so popular that some Russian restaurants offer a chunk of salted pork fat as a stand-alone item.

Next to heart disease, violence and accidents claim the most Russian men. More die every year of accidents, poisonings, drownings, homicides and suicides than die of cancer. Alexander Pochinok, Russia's labor minister, calls the accident rate "unbelievable."

About 40,000 Russians die every year of alcohol poisoning. In the U.S., with nearly twice Russia's population, alcohol poisoning kills about 300 a year. Roughly 17,000 Russians drown annually, most of them drunken men, a rate nine times higher than in the U.S., where most drowning victims are children.

Such statistics follow a decade of financial and social upheaval. Russia has been sliding toward poor health since the mid-1960s, but perestroika precipitated a dizzying plunge. Russia's overall death rate jumped by almost a third in the past decade, mostly due to heart disease and violent deaths. Health experts say the sudden loss of stability and security simply drove some Russians over the edge.

But if capitalism has taken its toll, so did communism. Russians were drilled for decades to believe that the state would take care of their health. As a result, said Raphael Oganov, director of Russia's National Research Center for Preventive Medicine, Russians have continued to suffer from their bad habits while Westerners started to correct theirs.

"In the Soviet Union, it was embarrassing to care about your health," Oganov said. "We were made to think that. The Ministry of Health was in charge of your health. Your priority was to work for the society."

Until the mid-1960s, the Soviet populace had no reason to mistrust the Health Ministry. Life expectancies in the West and the Soviet Union differed by only a few years. Both countries waged the same successful battle against infectious disease.

But the West moved on to a bigger, more expensive fight against chronic and preventable ills such as heart disease and many forms of cancer. Health-care spending grew by leaps and bounds, as did emphasis on prevention.

Goskomstat, the Soviet Union's statistical agency, illustrated the political leadership's head-in-the-sand approach in its annual reports. When it became clear in the 1970s that Westerners were living longer, mortality rates were no longer published.

Russia finally is focusing on at least some areas. A new law bans cigarette sales to minors and restricts smoking in public places. The Kremlin's budget for next year requests a 60 percent increase in doctors' salaries.

Still, Russian leaders don't favor bold measures, shying away from the World Health Organization's recommendation of higher cigarette taxes. A pack of Pall Malls or Winstons in Moscow costs 50 cents, compared with $4.50 in a Washington, D.C., vending machine. Russian cigarettes cost even less.

Few even suggest higher alcohol prices. A half-liter of vodka costs $1 in Moscow. Some Russians consider beer a breakfast drink; in the state's eyes, it isn't an alcoholic beverage.

In the end, capitalism may be one of the strongest forces for health. Being sick is costly; Russians are finding disabling accidents and chronic disease lead to a life of poverty.

"The market economy makes people think about their health," said Oganov. They "start to understand that their health means money."