Following the demographic collapse of the 1990s, economic recovery at the start of the 21st century, heralded a period of declining mortality, gradual increments in life expectancy and a small uptick in childbirths. In the 2010s, as life expectancy continues to rise, the smaller population cohort, born in the 1990s, enters both the labour force and the age of childbearing. This combination is delivering a renewed squeeze on the structure of the Russian population, which now has one of the most rapidly ageing populations in the world. This squeeze gives rise to an acute pension burden and a growing health burden. The latter, in the form of the growing challenge of chronic disease, is the subject of this paper. Chronic disorders, including CVD, cancer, respiratory disease and diabetes, are the leading causes of mortality globally and the incidence of these diseases is rising in Russia. Using individual level data, representative of the Russian population, we find that more than 40% of the population report living with multiple chronic diseases and we explore the distribution of this burden, it’s impact on the quality of life of elderly Russians and possible policy and individual responses.