is responsible for primary and secondary education, as well as vocational education; while the Ministry of Education and Science of Russia is responsible for science and higher education. Regional authorities regulate education within their jurisdictions within the prevailing framework of federal laws. Russia is among the world's most educated countries, and has the sixth-highest proportion of tertiary-level graduates in terms of percentage of population, at 62.1%. It spent roughly 4.7% of its GDP on education in 2018. Russia's pre-school education system is highly developed and optional, some four-fifths of children aged 3 to 6 attend day nurseries or kindergartens. Primary school is compulsory for eleven years, starting from age 6 to 7, and leads to a basic general education certificate. An additional two or three years of schooling are required for the secondary-level certificate, and some seven-eighths of Russians continue their education past this level. Admission to an institute of higher education is selective and highly competitive: first-degree courses usually take five years. The oldest and largest universities in Russia are Moscow State University and Saint Petersburg State University. There are ten highly prestigious federal universities across the country. Russia was the world's fifth-leading destination for international students in 2019, hosting roughly 300 thousand. Health Russia, by constitution, guarantees free, universal health care for all Russian citizens, through a compulsory state health insurance program. The Ministry of Health of the Russian Federation oversees the Russian public healthcare system, and the sector employs more than two million people. Federal regions also have their own departments of health that oversee local administration. A separate private health insurance plan is needed to access private healthcare in Russia. Russia spent 5.65% of its GDP on healthcare in 2019. Its healthcare expenditure is notably lower than other developed nations. Russia has one of the world's most female-biased sex ratios, with 0.859 males to every female, due to its high male mortality rate. In 2019, the overall life expectancy in Russia at birth was 73.2 years (68.2 years for males and 78.0 years for females), and it had a very low infant mortality rate (5 per 1,000 live births). The principle cause of death in Russia are cardiovascular diseases. Obesity is a prevalent health issue in Russia; most adults are overweight or obese. However, Russia's historically high alcohol consumption rate is the biggest health issue in the country, as it remains one of the world's highest,