Dead Souls

A prominent demographer warns that the spread of tuberculosis and AIDS in Russia will soon make Western hand-wringing over the pace of Russian "economic reform" seem quaint

HEALTH in Russia is even worse than most Russian and foreign commentary would indicate, and the consequences for Russian society, the Russian economy, and the Russian military will be enormous.

Environmental issues lurk behind much of the public-health problem. Radioactive contamination is rife. Chemical contamination, such as by dioxin, is largely to blame for the fact that life expectancy for both men and women in the town of Dzerzhinsk, in the region of Nizhegorodskaya, is no better than fifty years. At least until 1995 DDT continued to be used, despite an announcement by the Soviet government almost three decades ago of a ban on its production and use. Bad water nationwide has led to high rates not only of bacterial dysentery but also of hepatitis and cholera. The air in Omsk is polluted; authorities two years ago distributed some 60,000 gas masks to residents. And thermal-power plants throughout the country are spewing forth carcinogens, owing to incomplete combustion. Lead emissions in Russia are about fifty times as great as those in all of the European Union. I have seen a Russian government report indicating that as a result of lead pollution in one locale, "76.5 percent of the children in the town are mentally retarded."

But even absent these environmental problems, public health in Russia would be appalling. I anticipate that an unprecedented surge in the incidence of infectious and parasitic diseases, combined with existing high levels of alcohol poisoning and violent death, will contribute to a continued lowering of life expectancy. The Russian population is likely to decline as well, by about 800,000 to a million people a year until 2010, when the total may well be no more than 138 million. Alcoholism, drug abuse, sexually transmitted diseases, malnutrition, and various chronic and infectious diseases already mean, among other things, that a third of the adult population is incapable of reproduction.

The incidence of tuberculosis in Russia has skyrocketed. The number of deaths ascribed to tuberculosis in Russia in 1996 (24,877) was almost 15 percent greater than the number of new infections (usually nonfatal) that year in the United States. The Russian mortality rate for tuberculosis is 16.9 per 100,000; the U.S. rate is 0.5. According to the State Statistical Agency, the number of new cases of tuberculosis that occurred in Russia in 1996 is 99,000 -- an official number that is in fact far too low. It is known that at least a tenth of prison inmates in Russia have tuberculosis, and that some 850,000 to one million Russians are in prison. Are these infected prisoners in the official data? For that matter, do the agency figures include the homeless, forced migrants, refugees, people living in railroad stations, people who avoid the medical establishment, and so on? I believe that the number of new cases is actually closer to 150,000 each year. And given that even ordinary pharmaceuticals are pathetically scarce, are not most of these people going to die of the disease?

If a memorandum titled "Epidemic Tuberculosis in Russia," prepared by the Ministry of the Interior and described in a Newsday article by Laurie Garrett, is even close to being correct, then the Russians face a bleaker future than they (or we) could have thought possible. To quote: "By the year 2000 the incidence of [tuberculosis] will increase '50 times compared with now'; mortality will increase seventy-fold; and deaths in children are expected to rise ninety-fold." If these predictions prove true, then Russian deaths attributable to tuberculosis will be more numerous than the total reported for heart disease and cancer. In 2000, according to these numbers, tuberculosis deaths in Russia will reach approximately 1.75 million, whereas I estimate that heart-disease and cancer deaths will number about 1.5 million. This says something extraordinary about the state of public health.

HIV and AIDS cases in Russia and deaths from AIDS are also on the verge of exploding. The former Minister of Health, Tatyana Dmitriyeva, has forecast that a million Russians will be infected with HIV by 2000. Assuming that only half that many are infected and that it costs "only" $15,000 per patient per year to administer protease inhibitors, AZT, and 3TC, where is the $7.5 billion a year for these drug cocktails to be found? The answer is nowhere. AIDS patients in Russia will die.

The growing number of Russian AIDS cases reflects a sharp rise in sexual promiscuity and hard-drug use. In the past five years syphilis cases among girls who are fourteen or younger have increased thirtyfold. Chlamydia rates are said to be very high in the same age group, though very few, and likely unreliable, data are available. How sick will these children be in subsequent years? Will they be able to have children themselves? Will their children also be sick? Will they become part of Russia's growing army of drug abusers, now thought to number four to six million? Many of them, of course, will simply die young.

Here is another way of viewing the overall health situation: How many of today's sixteen-year-old males will survive to age sixty? In the United States the figure is about 83 percent. In Russia it is only 54 percent; a hundred years ago in the European part of Russia the figure was about 56 percent. Of course, many of the Russian men who survive to age sixty will be very sick.

Analysts specializing in geopolitics, economics, or the military who ignore these issues do so at the risk of overlooking Russia's most fundamental realities. So much of the shrinking Russian population may soon be so ill that long-term solutions to the country's political, economic, and military problems will be inconceivable.

Murray Feshbach is a research professor at Georgetown University and the editor in chief of (1995).

Illustration by Luba Lukova

The Atlantic Monthly; January 1999; Dead Souls; Volume 283, No. 1; pages 26 - 27.