[fwd from JRL: From: Christian Caryl <[EMAIL PROTECTED]> U.S. News and World Report] Trouble on Main Street It's easy to imagine a time, not all that long ago, when Andrei was a vigorous, healthy teenager. Now, at the grand old age of 24, he is already wasting away. His cheeks are sunken, and he carries the weight of his wiry frame with visible effort. He is in an advanced stage of tuberculosis, the legacy of his two years in a Russian prison filled with diseased inmates. "Yes, I was a criminal," says Andrei, who will reveal neither his last name nor his crime. "I broke the law, and I received the sentence I deserved. But in the end I paid for my crime with my freedom, my youth, and my health." Andrei is no longer in jail. These days his home is the Tuberculosis Hospital in the southern Russian city of Taganrog, population 284,000. But here, as in prison, there is no lack of company. Fellow patients range from other ex-cons, some in their teens, to middle-aged military officers and farm workers. And the statistics suggest that the hospital's dedicated but grossly underpaid staff will have their work cut out for them in years to come. One health-care worker says that a recent test of Taganrog schoolchildren revealed that 50% were infected with the disease. A confidential tally by the Taganrog city government suggests an ominous trend. In 1997 the number of children under age 14 sick with the disease was 0; by the following year the figure had climbed to 12, and by1999 it was 29. Those numbers may be small, but they mirror an explosive TB epidemic in the country at large. Demographer Murray Feshbach at Georgetown University says that 7000 children under the age of 15 died of the disease in 1997. He estimates that Russia could see 200,000 new cases of TB this year; a more optimistic estimate by the World Health Organization (WHO) puts the number at 150,000. And TB, in turn, is just one ingredient in a vast tide of ill health, from malnutrition to AIDS, washing over the country's beleaguered health system - with predictably catastrophic effects on the state of Russia's population. At the end of 1999, according to the official statistics, there were 145.5 million Russians, 2.8 million fewer than in 1992 - even though hundreds of thousands of people, mainly ethnic Russians from other former Soviet republics, immigrated to Russia during the same period. Now that trickle of immigration has stopped, and Feshbach believes that the overall population of Russia could sink by another third within the next 50 years. Like many other scientists, he sees implications not just for public health, but for the economy and national security as well: "What are the implications of that for the labor force, for the armed forces? It's a multi-dimensional issue. It's not just demography qua demography." In this respect, Taganrog, an otherwise pleasant seaport town on Russia's temperate southern rim, is anything but extreme. Indeed, according to Natalya Rimashevskaya, Taganrog is downright average - a sort of statistically average Russian Main Street. Rimashevskaya should know. For the past 40 years her employer, the Russian Academy of Sciences in Moscow, has been using Taganrog as a living laboratory for a unique long-term study of nationwide health and social trends. And the trend that emerges with startling clarity is this: Russians are dying out. In Taganrog the birth rate has more than halved over the past 15 years (from 15.25 births per thousand in 1985 to 6.61 in 1999) - a pace that parallels Russia's development as a whole. At the same time, life expectancy has dropped (to a mere 59 for men, 71 for women). The result: a statistical effect Rimashevskaya calls "the Russian cross." The downward-sloping birth rate intersected the upward-sloping death rate in 1991, and Russia's population has been shrinking apace ever since. There are two other places in Taganrog that tell the story. One is the city cemetery, a rare island of growth in the city's otherwise sluggish economy. Construction workers are feverishly clearing land for an expansion, and plans for a new cemetery are in the works. The demand is there: an official says that townspeople are dying off at the respectable clip of 400 per month. At the cemetery entrance, a visitor's eye is caught by an array of particularly ostentatious gravestones, made of polished marble and featuring live-sizes engraved images of the deceased - all tough-looking men who died in their 30s and 40s. One of the little old ladies sitting on a bench nearby offers a terse explanation: "Bandits." But gangland killings are merely a drop in the bucket. Nicholas Eberstadt, another U.S. expert, says that the average Russian male now runs an almost 1 in 4 chance of dying from some sort of external trauma - compared with 1 in 30 in the United Kingdom. Car accidents, drownings, and fights all take their toll - often in lethal combination with that familiar Russian plague of alcohol. Per capita alcohol consumption of 8 liters per year virtually guarantees major health problems, says the WHO; Russians drink 15 liters per capita per year. Then there's Maternity Hospital No. 1, where a well-tended building and enthusiastic doctors can't quite paper over the sad reality that the baby business has seen better times. Rooms are visibly under-occupied. These days, doctors there say, the city's two maternity hospitals are turning out new Russians at the rate of around 180 births a month - half of what it was back in the early 1980s, and well under half of the cemetery's robust figure. And it's not just that fewer women are giving birth. Today's newborns weigh on average 200-400 grams less than they did 15 years ago, and up to a whopping 60% of the women entering Maternity Hospital No. 1 are suffering from anemia. "The mothers who are giving birth are sick, and they are giving birth to sick children," says Rimashevskaya, the Moscow demographer. Her interviewers in the field have pinpointed a central reason for the reluctance to give birth: The shock of Russia's economic free-fall in the 1990s, when its GDP fell by more than half. Confronted with that scale of instability, few families feel prepared to buck the odds. Indeed, researchers emphasize that psychology plays as much a role in the general health cataclysm as purely physical factors. Tuberculosis is the classic example. "TB is a social disease," says Lena Yurava, a 34-old nurse in Andrei's hospital in Taganrog. "People have lost their jobs, and life has become harder. In an earlier age, people got TB from unhappy love. It's a disease that comes from stress. We could heal these people if we could make them happy. But only God can do that." The resulting crisis of demographic confidence is making itself felt at every walk of life. In 1993, for example, Taganrog's Elementary School No. 12 boasted 100 first-graders; four years later there were only 80. That decline precisely tracks the sharp drop in the birth rate that took place in the first half of the 1990s - itself a response, Rimashevskaya argues, to the "shock therapy" economic reforms that began in 1992. "A minimum class size is 25," says Olga Kulikova, a teacher at School No. 12 and a fieldworker in the Academy of Sciences study. "So that means there are now three first-grade classes at the school where there were four before." Draft boards in the city are trying to cope with growing numbers of malnourished and sickly young men. And an aging population is putting additional strain on an already underfunded health-care system. Local journalists say that demographics have become such a sensitive topic in Taganrog that the city government (which owns controlling shares in the town's media) forbids them to write about it. The city's head health inspector, Inna Yegorova, dodges a reporter's questions about the rate of TB infection among children. Then she excises particularly "sensitive" figures from a recent health survey before handing it over. Even then she's worried that she might have said too much: "They won't put me in jail for this, will they?" _______________________________________________ Crashlist resources: http://website.lineone.net/~resource_base To change your options or unsubscribe go to: http://lists.wwpublish.com/mailman/listinfo/crashlist
