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WEEKLY NEWSLETTER
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Kazakstan
Index
The deterioration of the public health system has hit Kazakstan's
population hard. Rates of infant mortality and overall mortality have
risen in the 1990s as the fertility rate has decreased, contributing to
the first drop in the republic's population since World War II. Infant
mortality was twenty-seven per 1,000 live births in 1991, the lowest rate
among the five Central Asian republics but higher than that for any
non-Central Asian republic. A lack of medicines and facilities, together
with a general deterioration in physical environment and living standards,
has promoted outbreaks of several potentially epidemic diseases, including
diphtheria (its incidence increased from thirty-five cases in 1993 to 312
in the first ten months of 1994), poliomyelitis (two cases in 1994), viral
hepatitis, and cholera (of which outbreaks occurred in 1992 and 1993). The
incidence of tuberculosis has grown substantially, with as many as 11,000
new cases and 2,000 deaths reported annually (see table 5, Appendix).
According to a 1995 report of the Contagious Disease Association in
Almaty, a bubonic plague-carrying rat population was moving from the
Balkhash region, where the plague is endemic, southward toward Almaty,
whose municipal government had taken no measures to control rats.
The first death in Kazakstan attributed to acquired immune deficiency
syndrome (AIDS) was reported in July 1993. At that time, nineteen carriers
of the human immunodeficiency virus (HIV) reportedly were registered in
Kazakstan. Of that number, three were identified as homosexuals, two were
preschool children, and nine were foreign citizens, who were deported. In
mid-1995, the WHO reported that twenty-seven people had been diagnosed
with AIDS or as HIV-positive between 1993 and 1995. The Kazakstan AIDS
Prevention and Control Dispensary was established in Almaty in 1991, with
twenty-two branch offices and diagnostic laboratories elsewhere in the
republic. However, in the early 1990s diagnosis and treatment relied on
foreign funds and equipment because domestic health funds were barely
sufficient to maintain clinic buildings. Fewer than 500 requests for
screening were received in 1993. In mid-1995, the government set up the
Coordinating Council for Combating AIDS under the direct administration of
the prime minister.
The shortage of health care has put children at particular risk.
Approximately 15 percent of newborns in 1994 were unhealthy, most often
suffering from bronchiopulmonary and cardiovascular problems. Measles,
diphtheria, brucellosis, and other childhood diseases became more
prevalent during the early 1990s.
Extensive pollution and degradation of large segments of the natural
environment have increased the strain on public health. Both the air and
water of many of the large cities are badly polluted. Three regions have
been identified as having particularly hazardous environments. Öskemen
(formerly Ust-Kamenogorsk) in the far northeast has been rated the third
most polluted city in the former Soviet Union, with ten times the maximum
permitted levels of lead in the air and high concentrations of beryllium,
thallium, mercury, cadmium, antimony, and arsenic in the municipal water
supply. Just west of Öskemen, in Semey, a major site of Soviet
nuclear testing from 1949 to 1991, radiation has contaminated the air and
soil. Experts believe that the tests, which were conducted in the
atmosphere until 1963, contaminated the environment of the entire country
of Kazakstan. In one village, Kaynar, near the main proving ground, 140 of
3,400 children were found to have been disabled since birth; in a random
sample of another 600 of the town's children, all were found to be
suffering ill health of one form or another. Radiation is believed the
cause of such statistics. The third major area of environmental
degradation is the Aral Sea Basin along the southwestern border, where
agricultural runoff and untreated sewage have caused advanced pollution of
groundwater (see Environmental Problems, this ch.).
Water contamination is a serious environmental health hazard in
Kazakstan because of poor management of drinking water and insufficient
sewage treatment. About 30 percent of rural communities obtain water from
shallow wells; the water is vulnerable to contamination by materials
leached from the surface. As late as 1985, only 37 percent of homes had
sewerage systems and running water, and even schools and hospitals had
primitive sanitary systems that caused frequent outbreaks of intestinal
illness.
The diet and lifestyle of many citizens, especially in the cities,
contribute further to poor health. The average diet is high in meat and
salt and low in vegetables and fruits. The hyperinflation of 1992-93 cut
deeply into family budgets, limiting both the variety and quantity of food
most ordinary people consume. Smoking is almost universal, especially
among men, and alcoholism is common. Other forms of substance abuse such
as the use of hemp, morphia products, and glue are common, especially
among young people.
Occupational hazards constitute another major health problem.
Especially during the economic hardships of the early 1990s, public health
authorities refrained from measures such as closing polluting factories or
restricting the use of fertilizers, pesticides, and irrigation water out
of a fear of accelerating the general decline in production. Because of
the dangers posed by exposure to toxic smoke and fumes, lead and phosphate
plants limit workers to ten years of employment. With little restriction
on how they are operated, factories in Kazakstan note high rates of
morbidity, absenteeism, and permanent disability among their employees.
Data as of March 1996
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