DZERZHINSK, Russia -- After a career on the front line in the
battle to stave off Russia's worsening demographic nightmare, Dr. Sergei
Shamin has a few choice words for his fellow Russians.
"What irritates me and makes me furious is why our people don't want
to be healthy!" he says. "Why do they want to be sick?"
In a city so polluted that even a puritanical lifestyle is unhealthful,
he has seen it all. "If there's a person who should not be anywhere near
a smoker, he smokes himself. If there is a person who should not get even
a whiff of alcoholic fumes, he gets himself drunk. If there is a person
already in weak and perilous health, he applies for and takes a job working
in hazardous conditions." Shamin, 48, is a gadfly for good health in Dzerzhinsk,
which is about 250 miles east of Moscow. He directs the Institute of Industrial
Disease and Pathology in the city, which is regarded as one of Russia's
most severely polluted. He recalls catching a man sent to breathe salt
vapors as therapy for his chemical-seared lungs sneaking off into a dark
corridor for a cigarette.
Such self-destructive tendencies, he believes, help account for the
widening gap between births and deaths in Russia. He also blames public
policies that he believes pay people to be sick but discourage them from
getting early treatment or taking steps to stay healthy.
There are approximately 4 million fewer Russians than there were 10
years ago when the Soviet Union collapsed. The country's population, 148
million in 1992, has dropped to 144 million this year, even counting the
millions of immigrants from other post-Soviet states that it has absorbed
over the same
period.
Long part of the world's third-most populous country, the Soviet Union,
Russia now ranks sixth behind China, India, the United States, Indonesia
and Brazil.
Behind Each Death Is a Personal Tragedy
Some demographers believe Russia's population will dwindle to 130 million
by 2015, and Russia will find itself even lower on the totem pole, behind
Pakistan, Bangladesh, Nigeria, Mexico, the Philippines and perhaps a few
other countries.
Russia's demographic squeeze is caused by a significant rise in the
rate of deaths, coupled with a plummeting birthrate. In the 1990s, in the
face of economic uncertainty, many women delayed or abandoned plans to
have children.
The death rate accelerated, especially among working-age males. In a
recent Rand Corp. paper, "Dire
Demographics: Population Trends in the Russian Federation," researchers
theorize that social upheaval and declines in real incomes in some segments
of society heightened stress and increased mortality
from cardiovascular disease and from alcohol-related accidents, violence
and poisonings.
Behind those grim global numbers are heart-rending individual cases,
says Dr. Svetlana Solovyova, a general practitioner in Dzerzhinsk, who
says she sees patients in their 30s every day who are being killed by alcohol
and disease.
The 38-year-old physician does not expect to live a full life herself.
Her husband, Mikhail, is on disability after developing a pancreatic disease,
which he believes was caused in part by working as a teenager in a factory
that produced DDT. He is only 33.
"Some people in the country, working in villages, somehow they survive
until their 90s. I must say, we will never live to that age. It would be
great if I even live to see my pension," Solovyova said. She becomes eligible
at 55.
Although there is nothing wrong with her, she expects to die "because
of this constant stress of trying to survive, trying to find something
to eat and give an education to our child."
At any rate, the doctor, who earns 1,500 rubles a month--about $50--is
convinced that "we will never, ever live well."
As for her patients at a public health clinic, vodka is a major shortener
of lives. She said the proclivity to drink is an outgrowth of their lack
of hope.
"People reckon they have enough money to buy food, and what's left--they
will drink it away--because this money will be worthless in a while anyway."
Dzerzhinsk was designated by Communist central planners as a center
of Russia's chemical and chemical-weapons industries. In 1997, the environmental
group Greenpeace claimed that the average life expectancy of its citizens
had dropped to around 45.
Shamin disagrees with that estimate but noted that the city's annual
death rate, 17 per 1,000, is significantly higher than Russia's national
average of 14 per 1,000.
Retirement Often Cut Short by Death
In the city of 300,000, that translates to about 900 extra deaths annually.
(In the United States, the morbidity rate is around 9 per 1,000.) [Оригинальная
мысль: сравнить смертность и заболеваемость]
"Retiring sometimes may sound very sad in this town because people go
on pension and die in three years, two years, sometimes a year or less.
It often depends on what enterprise you worked at," said Dimitri Levashov,
28, an ecological activist.
According to figures from the city's ecology department, prior to Russia's
1998 economic crash, about 300,000 tons of chemical waste were dumped around
town every year and some 190 chemicals were emitted into the atmosphere,
many of them hazardous, Levashov said. The situation is better now, because
the factories are operating at 30% of capacity.
Plant managers of failing businesses have few means to clean up their
operations and only toothless legal requirements, he said.
Shamin uses contacts with industry executives to encourage them to improve
conditions. He also argues, mostly fruitlessly, that workers should limit
work in environmentally dangerous plants and seek treatment when they first
notice problems with their pulmonary and nervous systems. Fearing to lose
pay, they typically wait years, until they are almost disabled, he said.
Shamin has been speaking out on health issues since he was a young man
battling the local Communist Party. One incident sticks out in his memory
as an example of the old party bureaucracy's callous disregard for public
health.
In 1988, a cloud of noxious gas descended on him and others in line
at Dzerzhinsk's only cinema. He believes the gas was a nitric oxide leak
from a chemical plant. The next day he wrote the first secretary of the
city Communist Party committee, demanding an investigation.
Shamin was summoned to the committee, where the infuriated secretary
for ideology almost screamed at him, telling him to mind his own business.
"We will show you!" he recalled the red-faced woman shouting as they
parted. But Shamin, then a communist himself, said: "I know I am right
and you can't scare me."
Now Shamin irks the establishment in other ways. When he proposed in
public recently that the social security system reduce benefits to people
who refuse to quit smoking and drinking, municipal authorities were peppered
with demands that he be dismissed.
Shamin still has the same answer: "I know I am right."
Sergei Loiko of The Times' Moscow Bureau contributed to
this report.