My projections, based on a model developed for West Germany
by the Population Reference Bureau, are less apocalyptic than those of
some other Russian officials, Duma members, and demographers. A new study
produced under the auspices of the Institute of Social and Political Research
of the Russian Academy of Sciences, for example, predicts that population
will decline to between 70 and 90 million by 2045. If one takes the annual
750,000 decrease noted by Putin and multiplies it by 50 years, the result
is a drop in population of 37.5 million persons, to a net total of 108
million not far from my estimate of 100 million. The U.S. population, meanwhile,
is projected by the U.S. Bureau of the Census to grow by 2050 from today's
275 million to 396 million, a level almost four times the projected Russian
In broad demographic terms, one can say that Russia's population is
being squeezed by two pincers. On one side is the fertility rate, which
has been falling since the early 1980s. Russian women now bear little more
than half the number of children needed to sustain the population at current
levels. In absolute terms, the number of annual births has dropped by half
since reaching a high of 2.5 million in 1983. Due to Russia's rising mortality
rates, fertility would need to reach 2.15 births per woman just to reach
the so-called simple population replacement level. As of 1999, however,
the total fertility rate stood at 1.17 births per woman. That is to say,
Russian women bear an average of 1.17 children over their entire fertile
life, from ages 15 to 49. Fertility would need to rise by some two-thirds
to reach the replacement level.
The Goskomstat projection points to an increase in fertility to 1.7
births per woman by 2006. But this prediction seems to be based on a simple
extrapolation of existing trends that does not take into account the deterioration
of Russians' health. The harsh reality is that the number of women in the
prime childbearing ages of 20 to 29 is falling, while the rates of sexually
transmitted diseases among men and women (which affect fertility) and gynecological
illnesses are both rising. The ranks of eligible parents, especially fathers,
are being thinned by tuberculosis, HIV/AIDS, alcoholism, drug abuse, and
other causes. Fifteen to 20 percent of all Russian families experience
infertility, with males accounting for 40 to 60 percent of the cases. Even
as mortality and disease take more and more young people out of the pool
of potential parents, attitudes toward childbearing have changed for the
worse. An estimated two-thirds of all pregnancies now end in abortions.
It is hard to see how the hoped-for fertility gains will occur. A steeper
decline in Russia's population seems unavoidable.
Mortality rates are also assumed to rise in the official calculation,
but much less markedly than I anticipate. Some perspective on the Russian
situation is provided by a comparison with the United States, which projects
an average life expectancy at birth and survival rates for specific age
groups that are far from the best in the world especially among 15- to
19-year-old males, who kill themselves with drugs, alcohol, and motorcycles.
But in the United States, a boy who lives to age 16 has an 88 to 90 percent
chance of living to age 60. His Russian counterpart has only a 58-60 percent
chance. And those chances are shrinking.
Tuberculosis is only one of the maladies whose surging incidence is
not reflected in current Goskomstat projections. The disease flourishes
among people weakened by HIV/AIDS, alcoholism, and poverty. Findings by
the research institute of the Russian Federal Security Service project
enormous numbers of deaths from tuberculosis. Whereas only 7.7 of every
100 new Russian tuberculosis victims died in 1985, the death rate is now
25.5 per 100. According to official reports, the number of tuberculosis
deaths soared by 30 percent in the 1998-99 period. The 1999 death toll
of 29,000 was about 15 times the toll in the United States, or nearly 30
times greater when measured as deaths per 100,000 population in both countries.
The Russian authorities also underestimate the future impact of HIV/AIDS,
spread chiefly by sexual contact and intravenous drug use. Vadim Pokrovskiy
of the Federal Center for AIDS Prevention, Russia's leading HIV/AIDS epidemiologist,
estimates there will be five to 10 million deaths in the years after 2015
(deaths that, I believe, aren't reflected in the projections). Most of
the victims will be 15 to 29 years old, and most will be males further
diminishing the pool of potential fathers.
Moscow reported 2.5 new cases of HIV nationally per 100,000 population
in 1998, but the actual rate may be five, 20, or even 50 to 100 times greater,
according to Russian epidemiologists and health officials. (The U.S. HIV
incidence rate was 16.7 new cases per 100,000 population in 1998.) The
Baltic port city of Kaliningrad and its surrounding oblast hold the unhappy
distinction of recording the highest official rate of HIV increase, at
76.9 new cases per 100,000. Moscow, however, is currently overtaking it.
Some Russian demographers take comfort from the fact that their country
is not entirely alone, since deaths exceed births in a number of European
countries. But in countries such as Germany and Italy, the net ratio is
close to 1.1 deaths to every birth. In Russia, deaths exceeded births by
929,600 in 1999, a ratio of 1.8:1 . If health trends and environmental
conditions are not dramatically changed for the better, Russia could see
two or more deaths for every birth in the not-too-distant future.
None of this is to say that there are not some signs of improvement.
Childhood vaccination rates for tuberculosis, diphtheria, whooping cough,
and other diseases have risen since 1995. Vaccination for rubella (German
measles), which causes birth defects when contracted by pregnant women
in the first trimester, was added to Russia's prescribed immunization calendar
in 1999. (However, no vaccines are produced in the country and none are
yet imported; almost 600,000 cases were reported in 1999.) But the larger
trends support the vision of looming demographic catastrophe. And a number
of other developments also offer dark portents for the country's future
rates of fertility and mortality, and for the general health of its people,
especially its children.
Sexually transmitted diseases have seen incredible rates of increase
during the past decade. These diseases cripple and kill, damage reproductive
health, and are associated with the spread of HIV/AIDS. The causes can
be traced to the explosion of pornography and promiscuity; to the growth
of prostitution, notably among 10- to 14-year-old girls; and, especially,
to drug abuse involving shared needles and syringes. In 1997, the Ministry
of Internal Affairs estimated that the market for illegal drugs was around
$7 billion, 600 times greater than in 1991.
The Russian Ministry of Health reported 450,000 new cases of syphilis
in 1997, and Goskomstat published a figure of close to 405,000. These are
the last reasonably accurate statistics we are likely to have, thanks to
a 1998 law that imposes prison terms on syphilitics who contract the disease
through drug abuse.
Just as one would predict, the number of registered new cases of syphilis
declined in 1998 and 1999. However, the explosion in new cases of HIV,
and a concomitant increase in the estimated number of drug addicts, belie
the latest figures on syphilis. The epidemiological synergy between HIV/AIDS
and other sexually transmitted diseases (including gonorrhea, which is
vastly under-reported) suggests not only that syphilis is more widespread
than reported but that further increases in the incidence of HIV/AIDS can
The 1998 law that classified drug addicts as criminals ensured that
few addicts a group at high risk for HIV will seek treatment. A specialist
cited in Komsomol'skaya Pravda in 1998 made this grim prediction: We will
see increased risk of complications and overdoses, the death rate among
drug addicts will rise, incidence of HIV/AIDS will rise; and...the illegal
market of drug-related services will begin to develop quite intensively.
Smoking is a habit among an estimated 70 percent of Russian males and
one-third of females, and multinational tobacco companies aim to increase
their sales in the country. The World Health Organization estimates that
some 14 percent of all deaths in 1990 in the Soviet Union and Eastern Europe
were traceable to smoking-related illnesses; it expects that number to
rise to 22 percent by 2020.
Alcohol consumption reflects an epidemic of alcoholism. Russian vodka
produced for the domestic market (usually in half-liter bottles) comes
with a tear-off top rather than a replaceable cork or screw top because
it's assumed that the bottle, once opened, will not be returned to the
refrigerator. An estimated 20 million Russians roughly one-seventh of the
population are alcoholics. Russia's annual death toll from alcohol poisoning
alone may have risen to 35,000 in 2000, as compared with 300 in the United
States in the late 1990s.
Hepatitis B has sharply increased in incidence, but the sole producer
of vaccines for the disease told me in Moscow that only 1.3 million doses
are produced annually to meet a total demand of 13 to 14 million doses.
Perhaps even more alarming in the long run are increases in the incidence
of hepatitis C, an illness that chiefly attacks the liver and requires
a very costly treatment protocol. The disease is often fatal.
Micronutrients are in short supply, especially iodine. No iodized salt
has been produced in Russia since 1991, and little or none has been imported.
In young children, iodine deficiency causes mental retardation.
Avitaminosis is common. A longitudinal study by the Institute of Nutrition
of the Russian Academy of Medical Sciences finds shortages of folic acid
as well as vitamins A, B complex, D, and E among 30 percent of the population.
Heart disease exacts a toll, in age-standardized death rates, more than
twice that in the United States and Western Europe. The death rate from
such disease per 100,000 population is currently 736.1 in Russia, 267.7
in Belgium, 317.2 in the United Kingdom, and 307.2 in the United States.
Cancer is becoming more common. New cases increased from 191.8 per 100,000
population in 1990 to 200.7 in 1998. The incidence is likely to rise as
a consequence of long-term exposure to low doses of radiation from decades
of nuclear testing, as well as to benzo(a)pyrene, dioxin, and other industrial
carcinogens. As in so many other cases, official statistics understate
the problem. There is significant under-reporting of breast cancer, for
example, especially among women of Muslim origin, who are reluctant to
seek treatment from male doctors.
To all the foregoing challenges to the Russian future we must add a
daunting collection of environmental ills. Russia will have to cope with
a legacy of industrial development undertaken virtually without heed of
the consequences for human health and the environment, just as it will
have to contend with the consequences of decades of testing and stockpiling
of nuclear, chemical, and biological weapons.
The crises that temporarily focus worldwide attention on these problems,
such as the 1986 Chernobyl nuclear power plant accident, only begin to
hint at their severity. The news media beamed shocking reports of the 1994
Usinsk oil spill around the world, but it was only one of 700 major accidents
and spills (defined as those involving 25,000 barrels of oil or more) that
occur every year in Russia, spreading phenols, polyaromatic hydrocarbons,
and a variety of other toxic chemicals. As Victor Ivanovich Danilov-Danilyan,
the former head of the State Committee on Environment, notes, these losses
are equivalent to about 25 Exxon Valdez spills per month!
Radioactivity remains a continuing concern. After the 1963 Test Ban
Treaty barred open-air atomic weapons testing, the nuclear powers continued
to conduct underground tests. But there was an important difference in
the Soviet Union. There, many of the nation's more than 100 nuclear explosions
occurred in densely populated regions such as the Volga, as well as in
the Urals and Yakutiya (Sakha) regions. After first denying that any of
those explosions had been vented into the atmosphere, then Minister of
Atomic Industry Viktor Mikhaylov later admitted that venting had occurred
in 30 percent of the underground blasts.
What goes on today within the 10 formerly secret nuclear cities devoted
to the development and production of nuclear weapons in Russia remains
largely a mystery. Around the city of Chelyabinsk, a thousand miles east
of Moscow in the Urals, some 450,000 Russians face unknown risks from a
series of spills and accidents that occurred from the late 1940s to the
1960s. And area rivers may have been tainted by seepage from nuclear waste
directly injected deep underground at the Krasnoyarsk, Dmitrovgrad, and
Tomsk sites. Near the Tomsk-7 facility, the site of a serious nuclear accident
in 1993, Russian and American environmentalists recently found evidence
of phosphorous-32, a radionuclide with a half-life of only about two months.
The discovery strongly suggests that radioactive wastewater used in cooling
Tomsk-7's two remaining plutonium-producing plants was illegally dumped.
Chemical pollution is widespread. Even in Moscow, which is home to much
heavy industry, there is evidence that pollution has caused genetic deformities
in the young [see photo, facing page]. In a study of the impact of chemical,
petrochemical, and machine-building industries on human health, the Russian
Ministry of Health found that newborns suffered congenital anomalies at
a much higher rate (108 to 152 per 10,000 births) in industrial cities
than in rural localities (39 to 54 per 10,000).
Alarming cases of mercury pollution, which causes illness and birth
defects, have been reported (though aggregate official data have never
been published). Three years ago, 16 tons of mercury was released upriver
from the major northern city of Arkhangel'sk. In Krasnoural'sk, a city
in the Urals that produces car batteries, Russian and American researchers
have found that 76.5 percent of the children are mentally retarded. Lead
is the cause. Cadmium and arsenic are prevalent in the air and land throughout
much of Russia. In the Arctic north, wind-blown heavy metal salts and other
pollutants from the city of Norilsk's nonferrous metal plants have left
the land barren and treeless for 75 kilometers to the southeast. Lakes
and rivers everywhere are badly polluted by heavy metals dumped by industry
and allowed to run off farmland. Estimates by the Yeltsin-era Ministry
of Ecology and other observers suggest that only 25 to 50 percent of Russia's
fresh water is potable.
The world has not been blind to Russia's plight. By late 1998, the United
States and other donors had sent more than $66 billion in aid, according
to a U.S. government estimate. The list of donors includes even South Korea,
and recently officials of the European Union and the World Health Organization
have recognized the need to act aggressively. But the aid has been inadequate
and piecemeal, and its delivery has been hampered by corruption and inept
administration. The frightening reality is that it may already be too late
to help. Andrey Iliaronov, an economic adviser to President Putin, has
pointed to 2003 as the year of reckoning, when the demographic crisis,
the crumbling infrastructure, and the burden of massive foreign debt may
combine to deal a crippling blow to Russia's remaining productive capacity
and thus, to its ability to help itself.
Where will the money come from for all the myriad improvements needed
in reproductive and child health, for tuberculosis prevention and treatment,
for HIV/AIDS cocktails of protease inhibitors? Who will supply the $400
billion needed to clean up the water supply over the next 20 years, or
the $6 billion to clean up chemical weapons storage sites, or the hundreds
of billions to clean up nuclear waste? The list of needs is depressingly
long, and the Russian government has not always taken the right steps to
address them. Last year, for example, President Putin abolished Russia's
main environmental agency, the State Committee on Environment, and transferred
its responsibilities to the Ministry of Natural Resources, which is in
the business of developing the country's oil and mineral reserves. And
yet, despite how daunting the task may seem, and how long the odds of success,
we cannot simply ignore the ruin in Russia. The United States and other
nations of the world have a profound interest in helping to avert an economic
and demographic Chernobyl that would give a fearful new meaning to the