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Los Angeles Times
December 16, 2001
Disregard for Health Is Killing Russians
Europe: As pollution and alcoholism raise the death rate, economic uncertainty lowers the birthrate, creating a demographic crunch.
By JOHN DANISZEWSKI, TIMES STAFF WRITER

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.)

"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.