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. Ískemen (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 Ískemen, 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.
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