A Country on the Verge
By MURRAY FESHBACH
President Bush and President Vladimir Putin of Russia will have much to discuss when they sit down in St. Petersburg today: Iraq, terrorism, nuclear arsenals, NATO expansion. It is vital, however, that they also address Russia's mounting health crisis.
As Mr. Putin has pointed out in two of his four state of the union messages, Russia faces shocking demographic trends. For every 10 babies born, 17 Russians die. The government predicts that the population will decrease 30 percent to 40 percent by 2050. And even these dismal figures may be too optimistic, as they are based on Western European models of public health and not the Russian reality of widespread substance abuse and tuberculosis and pending AIDS epidemics.
Although Russia's H.I.V. problem, for example, doesn't now compare to a country like Botswana with its 20 percent infection rate, we are seeing some cities with 5 percent of adult men infected, meaning cases in women will soon rise and the country may well follow the African pattern.
How bad are things? Take a look at a few statistics and projections from the Russian government, international health groups and Russian experts:
Population. Today: 145 million. 2050 estimate: 101 million.
Fertility. Today: 1.25 children per woman. 2050 estimate: 1.6 to 1.75 per woman. (2.15 children per woman are needed to maintain a population.)
H.I.V. cases. Today: the official Russian figure is 240,000; the United Nations AIDS organization estimates 750,000 to 1.2 million. 2020 estimate: 5.3 million to 14.5 million.
AIDS deaths. Total to date: 593. 2010 estimate: 72,000 to 120,000 each year. 2020 estimate: 252,000 to 648,000 each year.
Deaths by alcohol poisoning. 1991: 16,100. 2001: 41,100.
Tuberculosis cases. Today: the official Russian estimate is 135,000; the World Health Organization estimates 196,000.
Tuberculosis deaths in 2001. Russia: 29,000. United States: 781.
Heart disease (deaths per 100,000 people in 2001). Russia: 893. United States: 352.
Current life expectancy. Russian men average 58.2 years, women 72 years. American men average 74 years, women 79 years.
Odds that a man will live to age 60. Russia: 55 percent. United States: 88 percent.
President Bush's $15 billion AIDS package for Africa and the Caribbean is welcome, but Americans should recognize that the difficulties Russia faces may be almost as great. And the Russian deterioration may come with greater consequences. Epidemics invite chaos, and that's the last thing we want in a struggling democracy with huge arsenals of nuclear, chemical and biological weapons.
How can we help? Russia needs money and outside experts to analyze its problems, educate officials and train health workers. England, Japan and the Scandinavian countries have been assisting as well, and could do more. By 2020, the Russian AIDS program will need $28.5 billion for medications alone. Of course, this aid could be made contingent on Russia being more accurate and forthcoming with its health statistics ? China's SARS cover-up was a warning of how important transparency on diseases is in our interconnected world.
The Bush administration is certainly aware of Russia's condition ? Secretary of State Colin Powell repeatedly brought up Russia's skyrocketing AIDS rates with officials in Moscow earlier this month. At today's summit meeting, Mr. Bush can start turning that concern into a commitment.
