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. Öskemen (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 Öskemen, 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.
Data as of March 1996