A Sick and Shrinking Nation By Murray Feshbach
If demography is destiny, then the destiny of Russia for the next 50 years is appalling.
Consider: In mid-year 1990, the population of Russia was 148.3 million. By 2015 it is expected to be as low as 138.4 million, and possibly even down to around 131 million. In fact, given some more recent statistics and projections on fertility rates, the lower projection seems more likely, especially given anticipated higher mortality rates as losses from the epidemics of tuberculosis and AIDS manifest themselves after 2005. Combining this information, as well as other factors, a projection of 80 million by 2050 is not out of line.
The implications of such population declines for the labor force, armed forces and Russian society as a whole are enormous, and affect Russian policy in a number of ways. With the population declining at such rates, the health of each individual at the margin becomes even more important. With fewer children being born, reproductive health of their mothers is the key to healthy children.
But some 75 percent of all pregnant women in Russia have a serious pathology during their pregnancies, not only from anemia (reflecting iron deficiency that is likely due to malnutrition) but from increases in diabetes, endometriosis and sexually transmitted diseases (other than HIV/AIDS). Infertility reportedly is increasing by more than 3 percent per year, over and above the 15 percent to 20 percent of all couples who are infertile at this point in time. In this regard, new incidence of syphilis has increased 77 times since 1990 for both sexes, and some 50 times for 10- to 14-year-old girls. For the armed forces, figures for the past five years show an 11-fold increase in the number of draftees showing up with syphilis, unfit for service.
Malnutrition may also account for the serious increases in stunting and wasting--that is, changes in height and weight by age. Smaller chest measurements are attributed by the chief pediatrician of the country to malnutrition throughout the nation.
Tuberculosis cases are expected to increase to 1 million cases by 2002--and cases of multi-drug resistant TB, which now number around 30,000, can be expected to overwhelm the health care system, along with the 2 million projected HIV/AIDS cases.
My estimate of the cost of treatment for these ill persons is close to $30 billion. There is no such amount of money available, even from the International Monetary Fund, let alone from a Russian budget now being affected by warfare in Chechnya, and by who knows what other territorial conflict in the future.
The rates of other major illnesses in Russia lead to even more negative projections of future population. For example, cancer and heart death rates for 15- to 19-year-olds are double the U.S. rates, according to a joint U.S.-Russian report. For this age group, suicides in Russia also are about double those of the United States. In addition, high rates of alcoholism and tobacco use among the entire population seem likely to continue to add to the burden on the public health system.
Looking at the labor force just in the next 15 years (before the major drop that can be expected to follow), the working age population, after a rise of around 5 million, will decrease almost 9 million as the lower fertility rates begin to be felt. After this point in time one can fully expect the working age population to decrease even more as lower numbers of births take place. Moreover, the health of these newborns will be even poorer. Thus the need to increase labor productivity will be even greater--just to maintain GDP at a steady level.
I do not expect this productivity increase to take place, nor is there likely to be any major substitution of foreign capital for labor in the near term, since corruption continues to be rampant and the rule of law practically nonexistent. Thus GDP will fall and less money will be available to improve the health of the smaller number of women producing healthy babies for the labor force and armed forces.
Will this cause the restive areas beyond Chechnya, such as the far eastern region, Sakha, Tatarstan and others, to seek more autonomy? If the problems between Russia's center and its periphery resulting from these demographic trends are as serious as I believe they will be, then the ability of the center to control the delivery of natural resources will be much constrained. If the republics withhold the large share of, say, newly discovered titanium in Sakha that would usually go to the center, what will Moscow do?
And what kind of troops will Moscow have if they are not only smaller in number and physical size but suffering from serious illnesses?
These are cruel questions to be faced by a country with a long history of expansion--now facing a future that seems to lead only in the other direction.
Murray Feshbach is a research professor at Georgetown University.