A number of forecasts were published in 2002 warning of the markedly deteriorating demographic situation in Russia, with some authors even talking of a demographic crisis. The question remains of the extent to which these processes are associated with the economic and political changes going on in the country and the extent to which this is the culmination of long-term demographic trends. The experts differ in their opinions and the following paper will not provide an entirely unequivocal answer either.
Over the last ten years the number of inhabitants of the Russian Federation has fallen by 4.3 million and according to long-term forecasts, over the next fifty years it will probably fall to the 100 million mark. These figures clearly indicate that the decline in the population, stemming both from a rise in the mortality rate and a sharp drop in the birth rate, is becoming a significant problem. Until the mid-1990s, the natural decrease in the population was partly balanced out by immigration, primarily from the countries of the former Soviet Union, but this influx of immigrants is progressively diminishing. During the 1990s there was also a sharp deterioration in the health of the population, which is very persuasively demonstrated by the reduction in life expectancy at birth, the high mortality rate among men of a productive age and the spread of epidemics such as AIDS, tuberculosis and hepatitis.
The Russian government is aware of the urgency of these problems, however, and has come up with a number of programs and policies to deal with them. One characteristic example is the Demographic Development Policy for the period to 2015, to which we shall devote our attention in the second half of this paper on the possible solutions to this problem.text clanku
1. Population Loss
Since 1992, when population numbers peaked (at 148.3 million), the number of inhabitants of the Russian Federation has fallen by more than four million to 143.9 million in 20021. The great majority of long-term forecasts expect this trend to continue. The official Goskomstat forecast anticipates that in 2050, 101.2 million people will live in Russia (according to the medium scenario)2. UN experts come to similar conclusions, i.e. that RF population figures will come to 104 million in the medium scenario. The estimates of prominent Russian demographers arrive at a lower medium in all cases and in the pessimistic scenario they come to 70 million inhabitants.3 However, it should be pointed out that long-term population forecasts have to deal with a large number of development factors, from the birth rate, mortality rate and immigration to various political and economic development factors and so forth, so they cannot be fully relied upon but need to be seen more as trend indicators. Nevertheless these long-term forecasts do raise the question of what is behind this decline.
The answer is evidently simple: since 1992 the number of deaths has exceeded the number of births, leading to a reduction in natural population increase. Natural population increase, or in our case decrease, is considered to be the difference between the number of live births and deaths over a certain period of time. Overall population increase or decrease also reflect net migration, comprising the difference between the number of immigrants and the number of emigrants.
After the mortality rate was stabilized at the beginning of the last century, population trends have been primarily affected by fertility. After the break-up of the Soviet Union, the total fertility rate declined from 2.007 (children per adult female) in 1989 to 1.249 in 2001. If we express the difference between these years in absolute figures, the number of those born in 1989 was 2,160,559 while this figure had fallen by 40% in 2001 to 1,311,604. Since 1999, when fewest children were born, the number of newly born children rose slowly and in 2002, according to preliminary results, 75,000 more children were born than in the previous year. However, this growth is anticipated because those born in the population boom years of the 1980s are now reaching fertile age. Over the longer term it is forecast that the increase in the total fertility birth rate will continue but that the total fertility rate will settle at 1.4 to 1.54. It should be pointed out here that the replacement level of population is reached when, on average, women give birth to 2.1.
However, a low birth rate is not just typical of the states of the former Communist block. It is also faced by a number of Western European countries as shown by the following table.
|State||RF (2001)||Czech republic||Lithuania||Belarus (2001)||Tajikistan||France||Germany||Italy||USA|
|Total Fertility rate||1,2||1,13||1,35||1,27||3,7||1,77||1,29||1,19||2,02|
Two explanations are put forward to account for this sharp fall in the birth rate. The first says that it is for economic reasons while the second says that the fall in the birth rate is associated with a change in values and the process of "individualization". The following facts speak in favour of the economic explanation. If we look at the fertility rate in the late 1980s, before the break-up of the Soviet Union, it comes to 2 or more, which was fully comparable, for example, with Britain or France. In 1990, when there was a sharp fall in the standard of living for many people, the total fertility rate fell below the level of 2, and continued to fall until it reached a minimum of 1.171 in 1999, i.e. immediately after the economic crisis of 1998. The cost of bringing up a child continued to rise but wages and benefits did not follow suit. Public opinion polls performed by the Russian Centre for Public Opinion and Market Research (WCIOM) show that:
- a. 46% of respondents described the material situation of their family as bad or very bad
b. 48% believed their family had adapted to the new conditions
c. 53% did not believe that the circumstances of their families would improve in the future5
Mention might also be made here of representative research to find how many children the Russians considered ideal, how many they would want and how many they would actually have. The results for 2000 showed that on average they would want two children (2.12) and that they actually expected to have one child (0.94). 6 This research indicates to me that as far as their values are concerned, the Russians are geared to having more than one child, but for "various" reasons they cannot afford to do so.
Supporters of the second approach stress the effects of the values on reproductive behaviour. Vishnevskii believes that demographic processes are independent of social conditions to a certain extent and that demographic processes should be seen in their global context. The reduction in the birth rate may thus be understood to be all part of the process involved in the second demographic transition that came about in Western Europe from the mid-1960s onwards. This second demographic transition, accompanied by a fall in the total fertility rate below the level of simple reproduction, as well as by increasing cohabitation and a rise in the age for bearing one's first child, is most often associated with the growth of individualism and a change in the values of the population.7 This explanation fits the gradually rising age for having one's first child, which came to 25.9 years in 2001. In Western Europe the age of motherhood has been rising progressively since the 1970s. S. Zacharov8 believes that in 2015 the highest birth rate should shift from the 20-24 age group to the 25-29 age group, which he says will be the culmination of the second demographic transition.
In addition to economic conditions and the climate of opinion in society, fertility is also affected by the state of health of women at a reproductive age. The Chief Obstetrician and Gynaecologist of the Russian Federation, V. Kulakov, says that women's health is also deteriorating. 15% of women between the ages of 15 and 49 are sterile. Half of all pregnant women suffer from anemia, which contributed to the fact that in 2001, 58.8% of children born suffered some form of inherent disorder.9
The legalization of abortion and the availability of contraceptives also naturally have their effect on fertility. Hence in connection with the falling birth rate there is also some talk in Russia of restricting abortions10 and family planning programmes (including advice on planned reproduction) and the possibilities of a pronatal policy are also under consideration.
In 2001, two thirds11 of all pregnancies ended in abortion12. This high abortion rate in Russia may be explained in terms of historical development. Russia first legalized abortions as far back as 1920 during the famine, with the aim of curtailing illegally performed abortions, which cost many women their lives. Under socialism abortions became the most widespread family planning method as high-standard contraceptives were not available and for the healthcare service it was economically advantageous to carry them out so that health service workers were not too concerned about prevention13. To this day abortions are very popular, according to a number of obstetricians, because many women are prejudiced against the contraceptive pill, which in any case few can afford.14 In a public opinion research poll carried out in 1999 on the question of whether or not abortions should be banned, only 6% of women and 11% of men answered positively.15 Great consternation was caused, and not only in medical circles, by an initiative put forward by Deputy A. Chuev, who in order to improve the demographic situation proposed a restriction on free abortions on so-called social grounds (i.e. if the woman or her partner is unemployed or have nowhere to live) and an increase in the charge for abortions to a level that would make them prohibitive to the majority of the population. It is unnecessary to emphasize the effect on the health of women such a decision would have.
One aspect that can be viewed as positive is the markedly improved healthcare provided to pregnant mothers during the 1990s, which had a favourable effect on the maternity mortality rate figures, causing them to fall by one third, while the abortion mortality rate was cut by one half.16 Infant mortality has also fallen from 17.4 infant deaths per 1000 live births to the current 14.617, which is still high, however, in comparison with the developed world.
The most significant effort to increase the birth rate and to improve the standing of children18 might be considered to be the "Deti Rossii"19 programme, which was adopted by the Russian government on 3rd October 2002 for the 2003-2005 period. Its aim is to improve care for women during pregnancy, to improve medical care and the education provided to all children, particularly to improve the living conditions of orphans - "street children"20, the handicapped and also talented children.
A role is also played in the decline in the population by the increase in the overall mortality rate that we have witnessed over the last ten years in Russia. The most telling statistic on the mortality rate is the life expectancy at birth, which is based on specific mortality rate levels in individual age groups. Throughout the 1990s we can observe a falling life expectancy at birth, which is an entirely unprecedented phenomenon for a developed country in peacetime.
The life expectancy at birth for Russian men and women in 2001 came to 65.29 years. The life expectancy at birth for women in 2001 was 13 years higher (72.34) than for men (58.96). These figures suggest, for example, that only 58% of boys who are now 16 will reach the age of 60. For comparison, a table can be drawn up to show the life expectancy at birth in several countries.
Life expectancy at birth for men and women in selected states in 1999
|State||RF (2001)||Germany||USA||France||Ukraine||Lithuania||Armenia (2000)||Kazakhstan (2000)||China|
The most important factor in the current extremely low life expectancy at birth for Russian men is the working-age male mortality (15-59), which has almost doubled since the 1980s. In 2001, 514,688 men died between the ages of 15 and 59. The most frequent cause of death was from cardiovascular disorders (869.4 deaths per 100,000 inhabitants) followed by deaths from external causes (230.1 deaths per 100,000 inhabitants) including alcohol poisoning, wounds and injuries, suicides and murders. Mention should also be made here of the high suicide rate, which reached 39.7 per 100,000 inhabitants in 2001.
A higher mortality rate was recorded throughout the 1990s in all age groups. There are several theories to account for this dramatic increase. One sees a connection between the high mortality rate and increased consumption of alcohol, another points to the stress caused by the loss of a sense of security and the grim economic situation, others see the cause in the deteriorating standards of the Russian healthcare system.
V. V. Prochov21 believes it is the social problems associated with the transformation which have significantly contributed to the deterioration in the health of the population. He says they can be blamed for the sharp rise in cardiovascular diseases (by 40% since the 1980s), the number of suicides, murders22 and the increased mortality rate resulting from psychological problems. Up to 70% of the population suffers "psychological, emotional and social" stress, which in addition to the direct consequences involving an increase in the number of depressions and neuroses is also indirectly reflected in increasing consumption of alcohol and drugs.
An alternative explanation is given by A. G. Vishnevskii, who believes that the high mortality rate is only an extension of an earlier trend. In the socialist state there was always a preference for society at the expense of the individual, which was reflected here in a neglect of health protection and of the healthcare system as such. The depreciation in the value of health was also caused by the paternalistic role of the state, which only ascribed the individual a marginal role in the protection of his own health. He believes this is also shown by public opinion research polls in which the population is disturbed more by the low fertility rate than by the high mortality rate.23
A certain share in the blame for the dismal mortality rates is also apportioned to the poor state of the Russian healthcare system. Andreev and Kharkova24 believe the orientation of the healthcare system needs to be fundamentally changed. A system based on an extensive network of healthcare establishments, an improvement in conditions of hygiene, mass inoculation and an increase in the number of doctors certainly proved effective in the first half of the 20th century in the fight against infectious diseases but it does not match the predominant type of illness today, for since the 1960s, the mortality rate in Russia has risen primarily as a result of cardiovascular diseases and injuries. The authors believe that the Russian healthcare system is not technically equipped to achieve a second epidemiological revolution involving the treatment of "diseases of civilization", nor is it too successful in the field of preventative healthcare.
However, the government has become aware of the necessity to provide preventative healthcare and in addition to programmes aimed primarily at inoculation it is also involved in a number of campaigns to promote a healthy life-style. In developed countries, the life-style factor is considered to have up to a 50% influence on health.25 In view of the high proportion of "diseases of civilization" in overall mortality, life-style26 can also be considered a very important determinant in Russia and so nutritional habits and alcohol consumption will continue to be dealt with. As has been said, during the 1990s there was a significant drop in the standard of living for a large number of families. This reduction in income was reflected in the deteriorated dietary balance of many. The authors of "Losses and Gains in Russia in the 1990s" say there has been a return to what is known as the "bread and potatoes" diet, which was typical of the 1940s and 1950s. There was a significant reduction in the amount of meat, vegetables and fruit consumed while high consumption of sugar, bread and potatoes was also maintained.27 Paradoxically, rich families do not keep to a healthy diet either and merely consume a lot more of all types of food. The Russian authorities are trying to deal with the problems surrounding vitamin deficiences by issuing standards promoting the addition of certain vitamins and minerals in everyday products.28
Another factor which has made a significant contribution to the deterioration in health and particularly the high mortality rate among men is alcohol. The sharp decrease in the male mortality rate and the increase in life expectancy at birth during the anti-alcohol campaign29 of 1984-1987 are often cited as proof of this, as is the reversal in this trend just after the end of the campaign. Alcohol is particularly associated with numerous deaths from so-called external causes as well as many suicides.30 During the 1990s, 14 litres of pure ethanol were consumed per person31 (including infants) in Russia. And this is just one of the many problems. If the forecasts on the spread of AIDS turn out to be correct and the tuberculosis and hepatites epidemics are not arrested quickly enough, the resulting mortality rate will make the already complicated demographic situation in Russia significantly worse. The epidemiological crisis can be seen as one of the most pressing problems in the field of public health so I consider it important to mention some statistics on this subject.32
1.2.1. Epidemiological crisis
A considerable stir was caused by a CIA report published in October33 on the AIDS epidemic, in which Russia (together with Nigeria, Ethiopia, India and China) was singled out as a country that would be hit hard by the second wave of AIDS. According to CIA projections, by 2010 Russia will have five to eight million people who are HIV positive (6-11% of the population), particularly those at an economically active age, which together with other unfavourable demographic trends would result in significant economic34 and geopolitical weakening for Russia. This report attracted an immediate response from Russian experts, who cast doubt on the calculation methods. Their primary objection was against the coefficient 1035, used to multiply projections based on official statistics. Russia tests 16% of people in risk groups (24 million), from which it follows that the actual number of sufferers should not be three or four times higher than that given by statistics. They also believe that the spread of AIDS will tend to fall off because the epidemic has already broken out in the most vulnerable groups and regions.36
In the period from 1987 to 1995, a total of 1,086 people were infected.37 Several times this number, i.e. five to ten thousand HIV positive cases, are now registered in Russia every month. The growth dynamic of the disease is the highest in the world after Ukraine according to the Federal Centre for the Fight against Aids.38 Nevertheless the 'recently infected' figures are falling. In the period between January and June 2002, 28,670 people were infected while the figure for the same period in 2001 was 44,887.
The overall number of those infected in June of this year came to 207,700, which in the age group from 15 to 49 represents 0.3% of the population. As of July of this year, AIDS was diagnosed in 737 people39 but the experts point out that the actual number of people infected will be higher. The Director of the Federal Center for the Fight against AIDS, V. V. Pokrovskii, anticipates that there will be approximately one million people infected and a similar opinion is held by CIA experts, whose studies anticipate one to two million.
nbsp;In Russia there are 4,000 HIV positive children, 70% of whom were infected because they were born to infected mothers, so the Russian Ministry of Health has launched a programme entitled "Reduce the Risks, Protect the Future of Russia", wherein HIV positive mothers will receive free VIRAMIN, which should restrict transmission.40 Funding for these programmes is now a great problem41 and there is also clear discrimination against those infected, both in everyday life and as regards access to health services.42
nbsp;With the deteriorating social conditions in the 1990s, tuberculosis, which had almost been eradicated, has reappeared.43 The tuberculosis incidence rate, if we only count new cases, was 90.7 per 100,000 inhabitants in 2000, which means that tuberculosis has been diagnosed for the first time in 132,071 people. A total of 7.7% of the population is infected with tuberculosis, meaning 264.1 sufferers per 100,000 inhabitants. In 2000, there were 384,400 patients with active tuberculosis.44 It is not only the number of people suffering from tuberculosis which is alarming, but also the significant increase in the number of people infected by resistant strains, which require long and costly treatment. Foreign analysts see the main problem in successfully controlling TB in insufficient funding. The provision of a continuous supply of expensive medicines for treatment would require one quarter of all the funds available to the Russian healthcare system.45 The Russian Ministry of Health is trying to confront tuberculosis with a programme entitled "Urgent Measures in the Fight against Tuberculosis 1998-2004". The promised economic effects include savings on treatment involving unfitness for work and invalid pensions, a 30% reduction in hospital costs and a 60% reduction in out-patient costs.
nbsp;Another epidemic threatening the Russian population is that of hepatites. A total of seven million people suffer from it, five million with type B and two million with type C in its chronic form. As the largest group of sufferers is in the 15-30 age group, it is being said that this virus might be even more dangerous for Russia than HIV.46 People are infected by hepatites primarily as a result of intravenous drug use or unprotected sexual intercourse, but healthcare establishments themselves remain a considerable source of infection. Russia is trying to check the further spread of this disease by inoculation, as the costs of treating one person come to thousands of dollars while the vaccine costs 100-180 roubles. Drugs to treat hepatitis C (which is basic incurable) have to be paid for and their monthly cost is more than half the average wage. Sadly, these drugs are not even free for children infected by inoculations at healthcare establishments.
nbsp;While the birth rate and the mortality rate have significantly contributed to the decline in the population, the influx of immigrants has had an alleviating effect.
So now we come to the final factor of populational changes – migration. Throughout the 1990s, Russia was the target country primarily for ethnic Russians from the former republics of the Soviet Union, but this flow of immigration has slowly dried up. The greatest number of immigrants come from Ukraine (36,503), Uzbekistan (24,873) and Moldavia (7,569) while from countries outside the former Soviet Union 1,627 came from Germany and 1,373 from Israel. As the Demographic Development Policy shows, the Russian government is fully aware of the importance of immigration for the future of Russia and so is trying to improve its immigration policy legislation. Two kinds of quotas have been established for immigrants. The first applies to permits for temporary residence and guarantees immigrants employment rights comparable to those of Russian citizens. This quota was set at 439,000 for 2003 and is further elaborated at a regional level. The second quota only applies to employment permits and was set at 530,000 for 2003. A register with details of foreign citizens was also established, providing better control of those involved in illegal activities.
However Russia is not only a target country – 120,000 people left Russia in 2001. Emigrants most often headed for the UIS countries and the Baltic republics (62,545). This emigration can be explained as involving members of other ethnic groups returning home from Russia. Almost 59,000 left the former Soviet Union entirely. Their most frequent goal throughout the period was Germany, where 43,682 Russians emigrated in 2001, followed by Israel47 (4,835) and the USA (4,527). There were frequent fears in the early 1990s of a "brain drain". Some analysts predicted that 2.5 to 7 million highly educated specialists could emigrate,48 but these fears did not materialize. Shkolnikov, who drew up an analysis of Russian emigrants, came to the conclusion that only a small group of emigrants had higher education and that the departure of top specialists (engineers and scientists) who cannot at present find suitable employment in Russia will not result in the damage to the Russian economy that has been generally anticipated. Some mention should also be made of internal migration because the depopulation of some areas of Russia is also becoming a problem. The following table clearly shows that people are moving from the east and the north into central Russia. This process can be viewed as a direct consequence of the break-up of the Soviet Union and its current economic problems. With the effects of inflation, the additional payments made and bonuses added to wages lose their incentive value and in a number of mostly single-industry cities there is a sharp rise in unemployment. Moreover a number of citizens of Ukraine and Belarus citizens are returning to their countries for fear of losing their citizenship.
Net migration between the federal areas of the RF between 1991 and 2000 (thousands)
|Regional exchange||Increase and decrese in population|
|Southern||The Volha Valley||Uralian||Siberian||Far East|
|The Volha Valley||-294,6||38,2||-63,5||-19,4||-59,4||-72,4||-118,1|
2. Population ageing
The fall in the birth rate contributes to another unwelcome demographic phenomenon –population ageing. In demographic terms this is a process whereby the age structure of the population gradually changes, with the proportion of those older than 60 or 65 rising and the proportion of those under 15 falling.
For developing countries the age structure graph resembles a pyramid but the following graph shows that Russian society involves a regressive population type.
Age structure, 2001
SOURCE: Russian Demographic Yearbook, 2002
nbsp;Population ageing has hitherto been slowed down by the high mortality rate. The following statement may be considered to be unethical but in its way a high mortality rate alleviates the social system. If there are now 34 pensioners for every 100 economically active citizens, with the mortality rate of a developed country this index would rise to 42. For the current pension system, which already suffers from a number of shortcomings, the population decrease combined with an increase in the numbers of the elderly will constitute enormous pressure, which will further aggravate the existing situation.
According to predictions, however, the population at a productive age will grow for several more years, because the strong cohorts born in the 1980s are coming onto the labour market while the weak cohorts born in the 1940s period will be retiring. In figures this means that in 2005 the workforce will come to more than 92 million, which represents 64% of the population. This demographically favourable situation will last until 2010 and provide Russia with several years for the necessary reforms.
The problems surrounding population decrease and ageing are a great challenge to the economic situation of the country and they necessitate changes in such areas as healthcare, education, the pensions system and elsewhere. In this connection the question of the impact of this situation on the army is often discussed. Thus I shall attempt to show the possible effects of demographic changes in this respect.
The strong cohorts of the 1980s are currently coming to maturity and problems should thus not arise until the second half of the first decade, when the weak population segments of the 1990s reach recruitment age. According to forecasts made by the U.S. Census Bureau, the number of recruits in 2015 will be reduced by one half. The fall in the number of potential recruits is not the only problem dogging the Russian army, however. The health of recruits is also markedly deteriorating.
Army expert Mikhail Khodarjonok points out that if drug addiction continues to increase at the same rate50, new recruits will not be able to meet army requirements within two years.51 As regional quotas must be filled, even those with inadequate health are often recruited into the army while the fully healthy will avoid conscription by paying bribes. As Russia does not have the necessary funds to modernize its army and the number of soldiers defending its large territory will decrease, all Russia can do is rely on its nuclear weapons. An indication of this strategy was given in Putin's April 2000 speech introducing a new doctrine permitting use of nuclear weapons in the event of a mass attack using conventional weapons. In this situation it would be rational to consider professionalizing the army, although this measure would be very expensive and would also mean mass redundancies and a loss of the hitherto clear support of the army for Putin, so it is not too likely to occur in the near future.
3. Are these demographic trends reversible?
The above demographic problems and their possible consequences certainly raise the question of whether it is at all possible to reverse this unfavourable demographic trend. One important step taken by the Russian government has been to investigate the objective situation on the ground by means of the First Russian Population Census, which took place from 9th to 16th October 2002. This was a campaign of mass proportions, the effectiveness of which has been cast in considerable doubt by a number of people. About 90% of the population took part in the census, but some would claim that if participation in a census is less than 95% then it is not particularly revealing. The government tried to accommodate people's fears for their safety and permitted three ways to fill in the census form: either themselves at home, or at a district census centre or by telephone so there was no opportunity for checks by a census officer on the extent to which the figures tallied. However, it is very likely that because of fears over the misuse of information provided, many people misrepresented their material circumstances in particular. Many questions was rised by the results of census in Chechnya. According to previous estimates the number of Chechens was determined to be around 750,000 but according to the census results there were 1,088,000. Official sources claim that this is a realistic figure because after the break-up of the Soviet Union, thousands of Chechens returned from Central Asian republics and there is an unusually high fertility rate there. Some also believe that the Chechens officials intentionally exaggerated the number of children and pensioners in order to obtain more for their state budget
. Similar contentions and suspicions hang over many of the other regions, but in the Chechen case it is a very striking discrepancy.
3.2. The Russian Federation Demographic Development Policy to 2015
The solution to this probem of how to improve the current demographic situation is very complex and there are several plans for addressing it. We shall mention several conclusions made by RAND oraganization experts
together with the recommendations from the Russian Federation Demographic Development Policy to 2015. This document comprises three main points:
An improvement in the health of the population.
The main role in the health improvement campaign will be played by prevention, which should involve not only healthcare workers but also non-profit organizations and the mass media. There is also an endeavour to curtail the consumption of alcohol by means of pricing policy, changes in sales of alcoholic drinks, thorough quality control and advertising restrictions. Specially trained hot line staff and psychiatrists will attempt to deal with the psychological problems that often result in suicide. The network of healthcare establishments is also to be modernized, particularly in rural areas. Many injuries should be prevented in future by changes in labour-law legislation and the development of accident insurance.
A rise in the birth rate.
The policy is to promote births both by altering the orientation of values more in favour of families and by means of a series of measures favouring families with children.
Immigration policy aims include incentives for immigrants particularly from the countries of the former Soviet Union and the Baltic states and at the same time a restriction on the flow of emigrants from Russia by improving existing economic conditions. It is essential to take action to regulate migration flows, which may compensate for the natural decrease in the population of the RF. If the number of immigrants is increased, it is essential to ensure their integration into society and to take into account their age, sex, health and qualifications.
The overall policy, linking in with a number of other programmes, is certainly full of laudable ideas but the question of funding for individual schemes remains an open one.
3.3. General solutions
RAND Institute experts also see short-term solutions in health improvements. Over the longer term, however, Russia has to accept a lower population size and focus more on improving living conditions. Usage of the pronatal policies which are sometimes put forward is contentious, as international experience has shown, as their effect is usually only short-term. Women have the same number of children but with shorter intervals so as to take advantage of the benefits on offer. Even if the number of births increases, this results in a marked intervention in the age structure of the population and the population boom years result in intolerably great short-term pressure on the health system and subsequently education services, which, however, it is pointless to extend too much because less populous years normally follow. Another disadvantage of pronatal policy is its high cost. Another way of increasing and rejuvenating the population entails a liberal immigration policy. The immigration of primarily ethnic Russians from the former Soviet Union republics significantly stemmed the decline in the population. However, since 1997 it has been continually dwindling and immigration forecasts make similar predictions for the future. RAND Institute experts believe that Russia should accept half a million immigrants every year in order to maintain its population size. If this indeed took place, one quarter of the population in 2050 would be made up of immigrants and their descendants. When we take Russian xenophobia into account, however, this does not seem very likely to occur.
Another restriction on excessive openness towards immigrants is the fear that they could concentrate in border regions, which causes alarm in view of the depopulation of these regions by the Russians themselves. In the Far East, where over the last ten years the population has decreased by 12%, there are now 7 million inhabitants while on the other side of the border there are 105 million Chinese. There are now 545 pensioners for every 1000 economically active citizens and in ten years' time this figure will have reached 669.
According to the Minister of Internal Affairs, Boris Gryzlov, "our task is to repopulate these regions…, it is essential to create economic conditions in these areas to attract people into them.
Moreover his policy states: "it is also essential to maintain the population figures in important geopolitical regions of the Russian Federation, with a workforce from other regions being able to work here, rotating after a certain time, and incoming immigrants could also be settled here, particularly specialists."
The only possibility of reversing the unfavourable demographic situation consists in improving the economic situation in the country. Better financing of public services, particularly healthcare, will lead to an improvement in the health of the population, and so indirectly affect demographic stability.
Russia's chances lie in changing its order of priorities: to partially resign its role on the international stage, to devote itself more to its domestic problems and to focus on the individual and his everyday living conditions. However, in the context of its history to date, this would be a complete novelty.
1Population figures are given for the beginning of the year, Rossijskij demograficzeskij jezegodnik.
2In the most optimistic scenario 120.6 million and in the most pessimistic a mere 79.4 million.
3In December 2001, a seminar took place on methods of forecasting the size of the population under the auspices of the Ministry of Social Affairs, in which these individual scenarios were discussed. (For more details see http://demoscope.ru/weekly/2002/051/tema05.php)
4For more detailed birth rate forecasts see: http://demoscope.ru/weekly/2002/051/tema05.php
5Da Vanzo, J., Grammich, C. (2001) Dire Demographics: Population Trends in the Russian Federation. p. 24. www.rand.org/publications/MR/MR1273
7Kalibova, K. 1998. Uvod do demografie (Introduction to Demographics). Prague: Karolinum.
10The birth rate was regulated by Stalin in this manner in 1936 but this order was revoked two years after his death.
11Pregnancies in 2001 were terminated by abortions performed by doctors in 60% of cases, miscarriages in 10% of cases and in only 30% of cases did they result in births.
12As a point of interest, in the 1960s three quarters of all pregnancies were aborted.
13Dire Demographics, p. 30 – healthcare establishments were financed according to the number of beds that were occupied and hospitalization for abortions required at least three days at that time.
14Throughout the 1990s, sales of birth control pills rose gradually but they have stagnated since the 1998 economic crisis.
16For details of this issue see the speech by the Deputy Minister of Health, O. V. Sharapov: http://www.minzdrav-rf.ru/in.htm?rubr=100&doc=1283)
17There is a significant difference here between urban (14) and rural areas (16.2).
18Report on children's health presented to the RF government:
19Postanovlenie Pravitelstva RF 3. 10. 2002, No. 732.
20According to Russian Health Ministry statistics there were 630,000 children living in children's homes in 2000 and 2.8 million living on the streets.
22General A. Gurov, Chairman of the Duma Security Commission, points out that the statistics do not reflect the actual number of deaths caused by criminal acts. To the 86,000 victims of violent crimes who died on the spot, another 40,000 should be added, who died in hospital as a result of criminal acts. http://duma.edin.ru/user/index.cfm?tpc_type=&TPC_id=999
25The mortality rate is closely associated with the health of the population. This is subject to the following factors: 50% life style, 20% genetic factors, 15% healthcare services and 15% environment, and of course we must also take indirect socio-economic factors into account. The weighting of the effects of these four health determinants is different in various societies – the above applies to the developed world.
26Life style is understood to comprise the following factors: socio-economic status, type of work, diet, movement, alcohol and smoking.
27Consumption of individual foodstuff types per person in 1999 (kg)
|Foodstuff||Meat||Fruit and vegetables||Bread||Potatoes|
28State policy on the healthy diet of the RF population for the period to 2005 (Postanovlenie Pravitelstva RF of 10.8.1998, No. 917).
29This campaign reduced state alcohol production, launched efforts against distillation and distribution of homemade alcoholic beverages, raised state prices for liquor, and fostered compulsory treatment of alcoholism where indicated.
30For detailed studies on the relationship between alcohol and suicide rates see http://demoscope.ru/weekly/2002/073/tema01.php
31The author also took illegally produced alcohol into account.
32The epidemiological situation is particularly fraught in prisons. According to Jirij Kalinin, Deputy Minister of Justice, "the prison service is slowly changing into a prison hospital service". Of the 500,000 convicted prisoners, he states that 90,000 suffer from the active form of tuberculosis, 36,000 are infected by HIV, 200-300,000 have psychological disorders, 102,000 are drug addicts and 72,000 are chronic alcoholics. Treatment for such a large number of prisoners requires a loan from the European Bank for Renewal and Development. www.mednovosti.ru
34According to an economic model of the consequences of AIDS drawn up by K. Rul, V. Pokrovski and V. Vinogradov (www.worldbank.org.ru/rus/group) AIDS will be a disproportionate burden on the economy (with the costs of treating sufferers, the decline and deterioration of the workforce and so forth) and will lead to long-term impairment of the pensions and healthcare system.
35This high coefficient is mostly used only for developing countries, where testing of the population is almost totally lacking.
36A.Mazus, Director of the Moscow Centre for the Fight against AIDS. http://vip.lenta.ru/bgcolor/2002/10/04/aids
38The UNADIS Report of 2001, comparing the numbers of those infected per one million inhabitants of European countries, gives the following order: 1. Estonia (1,067), 2. Russia (612) 3. Latvia (345).
40RIA Novosti 13. 11. 2002.
41Current financing covers just 450 people, although there are already 2,000 AIDS patients in Russia, there will be 200,000 in several years, Vadim Pokrovsky, Director of the Federal AIDS Centre., Russia Lacks AIDS Funds, New York Times; New York, N.Y.; Jul 5, 2002.
42Russia is hopelessly ill-prepared for the coming epidemic of AIDS, The Economist; London; Sep 28, 2002.
43For more details: www.demoscope.ru/weekly/2002/075/index.php
45Report of the Commission on Macroeconomic and Health www.who.int/director-general/speeches/2000/english/20001102_moscow.html
47Emigration to Israel peaked (at almost 30,000) in 1999 as a result of the economic crisis of 1998 and the anti-semitic sentiments in society. Putin's favourable policy towards the Jews and the improvement of the economic situation led to another fall in emigration).
48Dire Demographics, p. 17.
49As retirement for men is set at 59 in Russia, it is better to use the lower limit.
50The number of drug addicts among recruits rose sixfold from 1995 to 2000.
51Belosevsky, D. Drogy v Rusku brani odvodu tisicu brancu, Drugs in Russia prevent the conscription of thousands of recruits, Hospodarske noviny 9.12.2002.
52RIA Novosti 19.11.02.
53RAND organization – www.rand.org
54In December, the WCIOM carried out research into xenophobia using Boogard’s scale of social distance and found that while only 27% of respondents would be against the marriage of a family member with an American or Frenchperson, 46% would not approve of such a marriage with a Jew and 56-58% would be against such a marriage with a person from one of the Caucasian republics.
55ITAR-TASS, 14. 7.2002.
56RIA Novosti 24.3. 2002.
57There is a correlation between the mortality rate and macroeconomic stability - Brainerd, Elizabeth, “Market Reform and Mortality in Transition Economies,” World Development, Vol. 26, No. 11, November 1998, pp. 2013–2027.
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