Russia's Tuberculosis Catastrophe

TOMSK, SIBERIA: Europe ignores Russia’s public health problems at its peril. So do the other industrialized countries who cheered the Soviet Union’s fall but have failed to respond to the collapse of Russia’s health and social-service infrastructure. For out of a confused swirl of economic ideology and sometimes insensitive advice has emerged a new form of drug-resistant tuberculosis that is proving hard to contain. Much has been made of Russia’s plummeting life expectancies – its "mortality crisis." Although that grim trend appears to be being slowly reversed, another problem is spiraling out of control: tuberculosis. In several regions of Russia, young men fall ill and die from tuberculosis at rates well in excess of ten times those documented a mere decade ago; in some non-Russian areas of the former USSR, the story is even worse.

A confluence of events is to blame, including the collapse of Russia’s social safety net at the very moment when petty crime, and thus imprisonment, was reaching new heights. Russia and the United States have long been world leaders in rates of imprisonment. In the context of wars and economic disruption, Russia has pulled ahead. Tuberculosis is now epidemic within Russia’s prisons and jails. One in ten prisoners is sick with the disease. Victims of tuberculosis, especially drug-resistant tuberculosis, are likely to have served time in prison or to have a close relative who has gone through the Russian justice system. Like other airborne plagues, drug-resistant tuberculosis cannot be stopped by either prison walls or national boundaries. In the state of Massachusetts, where I practice medicine, close to 70% of all tuberculosis cases are diagnosed in people born abroad. The proportion is much the same throughout Western Europe.

The epidemics of recent years are fundamentally “transnational” in character, as befits the global era. As infecting organisms easily cross frontiers, solidarity and generosity usually get tied up in customs. So far, Russian health specialists have received much haughty advice but little practical assistance from their colleagues abroad.

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