State of the World's Minorities and Indigenous Peoples 2013 - Case study: Indigenous health care system in the remote areas of the Russian north

by Irina L. Stoyanova

High prevalence of tuberculosis and other infectious diseases, particular problems with alcohol and mental health, and difficulties accessing health care are among the most pressing health problems facing indigenous peoples in Russia's far north.

There are few studies and little data on the health of indigenous peoples in the Russian Arctic, because these groups live in remote areas with few medical services. Considerable variation exists across the different regions of the Russian north, influenced by local geographic, ethnic, administrative and political factors. Nevertheless, the following general observations about Russian indigenous peoples' health can be made.

As of 2004, the average life expectancy of Russian indigenous peoples was 15 years shorter than the Russian average. Mortality rates are significantly above the national average; infant mortality rates are estimated to be twice as high as the national average. Poor health and other factors have led to drastic declines in the indigenous population and some small indigenous groups have reached the brink of extinction.

Changes in traditional diets, together with a general decrease in physical activity, have significantly impacted the health of the indigenous population. A contributing factor for the increase in diabetes, obesity and anaemia is the increasing use of imported store-bought, 'ready-made' foods and decreasing consumption of traditional foods such as meat and local plants.

Infectious diseases, particularly tuberculosis, and sexually transmitted infections are a growing problem. The prevalence of tuberculosis among indigenous peoples of the Russian north is almost five times higher than among non-indigenous people, and the death rate is almost nine times higher than among the non-indigenous population. Rates of active tuberculosis for Siberian Inuit, for instance, are alarmingly high. The mortality due to this disease is as high as 40 cases per 100 persons in the Khanty-Mansi Autonomous Okrug and in the Yamalo-Nenets Autonomous Okrug this index is 87, whereas in Russia this average index is 10.

Tuberculosis is a particular problem for indigenous peoples because of the effect of low temperatures, reduced immunity and poor living conditions. In Krasnoyarsk Krai, for example, the spread of tuberculosis in the last three years is particularly exacerbated due to lack of clean drinking water and adequate sewerage systems. Poor sanitation and hygiene conditions of the population in northern settlements greatly contribute to the spread of not only tuberculosis but also other infections, such as dysentery, hepatitis and parasitic worm infestations.

The remoteness and small size of indigenous settlements affects access to and the expense of medical care. All indigenous peoples of Russia are entitled to free medical care system coverage, which includes a compulsory annual check-up at state and municipal health care facilities. Yet federal and regional health care programmes do not always provide medical brigades to visit remote areas. For example, the village of Pareni in Kamchatka has reportedly had no access to medical care for two years. In Chukotka, it takes up to 28 hours for medical attention to be received. In remote villages the only way to receive medical help is via a scheduled flight or air ambulance service.

Medical personnel often lack modern, mobile equipment that allows them to go out and examine the population in remote settlements, such as reindeer herding camps. Nomadic reindeer herding is the traditional livelihood of many indigenous peoples of the Russian north. Working with indigenous peoples out in the tundra is complicated due to the practical difficulties of carrying out examinations in the constantly moving reindeer herding camps, as well as difficulties with controlling the prescribed treatment.

Poorly equipped health care facilities and lack of investment mean that it is extremely difficult to retain medical staff and attract specialists to come and work in rural hospitals. According to Dr Victor Mizernyuk, the Head Physician at the Lovozero Central Municipal Hospital:

'To rely on the indigenous population and give them medical education doesn't seem to be an option, since the young physicians after graduation from medical school, won't go back home, no matter how you try to entice them. The situation is extremely difficult – our own people don't come back, and outsiders don't come to the countryside.'

Alcohol dependency and mental health

Another serious problem facing Russian indigenous populations is alcohol dependency. The Committee on Northern Affairs and National Minorities states in its materials that over the past 10 years there has been an almost twenty-fold increase in alcohol abuse among indigenous peoples, particularly among women and adolescents. In the Yamal region, for instance, there is a serious concern about girls smoking and becoming addicted to alcohol as they mature and become mothers in the future. A growing proportion of indigenous households' income goes on purchasing alcohol.

Studies demonstrate that alcohol abuse in the Russian north is linked with a range of social and economic factors. Problems arise when reindeer herders move to permanent settlements. The ever-growing availability of liquor and advertisements for beer and alcohol beverages, the isolation of the parents from their children, who are away at boarding schools, and the stressful effects of 'modernization' are among the factors that often lead to alcohol dependency. This is why awareness of the particular psychological issues facing indigenous peoples is important if effective psychotherapeutic help is to be offered.

The steady growth of suicides and violent behaviour among the indigenous populations in the Russian north is another alarming trend. Suicide rates are up to four times the Russian average. The Yamalo-Nenets Autonomous Okrug and Koryak Okrug have some of the highest rates in the world: 133.6 cases per 100,000 people. In comparison, the national suicide rate average is approximately 38 cases per 100,000. Homicide rates are correspondingly 70 per 100,000 among indigenous peoples, and 27 per 100,000 for the national average.

Also reported among indigenous peoples of the Russian north are mental disorders and poisoning by drugs and toxic substances. A large number of mental disorders – significant delays in development, signs of emotional distress and psychological tension – are found in indigenous children and the prevalence of these conditions is increasing with each year.

Urgent areas of action

It is important to:

• Collect reliable data on the health and living conditions of indigenous groups in Russia. The federal and local authorities need to enact legislation for the introduction of mandatory unified statistical health reports and annual monitoring of the health of indigenous peoples.

• Train medical personnel to consider the conditions in the north and the specific psychological challenges facing the indigenous peoples, and provide better training for doctors and nurses from among the residents of remote areas.