The combination of high levels of pollution and a deteriorating public health system causes concern for the health of many living around the Caspian Sea. Socio-political and economic changes in the former Soviet countries are largely to blame.
Apart from two large urban areas – Baku-Sumgait and Makhachkala-Kaspiisk – and the Iranian coast on the southern shore, a very densely populated coastal strip where one agglomeration leads into the next, most of the population living on the shores of the Caspian is rural, with strong religious and family traditions actively maintained. It is consequently not surprising that several countries and provinces – Iran, Daghestan, Turkmenistan and parts of Azerbaijan – still enjoy very high population growth rates (in excess of 10 per 1,000). Even if over the last two decades, or perhaps longer, the fertility rate has dropped significantly, the authorities nevertheless have to cope with all the health, education and employment problems associated with a rapidly rising, youthful population.
Public health policies during the Soviet period eliminated several traditional diseases. But for lack of adequate investment in medical equipment and drugs in the 1970s and 1980s they failed to effectively halt a worrying rise in the overall and infant death rate. This setback is very noticeable all over Russia, but in much of the Caspian basin it went hand in hand with a shortage of amenities, due to the distance from the country’s main economic centres. Iran is gradually catching up lost time and supplying rural areas with adequate medical equipment, but the opposite is happening in other countries. Here, with the decline in public expenditure on health and education, the general level of public health is either steady or actually declining. Inequality is on the rise, with the switch to a two-tier health service under which payment is demanded for an increasing range of treatments, putting them out of the reach of much of the population.
Several additional factors have contributed to the emergence of new health problems, in particular the increase in perinatal or infant mortality, the reappearance of diseases such as tuberculosis or polio that had almost been eradicated, and an increase in the number of hepatitis and cholera foci. In Azerbaijan, the highest morbidity rate is related to diseases of the respiratory organs (11,274 cases per 100,000 people), with a similar situation in Atyrau and figures twice as bad in the Mangistau oblasts, linked to exposure to pollution. There are still problems obtaining a supply of good quality drinking water, except in a few hilly regions. In the country and in many cities the water pipes and sewage systems are urgently in need of improvement, contributing to unsatisfactory public hygiene. Azerbaijan’s programme on Poverty Reduction and Economic Development also recognizes that one of the primary causes of morbidity and mortality in children is diarrhoeal disease, usually caused by contaminated water.
Furthermore the number of industrial facilities with a high risk of pollution is tending to increase due to exploitation of new oil and gas fields. The concentration of heavy metals and toxic or even radioactive materials is a recurrent problem in old industrial centres such as the Apsheron peninsula. Similar sources of pollution have existed since the 1960s and 1970s in the west of Turkmenistan and in the Astrakhan and Atyrau areas. Little is known about the radiation exposure of people living in areas of high radioactive pollution, in the Atyrau oblasts, home to a former nuclear testing site.
Despite increasing pressure from national and international NGOs the local authorities are still uncertain as to how to act. When confronted with cases of flagrant pollution they tend to step up pressure on industrial organisations, with backing from international programmes and credits. At the same time they have little patience with any signs of discontent among local people, who need treatment and have little choice of alternative housing. The economic weight and physical presence of heavy industries make it very difficult to introduce proper health standards to protect local people against the most basic risks.