Health care 6012001
ECOLOGY AND COMMUNITY HEALTH IN THE NORTH
1 Palmira G. Petrova , Natalia ABSTRACT ul 2 Health of a nation is a sensitive barometer of the environmen P. Yakovleva and Fedora A. situation, especially in the North, where vulnerable nature ~ot Zakharova3 resist intensive industrial development. The geographical l~ and severe climatic conditions of the Republic of Sakha (Yakutia) significantly sharpen any negative impact of industrial activity 00 the state of the environment. The impact of ecological fa~ors; the health of population has been studied in the case of a diam province (Vilyuy region), where a complex of chemical Poll:: from diamond mining, products of wood decay in places of fl. ing of the water reservoir for the Vilyuisk power station, ~ mineralised underground waters and consequences of und: ground explosions have caused a substantial negative effect ~ in ' Medical Institute environment and people. Studies on the health of the papulanon cl the Vilyuy region has shown that sickness and morbidity ratesand Yakutsk State University viral hepatitis, tuberculosis, pathologies during pregnani other diseases are higher in comparison to rates in the Repu c ~ Yakutsk. Republic of Sok.ha, Russian a whole, a feature which has been attributed to environmental deg radation in the area. (Int J Circumpolar Health 2001;60: 170-lJ7) Federation . . industrial Key WOrds : 1Uver Vi?fu.r, North ef Russia, diamon d 1111nin9, pollution, health ef p"f'tllation. 2 Centre for Environmental Informatics
School of Sciences, University T he Republic of Sakha (Yakutia) in Eastern Siberia lies wittiinf 71° and 55°3' northern latitudes and occupies an area ~ of Sunderland, Sunderland. UK 3103.2 ~housand square kilometres, which is about IS% of the terntory of the Russian Federation (See Fig. I). Part . 1 Department of human physiology Yakutia (40% of its tenitory) lies within the Arctic Circle in the area of pervasive permafrost. Yakutia has a sharp corrtr Medical Institute nentaI d.•mate: seasonal temperatures vary trom -6"°Cv in the winter· to + 38°C in the summer. Moreover; spec1·fi c dimatJC Yakutsk State University characteristics include low and unstable atmosphenc. Pres· . sure. pure anti-cyclone. weather type and lack o f 1·ght1 dunng Yakutsk, Republic of Sak.ha. Russian the long Polar night. From an ecological point of vieW. ~ temtory is characterised by slow rehabilitation of land Federation water, low potential for dispersion and absorption of air pal-
luurnaiioQa/ Journal of Circumpolar Health 170 Health care 6012001
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lution, and extremely slow growth rates of vegetation due to permafrost. That is why industrial development in the area cause a substantial negative impact on natural ecosystems. The Republic of Sakha is rich in mineral resources, among which the most valuable are diamonds. The development of diamond-mining industry in Western Yakutia began in the 1950'swith the discovery of diamond deposits in the basin of the river Vilyuy. Development of overall infrastructure in the area, including the development of hydroelectric engineering in 1970 's, is closely related to diamond mining. In the I 990's, negative impact of industrial activity has exhibited itself not only on the environmental situation, but on the health of population in the settlements located along the river Vilyuy. Moreover; twelve underground explosions were made in the territory of Yakutia between 1974 and 1987, ten of which were made in the territory of the dia mond province [I I]. Industrial pollution accelerated the pro cess of migration of chemical elements through the ecological scheme: industry - river system - river biocoenosis - hu mans. The research conducted by the leading scientific depart ments of the Republic, including the Yakutsk Scientific Centre of the Siberian Brunch of the Russian Academy of Sciences, the Yakutsk State University. the Academy of Sciences of the Republic of Sak.ha (Yakutia) and others, concluded that the creation of a large diamond-mining complex and system of
171 International Journal of Ctrcumpolar Health Health care 6012001
water reservoirs in Western Yakutia has become the main reason for environmental degradation of the river Vilyuy and its water quality, and as a result of this the health of the pop ulation has deteriorated [8, 9, IO].
MEDICO-DEMOGRAPHIC SITUATION INTHE REPUBLIC OF SAKHA
The population in the Republic of Sakha amounts to 988 thousand people, 64 % of whom live in cities and 36 % in rural areas. For the last decade the birth rate in the Republic has constantly decreased, but it is still higher than in Russia In 1989, the birth rate per 1000 people in Yakutia was 21.I (compared to 14.6 in Russia) and decreased to 13.7 (8.8 in Russia) in 1998. Although the total population mortality rate per I 000 people is lower than in Russia, it shows a growing trend: from 6.1 in 1989 up to 8.9 in 1998. Genderand age aspects of the mortality of population are very important characteristics. Mortality of men exceeds the mortality of women 1.8 times. Among the people of working age (from 15 to 55 years) the death rate is high ( 46.7% in 1998), peo ple over working age make up 47.8% and people under working age 5.5% of the dead [I]. Undoubtedly. this situation has a negative impact on the growth of the population. Dis eases of the cardiovascular system, accidents, poisoning. trau mas and tumours are the main reasons for mortality of working age people. Although the natural growth of the pop ulation in the Republic has a positive balance, while in Russia it is negative, it has decreased from 15.8 per I 000 people in 1989 to 4.8 per I 000 people in 1998 [I, 7]. Infant mortality. which is a widely used indicator for social welfare and the health of population, has been relatively stable during the last 5 years and is showing a decreasing tendency: 19.5 per I 000 people in 1995 and 18.9 in 1999 (I]. In 1997 the life expectancy at birth in the Republic was 64.6 years, which is 2.3 years less than the Russian index ( 66.9 years) (See Fig. 2). According to data of the life expectancy at birth, the women in the Republic live on average 10.7 years longer than the men. Total sickness rate in the Republic is very high. In 199? major diseases in the structure of the total sickness rate in the Republic of Sakha were diseases of the respiratory system (46.9%). traumas (11.7%), diseases of the nervous system (8%), skin diseases (5.3%), infectious and parasitogenic diseas es (4.7%) (7].
International Journal of Circumpolar H ealib ,_ 172 Health care 6012001
years 70 68 68,1 •69,4_--~9 __ ,- 67,9 68 • 66,9 .. .. 66,9 66 63, 64
62
60
58 1982 1985 1990 1991 1992 1993 1994 1995 1996 1997 Fig. 2. Comparison of life expect· ancy at birth in die Republic of ~Republic of Sakha "' Russia Sakha and Russia in 1989- I 998.
MEDICAL PROBLEMS INTHEVILYUY REGION
The Vilyuy region unites 5 ulusses (administrative districts of the Republic of Sakha): Mimy, Nyurba, Verkhnevilyuisk. Vilyuisk and Suntar, which are situated along the river Vilyuy. Almost 18% of the total population of Yakutia ( 191, I 00 people in 1997) and 35% of the indigenous people in the Republic live here. Diannond mines heavily contaminated rivers because of drainage from spoil heaps, dispersion of ground waters from kimberlite pipes and the disposal of"technical" waters from the processing operations. High concentrations of aluminium, chromium, nickel, cobalt, copper; zinc, scandium, vanadium, ti tanium, manganese, barium and strontium have been found in the bottom sediment of the rivers Markha, Malaya Botuobiya adVilyuy. The creation and development of the diamond-min ing industry was closely linked to the development of hydro electric engineering in the areaThe building ofthe hydroelec tric station started with the creation of the Vilyuy water reser voir; which covered an area of 196,000 thousand hectares. The artificial regulation of the flow of the river Vilyuy signifi cantly changed the hydrological, hydro-chemical and hydro biological characteristics of the flooded area, and the reser voir itself became the source of hydrogen sulphide and phe nols that contaminated the environment [9]. Its is quite possible that since mid- I 990s the contamina tion of the river Vilyuy with heavy metals and organic toxi cants has decreased due to a fall in the industrial production,
173 International Journal ef Circumpttlar Health "
Health care 6012001
I1 the construction of cleaning-up facilities and a reduction in 1 thecreation of phenol in the Vilyuy water reservoir: Medico- 1 genetic research conducted in the area has shown that envi ronmentally caused pathology among observed people of the Vilyuy region is more closely linked to chemical contami nation than to radioactive pollution [6). There is a high s·1ckness rate and morbidity among chil dren and adults in the Vilyuy region, especially in Verkhnevi~ uisk uluss, e.g. in 1996 the total sickness rate in Verkhnevi~ uisk uluss was I 594 per I 000 people, compared to I 125 in the Republic.The frequent development of chronic tonsil and adenoid diseases indicates that the suppression of the im mune system is formed at an early age and this provides con ditions for the persistence of pathogenic micro-organisms. Investigation of the condition of the immune system of the population revealed signs off-cell chain depression, the de crease of main globulin types (A. M,Y) and a weakening of the neutrophiles' phagocyte activity. Considerable shifts in immunochemical indices, such as a high level of destabilisation of receptor albumin. circulating immune complexes and titre of natural antibodies to sheep erythrocytes, all together confirm the lowering of organism resistance (See Table I). Changes in the immune system corre lated with the high content of some heavy metals which refer to antropogenic toxicants (aluminium, chromium, manganese. molybdenum and nickel) in the blood and hair of studied sub jects [5). The reduction of organism resistance and anti-toxic pro tection of the population in the Vilyuy region is also con firmed by the increase in population invalidation, the growth of tuberculosis and the sickness rate of fertile age women and the high infant death rate.These data describe the condi tions of the genetic fund of the indigenous people of the Re public of Sakha and may serve as a basis for predicting the state of health of population in the nearest future. . It must be noted that the environmental degradation in the area affects the organism not only through an impact on the immune system, but also through its influence on liver. destroying its capasity for neutralisation and disintoxicatJon. Consequently, the incidence of viral hepatitis has been vert high during recent decades, significantly exceeding the indices in Russia, especially in the Nyurba, Verkhnevilyuisk and Vilyuisk ulusses.The sickness rates of viral hepatitis in the Vilyuy region. with the exception of Mimy uluss, are always higher than; the Republic as a whole. In 1992 the sickness rate of vi hepatitis in Nyurba uluss amounted to 2681 per I 00 thOtl- laternationa/ journal of Circumpolar Health 174 Health care 6012001
Table I. Distributiar of people with disorders in immunology parometers miong the population of die Yilyuy rezian.
Parameters Nature of The number of persons with pathologies in certain ulusses, in % Dillerences ~ disorders the groups
Mimy Suntar Ny\rila Verl .!N I.I 11,0 5,0 P1.i.+J< O.OS CIC 55,6 62,4 n.• P1.u.•< 0,01 iN 100,0 ... 3.3 26,4 17,6 P,.u.,<0,01 Note: R-molecules - globulin, NAB - natural antibodies, CIC- cin;ulamg immune complexes. sand people, while in the Republic as a whole the sickness rate of hepatitis was 380 per I00 thousand people. In 1995 the sickness rate of viral hepatitis reached 2764 per I 00 thousand people in Verkhnevilyuisk andVilyuisk ulusses, com pared to the same index of I 57 per I 00 thousand people in the Republic as a whole. There is a possibility that a small but constant excess of heavy metals and phenol in the waters of the riverVilyuy, pro motes the occurrence of primary light forms of toxic hepati tis and the reduction of immune reactivity. Based on this, there are frequent epidemics of hepatitis, with a virus that has a very high ability for mutation. The epidemiological situation of tuberculosis in the Re public of Sakha, as well as in Russia as a whole, has worsened since 1990 and currently it is one of the most important so cial and medical problems in the Republic.The epidemiologi cal situation of tuberculosis is unfavourable in almost all ulus ses of the Vilyuy region, especially in Nyurl:>a and Verkhnevily uisk ulusses, where the sickness rates of tuberculosis exceed the average index in the Republic two times.Although Mimy uluss is an exception from the general situation with tubercu losis, there is a clear tendency towards an increase of sickness, morbidity, bacillus-carrier of tuberculosis (Fig. 3). A negative tendency is also seen in the health of women. the duration of pregnancy and childbirth in the Vilyuy region. Extragenital pathology (anaemia. pathology of the urogenital system, diseases of the vascular system and endocrinopathy) occupies the main place in the pathology of pregnancy in the Vifyuy region. On one hand, the heavy pathology of pregnan cy in the forms of gestosis leads to difficult confinement on 11' lnttrnational journal ef Circumpolar Health flea/th care 60IZOO1 160 140 120 100 60 eo 40 20 0 1991 1992 1993 1994 1995 1996 1997 1998 Rf. 3. Sidcness late of IUber mo.is., die Vf1uy rep per •Mimy Wiss ONyurba uluss • Suntar uluss I 00 dlousond peop1t in I 991- 0Ver1dmevilyuisk uluss •Vilyuisk uluss •Republic of Sakha 1998. llRuaaia the other hand, it reduces the number of healthy new-barns and also promotes negative demographic dynamics [6]. DISCUSSIONS AND CONCLUSIONS Ecological and medical research established that the leading conditions of limited health of the people in the Vilyuy region are disturbances in the immune status (not only immune de ficiency. but also hyperimmune reactivity based on most aller gic diseases) and in liver protection functions. Due to a de crease of the organism·s resistance to the impact of toxicants of chemical and physical origin, infectious diseases (hepatitis, tuberculosis and others) are widespread, as are diseases of secondary synthesis of endogenic toxicants - alcoholism. drug addiction, drug diseases. Taking into account that the disturbances in immune reac tivity and liver protection functions are the primary and lead ing reasons of total morbidity of the population in environ mentally unfavourable regions, the strategy of practical health care system development must be aimed at: REFERENCES Defining the roles of different factors in the I . Ministerstvo zdn~-oohraneniya Respubliki s..ha (Yaltuti.i). Gosu larcnational journal '?/Circumpolar Health 176 Health care 6012001 real. Prophylactic measures aimed at stopping the threat of 4. Ministerstvo zdravoohraneniya Respubliki health degradation of the population in the Vilyuy region must Saha (Yakutia). Zdorovye naseleniya Respubliki Saha (Yakutia) i deyatel'nost' be carried out on two fronts: uchrezhdeniy zdravoohraneniya v 1992-1994 Improvement of the environmental situation, gg.Yakutsk 1995. especially drinking water quality. 5 . Petrova PG. Elcologia, adaptaziya i zdorovye. Yakutsk 1996. Increase of organism resistance to antropogenic 6. Petrova PG, Kershengolz BM, Krivoshapkin factors of the environment, early diagnostics and VG, Savvinov DD. Mediko-ekologicheskie prophylactics of manageable diseases. problemy zdoroviya naseleniya promyshlennogo regiona Respubliki Saha There is an urgent need for an improvement of the health (Yakutia). Dalnevostochny Medizinskii care system in the Republic ofSakha with particular reference Zhurnal 1999;1:8-16. to the health status of residents in the areas of environmental 7. Pravitelstvo Respubliki Saha (Yakutia). Gosudarstvenny doklad o sostoyanii contamination, especially in the area of diamond mining de okruzhajushei sredy Respubliki Saha (Yakutia) velopment. v 1998godu.Yakutsk 1999. 8. Savvinov DD, ed. Ekologia reki Vilyuy: promyshlennoe zagryaznenie.Yakutsk 1992. Palmira G. Petrova 9. Savvinov DD, ed. Ekologia reki Vilyuy: sostoyanie prirodnoi sredy i zdorovya Russian Academy of Medical Sciences, Siberian Branch, 4 naseleniya.Yakutsk 1993. I 0. Savvinov DD, Shumilov JV, ed. Ekologia Vilyuya. Materialy k ozenke ekologicheskogo Timakov str., Novosibirsk, 630 I 17 Russia sostoyaniya. Yakutsk 1996. 11. Yakovleva NP,AlabasterT, Petrova PG. Natural Phone (3832) 334869; fax (3832) 324254, resource use in the Russian North, a case study of diamond mining in the Republic of Saleha. Environmental health management (In E-mail: [email protected] press). 111 laternatloaal Journal of Circumpolar Health