State policy and the health of indigenous peoples of the Russian North
A statement to the Organising Committee by Larisa I. Abryutina, Vice President, RAIPON, 28 January 2003
Summarised by Helle Goldman, ANSIPRA
As the Russian Ministry of Health is well aware, there are severe health problems among the indigenous peoples of the North who live in remote places and lead traditional life-ways (as well as non-indigenous people who have adopted similar ways of life).
One condition exacerbating this alarming situation is the fact that the provision of health care is largely in the hands of regional authorities, but it is the Ministry of Health, a federal body, which answers to Russia’s Organising Committee—and to the global community—with respect to indigenous peoples’ health issues. This is inconsistent with practice in other Arctic and sub-Arctic countries where, as far as I know, federal authorities are responsible for the main share of matters concerning indigenous peoples’ health care. In the United States, for instance, the Indian Health Service (which includes the Northern Department, in charge of indigenous health matters in Alaska) has this role. In Canada the situation is similar: financing, organisation and implementation of the indigenous peoples’ health care are under the purview of federal authorities and special ministries. (It should be added that in these countries, indigenous health care provision is carried out with the participation of the indigenous peoples themselves.) There are very sound reasons for this kind of arrangement. Indeed, even in Russia this was recognised at the beginning of the Soviet era, hence the establishment of the Committee for Assistance to the Indigenous Peoples of the North.
Another factor is the discordance between the areas whose residents are most affected by health problems and the plans which the authorities propose to redress them. I recall, for example, an article by an official from “Goskomsever”1). In the first part of the article he sheds tears for the poor nomad children who faint from undernourishment and even die in the tundra. But in the second part he optimistically proposes solutions to these problems that involve computer/video monitoring systems, expeditions of Moscow researchers, and other measures within the framework of the “Children of the North” programme. While such tactics can lead to improvements in the lives of district centre residents, they have essentially no impact on those who are suffering the most: people in very remote areas. The same criticism applies to the Federal Target Programme “Economic and Social Development of the Indigenous Peoples of the North until 2011” (see ANSIPRA Bulletin No. 7).
How did this situation arise? Diverse and numerous aspects of indigenous peoples’ lives have been negatively impacted from outside through history. During the Soviet era indigenous peoples experienced the loss of political self-determination, the erosion of traditional health care practices (in which specialists like kulaks and shamans played central roles), compulsory collectivisation, and the systematic separation of children from their parents. The profound cultural transformations and attitude shifts which went hand-in-hand with these changes undermined the traditional socio-cultural cornerstones which had always sustained the indigenous peoples of the North in their harsh homelands.
At the same time, the Soviet structure created a system of socio-economic “props” which attempted to compensate for some of these losses. A strong agriculture sector was developed, hunting and fishing were pursued according to Soviet premises, and employment among indigenous people was close to 100 %. The Soviet system introduced kindergartens and schools; hospitals, clinics, and obstetrics stations were set up. With the establishment of the Committee of the North in 1924 came a medical department particularly responsible for organising mobile medical groups to reach remote indigenous peoples.
The next transformational wave followed the break-up of the Soviet Union and the subsequent transition to a market economy. These changes were as radical as those of the preceding era, though the trends were now in the opposite direction as attributes of the previous period were destroyed. Sovkhozes 2) were subjected to a total reorganisation, often incompetently carried out. In the process, reindeer herding and some other economic branches rooted in traditional indigenous modes of subsistence were ruined.
Having already undergone massive transformations, indigenous peoples found themselves largely unable to adapt themselves to these new changes. The dissolution of the sovkhozes and the loss of reindeer stock resulted in a sharp decrease in living standards: nutrition deteriorated, among other things. Simultaneously, government-provided medical care, education, communication lines, and other elements of Soviet life that indigenous peoples had learned to depend upon were cut back. Indigenous peoples were now impeded by maladaptation: they had adapted to an all-encompassing system that had fallen to pieces, and could not function effectively in the new era. This is one of the tragic underlying problems of Russia's northern indigenous peoples.
Whereas mobile unit doctors used to seek out every reindeer-breeder, taking special care with pregnant women and children, today not even tuberculosis examinations are carried out for several years, not to mention such “trifles” as dentistry, eye examinations and so on. Can this just be attributed to a current lack of government funds? A letter from a reindeer-breeder indicates otherwise:
“Sometimes an expensive MI-8 or MI-6 helicopter arrives in the tundra with medical and scientific personnel on board. Physicians fill in their forms, take some tests or X-ray photographs and then fly away. If a reindeer-breeder from the tundra or taiga asks them to treat a tooth or supply a pair of spectacles, or to give him some pills, he is told that they have no money to buy medicines, there are no specialists, no equipment, that he should travel to a central regional hospital and so on. But why do they use such an expensive helicopter then?”
Factors affecting the natural environment have made matters worse. According to research carried out by RAIPON and AMAP, the northern regions are heavily contaminated by persistent organic pollutants and other substances, which build up in the food chain and are toxic to humans and animals. Tests reveal, for example, that pollutants in maternal milk exceed levels regarded as safe. This negatively impacts immunity, mental development and other health parameters—not only of today’s generation, but also their offspring. In some regions people have had to reduce their consumption of traditional northern food or even abandon it altogether. With outside foods in short supply following the breakdown of collectivities, indigenous peoples have come to rely again on traditional foods for their survival. But now these are also endangering their health.
Thus, many health care achievements made during the Soviet period have been lost, while health indices, mortality rates and life expectancy have approached those of the 1920s. A significant proportion of infants are born with birth defects; too many die during the first years of life. A high suicide rate combined with disease and alcoholism means that many adults do not reach old age. Not surprisingly, there is mass migrations from tundra regions; former reindeer herders join the lowest socio-economic stratum in the northern residential centres; a proportion scrape along by begging and stealing. As R. G. Abdulatipov has pointed out, the indigenous peoples of Russia’s North stand on the brink of extinction.
Regardless of how well-intentioned they are, plans and proposed strategies to redress this grim situation seem ill-conceived and poorly thought out. Let’s take as an example the Federal Target Programme called “Economic and Social Development of the Indigenous Peoples of the North until 2011”. The raft of economic measures which it sets out includes the establishment of trading stations, slaughtering and processing plants. But the plan does not include answers to these kinds of questions: What will the trading stations trade in, and where are the products going to come from? What are the processing plants going to process? There is a great deal of wishful thinking in such proposals, but no solid ground for real achievements.
What steps can we take to address the dire health problems of the indigenous peoples of the North? First, the errors of state policy which have contributed to this situation must be admitted at the highest levels of authority, and there must be a political will to overcome the current crisis. Second, specific details of the health crisis must be better understood. This will entail analyses of health data, which are currently not even being collected. The lack of reliable nation-wide medical statistics on the indigenous peoples of the North hinders the formulation of solutions.
Another important step will be to rectify the balance of responsibility between federal and regional authorities. In the past, relations between the political centre and the regions were simple: all questions were settled by the Union and Republican bodies while the regions played an executive role. But during the post-Soviet redistribution of power, health care for regional populations has passed to the jurisdiction of the individual administrative units of the Russian Federation. In northern regions this has had negative consequences for indigenous people because the regional administrative units are not always able to solve their problems competently and effectively. A related problem is the lack of a horizontal integration—efficient connections between different ministries, departments and organisations at the same “level”. In fact, what is urgently needed is a unified body in Russia which would formulate and implement the whole complex of measures addressing the peoples of the North, and be accountable for them.
It is also vital that the protection of the environment and health of the indigenous peoples of the North be legislatively secured. Article 25 of ILO Convention 169 states:
“Governments shall ensure that adequate health services are made available to the peoples concerned, or shall provide them with resources to allow them to design and deliver such services under their own responsibility and control, so that they may enjoy the highest attainable standard of physical and mental health.”
This must be the foundation for a Russian legal framework. Lawmakers are proud of the current federal law entitled “On the Guarantees of Rights of the Indigenous Peoples of the Russian Federation”. But indigenous health matters are inadequately covered in this weighty piece of legislation; medical treatment, for example, is just mentioned in passing. In general, the relevant federal and regional legislative acts spell out no concrete mechanisms, and earmark no firm sums of money, for carrying out the rights they “guarantee”. There is ample room for misinterpretation at the local level.
Increased health care funding is another important ingredient but, as I’ve argued, it has not been the only cause of the woefully inadequate health care plan for the indigenous peoples of Russia’s North. By the same token, infusions of money alone will not reverse the situation. To be effective, health care funds must be used wisely, based on an intimate understanding of the current crisis and its causes, learning from examples in other northern countries, and involving indigenous peoples’ participation in every step of the process.
Let us build on the fact that the indigenous peoples of the North are today acknowledged and esteemed; their problems are the focus of attention both within Russia and globally. Remember that this is the International Decade of the World's Indigenous People, an event which the United Nations established to mark the importance of the world’s indigenous peoples.
In conclusion, I recommend the addition of the following statement to the draft resolution of this meeting of the Organising Committee:
“1. We appeal to the President of the Russian Federation, to the Heads of the Federal Assembly and the Government of the Russian Federation that the Russian State admit its responsibility for mistakes made during previous years, and accepts responsibility for redressing the current indigenous peoples’ health care crisis with appropriate emergency and long-term measures that include the participation of indigenous peoples.
2. We propose the establishment of a State Committee on the affairs of the traditional natural resources use and the indigenous peoples of the North. This must not turn out to be a recreation of “Goskomsever” (neither in its aims and objectives nor in its methods of work and personnel staff). This Committee must be similar to the Committee on Assistance to the Indigenous Peoples of the North, was in place from 1924 to 1938 and was affiliated to the Presidium of the All-Union Central Executive Committee. The new Committee must concentrate on a wide range of economic, social and cultural development matters concerning the indigenous peoples of the North. For this it is necessary to withdraw appropriate powers, functions and funds from federal and regional authorities so these can be redirected to the new committee. The main objective of the Committee’s health care department is to provide adequate public health care. The officials of the Committee must be researchers specialised in the problems of the North, including anthropologists as well as specialists who are themselves Northern indigenous peoples. The following specific ends must be met:
3. To realise the suggestions listed above it is necessary to establish, with the assistance of RAIPON, a commission affiliated to the central government of the Russian Federation.”
1)State Committee for Northern Affairs (post-Soviet Russia)
2) State farms, abbrev. sovyetskoye khozyaystvo, a form of collectivity