Accessible Health Care for Indigenous Peoples of the North in the Russian Federation: A Strategy for Survival

Date: May 2001

RAIPON (Russian Association of Indigenous Peoples of the North)

At present the indigenous peoples of the North, Siberia and the Far East in Russia appear to be on the brink of socio-economic extinction, demographically depleted and politically alienated. These facts are confirmed by the statistical data and scientific research. A special characteristic of the peoples of the North is that they continue to use land and resources in their traditional environment, which is marked by extremely harsh natural conditions. The situation is all more alarming as they are the most archaic and vulnerable part of the Russian population. On the whole, peoples of the North had experienced integration into the Russian society as a degrading process, resulting in a deep crisis. Destruction of the family, partial or complete isolation of children from their parents, and education and raising of the children with no consideration of their cultural, physiological and mental particularities had pernicious consequences for aborigines of the North.

The crisis manifests itself in the sharp downturn of the indexes of the health of indigenous peoples of the North – significant decrease in life duration (the average age of aborigines in some regions in the North is as low as 37 years), increase in mortality, including the natal mortality (in some ethnic groups this index exceeds 70 per 1000 live births), and an increase in the disease rate (for example, incidence of tuberculosis in aborigines is 10 times higher than in Russia).

In some settlements up to 85% of the inhabitants are infected with opisthorhosis (liver fluke infection). The incidence of stabbings among indigenous peoples is 25 times higher than that of the general population. Communicable diseases, consisting 80% of all illnesses, tend to be chronic. Negative tendencies are traced out in many other statistical data on indigenous peoples that reveal specific patterns of origin and development of various diseases. The prevalence of alcoholism among indigenous peoples is up to 20 times higher than an average national proportion. The spread of alcoholism was followed by an increase in suicide mortality. In the period of 1995-98, for example, the number of suicide cases in the Chukotskiy Autonomous Okrug was 150 per 100,000 inhabitants while throughout Russia the suicidal index in 1995 was at most 61 per 100,000 inhabitants.

High morbidity and mortality are determined by the inadequate organisation of health care, striking poverty, aggravated living and environmental conditions, and especially by combination of all these factors with anthropo-biological characteristics peculiar to aborigines of the North. Many researchers recognise morphological and physiological features of indigenous peoples formed under geoclimatic conditions of the Arctic zone as a “norm”. Lack of information concerning those characteristics was especially harmful for aboriginal children who were exposed to radical external influence. In the Soviet era children of aborigines were separated from their parents. The children were brought up in boarding schools by people of the mainstream culture. At present this educational method is still applied. Furthermore, there are no recommendations for nutrition in nurseries which relate to the particularities of traditional feeding. For example, the majority of aborigines cannot digest cow’s milk. All the political, economic, cultural and ecological changes led the community of indigenous peoples to the current state of degradation and resulted in physical and mental deterioration.

Thus, peoples of the North are the most vulnerable and suffering group in Russia and are in urgent need of political and legal defense, social, economic and medical assistance. That this category of people lacks or has little access to the necessary aid, is explained by a considerable level of discrimination in the public health service in Russia. In the regions of the North, Siberia and the Far East the existing system of health care has been destroyed, especially the medical aid institutions in the Northern areas. As a result, timely and comprehensive, and especially prophylactic, medical services appear to be practically inaccessible for indigenous people leading a traditional nomadic lifestyle.

The situation is aggravated by the fact that peoples of the North are just subjects for State policy and have no possibility to solve their own problems independently. The modern Russian legislation in the health sphere is mostly of declarative character, and concerning the peoples of the North does not guarantee human rights according to the international standards and WHO recommendations.

RAIPON attempts to attract the attention of international (including the World Health Organisation) fora, as well as Russian organisations, to the anthropo-biological aspects of the crisis of the peoples of the North and to raise awareness of the necessity to radically change the health care situation of the Northern indigenous peoples.

The mission of RAIPON is to initiate practical activities in Russia aimed at improving the indigenous peoples’ living standards. The list of these activities is really lengthy, but one of the main problems undoubtedly is the development of the State policy and the elaboration of health care concepts relevant for the indigenous peoples of the North. One of the main components of this should be the principle of establishing partnership relations with the indigenous peoples, delegating rights to design and manage the health service.

The first practical act on the realisation of this principle should be, in RAIPON’s opinion, the creation of a model for independent public health service – a Center of Indigenous Peoples Health under RAIPON.

This idea of establishing a Health Center (HC) establishing under RAIPON was welcomed at the Summit of Arctic Leaders held in Moscow in 1999. Furthermore, the idea was supported at the International Scientific Conference, jointly organised by the International Arctic Science Committee (IASC), the Russian Academy of Sciences (RAS) and RAIPON in May 2000. In addition to practical measures it was recommended to include scientific research the range of the Health Center’s activities.

The realisation of the project would lay the basis for a completely new approach towards improvement of the health situation of peoples of the North. However, accomplishment of the objectives and research set forth is beyond the financial scope of RAIPON and should be considered as a separate activity.

The Health Center will be acting as a public service established by the members of the Russian Association of Indigenous Peoples of the North (RAIPON). Its main goal is protection of the interests of indigenous peoples of the North in the sphere of health care.

Goals and objectives:

• to protect the rights of indigenous peoples in accordance with their needs, the Russian legislation and international legal acts; to assist the indigenous peoples of the North to practice their rights, lifestyle and health care;
  
• to put in effect a set of actions aimed to improve the physical and mental health of indigenous peoples;
  
• to lay the ground work for the realisation of the necessary reforms; to set the guidelines for the State policy regarding indigenous peoples’ health care;
  
• to set up a model for the self-governance in the public health service of peoples of the North;
  
• to provide practical aid for the most impoverished people of the North via organisation of rehabilitation and various consultative assistance in the field of health protection and law.
  
  

Planned activities:

To implement the goals and objectives stated above the HC will carry out the following activities:

• Information and analysis comprise collection and processing of various medical and demographic data regarding the territories of indigenous peoples of the North;
  
• Creation of a Data Bank and the Health Atlas of Indigenous Peoples of Arctic Russia;
  
• Education comprises creation, publication and distribution of a ‘Medical Handbook for Indigenous Reindeer Herders, Fishermen and Hunters’. A short documentary film on health and health service problems of peoples of the North is also planned;
  
• Protection of human rights comprises the protection of patients’ interests revealing cases of violation of health care rights, organising seminars and legal consultations for peoples of the North. Participation in drafting and discussion of legislative acts and proposal to various programs is also foreseen;
  
• Rehabilitation comprises organisation of medical and legal consultative aid, implementation of sanitary measures and financial support for the patients who need consultative and medical aid in the specialised clinics of the Russian Federation;
  
• Humanitarian aid includes purchase and transportation of drugs and equipment for the peoples who lead a traditional nomadic life;
  
• Participation to various programmes of Russian and international organisations and departments designed to solve the socio-economic problems of peoples of the North.
  
  

IMPLEMENTATION OF THE PROJECT

The Health Center will perform the following tasks:

• enlist the participation of local and regional activities, to establish a network for collecting reliable information on the health and medical service problems of the aborigines; on the basis of the data received from the regions as well as existing statistical and analytical data of the various bodies and organisations to detect the principal problems – general and local, to map the problems and gaps and to determine the priorities;
  
• formulate the optimal variants of strategy and methods for solving of the existing problems;
  
• work out evaluation criteria and tools for progress measuring;
  
• select partners and define their roles;
  
• seek resources and funds;
  
• conduct ongoing work to identify people living on the territories of traditional nature use who need specialised aid, both medical and legal, and to assist in delivering of the aid in every possible way;
  
• establish partnerships with the RF Ministry of Health, the Russian Academy of Medical Sciences (RAMS) and other departments and organisations.
  
  

The staff members of the Health Center will:

• compile, publish and distribute the ‘Medical Handbook for Indigenous Reindeer Herders, Fishermen and Hunters’ (the handbook should comprise the special health issues pertaining to each indigenous group, regional problems, principles of traditional medicine, human rights in the sphere of health care);
  
• develop the methods for aboriginal activists’ training;
  
• organise evacuation for aboriginal patients form the subsistence areas to the central regions for delivering qualified and specialised medical aid.
  
  

The Health Center will accommodate patients from northern regions who arrive in Moscow for consultative and diagnostic aid and/or medical treatment. Whenever possible the HC will cover transport and treatment expenses of the most impoverished patients. At the local level, there must be social service staff who will assist to Center activities in all regions. If sufficient funds are allocated, establishment of interregional (or district) health centers in one or two northern regions is possible. Setting up a medical telecommunication connecting regions and the HC is also possible.

Thus, through the implementation of the project RAIPON will develop a conceptual basis for the health protection and care of the peoples of the North and will make comprehensive practical health service accessible to communities and patients and keeping up with the changes in society. This new concept regarding the health protection service for Arctic peoples will be further represented in state bodies leading to changes in the State policy and ensuring long-term support for the Health Center for Indigenous Peoples of the North under the RAIPON umbrella.

Participants of the project:

This project will be performed by a working group organised by the RAIPON Coordinating Council. The council will supervise the work of the working group and the HC. The project will be coordinated by its initiator – Dr. Larisa Abryutina, who is a physician by profession and has been elected a Vice-President of RAIPON. She has been practicing for 15 years in the mobile medical service in Chukotka. Members of RAIPON and invited specialists and researchers will also join the working group and will work in the Health Center.