Many know about Africa's severe health problems, but few are aware of a parallel tragedy building in Russia.
Devastated by disease and alcoholism, mortality rates have risen dramatically since the fall of communism. Furthermore, very little is being done either by the Russian government or the world community.
At the moment, deaths exceed births by about 700,000 a year. Some experts say Russia's population could drop to 80 million in 50 years from 150 million today.
"The loss of life from this quiet crisis in Russia has been a catastrophe of historic proportions," says Nicholas Eberstadt, a scholar at the American Enterprise Institute in Washington. "Mortality and disease will pose major obstacles to economic development ... for decades to come."
"If demography is said to be destiny, the destiny of Russia for the next 50 years or more is appalling," says Murray Feshbach, a research professor at Georgetown University's School of Foreign Service in Washington.
These grim views are based on economic, health, and demographic trends in Russia since the fall of communism, and no rapid way out of the disaster is easily visible. One hopes these views will serve as warnings. Will Russian politicians and citizens, seeing the flashing red lights of danger, change direction and break through the damaging fog of alcoholism, sexually transmitted diseases, sharing of drug needles, and corruption?
Already the breakup of the Soviet Union has greatly diminished Russia's might. "In barely a decade, Moscow has plummeted from the status of an imperial superpower to a condition of astonishing geopolitical weakness," notes Mr. Eberstadt in Policy Review, a Heritage Foundation publication. Furthermore, Russia's gross domestic product halved in the 1990s.
So far Russia hasn't adequately tackled its catastrophic health scene - nor does it appear to be a matter of public concern.
While there are more than a dozen political parties fighting for votes this election season, none has chosen to make public health a major campaign issue. It wasn't mentioned much in the recent parliamentary elections.
Nor are many Russian citizens, perhaps unused to participatory democracy, organizing a push for improved spending programs for health or demanding temperance measures.
The Soviet Union was infamous for its staggering vodka consumption. Contemporary Russia's thirst for vodka has gotten worse. Russian men on average are drinking about five bottles of vodka per week.
The World Health Organization (WHO) stipulates that eight liters of alcohol per capita is the upper limit for consumption before major health problems ensue. Russians - adults and children alike - consume 14 to 15 liters per capita per year. And Vodka output rose 65 percent in the first half of 1999.
In effect, many Russians are drinking themselves to death.
More than 35,000 people died from accidental alcohol poisoning in 1996. In fact, daily headlines in Moscow during the winter include body counts of the inebriated people who died of exposure. In the United States, which has almost twice the population, about 300 a year die from the same cause.
Drinking is behind many of the violent and accidental deaths in Russia. According to Eberstadt, with the present pattern, a baby boy stands almost a 1 in 4 probability of dying from some sort of external trauma. That compares with about 1 in 30 in Britain. Russian women are twice as likely to die from alcohol poisoning or injury as American men. Alcohol abuse, Eberstadt figures, also plays a role in high rates of coronary disease and other fatal diseases.
Russians are also heavy tobacco users. Two-thirds of men and one-third of women smoke. Medical authorities say smoking accounts for 20 to 30 percent of deaths from heart disease and cancer. And Russian death rates from these diseases are twice those in the US.
Feshbach further sees a rapid spread of drug-resistant tuberculosis, AIDS, and other sexually-transmitted disease in Russia. One study predicts some 13 million Russians will be infected by HIV by 2005.
"This is getting close to Africa," Feshbach says. Eberstadt doesn't regard the AIDS problem as being so severe, but he does find the breakout of AIDS surprising in an industrial country with an educated population.
So what is to be done?
Teresa Ho, manager of the World Bank's health programs in Russia, says Feshbach's terrible predictions of diseases will come fully true only if nothing is done. And that's not entirely the case.
Russia's health ministry itself is experimenting with more modern hospital practices to make more-efficient use of public-health funds and thus provide services to more people.
The World Bank is considering a $150 million loan for a program to deal with AIDS and tuberculosis. WHO, other UN organizations, the Soros Foundation, and the US and other nations are trying to help in modest ways.
Eberstadt emphasizes the need for a determination within the Russian public and political scene to pay more attention to the catastrophe. Public attitudes toward healthy behavior must change.
A transition to a civil society under the rule of law "would have a positive and tangible effect on Russian health," he says. It could encourage business and reduce the poverty behind some of the health problems.
Mikhail Gorbachev took measures to restrain alcohol consumption during his 1980s presidency. Death rates declined. But the measure was a disaster from a political standpoint. No political leader has since dared to challenge Russia's drinking binge.
"The leadership remains relatively silent," notes Ms. Ho. There is no organized campaign to spread "healthy life styles" among Russians.
Without rapid policy measures, Russia's population will drop 45 percent in 50 years - the same period in which US population is expected to rise 45 percent, from 272 million to 393 million. Russia ranks 125th in average life expectancy among 188 nations studied by the UN.
The ultimate effect of inaction is captured in a chilling question posed by Eberstadt: Will Russia be "too sick to matter" in world affairs?
A Harvard University expert on Russia, Graham Allison, argues that the health crisis in Russia with its 30,000 nuclear weapons makes it even more important for the West to provide help to the troubled nation. "It is Russia's weakness that is the greater danger to America."
*David R. Francis is senior economic correspondent for the Monitor.
(c) Copyright 1999. The Christian Science Publishing Society