HEALTH IN UZBEKISTAN
Life expectancy at birth: total population: 73.55 years; male: 70.5 years; female: 76.78 years (2015 est.), country comparison to the world: 125. "Life expectancy" is an abstract and complicated concept a complex formula that attempts to predict the lifespan of children born today by subjecting a hypothetical child born today to the current risk of dying in each bracket he or she mature through until, in effect, the accumulated risk of death is 100 percent. [Source: CIA World Factbook =]
According to Azimov, Mutalova, Huseynov, Tsoyi, Rechel: “Life expectancy at birth in 2012 was recorded in official statistics at 70.7 years for males and 75.5 years for females. However, World Bank estimates are lower, suggesting a male life expectancy at birth of 64.8 years and a female life expectancy of 71.5 years. The discrepancy is due to a combination of factors, in particular under-reporting of infant mortality, as well as differences in definitions, methodology and sources (with the World Bank estimates being based on survey data). [Source: “Uzbekistan: Health System Review” by Azimov, Mutalova, Huseynov, Tsoyi, Rechel, Health Systems in Transition, 2014 ^=^]
Infant mortality rate: total: 19.2 deaths/1,000 live births; male: 22.78 deaths/1,000 live births; female: 15.4 deaths/1,000 live births (2015 est.), country comparison to the world: 91. Death rate: 5.3 deaths/1,000 population (2015 est.), country comparison to the world: 180. =
Obesity - adult prevalence rate: 14.3 percent (2014), country comparison to the world: 119. Children under the age of 5 years underweight: 4.4 percent (2006), country comparison to the world: 97 =
As Uzbekistan struggled to revise its Soviet-era health care system, the physical condition of its population was exacerbated by severe environmental conditions that were inherited from the Soviet period and were not addressed effectively in the first years of independence. Key health indicators showed a correlation between the high level of air and water pollution and health problems. [Source: Library of Congress, March 1996 *]
Health Problems and Disease in Uzbekistan
Uzbekistan has some serious health problems. Epidemics have been caused by high pollution levels, especially in Aral Sea region. Infant mortality increased very fast beginning in the 1970s. Among the most common diseases are those associated with polluted drinking water: typhoid, hepatitis, dysentery, cholera, and various types of cancer. The chief causes of death are, in order of frequency, disorders of the cardiovascular, respiratory, and digestive systems and infectious and parasitic diseases. [Source: Library of Congress February 2007 **]
According to Azimov, Mutalova, Huseynov, Tsoyi, Rechel: “Diseases of the circulatory system (mainly ischaemic heart disease and cerebrovascular disease) are the most common causes of death in Uzbekistan. The mortality rate from diseases of the circulatory system has increased in Uzbekistan since the 1980s, a development that mirrors the trends in other countries of central Asia and the Commonwealth of Independent States (CIS), but contrasts with trends in western Europe, where mortality from this group of causes of death has continuously declined in recent decades. Also similarly to other countries of the region, there has been a resurgence of tuberculosis in the years after independence, as well as an increase in multi-drug and extensively drug-resistant tuberculosis, and HIV infections have increased steeply in the 2000s and early 2010s. [Source: “Uzbekistan: Health System Review” by Azimov, Mutalova, Huseynov, Tsoyi, Rechel, Health Systems in Transition, 2014 ^=^]
Goiter, caused by a lack iodine is a problem in some places. For treatment some people live in salt caves so they can breath in air rich in iodized salt. Until a hundred years ago Bukhara was laced with canals and more than 200 stone pools, known as hauz, that brought in water for drinking, bathing and washing as well as a host of diseases—such as the Bukhara boil, which has been compared guinea worm disease—that lowered the average lifespan of the city to 32. The Soviets filed all the canals and pools—except for one, Lab-i-Hauz. Not surprisingly disease rates plummeted.
Pollution and Health Problems in Uzbekistan
According to experts, the most immediate impact of the environmental situation in Uzbekistan is on the health condition of the population. Although it is difficult to establish a direct cause and effect between environmental problems and their apparent consequences, the cumulative impact of these environmental problems in Uzbekistan appears to have been devastating. [Source: Library of Congress, March 1996 *]
Frequently cited in Uzbekistan's press are increasing occurrences of typhoid, paratyphoid, and hepatitis from contaminated drinking water; rising rates of intestinal disease and cancers; and increased frequency of anemia, dystrophy, cholera, dysentery, and a host of other illnesses. One Russian specialist includes among the ailments "lag in physical development," especially among children. According to this observer, sixty-nine of every 100 adults in the Aral Sea region are deemed to be "incurably ill." In 1990 life expectancy for males in all of Uzbekistan was sixty-four years, and for females, seventy years. The average life span in some villages near the Aral Sea in Karakalpakstan, however, is estimated at thirty-eight years. *
Pollution is blamed for a 50 percent increase in the infant morality rate between the early 1980s and mid 1990s. In some places 1 out very 10 babies died before the age of one, one of the highest in the world. Infant mortality increased by as much as 49 percent between 1970 and 1986 to an average of 46.2 deaths per 1,000 live births. In 1990 the average rate of mortality before age one for the entire country was sixty-five deaths per 1,000 live births. In the mid-1990s, official data estimated the level of infant mortality in parts of Karakalpakstan — which is around the dried up parts of the Aral Sea — at 110 per 1,000 live births; unofficial estimates put the level at twice that figure. In 1992 the national maternal mortality rate was 65.3 per 100,000 live births, with considerably higher rates in some regions. *
High cancer rates, high infant morality and hepatitis have been linked directly or indirectly to the use of toxic chemical in the cotton industry.
Health, Disease and the Aral Sea
The toxic dust and salty grit from the dry lake bed carried by the dust storms is linked with increases in birth defects, typhus, cholera, gastritis, respiratory and eyes disorders, tuberculosis, childhood anemia, various kinds cancers and one of the highest infant mortality rates in the world. Some women have as many as 10 miscarriages.
People exposed regularly to the dust have high rates of anemia, goiter, respiratory diseases, throat cancer, kidney and liver problems, and stomach and intestinal ailments. In some places 85 percent of all people have anemia. The rates of cancer of the esophagus are among the highest in the world. Children gets rickets from poor nutrition. One study found high levels of DNA damage which may be linked to the high cancer rates.
The high infant mortality rates are often linked with the high rates of anemia among women who drink water with sand and stones. which accumulates in the kidneys and causes lose of blood during urination, They don’t eat enough protein to compensate for the blood lose. As a result the women become anemic and give birth to stillborn or handicapped babies. Studies found that 40 percent of the people that live in the Aral Sea area suffer from kidney disease linked to salinization.
Martin Fletcher wrote in The Times, “ Even today, 29 per cent of local people suffer from respiratory illnesses, and 47 per cent of women of fertile age suffer from blood diseases such as anaemia. Rates of cancer, miscarriages, infant mortality, birth defects, tuberculosis, kidney and skin diseases have soared. Mark Synnott wrote in National Geographic: “ Besides toxic levels of sodium chloride, the dust is laced with pesticides such as DDT, hexachlorocyclohexane, toxaphene, and phosalone—all known carcinogens. The chemicals have worked their way into every level of the food chain. Today Karakalpakstan registers esophageal cancer rates 25 times as high as the world average. Multidrug-resistant tuberculosis is a major problem, and respiratory diseases, cancers, birth defects, and immunological disorders are widespread. [Source: Mark Synnott, National Geographic, June 2015; Martin Fletcher, The Times, June 23, 2007]
Plague in Uzbekistan
There have been periodic reports of the plague in Central Asia. The germ that causes the plague is common among rodents found throughout Central Asia. The strain they carry is among the most virulent and lethal pathongens known. Among the animals most associated with the disease are marmots and gerbils. One of the main carriers is a rat-size rodent with kangaroo-like legs called the great gerbil. In the early 2000s there was an population explosion of these animals that coincided with bumper crops of grains that they eat. The Black Death of 1347-1351 originated in Central Asia and made its way to Europe on ships leaving from the Crimea.
At least 10 people died in an outbreak of the plague in Turkmenistan in the summer of 2004. Many think the death toll was much higher. There were reports of the disease in Ashgabat, Merv and Turkmenbashi and it was unclear how many cases were bubonic plague or the more lethal and dangerous pneumonic plague. Measures taken by the government included requiring heath care workers to sign a pledge saying they will not use the word “plague” and instituting border controls to “prevent disease from entering Turkmenistan from neighboring states.”
Tests in Uzbekistan confirmed the presence of the plague on rodents and fleas living along the Turkmenistan border, As as precautionary measure in that country cattle breeders, old workers and geologist and thousands of camels were quarantined. Uzbekistan also imposed border controls to prevent anyone with the disease from crossing the border from Turkmenistan. Antiepedemic teams were stationed in the area.
In the Soviet era the Soviet government had emergency plans in place to isolate and combat the disease when the outbreaks occurred. News of these outbreaks rarely reached the outside world — with exception of one outbreak in Turkmenistan that is said to have left hundreds dead — and were quickly controlled and contained.
The Soviet system to deal with disease emergencies are either no longer in place or are at least no longer sound as they once were. There are worries that a serious outbreak could occur. The situation is particularly worrisome in Turkmenistan, which is hostile to outsiders and international nongovernmental organizations.
AIDS and HIV in Uzbekistan
HIV/AIDS - adult prevalence rate: 0.18 percent (2013 est.), country comparison to the world: 96. HIV/AIDS - people living with HIV/AIDS: 34,700 (2013 est.), country comparison to the world: 65. HIV/AIDS - deaths: 2,700 (2013 est.), country comparison to the world: 51. [Source: CIA World Factbook =]
The reported incidence of human immunodeficiency virus (HIV) has increased sharply beginning in 2002, partly because of a new government reporting policy and partly because of increased drug abuse. In 2005 about 5,600 cases of HIV were known, after 2,000 new cases appeared in 2004. At least two-thirds of cases have been linked with drug abuse. The geographic centers of the HIV cases are Tashkent and Surkhandarya Province on the Afghanistan border. Expanding drug trafficking through Uzbekistan has led to increased drug addiction in urban areas. Some HIV treatment and counseling centers exist. [Source: Library of Congress February 2007 **]
In the 1990s, the numbers of reported AIDS cases was relatively low but has increased since then primarily as a result of increased drug usage as has been the case in in Russia. According to the WHO, Uzbekistan reported one case of acquired immune deficiency syndrome (AIDS) in 1992, one in 1993, and none in 1994. No treatment centers or AIDS research projects are known to exist in Uzbekistan. [Source: Library of Congress, March 1996 *]
According to the U.S. Department of State: “According to statistics provided to the press by the Republican Center for Combating AIDS, as of January 1, there were 28,136 HIV-positive individuals in the country. Persons known to be HIV positive reported social isolation and discrimination by public agency workers, health personnel, law enforcement officers, landlords, and employers after their HIV status became known. The military summarily expelled recruits in the armed services found to be HIV positive. The government’s restrictions on local NGOs left only a handful of functioning NGOs to assist and protect the rights of persons with HIV/AIDS. No credible demographic or health survey data dealing with HIV/AIDS was publicly available. [Source: “Country Reports on Human Rights Practices for 2014: Uzbekistan ,” Bureau of Democracy, Human Rights and Labor, U.S. Department of State \*\]
According to the United Nations: “The first case of HIV in Uzbekistan was recorded in 1987 and until 1999 only 76 cases were registered in the country. Since then, the number of HIV infections recorded has increased drastically. By the end of 2006 the cumulative number of HIV infected persons registered was reported as 10,015 (HIV prevalence of 32.7 per 100,000 people). However, UNAIDS estimates that the number of people living with HIV/AIDS in Uzbekistan is 31,000, the highest estimated prevalence of HIV in Central Asia. [Source: “Illicit Drug Trends in Central Asia”, United Nations Office on Drugs and Crime Regional Office for Central Asia, April 2008 |~|]
“Uzbekistan has the lowest rates of IDU, estimated to be 0.49 percent of the adult population; however, it has the second highest prevalence of registered HIV. Given that IDU is responsible for 60 percent of cases (81 percent of known cases), this could mean that the HIV epidemic is more concentrated in Uzbekistan. |~|
Total HIV cases in Uzbekistan: 0.2 in 1996; 0.2 in 1997; 0.2 in 1998; 0.3 in 1999; 0.9 in 2000; 3.1 in 2001; 6.9 in 2002; 13.2 in 2003; 20.7 in 2004; 27 in 2005; 32.7 in 2006. New HIV cases in Uzbekistan: 0 in 1996; 0 in 1997; 0 in 1998; 0.1 in 1999; 0.6 in 2000; 2.2 in 2001; 3.9 in 2002; 7.1 in 2003; 7.7 in 2004; 8.3 in 2005; 8.2 in 2006. |~|
“In 2006 alone, 2,205 new HIV cases were recorded, equal to 22 percent of all HIV cases. Of cases reported in 2005, the majority (78 percent) were males. The parenteral route (including injecting drug use) is the main route of transmission, accounting for 60 percent of HIV cases in Uzbekistan. Sexual contact is responsible for 18 percent of the cases reported; 0.5 percent, mother to child transmission; and 17 percent are reported as “unknown”. |~|
Regional Breakdown of AIDS and HIV in Uzbekistan
According to the United Nations: “Sub-nationally, Tashkent city reported the highest cumulative total of 3,671 HIV cases. This constituted a rate of 170 HIV cases per 100,000 people, the highest in Central Asia.8 Likewise, Tashkent city reports Central Asia’s highest incidence of new HIV cases at 28 per 100,000 (698 new cases). Tashkent city also has the largest prevalence of registered drug users, the highest volume of drug related crime, and the second highest volume of seizures. [Source: “Illicit Drug Trends in Central Asia”, United Nations Office on Drugs and Crime Regional Office for Central Asia, April 2008 |~|]
“Although the prevalence of registered opiate users in Tashkent oblast is one of the lowest (0.4 percent), the cumulative number of HIV cases (1,787) and the rate of 72 HIV cases per 100,000 people are the highest for any oblast in Uzbekistan (excluding Tashkent city). |~|
“Additionally, the cumulative number of HIV cases registered in Samarkand is reported at 505 with a rate of 17 HIV cases per 100,000 people. While Samarkand oblast has one of the highest opiate use prevalence in Uzbekistan, the proportion of injecting drug users is one of the lowest (around 38 percent), possibly explaining the low levels of HIV. |~|
“In Surkhandarya the cumulative number of HIV cases was reported as 268 (14 per 100,000 people), with more than 90 percent of the HIV cases reportedly among men, significantly higher than the national proportion of 78 percent. It may be noted that Surkhandarya also has a high relative opiate use prevalence of 0.8 percent. |~|
Children Infected with HIV in Uzbekistan
In 2010, Reuters reported: “Nearly 150 children were infected with HIV in hospitals in eastern Uzbekistan and 12 medical staff have been sentenced to jail terms of five to eight years for negligence, a news website said. At least 14 children have died, out of 147 who were infected with HIV, the virus that causes AIDS, in the eastern city of Namangan in 2007-8, regional prosecutor Bakhtier Shodmonov said in a documentary posted on the news portal Fergana.ru. [Source: Reuters, March 22, 2010 <<<]
"Not conforming to sanitary rules and not taking anti-epidemiological measures, employees at the medical establishments were negligent in their duties. Today of 147 children, 14 are no longer alive," Shodmonov said in the film. The website said the footage was from a film made earlier this year for state television, but never broadcast in the tightly controlled Central Asian nation. <<<
The infections were caused by unsterilised syringes and intravenous drips, relatives of the victims said in the film. The press office of the prosecutor general's office was not available for comment, and a health ministry official declined comment. <<<
Handicapped People in Uzbekistan
According to the U.S. Department of State: “The law prohibits discrimination against persons with disabilities, but there was societal discrimination against those with disabilities. According to official statistics, there were 550,000 persons with disabilities, but activists believed the actual number may be more than three million. The government continued efforts to confirm the disability levels of citizens who received government disability benefits. Officially, authorities did so to ensure the legitimacy of disability payments, but unconfirmed reports suggested that, in the process, authorities unfairly reduced benefits to some persons with disabilities. [Source: “Country Reports on Human Rights Practices for 2014: Uzbekistan ,” Bureau of Democracy, Human Rights and Labor, U.S. Department of State \*\]
The law allows for fines if buildings, including private shops and restaurants, are not accessible, and activists reported that authorities fined individuals or organizations in approximately 2,500 cases during the year. A 2013 law reduced the fine for failing to create the necessary conditions for persons with disabilities from 6.4 to 9.2 million soum ($2,680 to$3,830) to 2.2 million soum ($920). Disability activists reported that accessibility remained inadequate, noting, for example, that many of the high schools constructed in recent years had exterior ramps but no interior modifications to facilitate access by wheelchair users. \*\
The Ministry of Health controlled access to health care for persons with disabilities, and the Ministry of Labor and Social Protection facilitated employment of persons with disabilities. No information was available regarding patterns of abuse in educational and mental health facilities. The labor law states that all citizens enjoy equal employment rights, but disability rights activists reported that discrimination occurred (see section 7.d.) and estimated that 90 percent of persons with disabilities were unemployed. The government indicated 17,000 jobs were set aside for persons with disabilities. There were no government programs to ensure access to buildings, information, and communications, and activists reported particular difficulties with access. Activists also reported instances in which persons with disabilities were not provided sign language interpreters during police investigations and court hearings. \*\
According to the government, of the 78,964 children with disabilities in the country, 9,739 attended public schools, 17,328 attended 84 specialized schools, 10,064 were home schooled, and 21,291 attended one of 195 specialized preschool centers. Students studied braille books published during Soviet times. There were computers adapted for people with vision disabilities. \*\
Mental Health in Uzbekistan
According to Azimov, Mutalova, Huseynov, Tsoyi, Rechel: “In Uzbekistan, psychiatric care is integrated into the statutory public health system and included into the guaranteed package of medical services. While it is predominantly delivered in the public sector, the stigmatization attached to seeking mental health care might deter patients from utilizing the public sector and give rise to a demand for alternatives, which can include both private practices and private arrangements with publicly employed physicians. [Source: “Uzbekistan: Health System Review” by Azimov, Mutalova, Huseynov, Tsoyi, Rechel, Health Systems in Transition, 2014 ^=^]
“Officially, the public sector is the only provider of mental health services in Uzbekistan. It is estimated that about 3 percent of state health funding is utilized for mental health services; of this, 89 percent is spent on hospital services. Mental health services in the public sector are free. Medication coverage for mental health patients is relatively well funded and approximately 80 percent of medications seem to be provided for free by the government (WHO-AIMS, 2007). ^=^
“Since independence, some efforts have been undertaken to develop a legal framework for psychiatric care. The Law on psychiatric services, adopted by the Parliament in 2000, defines the minimum government guaranteed package of psychiatric and social services for mental health patients. Relevant changes have also been made to the criminal code of the country, to which a new section related to the involuntary placement of patients in psychiatric inpatient institutions has been added. ^=^
“A number of initiatives were implemented in the public system of mental health care with the aim of shifting service delivery from inpatient to outpatient care. New outpatient facilities, such as centres for mental health promotion, specialized outpatient centres and child care services, were organized and new services, such as suicide prevention, were designed. A significant reduction in mental hospital beds was also implemented. ^=^
“In many countries, psychologists and social workers contribute significantly to the delivery of mental health care. In Uzbekistan, social services are not closely integrated with mental health care. Psychologists, although part of the health system at the point of delivery, are not fully integrated into the health system. The training of psychologists falls outside the scope of medical education and is outside the remit of the Ministry of Health. Health professionals involved in the delivery of mental health care are included in the category of professions with occupational hazards. This entitles them to special provisions, such as a lower age for retirement, additional vacation and mark-ups on their salaries. ^=^
Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, U.S. government, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.
© 2008 Jeffrey Hays
Last updated April 2016