Kazakstan - SOCIETY

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Kazakstan - Population

Total population was estimated in 1994 at 17,268,000, making Kazakstan the fourth most populous former Soviet republic. As of 1990, 57 percent of the country's residents lived in cities. Because much of the land is too dry to be more than marginally habitable, overall population density is a very low 6.2 persons per square kilometer. Large portions of the republic, especially in the south and west, have a population density of less than one person per square kilometer. In 1989 some 1.4 million Kazaks lived outside Kazakstan, nearly all in the Russian and Uzbek republics. At that time, an estimated 1 million Kazaks lived in China, and a sizeable but uncounted Kazak population resided in Mongolia.

Demographic Factors

The birth rate, which is declining slowly, was estimated at 19.4 births per 1,000 population in 1994 (see table 2, Appendix). The death rate, which has been climbing slowly, was estimated at 7.9 per 1,000 population--leaving a rate of natural increase of 1.1 percent, by far the lowest among the five Central Asian republics. In 1995 the total fertility rate--2.4 births per woman, a drop from the 1990 figure of 2.8--also was far below the rates for the other Central Asian republics. In the first six months of 1994, some 1.8 percent fewer babies were born than in the same period the previous year. In the same months, the number of deaths rose by 2.5 percent compared with those in the same period in 1993. In some provinces, death rates are much higher than the average, however. Shygys Qazaqstan (East Kazakstan) Province has a death rate of 12.9 per thousand; Soltustik Qazaqstan (North Kazakstan) Province, eleven per 1,000; and Almaty Province, 11.3 deaths per 1,000. The cause of nearly half of these deaths is cardiovascular disease.

Because of declining life expectancy and decreases in the size of the Russian population, which is demographically older and has a low birth rate, the republic's residents are a relatively young group; in 1991 there were only 149 pensioners per 1,000 population, as opposed to 212 per 1,000 in the former Soviet Union as a whole (see table 3, Appendix). The republic is experiencing a pronounced outflow of citizens, primarily non-Kazaks moving to other former Soviet republics. Although figures conflict, it seems likely that as many as 750,000 non-Kazaks left the republic between independence and the end of 1995. Official figures indicate that in the first half of 1994 some 220,400 people left, compared with 149,800 in the same period of 1993. In 1992 and 1993, the number of Russian emigrants was estimated at 100,000 to 300,000. Such out-migration is not uniform. Some regions, such as Qaraghandy, have lost as much as 10 percent of their total population, resulting in shortages of technicians and skilled specialists in that heavily industrial area.

To some extent, the outflow has been offset by in-migration, which has been of two types. Kazakstan's government has actively encouraged the return of Kazaks from elsewhere in the former Soviet Union and from China and Mongolia. Unlike other ethnic groups, ethnic Kazaks are granted automatic citizenship. More than 60,000 Kazaks emigrated from Mongolia in 1991-94, their settlement--or resettlement--eased by government assistance. Most were moved to the northern provinces, where the majority of Kazakstan's Russian population lives. Because these "Mongol Kazaks" generally do not know Russian and continue to pursue traditional nomadic lifestyles, the impact of their resettlement has been disproportionate to their actual numbers.

The other major source of in-migration has been non-Kazaks arriving from other parts of Central Asia to avoid inhospitable conditions; most of these people also have settled in northern Kazakstan. Although officially forbidden and actively discouraged, this in-migration has continued. In a further attempt to control in-migration, President Nazarbayev decreed that no more than 5,000 families would be permitted to take up residence in the republic in 1996.

<>Ethnic Groups
<>Clans
<>The Role of Women

Kazakstan

Kazakstan - Ethnic Groups

Kazakstan is the only former Soviet republic where the indigenous ethnic group is not a majority of the population. In 1994 eight of the country's eleven provinces had Slavic (Russian and Ukrainian) population majorities. Only the three southernmost provinces were populated principally by Kazaks and other Turkic groups; the capital city, Almaty, had a European (German and Russian) majority. Overall, in 1994 the population was about 44 percent Kazak, 36 percent Russian, 5 percent Ukrainian, and 4 percent German. Tatars and Uzbeks each represented about 2 percent of the population; Azerbaijanis, Uygurs, and Belarusians each represented 1 percent; and the remaining 4 percent included approximately ninety other nationalities.

Kazakstan's ethnic composition is the driving force behind much of the country's political and cultural life. In most ways, the republic's two major ethnic groups, the Kazaks and the "Russian-speakers" (Russians, Ukrainians, Germans, and Belarusians), may as well live in different countries. To the Russians, most of whom live in northern Kazakstan within a day's drive of Russia proper, Kazakstan is an extension of the Siberian frontier and a product of Russian and Soviet development. To most Kazaks, these Russians are usurpers. Of Kazakstan's current Russian residents, 38 percent were born outside the republic, while most of the rest are second-generation Kazakstani citizens.

The Nazarbayev government has announced plans to move the capital from Almaty in the far southeast to Aqmola in the north-central region by 1998. That change would cause a shift of the Kazak population northward and accelerate the absorption of the Russian-dominated northern provinces into the Kazakstani state. Over the longer term, the role of Russians in the society of Kazakstan also is determined by a demographic factor--the average age of the Russian population is higher, and its birth rate much lower.

Kazakstan

Kazakstan - Clans

One aspect of Kazak traditional culture, clan membership, is acquiring importance in the postindependence environment. Historically the Kazaks identified themselves as belonging to one of three groups of clans and tribes, called zhuz , or hordes, each of which had traditional territories. Because the Lesser Horde controlled western Kazakstan and the Middle Horde migrated across what today is northern and eastern Kazakstan, those groups came under Russian control first, when colonial policies were relatively benign. The traditional nobles of these hordes managed to retain many of their privileges and to educate their sons in Russian schools. These sons became the first Kazak nationalists, and in turn their sons were destroyed by Stalin, who tried to eradicate the Kazak intelligentsia during his purges of the 1930s.

The Large, or Great, Horde was dominant in the south, and hence did not fall under Russian control until colonialism was much harsher. Substantially fewer Great Horde Kazaks became involved in politics before the revolution, but those who did became socialists rather than nationalists. For that reason, the Great Horde members came to dominate once the Bolsheviks took power, especially after Kazakstan's capital was moved from the Lesser Horde town of Orenburg (now in Russia) to a Great Horde wintering spot, Almaty. Kunayev and Nazarbayev are said to have roots in clans of the Great Horde.

With the collapse of the CPK and its patronage networks, and in the absence of any other functional equivalent, clan and zhuz membership has come to play an increasingly important role in the economic and political life of the republic at both the national and the province level. The power of clan politics has been visible in the dispute over moving the national capital to Aqmola, which would bolster the prestige of the Middle Horde, on whose lands Aqmola is located. In general, members of the Lesser and Middle hordes are more Russified and, hence, more inclined to cooperate with Russian industrial and commercial interests than are the members of the Great Horde. Akezhan Kazhegeldin, prime minister in 1996, was a Middle Horder, as was the opposition leader Olzhas Suleymenov. Although mindful of Russia's strength, the Great Horders have less to lose to Russian separatism than do the Lesser and Middle horders, whose lands would be lost should the Russian-dominated provinces of northern Kazakstan become separated from the republic.

Kazakstan

Kazakstan - The Role of Women

Like its 1993 predecessor, the constitution of 1995 defends women's rights implicitly, if not entirely explicitly. The document guarantees citizens the right to work and forbids discrimination based on geographic origin, gender, race, nationality, religious or political belief, and language.

In practice, social opinion tends to associate women in the workplace with the abuses of the Soviet past. The early 1990s saw the loss of more than 100,000 day-care spaces, and public opinion strongly favors returning primary responsibility for the rearing and educating of children to mothers. In April 1995, President Nazarbayev said that one of the republic's goals must be to create an economy in which a mother can work at home, raising her children. This general opinion has been reflected in governmental appointments and private enterprise; almost no women occupy senior positions in the country, either in government or in business.

The declining birth rate is another issue with the potential to become politicized because it affects the demographic "race" between Kazaks and Russians. With demographic statistics in mind, Kazak nationalist parties have attempted to ban abortions and birth control for Kazak women; they have also made efforts to reduce the number of Kazak women who have children outside marriage. In 1988, the last year for which there are figures, 11.24 percent of the births in the republic were to unmarried women. Such births were slightly more common in cities (12.72 percent) than in rural areas (9.67 percent), suggesting that such births may be more common among Russians than among Kazaks.

Women's health issues have not been addressed effectively in Kazakstan. Maternal mortality rates average 80 per 10,000 births for the entire country, but they are believed to be much higher in rural areas. Of the 4.2 million women of childbearing age, an estimated 15 percent have borne seven or more children. Nevertheless, in 1992 the number of abortions exceeded the number of births, although the high percentage of early-stage abortions performed in private clinics complicates data gathering. According to one expert estimate, the average per woman is five abortions. Rising abortion rates are attributable, at least in part, to the high price or unavailability of contraceptive devices, which became much less accessible after 1991. In 1992 an estimated 15 percent of women were using some form of contraception.

Kazakstan

Kazakstan - Religion

By tradition the Kazaks are Sunni Muslims of the Hanafi school, and the Russians are Russian Orthodox. In 1994, some 47 percent of the population was Muslim, 44 percent was Russian Orthodox, and 2 percent was Protestant, mainly Baptist. Some Jews, Catholics, and Pentacostalists also live in Kazakstan; a Roman Catholic diocese was established in 1991. As elsewhere in the newly independent Central Asian states, the subject of Islam's role in everyday life, and especially in politics, is a delicate one in Kazakstan.

Islam in the Past

As part of the Central Asian population and the Turkic world, Kazaks are conscious of the role Islam plays in their identity, and there is strong public pressure to increase the role that faith plays in society. At the same time, the roots of Islam in many segments of Kazak society are not as deep as they are in neighboring countries. Many of the Kazak nomads, for instance, did not become Muslims until the eighteenth or even the nineteenth century, and urban Russified Kazaks, who by some counts constitute as much as 40 percent of the indigenous population, profess discomfort with some aspects of the religion even as they recognize it as part of their national heritage.

Soviet authorities attempted to encourage a controlled form of Islam as a unifying force in the Central Asian societies while at the same time stifling the expression of religious beliefs. Since independence, religious activity has increased significantly. Construction of mosques and religious schools has accelerated in the 1990s, with financial help from Saudi Arabia, Turkey, and Egypt. Already in 1991, some 170 mosques were operating, more than half of them newly built; at that time, an estimated 230 Muslim communities were active in Kazakstan

<>Islam and the State

Kazakstan

Kazakstan - Islam and the State

In 1990 Nazarbayev, then party first secretary, created a state basis for Islam by removing Kazakstan from the authority of the Muslim Board of Central Asia, the Soviet-approved and politically oriented religious administration for all of Central Asia. Instead, Nazarbayev created a separate muftiate, or religious authority, for Kazak Muslims. However, Nazarbayev's choice of Ratbek hadji Nysanbayev to be the first Kazak mufti proved an unpopular one. Accusing him of financial irregularities, religious mispractice, and collaboration with the Soviet and Kazakstani state security apparatus, a group of believers from the nationalist Alash political party attempted unsuccessfully to replace the mufti in December 1991.

With an eye toward the Islamic governments of nearby Iran and Afghanistan, the writers of the 1993 constitution specifically forbade religious political parties. The 1995 constitution forbids organizations that seek to stimulate racial, political, or religious discord, and imposes strict governmental control on foreign religious organizations. As did its predecessor, the 1995 constitution stipulates that Kazakstan is a secular state; thus, Kazakstan is the only Central Asian state whose constitution does not assign a special status to Islam. This position was based on the Nazarbayev government's foreign policy as much as on domestic considerations. Aware of the potential for investment from the Muslim countries of the Middle East, Nazarbayev visited Iran, Turkey, and Saudia Arabia; at the same time, however, he preferred to cast Kazakstan as a bridge between the Muslim East and the Christian West. For example, he initially accepted only observer status in the Economic Cooperation Organization (ECO), all of whose member nations are predominantly Muslim. The president's first trip to the Muslim holy city of Mecca, which did not occur until 1994, was part of an itinerary that also included a visit to Pope John Paul II in the Vatican.

By the mid-1990s, Nazarbayev had begun occasionally to refer to Allah in his speeches, but he had not permitted any of the Islamic festivals to become public holidays, as they had elsewhere in Central Asia. However, certain pre-Islamic holidays such as the spring festival Navruz and the summer festival Kymyzuryndyk were reintroduced in 1995.

Kazakstan

Kazakstan - National Identity

As in the other Central Asian republics, the preservation of indigenous cultural traditions and the local language was a difficult problem during the Soviet era. The years since 1991 have provided opportunities for greater cultural expression, but striking a balance between the Kazak and Russian languages has posed a political dilemma for Kazakstan's policy makers.

Language

The two official languages in Kazakstan are Russian and Kazak. Kazak is part of the Nogai-Kipchak subgroup of northeastern Turkic languages, heavily influenced by both Tatar and Mongol. Kazak was first written only in the 1860s, using Arabic script. In 1929 Latin script was introduced. In 1940 Stalin decided to unify the written materials of the Central Asian republics with those of the Slavic rulers by introducing a modified form of Cyrillic. In 1992 the return of a Latin-based alphabet came under discussion, but the enormous costs involved appear to have stopped further consideration of the idea.

Kazak first became a state language in the late Soviet period, when few of the republic's Russians gave serious thought to the possibility that they might need Kazak to retain their employment, to serve in the armed forces, or to have their children enter a Kazakstani university. At that point, fewer than 5 percent of Russians could speak Kazak, although the majority of Kazaks could speak Russian. However, with the separation between Russia and Kazakstan that followed independence, Russian nationalist sentiment and objections to alleged discrimination in official language policies have increased, especially in the north, as Russians have felt the threat of Kazak becoming the sole legal state language. Meanwhile, Kazaks have strongly defended the preeminence of their tongue, although mastery of the language is far from universal even among Kazaks. According to some estimates, as much as 40 percent of the Kazak population is not fluent in Kazak. The standard language of business, for example, is Russian.

Even those who are fluent find Kazak a difficult language to work with in science, business, and some administrative settings because it remained largely a "kitchen" language in Soviet times, never developing a modern technical vocabulary. Nor has there been extensive translation of technical or popular literature into Kazak. Thus, for most Kazaks Russian remains the primary "world language." In fact, President Nazarbayev defended making Kazak the sole official language on the grounds that decades of Russification had endangered the survival of Kazak as a language. The practical primacy of Russian is reflected in the schools. Despite efforts to increase the number of schools where Kazak is the primary language of instruction, Russian appeared to continue its domination in the mid-1990s. In 1990 about twice as many schools taught in Russian as in Kazak. Although institutions of higher learning now show a strong selection bias in favor of Kazak students, Russian remains the language of instruction in most subjects.

The issue of languages is one of the most politicized and contentious in Kazakstan. The volatility of the language issue has been augmented by Russia's controversial proposals, beginning in 1993, that Kazakstan's Russians be granted dual citizenship. Although Nazarbayev rejected such a policy, the language controversy prompted him to postpone deadlines for implementation of laws making Kazak the sole official language. Thus, it is unlikely that most adult non-Kazaks will have to learn Kazak. Nevertheless, demographic trends make it probable that the next generation will have to learn Kazak, a prospect that generates considerable discomfort in the non-Kazak population. The 1995 constitution does not provide for dual citizenship, but it does alleviate Russian concerns by declaring Russian an official language. That status means that Russian would continue as the primary language of communication for many ethnic Kazaks, and it will remain acceptable for use in schools (a major concern of Russian citizens) and official documents.

<>Culture

Kazakstan

Kazakstan - Culture

Before the Russian conquest, the Kazaks had a well-articulated culture based on their nomadic pastoral economy. Although Islam was introduced to most of the Kazaks in the seventeenth and eighteenth centuries, the religion was not fully assimilated until much later. As a result, it coexisted with earlier elements of shamanistic and animistic beliefs. Traditional Kazak belief held that separate spirits inhabited and animated the earth, sky, water, and fire, as well as domestic animals. To this day, particularly honored guests in rural settings are treated to a feast of freshly killed lamb. Such guests are sometimes asked to bless the lamb and to ask its spirit for permission to partake of its flesh. Besides lamb, many other traditional foods retain symbolic value in Kazak culture.

Because animal husbandry was central to the Kazaks' traditional lifestyle, most of their nomadic practices and customs relate in some way to livestock. Traditional curses and blessings invoked disease or fecundity among animals, and good manners required that a person ask first about the health of a man's livestock when greeting him and only afterward inquire about the human aspects of his life.

The traditional Kazak dwelling is the yurt, a tent consisting of a flexible framework of willow wood covered with varying thicknesses of felt. The open top permits smoke from the central hearth to escape; temperature and draft can be controlled by a flap that increases or decreases the size of the opening. A properly constructed yurt can be cooled in summer and warmed in winter, and it can be disassembled or set up in less than an hour. The interior of the yurt has ritual significance; the right side generally is reserved for men and the left for women.

Although yurts are less used for their original purpose than they once were, they remain a potent symbol of "Kazakness." During demonstrations against Nazarbayev in the spring of 1992, demonstrators and hunger strikers erected yurts in front of the government building in Almaty. Yurts are also frequently used as a decorative motif in restaurants and other public buildings.

Because of the Kazaks' nomadic lifestyle and their lack of a written language until the mid-nineteenth century, their literary tradition relies upon oral histories. These histories were memorized and recited by the akyn , the elder responsible for remembering the legends and histories, and by jyrau , lyric poets who traveled with the high-placed khans. Most of the legends concern the activities of a batir , or hero-warrior. Among the tales that have survived are Koblandy-batir (fifteenth or sixteenth century), Er Sain (sixteenth century), and Er Targyn (sixteenth century), all of which concern the struggle against the Kalmyks; Kozy Korpesh and Bain sulu , both epics; and the love lyric Kiz-Jibek . Usually these tales were recited in a song-like chant, frequently to the accompaniment of such traditional instruments as drums and the dombra , a mandolin-like string instrument. President Nazarbayev has appeared on television broadcasts in the republic, playing the dombra and singing.

The Russian conquest wreaked havoc on Kazak traditional culture by making impossible the nomadic pastoralism upon which the culture was based. However, many individual elements survived the loss of the lifestyle as a whole. Many practices that lost their original meanings are assuming value as symbols of post-Soviet national identity.

For the most part, preindependence cultural life in Kazakstan was indistinguishable from that elsewhere in the Soviet Union. It featured the same plays, films, music, books, paintings, museums, and other cultural appurtenances common in every other corner of the Soviet empire. That Russified cultural establishment nevertheless produced many of the most important figures of the early stages of Kazak nationalist self-assertion, including novelist Anuar Alimzhanov, who became president of the last Soviet Congress of People's Deputies, and poets Mukhtar Shakhanov and Olzhas Suleymenov, who were copresidents of the political party Popular Congress of Kazakstan (see Structure of Government; Political Organizations, this ch.). Shakhanov also chaired the commission that investigated the events surrounding the riots of December 1986.

An even more powerful figure than Shakhanov, Suleymenov in 1975 became a pan-Central Asian hero by publishing a book, Az i Ia , examining the Lay of Igor's Campaign , a medieval tale vital to the Russian national culture, from the perspective of the Turkic Pechenegs whom Igor defeated. Soviet authorities subjected the book to a blistering attack. Later Suleymenov used his prestige to give authority to the Nevada-Semipalatinsk antinuclear movement, which performed the very real service of ending nuclear testing in Kazakstan. He and Shakhanov originally organized their People's Congress Party as a pro-Nazarbayev movement, but Suleymenov eventually steered the party into an opposition role. In the short-lived parliament of 1994-95, Suleymenov was leader of the Respublika opposition coalition, and he was frequently mentioned as a possible presidential candidate.

The collapse of the Soviet system with which so many of the Kazak cultural figures were identified left most of them in awkward positions. Even more damaging has been the total collapse of public interest in most forms of higher culture. Most of the books that Kazakstanis buy are about business, astrology, or sex; the movies they see are nearly all American, Chinese, or Turkish adventure and action films; most concerts feature rock music, not infrequently accompanied by erotic dancing; and television provides a diet of old Soviet films and dubbed Mexican soap operas. Kazakstan's cultural elite is suffering the same decline affecting the elites of all the former Soviet republics. Thus, cultural norms are determined predominantly by Kazakstan's increasing access to global mass culture.

Kazakstan

Kazakstan - Education

The constitution of 1995 specifies that education through secondary school is mandatory and free, and that citizens have the further right to compete for free education in the republic's institutions of higher learning. Private, paid education is permitted but remains subject to state control and supervision.

In 1994 Kazakstan had 8,575 elementary and secondary schools (grades one through twelve) attended by approximately 3.2 million students, and 244 specialized secondary schools with about 222,000 students. In 1992 about 51 percent of eligible children were attending some 8,500 preschools in Kazakstan. In 1994 some 272,100 students were enrolled in the republic's sixty-one institutes of higher learning. Fifty-four percent of the students were Kazak, and 31 percent were Russian.

The educational situation since independence is somewhat difficult to judge because of incomplete information. The republic has attempted to overhaul both the structure of its education system and much of its substance, but the questions of what should be taught and in what manner continue to loom large. A particularly sensitive and unresolved issue is what the language of instruction should be, given the almost equal distribution of the population between ethnic Kazaks and ethnic Russians. In 1994 most instruction still was in Russian because Kazak-language textbooks and Kazak teachers were in short supply. Enrollment was estimated to be 92 percent of the total age-group in both primary and secondary grades, but only 8 percent in the postsecondary age-group.

Serious shortages in funding and resources have hindered efforts to revamp the education system inherited from the Soviet Union. Even in 1990, more than half the republic's schools were operating on two and even three shifts per day; since then, hundreds of schools, especially preschools, have been converted to offices or stores. Elementary- and secondary-school teachers remain badly underpaid; in 1993 more than 30,000 teachers (or about one-seventh of the 1990 teaching staff) left education, many of them to seek more lucrative employment.

Despite the obstacles, efforts have been made to upgrade the education system, especially at the highest level. Kazakstani citizens still can enroll in what once were the premier Soviet universities, all of which are now in foreign countries, in particular Russia and Ukraine. In the mid-1990s, however, such opportunities have become rare and much more expensive. This situation has forced the upgrading of existing universities in Kazakstan, as well as the creation of at least one new private university, Al-Farabi University, formerly the S.M. Kirov State University, in Almaty. The largest institution of higher learning in Kazakstan, Al-Farabi had 1,530 teachers and about 14,000 students in 1994. A second university, Qaraghandy State University, had about 8,300 students in 1994. In addition, technical secondary schools in five cities--Aqmola, Atyrau, Pavlodar, Petropavl (formerly Petropavlovsk), and Taldyqorghan (formerly Taldy-Kurgan)--have been reclassified as universities, increasing regional access to higher education. Altogether, in 1994 Kazakstan had thirty-two specialized institutes of higher learning, offering programs in agriculture, business and economics, medicine, music, theater, foreign languages, and a variety of engineering and technical fields. In the area of technical education, the republic has taken aggressive advantage of offers from foreign states to educate young Kazaks. In 1994 about 3,000 young people were studying in various foreign countries, including the United States.

One trend that particularly worries republic administrators is the pronounced "Kazakification" of higher education, as the republic's Russians either send their children to schools across the Russian border or find it impossible to enroll them in local institutions. Kazakstan's law forbids ethnic quotas, but there is evidence of prejudicial admittance patterns. The class that entered university in 1991, for example, was 73.1 percent Kazak and only 13.1 percent Russian.

Kazakstan

Kazakstan - Health

The early years of independence have had a disastrous effect on public health. In the 1980s, Kazakstan had an extensively developed public health system that delivered at least basic care without charge even to very remote communities. By 1993, however, Kazakstan rated below average or lower among the former Soviet republics in medical system, sanitation, medical industry, medical research and development, and pharmaceutical supply.

Health System

In 1994 the health system had twenty-nine doctors per 1,000 people and 86.7 other medical personnel per 1,000. There were 1,805 hospitals in the republic, with seventy-six beds per 1,000 people. There were 3,129 general health clinics and 1,826 gynecological and pediatric clinics. Conditions and services at these facilities varied widely; it was not uncommon, for example, for rural clinics and hospitals to be without running water.

The constitution of 1995 perpetuates the Soviet-era guarantee of free basic health care, but financing has been a consistent problem. In 1992 funding allotted to public health care was less than 1.6 percent of GDP, a level characterized by the World Bank as that of an underdeveloped nation.

Because doctors and other medical personnel receive very low pay, many medical professionals have moved to other republics--a large percentage of Kazakstan's doctors are Russian or other non-Kazak nationalities--or have gone into other professions. Nonpayment even of existing low wages is a common occurrence, as are strikes by doctors and nurses.

In the 1980s, Kazakstan had about 2,100 pharmaceutical-manufacturing facilities; drugs were also available from other Soviet republics or from East European trading partners within the framework of the Council for Mutual Economic Assistance (Comecon). Since independence most such supply connections have been terminated, and many domestic pharmaceutical plants have closed, making some types of drugs virtually unavailable. As a result, vaccination of infants and children, which reached between 85 and 93 percent of the relevant age-groups in 1990, decreased sharply in the early 1990s. Kazakstan ran out of measles and tuberculosis vaccine in late 1991, and the World Health Organization (WHO) estimated that more than 20 percent of children were not receiving basic vaccinations in 1992.

To some extent, the provision of drugs has been taken over by a government-owned company, Farmatsiya, which purchases about 95 percent of the medical equipment and supplies for the government. There have been persistent complaints that Farmatsiya pays far too much for foreign equipment and medicines in return for nonmedical considerations.

Private medical practice is permitted in general medicine and in some specialized fields; private surgical practice is forbidden, as is private treatment of cancer, tuberculosis, venereal disease, pregnancy, and infectious diseases. Some types of private practice have been introduced directly into the state clinics, creating a confusing situation in which identical procedures are performed by the same personnel, some for state fees and others for higher private fees. A substantial unofficial market has developed in the distribution of hospital supplies; patients often are expected to pay for the bandages, anesthesia, and other materials and services required for the "free" treatment received at medical facilities. Kazakstan has no system of medical insurance.

In the mid-1990s, the largest growth area in medicine was in services not requiring large capital outlays by the practitioner. This area, which includes acupuncturists, fertility consultants, substance-abuse therapists, physical therapists, and dentists, is only lightly regulated, and the incidence of charlatanism is high.

Kazakstan has negotiated some international agreements to improve health care. In 1992 an association of scientific organizations specializing in contagious diseases established its headquarters in Almaty. The group, which includes doctors and technicians from Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, conducts joint research with scientists in China, Mongolia, and Vietnam. A 1995 medical cooperation agreement between the Kazakstani and Iranian ministries of health called for exchanges of medical students and experts, joint research projects, exchanges of information on the latest medical advances (with an emphasis on contagious diseases), and mutual natural-disaster assistance.

<>Health Conditions

Kazakstan

Kazakstan - Health Conditions

The deterioration of the public health system has hit Kazakstan's population hard. Rates of infant mortality and overall mortality have risen in the 1990s as the fertility rate has decreased, contributing to the first drop in the republic's population since World War II. Infant mortality was twenty-seven per 1,000 live births in 1991, the lowest rate among the five Central Asian republics but higher than that for any non-Central Asian republic. A lack of medicines and facilities, together with a general deterioration in physical environment and living standards, has promoted outbreaks of several potentially epidemic diseases, including diphtheria (its incidence increased from thirty-five cases in 1993 to 312 in the first ten months of 1994), poliomyelitis (two cases in 1994), viral hepatitis, and cholera (of which outbreaks occurred in 1992 and 1993). The incidence of tuberculosis has grown substantially, with as many as 11,000 new cases and 2,000 deaths reported annually (see table 5, Appendix). According to a 1995 report of the Contagious Disease Association in Almaty, a bubonic plague-carrying rat population was moving from the Balkhash region, where the plague is endemic, southward toward Almaty, whose municipal government had taken no measures to control rats.

The first death in Kazakstan attributed to acquired immune deficiency syndrome (AIDS) was reported in July 1993. At that time, nineteen carriers of the human immunodeficiency virus (HIV) reportedly were registered in Kazakstan. Of that number, three were identified as homosexuals, two were preschool children, and nine were foreign citizens, who were deported. In mid-1995, the WHO reported that twenty-seven people had been diagnosed with AIDS or as HIV-positive between 1993 and 1995. The Kazakstan AIDS Prevention and Control Dispensary was established in Almaty in 1991, with twenty-two branch offices and diagnostic laboratories elsewhere in the republic. However, in the early 1990s diagnosis and treatment relied on foreign funds and equipment because domestic health funds were barely sufficient to maintain clinic buildings. Fewer than 500 requests for screening were received in 1993. In mid-1995, the government set up the Coordinating Council for Combating AIDS under the direct administration of the prime minister.

The shortage of health care has put children at particular risk. Approximately 15 percent of newborns in 1994 were unhealthy, most often suffering from bronchiopulmonary and cardiovascular problems. Measles, diphtheria, brucellosis, and other childhood diseases became more prevalent during the early 1990s.

Extensive pollution and degradation of large segments of the natural environment have increased the strain on public health. Both the air and water of many of the large cities are badly polluted. Three regions have been identified as having particularly hazardous environments. �skemen (formerly Ust-Kamenogorsk) in the far northeast has been rated the third most polluted city in the former Soviet Union, with ten times the maximum permitted levels of lead in the air and high concentrations of beryllium, thallium, mercury, cadmium, antimony, and arsenic in the municipal water supply. Just west of �skemen, in Semey, a major site of Soviet nuclear testing from 1949 to 1991, radiation has contaminated the air and soil. Experts believe that the tests, which were conducted in the atmosphere until 1963, contaminated the environment of the entire country of Kazakstan. In one village, Kaynar, near the main proving ground, 140 of 3,400 children were found to have been disabled since birth; in a random sample of another 600 of the town's children, all were found to be suffering ill health of one form or another. Radiation is believed the cause of such statistics. The third major area of environmental degradation is the Aral Sea Basin along the southwestern border, where agricultural runoff and untreated sewage have caused advanced pollution of groundwater (see Environmental Problems, this ch.).

Water contamination is a serious environmental health hazard in Kazakstan because of poor management of drinking water and insufficient sewage treatment. About 30 percent of rural communities obtain water from shallow wells; the water is vulnerable to contamination by materials leached from the surface. As late as 1985, only 37 percent of homes had sewerage systems and running water, and even schools and hospitals had primitive sanitary systems that caused frequent outbreaks of intestinal illness.

The diet and lifestyle of many citizens, especially in the cities, contribute further to poor health. The average diet is high in meat and salt and low in vegetables and fruits. The hyperinflation of 1992-93 cut deeply into family budgets, limiting both the variety and quantity of food most ordinary people consume. Smoking is almost universal, especially among men, and alcoholism is common. Other forms of substance abuse such as the use of hemp, morphia products, and glue are common, especially among young people.

Occupational hazards constitute another major health problem. Especially during the economic hardships of the early 1990s, public health authorities refrained from measures such as closing polluting factories or restricting the use of fertilizers, pesticides, and irrigation water out of a fear of accelerating the general decline in production. Because of the dangers posed by exposure to toxic smoke and fumes, lead and phosphate plants limit workers to ten years of employment. With little restriction on how they are operated, factories in Kazakstan note high rates of morbidity, absenteeism, and permanent disability among their employees.

Kazakstan

Kazakstan - Social Welfare

The Soviet system of social welfare, which remained in place in Kazakstan in the early 1990s, presupposed a very high level of public services. The 1993 constitution maintained most of the assumptions of the Soviet era without providing a clear mechanism for paying for "guaranteed" workers' benefits such as free education, medical care, pensions, and vacations. The constitution ratified in 1995 somewhat reduces the list and scale of guaranteed protections, but remaining guarantees include a minimum wage, pensions for the retired and the disabled, social benefits for orphans and for people who are elderly or infirm, legal assistance, housing, and what is called "social defense against unemployment."

In practice, social benefits have proven difficult to supply because of financial considerations and the lack of a firm organizational structure for service provision. For example, in the Soviet period housing was supplied by the state or by employers. In 1990 housing began to be privatized, a process almost completed by the mid-1990s. The result has been a healthy resale market for existing housing. In 1995 apartment costs in Almaty could exceed 15,000 tenge (for value of the tenge, see Glossary) per square meter, but there had been no corresponding boom in new housing construction, in part because privatization of the land on which such housing would stand remained a sensitive and unresolved issue. As a result, the republic's housing crisis, already acute in the Soviet period, has grown far worse. In the mid-1990s the housing shortage was especially serious in Almaty, where tens of thousands were on waiting lists. In 1995 housing construction decreased by about 25 percent.

Perhaps the biggest problems have emerged in the areas of pensions, aid to large families and other social assistance, and unemployment compensation. An independent pension fund was created in 1991 on the basis of a social insurance tax on enterprises (37 percent of wages in 1992) and contributions by employees (1 percent of wages in 1992). The national budget nominally covers remaining deficits in the pension fund. Pensions initially were set at 60 percent of average pay, with minimal pensions available even to elderly citizens such as housewives who never had drawn a salary. However, the high inflation of 1991-93 badly eroded existing pensions; the state has continually adjusted pensions upward in a futile struggle to keep pace (see Prices, Wages, and Currency, this ch.). In addition, the administration of pensions has been reconfigured several times, leading to lengthy delays in the payment even of the small sums pensioners are owed. Such delays have prompted numerous public demonstrations. Although the value of pensions has shrunk dramatically in real terms, by 1992 government expenditures on them were 4.7 percent of the GDP. In March 1995, the government had to divert 632 million tenge from the national budget to cover pension arrears.

Similar problems have occurred in other categories of allowances to citizens, especially lump-sum payments to newborns; child allowances to large families (those with four or more children) and abandoned children; assistance to single mothers; and assistance to the children of soldiers. In 1992 payments in these categories reached 5 percent of Kazakstan's GDP. Slow payment and the lag between inflation and cost-of-living adjustments have had a particularly severe effect on Kazakstan's poorer families, for some of whom government subsidies provide as much as one-quarter of total income. In 1994 about 2.1 million citizens received retirement pensions, and about 800,000 received other types of pension.

Unemployment is perhaps the most difficult category of social problem because it is a phenomenon that officially did not exist until 1991 and still carries a considerable social stigma. As of January 1, 1995, some 85,700 people officially were registered as unemployed, about 55 percent of them in rural areas. However, this figure is commonly assumed to be too low because many workers still are nominally employed, even though their salaries have been reduced or stopped altogether under a variety of cutback conditions. In January 1995, some 230 enterprises, with a normal work force of about 51,000 employees, were standing idle; by April 1995, the number had grown to 376 enterprises with more than 90,000 employees.

Kazakstan