Human health is affected by a broad spectrum of factors including social, economic, sanitary-hygienic and environmental conditions, life style, access to health care services and the quality of health care systems. According to WHO data, up to 80% of morbidity is due to exposure to different environmental factors of a physical, chemical and biological character (see appendix for fuller version).

The Caucasus was traditionally characterised by moderate to serious environmental and hygienic conditions in urban and industrial areas, linked to its underdeveloped sanitation infrastructure, environmental pollution from industries and traffic, and serious sanitary-hygienic and environmental problems in rural areas connected to the intensive use of pesticides and other chemicals and poor sanitation infrastructure or the lack thereof (Ministry of Environment and Nature Resources Protection, Russian Federation, 1994).

High figures of infectious diseases were traditionally reported in some parts of the region. High morbidity due to typhus, dysentery and viral hepatitis was observed in the cities of the North Caucasus. In rural areas, gastrointestinal diseases and poliomyelitis caused morbidity figures of higher than average values. High morbidity due to typhus was observed in cities of Armenia and Azerbaijan as well (Ministry of Environment and Nature Resources Protection, Russian Federation, 1994). Apart from this, there has always been and continues to be a high risk for epizootic outbreaks in the North Caucasus, since the region has natural sources for contagious diseases such as plague, tularaemia, brucellosis. Lack of animal vaccination and poor sanitary-epidemiological conditions only aggravate the situation.

Since 1990, sanitary-hygienic conditions have been worsening in the region. Outbreaks of infectious diseases, especially gastrointestinal ones, have become routine. They have also occurred in areas where they hardly ever occurred before, namely Georgia (State Committee of the Azerbaijan Republic on Nature Protection, 1993; UN-ECE/MNP of Armenia, 2000; WHO/MoH of Georgia, 2001; Ministry of Environment and Nature Resources Protection, Russian Federation, 1996).

This may be traced to sharply reduced abilities of state sanitary-hygienic services to conduct regular inspections of food products and drinking water due to lack of finances and technical equipment. Existing water supply and sewage systems are inadequately maintained and frequently cross-contamination of sewage and drinking water occurs. Water intake facilities are not properly protected and do not meet sanitary and hygienic requirements. In many locations, the lack of chlorine does not allow for proper treatment of drinking water. Over-loaded landfills that do not meet health and environmental requirements, and illegal dumpsites cause the contamination of ground waters, which are the major sources for drinking water in many of parts of the region.

The overall situation is such that the population in general has become vulnerable to infectious diseases. The need to treat foodstuffs and drinking water with utmost caution has become a fact of daily life – an absolutely new situation that has not been necessary for decades. The poor and IDPs living in refugee camps are especially vulnerable. Considering existing economic problems and general mismanagement, the above problems will continue to fester in the short to medium term.

Although it is very difficult to establish links between environmental pollution and morbidity rates, there is some scientific evidence linking high ambient concentrations of different pollutants emitted from stationary and mobile sources to increases in the morbidity rate for specific diseases like respiratory and cardiovascular diseases, specifically, hypertension and heart attacks, skin and endocrine diseases, cancer, and lowered children’s IQ. All these have been routinely documented in leading industrial centres of the region.

Recent ambient air quality data for selected major cities of the Caucasus indicate declining or stable trends for most pollutants, due to the fall in industrial activities and hence, industry-related emissions. However, this is offset to some extent by an increase in traffic-related emissions. In the South Caucasus, there is noticeable trend of concentration of population and economic activity in the few largest urban centres. These have led to a dramatic increase in vehicles that are old (10 years or older), poorly maintained and use low quality fuel. Traffic is poorly organised, and congestion is routine. Since traffic is a major source for ambient air pollution in most Caucasus cities, particulates and lead are assumed to be the most serious health concerns. There are a number of studies supporting this thesis, for instance, the study of health effects of short-term exposure to TSP for the city of Yerevan (MNP of Armenia, 2001), studies for the cities of Baku, Sumgayit and Ganja on PM₁₀ concentration (State Committee on Ecology and Control of Natural Resources Utilization, Azerbaijan, 1998), and studies on lead impact on health for Tbilisi (NORCE & MoE of Georgia, 2000).

During the Soviet era, the morbidity and mortality rates due to neoplasm and birth defects were traditionally high among the rural population of the Caucasus, mainly due to unsustainable use of pesticides. At present, whereas the overall pesticide use has declined here, health concerns related to pesticides still exist. Specifically, many individual farmers are not aware of health and environmental requirements for pesticide use, and pose a high threat to their own and other people’s health and environment. Another problem is related to obsolete pesticides and other agro-chemicals that are not properly stored and cause the contamination of ground waters and soil. This poses a high risk to human health through drinking water and food contamination.

The situation in the public health care system has also dramatically changed. While during Soviet times it was never very advanced or efficient, it did provide universal access and was free. The post-Soviet transition crisis has resulted in a marked deterioration of this system, although this process has been uneven. Russia has managed to retain the previously existing model and is even expanding the system. On the other hand, a crisis in the system is obvious, and quality is falling. It has become especially more discriminatory towards the less affluent population since under-the-table payments are almost mandatory. In the South Caucasus, the poor are virtually alienated from the health-care system, in Armenia and Georgia quite perversely because of the WB sponsored reforms.¹  Even for the more affluent families paying for medical treatment can often mean sliding below the poverty line. People routinely postpone visits to doctors or self-medicate, causing additional aggravating factors in the case of contagious and infectious diseases.

More importantly, health-care systems have lost their ability to practice preventative medicine and usually treat people in advanced stages of disease. Poor infrastructure facilities, and the lack of technical and financial resources to conduct the most routine sanitary and hygienic oversight services are too much for the people in the system to cope with. Although qualified professionals in the system still exist, they too lag behind in their knowledge of recent tools and methods used in contemporary toxicology and epidemiology. Environmental and other authorities responsible for data collection also do not have enough resources to regularly monitor ambient environment quality, detect high pollution episodes and take specific measures for human health protection. Existing ambient standards are out of date and need revision. Besides, more often than not authorities simply do not react to easily observable trends and situations with obvious health hazards, while the public in general lacks information, understanding, organisation and effective means to alter the situation.²