Health and human security - Environmental and Human Security in the Arctic - page 164

1 First, we outline the threats that communicable diseases, predominantly

AIDS and tuberculosis, pose in Northwest Russia and describe the efforts
of the Task Force to address these issues.

2 Second, we describe the general attitudes of Russian participants involved

in the Task Force programmes to elucidate some of the dispositions that
can facilitate or challenge international collaboration around health issues
in Russia.

3 Third, in order to clarify the challenges faced by those aiming to develop

international collaboration, we describe the reception by Russians of a
tuberculosis prevention strategy that was created initially by the World
Health Organization (WHO) to combat tuberculosis in developing coun-
tries. This example illustrates some of the challenges associated with
effective sharing of health lessons between the developing and developed
world.

4 We then describe how the Task Force's emphasis on and support for

programmes focusing on the spread of communicable diseases amongst
marginalized groups, such as drug users, prisoners and prostitutes, was
received by Russian and Baltic programme participants. This is particu-
larly critical to assessing the potential role of the human security discourse
in Russia, because human security has often been used as a tool to direct
attention towards society's most vulnerable members.

5 Finally, in order to augment the prior discussion of the role of attitudes

and dispositions, we highlight structural peculiarities that can challenge
the implementation of new approaches to public health in the FSU.

AIDS and tuberculosis in Russia and the
Baltic states
At the end of the 1990s, the health situation in Russia and the Baltic states
was causing serious concern among medical experts and officials in the West.
Life expectancy had decreased dramatically since the break-up of the Soviet
Union, mainly as a result of diseases caused by malnutrition, smoking and
alcohol consumption (Task Force 2000:9-11; McKee 2001). Furthermore,
HIV/AIDS had emerged as an increasingly widespread cause of suffering in
the post-Soviet era. Tuberculosis, a disease that in Western societies had been
more or less eliminated or at least controlled effectively, was also re-emerging.
Faced with a looming tuberculosis epidemic, centuries-old fears of infectious
diseases spreading like wildfire from person to person and country to country
were being rekindled. Although Russia and the Baltic states were considered
to be most at risk from tuberculosis and HIV/AIDS, some went so far as to
suggest that the epidemics could destabilize the political climate in Northern
Europe as a whole.
The most severe effects of both the HIV/AIDS and tuberculosis epidem-
ics have been felt in Russia. In the case of tuberculosis, after levelling out at