Environmental Links to Ukrainian Population’s Health - Issue Papers
1. Significant environmental conditions affecting women’s health in Ukraine
It is worth noting that the system of health regulation being in use in Ukraine (except norms related to
onizing radiation) assesses factors of danger from the position of no risk, i.e. of the norms are met, public
health is not exposed to damage. At the same time, possible negative impacts of negative environmental
factors on human health are present at any level. Therefore, the available methods of assessment ignore
the interests of the hypersensitive category of the population and complicate a quantative evaluation of
health damage through negative factors.
Epidemiological research with involvement of international experience on the assessment of impacts of
environmental factors on public health are very expensive, and there are only a few in Ukraine. Results of
many projects of this kind, even though published in recognized Ukrainian magazines, are fairly unrecognized
by the world’s community due to serious shortcomings of the methods of research, verification of
cases and means of material analysis. However, in the country there are representative data bases, which
based on international experience may be used in some cases to evaluate negative factors.
Global scale catastrophe
In 1986 Ukraine’s sad fortune flew throughout the world caused by the accident that happened at
Chornobyl nuclear plant. The consequences of the accident gave all grounds to believe this event was the
largest human-made and environmental catastrophe in the world - a global scale catastrophe. The reactor
in the 4th unit had contained 192 tonnes of fuel, about 4% of which was released into the atmosphere over
10 days. These were mostly radioactive iodine, strontium, plutonium and some other isotopes. With regard
to a decay, the total release of radioactive substances reached 50 million Curie. This is equivalent to the
explosion of over 500 atomic bombs like those that were thrown by the USA’s military forces onto the
Japanese city of Hiroshima. The cloud formed over the Chornobyl NPP, was blown by the wind to the
North and covered Ukrainian Polissia, considerable part of Belarus and some Russian regions. Within a
short period of the catastrophe, radioactive fall-out was identified on the territories of Sweden and Finland,
and later - in Poland, Germany and France. Radiation penetrated the atmosphere of the whole Northern
hemisphere, which prevented the Soviet government from hiding the accident.
Huge areas were exposed to radioactive contamination. Consequently, examination were conducted which
showed that only in Ukraine contamination with plutonium-239 (with density of 0.1 Curie and over per 1
sq.km) covered 700 sq.km; strontium-90 (3 Curie and over per 1 sq.km) and cesium-137 (5 and over
Curie per 1 sq.km) covered over 3,420 sq.km (33).
Water sources suffered considerable contamination. The heaviest exposure was found in rivers which
flow not far from the Chornobyl NPP, Kyiv water storage as well as water intake basins of the rivers
Dnieper and Prypyat. All water storages of the Dnieper basin from which 30 million Ukrainians take their
water - immediately showed traces of radioactivity. It is worth remembering the threat of radionuclide
penetration into underground water sources.
In general 130,000 sq.km of Ukrainian territory (20%) is contaminated with long living radionuclides. 2,294
settlements are situated throughout this area. The total figure of victims of the Chornobyl disaster in
Ukraine comes to 3.2 million persons including 1 million children. The Ukrainian population, currently 50.5
million, will continue to undergo exposure to low dosage radiation for a long time ahead (33).
It is worth noting that Ukrainian scientists don’t share a single point of view on the health impacts of low
dosage radiation. Along with the opinion that radioactive background is the major contributing factor to the
deteriorated public health, there is also a concept that the Chornobyl consequences don’t pose a larger
threat than socio-economic factors, and exposure of the Ukrainian citizens to continuous emotional and
psychological stress.
But, there is also the opinion of the residents of our country themselves. According to a sociological study
conducted in May 1998 by the «Democratic Initiatives» Foundation, 33.1% men and 40.2% women
believe the Chornobyl consequences are the major environmental cause of their damaged health; another
33.6% of men and 32.6% of women believe it to be significant but not of more influence than the other
factors of nature contamination (5).
Urban environment
In 1996-1997 the project «Ukrainian Initiatives on Health Protection» was elaborated by the Cabinet of
Ministers of Ukraine with the assistance of UNICEF, UNDP, WHO and the World Bank. The results of
the investigation were published in the book «Health of Women and Children in Ukraine», Kyiv, 1997.
According to its data, 21% of all illnesses are caused by air pollution and 13% by polluted drinking water,
making a total of 34%. 37% are caused by social factors (6).
At the XIII Congress of Hygienists (1997) it was stressed that the pollution of the biosphere in Ukraine is
very near the threshold level. As far as it is known, beyond this level the biosphere begins to transform to
a new state, which is very difficult to forecast. Ukraine mines 5% of the world’s mineral resources.
Because of this huge amount of mining which uses obsolete technologies, the annual quantity of pollutants
per square kilometer is more than by 6.5 times higher than US level; and 3.2 times the European Community
level. Annually wastes to the atmosphere constitute 12.4 million tons, including 8.6 million tons from
permanent sources.
As mentioned above, air pollution is one of the most significant factor of impact on Ukrainian public health.
Given the economic crisis and stagnation in industry, air pollution in populated areas of Ukraine has been
gradually decreasing as the gross discharges of contaminants into the atmosphere reduced. As many
production plants almost halted, experts and public representatives share a mistaken idea that the air
quclity in our country has reasonably improved. However, there are data on levels of atmospheric air
pollution in major industrial cities and administrative and cultural centers of Ukraine where monitoring is
being exercised at centers in Ukrainian Gidrologic and Meteorologic Center and the Sanitary and Epidemiological
Service. The data reveals that health risks remains considerable.
According to the Ministry for Environmental Protection and Nuclear Safety of Ukraine, in 1995, the air in
Ukrainian cities contained 36 pollutants. Around 60% of the registered contamination came from the most
common sources: sulfur dioxin, carbon monoxide and nitrogen dioxide. As for specific hazardous substances
in the cities monitored, the average annual concentrations of the following pollutants exceeded
safety levels: formaldehyde by 3 times; benzo(a)pyrene by1.9 times, phenol by 1.5 times, and ammonia by
1.36 times.
In 1998 the following average annual concentrations were registered in Kyiv in excess of the permitted
level: nitrogen dioxide - 2.1 times higher; benzo(a)pyrene - 1.4 times higher.
The highest air pollution remains in the cities of southeastern region (Dnipropetrovsk,
Donetsk, Zaporizzhia, Lugansk, Kharkiv regions) - 79% of all gross releases throughout the country. Major sources
of pollution are as follows: industry - 65% and road vehicles - 35% in the total volume of releases.
In 1995 road vehicles emitted 1,796 thousand tons of pollutants into the atmosphere. At the same time, it is
known that since 1993, the quantity of cars has at least doubled in Ukraine.
Every year an average amount of 285 kg pollutants fall on every Ukrainian citizen, some regions demonstrate
a figure of 500 kg and over. 34% of population are exposed to contaminated air.
The major causes of this threat are the large number of industrial enterprises in the southeastern region,
obsolete technologies, ineffective treatment facilities, poor technical control under operation of treatment
facilities, and use of leaded petrol in road vehicles.
Public health, in particular, reproductive health, is exposed to the threat of domestic air pollution resulting
from wide applications of chemical substances and natural gas in homes. Taking into consideration that
Ukrainian women spend 25% more time working about the house, so women are exposed to domestic
contaminants more than men.
Annually the quantity of waste water, and emissions to rivers and water reservoirs, constitutes 4.3 billion
sq. meters. In recent years the quantity of lead has increased by 10.8 times; copper by 5.2 times; nickel by
4.8 times, and zinc by 3.7 times.
Drinking water quality assessment is carried out by the sanitary and epidemiological service of the Ministry
for Health Protection, communal services and other departmental water utilities on the basis of the
state standard «Drinking water» and norms «Drinking water» (#383-96).
According to investigations by the MAMA-86 «Clean Drinking Water in Ukraine» program, the sanitary,
chemical and biological quality of drinking water fails to meet the State Standard almost everywhere in the
country. This is because of the declining state of water sources, the inadequate sanitary and technical
state of the water mains and sewage treatment facilities. These facilities suffer from frequent accidents,
inadequate operation, and shortage of disinfectant at the distribution networks of drinking water supply
(19).
The results of the bodies which monitor quality of the surface water resources of the I and II category in
Ukraine demonstrate that untreated municipal and industrial wastewater, sewage, and parasite agents
contaminate them. Periodic acute epidemics of intestine infections, cholera, and hepatitis A are caused by
inadequate quality of drinking water.
In 1998 MAMA-86 conducted independent water analysis in 4 cities and a sociological survey of consumers
in 11 cities as part of our Water Project, funded by the Dutch agency NOVIB. These detected the
high levels of mineralization i.e. inorganic compounds in Odessa and Tatarbunary, heavy metals in excess
of national limits in Artemivsk, Tatarbunary, Kyiv, and Odessa; chlorine organic compounds in
Artemivsk, Kyiv, Odessa, and Tatarbunary. Excess levels of DDT and its metabolites were found in Odessa, and
levels very close to the limit - were found in Kyiv (19).
According to the sociological survey, which involved 1,678 respondents, 64% perceive drinking water
quality to be a major environmental problem (Ibid.).
One of the main problems in the cities is a physical factor - noise. In large cities of more than 1 million
inhabitants, 60% of population suffer from noise pollution.
There are some grounds to suppose certain levels of acoustic contamination have negative health impact
and contribute to how person feels.
In rural areas
Total area of Ukraine makes 603,800 sq.km. Ukraine occupies one third of the territory of Central Europe
and owns almost 40% of the global stock of black earth, which is the most productive agricultural soil.
However, the percentage of land «undisturbed by human activities» is only 27.4% (in Canada the same
figure is 65%). If we add the impact of the Chornobyl accident, we are left with only 114.8 thousand
sq.km. of moderately contaminated, and 49.1 thousand sq.km of conventionally clean land in Ukraine,
favourable for human life. This means, in fact, that only one quarter of its territory is safe for human
health, and that three quarters of the land has deteriorated as a result of thoughtless human activity.
Radioactive contamination described above is the worst problem for the rural population. The collective
dose of external radiation for ten years has reached 16.5 man-Sievert and 69% of the dose falls to rural
citizens. The citizens of 5 regions (Kyiv, Zhytomyr, Rivne Volyn and Chernigiv) received 60% of the total
collective dose over ten years.
After the accidental release considerable part of radionuclides accumulated in the upper layer of the
ground, now the ground is the main source of radionuclides entered into the agricultural products.
The second important problem in the rural area is pesticide contamination. Despite the fact that Ukraine is
applying far less pesticides than previously, significance of this factor doesn’t decrease. In our country the
situation is further complicated by existing stockpiles of pesticides, which started in 1969. In the early
1970s there were some attempts to collect banned pesticides in specially equipped storage sites.
According to official statistics, stockpiles of unusable pesticides currently amount to 10.7 thousand tons in
109 centralized state storage sites and 22 thousand tons in 4 thousand storage sites which belong to collective
agricultural facilities, joint stock companies and farmers’ co-operatives. According to the results of a
study carried out by the Ministry for Environment and Nuclear Safety, in every region there between 30
and 1000 tons of pesticide stocks. The majority of unusable pesticides are first and second grade hazardous
substances. Inadequate storage conditions and long-term preservation of out-of-date pesticides,
inadequate quality of containers and packaging, - all these factors result in the formation of unknown
pesticide mixtures called «devil’s cocktail». Storage of toxic substances in inadequate storage facilities
result in leakage, which is a threat to environment and human health and leads to environmental disaster.
2. Health effects as a result of the environmental conditions
According to scientific studies, the influence of environmental factors on human health are either acute or
chronic. Most of the factors in Ukraine produce a chronic influence.
The dynamics of the mortality rate and an average life span of the population and the specific groups are
considered to be an integrated medical & demographic indicator.
Now, let us analyze changes, which have occurred in the health of the Ukrainian population. During the
last 6 years the Ukrainian population has decreased by 1.5 million people solely due to depopulation. This
figure is comparable only to the rate of mortality during the 1932-1933 Starvation-Extermination when 3-6
million Ukrainians died; the 1947 Starvation-Extermination when 1 million Ukrainians died; and the Second
World War when 5.3 million died. It is presupposed that if the rate of depopulation stays the same, the
nation will be decreased by 5 million people by 2005. The mortality rate in Ukraine is now among the
highest ten in the world.
There is a further manifestation of the demographic crisis: life expectancy has fallen to a level unprecedented
in a non-warring country. The life span of men has reduced by 10-11 years; and that of women by
3-4 years. In 1996 the average life expectancy of men was 61.1 years, compared to 72.8 years for
women. The increasing gap between the life expectancy of men and women shows once more the declining
health and demographic situation in country. In Ukraine this gap has increased from 9.7 years in 1991
to 11.2 years in 1996. A gap in excess of 10 years is now typical for the whole of Ukraine. This figure
was registered in 17 oblasts of Ukraine. In 11 regions the gap is even greater.
As it was mentioned, the consequences of the Chornobyl accident have substantially affected the health of
the population. One fact serves as an example: almost 150 thousand people, more than a half of them
children, have excessive levels of lead in the thyroid gland. Thyroid gland cancer has increased enormously
since 1990. It is most widespread in the regions of Kyiv, Zhytomyr, Cherkassy, Chernigiv, and
Rivno, which were much more contaminated with radiation than other regions. In 1981-1985 25 cases of
thyroid gland cancer were registered. During 1986-1997 more than 900 children have been operated on
for this. So, it has increased 40-50 times among children. The children who were 5-6 years old at the time
of the Chornobyl disaster are the most vulnerable group. Ukraine has the second highest rate of thyroid
cancer in the world after Belarus (25).
According to long-term monitoring (1980-1996) of the oncoepedemiological situation in Ukraine and
specific Ukrainian regions, the level of cancer rate in population is gradually growing. For instance, in 1980
newly registered oncological patients made 238.3 per 100 thousand population, in 1996 this figure reached
309.4 per 100 thous. population, i.e. the absolute increment of the indicator exceeded 30% (45% in men
and 27.8% in women) (24).
The international average of increases in cancer cases is less rapid and does not exceed 26.0% for men
and 21.0% for women.
Women constitute 54% of the Ukrainian population, e.g. more than 27 million 482 thousand. Death caused
by cancer among women takes the second place in the structure of mortality (30,7%). 7800 women died
from cancer of the reproductive system in 1995. 76.6 thousand new cases of cancer were registered
among women in 1996. Breast cancer has increased twice during recent years. One Ukrainian woman
dies from breast cancer every hour. Two women out of every three have some pre-cancer changes in the
breast. 10-15% of them will contract cancer (16).
In general, there are 741,545 people registered with cancer. Every year 160 thousand new cases are
registered. 60-70% of the population has some genetic inclination to cancer (16). But officially it is not
recognized as a consequence of the Chornobyl disaster.
Another indicator of the demographic crisis is the reduction of the birth rate in Ukraine. The birth rate has
fallen from 630.8 thousand in 1991 to 467.2 thousand in 1996, which is nearly a 25% drop. This small birth
rate don’t ensure the reproduction of the population. Contemporary Ukraine belongs to the group of
European countries with the lowest birth rate, as well as Spain, Italy, Germany, Bulgaria and Russia.
The main reason of the decrease in birth rate is the catastrophically bad state of the population’s reproductive
health, in particular women’s. The medical research data show that 70% of pregnant women today
suffer from obstetric and other disorders. Among them 27.9% suffer from anaemia according to official
data; 8.1% suffer from late toxicosis; 5% from cardiovascular disorders; and 7.6% from urogenital diseases.
The increase premature births has risen from 4.9% in 1992 up to 5.2% in 1995. The number of abnormal
deliveries and the rate of stillborn babies are also increasing. The rate of infant mortality in 1996 reached
14.3 per mille (per 1000 persons) and 13.5 per mille in 1997. The maternal mortality rate is 33.6 cases per
100 000 live new-born babies, i.e. two times higher than the target set by WHO for 2000.
So, it is not surprising that, according research by the Ukrainian Research & Development Institute of
Gynaecology and Obstetrics, 70% of children in Ukraine are currently born with development disorders. If
we look at that fact from the point of view of the national health, only 30% of children are born healthy,
and only 20% of these 30% remain healthy until the age when they graduate from school.
According to the Health Minister’s data, the level of child morbidity has increased by 2.5 times since 1987.
And the quantity of children in good health has decreased from 23% in 1988 to 5% in 1996-1997 (27).
The huge influence of Chornobyl on the environment and on human health is evident. It has proved that
permanent exposure to low doses of radiation causes pathological changes in the human organism: it
provokes cardiovascular diseases, malignant tumours, thyrotoxic disorders, diabetes, asthma, weakened
immunity, etc. (1, 18, 27).
It should be noted that the age of menopause of Ukrainian women is 47.4 years, which is lower than the
European average age, which is 51.4 years. Increased radiation activity is believed to have a crucial
impact on the aging rate of the female population (20).
It is very difficult to separate the influence of different environmental factors: radiation, air pollution in
cities, drinking water quality, pesticides wastes etc.
The existing research on this problem is insufficient. There are some scientific investigations on the
environmental impact on human health in industrial and rural areas, but they are not systematic in character
and do not embrace all the categories of the population, or all the regions in Ukraine. At the same time,
it is known that the aggregate impact of low dosage radiation together with the presence of lead and
nitrates has a greater negative impact than the sum of its parts (18).
Industrial areas
Now, research into the incidence of cancer of the female reproductive system in industrial regions has
shown the growth of breast, ovary, and tumours of the ovary and cervix between 1980 and 1995.
The traditional industrial regions of Dnipropetrivsk, Donetsk, Lugansk, Kharkiv and Kyiv show the highest
levels of all these illnesses except ovary cancer. This is caused by a high level of carcinogenic contamination
in these regions (3).
Rural areas
According to N.Vashkulat, the intensification of agricultural production with the use of pesticides, minerals
and fertilizers, has provoked an increase in the rural population’s morbidity, especially for children’s one. If
the trend for using pesticides, minerals and fertilizers becomes further established, children’s morbidity
could increase by 1.20-1.68 times by 2010 (2).
According to data from the Ukrainian Scientific and Hygienic Center of Ministry of Health of Ukraine,
women who are exposed to pesticides for a long time develop disorders in the functions of the reproductive
system. 30.1% of these women have fibromyomas and inflammations of the uterus and annexums,
20.9% suffer from erosion of the cervix uteri. 60% of fertile women have gynaecological illnesses in rural
areas in Ukraine.
3. Government’s measures on public health improvement
In 1991 the national law «On Environmental Protection» was passed. It is a complex measure in the
domain of environment protection. The special section «Environmental rights and duties of the citizens»
ensures the right of cizitens to a safe and healthy environment.
In 1992 the legal framework «On Health Protection» was approved, which contains specific section about
the rights and duties of the citizens in the field of health protection.
The Ukrainian Constitution, which was adopted in 1996, ensured a number of important provisions as to
environmental protection and human health. Article 3 of the Constitution defines a person, his life, his
honour and dignity, immunity and safety as the highest social values. Article 50 guarantees the right of
every person to a safe and healthy environment and compensation for damage resulting from violations of
this right. According to article 13, the Ukrainian government bears responsibility for safety and stability as
well for overcoming the consequences of the Chornobyl catastrophe. Article 49 ensures free of charge
medical service.
Special Ukrainian laws «On the Legal Regime of the Territory that was exposed to Radioactive Contamination
as a Result of Chornobyl Catastrophe» and «On the Status and Social Protection of the Victims of
the Chornobyl Catastrophe» have defined a regime of zones of radioactive contamination, categories of
victims and special privileges for medical services, improvements in living conditions and taxation
priveleges to be granted to these victims.
Only some of laws and regulations adopted by the Ukrainian government are specified above. It is worth
noting that the legislative framework of Ukraine stipulates rather careful protection of public rights for
environmental safety and health protection. But laws cost nothing if they remain only on paper. Firstly,
there is a lack of law implementation mechanisms at the level of executive power, secondly, the state lacks
the financial resources to implement them owing to the economic crisis. For instance, disabled children
receive from the state a social subsidy of 4.9 hrv ($1.2) a month. This money is not enough even for a
slice of bread a day during a month. For the first quarter of 1999 it is planned to spend 300 thousand hrv
($75,000) for medical services to Chornobyl victims, this makes almost 8 kopecks ($0.02) per 1 person.
But the fact that a donation is available, which are completely formal, gives the Ukrainian government the
right to report at all levels, including at the international level, that it provides «special care» to the most
sensitive groups of population.
As to the right to a safe and healthy environment, according to sociological data, 81.5% women and 72.6
men lack environmental safety (5).
In 1999-2003 it is planned to introduce the “Program Aimed at Genetic Monitoring”. The Program’s target
is to create a special service for the evaluation of the genetic impact on the population in different Ukrainian
regions and to monitor relationship between genetic deviations and levels of environmental pollution.
The responsible institution will be the Ukrainian Scientific Center for Medical Genetics. The Supervising
Council will be headed by the Ministry of Health. But implementation of this Program depends on budget
allocations. It has no separate allocations as yet. In 1999 it is planned to finance it from health sector state
budget, which is very limited.
4. The threats to women’s health from work environments, including threats to their reproductive
health
In general, nearly 87.6% of industrial and agricultural enterprises do not meet the safety standards set by
the government. According to operative data, in 1997, 3,529 cases of professional diseases were registered
compared to 5,221 cases in 1996. During the first quarter of 1998 registered cases amounted to 708
cases against 1,029 for the same period in the previous year. However, this is linked to improvements of
labor conditions, but, firstly, to stagnation in industry, and secondly, to changes in methods of diagnostics of
professional pathology.
In 1997, 19% of women employed in industry worked under adverse occupational conditions. The figure
for 1998 is 20.5%. The quantity of non-state enterprises is increasing, and according to official statistics
more than 1,000 of them have hazardous work environments. According to official data over 3 million
persons are working under conditions that don’t meet sanitary and hygienic norms. According to the data
of the Ukrainian Scientific Hygienic Center of the Ministry for Health Protection of Ukraine, working
conditions are cited as the causes of ilness in 5-6% of women (700-750 cases annually).
The reasons for the extremely inadequate situation in the labor protection is, primarily, the restructuring of
the national economy, and changes in management structures. Even now ministries and departments can
not determine technical policy of every enterprise, departmental norms, organizational and methodical
management, departmental supervision etc. In other words, centralized management has already become
impossible to exercise, but new mechanisms of management and supervision of labor protection are not
formed.
Labor relations, forms and methods of work are changing, and regulation of health and safety issues is
now devolved to local level , and the local authorities are not ready for it.
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Secondly, a process of fast physical depreciation of the capital assets and ageing of technologies is on the
way with almost complete absence of renovation. Depreciation reaches over 70% in some industries. For
instance, life terms of almost all agricultural machinery and equipment except for some isolated new
foreign-made items have expired. They continue an operation thanks to human ingenuity and patience.
The third reason for the inadequate situation in the field of labor protection is a dramatic decrease in
facilities accident prevention. The security as to special clothing, footwear and other individual means of
protection makes 50-60%, sometimes it is not more than 10% of required volume. For instance, the proportion
of acciden ts resulting from a fall from high altitude moved to the third place due to lack of safety
belts and it amounts to 13% of accidents. In agriculture, for example, the workers are not supplied with
special clothing, special footwear and other means of individual protection at all. This contributes to the
high level of injuries and professional diseases.
The erratic operation of enterprises has caused a dramatic fall in labor and production discipline. Every
third death in the machine-building and agribusiness sectors are related to alcohol, and every second death
in the agricultural sector among machine operators was caused by drunkenness on the part of the victim.
Disorganized production conditions contribute to the reduced role in labor protection services. Employers
and top local officials are participating in the significant or complete reduction of labor protection services.
5. Measures taken by government and employers to address the threats to women’s health at
work and protect the health of women in the workforce
Ukrainian legislation on labor protection constitutes four volumes. Most of the existing laws were adopted
in the soviet period. Officially, the health of women in the workforce is protected, particularly pregnant
women. But now, high basic wage rates, and extra privileges such as additional paid vacations, a shorter
working day, free food etc, attract women to jobs at environmentally hazardous enterprises. The situation
is paradoxical, because women prefer to be employed under hazardous conditions than to be unemployed.
That is why a lot of them hide their pregnancy as long as possible. And the government cannot control
environmental conditions in the private sector.
The President’s Decree of March 9, 1998, #182/98 established the National Committee on Supervision of
the Labor Protection. The Committee is delegated to draft orders for the complex management of labor
protection. This includes state supervision of these issues in local departments; the issue of permits for
developing new technologies; the application of new machines, mechanisms, and equipment and other
means of manufacture including those purchased abroad. The law also envisages the establishment of
self-financing subdivisions in the local departments and the Committee. Furthermore, the following provisions
should be developed: activities related to prevention of injuries in the home; coordination of academic
and research activities; formation and use of finances for labor protection funds; structural subdivisions of
the State Labor Protection Supervision Committee.
