Levels and trends of persistent organic pollutants in human populations living in the Arctic.

The Arctic Monitoring Assessment Program (AMAP) is tasked with monitoring and assessing the status of environmental contaminants in the Arctic, documenting levels and trends, and producing science-based assessments. The objectives of this paper are to present the current levels of persistent organic pollutants (POPs) across the Arctic, and to identify trends and knowledge gaps as detailed in the most recent AMAP Human Health Assessment Report. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of POPs were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada), as well as populations in the coastal Chukotka district (Russia) for legacy POPs only. Concentrations of most POPs are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The exceptions are per- and polyfluoroalkyl substances, with concentrations of some long-chain PFAS such as perfluorononanoic acid increasing in populations in Nunavik, Greenland and Sweden. This paper provides a more extensive summary of levels of contaminants in adults, pregnant women, and children across the Arctic than previous AMAP human health assessments, particularly for levels of long-chain PFAS, which are currently under consideration for inclusion in the Stockholm Convention.

Levels and trends of metals in human populations living in the Arctic.

The 2021 Arctic Monitoring Assessment Program (AMAP)'s Human Health Assessment report presents a summary of the presence of contaminants in human populations across the circumpolar Arctic and provides an update to the previous assessment released in 2015. The primary objective of this paper is to summarise some of these findings by describing the current levels of metals across the Arctic, including key regional and temporal trends based on available national data and literature, and highlight knowledge gaps. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of mercury (Hg) were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada). Still, concentrations of several metals are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The 2021 AMAP human health assessment report and this paper provide an extensive summary of levels of metals and trace elements in adults, pregnant women, and children across the Arctic.

Forty-Year Biomonitoring of Environmental Contaminants in Russian Arctic: Progress, Gaps and Perspectives.

This article presents a comprehensive survey of the studies on the biomonitoring of persistent organic pollutants (POPs) and metals in biota and human tissues on the territory of the Russian Arctic. It is concluded that a relatively small number of studies were carried out during the last 40 years; for several Russian Arctic regions there is no data up to date, and for some regions the data are scarce, with most of the studies carried out in 1990s, followed by the large-scale GEF/AMAP/RAIPON project of 2001-2004 covering four regions. After that, single projects have been implemented in a few regions. Only the Nenets okrug and the Chukotka okrug (and hardly the Murmansk oblast) can be attributed as the regions where the biomonitoring of contaminants was carried out during last decades on several occasions, and for which the content of POPs and metals in biota and the human organism was assessed in 12-15-year dynamic trends (at least "at three points"). For the rest of the Russian Arctic territories, only fragmentary "cross-sections" of biomonitoring data is available, mainly obtained in the 1990s or early 2000s, which do not allow judging either the dynamics of the processes or the current state of affairs. The overwhelming majority of the studies in the Russian Arctic (more than 90%) were carried out within the framework of international projects, i.e., with cofinancing, assistance and contribution (including laboratory analyses) from the foreign colleagues and partners. The shortcomings of the Russian system of biomonitoring, including the weakness of the laboratory and research base, are considered. Perspectives of the Russian Arctic biomonitoring are discussed in detail, with the proposal of the elaboration of the national Russian Arctic Contaminants Program (RACP).

MercuNorth - monitoring mercury in pregnant women from the Arctic as a baseline to assess the effectiveness of the Minamata Convention.

Exposure to mercury (Hg) is a global concern, particularly among Arctic populations that rely on the consumption of marine mammals and fish which are the main route of Hg exposure for Arctic populations.The MercuNorth project was created to establish baseline Hg levels across several Arctic regions during the period preceding the Minamata Convention. Blood samples were collected from 669 pregnant women, aged 18-44 years, between 2010 and 2016 from sites across the circumpolar Arctic including Alaska (USA), Nunavik (Canada), Greenland, Iceland, Norway, Sweden, Northern Lapland (Finland) and Murmansk Oblast (Russia). Descriptive statistics were calculated, multiple pairwise comparisons were made between regions, and unadjusted linear trend analyses were performed.Geometric mean concentrations of total Hg were highest in Nunavik (5.20 µg/L)  and Greenland (3.79 µg/L), followed by Alaska (2.13 µg/L), with much lower concentrations observed in the other regions (ranged between 0.48 and 1.29 µg/L). In Nunavik, Alaska and Greenland, blood Hg concentrations have decreased significantly since 1992, 2000 and 2010 respectively with % annual decreases of 4.7%, 7.5% and 2.7%, respectively.These circumpolar data combined with fish and marine mammal consumption data can be used for assessing long-term Hg trends and the effectiveness of the Minamata Convention.

Traditional Diet and Environmental Contaminants in Coastal Chukotka II: Legacy POPs.

The article is the second in the series of four that present the results of a study on environmental contaminants in coastal Chukotka, conducted in the context of a multi-disciplinary investigation of indigenous foodways in the region. The article presents the results of the analysis of legacy Persistent Organic Pollutants (POPs) found in the samples of locally harvested food and indoor matters, collected in 2016 in coastal Chukotka. Temporal trends and circumpolar comparisons of POPs in food have been carried out. Estimated daily intakes (EDIs) of POPs by local food consumption were calculated based on the food intake frequencies (questionnaire data). Concentrations of the studied legacy POPs in marine mammal blubber were relatively high (up to 100⁻200 µg/kg ww) but not exceeding the allowable limits. Gray whale blubber and whale mantak were the most contaminated foods, followed by the ringed, spotted and bearded seal blubber, then by walrus blubber and fermented walrus (deboned walrus parts aged in subterranean pits, typically over a period of 6 months). At the backdrop of general decrease or invariability (compared to the previous coastal Chukotka study 15 years ago) of the majority of POPs, an increasing tendency of HCB, mainly in marine mammals, were noted. Legacy POPs in marine mammals sampled in Chukotka were generally much lower than in those sampled in Alaska and northern Canada. We suggest that the Alaska Coastal Current from the Bering Sea plays a major role in this phenomenon. Analyses of the additional sources of in-home food contamination (home-brewed alcohol, domestic insecticides) have revealed relatively high levels of HCHs, DDTs and PCBs, which still represent a share of dietary exposure of local people to POPs.

Traditional Diet and Environmental Contaminants in Coastal Chukotka III: Metals.

The article is the third in the series of four that present the results of a study on environmental contaminants in coastal Chukotka, which was conducted in the context of a multi-disciplinary investigation of indigenous foodways in the region. The article presents the results of the analysis of metals found in the samples of locally harvested terrestrial, freshwater, and marine biota collected in 2016 in coastal Chukotka. For some species of local fauna and flora, the metals content was demonstrated for the first time. Lead and Hg were low in all foods, while As concentrations were up to four mg/kg ww in fish and marine mammals blubber. Wild plants showed accumulations of Mn (up to 190 mg/kg ww), Al (up to 75 mg/kg ww), Ni, Ba, and Sr. Seaweed contained high levels of As (14 mg/kg) and Sr (310 mg/kg); ascidians (sea squirts) contained Al (up to 560 mg/kg), Cr, and Sr; and blue mussels contained Cd (2.9 mg/kg) and Al (140 mg/kg). Exceedances over the Russian allowable levels were revealed for As, Cd, and Al in different food items. Absence of the established limits for Al and Sr in seafood, and Mn in wild plants and berries, impedes the determination of excess levels. Temporal trends and geographic comparisons of metals in foods have been carried out. The estimated daily intakes (EDIs) of metals by local food consumption were calculated based on the food intake frequencies. Follow-up (15 years after the first study) analyses of Hg, Pb, and Cd concentrations in local foods has not revealed any increase, while a slight decrease tendency was noted for some of the metals in several foods.

Traditional Diet and Environmental Contaminants in Coastal Chukotka IV: Recommended Intake Criteria.

The article is the last in the series of four that present the results of a study on environmental contaminants in coastal Chukotka, conducted in the context of a multi-disciplinary investigation of Indigenous foodways in the region. The article presents the Recommended Food Daily Intake Limit (RFDIL) guidelines of the locally harvested foods in coastal Chukotka. The guidelines were developed based on the results of the analysis of the legacy persistent organic pollutants (POPs) and metals found in the samples of locally harvested food, which was collected in 2016 in the villages of Enmelen, Nunligran, and Sireniki on the south coast of the Chukchi Peninsula, Russian Arctic. The overall aim of the article is to expand the toolset for dealing with the challenges of: (1) setting the dietary recommendations when we assess multiple contaminants in a variety of foods (and our method of RFDILs calculation is an example of a possible approach), and (2) managing the real-life circumstances when many types of foods are mixed in many dishes regularly and the concentrations of contaminants in these mixed dishes become uncertain. Drawing on perspectives from the fields of environmental health sciences, humanities, social sciences, and visual art, the authors consider the RFDILs of the examined foods in the context of the culinary practices and aesthetics values (those that relate to the culturally held ideas of beauty ascribed to a dish or the processes of its preparation and consumption) of the Indigenous Arctic cuisine in the region of the Bering Strait, and in the broader dynamics of food and culture.

Traditional Diet and Environmental Contaminants in Coastal Chukotka I: Study Design and Dietary Patterns.

The article is the first in the series of four that present the results of a study on environmental contaminants in coastal Chukotka, conducted in the context of a multi-disciplinary investigation of indigenous foodways in the region of the Bering Strait. We provide an overview of the contemporary foodways in our study region and present the results of the survey on the consumption of locally harvested foods, carried out in 2016 in the Chukotkan communities of Enmelen, Nunligran, and Sireniki. The present results are evaluated in comparison to those of the analyses carried out in 2001⁻2002 in the village of Uelen, located further north. Where appropriate, we also draw comparative insight from the Alaskan side of the Bering Strait. The article sets the stage for the analyses of legacy persistent organic pollutants (POPs) and metals to which the residents become exposed through diet and other practices embedded in the local foodways, and for the discussion of the Recommended Food Daily Intake Limits (RFDILs) of the food that has been sampled and analyzed in the current study.

Public Health Practice Report: water supply and sanitation in Chukotka and Yakutia, Russian Arctic.

Information from 2013-2015 have been analysed on water accessibility, types of water service to households, use of water pretreatment, availability of sewerage, use of sewage treatment in Chukotka Autonomous Okrug and Yakutia Republic, based on evaluation information accessible in open sources, such as regional statistics and sanitary-epidemiologic reports. The main causes of the poor state of water supply and sanitation in the study regions include: very limited access to in-home running water (one-quarter of settlements in Chukotka and half of settlements in Yakutia have no regular water supply) and lack of centralised sewerage (78% and 94% of settlements correspondingly have no sewerage); lack of water pretreatment and sewage treatment, outdated technologies and systems; serious deterioration of facilities and networks, frequent accidents; secondary pollution of drinking water. Lack of open objective information on Russian Arctic water supply and sanitation in the materials of the regional and federal statistics hampers the assessment of the real state of affairs. The situation for water and sanitation supply in these Russian Arctic regions remains steadily unfavourable. A comprehensive intervention from national and regional governmental levels is urgently needed.

The Impact of a Nickel-Copper Smelter on Concentrations of Toxic Elements in Local Wild Food from the Norwegian, Finnish, and Russian Border Regions.

Toxic elements emitted from the Pechenganickel complex on the Kola Peninsula have caused concern about potential effects on local wild food in the border regions between Norway, Finland and Russia. The aim of this study was to assess Ni, Cu, Co, As, Pb, Cd, and Hg concentrations in local wild foods from these border regions. During 2013-2014, we collected samples of different berry, mushroom, fish, and game species from sites at varying distances from the Ni-Cu smelter in all three border regions. Our results indicate that the Ni-Cu smelter is the main source of Ni, Co, and As in local wild foods, whereas the sources of Pb and Cd are more complex. We observed no consistent trends for Cu, one of the main toxic elements emitted by the Ni-Cu smelter; nor did we find any trend for Hg in wild food. Concentrations of all investigated toxic elements were highest in mushrooms, except for Hg, which was highest in fish. EU maximum levels of Pb, Cd, and Hg were exceeded in some samples, but most had levels considered safe for human consumption. No international thresholds exist for the other elements under study.

Food and water security issues in Russia III: food- and waterborne diseases in the Russian Arctic, Siberia and the Far East, 2000-2011.

BACKGROUND: The food- and waterborne disease situation in Russia requires special attention. Poor quality of centralized water supplies and sewage systems, biological and chemical contamination of drinking water, as well as contamination of food products, promote widespread infectious diseases, significantly exceeding nationwide rates in the population living in the two-thirds of Russian northern territories. OBJECTIVES: The general aim was to assess the levels of food- and waterborne diseases in selected regions of Russian Arctic, Siberia and the Far East (for the period 2000-2011), and to compare disease levels among regions and with national levels in Russia. STUDY DESIGN AND METHODS: This study is the first comparative assessment of the morbidity in these fields of the population of 18 selected regions of Russian Arctic, Siberia and the Far East, using official statistical sources. The incidences of infectious and parasitic food- and waterborne diseases among the general population (including indigenous peoples) have been analyzed in selected regions (per 100,000 of population, averaged for 2000-2011). RESULTS: Among compulsory registered infectious and parasitic diseases, there were high rates and widespread incidences in selected regions of shigellosis, yersiniosis, hepatitis A, tularaemia, giardiasis, enterobiasis, ascariasis, diphyllobothriasis, opistorchiasis, echinococcosis and trichinellosis. CONCLUSION: Incidences of infectious and parasitic food- and waterborne diseases in the general population of selected regions of the Russian Arctic, Siberia and the Far East (2000-2011) are alarmingly high. Parallel solutions must be on the agenda, including improvement of sanitary conditions of cities and settlements in the regions, modernization of the water supply and of the sewage system. Provision and monitoring of the quality of the drinking water, a reform of the general healthcare system and the epidemiological surveillance (including gender-divided statistics), enhancement of laboratory diagnostics and the introduction of preventive actions are urgently needed.

Food and water security issues in Russia II: water security in general population of Russian Arctic, Siberia and Far East, 2000-2011.

BACKGROUND: Poor state of water supply systems, shortage of water purification facilities and disinfection systems, low quality of drinking water generally in Russia and particularly in the regions of the Russian Arctic, Siberia and Far East have been defined in the literature. However, no standard protocol of water security assessment has been used in the majority of studies. STUDY DESIGN AND METHODS: Uniform water security indicators collected from Russian official statistical sources for the period 2000-2011 were used for comparison for 18 selected regions in the Russian Arctic, Siberia and Far East. The following indicators of water security were analyzed: water consumption, chemical and biological contamination of water reservoirs of Categories I and II of water sources (centralized--underground and surface, and non-centralized) and of drinking water. RESULTS: Water consumption in selected regions fluctuated from 125 to 340 L/person/day. Centralized water sources (both underground and surface sources) are highly contaminated by chemicals (up to 40-80%) and biological agents (up to 55% in some regions), mainly due to surface water sources. Underground water sources show relatively low levels of biological contamination, while chemical contamination is high due to additional water contamination during water treatment and transportation in pipelines. Non-centralized water sources are highly contaminated (both chemically and biologically) in 32-90% of samples analyzed. Very high levels of chemical contamination of drinking water (up to 51%) were detected in many regions, mainly in the north-western part of the Russian Arctic. Biological contamination of drinking water was generally much lower (2.5-12%) everywhere except Evenki AO (27%), and general and thermotolerant coliform bacteria predominated in drinking water samples from all regions (up to 17.5 and 12.5%, correspondingly). The presence of other agents was much lower: Coliphages--0.2-2.7%, Clostridia spores, Giardia cysts, pathogenic bacteria, Rotavirus--up to 0.8%. Of a total of 56 chemical pollutants analyzed in water samples from centralized water supply systems, 32 pollutants were found to be in excess of hygienic limits, with the predominant pollutants being Fe (up to 55%), Cl (up to 57%), Al (up to 43%) and Mn (up to 45%). CONCLUSION: In 18 selected regions of the Russian Arctic, Siberia and Far East Category I and II water reservoirs, water sources (centralized--underground, surface; non-centralized) and drinking water are highly contaminated by chemical and biological agents. Full-scale reform of the Russian water industry and water security system is urgently needed, especially in selected regions.

A call for urgent monitoring of food and water security based on relevant indicators for the Arctic.

This perspective paper argues for an urgent need to monitor a set of 12 concrete, measurable indicators of food and water security in the Arctic over time. Such a quantitative indicator approach may be viewed as representing a reductionist rather than a holistic perspective, but is nevertheless necessary for actually knowing what reality aspects to monitor in order to accurately understand, quantify, and be able to project critical changes to food and water security of both indigenous and non-indigenous people in the Arctic. More relevant indicators may be developed in the future, taking us further toward reconciliation between reductionist and holistic approaches to change assessment and understanding. However, the potential of such further development to improved holistic change assessment is not an argument not to urgently start to monitor and quantify the changes in food and water security indicators that are immediately available and adequate for the Arctic context.

Indicators of food and water security in an Arctic Health context--results from an international workshop discussion.

In August 2012, a literature search with the aim of describing indicators on food and water security in an Arctic health context was initialized in collaboration between the Arctic Human Health Expert Group, SDWG/AHHEG and the AMAP (Arctic Monitoring and Assessment Programme within the Arctic Council) Human Health Assessment Group, AMAP/HHAG. In December 2012, workshop discussions were performed with representatives from both of these organizations, including 7 Arctic countries. The aim of this article is to describe the workshop discussions and the rational for the 12 indicators selected and the 9 rejected and to discuss the potential feasibility of these. Advantages and disadvantages of candidate indicators were listed. Informative value and costs for collecting were estimated separately on a 3-level scale: low, medium and high. Based on these reviews, the final selection of promoted and rejected indicators was performed and summarized in tables. Among 10 suggested indicators of food security, 6 were promoted: healthy weight, traditional food proportion in diet, monetary food costs, non-monetary food accessibility, food-borne diseases and food-related contaminants. Four were rejected: per-person dietary energy supply, food security modules, self-estimated food safety and healthy eating. Among 10 suggested indicators of water security, 6 were promoted: per-capita renewable water, accessibility of running water, waterborne diseases, drinking-water-related contaminants, authorized water quality assurance and water safety plans. Four were rejected: water consumption, types of water sources, periodic water shortages and household water costs.

Cancer incidence and mortality in Chukotka, 1997-2010.

OBJECTIVES: The general aim was to assess cancer incidence and mortality among the general population of Chukotka in 1997-2010 and to compare it with the population of Russia. METHODS: Cancer data were abstracted from the annual statistical reports of the P.A. Hertzen Research Institute of Oncology in Moscow. The annual number and percent of cases, crude and age-standardized cancer incidence (ASIR) and mortality (ASMR) rates per 100,000 among men and women in the Chukotka Autonomous Okrug were determined for the period 1997-2010 for incidence and 1999-2010 for mortality. Two years' data were aggregated to generate temporal trends during the period. In age-standardization, the Segi-Doll world standard population used by the International Agency for Research on Cancer was used. RESULTS: The higher incidence and mortality rate of cancer (all sites combined) among men compared to women, which was observed in Russia nationally, was reflected also in Chukotka, although the difference between men and women was not statistically significant. Overall, the patterns of cancer sites are similar between Chukotka and Russia, with cancer of the lung/trachea/bronchus and stomach occupying the top ranks among men. Oesophageal cancer is common in Chukotka but not in Russia, whereas prostate cancer is common in Russia but not in Chukotka. Among women, breast cancer is either the commonest or second commonest cancer in terms of incidence or mortality in both Chukotka and Russia. Cancer of the lung/trachea/bronchi ranks higher in Chukotka than in Russia. The rate of cancer incidence and mortality for all sites combined during the 13-year period was relatively stable in Russia. Dividing the period into two halves, an increase among both men and women was observed in Chukotka for all sites combined, and also for colorectal cancer. CONCLUSIONS: This paper presents previously unavailable cancer epidemiological data on Chukotka. They provide a basis for comparative studies across circumpolar regions and countries. With its small population, cancer rates in Chukotka tend to be highly unstable and fluctuate widely from year to year. Even when aggregated over a decade or more, only broad conclusions regarding patterns and trends can be made regarding some of the commonest cancer sites, or with all sites combined. Chukotka experienced substantial social and economic dislocations during the period under study, which could conceivably affect risk factor distribution and the quality of medical care.

Health and society in Chukotka: an overview.

This study provides a historical overview of the changes in the socio-economic and health status of the population of Chukotka, from the Soviet to the post-Soviet period, with special attention paid to the circumstances of indigenous people. Past health studies in Chukotka are reviewed and key demographic and health indicator data presented. Since the 1990s, Chukotka's population has shrunk to a third of its former size due to emigration of non-indigenous and mostly younger people, with a corresponding increase in the mortality rate due to aging of the population. However, the indigenous population has remained stable. Among the most important causes of mortality are injuries. The living conditions of indigenous people continue to be a cause of concern, beset by high rates of poverty, unemployment, alcoholism, suicide and a variety of infectious diseases, such as tuberculosis and sexually transmitted infections. The economy, general infrastructure and health care system of Chukotka have been considerably improved by the Abramovich administration in the 2000s.

Cancer mortality in the indigenous population of coastal Chukotka, 1961-1990.

OBJECTIVES: The general aim was to assess the pattern and trend in cancer mortality among the indigenous people of coastal Chukotka during the period 1961-1990. METHODS: All cases of cancer deaths of indigenous residents of the Chukotsky district in the north-easternmost coast of Chukotka Autonomous Okrug were copied from personal death certificates. There were a total of 219 cancer deaths during the study period. The average annual number of cases, percent, crude, and age-standardized cancer mortality rates (ASMR) per 100,000 among men and women for all sites combined and selected sites were calculated. Data were aggregated into six 5-year periods to assess temporal trends. Direct age-standardization was performed with the Segi-Doll world standard population used by the International Agency for Research on Cancer. RESULTS: The indigenous Chukchi and Eskimo people living in Chukotsky district were at higher risk of death from cancer during the 30-year period between 1961 and 1990, with ASMR among men twice that of Russia, and among women 3.5 times higher. The excess can be attributed to the extremely high mortality from oesophageal cancer and lung cancer. CONCLUSIONS: The indigenous people of coastal Chukotka were at very high risk of death from cancer relative to the Russian population nationally. The mortality data from this study correspond to the pattern of incidence reported among other indigenous people of the Russian Arctic. Little information is available since 1990, and the feasibility of ethnic-specific health data is now severely limited.

Occupational accidents in Russia and the Russian Arctic.

BACKGROUND: According to official statistics, the rate of occupational accidents (OAs) and fatal injuries in Russia decreased about 5-fold and 2-fold, respectively, from 1975 to 2010, but working conditions during this period had the opposite trend; for example, the number of people who work in unfavourable and hazardous conditions (particularly since 1991) has increased significantly. METHODS: This review summarises the results of a search of the relevant peer-reviewed literature published in Russia and official statistics on OAs and occupational safety in Russia and the Russian Arctic in 1980-2010. RESULTS: The occupational safety system in Russia has severely deteriorated in the last 2 decades, with legislators tending to promote the interests of industry and business, resulting in the neglect of occupational safety and violation of workers' rights. The majority of workers are employed in conditions that do not meet rules of safety and hygiene. More than 60% of OAs can be attributed to management practices--violation of safety regulations, poor organisation of work, deficiency of certified occupational safety specialists and inadequate personnel training. Research aimed at improving occupational safety and health is underfunded. There is evidence of widespread under-reporting of OAs, including fatal accidents. Three federal agencies are responsible for OAs recording; their data differ from each other as they use different methodologies. The rate of fatal OAs in Russia was 3-6 times higher than in Scandinavian countries and about 2 times higher compared to United States and Canada in 2001. In some Russian Arctic regions OAs levels are much higher. CONCLUSIONS: Urgent improvement of occupational health and safety across Russia, especially in the Arctic regions, is needed.

Occupational health and health care in Russia and Russian Arctic: 1980-2010.

BACKGROUND: There is a paradox in Russia and its Arctic regions which reports extremely low rates of occupational diseases (ODs), far below those of other socially and economically advanced circumpolar countries. Yet, there is widespread disregard for occupational health regulations and neglect of basic occupational health services across many industrial enterprises. STUDY DESIGN AND METHODS: This review article presents official statistics and summarises the results of a search of peer-reviewed scientific literature published in Russia on ODs and occupational health care in Russia and the Russian Arctic, within the period 1980-2010. RESULTS: Worsening of the economic situation, layoff of workers, threat of unemployment and increased work load happened during the "wild market" industrial restructuring in 1990-2000, when the health and safety of workers were of little concern. Russian employers are not legally held accountable for neglecting safety rules and for underreporting of ODs. Almost 80% of all Russian industrial enterprises are considered dangerous or hazardous for health. Hygienic control of working conditions was minimised or excluded in the majority of enterprises, and the health status of workers remains largely unknown. There is direct evidence of general degradation of the occupational health care system in Russia. The real levels of ODs in Russia are estimated to be at least 10-100 times higher than reported by official statistics. The low official rates are the result of deliberate hiding of ODs, lack of coverage of working personnel by properly conducted medical examinations, incompetent management and the poor quality of staff, facilities and equipment. CONCLUSIONS: Reform of the Russian occupational health care system is urgently needed, including the passing of strong occupational health legislation and their enforcement, the maintenance of credible health monitoring and effective health services for workers, improved training of occupational health personnel, protection of sanitary-hygienic laboratories in industrial enterprises, and support for research assessing occupational risk and the effectiveness of interventions.

Occupational diseases in Murmansk Oblast: 1980-2010.

BACKGROUND: Official statistics tend to underestimate the incidence of occupational disease (OD) nationally and regionally in Russia. OBJECTIVES: The general aim was to obtain an accurate estimate of ODs in Murmansk Oblast in 1980-2010 and to determine the rate of specific types of ODs among cohorts of workers who had been exposed to the hazardous factors causing the disease. MATERIALS AND METHODS: Data were retrieved from the Murmansk Oblast ODs database for the oblast and 2 enterprises--Apatite JSC and Kolskaya MSC--which contributed to more than half of the ODs in the oblast in 1980-2010. The total number of ODs and 5 specific categories (musculoskeletal, respiratory, nervous diseases, hearing loss and vibration disease) were analysed. RESULTS: THE TOTAL RATE OF ODS AMONG WORKERS OF MAIN SHOPS IN BOTH ENTERPRISES WHO WERE ACTUALLY EXPOSED TO HARMFUL FACTORS WERE EXTREMELY HIGH: the rate for Apatite JSC was 25 times higher than in Russia and 15 times higher than in Murmansk Oblast, while the rate for Kolskaya MSC was about 30 and 20 times greater than in Russia and in Murmansk Oblast, respectively; in the 2000s the difference reached 100-150 times. The rise in reported ODs in both enterprises corresponded to the time when intensive medical examinations were conducted by the Kola Research Laboratory for Occupational Health (KRLOH) in Kirovsk. A similar pattern was also observed for the sub-categories of musculoskeletal, respiratory, nervous diseases, hearing loss and vibration disease. It is likely that the true burden of OD is even higher due to misdiagnosis, reluctance of workers concerned about job security to present for care and the lack of reliable information on working conditions needed to establish a causal link between disease and occupational exposure. CONCLUSIONS: As with many other regions across Russia, ODs in Murmansk Oblast are grossly underestimated. Serious problems exist in the Russian occupational health care system and the collection of occupational health statistics that require urgent, fundamental reform.