Articles assessing the dire state of public health in Russia keep appearing.

Here is another. Some numbers:

… remember tuberculosis? In the United States, with a population of 303 million, 650 people died of the disease in 2007.

In Russia, which has a total of 142 million people, an astonishing 24,000 of them died of tuberculosis in 2007. Can it possibly be coincidental that, according to Gennady Onishchenko, the country’s chief public health physician, only 9 percent of Russian TB hospitals meet current hygienic standards, 21 percent lack either hot or cold running water, 11 percent lack a sewer system, and 20 percent have a shortage of TB drugs?

Or this:

Peter Piot, the head of UNAIDS, the U.N. agency created in response to the epidemic, told a press conference this summer that he is "very pessimistic about what is going on in Russia and Eastern Europe . . . where there is the least progress."

This should be all the more worrisome because young people are most at risk in Russia. In the United States and Western Europe, 70 percent of those with HIV/AIDS are men over age 30; in Russia, 80 percent of this group are aged 15 to 29.

The problem with these mega-trends is that once the negative demographic momentum caused by them builds up, it is almost impossible to change it for the better. Fact: fewer babies now mean fewer women to have children 25 years later:

Russia’s birth rate has been declining for more than a decade, and even a recent increase in births will be limited by the fact that the number of women age 20 to 29 (those responsible for two-thirds of all babies) will drop markedly in the next four or five years to mirror the 50 percent drop in the birth rate in the late 1980s and the 1990s.

So what? Russia can duff up Georgia any time it wants. Post-Soviet Russian Pride, and all that.