11 Former Soviet Union Hserv 482
Dec 14, 2015
11 Former Soviet Union
Hserv 482
Learning Objectivesdescribe the health achievements of countries of the
Soviet Union from its origins to its demise
discuss possible reasons for the decline of health in countries of the former Soviet Union
STUDENT IMPRESSIONS/EXERIENCES?
Trends for population health in the Former Soviet Union?
1930-1940
1950-1970
1980-1990
1990-2000
Comparisons with USA for life expectancy
– 1900
– 1960
– 1980
– 1996
TRENDS
Shkolnikov
Population 1995-6
Shkolnikov Population 1995-6
Soviet HistoryTsarist period 1400s to 1917
1917 Revolution,
Golden Age (1918-29)
Stalin consolidation era (1929-41)
Great Patriotic War (1941-5)
Khrushchev (1956-64)
1964-82
Gorbachev era (1985-91)
1991-2 on
Tsarist period 1400s to 1917tight control, an imperial bulwark against liberal and
democratic ideas of Europe
Royal Family and church ruled ruthlessly over illiterate peasantry
rigorous censorship
serfdom abolished in 1861 to forestall more radical social changes
early 20th century, urban factories and universities a breeding ground for radical opposition inspired by socialists and anarchists
1917 Revolution, led by urban intellectuals
peasants seized land, workers took over factories, soldiers deserted
takeover by Lenin led to Soviet Union (“bread, land and peace”)
Bolsheviks Mensheviks– larger faction in Second Congress of the Russian Social
Democratic Workers' Party (1903) – Sided with Lenin and became Russian Communist Party
Socialismoriented towards creation of social
order in which :
there is maximum feasible quantity of access for all human beings – to economic resources – to knowledge– to political power
minimum possible domination exercised by any individual or social group over any others
FREE ASSOCIATION OF PRODUCERS
Marx: path to a socialist society
– through class conflict arising from class inequality – which leads to class consciousness – the path is by revolution
need to abolish private ownership of property
Marx in Soho play by Howard Zinn
Communism:Process of class conflict, revolutionary struggle
resulting in victory for proletariat and …
establishment of classless socialist society with
– abolition of private ownership, and
– means of production and subsistence belonging to the community (may not be socialism)
1917 Revolution resultsnationalized industry under workers control
destroyed former class system
abolished private ownership of land when property of nobility taken over
abolished rank in military
Golden Age (1918-29)major powers hostile to USSR,
– Churchill recommended ‘strangling Bolshevik baby in its cradle’
– counter-revolutionary war supported by 21 countries, finally ended in 1921
– economy crippled, people war-wearyBolsheviks fell back to authoritarian tactics, demands
for local control suppressed1920s adopted some market freedoms for peasants to
deal with catastrophic fall in food productionLenin died in 1924, leading to fight for powercharacterized by intense debate, flowering of arts,
literature, music & gains in public health
Stalin consolidation era (1929-41)five year plans stressing
– fast industrialization (production increased rapidly)– urbanization– collectivization of agriculture (production faltered)
moderately well-off peasant families (petty capitalists) had their property seized, deported to labor camps or executed (5 to 10 million)
Stalin consolidation era (1929-41)purges of bureaucracy after making confessions
Gulag: system of concentration camps, – largest employer in Europe
no control devolved to people (Stalinism)– command economy– police state repression– military buildup
created system of hierarchical privilege
Class system began under Stalinworking class
– promised housing, wages, safety, but never got it• "you pretend to work, we'll pretend to pay you"
rural peasants– worse off than serfs used to be in many cases
nomenklatura (Communist Party Elite) – special privileges – purloined state property– exercised patronage
Great Patriotic War (1941-5)Lost 7.5 million soldiers, 6-8 million civilians, 25
million left homeless
People pulled together, – popular fondness for Stalin emerged
Occupation of Eastern Europe from Turkish border to Baltic led to Soviet Union with 15 republics
Khrushchev (1956-64)labor camps shut down,
some prisoners freed,
censorship eased,
socialism optimism surfaced
Red Army crushed anti-Stalinism revolution in Hungary 1956
Sputnik in 1957 boosted people’s self-esteem and USSR expected to overtake the west
USSR: 1964-82similar to Stalin without the brutality
widespread corruption, absenteeism, alcoholism– growth of nomenklatura, consolidating their
privileged position and discouraging change
profound sense of disillusionment especially for older generations whose idealism and faith in system had declined
economic growth declined
USSR: 1964-82dissenters harassed, imprisoned, exiled, or sent to mental
hospitals
military interventions in Czechoslovakia, Afghanistan, comparable to US in Vietnam and Central America – huge spending on military might
Cold War: – carved up world between 2 ‘superpowers’
increasingly educated citizenry
attempts at economic reforms in 1960s halted by bureaucracy
consumer dissatisfaction– shortages and quality of goods increased
Gorbachev era (1985-91) allowed free speech,
new ideas circulated,
sparked struggle for greater democracy– hundreds of independent organizations and political
clubs
open, contested elections for government posts
democratically elected parliament
Gorbachev era (1985-91) allowed limited free-market economy
– free-market economy and political choices not compatible with state-controlled economics and Soviet style communism
Gorbachev said he wouldn’t intervene in internal politics of Eastern Europe – people overturned their communist governments,
through civil unrest
“Communism” incapable of inducing “reform”
Nationalism grew in Soviet republics
Accomplishments of Russia and FSUrevered rulers brought suffering down upon people
(Ivan the Terrible, Peter the Great, Stalin)
Stalin inherited country that was primary casualty of WW I and bequeathed to successors a superpower– doubled production of coal and steel– tripled output of cement and industrial goods– increased pool of skilled labor by order of
magnitude
ALL HIGHER RATES OF INCREASE THAN THE WEST
Accomplishments during Stalin erafew revolts, Stalin era spiritually satisfying for
those who survived, in spite of the violent deaths
between 1940 and 1953 20 million lives lost in wars, equal number in purges
life expectancy rose from 44 when he took power to about 62 when he died
Stalin death’s led to intense elation, Socialist Utopia within striking distance,
– ascetic dedication of Revolution married to Consumerism
10 years later: no progress after self-sacrifice– people stranded without faith,
• Effect of media in portraying “good life” in west• Russian’s deprived of this “good life”
– US in 60s and 70s was preoccupied with revolts in cities, Vietnam War, women’s movement, etc. didn’t notice
• USSR was grinding down• productivity not improving• state projects: > 40% abandoned in 1975 cf 1.7% in 1965
– “economic sabotage” perhaps 20% in 1980
– since early 1950s per capita alcohol sales rose five fold, and with home brew, could be much higher
Attitudes towards Stalin1942: MAN OF THE YEAR, Time magazine
– Winston Churchill, Averill Harriman others dined with him
NYT front page headline March 6, 1953 on Stalin's death made no mention of purges or gulag, instead wrote that his death "brought to an end the career of one of the great figures of modern times-- a man whose name stands second to none as the organizer and builder of the great state structure the world knows as the Soviet
Union"
Soviet achievements to 1960focus on heavy industry and military weapons production
– Space Program (was ahead of USA initially)• Sputnik 1957 and space program putting first person into orbit 1961
• first manned orbiting spacecraft in 1964
• US had better technology except for heavy payload rockets
– Consumer production limited to mostly food and housing
economic growth from 1950 to 1960 was faster than Western Europe and USA– productivity peaked with Khrushchev (1953-64)
exports: armaments, oil, gas and gold
Economic growth dropped since mid-1960sSlipped below OECD rivals in 1970s, with increased
public (military) investment coming from goods and services economy ("reforms")– when Stalin died in 1953, living standards were considered lower
than under Czar Nicholas II,
– yet there were strong consumer expectations that no succeeding leader could fulfill (not Khrushchev, nor Brezhnev nor Kosygin).
Responses• imported grain from adversaries to feed people (Seattle
elevators)
• produced consumer goods such as refrigerators
• cut back on health services
After Stalin's deathglue holding USSR together in the late 70s, early
80s was – secret police and army– black market– political privilege
• restrictive and highly sophisticated
social cohesionlack of trust in system
– absenteeism, drunkenness on job
USSR was guided by a Russian minority, personality cult
Russian ethos (collective reserve of strength)• “beat your son and he will comfort you in old age”
– advice given by monk Sylvester, confessor to Ivan the Terrible
• Sayings– “whom I love, I beat”
– “happiness without suffering is incomplete”
– “don’t argue with misfortune, suffer”
– Dostoevsky “fundamental spiritual need of Russian people is ... for suffering, perpetual and insatiable, everywhere and in everything”
Responses to Productivity decline
tax alcohol – might awaken masses, and also cut government
spending elsewhere for lack of revenue– Yet by late 1980s, alcohol consumption declined, and
alcohol-related deaths dropped
Health Achievements in FSU
1897 life expectancy ~30 years (Imperial Russia), IMR ~250, US life expectancy then about 47
1920s, 30s great improvements, but data collection poor
Health during cold war, improvements continued
late 1950s – life expectancy ~68 slightly greater than in US, – IMR lower than Italy, or Austria
health in Central Asian republics of USSR better than Iran, Pakistan, Afghanistan
Health to around 1970, “communism is good for poverty
removal and for health" Amartya Sen
for equivalent GNP/capita, health was better in ‘communist’ countries
life expectancy stagnation/declinebegan in 60s, 70s in different degrees in different
areas– remarkable since it was difficult to push life
expectancy down in 20th century– UK gains during two world wars– France gained during WW I
Reasons for health declinenot health care system,
– which was always small in comparison to Western Europe and US (3-4 % of GNP and declining over time,
– numbers of people hospitalized declined• cardiology clinic in Moscow was on the fifth floor, no elevator
• “second economy” = bribery, tips works against the neediest
Health in countries of the former Soviet Union declined MUCH more
after 1991 with the breakupbulk of health decline occurred in middle-aged
adults, not infants– Steepest decline in urban and most economically
developed areas – (where economies changed most rapidly)
Social Chernobyl
SHOCK THERAPY
Andreev IJE 2003
2002
How aware are Russian’s of this catastrophe?
About as aware as Americans of their poor health relative to other countries, nor of our decline in relative health since 1960
Typical of structural violence– No outcry! cf. Rwanda genocide, or Holocaust– "no pain, no gain, need stay course of reforms"
Life Expectancy Declines in 20th C.Wars
– Spain 1936-39– West Germany 1943-46– Japan 1944-45
• Male life expectancy that year was 25, but by 1977 was highest
– South Korea 1950-53
Sub-Saharan Africa from 1990s onward
Russia alone 1.8 million excess deaths 1992-5– 1992-98 about 3 million excess deaths
• WW I Russian deaths were 1.7 million
Former Soviet Union toll more than 15 million deaths
INFORMAL TRUSTSocial cooperation necessary for people to secure enough to
avoid becoming destitute– only one in 8 earns enough from official job to meet basic
needs• but most get through without borrowing or spending savings, using
unofficial economies (subsistence agriculture, barter economy, second job, tips, bribes, foreign remittances
– NEGOTIABLE CREATIVE EXCHANGES:• after passing exams to graduate need "pay" teacher• parents of sick child told might be dead next week, unless you get expensive
"extra treatment"• taxi driver stopped on way to airport with foreign fare, fined $100 for
"being drunk"
Russians’ help friends without expecting money – “A hundred friends are worth more than a hundred rubles”– sometimes strangers oblige without being paid, and thereby enlarging
their own network of people upon whom they can call for help some day
MAFIA CAPITALISMRobber Capitalism
Russian Mafia exploits cash-rich individuals
– Has distracted attention from cash-free economies that depend on social cooperation
Billionaire Olympics
5987
469
0
50
100
150
200
250
300
350
400
450
500
USA Germany Russia
total of 1126 (2008)
6245433117
ECONOMIES IN RUSSIATwo economies for every family
– official economy with wage or pension– social economies in which goods and services
produced, exchanged, consumed without money changing hands (11% of Russian hh exist solely on social economy)
– Also “uncivil” economy for a third of Russian hh, with shadow economy or extra-legal or illegal (also called “second economy” before 1990)
• most vulnerable groups (poorest) least affected by this uncivil economy, and rely on official economy, and hence most at risk
• supply greatly exceeds demand here, about 17% of Russian hh rely on this economy along with official economy
Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia, World Bank 2001
Life Exp FSU 2001 UNDP
60
62
64
66
68
70
72
74
76
Czech Republic
Poland GeorgiaSlovakiaLithuaniaArmenia
AzerbaijanHungaryEstonia Bulgaria
Latvia
RomaniaBelarus
Uzbekistan
Ukraine
Moldova,Rep.of
TajikistanKyrgyzstan
RussianFederation
TurkmenistanKazakhstan
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Hierarchy and Fall in Life ExpectancyData on 71 regions from Russian state statistics
committee, including income surveys, adjusted for changes in consumer price index, using Robin Hood index (Gini more sensitive to extremes)
Male life expectancy fall from 1990 to 1994 (nadir)
Fall associated with labor turnover and RH index and associated less with mean hh income in 1990
Davey Smith 1996
Marmot & Bobak BMJ 2000
Association of Labor Turnover and Fall in Men's Life expectancy
Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia, World Bank 2001
Social Monitor 2003 Innocenti
Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia, World Bank 2001
Social Monitor 2003 Innocenti
Central Asia Human Development Report 2005
Central Asia Human Development Report 2005
Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia, World Bank 2001
Social Monitor 2003 Innocenti
16 nations, 169,776 people
Behavioral
Violence
Structural
Violence
Discrete yes no
Individual yes no
Visible yes no
MAGNITUDE OF STRUCTURAL VIOLENCE
SINCE 1992Structural
Violence Deaths
War deaths1900-1995
World ~200,000,000(compared to
healthiest countries)
109,746,000
FormerSoviet Union
~15,000,000(calculated compared
to 1991)
~20,000,000
SCF State of the World's Mothers 2004
In Phillips County,Arkansas, the birth rate among teenage girls in 2000 was 127 births per 1,000 women aged 15 to 19 - a rate higher than in 94 developing countries.
A fifth of 20-yr old women who gave birthin the US gave birth did so in their teens
Marmot, Lancet 05
SummaryFormer Soviet Union made remarkable health gains
until the 1960sPopulation health declined since then, as social capital
erodedMost vulnerable groups in the decline were single
middle-aged men and to a lesser extent single women
Political structures have profound impacts on health outcomes (structural violence)
Most people are ignorant of these issues, although major world forces have paid lip service in the past (Benjamin's Law)
Creative Destruction
"Any reform must be disruptive on an historically unprecedented scale. An entire world must be discarded, including all its economic and most of its social and political institutions."
– Create Middle America on the Volga
– If you can't make money from it, don't do it
'The essential fact about capitalism' Joseph Schumpeter
jobs
living standards
entire industries
health
livesMEDIUM-LEVEL NUCLEAR ATTACK