Mass Privatization and the Post-communist Mortality Crisis

The massive economic contraction that followed the disintegration of the Soviet system has attracted a great deal of scholarly attention. What has been relatively neglected is the most troubling aspect of the transitions, the explosive rise in ‘violent mortality’, or epidemic levels of cardiovascular disease and ‘external7 causes of death, such as alcohol poisoning, homicide and suicide.1 Countries in the ‘mortality belt’, spanning from Estonia in the north to Ukraine in the south, experienced life expectancy declines of up to six years within the first half-decade of reform — a peacetime mortality crisis unparalleled in modern history.2 To put this in perspective, eliminating all common forms of cancer corresponds to a life expectancy increase of approximately three years, a little less than half of the magnitude of Russia’s mortality experience.3 The United Nation’s MONEE project tabulates that the excess mortality during the 1990s, or deaths that would not have occurred if mortality had remained at 1989 levels, totalled over 3.2 million.4 This crisis is in no respects over; 15 years after transition 11 out of 25 of the post-communist countries have failed to recover to pre-transition levels of life expectancy,5 and public health professionals fear chronic disease epidemics and resurgent infectious disease crises such as AIDS and drug-resistant TB.