Explaining the Heterogeneity of Health Outcomes in Post-Communist Europe

This chapter examines the trends and patterns in population health of the former command economies of Central and Eastern Europe and the Former Soviet Union during the past half century. Even following a period of stagnation and decline from the 1960s to the 1980s, few could have anticipated the dramatic increases in mortality and morbidity that plagued large parts of the region during the early 1990s and then developed into grave public health crises in what became known as the ‘mortality belt’ countries of Belarus, Estonia, Latvia, Lithuania, Moldova, Russia and Ukraine. These countries exhibited exceptionally high rates of external cause and cardiovascular-related deaths, which responded rapidly to fluctuating economic fortunes and were the cause of millions of excess deaths during the 1990s, particularly among males. As economic recovery advanced in the 2000s, a pattern of divergence within the region itself set in. Some countries are now converging on Western health standards, while others—notably Russia, Ukraine and Belarus—remain closer to those of the less developed world, despite their more advanced industrial and social welfare heritage. This chapter argues that in these countries while material well-being, investment in public health care, and progressive social policies are important, these—and economic development more generally—also interact with specific cultural, historical and institutional factors that shape the outcomes we observe and that provide important lessons for comparative economics.