IJE Advance Access originally published online on April 27, 2006
International Journal of Epidemiology 2006 35(3):797-799; doi:10.1093/ije/dyl076
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Letter to the Editor |
Centrally planned economies, economic slumps, and health conditions
Institute of Labor and Industrial Relations and School of Social Work, University of Michigan, Ann Arbor, MI, USA
E-mail: jatapia{at}umich.edu
I am not sure why Boncz and Sebestyén,1 while ignoring contributors providing specific comments on Eastern Europe to the IJE debate on mortality and economic growth,2,3 refer in their letter to other contributions4,5 in which nothing is said about the issue. Whatever Boncz and Sebestyén's reasons for this, they discuss colourfully the division of Europe in Yalta (1945) into an American and a Russian sphere of influence, describing it as ‘the largest medical trial in history,’ in which the two groups of patients—countries—separated by ‘the iron curtain,’ were assigned to two different treatments, ‘capitalism’ and ‘socialism.’ Clever or gaudy, the metaphor seems to be stretched and I am doubtful to what extent it may be useful as a heuristic device. Indeed, a large portion of one ‘treatment group,’ the USSR, had been ‘treated’ from 1917. Then, after 1945, countries like China, Cuba, Vietnam, Ethiopia, etc. were included in a similar ‘treatment’ group, though this happened in other continents and not behind the European ‘iron curtain.’ Insofar as ‘the iron curtain’ refers to the lack of civil liberties, though that is basically the case in China today, ‘the curtain’ is now rarely—if ever—mentioned by freedom-loving politicians à la Kissinger and investors happily doing business in that country.
It is presently in fashion, and Boncz and Sebestyén go with it, to use the term ‘formerly socialist regimes’ to refer to the USSR and other countries that during former decades had authoritarian regimes organized under what the World Bank then called ‘centrally planned economies’. Since these countries had regimes that claimed themselves as socialist, nothing wrong seems to be implied by the use of this term. However, this use tends to blur things rather than clarify them. A number of countries defined themselves as socialist in the 20th century—for instance, Nazi Germany, India, and Sri Lanka—in spite of having regimes that were organized both politically and economically along lines quite different from the Soviet block regimes. In these, Leninist parties exerted authoritarian control of state power and, through it, managed a strongly centralized economy. In spite of the process of privatization of state-owned assets in the 1990s in Eastern Europe, China, and other economies formerly under centralized planning, there are substantial political continuities in many of them. For instance, Yeltsin and Putin were both high ranking officers in the ‘socialist years’ of the USSR and the same can be said about many other politicians and new tycoons in Eastern Europe, not to mention China. This emphasizes the permanence of power configurations and ruling elites, even with changing economic structures and policies.
Though this is not my field, I think there is substantial evidence to accept Boncz and Sebestyén's view that ‘the gap in life expectancy between the countries of Central and Eastern Europe and the countries of Western Europe was closing up during the 1950s and early 1960s’, but from the mid-1960s health conditions in Eastern Europe stagnated or worsened, whereas in Western Europe they improved steadily. Unmentioned by Boncz and Sebestyén, however, are other major instances related to the health experience in authoritarian regimes with centrally planned economies. For instance, the famine and the demographic crisis during the forced collectivization of agriculture and the peak political repression in Russia in the 1930s, and the disastrous consequences—in terms of drop in agricultural production and consequent famine—of the so-called Great Leap Forward in China in the late 1950s, which has been charged with somewhere between 14 and 26 million deaths.6 While the magnitude of these demographic disasters is under active discussion among social scientists, it has been a view generally accepted since the 1980s that China, along with the Indian state of Kerala, Sri Lanka, and Costa Rica, were outstanding examples of significant health progress in the decades after the Second World War.6–8 Obviously, these matters are troubled with major ideological undercurrents, and any particular sample of publications on these issues9–11usually contains both high-quality scholarship and not-so-good political propaganda.
In the 1990s the USSR disintegrated, most Central and Eastern European countries went from the Russian sphere of influence into the American one, and all the resulting countries went through a transition whose major aspects were the conquest of civil liberties and an accelerated process of privatization, often implying severe cuts in social services. The social and health consequences of these changes are still under discussion, but the amount of destitution, disease, and death, that the transition brought with it in the 1990s has been documented.12–14 Eastern Europe and Africa are the two major demographic disasters in the late 20th century. Fortunately, in terms of heath indicators, in recent years conditions seem to be improving in many countries in Central and Eastern Europe, but they are stagnant or worsening in Russia and other countries formerly part of the USSR (Figure 1). In China, where the lack of civil liberties coexists now with increasingly unregulated and open markets, the huge acceleration of economic growth since the 1980s has been associated with a strong deterioration of health care15 and a significant stagnation in the reduction of mortality rates since the 1980s.13
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To ascertain why life expectancy stagnated or worsened in the Soviet bloc countries in the 1970s and 1980s, why it dropped significantly during the social disruption and poverty-ridden transition of the early-mid 1990s, why it continued falling later in some countries but not in others, and why the socioeconomic crisis during the 1980s and 1990s, for instance, in Latin America, did not reverse the long-term trends in rising life expectancy—all these are in my view major issues to be investigated by social scientists.
References
1 Boncz I, Sebestyén A. Economy and mortality in Eastern and Western Europe between 1945 and 1990: the largest medical trial of history. Int J Epidemiol 2006;35:796–97.
2 McKee M, Suhrcke M. Commentary—Health and economic transition. Int J Epidemiol 2005;34:1203–06.
3 Tapia Granados JA. Response—Economic growth, business fluctuations and health progress. Int J Epidemiol 2005;34:1226–33.
4 Brenner MH. Commentary—Economic growth is the basis of mortality rate decline in the 20th century: Experience of the United States 1901–2000. Int J Epidemiol 2005;34:1214–21.
5 Tapia Granados JA. Increasing mortality during the expansions of the US economy, 1900–1996. Int J Epidemiol 2005;34:1194–202.
6 Riley JC. Rising Life Expectancy: A Global History. New York: Cambridge University Press, 2001.
7 Sen A. Public action and the quality of life in developing countries. Oxf Bull Econ Stat 1981;43:289–319.
8 Sen A. The economics of life and death. Sci Am 1993;268:40–47.[Web of Science][Medline]
9 Eberstadt N. The Tyranny of Numbers—Mismeasurement and Misrule. Washington, DC: American Enterprise Institute, 1995.
10 Navarro V. Has socialism failed? An analysis of health indicators under socialism. Int J Health Serv 1992;22:583–601.[Medline]
11 McGuire JW, Frankel LB. Mortality decline in Cuba, 1900–1959: Patterns, comparisons, and causes. Lat Am Res Rev 2005;40:83–116.
12 Cornia GA, Paniccià R (eds). The Mortality Crisis in Transitional Economies. New York: Oxford University Press, 2000.
13 United Nations Development Program. Human development trends 2005. Available at: http://hdr.undp.org/docs/statistics/data/flash/2005/2005.html (Accessed February 20, 2006).
14 Stillman S. Health and nutrition in Eastern Europe and the former Soviet Union during the decade of transition: a review of the literature. Econ Hum Biol 2006;4:104–46.[Medline]
15 French HW. Wealth grows, but health care withers in china. New York Times 14 January 2006:A1.
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