The Post-Socialist Mortality Crisis
March 22, 2023 2:54 PM   Subscribe

"Even in 1950–53, during the last years of Stalin’s regime, with the high death rates in the labour camps and the [delayed] consequences of wartime malnutrition and injuries, the mortality rate was only nine to ten per 1,000, compared with 14–16 in 1994." Sopo Japaridze's thread on recent research about the 7 million excess deaths in Eastern Europe since the 1990s.

Twitter threading seems randomly broken (Thanks, Elon Musk!) so here's the study she's summarizing: Deindustrialisation and the post-socialist mortality crisis, Cambridge Journal of Economics, Published: 20 March 2023.
An unprecedented mortality crisis struck Eastern Europe during the 1990s, causing around seven million excess deaths. We enter the debate about the causes of this crisis by performing the first quantitative analysis of the association between deindustrialisation and mortality in Eastern Europe. We develop a theoretical framework identifying deindustrialisation as a process of social disintegration rooted in the lived experience of shock therapy. We test this theory relying on a novel multilevel dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989–95 in Hungary and 514 towns in European Russia in 1991–99. The results show that deindustrialisation was directly associated with male mortality and indirectly mediated by hazardous drinking as a stress-coping strategy. The association is not a spurious result of a legacy of dysfunctional working-class health culture aggravated by low alcohol prices during the early years of the transition. Both countries experienced deindustrialisation, but social and economic policies have offset Hungary’s more immense industrial employment loss. The results are relevant to health crises in other regions, including the deaths of despair plaguing the American Rust Belt. Policies addressing the underlying causes of stress and despair are vital to save lives during painful economic transformations.
This paper seems to synthesize previous work by the same research group:

  • Deindustrialization and the Postsocialist Mortality Crisis
    An unprecedented mortality crisis struck Eastern Europe during the transition from socialism to capitalism. Working-class men without a college degree suffered the most. Some argue that economic dislocation caused stress and despair, leading to adverse health behavior and ill health (dislocation-despair approach). Others suggest that hazardous drinking inherited as part of a dysfunctional working-class culture and populist alcohol policy were the key determinants (supply-culture approach). We enter this debate by performing the first quantitative analysis of the association between economic dislocation in the form of industrial employment decline and mortality in postsocialist Eastern Europe. We rely on a novel multilevel dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989-1995 in Hungary and 514 medium-sized towns in the European part of Russia. The results show that deindustrialization was significantly associated with male mortality in both countries directly and indirectly mediated by adverse health behavior as a dysfunctional coping strategy. Both countries experienced severe deindustrialization, but social and economic policies seem to have offset Hungary’s more immense industrial employment loss. The policy implication is that social and economic policies addressing the underlying causes of stress and despair can improve health.
  • Did Alcohol Policy Really Cause the Postsocialist Mortality Crisis? Revisiting the Rebound and Affordability Hypotheses
    This article reexamines the argument that alcohol policies were the major factor behind the mortality crisis in postsocialist Russia. We show that the correlation between the Gorbachev anti-alcohol campaign (rebound hypothesis), alcohol prices in the 1990s (affordability hypothesis), and mortality reported in previous analyses is not robust to splitting oblasts into Far-East and the rest of Russia. Our analysis conducted on a sample of 534 towns in the European part of Russia also finds no robust evidence supporting the two hypotheses. In contrast, findings linking privatization to mortality are robust to controlling for the anti-alcohol campaign and the affordability of alcohol.
  • Deindustrialization and deaths of despair: mapping the impact of industrial decline on ill health
    A growing literature on deaths of despair has argued that workers’ declining life expectancy in deindustrialized rustbelt areas in the U.S. and the associated deepening of health inequalities signal the profound existential crisis of contemporary capitalism. Competing explanations downplay the negative consequences of “creative destruction” and focus instead on unhealthy lifestyles. This article contributes to this debate by presenting the first empirical analysis of the role of deindustrialization in the deaths of despair epidemic that hit Eastern Europe in the 1990s. Drawing on the thematic analysis of 82 semi-structured interviews in four deindustrialized towns in Hungary, the article constructs a general sociological framework for analyzing deaths of despair applicable to other rustbelt areas. Deindustrialization engenders individual and social processes that affect health by increasing stress and eroding coping resources. By conceptualizing deindustrialization as a fundamental cause of ill health, sociology has great potential to contribute to understanding the root causes of deaths of despair.
  • posted by kmt (22 comments total) 68 users marked this as a favorite
     
    This is a candidate for best post of the month.
    posted by parmanparman at 3:19 PM on March 22, 2023 [9 favorites]


    This looks fascinating. I'm looking forward to reading each of the links carefully.

    I always simplistically thought unemployment was primarily a problem of capitalist societies - that communist or communist-leaning societies made a point of employing nearly everyone (perhaps not in a GREAT job, but at least in SOME job). Of course I'm wrong about that. Can anyone point me to some good high-level info about how unemployment worked in the 1990s in Russia, Hungary, and other Eastern European nations?
    posted by kristi at 3:29 PM on March 22, 2023 [1 favorite]


    I’ve heard the breakup of the USSR and ensuing economic shock therapy caused one of (if not the) greatest drop in life expectancy in a country/region in history but always thought there had to be some caveats or qualifiers there. Of course I never got a chance to really do any deep reading into that :)

    Looking forward to digging into these, thank you for posting!
    posted by bxvr at 3:40 PM on March 22, 2023 [2 favorites]


    Can anyone point me to some good high-level info about how unemployment worked in the 1990s in Russia, Hungary, and other Eastern European nations?

    Note that these countries stopped being Communist (depending on how you define that, it's messy) some time in the early 90s.
    posted by praemunire at 4:05 PM on March 22, 2023 [10 favorites]


    I have to admit I was unaware that the cause of the mortality rise was caused by anything other than the massive disruption. I admit I didn't have any numbers to back me up, but "it's because they are a bunch of alcoholics and can now buy more alcohol" seems like a ludicrous bit of handwaving by the old Washington Consensus types to begin with.

    I’ve heard the breakup of the USSR and ensuing economic shock therapy caused one of (if not the) greatest drop in life expectancy in a country/region in history but always thought there had to be some caveats or qualifiers there.

    Qualifiers for sure. Russia lost 7 million people in a decade per the post. In WWII it lost 20+ million, or over 10% of its population. The Holodomor killed more than it lost in the '90s too. It did make me side eye the phrasing that "even" in Stalin's last years things weren't bad, as Stalin's last years were relatively peaceful, by his standards.

    Numbers for the hardest hit countries in other bad wars also eye poppingly horrific.
    posted by mark k at 5:13 PM on March 22, 2023 [14 favorites]


    I have to admit I was unaware that the cause of the mortality rise was caused by anything other than the massive disruption. I admit I didn't have any numbers to back me up, but "it's because they are a bunch of alcoholics and can now buy more alcohol" seems like a ludicrous bit of handwaving by the old Washington Consensus types to begin with.

    I agree, I don't think I'd even heard that one.

    Otoh if you told me that alcohol was one of the proximate ways that massive social dislocation killed people, I'd believe you. And that's consistent with the posted analysis that shows that death rates were sensitive to privatization shocks but not sensitive to alcohol policy changes.

    Of course, it would be particularly cruel to survey people drinking themselves to death because of their rational despair at finding themselves in a collapsed social system, and say it's happening because they're alcoholics.
    posted by grobstein at 5:22 PM on March 22, 2023 [17 favorites]


    The quantitative research is definitely good, mostly because it guards against people claiming that this stuff just didn't happen, but none of this is exactly news if you've talked to anyone who lived through that era in Hungary.

    I spent some time there in the early 2000s and worked largely with people who had started their careers / working lives under the Soviet-style system (I don't want to get into some no-true-Communist debate over definitions) and then had to navigate the transition in the middle of their careers and lives.

    And from what I can tell, it sucked a lot. And basically a good portion of that generation just drank themselves to death. Mostly men, although I met some women who could drink me under the table (with cheap rocket-fuel pálinka) and then get up the next morning and do it again.

    The Soviet-esque system basically made a lot of promises that in the end it couldn't deliver on. At least in some occupations in Hungary—the people I talked to mostly worked in the national theater, which is to say the highest echelon of professional theater in the country—the number of new entrants into the profession was carefully (and brutally) managed to meet expected demand. But if you made it into one of the top universities, and into one of the acting programs that were feeders to the national theater, and graduated, you were more or less guaranteed a position after graduation. Any excess candidates were culled along the way, such that the diploma (from the right place) was a golden ticket of sorts. And people did... unpleasant things to get those slots. Strings pulled, favors called in, etc. It was not some sort of meritocracy, any more than getting into Princeton or Harvard is. (Except while American elite universities discourage internecine competition—hence the "Gentleman's C" being about the worst you can do—I heard stories about the Hungarian universities that were dark as fuck.)

    Except then the wheels came off the whole Soviet-system bus, and people who'd spent their lives working within this extremely competitive, rules-based, no-holds-barred-if-you-don't-get-caught system—and in many cases excelled within it—suddenly found themselves S.O.L. in the new capitalist landscape. None of the skills they had developed, or relationships they'd built, were any good. Older people suddenly didn't have to retire (from their perspective, probably "weren't able" to retire), so positions didn't open up as planned, and... nothing. AFAICT, the government basically shrugged. The people who later on became my colleagues left the country for greener pastures and other careers. (Which is how I ended up working with a technical salesperson who at one point had been the up-and-coming ingenue of the national theater set.) Others didn't, and apparently spent the rest of their lives working out how much ethanol the human liver can manage to process before giving out. They were just surplus.

    It's all pretty fucked-up, but I don't think you can necessarily hang the blame on big-c Capitalism or Communism. The problem was the rapid dissolution of an entire economic system, exacerbated by a government that seemingly cared more about vacuuming up anything of value and handing it out to well-connected patrons, rather than maintaining any sort of soft landing for people who had spent a lifetime training for careers that suddenly didn't exist. That first part is a bit unique to the post-Soviet environment, at least in terms of the scale of the privatization-theft that occurred, but the second part surely isn't. I saw a different version of it in the post-industrial US, and the US government wasn't any more compassionate than the Hungarian one. ("Sorry the middle-class job you were counting on is gone due to our policy decisions, have you considered, uh, maybe just being like, really poor? Just dialing back your quality of life for a while? Like a couple of generations? kthxbye")

    The key similarities I see between the two situation isn't as much the economic system, but the existence of a political class in charge of that economic system who aren't directly beholden to the bulk of the people getting reamed by those economic policy decisions. As soon as you break that linkage, it becomes easy to make lots of people's lives materially worse, and when you do that, people die.
    posted by Kadin2048 at 5:42 PM on March 22, 2023 [63 favorites]


    kmt, thanks for this fascinating post. I appreciate that it's substantive, and focused... neither a 1-link deal nor an overwhelming linkapalooza.
    posted by Artifice_Eternity at 7:05 PM on March 22, 2023 [3 favorites]


    I came of age in Hungary during the nineties.

    My thoughts about the place, the people and the culture I'm supposed to be part of are not fit to put into this text box and would shock the conscience.
    posted by tigrrrlily at 8:35 PM on March 22, 2023 [15 favorites]


    Kadin2048: And basically a good portion of that generation just drank themselves to death. ... It's all pretty fucked-up, but I don't think you can necessarily hang the blame on big-c Capitalism or Communism.

    I wonder, though, 'cause I have this unconfirmed sense that the initial collision with capitalism has led to high rates of alcoholism in multiple cases, going back at least to the Gin Craze. (And the alcohol craze usually gets followed up with some kind of religious craze, often some descendant or cousin of Methodism.) Capitalism strips away anchors, strips away safety nets, and increases pressure; it is anxiety-inducing.

    At the same time, capitalism puts profit in front of everything, and there are few more profitable products to sell to a population trapped in a state of high anxiety than alcohol. I swear I've read more than one account of a confident British official predicting that some prospective colonial population would be brought very easily into the capitalist system once they develop a taste for strong liquor. And they were usually right, especially once the population was exposed to the pressures of capitalism.

    After a while societies figure out how to put some of those anchors and safety nets back in place so that they don't have to deal with capitalism in its rawest form, and the anxiety-induced crazes fade.

    That's my impression, anyway, based on random half-remembered examples here and there in my historical reading.
    posted by clawsoon at 8:38 PM on March 22, 2023 [10 favorites]


    See also this 2016 piece, "The Unnecessariat"
    posted by CheesesOfBrazil at 6:15 AM on March 23, 2023 [4 favorites]




    Also Svetlana Alexievich's Secondhand Time.

    I don't think we can just discard the effect of long-term brutalization of the population under totalitarian regimes in robbing people of their ability to adapt, though. (This is not an inherently Communist trait, of course.)
    posted by praemunire at 7:27 AM on March 23, 2023 [3 favorites]


    After privatization in Hungary, suppliers started dosing paprika with ground-up paint so it would stay bright red and sell better. Lead oxide was found in something like a third of paprika. A lot of people got sick (Hungarians eat a lot of paprika). Paprika was briefly banned as a result.
    posted by grobstein at 7:45 AM on March 23, 2023 [3 favorites]


    The quantitative research is definitely good, mostly because it guards against people claiming that this stuff just didn't happen

    Or that it is the result of some totally avoidable moral failing.

    The problem was the rapid dissolution of an entire economic system, exacerbated by a government that seemingly cared more about vacuuming up anything of value and handing it out to well-connected patrons, rather than maintaining any sort of soft landing for people who had spent a lifetime training for careers that suddenly didn't exist

    This pretty much describes the persecution and subjegation of the First Nations people of Canada post European contact. Probably parallels abound on the alcoholism front too. Certainly alcohol has and continues to be a problem.
    posted by Mitheral at 9:15 AM on March 23, 2023 [2 favorites]


    Scanning the thread, I don't see an acknowledgement that much of the misery inflicted upon the post-Soviet societies of the former Warsaw Pact was meted out on the instructions of Western financial experts. Whose efforts basically wound up handing the economies of those countries to the local mafiosi, with predictable results. Nobody's later career was adversely affected by any of this I don't think.
    posted by Aardvark Cheeselog at 11:21 AM on March 23, 2023 [11 favorites]


    Central/Eastern Europe is a big place, so in my opinion, figuring out what went wrong or right with an attempt to find just the one or a handful of causes (alcohol, western advice, deindustrialization) will oversimplify with negative consequences in terms of giving people a clearer understanding of history.

    For example, in the paper, the authors write about Eastern Europe, but really they only examine Hungary and Russia. The brief mention of places where life expectancy shot up as soon as communism collapsed (Czechia, Slovakia, Poland...) is immediately dismissed. IMO they had a theory and then found the data to match it.

    I don't mean to say that rapid deindustrialization wasn't or isn't an issue. But the fact that it went on is one thing; that it happened and nothing happened to improve people's lives in some places (but not others) is another thing.
    posted by UN at 1:15 PM on March 23, 2023 [7 favorites]


    I would think they went and gathered a bunch of data in Hungary and Russia because that's where the mortality crisis happened, not because they were fitting their data to their theory. But yeah, it would be useful to see a more in-depth discussion of why Poland didn't experience a similar crisis during deindustrialization.
    posted by Gerald Bostock at 4:37 PM on March 23, 2023


    Paprika was briefly banned as a result.

    Capitalism got Paprika banned in Hungary
    posted by Ray Walston, Luck Dragon at 4:03 PM on March 24, 2023 [2 favorites]


    Besides the lead and paint this article says a ban was put in place because of aflatoxin presumed to have been introduced by companies adulterating Hungarian paprika with cheaper import paprika (because the mould generating the toxin doesn't survive in Hungary's climate ).
    posted by Mitheral at 9:26 AM on March 25, 2023 [1 favorite]


    it would be useful to see a more in-depth discussion of why Poland didn't experience a similar crisis during deindustrialization.

    I would be interested in that as well.

    I'm not an expert by any means, just someone who has been to and knows a bunch of people from the area, but my sense is that under the Soviet system, Hungary had much more of its economy built around heavy primary industry, while Poland had a somewhat more diversified economy. (I'm having trouble finding statistics, but that's just based on the number of defunct blast furnaces and steel mills I saw while traveling around Hungary vs. Poland.)

    According to WP, Hungary had almost a 20% GDP decline between 1990-1993, which must have been just absolutely crushing. In comparison, Poland apparently suffered about 15%, which is still bad but significantly less bad. But it's not clear how much of that difference is due to different economic starting conditions, versus different ways of managing the economic transition. And Poland's arguable geographic advantages probably shouldn't be ignored, either. Hungary is landlocked and surrounded largely by other post-Soviet states (except Austria); Poland has coastline (and a number of good deep-water harbors) on the Baltic, and a land border with Germany over which the majority of its foreign trade now flows. Even with equally good leadership, Hungary still might just have had a tougher time.
    posted by Kadin2048 at 7:54 PM on March 26, 2023


    and a land border with Germany over which the majority of its foreign trade now flows.

    The geographic luck Poland and the Czech Republic had in the 1990s by being closer to Germany probably didn’t hurt — but that trade really began properly when those countries joined the EU and has really taken off in just the last few years (Poland and Czechia being ranked 3rd and 6th in imports to Germany, beaten by China and the US and sometimes the Netherlands but above bigger countries like France or Italy or the UK).

    Still, in the early 90s a plus point here and there may have made up for the difference.

    it would be useful to see a more in-depth discussion of why Poland didn't experience a similar crisis during deindustrialization.

    I agree, especially when looking at smaller industrial towns in Poland or even former East Germany. For example, were there similar levels of mortality in those de-industrialized towns that were 'hidden' by the general uptick in life expectancy there?
    posted by UN at 1:04 AM on March 27, 2023 [1 favorite]


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