The health crisis in the USSR

International Journal of Epidemiology

Volumn 35, Issue 6, 2006, Pages 1384-1394

  Eberstadt, Nick ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

CRISIS MANAGEMENT; HEALTH CARE; HEALTH STATUS;

ACCIDENT; AIR POLLUTION; ALCOHOLISM; ARTICLE; CRISIS INTERVENTION; GOVERNMENT REGULATION; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH PROMOTION; HEALTH SERVICE; INFANT MORTALITY; INFLUENZA; LIFE EXPECTANCY; LIFESPAN; LONGEVITY; MEDICAL CARE; PRIORITY JOURNAL; PUBLIC HEALTH; TREND STUDY; USSR;

USSR;

EID: 33846643902     PISSN: 03005771     EISSN: 14643685     Source Type: Journal    
DOI: 10.1093/ije/dyl238     Document Type: Article

References (88)

1. Samuel H. Preston, Mortality Patterns in National Populations (Academic Press, 1976).
2. World Development Report, 1980 (World Bank, 1980). The low estimate assumes a life expectancy of sixty for China; the high would be in line with the Bank's assertion that it is currently seventy. Even if life expectancy in the People's Republic were lower than this, however, the world average could quite easily exceed sixty-three, for in many regions of the world estimates lag far behind the gains the people have achieved. A recent trip to Java, for example, has convinced me that Djakarta's mortality data understate the length of life on that island of ninety million by at least five years.
3. With life expectancy at eighteen for men and twenty for women, parents must have an average of six and a half or seven children to keep the population from declining. See Ansley J. Coale and Paul Demeny, Regional Model Life Tables and Stable Populations (Princeton University Press, 1966). Few societies have registered fertility rates much higher than this; when they have, it has seldom been under the harsh conditions such a low life span would imply. Archaeologists now tell us that Neolithic man's lifespan was about eighteen to twenty years, and we know that his life was a battle to maintain his numbers.
4. The rich and the poor are still separated by an enormous gap in life chances: Infant mortality is four or five times higher today in the poor world than the rich, and a baby from the less developed regions can expect to die nearly twenty years before one who was fortunate enough to have been born at the same time in Europe, North America, Japan, Australia, New Zealand, or Israel. But if we take these tragic differences to mean that the poor have nothing to show for their participation in the twentieth century, we will be seriously mistaken. Progress in the less developed countries has been rapid and substantial. In India, for example, the length of the average life has nearly doubled since Independence. (Those who claim that the plight of the subcontinent's poor has gone unimproved for centuries always seem to forget this.) Over the past generation poor nations have consistently outpaced rich nations in the race to a healthier life. From 1960 to 1975, no rich country managed to improve its life expectancy by as much as 10 percent; by contrast, not a single poor country raised its own standing by less than 10 percent. These gains were absolute as well as relative. Since 1950 the collective life expectancy of the rich nations has increased by about a decade; for the poor nations, it is up more than fifteen years. See Health: A Sector Paper (World Bank, February 1980) and World Atlas of the Child (World Bank, 1979).
5. See Ansley J. Coale, Barbara A. Anderson, and Erna Harm, Human Fertility in Russia Since the Nineteenth Century (Princeton University Press, 1978)
6. and V.O. Schmelz, Infant and Early Childhood Mortality among Jews of the Diaspora (Jerusalem, 1971).
7. D. Peter Mazur, 'Using Regressions to Estimate Life Expectation in the USSR', Journal of the American Statistical Association, March, 1972.
8. See Charles K. Wilber's overly glowing account of this progress: The Soviet Model and Underdeveloped Countries (University of North Carolina Press, 1969).
9. Soviet authorities evidently consider infants of less than seven months' gestation, one kilogram in weight, and less than thirty-five centimetres in length who die within the first week of birth to be 'nonbabies'. For further details, see Davis and Feshbach's report.
10. Washington Post, June 26, 1980.
11. Where life expectancy is currently sixty-nine. See Alfred Sauvy, 'La population de l'Albanie', Population, March-April 1980. Albania's level of development may be gleaned from the reported popularity of its annual 'Festival of Electric Light'.
12. At this point we should dispose of two potential objections to Davis and Feshbach's report. The rise in Soviet mortality rates cannot be explained away by improvements in statistical coverage. The need for reliable numbers in a centrally planned economy is obviously great, and the Soviet statistical system has been a highly sophisticated operation for decades. See Vldimir G. Treml and John P. Hardt, eds., Soviet Economic Statistics (Duke University Press, 1972). Nor can the rise in death rates be passed off as a matter of demographic shifts, as long-living and slow-breeding Slavs are gradually replaced by Asian and Muslim comrades. The Asianization of the Soviet population, other things being equal, would indeed push death rates up, even if health conditions for each individual ethnic group went unchanged. But demographic shifts cannot account for more than about a tenth of the increase in mortality which has actually been registered. The rest must be due to a deterioration of health on the part of various Soviet nationalities.
13. Soviet medical reports quoted by Davis and Feshbach put the ratio of abortions to live births anywhere between two and a half to one and four to one. Since the USSR's total fertility rate is slightly over two, this works out to approximately six to eight abortions per woman. (In the United States, the average number of abortions per woman per lifetime is 0.5.) Six to eight, however, may be an underestimate: According to Soviet feminists, the figure is nearer ten: See the Philadelphia Bulletin, November 27, 1980. The Soviet Union's astounding abortion problem has not only gone unexplained, but largely unexamined in the West. One must wonder, however, whether the regime does not encourage dependence on abortion because it opens itself more easily to 'policy-oriented' manipulation than do other forms of contraception.
14. Vladimir G. Treml, 'Alcohol Consumption in the USSR', Journal of Studies on Alcohol, April 1975.
15. See Vladimir G. Treml, 'Alcoholism and State Policy in the Soviet Union', in Zbigniew M. Fallenbuchl, ed., Economic Development in the Soviet Union and Eastern Europe, vol. W (Praeger, 1976).
16. Literaturnaya Gazeta, April 5, 1978, quoted in Boris Weil, 'Alcoholism in the USSR', Free Trade Union News, October 1979. Ludmilla Thorne of Freedom House kindly brought this source to my attention.
17. John Dutton, Jr., 'Changes in Soviet Mortality Patterns, 1959/1977', Population and Development Review, June 1979.
18. Although all Soviet peoples, including those who are Muslims, probably have their share of alcoholics, alcoholism is predominantly a problem of the Slavs. In the Republic of Georgia, for example, only 20 percent of the population is Russian, yet Russians account for 80 percent of the hospitalized alcoholics. See David E. Powell, 'Alcoholism in the USSR', Survey, Winter 1971.
19. Others present a somewhat more optimistic picture. See Victor Mote, 'The Geography of Air Pollution in the Soviet Union' in Fred Singleton, ed., Environmental Misuse in the Soviet Union (Praeger, 1976).
20. Boris Komarov (pseud.), The Destruction of nature: The Intensification of the Ecological Crisis in the USSR (Frankfurt/Main: Posev Verlag, 1978). Forthcoming in English through M.E. Sharpe & Co.
21. Alcoholism, of course, is a known cause of birth defects as well. It is possible that the combination of heavy pollution and heavy drinking exerts a special strain on the body's filtering systems; surprisingly, there has been little research in the West about this.
22. See Toli Welihozkiy, 'Automobiles and the Soviet Consumer', in US Congress Joint Economic Committee, Soviet Economy in a Time of Change (Government Printing Office, October 10, 1979). Over the 1970s the number of traffic deaths has fallen in the US and risen steadily in the USSR.
23. Christopher Davis and Murray Feshbach, 'Life Expectancy in the Soviet Union', Wall Street Journal, June 20, 1978).
24. The Soviet Union does not publish mortality breakdowns by ethnic background. However, Davis and Feshbach have managed to collect infant mortality data for twenty Soviet cities for 1970 and 1974. In thirteen of the twenty, infant mortality was up. These cities represent every major region of the USSR: The Baltic Republics, the Ukraine, The RFSFR (including Siberia), the Caucasus, and the inner Asian frontier. Although Russian ethnics tend to be disproportionately represented in cities, a rise in infant mortality presumably could not be powered by a decline in their health alone.
25. A Soviet medical certificate, in fact, can mean very little. Israelis have learned that a large fraction of the Soviet 'doctors' they resettle are not qualified to practice medicine, and consequently require them to take a qualification test which many of them do not pass. As the inspection of recent issues of the Israel Press Digest will confirm, this has made for a bitter and protracted debate.
26. See William A. Knaus, Inside Russian Medicine (Grosset and Dunlap, 1980).
27. See Gregory Grossmann, 'Notes on the Illegal Private Economy and Corruption', in Soviet Economy in a Time of Change, op.cit.
28. Konstantin Simis, 'The Machinery of Corruption in the Soviet Union', Survey, Winter, 1977.
29. Imogene Edwards, Margaret Hughes, and James Noren, 'US and USSR: Comparisons of GNP', in Soviet Economy in a Time of Change, op.cit. These are their 'dollar estimates' for Soviet output; their 'ruble estimates' are lower, but follow the same pattern.
30. From 1965 to 1977, for example, the fraction of the American GNP going to health care increased from about 8 percent to about 11 percent. In large part this was due to Medicare and Medicaid, which much improved the medical care available to the poor. Following the institution of this form of semi-socialized medicine, American infant mortality rates, which had dropped disturbingly little over the previous decade, fell by almost half. See Kwang-sung Lee, et al., 'Neonatal Mortality: An Analysis of the Recent Improvement in the United States,' American Journal of Public Health, January 1980. At the same time, ischemic heart disease, which had been on the rise for half a century, began to subside; its incidence in the general population is more than 25 percent lower today than fifteen years ago.
31. See R.A. Stallones, 'The Rise and Fall of Ischemic Heart Disease', Scientific American, November 1980
32. and Ira Rosenwaike, et al., 'The Recent Decline in Mortality of the Extreme Aged: An Analysis of Statistical Data', American Journal of Public Health, October 1980.
33. See 'US and USSR: Comparisons of GNP', op.cit., and Allocation of Resources in the Soviet Union and China, US Congress Joint Economic Committee hearings, June 26-July 9, 1979 (US Government Printing Office, 1980).
34. See Herbert Stein, 'Federal Budget Dilemmas of 1980', AEI Economist, October 1979. From 1965 to 1978 the proportion of the American GNP consumed by defense dropped from 8.7 to 5.2 percent.
35. Of course, this attitude is not inconsistent with a desire for a strategic arms limitations agreement, especially if there is reason to hope that this can be hammered out to one's own particular advantage.
36. See Gertrude E. Schroeder, 'Consumption in the USSR: A Survey', Studies on the Soviet Union, No.4, 1970.
37. It is often argued that Khrushchev was ousted because he threatened the stability of the Party apparatus and the bureaucracy beneath it. Seweryn Bialer makes this case forcefully in his Stalin's Successors (Cambridge University Press, 1980). There is no doubt the Khrushchev managed to alienate practically the entire top level of Soviet leaders through his erratic performance; the shortcoming of his 'hare-brained schemes', however, was not only that they inconvenienced apparatchiki, but that they produced generally disappointing economic results.
38. In the nineteenth century Ernst Engel, a German economist, observed that households tended to spend smaller fractions of their income on food as their affluence increased. The people of the Soviet Union may be more prosperous today than they were fifteen years ago, but they seem to spend just as large a proportion of their disposable income on food. Since 1965 the purchasing power of the consumer economy (that is, GNP minus investment and defense expenditures) has increased by something like 51 percent; expenditures on food have increased by something like 52 percent. See 'US and USSR: Comparisons of GNP', op.cit., This is out of keeping with the laws of consumer economics, but such laws should not be expected to operate where prices are systematically gerryrigged and allocations of resources determined not by a market but a Politburo.
39. See for example Vera Golubeva, 'The Other Side of the Coin', in the Soviet feminist magazine Women and Society, translated into English in the May/June 1980 issue of Freedom Appeals.
40. See, for example, Florence Pitts, 'Hotel Cosmos: How the Biggest Soviet Hotel was Built', in Freedom At Issue, November/December 1980.
41. Robert F. Byrnes, 'Moscow Revisited: Summer 1978', Survey, Autumn 1977/ 1978.
42. See Hélène Carrère d'Encausse's superb Decline of an Empire (Newsweek Books 1979).
43. Lest anyone forget, the cult of personality did not end with Stalin. Leonid Brezhnev currently promotes one of his own. The Soviet press recently has been abuzz with praise for his memoirs, and his work has already 'sold' millions of copies. See Survey magazine's articles under the heading 'The New Literary Personality' in its Autumn 1977/1978 issue
44. and Graeme Gill's 'The Soviet Leader Cult; Reflections on the Structure of Leadership in the Soviet Union', British Journal of Political Science, June, 1980.
45. The following discussion draws heavily on these sources: Astolphe de Custine, Journey For Our Time (London: Hollis and Carter, 1952)
46. Hedrick Smith, 'The Russians (Quadrangle, 1976)
47. Karl Baedeker, Russia: A Handbook for Travelers (Scribner's, 1914)
48. Georgie Ann Geyer, Young Russians (Etc Press, 1975)
49. G.P. Fedotov, The Russian Religious Mind (Harvard University Press, 1960)
50. Dinko Tomasic, The Impact of Russian Culture on Soviet Communism (Glencoe Publishing Company, 1953)
51. V.I. Dal, Sayings of the Russian People (Moscow, 1957)
52. Geoffrey Gorer and John Rickman, The People of Great Russia (Chanticler Press, 1950)
53. Francesca Wilson, Muscovy: Russia Through Foreign Eyes (Praeger, 1970)
54. Margaret Mead, Soviet Attitudes Towards Authority (Schocken, 1966)
55. and John S. Reshetar, Jr., 'Russian Ethnic Values' in C.E. Black, ed., The Transformation of Russian Society (Harvard University Press, 1960). It is also much the better for the generous and incisive advice of Suzanne Massie, from whose considerable expertise in Russian culture I have benefited.
56. According to Robert Conquest's Kolyma: The Arctic Death Camps (Oxford University Press, 1978) more political prisoners died in a single Siberian camp in a single year under Stalin than in all the czars' jails in the nineteenth century, a rough indication, at least, of the sorts of differences we are talking about.
57. A recent samizdat manuscript by Joseph Diadkin, a dissident scientist, deals with this question of 'unnatural deaths' under Stalin. A preliminary summary of his forthcoming report can be found in the July 23rd edition of the Wall Street Journal.
58. The following discussion relies primarily on Roger Clarke, Soviet Economic Facts (Wiley 1972)
59. Abram Bergson and Simon Kuznets, eds., Economic Trends in the Soviet Union (Harvard University Press, 1963)
60. and United Nations, Patterns of Industrial Expansion, 1938/58 (United Nations, 1960).
61. For an account of these see George Fischer, Soviet Opposition to Stalin (Harvard University Press, 1952)
62. and Alexander Solzhenitsyn's Gulag Archipelago.
63. Note Hedrick Smith's surprise at this in his The Russians, op.cit. it has been reported that when a picture of Stalin flashes on screen in a Soviet theatre, about half the audience will applaud.
64. According to Joseph Diadkin, the total number of 'unnatural deaths' under Stalin was between forty-three and fifty-two million. How many of these we actually attribute to the dictator is a matter of opinion. Some analysts, for example, blame the severity of the Terror in the late 1930s on 'excesses' on the part of Stalin's underlings. More seriously, Stalin cannot be held directly accountable for the estimated twenty million deaths the Soviet people suffered at the hands of the Germans, although the argument can be made that if he had not executed Marshal Tukhachevsky and virtually the entire top echelon of military officers just before World War II the Red Army might have offered greater resistance to the Wehrmacht.
65. As Bialer notes, there are between 8,000 and 10,000 active dissidents in the Soviet Union today. See Stalin's Successors, op. cit.
66. Naturally, this may be just the visible edge of submerged dissent, but as Andrei Amalrik made clear in his Will the Soviet Union Survive Until 1984? (Harper and Row, 1970), the dissidents and the neo-Stalinists have rather different class backgrounds. The former are almost all members of the intelligentsia, while those who cheer for Stalin at the movies tend to come from the working class.
67. See Harrison E. Salisbury's 'Stalin Makes a Comeback', New York Times Magazine, December 23, 1979.
68. This feeling is reflected in Alexander Werth's Russia Under Khrushchev (Hill & Wang, 1962).
69. The exact date of this shift is unclear, but it very likely came in the early 1960s, with the simultaneous collapse of the last Stalinist panaceas and the frustration of various attempts at liberalization. Useful markers might be the failure of the Virgin Lands scheme in agriculture, the exposure of Lysenkoism as fraud in science, the rejection of Liberman-style reforms in economics, and, of course, the ouster of Khrushchev. For more information on the first three incidents, see Lazar Volin, A Century of Russian Agriculture (Harvard University Press, 1970)
70. David Joravsky, The Lysenko Affair (Harvard University Press, 1970)
71. and George R. Feiwel, The Soviet Quest for Economic Efficiency (Praeger, 1972).
72. A measure of the relaxation was the drop in prison camp populations from something like ten and a half million under Stalin to about one and a half million a few years later. See Alain Besançon, The Soviet Syndrome (Harcourt Brace Jovanovich, 1978).
73. John Bushnell, 'The New Soviet Man Turns Pessimist', in Stephen F. Cohen, Alexander Rabinowitch, and Robert Sherlett, eds., The Soviet Union Under Stalin (Indiana University Press, 1980).
74. The following discussion relies primarily on Robert Wesson's The Aging of Communism (Praeger, 1980). This book is a reliable and incisive reference for those concerned with the many aspects of the political problem confronting communist states today.
75. Although this must be examined skeptically. It is not clear how Soviet authorities calculate their availabilities of meat: Almost certainly the figures they give do not take full account of losses due to trimming, transportation, spoilage, and so forth. The Food and Agriculture Organization, which is not in the habit of questioning the statistics of its member states, automatically reduces the estimate it receives from the Soviet Union by 20 percent.
76. There is a contradiction here for, as Bialer demonstrates, the smooth functioning of the Soviet system depends in no small part on the promotion of apathy. See Stalin's Successors, op.cit.
77. There is a fifth force which can be drawn on: This is Russian nationalism. As James Billington has remarked, among the few organizations in the Soviet Union to enjoy genuine mass support are the Russian societies for the preservation of historical monuments, which he sees as vents of sorts for patriotism and nationalism. See his 'Soviet Attitudes and Values: Prospects for the Future' in the Wilson Center's The USSR and Sources of Soviet Foreign Policy (Smithsonian Institution, n.d.). Of course, Russian nationalism cuts both ways against an internal threat: Its centripal force could be met or exceeded by the reaction of the other peoples of the USSR who for the first time constitute a majority of the Soviet population.
78. 'Alcohol in the USSR: A Fiscal Dilemma,' op.cit.
79. Economist, December 29, 1979.
80. See Murray Feshbach and Stephen Rapawy, 'Soviet Population Trends and Policies', in US Congress Joint Economic Committee, Soviet Economy in a New Perspective (Government Printing Office, 1976).
81. Much has been written on this. See for example SIPRI, World Armaments and Disarmament, 1980 (New York: Crane Russak, 1980).
82. See Eric Breindel and Nick Eberstadt, 'Paradoxes of Population', Commentary, August 1980.
83. On the one hand, Soviet negotiators and representatives are often said to be cruder and more openly cynical than those they face, and Soviet policy has been marked by at least one tremendous and expensive setback - the Sino-Soviet rift. On the other hand, it can also be argued that the distribution of benefits from the Soviet-American grain deal of 1972 or the pattern of votes on the floor of the UN (in which it seems to take a brutal invasion of a Soviet neighbor to shake the assembly's confidence in the USSR) are in no way unrepresentative of Soviet skill abroad. A useful discussion of the debate may be found in Adam Ulam's Expansion and Coexistence: Soviet Foreign Policy, 1917-1973 (Praeger, 1974).
84. Richard F. Staar, 'Soviet Union', in Peter F. Duignan and Alvin Rabushka, eds., The United States in the 1980s (Hoover Institute Press, 1980).
85. See in particular Sir William Hayter, Russia and the World (Taplinger, 1970).
86. Raymond L. Garthoff, 'Soviet Views of the Interrelation of Diplomacy and Military Strategy', Political Science Quarterly, Fall 1979.
87. During World War II, both the United States and The Soviet Union allocated more than 40 percent of their resources to their military efforts. Today the proportion in the US is under 6 percent, and in the USSR, depending on whom we believe, anything from 7 percent to over 20 percent. See Arthur M. Cox, 'The CIA's Tragic Error', NYR, November 6, 1980
88. and Igor Berman 'The Way to Slow Down the Arms Race', Washington Post, October 27, 1980.