The Body Economic (28 page)

4
. See also G. Kitching. 1998. “The Revenge of the Peasant? The Collapse of Large-Scale Russian Agriculture and the Role of the Peasant ‘Private Plot' in That Collapse, 1991–97,” The
Journal of Peasant Studies
v26(1): 43–81; R. J. Struyk and K. Angelici. 1996. “The Russian Dacha Phenomenon,”
Housing Studies
v11(2). Available at:
http://www.tandfonline.com/doi/abs/10.1080/02673039608720854

5
. These projections were done by the US Bureau of the Census, led by Stephen Rapawy. See S. Rosefielde. 2000. “The Civilian Labour Force and Unemployment in the Russian Federation,”
Europe-Asia Studies
v52(8): 1433–47. Available at:
http://www.tandfonline.com/doi/pdf/10.1080/713663146
. The massive loss of people was in part driven by declining fertility (as documented by G. Cornia and R. Paniccia in their seminal book, The
Mortality Crisis in Transitional Economies
[New York, 2000]), but in terms of workforce losses the break that began in 1990 would not have affected working-ages as youth would not have become adults within the eight year timeframe.

6
. United Nations Development Programme, “The Human Cost of Transition: Human Security in South East Europe.” Available at:
http://hdr.undp.org/en/reports/regional/europethecis/name,2799,en.html

7
. S. Rosefielde. 2001. “Premature Deaths; Russia's Radical Economic Transition in Soviet Perspective,”
Europe-Asia Studies
v53(8): 1159–76.

8
. Source for Figure 2.1: Authors. Data from the World Bank World Development Indicators 2013 Edition.

9
. M. Field. 1999. “Reflections on a Painful Transition: From Socialized to Insurance Medicine in Russia,”
Croatian Medical Journal
v40(2). Available at:
http://neuron.mefst.hr/docs/CMJ/issues/1999/40/2/10234063.pdf
; cited from S. Sachs, “Crumbled Empire, Shattered Health,”
Newsday
, Oct 26, 1997, p. A4. In 1937, the head of the census was executed for getting the “wrong” data.

10
. Another sign that the former Soviet mortality data were reliable was that as all-cause death rates had increased greatly between 1991 and 1994, but breast and lung cancers rates among all age groups over the whole decade were steady. This stability is an indication of internal validity, as cancer deaths should not fluctuate rapidly and aren't directly impacted by the economy. See V. Shkolnikov, M. McKee, D. Leon, L. Chenet. 1999. “Why Is the Death Rate from Lung Cancer Falling in the Russian Federation?”
Eur J Epidemiology
15:203–6.

11
. M. McKee. 1999. “Alcohol in Russia,”
Alcohol and Alcoholism
34:824–29; M. McKee, A. Britton. 1998. “The Positive Relationship Between Alcohol and Heart Disease in Eastern Europe: Potential Physiological Mechanisms,”
Journal of the Royal Society of Medicine
v91; O. Nilssen, et al. 2005. “Alcohol Consumption and Its Relation
to Risk Factors for Cardiovascular Disease in the North-west of Russia: The Arkhangelsk Study,”
International Journal of Epidemiology
v34(4): 781–8 8. Available at:
http://ije.oxfordjournals.org/content/34/4/781.full

12
. D. Lester. 1994. “The Association Between Alcohol Consumption and Suicide and Homicide Rates: A Study of 13 Nations,”
Alcohol and Alcoholism
v30(4): 465–68. Available at:
http://alcalc.oxfordjournals.org/content/30/4/465.short
; M. McKee, A. Britton. 1998. “The Positive Relationship Between Alcohol and Heart Disease in Eastern Europe: Potential Physiological Mechanisms,”
Journal of the Royal Society of Medicine
v91; C. S. Fusch, et al. “Alcohol Consumption and Mortality Among Women,”
New England Journal of Medicine
a332(10): 1245–50. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/7708067
; R. Doll, et al. 1994. “Mortality in Relation to Consumption of Alcohol: 13 Years' Observations on Male British Doctors,”
BMJ
v309(6959). Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2541157/
; A. L. Klastky, M. A. Armstrong, G. D. Friedman. 1992. “Alcohol and Mortality,”
Ann Intern Med
v117(8): 646–54. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/1530196

13
. World Health Organization. European Health for All Database 2012 edition. See also V. M. Shkolnikov and A. Nemtsov, “The Anti-Alcohol Campaign and Variations in Russian Mortality,” Ch. 8 in
Premature Death in the New In de pen dent States
(Washington, DC, 1997). Available at:
http://www.nap.edu/openbook.php?record_id=5530&page=239
; V. Shkolnikov, G. Cornia, D. Leon, F. Mesle. 1998. “Causes of the Russian Mortality Crisis: Evidence and Interpretations,”
World Development
v25:1995–2011.

Some economists have contended Russia's mortality crisis in the 1990s was simply a rebound effect from ending the anti-alcohol campaign. The Russians who lived through Gorbachev's anti-alcohol campaign were, they argued, effectively “dead-men walking”—as soon as the campaign ended, they would simply drink themselves to death (e.g., Jay Bhattacharya, Christina Gathmann, and Grant Miller, “The Gorbachev Anti-Alcohol Campaign and Russia's Mortality Crisis,” March 2011. Available at:
https://iriss.stan-ford.edu/sites/all/files/iriss/Russia_mortality_crisis.pdf
). But when we looked closely at the data, we found that the people who were saved by Gorbachev's campaign weren't dying after the campaign ended. If they were, the dip in death rates in persons ages 20 to 24 in 1985 would correspond to an equal rise in deaths in persons 25 to 29 in 1990. But it did not. Instead, the rise in deaths in the early 1990s vastly outweighed the falls between 1985 and 1987 by more than 2 million deaths. In other words, the end of the anti-alcohol campaign was not the major cause of the rise in drinking-related deaths among Russian men.

Shkolnikov and colleagues investigated the possibility of a rebound effect in a detailed set of epidemiological studies in the mid-1990s, arriving at similar conclusions as we did. Shkolnikov et al. 1998 report evidence that the age-distribution of the mortality drops between 1985 and 1987 and increases between 1988 and 1992 were similar. However, they also find that the excess deaths were beyond the deaths avoided during the 1985–1987
improvements. Further, the probabilities of death in 1995 had become much higher than the initial levels of 1984 (see p. 1999). An examination of mortality fluctuations between 1985 and 1987 and those occurring between 1992 and 1994 show that the magnitude of the mortality drop under Gorbachev's anti-alcohol campaign is far outweighed by the rise in between 1992 and 1994. Among others, see Shkolnikov and Nemtsov, “The Anti-Alcohol Campaign and Variations in Russian Mortality”; and V. M. Shkolnikov, D. A. Leon, S. Adamets, E. Andreev, and A. Deev. 1998. “Educational Level and Adult Mortality in Russia: An Analysis of Routine Data 1979 to 1994,”
Soc Sci Med
47:357–69; Cornia and Paniccia, in their book, The
Mortality Crisis in Transition Economies
, conclude that, “Contrary to widespread opinion, the mortality changes of the 1990s are not a continuation of past trends” (Ch. 1, p. 4), which they subsequently prove (Ch. 1, section 5, pp. 20–21), noting that “In the case of Russia, Ukraine and Bulgaria (for males) the pre-transition trend is unable to capture the recent evolution of life expectancy. In addition, in the case of Russia, the negative divergences from the life expectancy trend observed during the transition outpace by far the positive ones estimated for the years of the anti-alcohol campaign.” Cornia and Paniccia further indicate that “even if causality between the initial falls and the subsequent rises in mortality could be unambiguously established, the former would explain only between 25 and 35 percent of the latter.” For a more detailed discussion see Appendix 1.1 and 5.5 in D. Stuckler, “Social Causes of Post-communist Mortality,” doctoral dissertation, University of Cambridge, 2009.

14
. Alcohol became such a contributing factor to illness that people were much more likely to die over weekends in the 1990s, when they were free from work and went on weekend-long benders—leaving the country in a hangover that lasted from Saturday morning to Monday. M. McKee, et al. 2006. “The Composition of Surrogate Alcohols Consumed in Russia,”
Alcoholism: Clinical and Experimental Research
. Available at:
http://onlinelibrary.wiley.com/doi/10.1097/01.alc.0000183012.93303.90/abstract
. See D. Leon, et al. 2007. “Hazardous Alcohol Drinking and Premature Mortality in Russia: A Population Based Case-Control Study,” The
Lancet
369:2001–9.

15
. In the countryside, people were drinking homebrewed liquors,
samogon.
M. Wines, “An Ailing Russia Lives a Tough Life That's Getting Shorter,”
New York Times,
Dec 30, 2000. Available at:
http://faculty.usfsp.edu/jsokolov/ageruss1.htm

16
. S. Tomkins, et al. 2007. “Prevalence and Socio-economic Distribution of Hazardous Patterns of Alcohol Drinking: Study of Alcohol Consumption in Men Aged 25–54 Years in Izhevsk, Russia,”
Addiction
v102(4): 544–53.

17
. A. Bessudnov, M. McKee, D. Stuckler. 2012. “Inequalities in Male Mortality by Occupational Class, Perceived Status and Education in Russia, 1994–2006,”
European Journal of Public Health
v22(3): 332–37. Available at:
http://eurpub.oxfordjournals.org/content/22/3/332.short
; Perlman and Bobak. 2009. “Assessing the Contribution of Unstable Employment to Mortality in Posttransition Russia: Prospective Individual-Level Analyses from the Russian Longitudinal Monitoring Survey,”
American Journal of Public Health
v99(10): 1818–25.

18
. For this reason, not only was unemployment itself but the fear of unemployment led to an increased risk of dying in Russia. See F. Perlman, and M. Bobak, “Assessing the Contribution.” These social benefit programs contributed to a very high health/GDP ratio in Soviet countries.

In general Soviet economies tended to have much higher life expectancies than capitalist economies at similar levels of GDP per capita (such as Chile, Turkey, Botswana, South Africa, etc.). On average, Soviet men had 4.8 years greater health and Soviet women had 7.7 years greater health for their country's level of income compared with capitalist economy averages.

19
. D. Stuckler, L. King, M. McKee. 2000. “Mass Privatization and the Postcommunist Mortality Crisis,” The
Lancet
v373(9661): 399–407. Available at:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960005-2/abstract
; see also Perlman and Bobak, “Assessing the Contribution.”

20
. L. Balcerowicz and A. Gelb. 1995. “Macropolicies in Transition to a Market Economy: A Three-Year Perspective,”
Proceedings of the World Bank Annual Conference on Development Economics 1994
. The International Bank for Reconstruction and Development. Available at:
http://www-wds.worldbank.org/servlet/WDSContentServer/IW3P/IB/1995/03/01/ 000009265_3970716143745/Rendered/PDF/multi0page.pdf

21
. “The need to accelerate privatization is the paramount economic policy issue facing Eastern Europe,” wrote Jeffrey Sachs. “If there is no breakthrough in the privatization of large enterprises in the near future, the entire process could be stalled for years to come. Privatization is urgent and politically vulnerable.” J. Sachs, “What Is to Be Done?” The
Economist,
Jan 13, 1990. Available at:
http://www.economist.com/node/13002085
; J. Sachs, “Shock Therapy in Poland: Perspectives of Five Years,” 1995. Available at:
http://tannerlectures.utah.edu/lectures/documents/sachs95.pdf

22
. A third major element of Shock Therapy was stabilization: a combination of austerity and tight monetary policy to keep inflation low. Lawrence Summers summarized the support for these three central policies of Shock Therapy: “The legions of economists who have descended on the formerly Communist economies have provided advice very similar. The three “- ations”—privatization, stabilization, and liberalization—must all be completed as soon as possible.” Cited in R. Stevens. 2004. “The Evolution of Privatisation as an Electoral Policy, c. 1970–90,”
Contemporary British History
v18(2): 47–75.

23
. M. Friedman, “Economic Freedom Behind the Scenes,” Preface to
Economic Freedom of the World: 2002 Annual Report,
by James Gwartney and Robert Lawson, with Chris Edwards, Walter Park, Veronique de Rugy, and Smitha Wagh (Vancouver, BC, 2002). Summers cited in T. Anderson, The
Concise Encyclopedia of Economics
. Available at:
http://www.econlib.org/library/Enc/EnvironmentalQuality.html

24
. Stevens, “The Evolution of Privatisation as an Electoral Policy.” There was no shortage of advice about which approach to take. The
Economist
magazine's editors argued in support of Shock Therapy, writing that the growing acceptance of gradualism
is “the greatest peril now facing the countries of Eastern Europe.” The editors of
Foreign Affairs
agreed: “The radiance of Western justice and success is the power that caused the east European nations and the Soviet Union to abandon what they were and attempt to become what we, the democracies, have made of ourselves. It is a moment to seize.” O. J. Blanchard, K. A. Froot, J. D. Sachs, The
Transition in Eastern Europe
(Chicago, 1994).

25
. B. Naughton,
Growing out of the Plan: Chinese Economic Reform, 1978–1993
(Cambridge, 1996).