Economic Liberalization and the Postcommunist Mortality Crisis

Background: During the early-1990s adult mortality rates in almost all

Post-communist European countries rose, although there have been

striking unexplained differences across countries and over time. This

article tests whether neoliberal economic liberalization policy, or

"shock therapy", involving rapid price and trade liberalization,

privatization and stabilization programs, can account for differences in

adult mortality rate trends in Post-communist European countries.

Methods: We used multivariate longitudinal regression to analyze male

working-age standardized mortality rates in Post-communist countries of

Eastern Europe and the former Soviet Union from 1989 to 2002.

Findings: Neoliberal economic liberalization programs, defined as

progress in implementing price and trade liberalization, mass

privatization and stabilization programs, increased short-term adult

male mortality rates by 30.0% (95% CI: 15.3% to 44.6%), with similar

results using the alternative liberalization indices from the European

Bank for Reconstruction and Development. The speed of liberalization was

more strongly associated with mortality increase than was its scale. One

mediating factor may be male unemployment rates, which was increased

substantially by economic liberalization (324%, 95% CI: 241% to 408%).

The effect of economic liberalization on mortality is mitigated at

greater levels of social capital and becomes insignificant when more

than 45% of a population is a member of at least one social organization.

Interpretation: Neoliberal economic liberalization strategies were a

critical determinant of differences in adult mortality trends in

Post-communist countries, and this effect is mediated by a country's

level of social capital. These findings may be relevant to other

countries where similar policies are being considered.