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The Health Crisis in the USSR

Rising Infant Mortality in the USSR in the 1970s

by Christopher Davis, by Murray Feshbach
United States Bureau of the Census, Series P-95, No. 74, 33 pp., free

I

If we could judge it solely by advances in health, the twentieth century would be a fabulous success. Few of us who take food and doctors for granted realize or appreciate this. In 1900 life expectancy for the whole of the human race was about thirty years.1 Today it is twice as long: at least sixty-one years, possibly sixty-three or more.2 Since the human lifespan was probably never much less than twenty for any length of time—to drop much below that level is to court eventual extinction3—this means that about three-fourths of the improvement in longevity in the history of our species has occurred in the last eighty years.4

Over much of this century the nation in the vanguard of the revolution in health was the Soviet Union. In 1897 Imperial Russia offered its people a life expectancy of perhaps thirty years. In European Russia, from what we can make out, infant mortality (that is, death in the first year) claimed about one child in four,5 and in Russia’s Asian hinterlands the toll was probably closer to one in three. Yet by the late 1950s the average Soviet citizen could expect to live 68.7 years: 6 longer than his American counterpart, who had begun the century with a seventeen-year lead. By 1960 the Soviet infant mortality rate, higher than any in Europe as late as the Twenties, was lower than that of Italy, Austria, or East Germany, and seemed sure to undercut such nations as Belgium and West Germany any year.

Results like this could not have been achieved without a total transformation of living conditions for the USSR’s sizable Asian and Muslim minority. This indeed has taken place.7 By 1960 Moscow could demonstrate that its Central Asians were living fifteen years longer than the Iranians, twenty years longer than the peoples of Pakistan, and nearly twice as long as the Afghanis. In the face of these and other equally impressive material accomplishments, Soviet claims about the superiority of their “socialist” system, its relevance to the poor countries, and the inevitability of its triumph over the capitalist order were not easily refuted.

Things look very different today. The Sixties and the Seventies have proved devastating to Soviet society. To observant travelers and analysts this is apparent in a hundred different ways; none, however, is so dramatic as the turn in health of the Soviet peoples. As Christopher Davis and Murray Feshbach’s startling report argues in convincing detail, health conditions in the USSR have worsened steadily since the mid-1960s, and the deterioration shows no signs of stopping.

Although its findings are sensational, Rising Infant Mortality in the USSR is a very careful piece of work. The credentials of its authors are unimpeachable: Davis is now England’s leading authority on Soviet health care, Feshbach the foremost American expert on Soviet population trends. Their study is based on data not from spy satellites, intelligence agencies, or “think tanks,” but rather from reports released by the Soviets themselves.

As the title suggests, Davis and Feshbach pay closest attention to infant mortality. According to Moscow’s Central Statistical Bureau (TsSU), infant mortality increased by more than a third between 1970 and 1975. Since 1975 TsSU has not reported the USSR’s infant mortality rate, but Feshbach’s estimate, based on the fragmentary evidence of local reports and adjusted for the approximately 14 percent of all infant deaths that authorities do not include in their mortality totals,8 is that it could be as high as forty per thousand today. 9 Infant mortality rates in both Western Europe and the United States are currently under thirteen per thousand.

Epidemic infant mortality, however, is only part of the picture. Except for teenagers, who are virtually indestructible so long as they do not kill themselves or each other, nearly every age group in the Soviet Union had higher death rates in 1975, the last year in which such figures were published, than in 1960. For men and women over thirty trends were particularly harsh. Death rates jumped almost 20 percent for people in their fifties, and by more than 30 percent for those in their forties. Men fared much worse than women: since 1965 their life expectancy may have declined as much as four years, to something like sixty-two today. Women, however, have not been spared: their life expectancy peaked at around seventy-three in the early 1970s, and may have dropped since then. This means that the average Soviet life span could be under sixty-eight today—lower, in other words, than it was in the late 1950s.

Measured by the health of its people, the Soviet Union is no longer a developed nation. Caloric intake, educational attainment, and the ratio of doctors to people all seem to be higher in the USSR than in Western Europe, and yet in the USSR life expectancy is six years lower, and its infant mortality rate three times as high. There is not a single country in all of Europe, in fact, in which lives are so short, or babies’ death rates so high—not even impoverished, half-civilized Albania.10 In the realm of health, the Soviet Union’s peers are to be found in Latin America and Asia. If Feshbach’s estimates are right, life expectancy in the USSR is about the same as the average for Costa Rica, Jamaica, Malaysia, Mexico, and Sri Lanka. By the same token, the Soviet infant mortality rate could be replicated in a nation composed in equal parts of Chile, the Dominican Republic, Panama, Taiwan, and Trinidad. These nations, however, are moving up, while the Soviet Union is moving down. If current trends persist, most of Latin America and East Asia will surpass the Soviet Union in a matter of years.

There can be no mistaking it: the Soviet Union is in the grip of a devastating health crisis. We can only understand the full severity of this situation when we remember how difficult it is to push life expectancy down these days. The amenities of modern life—cheap food, clean water, mass education, rapid communication, easy travel, competent doctors, wonder drugs, and the like—make it extremely hard to stay sick or die young. The health-promoting force of these innovations is so powerful that it cannot be overcome even by modern warfare: World War I did not succeed in lowering France’s life expectancy, or World War II Japan’s. The only country in modern times to have suffered a more serious setback in life expectancy was the “Democratic Republic of Kampuchea,” Pol Pot’s Cambodia. Clearly, something in Russia is going very, very wrong.11

What is it that ails the Soviet Union? We cannot be sure. The only people in a position to know are the Soviet authorities, and they have been reluctant to advertise their nation’s health crisis, or to highlight the flaws in their system responsible for it. As a consequence, Westerners are left with a puzzle in which most pieces are missing. Some of the blank spaces can be filled in reasonably well through detective work, and Davis and Feshbach turn out to be very good detectives. However, theirs is primarily a study of infant mortality, and every age group has its own set of vulnerabilities. The declining quality of baby food and nursing formula, the rising (though, by Western standards, hardly scandalous) rate of illegitimacy, and the uterine damage caused by the six to eight abortions the average Soviet woman undergoes during the childbearing years12—all of which Davis and Feshbach document—may partly explain the increase in infant mortality, but it will not account for the rising death rates of metalworkers in Kharkov, elderly men in Georgia, or the middle-aged women who work on the USSR’s collective farms.

We are not left wholly in the dark, however. The biggest problems affect everyone. One of these is alcoholism. Americans consider themselves a nation of problem drinkers, and not without reason, but the thirst for alcohol in the Soviet Union is a problem of an entirely different dimension. In the early 1970s, according to a study by Duke University’s V.G. Treml, the Soviet Union’s per capita intake of hard liquor was more than twice as high as America’s or Sweden’s.13 Another report by Treml suggests that drinking is even heavier today, thanks in part to the increase in purchasing power Soviet citizens enjoyed during the years of détente. Urban families in the Soviet Union devote nearly the same proportion of their weekly budget to alcohol that American families devote to food,14 and things have gotten to the point where factory foremen mark their workers sober and fit for duty if they can stand.15

Mortality breakdowns by cause of death are hard to come by for the Soviet Union, but John Dutton, a researcher now at North Carolina State University, has made a strong case for the complicity of heart disease in pushing up men’s death rates,16 and this is something alcoholism can exacerbate or even cause. Vodka and samogon (Russian moonshine) seem to take their toll on women and children as well. Davis and Feshbach note that Soviet doctors now rate alcoholism the third most frequent cause of illness for women, and that a report from Lithuania connects excessive drinking on the part of mothers and of mothers-to-be with half or more of the infant deaths in that Republic.17

Then there is pollution. Again, we think of this as a Western affliction, which indeed it is. The condition, however, seems to take on new meaning in the USSR. Its most obvious manifestation is air pollution. Western visitors have compared the air quality in some Soviet cities unfavorably with Japan’s.18 Davis and Feshbach show that the nation’s rising incidence of respiratory disease is rather unfavorably linked with what Soviet doctors call “changes in the environment associated with urbanization.” But those forms of pollution which can be seen are probably the least dangerous. Misuse and overuse of pesticides and fertilizers, the careless release of industrial waste and heavy metals into the waters, and radiation emitted from poorly constructed or only partially safeguarded nuclear facilities present far more deadly perils.

A samizdat book cited in Rising Infant Mortality19 suggests the sort of price the Soviet peoples may be paying for their government’s indifference to these hazards. Purportedly based on suppressed official data, this study by “Boris Komarov” claims that birth defects in the USSR are rising by five to six percent a year, and that the number of “defective” children whose care must be left to the state is increasing by more than 200,000 annually. The work of “Komarov” is as yet uncorroborated, but if pollution is in fact wreaking this sort of havoc on the newborn it must be killing off adults as well.20

Soviet reports often refer to death by “trauma”: this category seems to include suicide, murder, and fatal accidents. Suicide in the USSR may be on the rise, but there is really no way of telling: for official purposes, it does not exist. Conceivably, a spate of suicides could affect a nation’s death rate, but suicide accounts for such a small fraction of all deaths—less than I percent even in Scandinavia—that this is unlikely. The same holds true for murder: a few populations suffering from pathologically high homicide rates do in fact experience a slight shortening of life span, but there is no evidence that any of the Soviet peoples are among these.

  1. 1

    Samuel H. Preston, Mortality Patterns in National Populations (Academic Press, 1976).

  2. 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. 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. 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. 5

    See Ansley J. Coale, Barbara A. Anderson, and Erna Harm, Human Fertility in Russia Since the Nineteenth Century (Princeton University Press, 1978) and V.O. Schmelz, Infant and Early Childhood Mortality among Jews of the Diaspora (Jerusalem, 1971).

  6. 6

    D. Peter Mazur, “Using Regressions to Estimate Life Expectation in the USSR,” Journal of the American Statistical Association, March, 1972.

  7. 7

    See Charles K. Wilber’s overly glowing account of this progress: The Soviet Model and Underdeveloped Countries (University of North Carolina Press, 1969).

  8. 8

    Soviet authorities evidently consider infants of less than seven months’ gestation, one kilogram in weight, and less than thirty-five centimeters in length who die within the first week of birth to be “nonbabies.” For further details, see Davis and Feshbach’s report.

  9. 9

    Washington Post, June 26, 1980.

  10. 10

    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.”

  11. 11

    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 Vladimir 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.

  12. 12

    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.

  13. 13

    Vladimir G. Treml, “Alcohol Consumption in the USSR,” Journal of Studies on Alcohol, April 1975.

  14. 14

    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. 2 (Praeger, 1976).

  15. 15

    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.

  16. 16

    John Dutton, Jr., “Changes in Soviet Mortality Patterns, 1959/1977,” Population and Development Review, June 1979.

  17. 17

    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.

  18. 18

    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).

  19. 19

    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.

  20. 20

    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.

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