The New York Review of Books

To the Editors:

This note is a response to Nick Eberstadt, “The Health Crisis in the USSR” which appeared in The New York Review of Books, February 19, 1981. All quotes unless otherwise noted are from Eberstadt’s article. Contrary to Eberstadt’s sensationalist claims, neither Soviet medical care nor Soviet socialism is falling apart. While there is a real problem with infant mortality, Eberstadt grossly exaggerates and misinterprets its significance. The problem is a negative (and temporary) result of the rapid progress made in raising living standards and freeing women from their traditional roles.

Life Expectancy

Life expectancy in the USSR in 1975 was 70.4 years (up from 68.4 years in 1960 and 70.0 in 1970).^* Life expectancy in the US in 1975 was eight months longer than in the Soviet Union. Contrary to Eberstadt, life expectancy in the USSR is not the lowest in Europe, nor is it comparable to those of the less developed capitalist countries in Latin America. In 1975, Soviet life expectancy was higher than that of Finland, Portugal, Yugoslavia, Romania, Poland, Hungary, Czechoslovakia, and “half-civilized” Albania. The USSR was further considerably ahead of the major Latin American countries such as Mexico (64.7), Chile (62.6), Brazil (61.4), and Argentina (68.2). It should be noted that the Soviet overall life expectancy is only slightly lower than that of the major advanced capitalist countries such as the United Kingdom (72.4), Japan (72.9), and West Germany (71.3). In 1900, the average newborn Russian could expect to live for about thirty years (seventeen years less than a newborn in the US born at the same time) (Eberstadt, p. 23). In a little more than a single generation, the Soviet system was able to take a population which had been living in medieval conditions and bring it up to roughly Western European standards of nutrition and health care.

It should be noted that the life expectancy for non-whites in the USA in 1975 was 67.9 years. If the Soviet figures of eight months below the overall US average indicates a “mortality crisis alien to everything we understand about modern life” what does a differential of 6.4 years (between white and black life expectancy in the US in 1975) indicate? That it is nothing inherent in the Soviet form of socialism that is causing the slower increase in Soviet life expectancy between 1960 and 1975 of 2.0 years, compared to 3.1 for the USA, is demonstrated when comparing the two Germanies. In 1960, East Germany (traditionally the poorer rural region) had a life expectancy of 68.3 years (1.3 years less than West Germany), but by 1975, it had a life expectancy of 72.6 years (an improvement of 4.3 years) compared to the West German life expectancy of 71.3 (now a 1.3 year advantage for the East Germans). The East German life expectancy is in fact higher than that of Austria, Belgium, Italy, Switzerland, the United Kingdom, Canada, and Australia. If the US advantage over the USSR is sufficient to indicate a “deeply disturbing health crisis” and to imply “virulent anomie” and “rampant social decay,” what then can be inferred about West German, Canadian, Australian, or Swiss society, whose differential life expectancy compared to East Germany is of the same order?

Most of the stagnation in overall life expectancy in the USSR over the 1970s is due to increased infant mortality. While infant mortality rose by 36 percent from its all-time low in 1970–71 to 1975–76 (the last period data are available) the death rate for children aged one to four declined by 5 percent. There was no change at all in the death rates of those aged five to forty or those over sixty-nine. The only age group besides infants to experience a significant increase in its death rate over the 1970s was the forty to fifty-nine group (where alcoholism, which has become a more serious problem with increasing purchasing power, takes its toll) (see Davis and Feshbach, Table 1). The decrease in infant mortality in the 1970s runs against the strong long-term trend. In 1961–65, the rate averaged 30.3 per 1,000, in 1966–70 25.8 and 1971–75 26.3 per 1,000 (Davis and Feshbach, Table 2).

The increase in infant mortality has not occurred in all Republics of the USSR, in fact it has largely been concentrated in Central Asia. The five-year moving average for the Russian Republic (where half of Soviets live) was 23.3 per 1,000 in 1970 and 23.0 per 1,000 in 1975. The (estimated) infant mortality rate for Central Asia on the other hand rose from 34 per 1,000 in 1970 to 46 per 1,000 in 1975. Infant mortality in Central Asia before the revolution approximated 330 per 1,000 (Eberstadt, p. 23). In 1960, the rate for Italy was 44 per 1,000, while that for Austria was 38 and West Germany 34 per 1,000. Sixty years of Soviet power reduced the infant mortality rate in Central Asia to approximately 1/8 of its former magnitude, bringing it to Western European levels of about 25 years ago. It should be noted that infant mortality in Soviet Central Asia is qualitatively lower than that of comparable countries across the Southern Soviet border which share ethnic groups with the USSR. The infant mortality rate for Turkey in 1970 was 153 per 1,000; for Afghanistan in 1975, 269 per 1,000; and for Iran in 1975, 120 per 1,000.

While the qualitative improvement in diet and health care made available to Soviet Asians has enabled them to reduce their infant mortality to one-third/one-fourth that of the related peoples across the border, the rates for the Western Republics of the USSR are comparable with those of most Western European countries. The three-year moving average for 1970 for Estonia was 17.4, for Lithuania 18.3, for the Ukraine 17.3, for Belorussia 18.0. In 1973, these were respectively 16.4, 17.0, 18.3, 17.4, and 16.7—in three cases a decrease and in only one an increase. These figures compare favorably with the 1975 rates of 21 per 1,000 for Austria, 20 per 1,000 for West Germany, 21 per 1,000 for Italy, and 16 per 1,000 for the United Kingdom and the USA (24 for non-whites). Given the fact that these latter countries are considerably more wealthy and urbanized than the Western part of the Soviet Union, the Soviet attainment of equivalent infant mortality rates in its Western Republics is a significant achievement and certainly represents a major success of the Soviet health care system, rather than a “reversion to preindustrial standards.”

Urbanization and the Changing

Role of Women

The Soviet Union, especially its poorest and most rural regions, is rapidly urbanizing, e.g., in the 1959–1970 period, the rate of increase in urban population for Moldavia was 90.7 percent, Tadzhikistan 80.3 percent, Uzbekistan 68.5 percent, Kirghizistan 67.2 percent.

In the Soviet Union virtually all women now work outside the home. In 1970, the labor force participation rate of Soviet women aged sixteen to fifty-four was 89.1 percent. Women in urban areas often live at some distance from their place of employment and are often separated from their children, who are usually in child care centers for much of the day. A Soviet study of perinatal mortality rates in Latvia in the 1962–67 period found that the death rate was 15.0 per 1,000 for women who were not working, 13.7 for collective farmers, and 19.4 for wage workers (Davis and Feshbach, p. 12). This suggests that those women who are either full-time housewives or collective farmers are better able to look after their children’s health than those that work in the modern sector. Thus we would expect infant mortality to increase the most rapidly where urbanization and the labor force participation of women in the non-farm economy increased the most rapidly.

Medical Care

Eberstadt asserts “health conditions in the USSR have worsened steadily since the mid-1960s.” The much more careful authors on which he bases his article, however, argue, “During the 1970s, obstetrical, gynecological, and pediatric services have improved and inequalities in their distribution have lessened. The quality of Soviet medicine in general has probably not deteriorated” (Davis and Feshbach, p. 24). Contrary to Eberstadt’s claim the USSR has increased the share of its national product spent on health (while at the same time decreasing the share it allocated to the military). In 1969, the USSR spent 2.3 percent of its GNP on health and 13.6 percent on the military. In 1978, it spent 2.4 percent on health and 12.2 percent on the military. In this period, while the Soviet population grew by 8 percent, absolute resources allocated to health care rose by 59 percent (US Arms Control and Disarmament Agency; World Military Expenditures and Arms Transfers: 1969–1978, 1979, Table 1).

Although quality medical care for infants is readily available throughout the Soviet Union (including the rural parts of Central Asia) there remains a problem with getting many parents (especially those of rural and Islamic backgrounds) to fully utilize that care.

A Soviet study found that in 61 percent of the cases which resulted in death from pneumonia, the parents did not seek medical help until after the second day of illness, and in 19 percent of the cases the infants were hospitalized too late (Davis and Feshbach, p. 20). Another Soviet study of infant pnoumonia found that 22 percent of parents first tried to treat the disease themselves without consulting a doctor, and in 12 percent of the cases the child was sent to a day care center in spite of showing the first symptoms of the disease (cited in Davis and Feshbach, p. 19). It should be noted that the Soviets have intensified public education about proper child care (e.g., a Russian language edition of Dr. Spock’s child care manual has been published) (Davis and Feshbach, p. 20).

Changes in Child Care Patterns

The rapid decline of the extended family and of the availability of grandma to look after the children, concomitants of rapid urbanization, industrialization and rising living standards, combined with the almost universal labor force participation of women, has meant an especially rapid expansion of day care facilities which look after a rapidly growing proportion of children after the two months paid leave period which new mothers are allowed. In 1970, 50 percent of urban and 30 percent of rural children were in day care centers (Davis and Feshbach, p. 20). Between 1970 and 1977, the number of children in such centers increased by 37 percent. The rapid socialization of child care, while liberating for women, has had a negative effect on infant health. A Soviet study found that the frequency of illness among children in day care centers was almost twice as high as that for children not in such centers and that the difference was due mostly to the higher incidence of infectious diseases, especially influenza, among children in day care centers (Davis and Feshbach, p. 20).