суббота, 14 марта 2009 г.

Warning: capitalism can damage your health

Deaths rose sharply in communist countries that rushed to privatise. Does that prove economic "shock therapy" kills?

Anjana Ahuja

For a communist nation wishing to show off its capitalist credentials, mass privatisation was a killer move. Literally. In Russia, when the sell-off of state-owned companies was at its height, the death rate of working adults rose by 18 per cent and the life expectancy dropped by nearly five years. Men of working age, suddenly bereft of both employment and the healthcare that frequently accompanies it, found themselves greeting the Grim Reaper well ahead of schedule, sometimes having downed a bottle or two of aftershave.

This is, in caricature, the controversial thesis offered by David Stuckler, Lawrence King and Martin McKee, in The Lancet recently. The scientists - Dr Stuckler and Dr King are sociologists at Oxford and Cambridge respectively, and McKee is Professor of European Public Health at the London School of Hygiene and Tropical Medicine - claim that hasty mass privatisation in several former Eastern bloc and Soviet states coincides convincingly with a spike in their death rates. They speculate the main link between the two is unemployment, a well established cause of ill health and stress, as well as a trigger for life-shortening behaviour, such as binge drinking.

The study has ignited an intriguing, and sometimes ill-tempered, debate about how swiftly - or slowly - a fledgeling economy should emerge from its chrysalis. In their analysis, the researchers gently wag a finger at Jeffrey Sachs, the world-famous economist and advocate of “shock therapy” - the sudden lifting of price controls and subsidies, coupled with the flogging off of state companies and assets - to catapult countries irreversibly into capitalism. “The need to accelerate privatisation is the paramount economic policy issue facing Eastern Europe,” the economist once wrote.

Unsurprisingly, Professor Sachs is none too keen to have up to a million communist corpses piled at his door. He counters that the link between privatisation and deaths is “zero”; that a rise in dangerous drinking among Russians was due not to unemployment but to the abandonment of an anti-alcohol campaign; and that the notoriously poor Soviet diet must bear some blame. It's a peculiar choice, that last one, for the cerebral professor: short of adulteration with poison, diet cannot explain sudden changes in death rates.

As well as pointing this out, the academics retort that “the countries Professor Sachs cites as successes (in terms of their transition to free-market economies) were only successful because they did not follow his advice”.

It's not so much velvet glove, this spat, as boxing glove, and it looks like going the full ten rounds. At the very least, we should admit the possibility that shock therapy has hit the ropes. and why it matters. Because China and India are poised to sell off many of their state-owned enterprises in the hope of ascending to the top of the economic heap. Stop and think about it. Two of the most populous nations on earth are heading down the path of capitalism, and there is half-decent evidence that the way this path is travelled could spell the difference between life and death for millions.

Dr Stuckler and Professor McKee say their paper is about epidemiology, not ideology. Their aim was to peer deeper into the high human price paid for the death of communism in Europe, a fact that is not in dispute. Unicef estimates it caused three million premature deaths. The United Nations calculates that ten million men disappeared during the transition. Life expectancy dropped in many affected countries (for Russian men, who especially suffered, it fell from 64 to 58 between 1991 and 1994). Unemployment and hazardous drinking (including the consumption of spirits and even aftershave) were found to be serious factors.

But why did some countries, such as Russia and Kazakhstan, suffer steeper rises in their death rate than other countries going through similar turmoil, such as Slovenia? Dr Stuckler et al decided to try to put numbers and a timeline to a hunch: that the way market reforms were carried out might be the key. As the authors summarise: “Any disruption to the established social order creates high levels of social stress.” Anecdotally, the countries that sprinted to capitalism appeared to suffer most; those that cantered emerged relatively unscathed.

They defined “mass privatisation” as the transfer of at least 25 per cent of large, state-owned enterprises to the private sector within two years. On average, the countries with mass privatisation programmes saw the death rate for adult men (aged between 15 and 59) rise by 13 per cent; in total, it represented nearly a million extra deaths. Across the five worst countries, which included Russia and Kazakhstan, the average death rate shot up by 42 per cent for a short period in the early nineties.

Other countries, such as Croatia and Slovenia, which dismantled the machinery of communism more slowly, did not see such a dramatic rise. Also, those countries where people belonged to social networks such as the Church, or trade unions were less badly affected; interestingly, it is this aspect that the authors regard as their key breakthrough.

“The Poles came out well (from communism),” Professor McKee told me. “Why? Because they meet each other at Mass every Sunday.”

The authors speculate that those countries undergoing shock therapy unwittingly swept safety nets away with the old order. Many Russians lived in “one-company towns”; when the companies and jobs disappeared, so did healthcare, childcare and the social hub.

The Economist has lambasted the paper and the research has provoked a torrent of invective in the blogosphere. But what should matter more is whether the paper represents decent science; here, we must note the opinion of Professor Sir Michael Marmot, perhaps the biggest name in the field of how social circumstances affect health: “With all the caveats, Stuckler and colleagues' study is relevant beyond Eastern Europe...”

The paper has been wrongly viewed by outsiders as an ideologically motivated attack on capitalism; its authors have fallen victim to an occupational hazard of social science. “We are not stark raving Leninists,” sighs Professor McKee, who confesses to being flabbergasted at the critics. Of course capitalism is a good thing, he says, but we should pursue it with human welfare - as well as political and economic considerations - in mind. Privatising at a prudent pace, while ensuring the jobless have social support, is the ideal scenario.

China and India are embracing free markets. China alone has a population of 1.4 billion, roughly ten times that of Russia. If there is an inkling of truth in the analysis, then “shock therapy” could jeopardise tens of millions of lives. And there's nothing therapeutic about that.


8 комментариев:

Chernevog комментирует...

Right. There are always strong links between deaths of citizens and capitalism, particularly when the change to "free market economies" occurs.

Millions usually die of the results, because the systems of calculating deaths which occur during such changes are in and of themselves arbitrary.

A death certificate reads that a person has died of a heart attack, but this does not reflect the fact that the loss of even basical health care systems and access to doctors, nurses and medications under the "free market" system is never taken into account. The fact that the person who died may have had a heart condition that was being treated or could be detected in a nation that even had a relatively rudimentary national health plan no longer had the same access to heath care under a free market economy is never entered on the death certificate.

lastochka комментирует...

I know it very well because of my own bitter experience...Our family had lost three members: my father he didn't have any serious ilness, he was very good qualificated (programmer)
,but he was too much afraid to lost his job, because of his age, he was 64 years old by this time.He dead when we celebrated my 17 birthday, the insult was the reason of his death.
My brother and my uncle also become the victims of corruption and negligence from both juridical and medical systems later...

Chernevog комментирует...

This is common, not only in nations shifting to free market economies, but even in those where they are well established. In many countries where free market economies are well established, the death rate among those who do not have health insurance, or who have inadequate coverage is relatively large. The methods of determining how large are not easy, because those who do the counting never include the lack of available health care as a factor. But in the United States, for examples, studies have estimated that every year, anywhere from 22,000 to 50,000 people die prematurely due to lack of any sort of medical coverage.

In fact a 2002 study done in the U.S. ranked lack of health insurance as the third leading cause of death, following heart disease and cancer.

Yet the elected representatives in my state still insist that health care is not a right, but a priviledge. I find that a bit disingenuous, as they are provided with the best health care available, paid for by taxpayers, while 85 percent of the people they respresent are usually offered much less adequate coverage, or none at all.

I am very sorry for the losses you have had to experience.

lastochka комментирует...

I heard a little about the situation in US from one friend of mine in Ireland.His sister with husband moved to work to Japan because of the problems that you mentioned above. And I heard about the film of Michael Moore -"SiCKO".
I just know that such situation could never happen to my relatives if we live in USSR.

Chernevog комментирует...

You are probably correct. There were many economic studies done in the west that indicated that had the USSR not been pressured into a massive military buildup during the cold war, due to threats to communism from the west, the standard of living in the Soviet Union would have equalled that of the United States by 1993, and passed it by 2005.

Starting in 1917, the conservative governments in Great Britain and the United States both swore to "strangle" the infant communist state in its cradle and for the next 7 decades, the communist state was prevented from establishing the egalitarian state that was its goal, because it was almost continually under threat from the outside.

These studies were done in the wake of the efforts at detante starting with Richard Nixon, continued with Gerald Ford and Jimmy Carter.

Ronald Reagan, who was virulently anti-Communist immediately reversed detante, and started cold war militarism again, which required the Soviets to direct spending back towards the military sector, which caused economic hardship at home and resulted in the "fall of communism".

Nothing was more unimaginable to Reagan and his like than the idea that communism might be able to create a good standard of living for people living under it, if it was allowed to compete freely against the idea of free markets, without need to consider military threat.

There is really no evidence that the central planning that is part of communism is ineffective. It took the massive military conflict and the spending that went along with it to cause the fall of communism.

The Reagan administration had to nearly bankrupt the United States, creating a huge amount of deficit spending and raising national debt by massive borrowing to arrange for the Soviet Union to collapse. This is largely what has led to the current economic catastrophe, as the combined debt created by Reagan, George H.W. Bush and George W. Bush is about 8.5 trillion dollars, with another one trillion in added interest, makes up about 9.5 trillion dollars of the current 10.5 trillion dollars of the U.S. national debt.

To be honest, from an economic standpoint, I dont think it was worth it, and certainly not from a human standpoint.

One of the reasons that Russia was able to pay off the debt it accrued in the 1990's and begin to take over its own industries without "western assistance" lies in the fact that during the Soviet Era there was massive "capital formation", that is creation of industrial capacity and access to natural resources that was kept by the state, and not passed on to individuals to export to foreign banks, etc.

It seems in the long run, it was the Soviet Union that won the cold war, because the U.S. economy bankrupted itself to pay for the militarism required, and ran up huge deficits, while Russia has a much better balanced economy, little debt. Nations that were once under the sway of the United States in Latin America have taken a hard political turn to the left as well, totally rejecting free market economics.

The world economic meltdown started in the 1980's with the idea started by Reagan, that the government of the U.S. could pay for the cold war and future economic and military power projection by borrowing unlimited sums of money.

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