The Health Crisis in the USSR*

Review of Rising Infant Mortality in the USSR in the 1970s By Christopher Davis and Murray Feshbach, United States Bureau of the Census. Series P-95, No 74, September 1980, 33 pp., free. 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 Russian'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 mid 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 travellers 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 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 American 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 in life or World War The only country in modern times to have a more in life expectancy was the of something in Russia is very is it that the Soviet We cannot be The only people in a to are the Soviet and they have been to their health or to the in their for As a are with a in which most are of the can be in and Davis and Feshbach turn to be very is a study of infant mortality, and every age group has its of The of food and the by Western rate of and the by the six to the average Soviet the of which Davis and Feshbach the in infant mortality, but it will not for the death rates of in men in or the women who on the USSR's We are not in the The of these is themselves a nation of and not without but the for in the Soviet Union is a of different In the early 1970s, to a study by the Soviet Union's per of hard was more than twice as high as or report by that is even in part to the in Soviet the years of in the Soviet Union nearly the same of their to that American to and have to the their and for they can Mortality by of death are hard to by for the Soviet but a now at has a for the of in death and this is something can or even and seem to take their toll on women and as Davis and Feshbach that Soviet doctors now rate the third most of for and that a report from on the part of and with or more of the infant deaths in that is we of this as a Western which indeed it The however, to take on in the most is Western have the in Soviet with Davis and Feshbach that the of is rather with what Soviet doctors in the with those of which can be are probably the least and of and the of and the and from or only more in Rising Infant the of the Soviet peoples may be for their to these based on this study by claims that in the USSR are by to six percent a and that the of be to the is by more than The of is as yet but is in this of on the it be as Soviet reports to death by this to include and in the USSR may be on the but is no of for it not a of could a death rate, but for such a of all than percent even in this is The same for a from high rates do in a of life but is no evidence that any of the Soviet peoples are are and are under the of and no when on and in the of The Soviet Union may have only a as as the United but it has as The in the and in the under the or the of the is even Davis and Feshbach have that as much as a of the in death rates from men in their late may be to the of a in the health of people of nearly every and nearly every age take without a in the In the is but the of the Soviet but a but improvement in a and of in would seem almost a Davis and Feshbach, in their they evidence to the Soviet health is in the they however, which has been to a in the of the is not yet under in the Soviet and of of each year. The of from in fact, is to be on the of the it with which to the can is in the of the and in much of the poor as it is so easy to it from a of and is by a in food or and If Soviet is to with these it is to be the more and more of or the of in the Soviet Union be There are at least three the Soviet health are to be they are rather than is not a in the is which means its can expect to be and the of Soviet the in but without The USSR has more than twice as health as the United but they in which and in which such as and are and in which even can be a Their is probably not by the of to the of the other nation can a on the of a in its For these and other and do their to the According to Davis and Feshbach, and now only twenty a and the of per 20 percent from to may be its For figures on the Soviet Union's are but it is to be and to nearly the for in the are and who to be sure of or competent be to pay their doctors a the in of but be to pay and By of the those people who the poor and the people in the is to be on the in every part of the USSR's “socialist” If this is it could to for a health on the part of the USSR's most is evidence that the has to on for its As more and they more since and a human in Yet over the the Soviet Union has of its to According to one of the was percent in but only percent in We may with these but the is and the Soviets themselves According to one in Rising Infant health as a of the from percent around 1965 to percent in The Soviet Union may be the only to more of its to the health of its is one for a to a or to its undercut by the of it is to a which will for most of its can we for what is a on the part of a “socialist” to health this may seem to could be for it we take of Soviet In fact, from the of the this seem not only but even a the of the has been the of the and is a for with the the Soviet has been and in years it has and To force it its it with of The USSR's rate of has dropped since the mid-1960s, below that of its in the 1970s, and yet has been of total 1965 to last year for which we have for the from something like one in four to very nearly one in had to be at all this what was The United States and its were their in at the of the but for Soviet this was and than are at a in the of the in Soviet could have very at The of the were with only one they had to the of and for In this would be a their over both and is to be In it would a was no longer to force the to its in the of a of living by were lower than they had been under As his his of they it a they with nations, but only These could be a very powerful and had to be taken very as was to for in the was from in at least the This was not on and If they were in a they had to on the they would do so and very with the had and now a by what it on their The and of food would have to be even it of of of from would it be to by on the of such as or even a would that in a is so as who would or the a on and like health a sick is not nearly so difficult as a There is more to people however, than and in lives is it is of even are those of our which from in the first we all are a to a less but perhaps no less is the of which can us for a attention to its or and the will to live which such in do for the health of nation what a of health could never to Davis and Feshbach do not on the of and health in the are not their study is and in By the of a can only be and the human of any is and to If we the of by Rising Infant Mortality and the of and Western as possibly but which we a and we will have a of the of human in the health in the us look at the evidence we have on Death rates for men and and for and and so as we can for every are on the as I have out, is is so much a part of in fact, that the in the and for most of the Although we cannot about or death rates for seem to be and Rising Infant Mortality that Soviet have the of with infant it that even this has been for years, it has The death rate for in Davis and Feshbach is twice as high as for those look the conditions that be in these percent of the Soviet Union's their to as the of and in any year on the order of to are The of live by between four and of their was or to the who can on the about in the local and the with which that could be even only more at their do these about and the of people to look their health and to can we these of to that of is not or that the Soviet order is not in the of a The of nation on a of health is mortality of the the USSR is now is to we understand about modern In the as we in fact, the Soviet health be do we for we by what our and with this turn of make that those of us in the West are about the Soviet Union. We this is or and of such to the but they are not at its By with other for or to of or Soviet Union almost in its and while our to Soviet is and much more is than is as has the has when have more material at their than they can We are indeed with the but this is not so much for a of as a of For the Soviet in the of the us to in a no to our I do not to this The health in the Soviet however, cannot be without about Soviet and society. No of the mortality can the Soviet to a deterioration in the health, and no of that can be it the in Soviet as they are on the one by the of and on the other by the of the To only the men in Moscow are themselves to of the while the under is what we in the West would of the In of and the USSR as of the century a in which all more than a hundred themselves by a In a century and and the of the Soviet not only a which the and the of the but to the of this can be in part by of and it can be to conditions down by the people, who the group the USSR and both the and Soviet its all the European the were the least the wonder they do not so to this with will that the is not easily is and no less so for this not us from of the more from the to have that to the of the is a and of the This with in the and it is in from is than a to the for World War which the Soviet all to as In the between the and the Western of seem which of his at the of the Soviet had been to had the and of the and the part of of but to could be worse than to be from his people and to live this to a and even of it not to this in is a authority and which is in with at least one of We may remember the of the people of who in the the to and and over is and but is no order in We may remember as that the first by the and not as of but as of their their without the of the to the and will in it is not at all to such as I I without is with what do we make of this in the of the life which the or to their but their that the of the people is for and and in be to these For of years Western have that in the of the is not something to or even to face but rather more like a of to be to and this can to the current health in the By this I do not of that are to their or that men for in a death from If seem closer to their than in the I would that and for in with a in the that is to of for a and of and were not to Russia, but the to Imperial most were not men like but like the and the who down the people, but for a which could be and The and such a situation to be be to a of this The his country could have been under the only the and which were to make did not the same were This is a those of us in the West a country that was the of World War and to his a is but a single of the of the and his of the of his that between and a by perhaps twenty Soviet lives and a of perhaps not the USSR its of and its of and and increased its of by a of These rates of were higher than in the less and however, was the There was of and were at least a as it the to have been a for a of those who a full of this who to the death of at least twenty and perhaps as as of his are in this century only by is and even by a of in than the who that life much of its when the the of The of mortality I would in is not that was a in it can be as of the the and World War for to life expectancy in the Soviet Union from about when total to about sixty-two when The is that has on of in a the not only but the and To it was to For is a but not a it is at for his to on the and to from This was not yet in the 1950s. death was by a of For a it seemed that be was that a had that the of the would be to the of to a Soviet By the early it had that this would not be was and with it had both the and the of in the The these would not last of however, could not be could the of life the Soviet which would of would the and the This was the peoples of the Soviet Union found themselves between had been without and at the same of of the the of were no for a any this the USSR a but in the of the Soviet to If the was in its its were to without to or as we were by our in the Sixties and the it is perhaps that we did not that the Soviet Union was with more that our the it may that we are the down of a The of the is by has to a over the fifteen years. a of and a of the of the have been no in in the USSR for more than in and other of the the of has been for most of the The of seem to have to be only on In for only percent of the and were By 1975, to the was over and are on the Since the early 1950s per of have by a of to which is and total may have increased even more and of by death under for as much as 20 percent of Soviet today. The is it difficult to of people in its society. In the between the Soviet population and the was by 1975 it was nearly in not to any of these was the in death rates for nearly every group in society. By per the of and average for of living is than in the early for the are For the first since Soviet about of is less but it is less easily and will not and from the of To its country the on the of its most of and those which the and most would these the of I would that four seem to all the the the and of and the There are in on any of these in the current crisis. or the for could or but could only the the or the Soviet Union In the current the on but the fifteen years are any will not at The Soviet health the with The in death and probably cannot be at any the force the but this would be on could pay the full health and could do more than any to the The health could be but only at the of or The in death will probably what this in mortality and is a on the and a on is not at all that the country can this. The Soviet is currently to it may even have is in part to for this the of the and the which do not for the with a The by the that are than in the USSR can only be worsened by a deterioration in the health of the and its at the Soviet is If the to Moscow which will the the the or the This is not a situation which can be If is the will be even in the in not only the of with the United with the has achieved but possibly the Soviet of in and for the could the health and even to of the of the Soviet As a to all of is the in the of the Soviet In were for every by the of the the ratio will be down to not only the of the Soviet but the of the in are to be by the health and in the years. cannot how these will with are we understand about the and in any we in that the of the to and lives are different In the of a nation on the and of its the and of its the of its and the of its of in a which did not yet of the of human or the United but the may not be different in his age and Soviet and may or may not be more than their in the There is that they are To but one in the year of Moscow's the Soviet Union around the American For a of Soviet are as more and than those of the their and it can be that least at the Soviet to be more in more than the men in with they for us the in between East and West but analysts us the is we remember Soviet and is, by to a than Western to the of force in the United States the Soviet Union is more than a of the on that it could in a of could be that and that will with it of and even at we take all this we that it is at least for Soviet in the to even as the which it is not be to that in with a of is not a for when the in is both powerful and who would the of the Soviet health on or would that only for turn in Moscow's this situation have for the of the as