The serious economic and political transformation that occurred in post-communist countries was accompanied by a clear deterioration of the population’s health. The negative consequences of reform are not the same in every country, however. ‘In the 1990s, Russia encountered an unprecedented drop in the average life expectancy, particularly for men, who saw this parameter return to the high of the 1980s only in 2013. At the same time, the majority of Eastern European countries were rather quick to reach stable growth in the life expectancy after reforms were carried out,’ Vladimir Kozlov and Dina Balalaeva note.
Despite existing empirical data, science has not fully explained the reason behind such divides. The majority of research work refers to the specificities of economic reforms, the healthcare system, differences in cohort mortality, and alcohol consumption. There is not, however, an obvious answer as to why people’s health differs in post-communist countries.
In their research, Kozlov and Balalaeva prove that the simultaneous development of institutions of political and economic competition have a positive effect on health. This concerns the combination of democracy and a free market in the civilized sense, that is, without usurpation of power, the growth of gangster capitalism, or oligarchization.
To test their hypotheses, Kozlov and Balalaeva used regression analysis to study 29 countries between 1989 and 2011. The study’s dependent variables were average life expectancy and the number of deaths for specific reasons, while control variables included socioeconomic development, alcohol consumption, and military conflicts.
A distinguishing characteristic of post-communist transformation is the simultaneity of far-reaching economic and political reforms, which is frequently mentioned in academic literature. ‘In most cases of radical change, the focus is shifted towards the political system, while the economy fundamentally remains the same; or the economic system changes, but the political regime survives (typically in non-democratic countries),’ the authors comment.
All post-communist nations have simultaneously lived through a fall of the political system and economic shocks, which were followed by unavoidable reforms in both the political and economic spheres. The results of this varied across countries, however.
According to a report from the European Bank for Reconstruction and Development (EBRD), by 1995, the most successful countries – Hungary, for example – had adopted and ameliorated laws on competition, thereby neutralizing key cartels. In other countries like Georgia, reformers had only just begun working seriously on competition law by this time. ‘The Czech Republic, Hungary, and Slovenia had already become full-fledged democracies by 1993, while Russia and Georgia were in an intermediate position in the early 1990s,’ Kozlov and Balalaeva note. Other countries – Belarus and the majority of Central Asia – maintained the status quo, confidently turning towards authoritarianism.
As a result, two groups of countries formed based on the nature in which democratic and economic reforms were carried out.
On the one side are Central and East European countries, which were successful in carrying out both economic and political reforms: Slovenia, Slovakia, Poland, Lithuania, Latvia, Estonia, Hungary, and the Czech Republic.
On the other are Eurasian nations, where either economic or (in the majority of cases) political reform was overdue: Russia, Kazakhstan, Belarus, Azerbaijan, Armenia, and Kyrgyzstan.
Conversely, Uzbekistan and Turkmenistan have not undergone any reforms practically.
Empirical data indicate that if a country’s economic and political institutions were not developed evenly or simultaneously, the potential benefits of this development fell. Among such important benefits is the population’s health. In Central and Eastern European countries, the average life expectancy for men grew by five years between 1989 and 2011 to 71.9 years, while life expectancy increased 4.9 years for women to 80.3 years. The Eurasian group of countries had less optimistic results. The average life expectancy fell by 0.2 years for men to 65.1 years between 1989 and 2011, but grew 0.7 years for women to 74 years.
In other words, the study shows that economic and political liberalization only have a significant effect on life expectancy when acting in unison.
At the same time, unhealthy competition that results from economic and political institutions developing in different directions affects health indicators through various channels. One example is corruption in the healthcare sector, Kozlov and Balalaeva posit. This concerns purchasing medical diplomas or acquiring medical equipment through fraudulent tenders, for example. Other examples of this are the inability to develop medical innovations, as well as policy makers who actually know nothing about healthcare policy. There are other reasons for the poor health of a country’s citizens that are unrelated to medicine or healthcare. These include increasing stress in the workplace, a low level of material wealth, growing unemployment, and social inequality.
The results of the research contribute to academic literature on the specifics of so-called hybrid political regimes (electoral authoritarianism). Many post-Soviet countries, the authors note, differ in the hybridism of their regimes. This is Albania, Bulgaria, Macedonia, Romania, Serbia, and Slovakia in Central Europe, and Armenia, Belarus, Georgia, Moldova, Russia, and Ukraine in the former USSR.
The study confirms the hypothesis that nations with hybrid regimes often experience difficulties in achieving progress in the health of their citizens.