Rapid large-scale privatization and death rates in ex-communist countries: an analysis of stress-related and health system mechanisms.

During the transition to capitalism, the postcommunist countries have experienced devastating rises in mortality, although there has been considerable variation within and between countries and regions. Much of this population-level variation remains unexplained, but alcohol and psychological stress are found to be major proximal causes of rising mortality rates. The authors show that implementation of neoliberal-inspired rapid, large-scale privatization programs ("mass privatization") was associated with significant declines in life expectancy, as well as with greater alcohol-related deaths, heart disease, and suicide rates. The authors interpret these findings as evidence that rapid organizational reform created excess psychosocial stress, which, consistent with the public health literature, increases risk of death at the individual level. However, they also find that rapid privatization modestly contributed to a decline in health care resources, such as the number of physicians, dentists, and hospital beds per capita, although there is weak evidence that these reductions in health system capacity explain substantial differences in mortality at the country level.