Change and Continuity in Mortality Trends in Romania: A Case Study of Eastern European Mortality

Solveig Argeseanu, University of Pennsylvania

Several recent studies have discussed the decreases in life expectancy in Eastern Europe and the Former Soviet Union, many reporting that the countries of Eastern Europe experienced a decrease of several years in life expectancy during the second half of the twentieth century, and that they have lower life expectancy levels than other industrialized countries. Several interpretations have been offered to explain this increase in mortality, focusing on the role of personal behavior and lifestyles, the environment, the role of the state, and psychosomatic interactions. Often, the increasing mortality is attributed to the difficult political and economic transition and the collapse of the state healthcare sector experienced by Eastern Europeans since the end of the Cold War. This paper evaluates these arguments to determine the demographic bases of the observed trends through an analysis of mortality in Romania between the 1950s and the 1990s. I approach the topic from a more demographic perspective than has been done in much of the previous research, especially from the medical fields. The paper reviews trends in mortality to determine how mortality rates changed in Romania over the past 40 years. The following questions are addressed: how has life expectancy changed during the last four decades; at which age groups have changes in mortality taken place; which causes of death have dwindled and which have increased; and what are some of the possible explanations for these changes. The methodology consists primarily of several decomposition techniques. Death rates in each decade are compared to determine the contributions of differences in age distribution and those of differences in rate schedules. I decompose life expectancy using the Arriaga (1984, 1989) methods to determine the contribution of each age group to changes in life expectancy by and between genders over the decades. I also decompose age-specific differences in rates using the Kitagawa (1955) method to determine the effect of several main causes of death, including the specific causes that have been associated with the post-communist transition. The data used are from national statistical annuals and demographic annuals, as well as the WHO’s Population Database and Mortality Database. It would be unwise to use data from the communist period without considering data quality issues. I believe that the data can and should be cautiously used. The changes in life expectancy are not manipulated beyond recognition, and in fact decreases in life expectancy are reported in the 1980’s, when the pressure to manipulate data was greatest. Even where data were manipulated, they are the data against which later occurrences have been compared. It is therefore important to examine them, with an eye to the possibility that the reported increases in mortality are actually just a return to accurate reporting after the end of the communist regime. The period discussed in this paper witnessed a transition from a high mortality regime to a moderately low mortality regime. During the 1950s and 1960s, large improvements were accomplished, as the health care system tackled relatively amenable diseases like infectious, parasitic and respiratory diseases, providing universal healthcare and immunization. In more recent decades, the marginal returns to these measures have fallen, as can be expected, while measures to address chronic diseases and adult health did not keep pace with these emerging needs. The situation was then exacerbated by a socio-economic crisis in the years before and after the 1989 revolution. Life expectancy in Romania was among the lowest in Europe in the 1950s and remained among the lowest through the 1990s. The largest gains in health in were achieved in the 1960s and 1970s, when most age groups, and especially infants and children, experienced improvements in survival due to decreases in infectious, parasitic, and respiratory diseases. While some of these improvements continue, there have been periods of leveling off and even declines in life expectancy since the late 1970s, especially among men, and for both sexes especially among the working age population. The main causes of death to which these decreases can be attributed are cardiovascular disease, neoplasms, and diseases of the digestive system. As early as 1978, middle-aged men had started to experience decreases in health. The rises in working-age mortality is apparently not driven by the complications of the transition, at least in Romania, rather it is the result of problems that affected people’s lives before the 1989 revolution. The greatest negative changes in fact occurred during the last decade of the communist regime. The cohorts of the late 1950s, having benefited from increases in survival as babies, are experiencing increases in premature mortality in adulthood. This is not to discount the difficulties of the post-communist transition, which brought increasing poverty and more harmful lifestyles for many Eastern Europeans. The effects of these changes are simply not yet clear in survival outcomes in Romania. For now, we are primarily witnessing the cumulative negative impact of pollution, poverty and depression from past decades and the benefits of previous investments in the health care system.