Similar But Different: Health And Economic Crisis In 1990S Cuba And Russia

Social Science & Medicine 72 (2011) 1489e1498

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Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed

Similar but different: Health and economic crisis in 1990s Cuba and Russia
Iris Borowy*
Centre Alexandre Koyré, CNRS e Cermes3, 7 rue Guy Moquet, 94801Villejuif, France

article info

abstract

Article history:Available online 8 April 2011

The collapse of the Soviet Bloc caused devastating economic crises in Cuba and in the Russian Federation
but triggered remarkably different public health responses: while mortality rates in Russia increased
substantially the crisis was barely visible in Cuban public health statistics. Fundamental social, political
and cultural differences in the two countries andthe respective specificities of the crisis in either country
seem responsible, including different long-term health trajectories and different traditions of healthrelated agenda setting. Cuban policies combined traditional top down activism with grass root activities,
strengthening social capital, while the “shock therapy“ adopted in Russia had a corrosive effect on
society, increasingpsycho-social pressure and weakening support.
Ó 2011 Elsevier Ltd. All rights reserved.

Keywords:
Economic crisis
Public health
Cuba
Russia
Social capital
Mortality
Gender

Introduction
The relationship between economic crisis and public health is
far from clear. While some studies point to a negative impact
(Cutler et al., 2002), others suggest that any rapid economic change,
whetherexpansion or contraction, will have a negative effect
(Ruhm, 2005), and still others indicate that economic crisis lowers
mortality (Tapia Granados & Diez Roux, 2009) or has unclear or
contradictory health effects (Khang, Lynch, & Kaplan, 2005;
Stuckler et al., 2009). The contrasting public health responses to
economic crisis during the 1990s in Russia and Cuba therefore
provide a fascinatingcase study.
The Russian mortality crisis of the 1990s is well documented.
After 1991, life expectancy at birth for men dropped drastically until
it was a mere 59 years. Life expectancy for women still reached 72
years in 2002, leading to a spectacular gender gap of thirteen years
(Shkolnikov, McKee, & Leon, 2001). Accordingly, mortality rates
rose steeply during crisis years and remained on anelevated level
afterward. This development resulted overwhelmingly from
mortality increases among adults aged 30 to 49 years, especially
working-age men of relatively low educational level (Shkolnikov
et al., 2004). Morbidity was also affected. Infectious diseases
soared, especially tuberculosis but also diphtheria, syphilis, cholera,
and measles (Shkolnikov et al., 2001).
There is nearconsensus among all authors that the single most
important reason for the mortality crisis was increased alcohol

* Tel.: þ33 38208 61328.
E-mail address: iaborowy@vjf.cnrs.fr.
0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2011.03.008

consumption, especially among working class men. After a shortlived anti-alcoholism campaign in the 1980s,alcohol consumption
increased again. Estimates range from 12 to 15 l of pure ethanol per
capita per year (Shkolnikov et al., 2004; WHO, 2004a). In practice, it
was adult Russian males who consumed 90% of the alcohol, on
average 160e180 half-liter bottles of vodka a year (Cockerham,
2000). This consumption predictably affected directly related causes of death, such as alcohol poisoning,alcoholic cardiomopathy,
and liver cirrhosis but also other causes, including infectious
diseases and external causes. Pridemore, Tomkins, and Eckhardt
(2010) estimates that alcohol consumption played a role in nearly
one-third of all Russian deaths and nearly half of premature deaths
among working-age Russian males. Nothing remotely similar
occurred in Cuba. Instead, consumption levels rose...