ABSTRACT
An unprecedented mortality crisis struck Eastern Europe during the 1990s, causing around seven million excess deaths, and thereby representing one of the largest demographic catastrophes seen outside famine or war in recent history. Even though life expectancy has improved since then, the postsocialist mortality crisis has left lasting wounds, contributing to deep health inequalities that continue to exist until today. This chapter reviews the extant evidence about the upstream political-economic causes of this calamity. It shows that violent social dislocations wrought by rapid economic change and attendant public policies were central factors in the postsocialist mortality crisis. We pay special attention to the recent quasi-experimental evidence on the role of privatization and deindustrialization. Reviewing and evaluating the primary competing explanations of the crisis, the chapter demonstrates that comprehending its drivers necessitates a political economy of health approach that moves beyond individualistic, biological, and psychological explanations. Dysfunctional health behavior in the form of alcohol and drug abuse is a crucial, but only proximate and not ultimate, cause. In most cases, it is on a shared causal pathway linking upstream economic dislocations to individual ill-health. We conclude by pointing out the insightful parallels with the deaths of despair epidemic plaguing North America.
