Commentary: Health and economic transition

If economic fluctuations impact on mortality then a region where one might expect to see an effect would be the countries of the former Soviet Union. The Soviet Union had created a complex network of economic interdependency between its constituent republics. A product such as a car or a television set might incorporate components from ten or more republics, each being exchanged through a system of barter that was isolated from the global marketplace. This all changed in 1991. Each of the 15 republics became an independent country.1 Few had any experience of how to engage in international trade and what they produced, if they were able to get the constituent parts, could not compete with higher quality goods from other parts of the world. With governments no longer willing to pour subsidies into uncompetitive loss-making industries, manufacturing output slumped. Unemployment, which officially did not exist under communism, was soon widespread and many of those who still had jobs were paid late if at all.2 At the same time, each country underwent a series of rapid fluctuations in mortality. While the immediate causes are now understood,3 many questions remain about the factors underlying them. Do the findings reported by Tapia Granados help us to understand these events? (...)