Warning: Freedom Can Be Dangerous to Your Health

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THESE PAST FEW YEARS SHOULD have been the best of times for Eastern Europe. Oppressive communist regimes were swept aside, along with the walls, fences, laws and secret-police forces that kept whole populations locked away from the world. Freely elected governments are in office, and the free market is starting to take hold. At long last, East Europeans are looking forward to the kind of material prosperity that the West has known for decades. This should be a time of joy in the East, an era of good health, optimism and babies.

It is not. For many East Europeans the age of freedom is turning into the worst of times since World War II. Eastern Europe is going through a health crisis of dire proportions: demographers and health officials report rates of death and childlessness on a scale normally seen only in wartime. Ailments of both body and mind are near epidemic magnitude. In several countries, including Russia, the population is actually shrinking. "The drop is catastrophic" says Regine Hildebrandt, family minister in the state of Brandenburg government. "It is like war."

In Russia, Bulgaria, Estonia and eastern Germany, deaths are outnumbering births, in some areas 2 to 1. Life expectancy in nearly every part of the East is dropping, especially among men, at a time when even the poorest Third World countries are recording steady increases. In Hungary the average is 65 for men and 74 for women, in contrast to 67.3 and 75 in 1975 and to 73.4 and 81.8 for French men and women today. Death rates in Russia have soared 30% since 1989, with men bearing the brunt, says demographer Murray Feshbach of Georgetown University. By his estimate, life expectancy for Russian men has fallen to 59, about the same as in Pakistan.

"In the past, such abrupt shocks were observed in industrial societies only during wartime," notes Nicholas Eberstadt, a researcher at the American Enterprise Institute in Washington. Writing in the National Interest, a foreign affairs quarterly, he warns that the crisis threatens to undermine the East's struggle to build free and stable societies: "Adjustment to life after communism is proving not just difficult but positively traumatic throughout the entire former Soviet bloc."

The reasons for the crisis are complex. One obvious cause is communism's long and repressive reign. "Health care is no different from any other realm of our life," says Mikhail Prudkin, a Moscow oncologist. "All these problems did not emerge just in these past five or 10 years. They have been piling up for more than 70 years." Industrial pollution, careless handling of radioactive materials, poor safety standards in the workplace have all contributed.

Though communist governments allocated large parts of their budgets to health care, the resources were often used inefficiently. The communist passion for gigantism, for example, built hospitals with enormous capacities; once the system collapsed, so did the subsidies that kept it functioning, turning the facilities into costly white elephants. "In some of these places, they need only half or even a third of the beds they have," says Dr. Timothy Empkie, director for Project Hope in Central and Eastern Europe. "They have to make tough decisions about rationalizing their current facilities before they go on to necessary programs such as antismoking campaigns."