London School of Hygiene & Tropical Medicine

Countries seeking to make massive changes in the way their economies are run, for example by privatising formerly state-run sectors, must take into account the potential impact of such changes on people's health, experts warn today.

The warning comes after a study of former countries of the Soviet Union, including Russia, that underwent privatisation programmes in the 1990s, following the collapse of communism, revealed how the process coincided with large increases in male mortality in some countries. The findings are published in the Lancet Online First today.

The authors, from the London School of Hygiene & Tropical Medicine and from the Universities of Oxford and Cambridge, analysed mortality rates in working aged men (15-69 years) in post-communist countries in Eastern Europe and the former Soviet Union between 1989 and 2002. They found that mass privatisation programmes were associated with a rise in short-term adult male mortality rates of 12.8%. They suggest that unemployment, which rose by 56% during this period, was probably a key factor.

The five countries that experienced the highest rise in male mortality were Russia, Kazakhstan, Latvia, Lithuania and Estonia. Between them they saw unemployment triple (by 305%) and male mortality rise by 42%. These five countries implemented 'shock' rapid privatisation, but other countries which adopted slower rates of change fared much better.

Those that adopted a more gradual rate of change fared much better. The five best-performing countries were Albania, Croatia, the Czech Republic, Poland and Slovenia which saw a 10% fall in male mortality and only a 2% rise in unemployment. In addition to unemployment, other factors which were found to be associated with a rise in male mortality rates were stress, a decrease in the quality of healthcare (which had previously been provided by workplaces), rising social inequalities, social disorganisation and increased corruption.

Martin McKee of the London School of Hygiene & Tropical Medicine, co-author of the study, comments: 'The implications of this study are clear for countries such as China and India, which are starting to privatise large, state-owned sectors. The countries which phased in the changes gradually, and developed appropriate institutions aimed at helping workers to adjust, did not see these huge rises in male deaths. We found that when 45% of the population were members of at least one social organisation, then there was no longer a significant association between privatisation and male mortality'.

David Stuckler, the lead author, from Oxford university, comments 'This study helps us to understand the crucial consequences for health of the economic choices made by governments'.