Health and Social Change in Russia and Eastern Europe

Since lifestyles are the most likely primary social determinant of the downturn in longevity in the former socialist countries, it is necessary to discover why this is the case. The initial step in this process is to present a theoretical perspective to guide subsequent discussion. As defined in the last chapter, health lifestyles are collective patterns of health-related behavior based on choices from options available to people according to their life chances. Consequently, the behaviors that people select which affect their health, either positively or negatively, are not simply random acts of individuals but constitute a recognizable pattern of activities specific to certain groups, social strata, and societies.

Investigating this situation not only helps explain the rise in mortality in the former Soviet bloc, but also addresses a fundamental debate in sociology and other social sciences over the relative contributions of structure and agency Structure refers to the collective patterns associated with societies, institutions, social classes, communities, groups, and roles that both constrain and enable individuals, while agency is the freely chosen activities of individuals. Structures, then, can be conceptualized as sets of mutually sustaining schemas (rules) and resources that empower and constrain social action and tend to be reproduced by that action (Sewell 1992:19). Agency, in contrast, is a process in which individuals—influenced by their past but also oriented toward the future (as a capacity to image alternative possibilities) and the present (as a capacity to consider both past habits and future situations within

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