One of the most significant developments in world health in the late twentieth century is the decline in life expectancy in the former Soviet Union and Eastern Europe. This situation is without precedent in modern history. Nowhere else has health worsened so seriously in peace-time among industrialized nations. Ironically, these countries sponsored a communist ideology of socioeconomic equality that theoretically should have promoted health for all. However, the reverse occurred, and life expectancy for many people has been declining for over three decades. This is a surprising development. The likelihood that an entire group of industrialized societies under a stable administrative system would experience such a prolonged deterioration in public health was completely unexpected (Eberstadt 1994:217). Not only is this circumstance a health disaster for the individuals and societies involved, but it also represents an intriguing puzzle to be solved since a full explanation about why this happened has not been forthcoming (Eberstadt 1994; Makara 1994).
The purpose of this book is to solve that puzzle by providing an explanation for the rise of adult mortality in the former socialist countries. Although there are accounts identifying individual risk factors like alcohol abuse, smoking, and poor nutrition as major reasons for the downturn in life expectancy, it will be argued that these factors have their origins in the social conditions and behavioral patterns prevalent in society at large. To claim that alcohol, smoking, or poor eating habits are responsible for the large number of premature deaths does not explain why so many people in the former Soviet-bloc nations drank alcohol, smoked, or consumed less nutritious food to the extent that they significantly shortened their lives. As