From the mid-1960s to the late 1990s, male life expectancy in Bulgaria has been slowly but continuously turning downward in a yet unbroken decline. Longevity for women, in contrast, has steadily increased during the same period. What is it about the health situation of Bulgarian males that has been cutting off their life expectancy for approximately 30 years? This chapter examines this question in a search for the answer.
Bulgaria, with a 1994 population of 8.4 million people, is the southern-most Eastern European country and shares borders with Romania, Serbia, Macedonia, Greece, and Turkey. The original Bulgarian state was founded in 681 and was among the most powerful and advanced kingdoms of Europe in the early Middle Ages (Kaplan 1993). A predominantly Slavic nation, Bulgaria experienced cycles of regional power and decline before having its independence extinguished by the Turks in a series of battles fought between 1366 and 1396. The country was ruled by various Turkish overlords for nearly 500 years and cut off from the rest of Europe. Its population was generally relegated to the role of peasant farmers, and the arable land devoted to agriculture. As Robert Kaplan (1993:205) explains:
This chapter was written with the assistance of Nevyana Feschieva, M.D., Ph.D., Head, Department of Social Medicine and Biostatistics, Medical University, Varna, Bulgaria.