The social consequences of the fall of Communism : a sociological analysis of the health crisis in Eastern Europe
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Sociological interest in the relationship between the social structure and health began with the classic work of Durkheim, who first identified socially constructed patterns of suicide rates in Western European countries. Drawing on this structural tradition, a large literature has investigated how health is influenced and shaped by societal factors. Despite a great deal of research on the social causation of health, however, the potentially adverse effects of social structures have been rarely studied. If people's health is linked to broader social conditions, then it follows that health is also subject to societal disruption, especially in the wake of the breakdown or failure of the existing social structure. This dissertation advances our understanding of the relationship between the social structure and health at the population level, focusing on post-communist Eastern Europe as a case study. There are three interrelated goals in this dissertation: first, to elucidate differences in health and mortality outcomes between East Central Europe and the former Soviet Union; second, to numerically substantiate the association between drastic social change and the risk of death due to suicide; and third, to reveal the structural factors related to overall population health status in Eastern Europe. Using aggregate-level data for Eastern European countries for the post-communist period, I find that (1) there are growing inequalities in life expectancy and infant mortality between East Central Europe and the former Soviet Union, and mechanisms associated with disparities vary by gender and age; (2) consistent with Durkheim's theory of suicide, drastic structural change is related to increased suicide death rates for the period immediately after the collapse of communism; and (3) the malfunctioning of the social structure is inversely associated with the health status of populations. Taken together, fully understanding the health consequences of communism's fall in Eastern Europe requires research that looks beyond individual-level risk factors to incorporate the broader characteristics of the social structure in which populations are embedded.