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Romania Public Health
Health care in socialist Romania was provided free of
charge by
the state and, at least in theory, to all citizens.
Indeed, between
1940 and 1980, annual expenditures for public health
increased
considerably. There was a concurrent rise in the number of
physicians and hospital beds available to the population.
In 1950
there were 9.1 physicians and 41.6 hospital beds per
10,000 people.
By 1971 these numbers had risen to 12.1 and 84.7
respectively.
Using officially reported infant mortality rates and life
expectancy figures as indicators, public health improved.
Infant
mortality decreased from 116.7 deaths per 1,000 live
births in 1950
to 49.4 per 1,000 in 1970 and to only 23.4 per 1,000 in
1984. It
should be noted, however, that infant deaths were
officially
recorded only if the infant was older than one month. Over
the same
period, life expectancy rose for men from 61.5 to 67 years
and for
women from 65 to 72.6 years.
In later years, however, infant mortality apparently
rose quite
rapidly, particularly after 1984. In 1988 health officials
confirmed the rise in infant mortality, blaming the
incompetence of
medical personnel, geographic remoteness, harsh weather,
and even
"careless and uncooperative mothers" for the higher rate
of
mortality. Western observers suggested explanations such
as harsh
working conditions, especially in the textile industry,
environmental pollution, and a food supply that was
inadequate for
the needs of expectant mothers and infants. Shortages of
infant
formula and inadequate concentrations of powdered milk
resulted in
malnutrition and death. Perhaps the greatest factor,
however, was
the government's demographic policy that forced women who
were
unwilling or in poor health to bear children. In the first
year
after the demographic policy was introduced in 1966,
infant
mortality increased by some 145.6 percent. There were even
reports
of newborns in hospital incubators dying during
government-ordered
power shutdowns. In 1989 the death rate of newborns stood
at
roughly 25 per 1,000 live births.
Although the mortality rate among the elderly decreased
during
the decades following the war, an unstable food supply,
energy
shortages, and the increasing cost of living in the 1980s
posed
grave hardship for the aged, who lived on pensions that
averaged
only 2,000 lei per month. Staple foods were rationed
throughout the
1980s and were often unavailable except at exorbitant
prices on the
black market. In late 1988, one kilogram of meat was
priced at 160
lei, or about 8 percent of the monthly pension. Cheese
cost as much
as 120 lei and coffee about 1,000 lei per kilogram.
Although
utility rates rose sharply, most people periodically had
no hot
water, heat, or electricity. In late 1988, pensions were
raised an
average 8 percent for some 1,352,000 people. It seemed
doubtful,
however, that the raise would make an appreciable
difference in the
face of erratic food and energy supplies and steadily
rising
inflation.
The elderly, who represented a growing percentage of
the
population (14.3 percent in 1986), received shoddy
treatment from
the state. Through regulations issued at the local level,
they were
unable to move to larger cities--where food and health
care were
more readily available--even when their children offered
to care
for them. There was also widespread discrimination against
the aged
in health care. Hospitals responded to emergency calls
from
citizens over 60 years old slowly, if at all. Physicians
routinely
avoided treating the elderly in nonemergency cases and
reportedly
were under strict instructions from the state to reduce
drug
prescriptions for the aged. Homes for old people,
established and
run by the state social security system, had appalling
reputations.
In these institutions, the elderly suffered from
inadequate medical
care, poor hygienic standards, and the same food and
heating
shortages that affected the general population. After 1984
the
winter months brought many complaints that old people had
to go
without heat and hot water for as long as a week, and
there were
regular reports of deaths of elderly men and women because
of poor
heating.
The disreputable treatment of the elderly was ironic in
a
country that had a long tradition of geriatrics. After
1952 Romania
had an Institute of Geriatrics, directed by Dr. Ana Aslan
until her
death in 1968. Aslan was known internationally for
developing
"rejuvenation" drugs and for a philosophy of longevity
that
stressed social factors and material needs. The First
National
Congress of Geriatrics and Gerontology, held in Bucharest
in 1988,
failed to criticize the dire situation of the elderly in
Romania.
Medical care was unevenly distributed throughout the
country
for all citizens, not just the elderly. There were
substantial
differences between urban and rural standards. In the
1980s,
although half the population continued to live in rural
areas, only
7,000 (15.7 percent) of the 44,494 physicians worked in
the
countryside. Consequently, many citizens had to travel
great
distances to get medical care. The state did not provide
free
medical care to some 500,000 peasants and 40,500 private
artisans.
In addition, access to medical care often depended on the
gratuities proffered. It was common to offer medical
personnel
money, food, or Kent cigarettes
(see Banking, ch. 3).
Moreover the
quality of health care depended on social standing. For
example,
only special health units that served party members, the
Securitate, or the upper ranks of the military dispensed
Western
medications or had modern medical facilities comparable to
those in
the West.
Although many of the diseases of poverty had
disappeared,
cancer, cardiovascular disease, alcoholism, and
smoking-related
illnesses were prominent. Alcoholism, judging by the
dramatic
increase in production and consumption of alcohol after
the 1960s,
was a serious problem. By 1985 wine and beer production
was twice
that of 1950, and hard liquor production was four times
higher. In
1980 beer consumption was eleven times that of 1950,
brandy use was
2.2 times higher, and consumption of other alcoholic
drinks was 5.8
times greater.
Drinking was prominent in all segments of society, but
especially in the villages, where almost every occasion
for
celebration involved consumption of alcohol. Young workers
in
hostels were notorious for heavy and competitive drinking,
which
often led to brawls, destruction of public property, and
violent
crimes.
The deterioration of the standard of living exacerbated
the
drinking problem. Although food was scarce, the supply of
alcohol
was ample, and there was little else on which to spend
one's wages.
Moreover, the use of alcohol was encouraged by the
traditional
practice of offering bottles of liquor as bribes or gifts.
Finally,
official pronouncements aside, the sale of alcohol brought
considerable profit to the state, and little real progress
was made
against increased consumption despite its adverse effects
on labor
productivity and work safety.
After a long official silence on the incidence of AIDS
(acquired immune deficiency syndrome) in Romania, the
first media
references to the disease began to appear in late 1985.
Even then
the brief articles contained very little information. They
gave the
technical name and classification of the disease and
mentioned that
it was fatal but said nothing about how AIDS was
transmitted, its
symptoms, or what preventive measures could stops its
spread. The
articles mentioned only two risk groups--drug addicts and
hemophiliacs--and made no reference to the prevalence of
AIDS among
homosexual men. Most likely this omission was due to the
fact that
homosexuals as a group were never publicly acknowledged.
Not only
was homosexuality a taboo subject, it was illegal and
punishable by
one to five years in prison.
By 1987 Romania had reported only two deaths from AIDS
and only
thirteen carriers of the disease to the World Health
Organization.
But nothing about the cases, deaths, or carriers appeared
in the
Romanian press, which continued to emphasize that the
highest
incidence of AIDS occurred in the West, particularly in
the United
States. In 1988, however, a committee was established to
study the
disease, and between 1985 and 1987, thousands of people
were tested
for AIDS. In mid-1987 an information campaign was
initiated.
Articles in the press more frankly and factually covered
the
disease, admitting the existence of fifteen cases and two
deaths
from AIDS, as well as explaining for the first time that
male
homosexuals were the highest risk group. The symptoms were
also
listed. Still, efforts to combat the disease may have been
seriously hampered by sexual taboos that persisted in
Romanian
society. High-risk groups such as homosexuals and
prostitutes were
unlikely to voluntarily submit to screening for fear of
going to
jail. In addition, the health service was impaired by the
country's
economic deterioration, and there was little hard currency
available to purchase necessary testing and diagnostic
equipment
and supplies from the West.
Data as of July 1989
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