The Wounds of Post-Socialism: The Political Economy of Mortality and Survival in Deindustrialising Towns in Hungary
Background: In this dissertation I examine the political economy of the post-socialist mortality crisis as experienced in deindustrialising towns in Hungary. I develop and apply a relational political economy of health framework, putting emphasis on the economic institutions of post-socialist dependent capitalism in Hungary, as embedded in the semi-periphery of the global economy, their gendered implications and their cultural construction. Methods: I follow a mixed-method strategy combining quantitative and qualitative analyses. I rely on a novel dataset comprising data on settlement, enterprise, and individual levels. 260 companies and 52 towns were analysed in two waves. I group towns into severely and moderately deindustrialised categories (1989-1995); as well as into dominant state, domestic private and foreign ownership dominated categories (1995-2004). Population surveys in these towns collected data on the vital status and other characteristics of survey respondents’ relatives. I assess the relationship between deindustrialisation, dominant ownership and the mortality of individuals by random intercept multilevel discrete-time survival modelling. I also investigate the health implications of the lived experience of economic transformation in four towns with diverging privatisation and deindustrialisation histories through a qualitative thematic analysis of 82 in-depth semi-structured interviews. Findings: Severe deindustrialisation is associated with a significantly larger odds of mortality for men between 1989 and 1995 (OR=1.12; 95%CI=1.00-1.26; p=0.042). On the other hand, prolonged state ownership is related to a significantly lower odds of dying among women, compared to towns dominated by domestic private ownership (OR=0.74; 95%CI=0.62-0.90; p=0.002) or towns dominated by foreign investment (OR=0.79; 95%CI=0.65-0.96; p=0.019) between 1995 and 2004. The multi-sited semi-structured qualitative interviews revealed that companies are central institutions in the cognitive maps of workers and that the fates of these companies affected the health of workers in multiple ways, whereas state involvement was perceived as a cushioning mechanism. Interpretation: Severe deindustrialisation was a crucial factor behind the post-socialist mortality crisis for men, whilst prolonged state ownership was associated with the protection of life chances for women. The indirect economic benefits of foreign investment do not translate automatically into better health. Rapid economic transformations threaten health; they should be avoided where possible, but if this is not possible, strong safety nets should be in place.