The fall of Communism in Eastern Europe happened nearly thirty years ago, but historians are still piecing together what life was like behind the Iron Curtain. Many of the narratives about Communist regimes gravitate towards the major countries that pursued reformist policies, like Russia and China, but few texts focus on many of the satellite countries that also went through a period of Communist upheaval during the 20th century. There has been little written about the Hungarian People’s Republic (HPR) that discusses what daily life consisted of—and what health looked like—during the forty years it was a communist state. Rather than looking at the political or economic terrain of Eastern European countries, in this post, I will investigate the ties between public and mental health in the Hungarian People’s Republic.
Despite Budapest becoming a hub for medical breakthroughs and superior dental medicine in the late 19th and early 20th centuries, little has been written on the role Communism played in shaping this distinct part of Hungarian intellectual culture. Since an array of medical figures in the early 20th century came from Hungary, like Albert Kenessey and Ernő Jendrassik, it is surprising that its more modern history has been neglected, particularly because the health challenges that proliferated in the Communist period still plague Hungarian culture today.
Under Eastern European Communism, the government’s primary goal was to build up infrastructure to increase the economic success for the country. Especially in agricultural states such as Hungary, the shift from crop production to manufacturing drastically cut down the number of laborers who could till the land and reduced the amount of food that could feed the country’s populace. Legislators also assumed that under Communism, disease and illness would be extinguished because governments would implement universal health care. However, with most resources being used for industrial production, this goal was both tremendously unfeasible and scientifically impossible to accomplish. [1]
Unsurprisingly, given these aspects of Communist governance, the distribution of healthcare under the Ministry of Health was ineffective for the Hungarian people. Striving for universal care, medical facilities were stretched thin both with material resources and with medical personnel. While more people were covered by health insurance (from approximately 30% of the population in the 1930s and 1940s to universal care in 1972), the quality of care drastically decreased.[2] Doctors took bribes to offset their low pay, overcharged their patients, and even left them in hospital beds for longer than needed if the patient was wealthy.[3] Many facilities had few beds to offer the sick and elderly, and basic amenities like pain relievers and penicillin were always scarce.[4]
The outcome of this toxic combination of deteriorating health care and the push for massive economic growth (which never occurred) was mass consumption of tobacco and alcohol. While alcohol consumption had been culturally significant in Hungarian culture for generations prior to the mid-twentieth century, the rate of tobacco consumption and alcohol-related diseases increased substantially during the Communist years. According to a tobacco study done in 2013, “between 1966 and 1986, the estimated number of cigarettes smoked per person per day (sales-adjusted) increased from about 12 to 14 for men and from 3 to 4 for women, further increasing to around 6 for women in the late 1990s.”[5] And alcohol abuse persisted even after the country was liberated from Communism: as we see in Figure 1, the rate of cirrhosis grew exponentially in the latter decades of Communist occupation and into the 21st century.
Figure 1. Chronic Mortality Rates, Hungary. World Health Organization.
Like other Eastern European countries under Communism, the situation in Hungary was characterized by loneliness, exhaustion, and hopelessness (as reminisced, for instance, in Slavenka Drakulic’s 1991 memoir How We Survived Communism and Even Laughed). Importantly, the Hungarian experience under Communism also resulted in adverse health outcomes, particularly as citizens attempted to cope with their depression and stress by using alcohol and tobacco.[6] This self-medication had adverse consequences for both the physical and mental health of citizens: in a study that researched the correlation between alcohol abuse and suicide, the results illustrate a sharp spike in suicide deaths under the Communist regime. As suicide did not hold the same stigma as it did in other neighboring countries, and since most suicides were done by hanging (a method that is difficult to play off as anything other than suicide), the numbers are more accessible for analysis. As we can see in Figure 2, there was a strong correlation between the increased volume of alcohol consumed per capita to the number of deaths per 100,000 people in Hungary. Perhaps surprisingly, the history of suicide in Hungary during the 20th century has not resulted in much study, although scholars have noted that the act did not hold the same stigma as it did in neighboring countries.
Figure 2. Trends in alcohol consumption (litres absolute alcohol per capita) and suicide rate (per 100,000 inhabitants) in Hungary 1950-1990. Skog and Elkes, 1993.
Even today, the suicide rates and rates of alcoholism in Hungary are some of the highest in Europe.[7] In 2016, Hungary had the third highest rates of suicide after Lithuania and Russia.[8] It is no coincidence that the three nations that have the highest suicide rates are still coping with the legacy of Communist governance in the 20th century. After the fall of Communism in Europe, the new governments of the 1990s strongly pushed for “de-Communizing” tactics that reshuffled eastern European societies once again. But instead of correcting the weak links of universal health care in Hungary, the new government pushed for a widespread upheaval of government departments that ultimately left larger problems unattended. The health care reforms neglected to develop preventative programs to combat malnutrition, to address environmental health reinforcement and education, and to reduce the rate of alcoholism.
A legacy of the major fractures that Communism wrought in Hungarian society throughout the twentieth century, the physical and mental health problems that progressed under the Hungarian People’s Republic have carried over into the present day. It remains surprising how few research attempts have been made to better understand the sociopolitical context behind the history of suicide and alcohol abuse in Hungary, which would allow policy-makers to draw parallels in the present and change policies for the future. It is necessary that these histories be told – and not just in Hungary, but in the other countries that were under the Iron Curtain in the twentieth century – in order to achieve meaningful change in the well-being of citizens in post-Communist regimes.
Molly Nebiolo is a PhD student in World History at Northeastern University studying the history of medicine in the early modern period. She is also pursuing a graduate certificate in Digital Humanities.
[1] Kovrig, Bennett (1970). The Hungarian People’s Republic. Johns Hopkins Press: Baltimore, MD. P. 75
[2] Marree, Jorgen and Groenewegen, Peter P. (1997). Back to Bismarck: Eastern European Health Care Systems in Transition. P. 77.
[3] Heinrich, Hans-Georg. (1986). Hungary: Politics, Economics and Society. P. 114.
[4] Ferguson, Shannon C. and Irvine, Ben. (2003) Background Briefing: Hungary’s Healthcare System. Retrieved 22, October 2017. https://pdfs.semanticscholar.org/f2c8/bedee6d55619ef12b3b1cb05b35da07bdebf.pdf;
Korda, Michael. (2006) Journey to a Revolution. Success Research Corporation: New York, NY. P. 116.
[5] Forey, B., Hamling, Jan, Hamgling, John, Thorton, A., and Lee, P. (2013) International Smoking Statistics, Web Edition. P N Lee Statistics & Computing Ltd: Sutton, UK. P. 8
[6] Drakulic, Slavenka. (1991) How We Survived Communism and Even Laughed. W.W. Norton and Company: New York, NY.
[7] Szalai, Julia. (2013). Hungary’s Bifurcated Welfare State. Adam Smith Research Foundation: Glasgow, UK.; Lazeri, Ledia. (2017). World Health Organization: Hungary. Retrieved 20 November 2017. http://www.who.int/countries/hun/en/
[8] http://hungarytoday.hu/news/hungarys-suicide-rate-still-europes-3rd-highest-despite-declining-tendency-51086