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INTRODUCTION
In the early 1990s, the post-communist countries of Eastern Europe and the former Soviet Union (FSU) initiated changes that would fundamentally transform their political and economic institutions. Coincident with these changes, many countries in the region experienced a dramatic increase in mortality, especially among working-age males. Various studies have investigated this mortality spike, but debate continues on the underlying causal mechanisms.1
In a recent well-publicized contribution to this literature, David Stuckler, Lawrence King, and Martin McKee, henceforth SKM, argue in The Lancet that 'rapid mass privatization [of state-owned enterprises] ... was a crucial determinant of differences in adult mortality trends in post-communist countries' (Stuckler et al. , 2009, p. 1).2 The evidence offered in support of this claim consists of country-level regressions of the adult male mortality rate on measures of enterprise privatization. The authors' primary interpretation is that rapid privatization increased unemployment and consequently illness, for which they offer support from country-level analysis of unemployment. The estimated effects of mass privatization on both mortality and unemployment are reported to be positive and statistically significant only in the FSU; no evident effects are reported among Central and East European countries.
The publication of SKM's study has reignited debate over the effects of economic reform. The provocative tone of the Economist leader on the topic, titled 'Mass Murder and the Market', reflects the stakes involved: should reformers be held responsible for millions of premature deaths?3 Jeffrey Sachs, an architect of 'shock therapy' in post-communist countries, suggests that the study is a 'confused polemic that will not withstand serious epidemiological scrutiny'.4 On the other side, Joseph Stiglitz argues that '[the] Lancet is right that Poland was an example of more gradual policies', following SKM's suggestion that gradualism should be credited with reduced mortality, and he reasserts his view that ' "shock therapy" was a disastrous economic policy'.5
Did mass privatization increase mortality in post-communist countries? In this paper, we reexamine this relationship. We find that the estimated effect of privatization in cross-country data is not robust to recomputing the mass privatization measure using original-source data, to assuming short lags between economic policies and changes in mortality rates, and to controlling for country-specific mortality trends. We also examine the relationship between privatization...