EAR

See Brain; Hearing

EAST EUROPE AND FORMER USSR

At the start of the twenty-first century, over four hundred million people lived in eastern Europe and the former Soviet Union, more than in all of North America. Spanning twenty-seven independent countries, these populations represented every imaginable situation in which people grow old. Predominant religions in these countries included Islamic (central Asia and Albania), Orthodox (most European former Soviet republics, Bulgaria, Romania, and Serbia), and Roman Catholic (Poland, Czech and Slovak Republics, Croatia, and Slovenia) with important and substantial religious minorities throughout the region. Low per capita real incomes, with annual purchasing power equivalent to one or two thousand U.S. dollars, characterized central Asia and parts of the Balkans. Countries in central Europe (Poland, the Czech Republic, and Hungary) and the Baltic republics (Estonia, Latvia, and Lithuania) were much more highly educated, urbanized, and industrialized, but real annual incomes again lagged behind other features of development, with purchasing power equivalent to five to seven thousand U.S. dollars per capita.

Aspects of family organization, variations in centralization of government, and other important variations also distinguished these countries. Finally, the rate and level of population aging also varied tremendously across eastern Europe and the former Soviet Union.The youngest countries (Turkmenistan and Tajikistan in central Asia, on the northern borders of Iran and Afghanistan) counted less than 4 percent of their people at ages sixty-five or older. More than 40 percent were children below age fifteen, so for each person sixty-five or older these countries had ten children under fifteen.

By contrast, the oldest countries in the region, Bulgaria and Hungary, counted about 16 percent of their people at ages sixty-five or older. A matching 16 percent had not yet reached age fifteen, so for each person sixty-five or older there was only one child under fifteen. The percentage of people aged sixty-five or older was four times higher in the two old eastern European countries than in the two young central Asian countries. These examples were among the youngest and oldest populations found anywhere in the world at the turn of the century.

Population aging and the birth rate

Despite this cultural and economic diversity, only one fact is needed to explain such age contrasts. Low birth rates produce old populations. High birth rates produce young populations. Mortality and migration can affect age structure, but fertility dominates the picture. In this sense, the story of population aging is a simple one.

Figure 1 shows this graphically for eastern Europe and the former Soviet Union. The vertical axis measures children that a woman in each country could expect in her lifetime, given birth rates at the end of the century. The horizontal axis shows a ratio of people at age sixty-five or over to people under age fifteen. Bulgaria and Hungary, as described above, appear in the lower right corner of this figure. Turkmenistan and Tajikistan occupy the top left corner. All the other countries of the region array themselves along a line between these extremes, except for one country (Bosnia-Herzegovina) in the bottom left part of the figure that falls below this imaginary line.

Bosnia-Herzegovina had a higher birth rate during the twentieth century than most countries in eastern Europe. As a result, at the end of the century its youthful age structure still resembled Moldova or Armenia. However, Bosnia's birth rate fell drastically in the 1990s in the context of tragic political events. By the end of the century the birth rate looked "too low" for such a young country. Neighboring Albania, by comparison, had an even younger population. However, this even more Islamic country still had a high birth rate at the end of the century, so it conformed to the pattern in Figure 1. The apparent inconsistency of a young Bosnia with a low birth rate was only a transitional phase. With continued low fertility, population aging would bring Bosnia back into the pattern of other countries.

Sex ratio contrasts in old age

Like the rule that low birth rates make old populations, the sex difference in survival forms another worldwide demographic constant. At younger ages, low absolute death rates keep this difference from having much demographic effect. The sex ratio in all countries hovers near one man per woman until about age fifty. As people grow older and death rates increase, however, the survival difference begins to matter. Each generation becomes more "female" in old age. The ratio of men to women declines from about one man per woman at age fifty, to less than half a man per woman (or more than two women per man) by about age eighty. At the turn of the century, this rule was equally true in very young central Asian republics and in much older eastern European populations. However, the larger share of people at old ages in the European populations meant that the weight of the social problems created there was greater. The clearest such consequence concerns marital status at advanced ages.

Marital status contrasts at old ages

While widowhood is the normal marital status for women at advanced ages, most of the fewer surviving men spend most of their later years married. This standard pattern appeared throughout eastern Europe and the former Soviet republics.

For example, in Hungary at the end of the century, three-fourths of all men in their seventies remained married. A majority (52 percent) of men were married even after age eighty. In the oldest country in the region (Bulgaria) and in the young Asian republics of Tajikistan and Turkmenistan, the proportions of men married at these ages were about the same as in Hungary.

By contrast, in Hungary only one-fourth of women in their seventies remained married. Less than one woman out of ten remained married after age eighty. Just as for men, the percentage of women married at old age were about the same in the young Asian republics as in old eastern Europe.

Even though the shares of women married or widowed by age were about the same across all of these very diverse countries, population aging magnified the "widow problem" in older countries. For example, in younger Kazakhstan, percentages unmarried translated into slightly more than half a million unmarried women over age sixty-five, or about one out of every fourteen women in the total female population. In older Poland, similar percentages of unmarried women translated into almost two million unmarried women over age sixty-five, or about one out of every ten women in the total female population.

Availability of children

Because most women at old ages have no husbands, children become an important alternative source of social contact and support. However, the same low birth rates responsible for population aging also guarantee fewer children in aging populations. Figure 1 showed this parallel for entire populations, though Total Fertility Rates are only temporary annual measures of childbearing. Their volatility overstates long-term changes in completed family sizes. For individual women in populations, the change is less dramatic but still noticeable for different generations. Lifetime completed fertility of women also declined throughout the region. The long-term decline began earlier in the twentieth century in eastern Europe, and extended into the twenty-first century in the central Asian republics. Children as sources of support became more scarce at precisely the time that older widows increased as a share of the population.

This demographic paradox was accented in several eastern European and former Soviet countries at the turn of the century by the legacy of very severe losses of young men during the Second World War. Particularly for Russia, Germany, and other central combatants, an unusual share of women growing old as the twentieth century came to an end had either lost husbands early in life or never married at all. They were particularly unlikely to be married or to have any children or other immediate family. As their generation gradually passed from the stage in the twenty-first century, this intense shortage of family ties in a few countries was relaxed for younger generations.

Government support of aging populations

Not only do low birth rates directly cause population aging in a purely arithmetic way, by reducing the relative number of young people, but the economic and political context of these trends further reinforces the relationship. Traditional family-based intergenerational networks become unworkable when challenged by more people (mostly women who no longer have husbands) surviving longer, with fewer children. Many countries in the world faced this problem, and raised taxes on working-age households to pay for new programs for the growing older population. Demographic aging coincided with the appearance of the "welfare state" in many countries. In the national budgets of several prosperous but demographically old western European countries at the turn of the century, it was common for government revenues to account for nearly half of the total gross domestic product of the economy. Heavy taxes reduced disposable income of younger families, further discouraging births. Fewer births then reinforced population aging, in a spiral that generated growing concern among policy makers and scholars of population worldwide.

This strategy was no longer available to governments in eastern Europe and the former Soviet Union entering the twenty-first century. They were saddled with a legacy of centralization, mismanagement, and oppression that thoroughly discredited the previous political system, and for many people, destroyed trust in government itself. Alienation and cynicism, pervasive throughout the region, produced massive evasion of taxes. The state sectors of these economies shriveled throughout the region, from the Baltic to the Caspian Seas. At the turn of the century, available figures showed government revenues as a far smaller share of gross domestic product in these countries than in western Europe (even assuming that it was possible to measure gross domestic product in these disrupted economies).

Governments faced with revenue collapse had to decide where to allocate meager remaining funds. One victim of the shortage of government money was the health care system, since in all these countries the health professions had been largely absorbed into government employment. To the extent that this remained the case, health care was starved of resources. To the extent that health care was privatized, it immediately became inflated out of the reach of many ordinary citizens of these countries. As a result, economic prosperity was linked to enjoyment of healthy old age, both within and between countries in eastern Europe and the former Soviet Union. Figure 2 shows that in more prosperous countries (particularly central Europe and the Baltic republics) the share of life spent by women in a disabled state was much smaller than in poorer countries of the region (particularly the central Asian republics). For example, the relative prosperity of the Czech Republic explains why health in old age was better in that country (see Fig. 2). Of course, the link between money and health is not unique to this region. It appears wherever market forces dominate life.

Hardest-hit of all sectors of the population were the growing numbers of old-age pensioners, a crisis made even worse by the peculiar retirement ages adopted in the state socialist epoch: men generally retired at sixty, and women in many of these countries retired at fifty-five even though they consistently outlived men by many years. Actuarial pressures raised these ages in several countries after the collapse of state socialist governments, but even so, older citizens of the countries in eastern Europe and the former Soviet Union found their monthly benefits shrank to the vanishing point in real purchasing power. Although largely invisible because it involved people too old and frail to take to the streets and too dependent to go on strike, the resulting poverty and desperation formed a very real human tragedy.

In terms of care of the oldest members of the population, the initial transition out of communism is judged by history as a discouraging failure. However, precisely because the societies of eastern Europe and the former Soviet Union could not turn to old answers of the twentieth century in responding to population aging, they entered the new century with a stronger incentive than any other part of the world to develop new and innovative ways to deal with this demographic challenge.

For further details about the situation in eastern Europe and the former Soviet Union, and for sources of many figures used here, consult the U.S. Census Bureau publication Aging in Eastern Europe and the Soviet Union, by Velkoff and Kinsella and see the Internet web sites of the World Health Organization and the World Bank.

Elwood Carlson

See also Population Aging; West Europe.

BIBLIOGRAPHY

Carlson, E. "European Contrasts in Sex Ratios: Implications for Living Arrangements in Old Age." European Journal of Population 6, no. 2 (1990): 117–141.

Coale, A. "How a Population Ages or Grows Younger." In Population: The Vital Revolution. Edited by Ronald Freedman. Garden City, N.Y.: Doubleday-Anchor, 1964. Pages 47–58.

United States Census Bureau. Aging in Eastern Europe and the Soviet Union. Washington, D.C.

Velkoff, V., and Kinsella, K. Aging in Eastern Europe and the Former Soviet Union. Washington, D.C.: U.S. Government Printing Office, 1993.

World Bank. "World Development Indicators." Available on the World Wide Web at www.worldbank.org

World Health Organization. "World Health Report 2000." Available on the Internet at www.who.org