Around seven million Eastern Europeans died prematurely as former socialist economies transitioned to capitalism. To better understand this health crisis, we combine insights from Marx and Durkheim and present a novel theory on deindustrialization, social disintegration, and health. We substantiate this framework by analyzing 82 interviews with workers in deindustrialized Hungarian towns.
The debate on the “Deaths of Despair” has drawn attention to how deindustrialization acts as a major burden on workers’ health in the U.S. A decade before the onset of this American health crisis, an even more severe mortality crisis struck countries in Eastern Europe. Total excess mortality could have been around 7.3 million in 1990-1999 in Eastern Europe.
In parallel to this epidemic of excess deaths, Eastern European countries also experienced a severe industrial employment decline. This unprecedented mortality crisis and destruction of industrial capacity have widespread implications for the social fabric but have been neglected by sociologists.
In our recent study, we present a novel neoclassical sociological synthesis theorizing the deindustrialization-health association. We combine Durkheimian and Marxian concepts showing how deindustrialization creates ruptures in economic production that spill over to the field of social reproduction and gets embodied as ill health or dysfunctional health behavior.
Deindustrialization and ruptures in economic production
The industry’s collapse as an institution is a disintegrative process, creating ruptures in economic production that only a multidimensional analysis can capture. First, deindustrialization is a prime source of (1) labor market dislocation (job/income loss). In Eastern Europe during the early 1990s, many lost their jobs and permanently exited the labor market. Some could retire, others joined the ranks of the sub-proletariat (or underclass).
Second, deindustrialization also leads to (2) increased exploitation (work-load, precarity). Deindustrialization shifts the risks previously socialized through welfare arrangements back to workers. For example, fewer workers have full-time jobs with an unlimited contract, and more of them work as freelance pizza delivery “entrepreneurs,” taking on all the risk it entails. This was even more pronounced in socialist Eastern Europe, where securing a modicum of stability and welfare for workers was crucial for the legitimacy of socialist regimes.
Third, deindustrialization (3) increases social inequality (income, race/ethnicity). The industrial sector typically offers higher wages than the service sector, where wages are lower and unequal. Deindustrialization thus leads to rising income inequality. The same is true for Eastern Europe, where inequalities have also grown, and upward mobility has stagnated. Deindustrialization disproportionately hit the Roma ethnicity in Hungary, contributing to racial discrimination and segregation.
Fourth, deindustrialization also leads to (4) disruption of community services. Industrial companies usually provide a wide array of fringe benefits and health insurance coverage. The jobs that emerge after deindustrialization provide less of these benefits. The destruction of the industry also puts local government budgets under pressure, which must downsize public services to maintain fiscal balance.
Deindustrialization and ruptures in social reproduction
As deindustrialization transforms the field of economic production, its effects also spill over to the field of social reproduction. First, labor market dislocations and the disruption of services cause (a) material deprivation and physical suffering. Sudden loss of income creates multiple new stresses, such as increased food insecurity, difficulties with paying the mortgage, rent, or utilities, and poor housing conditions, which negatively affect health.
Second, increased exploitation leads to (b) job strain. Several workers we interviewed talked about increased stress even though they could keep their jobs. Increased exploitation in the precarious jobs emerging after deindustrialization increases job strain, leading to mental health problems. This implies that the effect of deindustrialization goes beyond income and job loss.
Third, labor market dislocations cause (c) fatalism and shame. Work identity is central to workers’ self-conception: they derive a positive sense of self from disciplined, hard industrial work. When individuals cannot fulfill the roles prescribed by their identity, it leads to fatalism, shame, and inferiority. Fatalism appears to be an essential factor in the deaths of the despair epidemic in the U.S. It was equally crucial among our interviewees in Eastern Europe.
Fourth, the disruption of public services also leads to (d) increased domestic work-load. When companies close, the decommodifying public services they provide become untenable, shifting the cost of care work onto families. Unpaid care responsibilities and the declining access to public or private care services intensify the domestic work-load, an essential source of chronic stress leading to lower self-reported health, as several interviewees described.
Fifth, social inequalities and the disruption of services lead to (e) anomie and anger. Sudden economic change (crisis or rapid growth) propels some to amass immense wealth while others fall behind. When this happens, individuals think that the distribution of hierarchy is unjust, and society’s moral order has broken down. Durkheim labeled this situation anomie. Under these circumstances, “men are more inclined to self-destruction.” Our interviewees reported widespread anger in response to the perceived injustices created by deindustrialization.
Sixth, labor market dislocation, exploitation, and the disruption of communal services lead to (f) community disintegration and hopelessness. Disintegration negatively affects workplace communities, neighborhood communities, friendships, and families. According to Durkheim, individuals left on their own find it harder to find meaning in their lives and are more prone to hopelessness. Community disintegration is a crucial determinant of ill health in the U.S. and Eastern Europe. Our interviewees described the emotional strain that the collapse of working-class communities caused in great detail.
Seventh, as Marx described, commodification, exploitation, and the disruption of services generate (g) alienation and powerlessness. Capitalism in general causes alienation, but deindustrialization intensifies it. The corollary of alienation is the sense of powerlessness. Our interviews show that the commodification of the labor process and the concomitant alienation and powerlessness damage mental and physical health. Many workers talk about a complete loss of control over their lives and a concomitant rise in hopelessness.
The figure below presents an overview of this neoclassical framework of deindustrialization and health.
Our neoclassical sociological framework combining insight from Marx and Durkheim is a novel contribution to political-economic theories of health and health inequality. Deindustrialization, the upstream policies, and the global challenges driving it are not unique to Eastern Europe. The combination of severe deindustrialization and the lack of effective regional and industrial policy created regionally locked-in left-behind areas with a cascade of social and economic problems in the East and the West. The neoclassical sociology of the lived experience of deindustrialization proposed here could be a fruitful way to analyze the root causes of the deaths of despair in other countries also.
To read more, see: Gábor Scheiring and Lawrence King. 2022. “Deindustrialization, social disintegration, and health: a neoclassical sociological approach” in Theory and Society.
Image by Raimo Papper via Flickr (CC BY-NC 2.0)