Public Health in East and Southeast Europe: Growth, Inequality and the state. Contemporary and Historical Perspectives

Public Health in East and Southeast Europe: Growth, Inequality and the state. Contemporary and Historical Perspectives

Olga Popova / Gergana Mircheva, Leibniz-Institut für Ost- und Südosteuropaforschung (IOS), Regensburg
Fand statt
In Präsenz
Vom - Bis
13.10.2022 - 15.10.2022
Nikola Gajic / Sara Žerić, Leibniz-Institut für Ost- und Südosteuropaforschung (IOS), Regensburg

The Ninth IOS Annual Conference came after two years break due to the COVID-19 pandemic. Being partially provoked by the recent pandemic, the conference addressed newly emerged phenomena that appeared during the pandemic within the regions of East and Southeast Europe. Looking at them from various academic disciplines, it also reminded us of the highly important subject of public health from the historical perspective. The aim of the conference was to shed light on the interrelations between public health, economic growth, and social inequality. By emphasizing and pointing to certain aspects of public health from the historical perspective, the conference aimed to show their reflections and casualties in contemporary societies. This report summarizes the papers presented at the conference and highlights major discussion topics.

The directors of the Leibniz institute, Ulf Brunnbauer and Hartmut Lehmann (Regensburg), addressed the guests and emphasized the importance and topicality of the conference, not just from the area studies’ perspective but on a global level as well. After this introduction, Olga Popova (Regensburg) and Gergana Mircheva (Sofia/Regensburg) jointly introduced the conference themes.

A major highlight was a keynote lecture delivered by DORA VARGHA (Berlin) on inequalities, consequences and the endings of epidemics in Eastern Europe. In the time of frequent and populistic proclamations of an "end" of the COVID-19 pandemic in many East European countries, Vargha gave a historical overview and offered a broad insight into the strategies that states are using to announce that a certain pandemic has come to an end. By giving various examples and focusing on the crucial points in each of them, she presented the similarities and differences between these cases. The keynote lecture concluded with a few cautious predictions for the future.

A panel on international influence and networks started with the presentation on conflicting demands in the foundation of public health initiatives in South-Eastern Europe before the First World War by CHRISTIAN PROMITZER (Graz). He addressed the historical roots of the still-existing orientalist and imperialist concept of the Western European states regarding the Balkan countries and their attitudes toward public health and hygiene. To locate the cleavages and trace the dynamics in the long-lasting process of modernizing and constructing public health systems in the newly established Balkan states during the 18th century, Promitzer focused on concepts of hygiene, medicalization, professionalization, and the interplay between power and science. In the concluding remarks, he stated that modern healthcare systems in Southeast Europe were highly influenced by Western standards. The agents of this influence, through the process of knowledge transmission, were the Europeanizing elites of the new nation states, who perceived the local population as traditionalist.

EVGUENIA DAVIDOVA (Portland) gave a talk on preventive healthcare in interwar Southeast European countries. She presented her comparative study on a relatively novel field within the social history of medicine and public health in Southeast Europe, introducing three different contexts in which public health nursing has already been established (USA) or developed (Bulgaria and the Kingdom of Serbs, Croats, and Slovenes/Yugoslavia). Against this background, Davidova underlined that, while at the beginning of the 20th century flourishing public nursing in USA served as an instrument of care for the poor and for the Americanization of immigrants, in Bulgaria and Yugoslavia it was part of a wholesome public healthcare reorganization during and after the First World War. Davidova analyzed the importance of public nursing in the case of the two Balkan countries, as it not only bridged the clinical and home combating against emerging social diseases, but also reshaped the existing gender norms.

VEDRAN DUANČIĆ (Klagenfurt) presented his work on the intertwined local and global meanings of primary health care in late socialism. He introduced the larger context of global health initiatives in the 1970s and the 1980s. Following the context, he then observed the strategic plan Yugoslavia had for the global transfer of (medical) knowledge and technology within the sphere of public health by looking at its participation at the WHO conference on public health in Alma-Ata in September 1978. After discussing the Yugoslav stances on the matter through their participation at the Alma-Ata conference, Duančić described the dynamics of the implementation process of the Yugoslav plan. He concluded that the plan was effective at its core, because it has managed to facilitate the transfer of knowledge and technology as crucial preconditions for economic, social, and cultural prosperity.

The second panel discussed questions of health and political environment, starting with a presentation by ANELIA KASSABOVA (Sofia) who analyzed the contradictions of the Bulgarian socialist demographic and health policies and the various social inequalities they produced within the alleged “needs-based health system”. The study focused on the work of Vladimir Kalaydzhiev, a key figure in the Bulgarian political scene and an influential public health administrator. By following Kalaydzhiev’s work, Kassabova managed to capture the inner tensions between the reformist dynamics in the country’s health system, on the one hand, and the following of ideological dogmas, on the other hand.

JAN AREND (Tübingen) analyzed the development of the term “stress” and the semantic changes it faced in Czechoslovakia/Czechia from the 1960s to the 2000s. The report pointed out how the social, political and economic changes that came with the collapse of socialism influenced the heterogenious body of expert and popular knowledge which defined “stress” and its management. By outlining different discourses and practices, Arend interpreted the “stress” concept as a way to describe people’s experience of rapid postsocialist transformations in everyday life.

ILIA NADAREISHVILI (Tbilisi) presented his joint work with KARSTEN LUNZE (Boston), in which they gave an overview of the national strategic responses to the COVID-19 pandemic in Georgia and analyzed these responses from the political, socio-economic, and cultural perspective. The report was based on the health policy analysis using a policy triangle framework that focuses on the content of policy, actors, context, and process. In the concluding remarks, Nadareishvili argued that the efficiency of the national strategic responses towards the pandemic crisis would be higher with the ensured apolitical and evidence-informed policies. Lastly, he pointed out that the success and acceptance of these policies are highly dependent on the volatile political and geopolitical relations, as these two factors consequently influence evidence-informed policy-making by potentially creating inconsistencies in decision-making and communication with the targeted audience.

The third panel on vaccination resistance started with JOSIP GLAURDIĆ and CHRISTOPHE LESSCHAEVE (Luxembourg) who explored the political foundations of vaccine hesitancy in the successor states of former Yugoslavia. By analyzing the results of a survey conducted on more than six thousand respondents from Bosnia and Herzegovina, Croatia, and Serbia, and by interpreting the data on the public health, economy, and sociodemographics of more than five hundred municipalities in Croatia, the authors concluded that vaccine hesitancy is strongly tied to the level of people’s support of nationalist populist ideas and the political parties representing these ideas.

MRIKA ALIU (Prishtina) presented the joint research on COVID-19 vaccine acceptance among marginalized populations in Kosovo that she did together with Ha Thi Hong Nguyen (Prishtina) and other contributors. At first, she gave an overview of the targeted minority groups and the overall course of the COVID-19 pandemic in Kosovo. The research has been based on a qualitative analysis of interviews and focus group discussions among the stakeholders and members of the Roma, Ashkali, and Egyptian communities. The study aimed at identifying barriers and facilitators for vaccine acceptance among the members of the aforementioned minority groups. After listing the findings and revealing the reasons why the members of these minority groups got vaccinated or were reluctant to do so, Aliu concluded that the epidemic measures and state policies should be specifically tailored to these groups. In addition, the usage of multi-component interventions would increase vaccine acceptance and reduce the COVID-19 infection rates.

ELIZAVETA PRONKINA (Paris) presented the joint study with her co-authors asking if past communist regimes can explain the vaccination divide in Europe. She emphasized that as of November 2021, all former Communist countries from Central and East Europe exhibit lower vaccination rates than the countries from Western Europe. Therefore, the aim of the study is to investigate whether institutional inheritance can explain the difference between these two groups of countries concerning vaccination decisions. By analyzing the data from the SHARE (Survey of Health, Ageing, and Retirement in Europe) COVID-19 module collected in 2021, Pronkina showed that the institutional inheritance of the Communist regimes indeed affected people's vaccination decisions to a certain extent.

Panel fourth on health inequalities was opened by DANIELA KOLEVA (Sofia) who focused on the privileged access to health services and social care of a specific population group in communist Bulgaria, from the 1950s onwards. This priviledged category of the population embraced the so called active fighters against fascism during the Second World War. Koleva outlined the social inequalities, produced by the state attempts to do justice by calculating the social contribution of the active fighters. Moreover, she discussed the value contradictions betwen the meritocratic principle, legitimizing the health- and social-care privileges, on the one hand, and the allegedly fundamental communist values of equality and solidarity, on the other.

RADINA VUČETIĆ (Belgrade) presented her research on the smallpox epidemic in Yugoslavia in 1972, focusing on the impact on everyday life and the socio-political implications of this epidemic. Vučetić laid out that generelly, the 1972 vaccination campaign was a success thanks to the systematic modernization of the Yugoslav health care system in the years before. Yet it also reflected inequalities in socialist Yugoslavia. Kosovo, which was the epidemic hotspot, was last to receive the vaccines, while Slovenia, whic recorded no infections, received the first batches of the vaccine.

TIJANA KARIĆ (Marburg) and VLADIMIR MIHIĆ (Novi Sad) presented the results of research on the spread of COVID-19 among the Roma population in Belgrade and Novi Sad. They had a special focus on whether the Roma were discriminated against by other populations, whether the information reached them late, whether they had rights to state benefits (such as monetary benefits) like other citizens, and how the information about vaccination reached them.

The fifth panel on state health care systems was opened by MARTIN IVANOV (Sofia) and MATTHIAS MORYS (York) who examined the Bulgarian public health care system under state socialism between 1944 and 1989. Based on data from 1910 to 1989, they challenged the dominant narrative that is used to this day to legitimize a centrally planned economy, when it comes to public health. The presenters used a large data-set of archival entries on heights, nutritional intake and consumption patterns in communist Bulgaria. Their research shows that the socialist period did not provide the breakthrough in living standards that the communist rules claimed to have achieved. One of their main questions concerned the picture of public health in the Bulgarian countryside. As they pointed out, many living standards indicators show that public health in Bulgaria improved after 1945. Moreover, Ivanov and Morys traced the connection between rural life, public health, and food consumption; and their research showed that 40 to 50 percent of people’s income was spent only on food. They reached the conclusion that despite the high state expenditures on public health and sanitation, the living standards of individuals did not improve accordingly.

Further, VIOLA LÀSZLÓFI (Paris/Budapest) examined the work of medical ethics committees set up at three Hungarian university clinics (in Budapest, Szeged, and Pécs), and those in the hospitals of Budapest in the context of the transformation of medical education in the 1970s. She discussed the extent to which these committees and the changing norms in medical education validated the ideological values and welfare ideas of the state-socialist system at the micro-level of health care, and how they mediated patients’ needs.

The sixth panel was dedicated to trust in public health. FLORIE MIFTARI BASHOLLI (Prishtina) presented results of a research that are produced by a large group of people, representing several organizations: the National Institute of Public Health (NIPH) of Kosovo, the Healthcare Faculty (University of Pristina), the World Health Organization (WHO) Office in Pristina, and Regional Office for Europe. As she argued, the most trusted sources of information were healthcare workers, NIPH, the Ministry of Health (MOH), and WHO. The institutions most trusted to handle the COVID-19 crisis were the police, followed by NIPH, MOH, hospitals, and family doctors.

ALARI PURJU (Tallin) continued with the topic of trust in institutions during the Covid-19 pandemic, but in this case in Estonia. Purju discussed some interesting facts: a comparison with neighboring countries, which are also Estonia’s most important trading partners, demonstrates that Estonia managed to deal with the healthcare crises and economic problems during 2020 and 2021 quite well – both in terms of trust in healthcare institutions, and with regard to the pandemic’s impact on the economy of the country.

The last panel on disadvantaged groups started with the presentation of KRISTINA POPOVA (Sofia) on ergotherapy and unpaid work in closed institutions for children with disabilities in Bulgaria in the 1950s and 1960s. Popova explained how the work of “inmates” of such institutions in early socialist Bulgaria was organized, explored, and reported. Her study was based on Ministry orders as well as on preserved documents of several homes for children and juveniles with disabilities in Sofia and Blagoevgrad, the homes’ production plans and reports.

Finally, GALINA GONCHAROVA (Sofia) and TEODORA KARAMELSKA (Sofia) presented preliminary results of their study on society’s attitudes and care system policies towards demented persons in Bulgaria and towards their families. Against this background, they examined care not so much in an institutional and legislative context, but in a biographical one. Empirically, they relied on in-depth biographical interviews, semi-structured expert interviews, and focus groups, conducted under the framework of the project “Generational models of coping with life crises: biographical, social and institutional discourses" (2017–2020)”, as well as and on a secondary analysis of sociological data, all of which was included in the presentation.

Concluding remarks were given by the organization committee: Ulf Brunnbauer, Hartmut Lehmann, Gergana Mircheva, and Olga Popova. As they stated, it is necessary to talk about public health both from a historical perspective and from the perspective of today, and from a multidisciplinary perspective, as this problem reaches into many different domains of social life. This conference has shown how the image of public health in East and Southeast Europe changed with regard to economic, political, and social factors from the beginning of the 20th century until today. The conference discussions have also underscored the consequences of socialist public health, the factors that contributed to the creation of public health systems in the first place and specific development patterns that can be detected in Eastern and Southeastern Europe throughout the 20th century. One of the prominent themes was the transnational circulation of knowledge, while at the same time the importance of local health care activists was highlighted. Path dependencies, therefore, are visible but not set in stone, as human agency can turn them around.

Conference overview:

Ulf Brunnbauer / Hartmut Lehmann (IOS Regensburg): Greetings

Olga Popova (IOS Regensburg), Gergana Mircheva (Sofia University / Humboldt Fellow at IOS): Introduction to the conference themes

Keynote lecture

Dora Vargha (Humboldt-Universität zu Berlin): Defining success: inequalities, unintended consequences and the endings of epidemics in Eastern Europe

Panel 1: International influence and networks

Chair: Ulf Brunnbauer (Regensburg)

Christian Promitzer (Graz): National self-assessment, imperial fields of influence and international networks: Conflicting demands in the foundation of public health initiatives in South-Eastern Europe up to the First World War

Evguenia Davidova (Portland): National emissaries for preventive healthcare: Visiting nurses in interwar Bulgaria and the Kingdom of Serbs, Croats, and Slovenes/Yugoslavia

Vedran Duančić (Klagenfurt): Alma-Ata, Yugoslavia: The intertwined local and global meanings of primary health care in late Socialism

Panel II: Health and political environment

Chair: Petru Negura (Regensburg)

Anelia Kassabova (Sofia): Ideas and ambitious promises, structural constraints and failures – the contradictory Bulgarian socialist demographic politics

Jan Arend (Tübingen): Stress and the transformation in Czechoslovakia/Czech Republic, 1960s–2000s

Ilia Nadareishvili (Tbilisi) / Karsten Lunze (Boston): COVID-19 pandemic response in volatile political and geopolitical environment – Georgian experience

Panel III: Vaccination resistance

Chair: Olga Popova (Regensburg)

Josip Glaurdić / Christophe Lesschaeve (Luxembourg): The politics of Covid-19 vaccination resistance in Southeast Europe

Mrika Aliu (Pristina) / Ha Thi Hong Nguyen: COVID-19 Vaccine acceptance among marginalized populations in Kosovo (Roma, Ashkali, Egyptian)

Elizaveta Pronkina et al. (Paris): The Covid-19 curtain: Can past Communist regimes explain the vaccination divide in Europe?

Panel IV: Health inequalities

Chair: Sinem Ayhan (Regensburg)

Daniela Koleva (Sofia): How can care produce inequality? The case of the “active fighters against fascism and capitalism” in Bulgaria

Radina Vučetić (Belgrade): “Everybody get vaccinated!”: Smallpox epidemics in Yugoslavia in 1972

Tijana Karić (Marburg) / Vladimir Mihić (Novi Sad): Health inequalities in time of Covid-19: The case of Roma in Serbia

Panel V: State health care systems

Chair: Heike Karge (Regensburg)

Martin Ivanov (Sofia) / Matthias Morys (York): Did public health and living standards actually improve under state socialism? Evidence from Bulgaria, 1944–1989

Viola Lászlófi (Paris/Budapest): Undisciplined patients, regulated medical authority? Changing norms of patient care in state Socialist Hungary

Panel VI: Trust in public health

Chair: Hartmut Lehmann (Regensburg)

Florie Miftari Basholli et al. (Pristina): Trust in healthcare and other institutions during Covid-19 pandemic in Kosovo

Alari Purju (Tallinn): Governance of the health care system and its impact on economy during the Covid-19 in Estonia

Panel VII: Disadvantaged groups

Chair: Gergana Mircheva (Sofia/Regensburg)

Kristina Popova (Sofia): Ergotherapy and/or unpaid work in the closed institutions for children with disabilities in Bulgaria in the 1950s–1960s

Galina Goncharova (Sofia) / Teodora Karamelska (Sofia): The care for people with dementia in Bulgaria: Between over-responsibility to the family and distrust in public health services

Concluding remarks