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An unprecedented mortality crisis struck Eastern Europe during the 1990s, causing around seven million excess deaths. We enter the debate about the causes of this crisis by performing the first quantitative analysis of the association between deindustrialisation and mortality in Eastern Europe. We develop a theoretical framework identifying deindustrialisation as a process of social disintegration rooted in the lived experience of shock therapy. We test this theory relying on a novel multilevel dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989-95 in Hungary and 514 towns in European Russia in 1991-99. The results show that deindustrialisation was directly associated with male mortality and indirectly mediated by hazardous drinking as a stress-coping strategy. The association is not a spurious result of a legacy of dysfunctional working-class health culture aggravated by low alcohol prices during the early years of the transition. Both countries experienced deindustrialisation, but social and economic policies have offset Hungary's more immense industrial employment loss. The results are relevant to health crises in other regions, including the deaths of despair plaguing the American Rust Belt. Policies addressing the underlying causes of stress and despair are vital to save lives during painful economic transformations.

Original publication




Journal article


Cambridge Journal of Economics

Publication Date





341 - 372