Transitions that Matter? Czechoslovakia's Break up and Human Stature.

Changes in a population's average stature are virtuous pointers of wellbeing which are sensitive to improvements in psychosocial environments during childhood. A major structural change that could have altered an environment during childhood is the transition from communist to a liberal democracy, and, more specifically, the meltdown of the Soviet bloc provides for a quasi-natural experiment. This paper examines the trends in heights in the Czech Republic and Slovakia before and after the transition and the subsequent break-up of the Czechoslovakian federation. We find that one additional year of exposure to a liberal democracy while growing up is associated with an increasing population stature of 0.28 cm among Slovaks and 0.15 cm among Czechs. We only find changes in stature among men who are more sensitive to environmental stress, especially at the lower end of the current socio-economic status. Results are robust to alternative datasets and measures of democracy.

'Avoidable' mortality: a measure of health system performance in the Czech Republic and Slovakia between 1971 and 2008.

BACKGROUND Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, including the year of separation in 1993, using the concept of 'avoidable' mortality. METHODS Age-standardized mortality rates for mortality from 'avoidable' and other (non-avoidable) causes have been calculated through indirect standardization to study national and regional trends between 1971 and 2008. RESULTS The paper shows that 'avoidable' mortality in both countries has been continuously decreasing while mortality from other causes has remained unchanged or increased slightly. For some 'avoidable' conditions, mortality rates of the two countries converge while for others divergence can be observed, with either the Czech Republic or Slovakia performing better. CONCLUSION Declines in overall 'avoidable' mortality suggest improvements in the health system's performance and quality of care in both countries, compared with mortality from other causes where factors outside the control of the health care system may be stronger determinants. For conditions where 'avoidable' mortality rates stagnate or increase, more in-depth research should be carried out to identify problems in the delivery of timely and effective prevention and treatment, and to establish steps that would reduce the numbers of unnecessary deaths.