Health and social welfare in Communist Czechoslovakia
Encyclopedia

Characteristics

In the 1980s, Czechoslovakia
Czechoslovakia
Czechoslovakia or Czecho-Slovakia was a sovereign state in Central Europe which existed from October 1918, when it declared its independence from the Austro-Hungarian Empire, until 1992...

 had a comprehensive and universal system of social security
Social security
Social security is primarily a social insurance program providing social protection or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. Social security may refer to:...

 under which everyone was entitled to free medical care and medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, in theory at least. National health planning emphasized preventive medicine
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...

. Factory and local health care centers, first aid stations, and a variety of medical clinics supplemented hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

s and other inpatient institutions. The ratio of physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s to inhabitants has improved steadily, climbing from 1 per 745 in 1954 to 1 per 278 in 1985, although there were shortages of doctors in rural areas. The shift in the distribution of health resources in the 1960s and 1970s was dramatic; facilities were improved, and the number of health care personnel in Slovakia
Slovakia
The Slovak Republic is a landlocked state in Central Europe. It has a population of over five million and an area of about . Slovakia is bordered by the Czech Republic and Austria to the west, Poland to the north, Ukraine to the east and Hungary to the south...

 and rural areas increased in general. Despite the improvements, about 40 % of all the medical equipment
Medical equipment
Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions.-Types:There are several basic types:* Diagnostic equipment includes medical imaging machines, used to aid in diagnosis...

 was obsolete, facilities were outdated and in short supply, the bureaucracy
Bureaucracy
A bureaucracy is an organization of non-elected officials of a governmental or organization who implement the rules, laws, and functions of their institution, and are occasionally characterized by officialism and red tape.-Weberian bureaucracy:...

 was excessive,and small bribery
Bribery
Bribery, a form of corruption, is an act implying money or gift giving that alters the behavior of the recipient. Bribery constitutes a crime and is defined by Black's Law Dictionary as the offering, giving, receiving, or soliciting of any item of value to influence the actions of an official or...

 was widespread.

Spas

Spa
Spa
The term spa is associated with water treatment which is also known as balneotherapy. Spa towns or spa resorts typically offer various health treatments. The belief in the curative powers of mineral waters goes back to prehistoric times. Such practices have been popular worldwide, but are...

s in Czechoslovakia were part of the health care system. In 1985 more than 460,000 people (5 % of whom were children) stayed at the 35 spas in the Czech lands and 23 spas in Slovakia. Many spas had existed for centuries, such as Bardejov
Bardejov
Bardejov is a town in North-Eastern Slovakia. It is situated in the Šariš region and has about 33,000 inhabitants. The spa town, mentioned for the first time in 1241, exhibits numerous cultural monuments in its completely intact medieval town center...

 (since the thirteenth century) in Slovakia and Karlovy Vary
Karlovy Vary
Karlovy Vary is a spa city situated in western Bohemia, Czech Republic, on the confluence of the rivers Ohře and Teplá, approximately west of Prague . It is named after King of Bohemia and Holy Roman Emperor Charles IV, who founded the city in 1370...

 in the Czech lands. Many of them specialized in the care and treatment of particular kinds of ailments. All had either mineral or hot springs
Hot Springs
Hot Springs may refer to:* Hot Springs, Arkansas** Hot Springs National Park, Arkansas*Hot Springs, California**Hot Springs, Lassen County, California**Hot Springs, Modoc County, California**Hot Springs, Placer County, California...

, and some also offered mud treatments. In bygone days, the spas were frequented by European royalty and the wealthy, but in the 1980s they were open to all, including foreign tourists (who made up 10 % of the patients in 1985). A number of people visited spas on vouchers provided by their trade union
Trade union
A trade union, trades union or labor union is an organization of workers that have banded together to achieve common goals such as better working conditions. The trade union, through its leadership, bargains with the employer on behalf of union members and negotiates labour contracts with...

s.

Life expectancy

In 1984 life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

 in Czechoslovakia was 67 years for men and 75 years for women. In 1950 women's life expectancy was approximately 4.6 years longer than men's; by 1983 this difference had increased to nearly 7.5 years. Infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...

 stood at 10.5 per 1,000 live birth
Live birth
In human reproduction, a live birth occurs when a fetus, whatever its gestational age, exits the maternal body and subsequently shows any sign of life, such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or...

s in 1984, down from 15.6 per 1,000 in 1975. As with medical care, the gap in life expectancy between the Czech lands and Slovakia was narrowed during this period.

Pensions

In 1985 slightly more than one-quarter of the Czechoslovak population received some kind of pension
Pension
In general, a pension is an arrangement to provide people with an income when they are no longer earning a regular income from employment. Pensions should not be confused with severance pay; the former is paid in regular installments, while the latter is paid in one lump sum.The terms retirement...

; the elderly, the disabled, widow
Widow
A widow is a woman whose spouse has died, while a widower is a man whose spouse has died. The state of having lost one's spouse to death is termed widowhood or occasionally viduity. The adjective form is widowed...

s, and orphan
Orphan
An orphan is a child permanently bereaved of or abandoned by his or her parents. In common usage, only a child who has lost both parents is called an orphan...

s were all entitled to assistance. Social security benefits (primarily retirement
Retirement
Retirement is the point where a person stops employment completely. A person may also semi-retire by reducing work hours.Many people choose to retire when they are eligible for private or public pension benefits, although some are forced to retire when physical conditions don't allow the person to...

 and disability
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...

) were equal for all wage earners. The average pension was less than Kcs1,000 per month (workers received an average pension of about Kcs 1,130, cooperative farmers about Kcs880, and independent farmers about Kcs720); this put pensioner
Pensioner
In common parlance, a pensioner is a person who has retired, and now collects a pension. This is a term typically used in the United Kingdom and Australia where someone of pensionable age may also be referred to as an 'old age pensioner', or OAP. In the United States, the term retiree is more...

s among the lowest income earners. A substantial minority of the retired (23 %) again took up employment to supplement their pensions.

Maternity and childcare benefits

Women workers had a full complement of maternity and childcare benefits. Maternity leave (at 90 % of full pay) was twenty-six weeks in the 1980s; an additional nine weeks were available for single mothers or for mothers having multiple birth
Multiple birth
A multiple birth occurs when more than one fetus is carried to term in a single pregnancy. Different names for multiple births are used, depending on the number of offspring. Common multiples are two and three, known as twins and triplets...

s. Employers could not deny a woman's request for an additional year of unpaid leave for child rearing (without loss of job seniority). A system of child allowances and maternity grants also assisted women who took unpaid leave. Women were allowed three days of annual leave in case of illness within the family. There were substantial family allowances, in addition to direct grants, to single parents or families with handicapped children. An unmarried mother, widow, or divorce
Divorce
Divorce is the final termination of a marital union, canceling the legal duties and responsibilities of marriage and dissolving the bonds of matrimony between the parties...

d mother could not be fired if she had a child under three years of age; if she had children between three and fifteen years of age, her employer had to find her another job before dismissing her.

Facilities for younger children

Nursery
Nursery school
A nursery school is a school for children between the ages of one and five years, staffed by suitably qualified and other professionals who encourage and supervise educational play rather than simply providing childcare...

 facilities for younger children were in very short supply; in 1984 they could accommodate less than 10 % of children under five years of age. Beyond the sheer lack of space, nurseries were poorly distributed and were often concentrated in older centers rather than in new housing developments where young families were likely to reside. Kindergarten
Kindergarten
A kindergarten is a preschool educational institution for children. The term was created by Friedrich Fröbel for the play and activity institute that he created in 1837 in Bad Blankenburg as a social experience for children for their transition from home to school...

s were in better supply, and a much higher percentage of children between the ages of three and six years attended these schools.

Birthrate and abortion rate

High employment of women and inadequate services contributed to the decline in Czechoslovakia's birthrate in the 1960s. Live births during the decade averaged 16 per 1,000 inhabitants, a significant drop from the 1950s. By 1968 the fertility rate was 2 % (in comparison with 3 % in the 1950s); at this rate the population would not replace itself. In the Czech lands, the population growth
Population growth
Population growth is the change in a population over time, and can be quantified as the change in the number of individuals of any species in a population using "per unit time" for measurement....

 rate stood at its 1930s low; in Catholic Slovakia, it was the lowest on record. The government adopted a variety of explicitly pronatalist policies in the 1970s. Family allowances increased, especially for second and third children. By 1973 a family with three children received roughly one-third the average worker's salary in allowances. Birth grants doubled so that they were the equivalent of two to four weeks of family income. Low-interest loans to newlyweds were designed so that a portion of the principal was canceled with the birth of each child (Kcs 1,000 for the first and Kcs4,000 for each subsequent child). All told, the financial incentives were substantial. In addition, couples with children had priority on apartment waiting lists and were entitled to larger living quarters, no small inducement in the face of Czechoslovakia's chronic housing shortage. Pronatalist policies appear to have had a strong influence on population growth during the 1970s. The birthrate climbed from its 1968 low (14.9 per 1,000 inhabitants) to a peak of 19.9 per 1,000 inhabitants in 1974—one of the highest rates among industrial nations. Perhaps a quarter of this increase reflected the increase in the number of women of child-bearing age in the 1970s. After 1974, however, the birthrate steadily declined, falling to 14.5 by 1985. Figures indicated that a trend toward one-child families was emerging. The message seemed to be that after one decade the government's aid program was ineffective.

A major factor influencing the birthrate was the abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...

 rate. The number of abortions fluctuated between the 1950s and 1980s, dropping in the early 1960s and the early 1970s. In 1985 there were reportedly 144,712 abortions, or 39 abortions per 100 pregnancies (33.5 per 100 in the Slovak Socialist Republic
Slovak Socialist Republic
From 1969 to 1990, the Slovak Socialist Republic was the official name of that part of Czechoslovakia that is Slovakia today. The name was used from 1 January 1969 until March 1990....

 and 42.1 per 100 in the Czech Socialist Republic
Czech Socialist Republic
From 1969 to 1990, the Czech Socialist Republic was the official name of that part of Czechoslovakia that is the Czech Republic today. The name was used from 1 January 1969 to March 1990....

). It has been suggested that abortion has remained one of the most favored means of birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

, despite the risks involved. A 1986 change in the abortion law
Abortion law
Abortion law is legislation and common law which pertains to the provision of abortion. Abortion has been a controversial subject in many societies through history because of the moral, ethical, practical, and political power issues that surround it. It has been banned frequently and otherwise...

 (eliminating the panel needed to approve a request for an abortion) suggested that the regime was giving up in its efforts to reverse at least this aspect of the adverse demographic trends.

Housing

Since statistics did not always provide a comparison between the numbers of households and existing housing units, the housing deficit remained difficult to gauge. A comparison of the number of marriage
Marriage
Marriage is a social union or legal contract between people that creates kinship. It is an institution in which interpersonal relationships, usually intimate and sexual, are acknowledged in a variety of ways, depending on the culture or subculture in which it is found...

s annually and construction of new 1 housing units between 1960 and 1975 shows that construction exceeded marriages only in 1975. The deficit was most acute in the 1960s, when an average of housing units was built for every 10 marriages; in 1985 the ratio rose to an average of 8.8 units per 10 marriages.

This approximation underestimated the housing deficit: it ignored divorces, the number of extended families
Extended family
The term extended family has several distinct meanings. In modern Western cultures dominated by nuclear family constructs, it has come to be used generically to refer to grandparents, uncles, aunts, and cousins, whether they live together within the same household or not. However, it may also refer...

 living together who would have preferred separate housing, and the decay of old housing . Even waiting lists underestimated how inadequate housing was in the 1980s. Separate housing for single adults had such a low priority with planners that single adults found it difficult even to get on a housing list.

One of the factors contributing to the housing shortage was the low construction rate of rental housing. Major reasons for this were high inflation
Inflation
In economics, inflation is a rise in the general level of prices of goods and services in an economy over a period of time.When the general price level rises, each unit of currency buys fewer goods and services. Consequently, inflation also reflects an erosion in the purchasing power of money – a...

, high construction
Construction
In the fields of architecture and civil engineering, construction is a process that consists of the building or assembling of infrastructure. Far from being a single activity, large scale construction is a feat of human multitasking...

 costs, and low (heavily subsidized) rents. In 1985 the average building cost for apartments rose to Kcs2,523 per square meter, and the average monthly rent—for the seventh consecutive year—was Kcs358 . Construction of individual homes peaked in 1977 at 40,107 and decreased to 29,608 in 1985. Building a home privately was possible, but acquiring labor and materials was difficult and sometimes risky; it often meant borrowing machinery illegally or paying bribes for materials.

Despite substantial gains in the 1970s, Czechoslovakia entered the 1980s with a housing shortage that was likely to take years to remedy. In 1986 the government announced a slight cutback in new housing construction for the 1986-90 housing plan, further aggravating the situation.

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