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Archivaria 87 Spring Children's Literature Volume 47, Classical World Volume , Number 3, Spring Cultural Politics Volume 15, Issue 1, March Meridians: feminism, race, transnationalism Volume 18, Number 1, April Prooftexts Volume 37, Number 2, Criticism Volume 61, Number 1, Winter Future Anterior Volume 15, Number 1, Summer Language Ahead of Print, vol. Syllecta Classica Volume 29 Asia Policy Volume 14, Number 2, April Ghana Studies Volume 3, Music and Letters Volume 99, Number 4, November As has been indicated, this may well require novel developments in the civil society of rural areas, but we have little systematic information on the roles and impacts of networks and associations in improving social and economic conditions.

And we know less about how they may be successfully established and sustained. Analysis crosses the boundaries between economics and sociology. Quantitative information is required on economic activities, but a necessary complement is required in qualitative analysis of the influence of networks, trusts or social norms. Rigorous in depth study of carefully selected local areas, using a mixture of quantitative and qualitative data, can develop a sense of the interaction between increasingly diverse mixes of measures in contrasting rural contexts where different factors influence their expression and impacts, and contribute to understanding of how and why they operate in the way they do.

These begin with selection and exploration of the objects of study, on the basis of general suppositions about the impact of policy which require testing. Multiple evidence sources should be scrutinized to test rival hypotheses, which might provide alternative explanations. Common protocols to investigate different expressions of the phenomenon impart additional robustness.

Analysis requires assessment of different patterns in the multiple data sources to refine and rule out competing hypotheses, both within individual case studies and between case studies carried out in different contexts see, for example, Coffey and Atkinson, Local diversity implies that decisions must vary at the local level, but an appropriate multi-level governance system for the administration of rural development undermines the traditional understanding of effective sovereign governments delivering policies and assessing their impacts.

Differences exist in the operation of the networks of interests which have arisen to bridge the lack of coordination and consistency, overlapping with formal government structures and including specialist and highly effective interest groups, and informal frameworks embodied in conventions, each able to inhibit or facilitate the actions of others Morrison, The incidence of these, their effectiveness in addressing disadvantage, their impacts, and efficiency in deploying limited resources and expertise are all poorly understood and require investigation.

Case study methods can contribute to understanding of what is analogous to diverse ecosystems of intersecting associations and organisations, businesses, infrastructures, and environmental systems Edwards, Extending this metaphor, interaction, duplication, and synergy of rural civil society, and niche creation and occupation, are additional conceptual tools for analysis and investigation. Because case-studies require examination of a great many variables, in detail, in a small number of cases, they are relatively expensive, and skilled evaluators are scarce.

There is a risk of becoming overwhelmed by detail in mixed method evaluations conducted at local level, due to their discursive nature. It is difficult to elaborate local level evaluation that fully reflects the complexity and diversity of rural areas, and at the same time convey the critical information back up to higher levels to permit balanced and informed decisions to be taken about resource allocation.

Generalisation from case studies, especially from cross-case comparison where each individual study has been carried out in a consistent manner, is possible, but involves a different logic to conventional induction. In economic analysis, acceptance and consequent adoption of case study approaches is far from widespread Bitsch, because they do not allow for the familiar statistical generalisations which come from large scale surveys.

In contrast, theoretical generalisations deriving from identifying causal dependencies in one context contribute to better understanding of different mixes of influences in other rural areas. Our ability to make sense of different studies conducted in cases selected for varying purposes of which an increasing number have now been completed: for example, Hart ; Lee et al.

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Perhaps this is the fundamental challenge to combine local level evaluation that fully reflects the complexity and diversity of rural areas, and yet to convey the critical information back up to higher levels to permit balanced and informed decisions to be taken about resource allocation across different regions and even countries. Strengths and weaknesses of European Union policy evaluation methods: ex-post evaluation of Objective 2, — Regional Studies , Vo.

Bitsch V. Agricultural economics and qualitative research: incompatible paradigms? Bryden J. Buckwell A. The Costs of the Common Agricultural Policy. London, Croom Helm. Commission of the European Communities MEANS collection: evaluating socio-economic programmes. A framework for indicators for the economic and social dimensions of sustainable agriculture and rural development. Champion A. Population change and migration in Britain since evidence for continuing deconcentration, Environment and Planning A , Vol.

Lifestyles in rural England. Coffey A. Making Sense of Qualitative Data. Thousand Oaks, CA: Sage. Committee on Land Utilization in Rural Areas Cmd , HMSO. Cooksy L. Quality, context, and use: issues in achieving the goals of metaevaluation. American Journal of Evaluation , Vol. Defra a. Social and economic change and diversity in rural England. Defra b. Rural Strategy London, Stationery Office. Defra Rural Development Programme for England Agriculture in the United Kingdom. Our Countryside: the future. A fair deal for rural England.

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London, Cm , Stationery Office. Dwyer J. Regional Studies , Vol. Edwards M. Civil Society. Cambridge, Polity Press. Fieldhouse E. Deprived people or deprived places? Exploring the ecological fallacy in studies of deprivation with the samples of Anonymised Records. Environment and Planning A , Vol.

Gasson R. Farm diversification and rural development. Journal of Agricultural Economics , Vol. Grigg D. The Dynamics of Agricultural Change. London, Hutchinson. Hart K. Decentralized development in the European Union. Progress in Development Studies , Vol. HM Treasury Opportunity and security for all: investing in an enterprising, fairer Britain.

The green book: appraisal and evaluation in central government. Hodge I. The integration of the rural economy. Built Environment, Vol. The economic diversity of rural England: stylised fallacies and uncertain evidence. Journal of Rural Studies, Vol. Barriers to participation in residual rural labour markets. Work, Employment and Society , Vol. Keeble D. Enterprising behaviour and the Urban-Rural Shift. Urban Studies , Vol.

Lee J. Networking: social capital and identities in European rural development. Sociologia Ruralis , Vol. Leon Y. Rural development in Europe: a research frontier for agricultural economists. European Review of Agricultural Economics , Vol. Sustainable rural economies: some lessons from the English experience. Sustainable Development , Vol. Midgley J. Patterns and concentrations of disadvantage in England: A rural-urban perspective. Morrison T. Pursuing rural sustainability at the regional level: key lessons from the literature on institutions, integration, and the environment.

Journal of Planning Literature , Vol. Moxey A. Agri-environmental indicators: issues and choices. Land Use Policy , Vol. Newby H. The Countryside in Question. North D. Rural industrialization. Ilbery Ed. OECD Paris, Organisation for Economic Co-operation and Development. PIU Rural Economies. Ray C. Beyond decentralisation: the evolution of the population distribution in England and Wales — Geoforum , Vol.

In the early s, progress in life expectancy for the Russian population slowed considerably. Annual increments in increasing life expectancy became very small until finally improvements ceased. For males the year was the turning point, when reductions in mortality from infectious diseases no longer offset negative tendencies in chronic diseases and violence. For females this point occurred several years later.

The decline in life expectancy was rather slow until the mid-seventies; but after that it accelerated, particularly for males. Mortality trends since clearly differ by age. A general deterioration at adult ages, particularly for men, contrasts with the slow progress at ages under 15 Figure 4. The probability of survival from birth to age 15 was increasing in spite of some short-term variations. The decrements in survival probabilities over are approximately equal for the three age intervals 0. Below we shall see that the negative changes between ages 20 and 60 are to a great extent responsible for a general decrease in life expectancy at birth.

NOTE: Dotted lines show extrapolations of trends based on Gorbachev's anti-alcohol campaign, which began in , caused a break from the long-term trends. In survival probabilities increased by 0. The decrease in survival probabilities was rather slow in but then accelerated in The dramatic mortality rise in resulted in a 0. In , the survival probabilities clearly deviate from the linear trends of shown in dotted lines in Figure 4.

Extrapolating on these very unfavorable trends leading up to results in values that are still better than the values actually observed in The continuous growth in male mortality at active ages has led to a very special age pattern of male mortality in Russia. Comparison of Russian mortality patterns by age to the Coale-Demeny model life tables [20] indicates clearly the spectacular excess mortality at adult ages since This excess mortality has been increasing over time and has its maximum at ages Figure 4. Whatever model is selected for comparison, the peculiarity of the Russian pattern is absolutely obvious.

However, in contrast to the s, infant mortality is lower than corresponding model values. The method of component analysis [21] allows us to split the difference between life expectancy for the Russian population in and into its components, by age and cause of death Table 4. Once again, increasing mortality at adult ages reveals itself as the main factor reducing life expectancy. The active ages age 15 to 64 contribute 2. Excess mortality of men aged 15 to 44 contributes 1.

Most of these losses are due to cardiovascular circulatory mortality, injuries, and violence. Declining mortality from infectious, respiratory, neoplasmic, digestive, and other diseases for most age groups under 15 partly compensates for the prevailing negative changes at older ages. For women, the trend in life expectancy is much less unfavorable. Between and , their life expectancy at birth decreased by 0. The components of that decline are different than those for males. The most important negative effect for women is attributable to circulatory diseases at older ages, while the negative effect of injury and violence is much smaller than for men.

For both males and females, the trend in cancer mortality is surprisingly stable. It has even shown some positive influence on life expectancy. Given that the increasing excess mortality of adult males from cardiovascular diseases and external causes are the main factors in declining life expectancy for the Russian population, we will now focus our attention on males between the ages of 15 and Age-adjusted standardized death rates for men aged will be used to compare mortality levels.

These standardized death rates, or SDRs, are weighted averages of age-specific death rates. Table 4. Below we will examine the situations in and the beginning and end points of gradual mortality growth , the year of minimum mortality due to anti-alcohol policies , and in the most recent maximum. Russian male SDRs from all causes between the ages of 15 and 64 have been increasing since In , mortality returned approximately to the level of in fact, in it was a little higher , and finally, in , it reached approximately twice the level in Most of this variation over time is related to changes in cardiovascular and accidental and violent mortality.

In Russia, as in the United States, circulatory diseases account for approximately 33 percent of total active-age SDR, while the proportion due to injuries and violence is much higher in Russia 32 percent versus 16 percent in the United States. In contrast, the proportion of cancer mortality is greater in the United States 28 percent versus 19 percent. Looking at specific causes of death, we find that, by , mortality in active ages from infectious diseases, rheumatism, and hypertensive disease reflecting Russia's initial delay in its epidemiological transition and mortality from stomach cancer had dropped below the levels of the s.

On the other hand, Russia has lost its former advantages over the United States in mortality due to some cancers, liver cirrhosis, and traffic accidents. This is also true for "other heart disease" and homicide. The leading role in the general increase in SDR for men aged 15 to 64 belongs to such causes of death as cerebrovascular disorders and ischaemic heart disease, lung cancer, accidental poisoning, suicide, and homicide. In , SDRs for these causes were already high, but they became even higher in The steady rise in the SDR for active ages was interrupted in the mids by a sharp decline caused by the anti-alcohol campaign Figure 4.

The rapid mortality decrease lasted only 3 years, from to Reduced mortality from external causes played the most important role in reducing total active-age mortality during the anti-alcohol campaign, although many other causes of death such as ischaemic heart disease, respiratory diseases, and liver cirrhosis contributed to the rapid changes in mortality since This will be discussed further below. The mortality level increased again after , with the level nearly restored by In , active-age mortality greatly exceeded that of the previous year, and grew beyond expectations based on long term trends upper panel in Figure 4.

Similar results for survival rates were shown in Figure 4. Some variations in mortality trends for men aged 15 to 64 within the broad classes of causes of death are noteworthy. For instance, different directions in trends for stomach cancer decreasing and lung cancer increasing resulted in relative stability of total mortality from neoplasms. Since , deaths from certain causes rose sharply compared to others of the same class, e. The dramatic increase in "other heart diseases" was probably induced by improvements in diagnosis of several specific heart diseases within that classification.

Comparing Russian mortality by leading causes of death to that in Western countries helps us to detect the distinct epidemiological outcomes of two fundamentally different social systems and approaches to public health. Comparisons with Eastern European countries show many similarities due to similar social and medical care mechanisms, although some important peculiarities of Russian trends are also evident.

Nevertheless, the general situation in CEE countries is substantially better than in Russia, in spite of the long-term worsening in mortality trends in many CEE countries. The rise in Russian mortality is clearly visible for all causes of death except cancers. The part played by circulatory diseases in the differences between groups of countries is overwhelming Figure 4. Not only has this level always been higher in Russia, but it has been increasing, whereas trends in circulatory diseases have been improving in the EC and the United States. The enormous level of male mortality from injuries and violence, and especially its rapid increase in the s, sharply differentiates the Russian trend from the Eastern European and Western countries.

For women the gap in violent mortality is much smaller, but again the Russian excess mortality is obvious, especially in recent years. Cancer mortality in men has become more and more significant as a component of the general mortality gap between Russia and the West. Until the early s, cancer mortality for men in Russia was higher than in the reference countries, but it was also rather stable. While in the s cancer mortality was growing in EC, CEE, and in the United States, the difference between these countries and Russia became very small by Thereafter, the Russian trend began to increase, while the EC and U.

Like Russia, the CEE average also exhibited a continuous increase. For females the difference in levels of cancer mortality across countries is much less significant; however in the s and the s, the Russian position is becoming relatively worse. Mortality from respiratory diseases has been declining for both sexes and in all countries except the United States.

Progress in Russia continued with some fluctuations until the s, when it slowed down. The sudden increase returned mortality due to respiratory diseases to its level. To examine the reasons for very low life expectancy in Russia in terms of causes of death, in Figure 4. In order to investigate the "normal" Russian pattern, we select the moment just preceding the unfavorable changes of Later, we shall specially investigate the most recent mortality increase. Hungary is chosen as a country of deep epidemiological crisis, which is probably rather similar to Russian's deterioration.

During the s and the s, the values of life expectancy at birth in Hungary were not very different from that in Russia. The United States versus Russia. The total difference in male life expectancy between the United States and Russia was 7. This amount consists of three main parts: 1 at ages above 40 there is a strong influence of high mortality from circulatory diseases in Russia and, to much smaller extent, mortality from neoplasms Figure 4.

For all ages together, the contribution of circulatory diseases to the total difference in male life expectancy between the United States and Russia is 3. For women, the structure of the gap in life expectancy 4. Excess mortality from external causes is significant at active ages, but is much less important than for men. The relatively low mortality of Russian women at older ages from neoplasms and respiratory and digestive diseases slightly compensates for the negative influence of very high cardiovascular mortality.

There is a hypothesis that the coding practice at advanced ages in Russia differs from many other countries. Many physicians and statisticians in Russia believe that there is a tendency to over-record cardiovascular deaths and under-record deaths from neoplasms and some other specific conditions. However, in our previous studies we have not found any hard evidence for such an assumption. Hungary versus Russia. Comparing the Russian male mortality pattern with that in Hungary, we discover a very peculiar structure of total difference in life expectancy 1.

It depends mainly on external causes of death, while the contribution of circulatory diseases is rather low Figure 4.

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Besides, mortality from certain chronic diseases, particularly diseases of the digestive tract, is substantially higher in Hungary than in Russia. This means that mortality from chronic diseases is very high in both countries, and is even worse in Hungary than in Russia for some causes of death. However, the enormously high Russian mortality from external causes in able-bodied ages reflects poorly on Russia in terms of the difference in male life expectancy.

For females the total difference in life expectancy between Russia and Hungary is rather small. In , life expectancy for Russia was higher by 0. The components related to external causes at young ages and circulatory diseases at older ages are unfavorable for Russia; however, the components related to cancers, digestive diseases, and other diseases are unfavorable for Hungary.

We have already emphasized several times the differences between male and female mortality. Russian male excess mortality is probably the highest in the world. As has been shown, during the rapid mortality decline in the early s females gained considerably more than males due to better trends at adult ages. This tendency has been strengthening over time. From to , the difference in life expectancy between males and females grew from 7.

To quantify the Russian mortality differentials by sex, we once again decompose the total difference in life expectancy according to leading classes of causes of death Table 4. Throughout the period, more than 60 percent of the difference between males and females is due to only two classes of causes of death: injury, poisoning, and violence; and circulatory diseases. In each year, except the very unique year , the injuries, poisoning, and violence explains around 35 percent of the total. The difference in mortality due to circulatory disease grew from 25 percent in to percent in the s and the s.

In sum, the widening gap between the sexes is due to increasing male excess mortality in cardiovascular circulatory diseases and cancer, but also from external causes of death. The spectacular reduction of the difference between male and female life expectancies in the difference fell from The recent increase in the gap from to is due to a new deterioration in injuries, poisoning, and violence as well as in cardiovascular diseases, all of which have been especially acute in men. Usually it is very difficult or even impossible to extract the impact of certain environmental factors or personal behavior on the mortality trend because, in actuality, all these factors are developing simultaneously.

The anti-alcohol campaign of provides the unique possibility to extract a pure effect of alcohol abuse on mortality. The action was so rapid and sharp that it is possible to assume that virtually nothing changed in other conditions of public health within that short period. In fact, these "other" conditions were changing rather slowly at that time. In June the Gorbachev government organized a great experiment on the Soviet population.

They tested the results of the introduction of a 2. They were able to directly implement this policy because in the mids state trade was the only legal source of alcohol in Russia. The main aspects of the anti-alcohol campaign were: reduction of state alcohol production; enforcement actions against distillation and distribution of homemade beverages "samogon," or moonshine ; elevation of state prices for alcohol in August and in August ; and further development of state institutions for compulsory treatment of alcoholism.

All of the anti-alcohol actions were directed to restriction of public access to alcohol, but they did not affect the motives and underlying factors of alcohol abuse. Thus, there was no hope to derive a long-term positive effect. Nevertheless, the anti-alcohol campaign brought about very strong-short-term fluctuations, which are clearly visible in Russian mortality trends. This paper points out only several principal findings, because we have already provided detailed analysis of the alcohol situation in Russia and mortality outcomes from the anti-alcohol campaign in another paper.

A sharp mortality drop is seen immediately after the introduction of anti-alcohol restrictions. The number of avoided deaths, estimated by comparison with the long-term trends in ASDRs, exceeds , about , among males and about , among females. In the Russian mortality rate reached its absolute minimum, and in the reverse upward trend began. In the mortality rate increased rather moderately, whereas in when actual alcohol consumption in Russia jumped from 12 to 14 liters of pure ethanol per capita mortality increased sharply.

The overwhelming role of injuries and violence in active ages for the general mortality decrease in and subsequent increase in is obvious Figure 4. Death rates for males aged 20 to 54 exhibit very large decrements in and increments in , compared to the minimum level of For instance, at ages and ages of the biggest relative changes in death rates the difference between ASDRs in and exceeds 0. Injuries and violence are responsible for the predominant part of these changes. However, a part of the variation in male ASDRs, particularly at older ages, is due to cardiovascular diseases.

Between and , life expectancy at birth increased by 3. So, the improvement of is slightly bigger than the later deterioration, although the positive and negative contributions of external causes of death and digestive diseases mostly liver cirrhosis are exactly symmetrical. The leading influence of accidental and violent causes of death in is obviously due to their exceptional level in Russia, which is far above any value observed elsewhere, but also due to the especially close relationship between these causes of death and alcohol consumption.

So, external causes of death compose the most important part of alcohol-related mortality in Russia. This mortality pattern does not correspond to the main causes of alcohol-related deaths in other countries with high alcohol consumption. For example, in France the level of mortality from alcoholism is about 5 times the level in Russia, while mortality from accidental poisoning by alcohol is negligible in France and enormously high in Russia.

Hence, alcohol abuse in Russia results mostly in immediate and acute consequences e. For an explanation of this phenomenon, we can refer to the influence of the Russian style of drinking.


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The immediate effect is often produced by drinking large doses of vodka in a short time with very little to eat. That can result in the loss of self control and in irresponsible or aggressive behavior.

However, we have to be cautious when comparing Russian death rates due to alcohol-related causes with those in Western countries because, in part, the difference depends on registration habits. It seems that many deaths caused by the acute effects of alcoholism are recorded in Russia as poisonings by alcohol or other accidents, without reference to the underlying alcoholism. Another interesting matter concerns the significant reduction in mortality from cardiovascular and some other degenerative diseases during the anti-alcohol campaign.

At first this seems surprising given the rather long pathogenesis of this sort of disease. However, a sudden reduction of alcohol consumption for people who are already predisposed to die from cardiovascular disease for instance, cardiac patients could certainly induce a rapid decrease in their mortality. Besides, before the campaign it is possible that some of the deaths from alcoholism were recorded as "acute heart disorders," according to the immediate cause of death.

In , life expectancy at birth for the Russian population took an unprecedented fall. Between and , Russian males lost 1. As we have seen, a big share of this decrease is linked to the increase in alcohol consumption, following its reduction during the anti-alcohol campaign. However, in some new and alarming tendencies, not related to alcohol abuse, appeared in the Russian mortality pattern.

In the following year they manifested themselves very clearly. In the public health situation worsened so much that at first it seemed unbelievable. Between and life expectancy decreased by 3 years for males and by 1. By , male life expectancy was 59 years, female life expectancy was 72 years. No country has exhibited such an abrupt change in peacetime.

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In this section we shall analyze several important aspects of the increase in Russian mortality in First of all, we shall look at the absolute increase in deaths to try to evaluate the pure effect of rising mortality on the natural decrease in the Russian population. Then we shall discuss specific changes in Russian mortality by age paying special attention to older age and infant mortality and by cause of death.


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Changes in death rates for selected avoidable causes of death are to be considered as good indicators of deterioration in medical care practices. Finally, we apply a simple extrapolation of trends in ASDRs assuming cohort effects on mortality to be negligible in order to clarify what part of the life expectancy decrease may be associated with long-term mortality tendencies, which will be considered later.

Absolute mortality increase.