Mortality Transition in Albania, 1950-1990 Thesis for the degree of Doctor of Philosophy of the University of London Arjan Gjonga University of London London School of Economics and Political Science 1998 UMI Number: U615819 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U615819 Published by ProQuest LLC 2014. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 7 ( 0 5 1 U- ABSTRACT Albania was noteworthy, not just for the isolationist policy of its government, or its domestic rigid policies applied to Europe’s poorest country, but because of its high life expectancy at birth. At the end of the eighties, life expectancy at birth passed the boundary of seventy, although the country’s GDP per capita was $ 2500 in 1990, the lowest in Europe (Madison 1995).This puzzled scholars, who either doubted the success of Albania, or because of the lack of firm information, speculated with different explanations (Watson, 1995). This research was initiated by this controversy in trying to first, estimate the scale of Albania’s success in improving life expectancy and document the mortality transition in Albania during the period 1950-1990. It also looks at the social, economic and political factors behind the success of improving life expectancy at birth from 51 to 71 years in a relatively short period of 40 years. The research attempts to explain why the Albanian pattern of mortality, with very high infant and child mortality and very low adult mortality, is so different from that of other East European countries, which had the same social and economic backgrounds. The analysis concludes that the life style factors are the most likely factors in explaining the controversial mortality pattern of Albania. The research uses a new set of complete data, obtained from formerly-closed Albanian State Archives, which were made available only after 1994. It is the first time that the cause specific data are used to analyse the mortality transition in Albania. The research starts with a description of country’s cultural and historical background. It continues with the political, social and economic transition during the communist rule 1945-1990, which are of particular importance in understanding the demographic regime in general, and the mortality transition in particular (Caldwell, 1986). The research continues with a detailed analysis of the availability and quality of mortality data. The analysis of mortality trends and patterns during this period confirms the success of Albania in achieving high life expectancy at birth by the end of eighties. It also shows that this was achieved by very low adult mortality, and relatively high infant and child mortality. The later analysis shows that this finding is related to the cause specific pattern of mortality, as well as regional differences within the country. The research ends with an international comparison of mortality trends and patterns in Albania, in the context of whether the Albanian success was part of the experience of countries that had “a good health at low cost” (Caldwell, 1986), or if the Albanian way is another route to low mortality. Contents INTRODUCTION CHAPTER 1 Albania and the Albanians 11 1.1 Geography of the country and the region 1.2 Population before independence of 1912 1.3 Independence of Albania - The creation and consolidation of the Albanian state 1.4 Pre-War Albania (The state of the country before World War II) 1.5 Albanians in the Balkans after the world War II to the present day (Demographic Aspects) CHAPTER 2 Communism in Albania - Political, Economic and 27 Social Implications 2.1 Political Implications 2.2 Economic Implications 2.3 Social Implications 2.4 Concluding notes CHAPTER 3 Data Description 49 3.1 Introduction 3.2 Data availability 3.3 Data quality 3.4 Concluding notes CHAPTER 4 General Trends and Patterns of Mortality, 1950-1990 77 4.1 Introduction 4.2 Mortality trends in post-world War II Albania 4.3 Age pattern of mortality in Abania, 1950-1990 4.4 Abanian mortality pattern and model life tables 4.5 Concluding notes 3 CHAPTER 5 Cause Specific Mortality, 1950-1990 99 5.1 Introduction 5.2 Main causes of death and incidence of disease in pre-world War II Albania 5.3 Composition of death by cause, 1950-1990 5.4 Cause specific mortality during 1950-1990: Trends and patterns 5.5 Contribution of different causes of death to changes in overall mortality 5.6 Concluding notes CHAPTER 6 Regional Differences in Mortality 133 6.1 Introduction 6.2 Regional differences in overall mortality 6.3 Regional differences in child and adult mortality 6.4 A wider perspective on regional differences 6.5 Concluding notes CHAPTER 7 Mortality in Albania in International Perspective 166 7.1 Introduction 7.2 Comparison of trends and patterns of mortality 7.3 Comparison of cause specific mortality 7.4 Concluding notes CHAPTER 8 Conclusions and an Agenda for Future Research 181 8.1 Main findings 8.2 Epilogue - Albania after 1990 8.3 Future research REFERENCES 187 APPENDIX A 194 APPENDIX B 199 APPENDIX C 208 4 List of Tables and Figures Table 1.1 Number of Albanians in Yugoslavia and Albania 1943-1991 (in census years) Table 2.1 Net Material Product and Gross Domestic Product. 1980-90 Table 2.2 Real Income per capita Table 2.3 Number of schools and number of students graduated from schools, 1950-1990 Table 2.4 Proportion of Women in the labour force Table 2.5 Percentages of women graduated from the university Table 2.6 Health Indicators of Albania Table 3.1 Direct comparison of 1969,1979 and 1989 censuses in Albania Table 3.2 Estimates of the completeness of the later census relative to the earlier census in Albania for the period 1950-1990. Table 3.3 The relative enumeration completeness in percentage. Table 3.4 The difference between the adjusted and reported populations by age and sex for Albania in 1950 and 1960 censuses. Table 3.5 Completeness of death registration calculated on the basis of different indirect methods. Albania 1950-1989. Table 3.6 Average completeness of death registration in Albania, 1950-1989. Table 3.7 The estimated completeness of death registration. Albania 1950-1989. Table 3.8 Adjustment coefficients for the registered number of infant deaths in Albania. 1950- 1989 Table 4.1 Mortality indicators, Albania 1950-1989 Table 4.2 Contribution of different age groups to changes in life expectancy at birth, 1950- 1989. Table 4.3 Comparison of age-specific Albanian mortality in 1950 with Coale-Demeny Model Life Tables. Table 4.4 Comparison of age-specific Albanian mortality in 1989 with Coale-Demeny Model Life Tables. Table 4.5 Comparison of age-specific Albanian mortality in 1950 and 1989 with Coale- Demeny Model Life Tables and United Nations Models. Table 5.1 Prevalence of Three Endemic Diseases in Albania 1927-1932 Table 5.2 Measurements of malaria in Albania resulting from a seven cities survey, 1932-1938 Table 5.3 Death Rates per 10,000 population by cause, 1950-1980 (Male and Female) Table 5.4 Net probability of dying in % for ages 0-1 and 1-5, by causes of death 5 Table 5.5 Net probability of dying in % for ages 5-15 and 15-60, by cause of death Table 5.6 Net probability of dying in % for ages 60-70, by cause of death and sex. Table 5.7 Net probability of dying in different age groups for deaths caused by cardiovascular diseases Table 5.8 Net probability of dying in different age groups for deaths caused by cancers Table 5.9 Contribution in years of different causes of death to the improvement of life expectancy at birth during 1957-1987. Table 6.1 Climate indicators of different locations in Albania Table 6.2 Crude death rates by districts in Albania Table 6.3 Regional differences of child and adult mortality in Albania Table 6.4 Mortality Indicators of Albania and Former Yugoslavia, 1950-1990 Table 6.5 Mortality Indicators of Albania and Kosovo, 1950-1990 Table 6.6 Mortality Indicators of Albania and Republic of Macedonia (of the former SFR of Yugoslavia), 1950-1990 Table 6.7 Variation from Albanian mortality pattern of some selected regions in the Balkans Table 6.8 Adult mortality measured by 45q15 of Albania and other regions in the Balkans. Table 7.1 Child and adult mortality estimates of Albania and other countries Table 7.2 Cause-specific comparison of adult mortality, Albania and other countries Table A1 1950 - Male population. Table A2 1950 - Female population Table A3 1960 - Male population. Table A4 1960 - Female population Table A5 1969 - Male population. Table A6 1969 - Female population Table B1 Life table, Albania 1950 Male Table B2 Life table, Albania 1950 Female Table B3 Life table, Albania 1960 Male Table B4 Life table, Albania 1960 Female Table B5 Life table, Albania 1969 Male Table B6 Life table, Albania 1969 Female Table B7 Life table, Albania 1979 Male Table B8 Life table, Albania 1979 Female Table B9 Life table, Albania 1989Male Table B10 Life table, Albania 1989Female 6 Table B ll Contribution of different age groups to changes of e0, male-female, 1950-1960 Table B12 Contribution of different age groups to changes of e0, male-female, 1960-1969 Table B13 Contribution of different age groups to changes of e0, male-female, 1969-1979 Table B14 Contribution of different age groups to changes of e0, male-female, 1979-1989 Table Cl Net probability of dying for males 1957 nqjx.