Guide Constructing the Social Problem: Causes of Drug Addiction in Early Soviet Medical Texts

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Is there a sense that more equal societies are less creative, less dynamic? The evidence suggests that there are more patents [for inventions] awarded per head of population in more equal societies. The same principle applies to organisations too, she says. The US political scientist Robert Putnam found that more ethnically and culturally diverse communities — particularly in America — were likely to possess less social capital. In a sense, all politicians believe in equality, the equality of opportunity — or at least they all pay lip service to it.

Without addressing outcomes, they say, the opportunities will always be heavily loaded in favour of the privileged. This seems to me a reasonable point.

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The problem, of course, comes in rebalancing those outcomes. One way, Pickett suggests, might be a re-evaluation of how we reward different skill sets. For example, at the moment numeracy and computer literacy are premium skills that often command high salaries. Whereas those with an ability to look after the old and infirm or an empathetic outlook required in social work are frequently much less highly valued by society and the market. However, as artificial intelligence makes increasing inroads into the computerised world, that imbalance could conceivably be smoothed out.

But as Pickett acknowledges, increased leisure, like increased equality, will necessitate a huge cultural shift and require an ambitious approach to education of both adults and children alike. The scale of the undertaking is not something that comes across in their book, which is mostly concerned with highlighting current systemic problems. Just how much these effects account for mental ill-health or, indeed, how mental ill-health is defined and measured, are subjects worthy of informed debate.

If nothing else, it surely warrants our attention that countries such as Germany, Sweden and Japan manage to thrive with much lower levels of inequality. Where, though, to start on narrowing the distance between rich and poor? If they could impose one piece of legislation tomorrow what would it be? The question of inequality is likely to play a bigger role in the next election than it has for more than a generation.

It would be better for all of us if that debate was informed by robust statistical analysis rather than the emotive politics of envy. Vast numbers of studies have now demonstrated the cognitive damage that living in poverty does to children. They also provide strong evidence that lower levels of ability among children in poorer families reflect the less stimulating and more stressful family circumstances that poverty produces.

The cognitive deficits found in studies of children from poorer families show clearly that they are created, rather than being innate and unalterable givens. Comparing children from high- , medium- and low-income families, it found that children in lower-income families had lower volumes of grey matter containing neural cells, dendrites and synapses , which is essential for cognition, information processing and behavioural regulation.

These differences were not accounted for by infant birth weight, early health, or by differences in head size at birth.

9.1. What Is Social Inequality?

Nor were the differences explained by maternal smoking, excessive drinking in pregnancy, birth complication, significant language or learning disorders and a number of other risk factors — children with risk factors such as these were excluded at the start of the study. Differences in brain volume between the income groups emerged and widened as children grew up and were exposed to their contrasting home environments for longer. Data from the Millennium Cohort Study in the UK showed not only that children in poverty had lower cognitive development scores at three, five and seven years old, but that the longer they lived in poverty, the more marked the effects were.

The evidence that the more time families spend in relative poverty, the worse the effects on the cognitive development of children has been clear from numerous studies for well over 20 years. The ways in which poverty damages development seem to be mediated by stress and lack of mental stimulation. A study which measured levels of the stress hormone cortisol in the saliva of infants of seven months, 15 months and two years old, found that the cognitive deficit of poor children was closely related to their cortisol levels, indicating that the effects of poverty were transmitted by stress.

They found that these factors completely accounted for the effects of poverty on cognitive development. The bottom graph, left, shows that children growing up in professional families in the US hear a vastly richer vocabulary during their early years than children in working-class families or families receiving benefits. Perhaps the most striking illustration of how educational inequalities are a consequence of socio-economic inequalities, rather than a cause, comes from a series of studies of UK children that tracks educational performance over time, comparing high and low achievers from different social backgrounds.

The most recent of these studies is shown in the top graph. It compares the educational performance of children from more and less deprived backgrounds over time. Their progress is charted from their initial test results at age seven shown as high, average and low on the left , and, moving rightwards, tracking their subsequent performance at ages 11, 14, 16, 18 and then at university.

Regardless of whether their initial scores are high, medium or low, the gap between the performance of children from the most and the least deprived backgrounds the gap between the continuous and the dashed lines widens as they get older. Children from the least deprived families either maintain their initial high relative position, or improve their average or low scores. Education enhances their performance. In contrast, the relative performance of children from deprived backgrounds who initially achieved a high or average score declines over time.

Deprivation makes so much difference that children from the least deprived backgrounds whose performance at age seven was only average or low, overtake — or at least catch up with — children who initially performed better than them but came from deprived backgrounds. It is clear that differences in cognitive development and intelligence are the consequence of inequality rather than its cause. The number of live births, by contrast, hovers between four and five million. Moreover, refugees tell of dying patients denied treatment because their ambulance driver was out shopping, 37 or turned up too drunk to get behind the wheel.

Visitors who can read Russian often remark on the incessant complaints about absenteeism in the local papers, and the frequency with which party leaders insist that economic targets could be met, even exceeded, if only more workers showed up at their jobs. What do these things say about alienation and depression, the desire of people to look after their health and to keep others alive? How can we fit these bits of information together to suggest that some virulent strain of anomie is not running rampant or that the Soviet social order is not in the midst of a deadly decay?

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The spectacle of an industrial nation embarking on a path toward preindustrial standards of health is deeply disturbing. A mortality crisis of the sort the USSR is now suffering is alien to everything we understand about modern life.

Chapter 9. Social Inequality in Canada – Introduction to Sociology – 2nd Canadian Edition

In the world as we know it, in fact, the Soviet health crisis should be impossible. How then do we account for it? We should consider why this is so. Some might blame secretive apparatchiki or restrictive Intourist itineraries, and of course such things contribute to the problem, but they are not really at its heart. And while our access to Soviet information is deliberately rationed and manipulated, much more is available than is sometimes claimed: as Robert Byrnes has noted, the day has finally come when Sovietologists often have more material at their disposal than they can assimilate.

We are indeed unfamiliar with the USSR, but this is not so much for a want of information as a lack of understanding. I do not propose to chart out this universe here. The health crisis in the Soviet Union, however, cannot be comprehended without considering several often misunderstood points about Soviet government and Russian society. No serious discussion of the mortality crisis can ignore the Soviet regime's seeming inability to prevent a deterioration in the nation's health, and no account of that can be satisfactory if it ignores the contradiction in Soviet political concerns as they are enunciated on the one hand by the rhetoric of Kremlin leaders and on the other by the operational structure of the state.

To oversimplify only slightly, the men in Moscow are forever addressing themselves to questions of the future, while the apparatus under them is fighting against what we in the West would consider problems of the past. One must wonder whether they do not remain so to this day. It is complex and contradictory—and no less so for occasionally appearing amorphous. But this should not prevent us from identifying some of the more obvious elements within it.

Foreign visitors from the Marquis de Custine to Hedrick Smith have noted that central to the Russian view of the world is a tremendous patriotism and love of the land. In highlighting the differences between the Russian and the Western point of view, certain incidents seem especially instructive. He had suffered the unspeakable horror and injustice of the Gulag, and endured the better part of two decades of KGB harassment, but to Solzhenitsyn nothing could be worse than to be torn from his people and forced to live apart.

While this speaks to a deep and even extraordinary sense of patriotism, it does not speak to this alone. Implicit in Solzhenitsyn's response is a special attitude toward authority and suffering which is in keeping with at least one important strand of Russian history. We may remember as well that the first two saints canonized by the Russian Orthodox Church, Princes Boris and Gleb, died not as martyrs of faith but as victims of their brother's plot, accepting their fate without resisting. It might be unwise to dismiss these words. For hundreds of years Western visitors have remarked that in the Russian view of the world suffering is not something to fear, or even to face indifferently, but rather more like a collective reserve of strength, to be added to and drawn on.

Perhaps this attitude can help to explain the current health crisis in the USSR. By this I do not mean, of course, that Russian mothers are indifferent to their children's illnesses, or that Russian men hope for expiation in a death from alcoholism. If anything, Russian mothers seem closer to their children than mothers in the West. I would suggest instead that deep patriotism and unthinking respect for authority, in combination with a faith in the strength that is to come of suffering, lay foundations for a distinctive and necessarily troubled style of government. Autocracy and repression were not unique to Russia, but the response to them arguably was.

Imperial Russia's most revered rulers were not enlightened men like Alexander II but instead despots like Ivan the Terrible and Peter the Great, who brought frightful suffering down upon the people, but for a purpose which could be seen and understood. The constraints and opportunities such a situation presents to potential leaders should be evident. Though hardly inevitable, Joseph Stalin's system might be said to represent a final logical extension of this particular governance. The hardships he put his country through could scarcely have been imagined under the czars, 42 if only because the technology and organizational skill which were to make them possible did not then exist.

At the same time, Stalin's results were incontestable. This is a point those of us in the West often overlook. Stalin inherited a country that was the primary casualty of World War I, and bequeathed to his successors a super-power. These rates of growth were geometrically higher than in the less devastated and Terror-free West. Most surprising, however, was the popular reaction. There was of course revulsion, and there were at least a few large-scale revolts. The seeds of today's mortality crisis, I would argue, lie in Stalinism.

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It is not that Stalin's own rule was a failure: in many ways it can be seen as an achievement of brilliance. Despite the continuing purges, the politically inflicted famines, and World War II, for example, Stalin managed to raise life expectancy in the Soviet Union from about forty-four when he assumed total power to about sixty-two when he died. The problem is that Stalinism has brought on an extensive failure of government in a system where the government encompassed not only political administration but the economy and society itself. To put it simply, Stalin's was an impossible act to follow.

For Stalinism is a self-immunizing process, but not a self-correcting system. Thus, it is at once inconceivable for his successors to continue on the tyrant's path and impossible to stray from it. This was not yet clear in the s. Stalin's death was followed by a period of intense elation. It was said that a new era had dawned, that the ascetic dedication of the Revolution would be married to the contentments of consumerism to bring forth a New Soviet Man. By the early s it had become clear that this would not be possible. The self-sacrificing obedience these engendered would not last long.

A new world of consumerism, however, could not be born. But meaningful liberalization would threaten the political apparatus directing society, and hence the Party itself. This was unacceptable. Thus the peoples of the Soviet Union found themselves caught between two worlds. Given the shape of things, moreover, there were no prospects for a future any better. If the problem was distinctively Russian in its construction, its results were to affect all, without regard to language or ethnicity.

Preoccupied as we Americans were by our own troubles in the Sixties and the Seventies, it is perhaps understandable that we did not immediately recognize that the Soviet Union was grappling with problems far more profound that our own. During the Eighties, it may become increasingly clear that we are witnessing the wearing down of a system. Despite a constant infusion of new technology and a steady upgrading of the education of the workforce, there have been no improvements in overall productivity in the USSR for more than five years; in agriculture and other important sectors of the economy, the efficiency of expenditure has been dropping for most of the past decade.

The simplest routines of management seem to have become arduous struggles, to be won only on occasion. In , for example, only 1. By , according to official figures, the proportion was over 40 percent. Discipline and morale are on the wane. Since the early s per capita sales of alcohol have risen by a factor of five; thanks to samogon , which is brewed and sold illegally, total consumption may have increased even more rapidly. The state is finding it increasingly difficult to keep track of people in its controlled society.

And then, not unrelated to any of these things, there was the rise in death rates for nearly every group in society. By some measures—electrical output per capita, the availability of meat 55 and clothing, average waiting time for new apartments—the standard of living is noticeably better today than in the early s. But prospects for the future are incontestably worse. For the first time since Operation Barbarossa, Soviet leaders must think seriously about combating anarchy. Today's anarchy, of course, is far less threatening, but it is also less easily confronted.

Crack divisions and Russian patriotism will not keep alienation and dissatisfaction from the gates of Moscow. To hold its country together today, the Politburo must rely on the cohesive power of its most effective instruments of government and those institutions which enjoy the deepest and most widespread support. At the risk of being arbitrary, I would suggest that four seem to stand out above all others: the army, the secret police, the restrictive and highly sophisticated system of political privilege, and the black market.

Feeding elitism or unleashing the black market, for example, could increase morale or efficiency temporarily, but could only intensify the long-term problems the Communist Party or the Soviet Union must eventually face. In the current struggle, the CPSU must rely heavily on inertia, but if the past fifteen years are any measure, inertia will not serve them at all. The Soviet health crisis presents the Politburo with serious problems. The increase in death and disease probably cannot be stemmed at any acceptable cost.

Cutting the liquor monopoly's output might force sobriety upon the Slavs, but this would be financially disastrous- taxes on alcohol could pay the state's full health and education bill 58 —and could do more than any samizdat tract to awaken the masses. The health budget could be increased, but only at the expense of military preparedness or economic growth. The rise in death rates, then, will probably continue. But consider what this means. An increase in mortality and morbidity necessarily is a burden on the economy and a drain on resources.

It is not at all clear that the country can afford this. The Soviet economy is currently stalling; according to some analysts, it may even have entered negative growth.

Inefficiency is in large part to blame for this slowdown; the debilitation of the workforce, and the demoralization which underlies it, do not bode well for the cadres charged with achieving a turnaround. The impending labor shortage, assured by the fact that there are fewer fifteen-year-olds than twenty-five-year-olds in the USSR today, 60 can only be worsened by a deterioration in the health of the population, and despite its attempts at modernization the Soviet economy is still highly labor-intensive.

If the economy begins to shrink, Moscow must decide which will feel the loss: the factory, the army, or the consumer. This is not a situation which can be muddled through. If investment is cut back, the economy will presumably be even feebler in the future. A cutback in military expenditures might not only imperil the chances of successful long-term competition with the United States, with whom the Red Army has finally achieved parity, 61 but possibly security within the Soviet sphere of influence.

A continuing peacetime cutback in goods and services for the consumer could intensify the health crisis, and even contribute to an erosion of the legitimacy of the Soviet government. As a backdrop to all of this, there is the continuing shift in the composition of the Soviet population. In , there were five Russians for every Muslim; by the end of the century, the ratio will be down to two-to-one.

One cannot help wondering how these problems will affect US relations with Moscow. Predictions are inappropriate; we understand too little about the USSR, and unexpected events might in any case prove decisive. Still, we must bear in mind that improving the ability of the state apparatus to project itself abroad and improving people's lives are two quite different things. In Bismarck's day the fortunes of a nation rested largely on the skill and eloquence of its emissaries, the competence and reliability of its informants, the judgement of its leaders and the strength of its armies.

Bismarck, of course, lived in a world which did not yet know of development aid, the doctrine of universal human rights, or the United Nations, but the laws governing international success may not be entirely different in his age and ours. Soviet diplomats, trade representatives, and propagandists may or may not be more skilful than their counterparts in the West. Fortunately for us all, the differences in military strength between East and West remain untested, but impartial analysts tell us the match is fairly even. Still, we must remember two things. First, Soviet military and diplomatic doctrine is, by some accounts, geared to a greater degree than Western doctrine to the application of force in day-to-day situations; 66 second, neither the United States nor the Soviet Union is spending more than a fraction of the money on weapons that it could afford in a time of crisis.

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  7. But if we take all this into account, we should see that it is at least also possible for Soviet power in the world to increase even as the domestic base upon which it is built deteriorates. It should not be necessary to explain that short-term strength, in tandem with a prospect of long-term weakness, is not a prescription for international stability—especially when the government in question is both immensely powerful and demonstrates expansionist tendencies.

    Those who would discount the effects of the Soviet health crisis on international politics, or would see within that crisis only incentives for an inward turn in Moscow's attention, should also consider whether this unhappy situation might have profound consequences for the rest of the world as well. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation.

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    Chapter 9. Social Inequality in Canada

    Google Scholar. Cite Citation. Permissions Icon Permissions. I If we could judge it solely by advances in health, the twentieth century would be a fabulous success. View large Download slide. Samuel H. World Development Report, World Bank, The low estimate assumes a life expectancy of sixty for China; the high would be in line with the Bank's assertion that it is currently seventy. Even if life expectancy in the People's Republic were lower than this, however, the world average could quite easily exceed sixty-three, for in many regions of the world estimates lag far behind the gains the people have achieved.

    A recent trip to Java, for example, has convinced me that Djakarta's mortality data understate the length of life on that island of ninety million by at least five years. With life expectancy at eighteen for men and twenty for women, parents must have an average of six and a half or seven children to keep the population from declining. See Ansley J. Few societies have registered fertility rates much higher than this; when they have, it has seldom been under the harsh conditions such a low life span would imply. Archaeologists now tell us that Neolithic man's lifespan was about eighteen to twenty years, and we know that his life was a battle to maintain his numbers.

    The rich and the poor are still separated by an enormous gap in life chances: infant mortality is four or five times higher today in the poor world than the rich, and a baby from the less developed regions can expect to die nearly twenty years before one who was fortunate enough to have been born at the same time in Europe, North America, Japan, Australia, New Zealand, or Israel. But if we take these tragic differences to mean that the poor have nothing to show for their participation in the twentieth century, we will be seriously mistaken.

    Progress in the less developed countries has been rapid and substantial. In India, for example, the length of the average life has nearly doubled since Independence. Those who claim that the plight of the subcontinent's poor has gone unimproved for centuries always seem to forget this. Over the past generation poor nations have consistently outpaced rich nations in the race to a healthier life. From to , no rich country managed to improve its life expectancy by as much as 10 percent; by contrast, not a single poor country raised its own standing by less than 10 percent. These gains were absolute as well as relative.

    Since the collective life expectancy of the rich nations has increased by about a decade; for the poor nations, it is up more than fifteen years. Coale, Barbara A. See Charles K. For further details, see Davis and Feshbach's report. Washington Post , June 26, Where life expectancy is currently sixty-nine. At this point we should dispose of two potential objections to Davis and Feshbach's report.

    The rise in Soviet mortality rates cannot be explained away by improvements in statistical coverage.


    The need for reliable numbers in a centrally planned economy is obviously great, and the Soviet statistical system has been a highly sophisticated operation for decades. See Vldimir G. Treml and John P. Hardt, eds. Nor can the rise in death rates be passed off as a matter of demographic shifts, as long-living and slow-breeding Slavs are gradually replaced by Asian and Muslim comrades.

    The Asianization of the Soviet population, other things being equal, would indeed push death rates up, even if health conditions for each individual ethnic group went unchanged. But demographic shifts cannot account for more than about a tenth of the increase in mortality which has actually been registered. The rest must be due to a deterioration of health on the part of various Soviet nationalities.

    Soviet medical reports quoted by Davis and Feshbach put the ratio of abortions to live births anywhere between two and a half to one and four to one. Since the USSR's total fertility rate is slightly over two, this works out to approximately six to eight abortions per woman. In the United States, the average number of abortions per woman per lifetime is 0. Six to eight, however, may be an underestimate: according to Soviet feminists, the figure is nearer ten: see the Philadelphia Bulletin , November 27, The Soviet Union's astounding abortion problem has not only gone unexplained, but largely unexamined in the West.

    Vladimir G. See Vladimir G. Fallenbuchl, ed. W Praeger, Ludmilla Thorne of Freedom House kindly brought this source to my attention. John Dutton, Jr. Although all Soviet peoples, including those who are Muslims, probably have their share of alcoholics, alcoholism is predominantly a problem of the Slavs. In the Republic of Georgia, for example, only 20 percent of the population is Russian, yet Russians account for 80 percent of the hospitalized alcoholics. See David E. Others present a somewhat more optimistic picture. Boris Komarov pseud. Forthcoming in English through M.

    Alcoholism, of course, is a known cause of birth defects as well. It is possible that the combination of heavy pollution and heavy drinking exerts a special strain on the body's filtering systems; surprisingly, there has been little research in the West about this. The Soviet Union does not publish mortality breakdowns by ethnic background. However, Davis and Feshbach have managed to collect infant mortality data for twenty Soviet cities for and In thirteen of the twenty, infant mortality was up. Although Russian ethnics tend to be disproportionately represented in cities, a rise in infant mortality presumably could not be powered by a decline in their health alone.

    A Soviet medical certificate, in fact, can mean very little. As the inspection of recent issues of the Israel Press Digest will confirm, this has made for a bitter and protracted debate. See William A. From to , for example, the fraction of the American GNP going to health care increased from about 8 percent to about 11 percent. In large part this was due to Medicare and Medicaid, which much improved the medical care available to the poor.

    Following the institution of this form of semi-socialized medicine, American infant mortality rates, which had dropped disturbingly little over the previous decade, fell by almost half. See Kwang-sung Lee, et al. At the same time, ischemic heart disease, which had been on the rise for half a century, began to subside; its incidence in the general population is more than 25 percent lower today than fifteen years ago. See R.