Mortality Transition in Albania, Thesis for the degree of Doctor of Philosophy of the University of

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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
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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
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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
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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
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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 1989 Male
Table B10 Life table, Albania 1989 Female
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Table Bll 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.
Table C2 Net probability of dying for females 1957 nqjx.
Table C3 Net probability of dying for males 1968 nqjx.
Table C4 Net probability of dying for females 1968 nqjx.
Table C5 Net probability of dying for males 1978 nqjx.
Table C6 Net probability of dying for females 1978 nqjx.
Table Cl Net probability of dying for males 1987 nqjx.
Table C8 Net probability of dying for females 1987 nqjx.
Table C9 Contribution to changes of e0 by age and cause of death, 1957-1968
Table CIO Contribution to changes of e0 by age and cause of death, 1968-1978
Table Cll Contribution to changes of e0 by age and cause of death, 1978-1987
Figure 1.1 Crude Rates for Albania and Kosova 1947-1990
Figure 2.1 The centralisation of Albanian Economy
Figure 2.2 Change in % of Real Income per capita
Figure 3.1 Population Pyramids - Albania (1950-1989)
Figure 4.1 Crude death rate, Albania 1938 - 1990.
Figure 4.2 Female mortality in Albania, 1950-1989
Figure 4.3 Male mortality in Albania, 1950-1989
Figure 4.4 qx values for different years during 1950-1989.
Figure 4.5 Contribution of different age groups to changes in e0, 1950-1989.
Figure 4.6 The change of male mortality levels in Albania compared with Coale-Demeny South
model.
Figure 4.7 The change of female mortality levels in Albania compared to South model.
Figure 5.1 Proportionate contribution of causes of death, 1950-1990
Figure 5.2 Net probability of dying for selected age groups for deaths caused by tuberculosis.
Figure 5.3 Net probability of dying for selected age groups for deaths caused by respiratory
diseases.
Figure 5.4 Contribution (in years) of tuberculosis & infectious diseases, and respiratory
diseases to changes of life expectancy at birth, 1957-1987.
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Figure 5.5 Contribution in years of cardiovascular diseases, and cancers to changes of life
expectancy at birth, 1957-1987.
Figure 5.6 Contribution in years of gastro-intestinal diseases to changes of life expectancy at
birth, 1957-1987.
Figure 6.1 Regional differences: Urbanisation and education levels
Figure 6.2 Topographical divisions in Albania
Figure 6.3 Regional differences in overall mortality measured by CDR, 1960-1989
Figure 6.4 Regional differences in overall mortality measured by e0, 1960-1989
Figure 6.5 Regional differences in child and adult mortality, 1960-1989
Figure 6.6 Geographical distribution of olive production and regional mortality
Figure 7.1 Life expectancy at birth and PPP/capita for selected CCEE, 1990
Figure 7.2 Life expectancy at birth, Albania and other European countries - 1989-1991
Figure 7.3 Comparison of Albania and selected Mediterranean countries in the consumption
per capita, of main food products in the 1990s.
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