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BMJ 2009; 338 doi: (Published 21 January 2009) Cite this as: BMJ 2009;338:b176

Rapid privatisation is bad for population health

In the early and mid-1990s, some eastern European countries experienced dramatic rises in mortality among men of working age. Most of these countries were going through profound social and economic changes at the time, including rapid mass privatisation programmes known as “shock therapy” by economists. A detailed analysis of trends in privatisation, deaths, and other social changes in 25 post-communist countries between 1989 and 2002 suggests a powerful link between the speed of privatisation and rises in mortality. Shock therapy, which peaked between 1992 and 1994, was associated with an overall 12.8% increase in mortality among working age men (95% CI 7.9% to 17.7%). It was also associated with a rapid rise in unemployment, which the authors suspect mediated much of the effect.

Russia and other countries of the former Soviet Union were worst affected. Even here, however, increases in deaths were slower and smaller in countries that privatised more gradually, such as Belarus. Social cohesion—defined by the popularity of social organisations such as churches, trades unions, and sports clubs—also seemed to protect some countries from the worst of the changes.

These analyses can’t establish true cause and effect, says a linked comment (doi:10.1016/S0140-6736(09)60043-X), but they are robust enough to act as a warning to other countries planning similar mass reforms—specifically, China, India, Egypt, and Iraq.

Premature girls do better with docosahexaenoic acid enriched breast milk

Developmental delay is a serious problem for babies born before 33 weeks’ gestation, and it may partly be caused by an early deficiency of the major brain lipid docosahexaenoic acid (DHA). Supplementing infant formula feeds has had mixed results, so Australian researchers supplemented expressed breast milk instead—by persuading mothers to take six tuna oil capsules a day. In their large trial, the supplemented milk was associated with significant improvements in the mental development of premature girls, but not boys. It had …

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