The European Journal of Public Health Advance Access originally published online on December 12, 2008
The European Journal of Public Health 2009 19(1):117-120; doi:10.1093/eurpub/ckn124
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Miscellaneous |
Homicide in post-Soviet Belarus: urban–rural trends
Andrew Stickley1, Mall Leinsalu1,2 and Yury E. Razvodovsky3
1 Stockholm Centre on Health of Societies in Transition (SCOHOST), Södertörn University, SE 141 89 Huddinge, Sweden.
2 Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
3 Central Scientific Laboratory, Grodno State Medical University, Grodno 230015, Belarus.
Correspondence: Andrew Stickley, Stockholm Centre on Health of Societies in Transition (SCOHOST), Södertörn University, SE 141 89 Huddinge, Sweden, tel: +46 8 608 4148, fax: +46 8 608 4030, e-mail: andrew.stickley{at}sh.se
Received June 5, 2008, accepted October 31, 2008
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
Background: To investigate the occurrence of homicide in urban and rural regions of Belarus in the post-Soviet period. Methods: All-age male and female homicide mortality and population data were obtained for the years 1990, 1995, 2000 and 2005 for urban and rural regions of Belarus. These data were recalculated into three age categories and directly standardised. To assess relative changes in rural–urban homicide rates across time Poisson regression models were used to calculate rate ratios. Results: Between 1990 and 1995 homicide rates rose sharply in urban and rural regions although the rise was greater in the former. Although there was little change in homicide rates in 2000, a notable divergence had occurred by 2005. While homicide rates rose slightly in rural areas, a large fall occurred in the rates of both men and women in urban areas. This resulted in significantly higher rural homicide rate ratios at the end of the study period. With some variations age-specific homicide rates followed this overall general pattern resulting in significantly higher homicide rate ratios in all rural groups aged 15 and above in 2005. Conclusion: It is probable that a combination of factors such as high levels of poverty, the effects of alcohol consumption, as well as the poor provision of emergency medical services underlie both the high levels of lethal violence and the growing rural–urban divergence in homicide rates in contemporary Belarus. Urgent action is now needed to address the deteriorating social and economic conditions underpinning violence, especially in rural regions.
Keywords: alcohol, Belarus, homicide, poverty, rural, urban
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
The social, economic and political turmoil that many former Soviet countries have experienced in the post-Soviet period has been accompanied by a sharp rise in all-cause mortality.1 This has included a large increase in the number of deaths from external causes, both accidental and purposely inflicted. In particular, deaths from homicide have grown sharply in many of these countries in recent years. In 2005, homicide rates were above their 1990 level in six former Soviet countries providing data to the WHO's European Region, while the overall rate for those countries belonging to the Commonwealth of Independent States remained 37% above its 1990 level.1 With the notable exception of Russia however,2–4 little attention has been devoted to the occurrence of homicide in the countries of the former Soviet Union (fSU). This is a serious omission as violence is increasingly being recognised as an important public health problem.5
Despite having never fully democratised and retaining many elements of the command economy,6 in recent years Belarus has nevertheless experienced a similar pattern of changes in its homicide rate to that seen in other countries in the European part of the fSU such as the Baltic States i.e. a rapid rise in the period 1990–95 after which its rate stabilised and then fell.1 However, even after this fall the homicide rate in Belarus in 2005 (8.41 per 100 000 of the population) was still 19% above its 1990 level and was thus over seven times higher than the rate in the European Union.1 Moreover, since the early 1990s increasing homicide rates have made a major contribution to the sharp rise that has occurred in mortality from external causes in Belarus,7 which itself has been an important element in the increase in overall mortality. In conjunction with a large rise in cardiovascular mortality and a falling birth rate this has resulted in a ‘demographic crisis’ in the country8 where the population decreased by over 400 000 people (i.e. 4%) between 1993 and 2005.9
The aim of the current study is to examine the changes in urban and rural homicide rates in the post-Soviet period. This is an important distinction as Western research has suggested that there may be differences in both the prevalence and causes of homicide in urban and rural areas.10 It is also possible that the predominance of homicide as an urban phenomenon in some Western countries such as the United States10,11 might not be replicated in fSU countries. An earlier study of homicide mortality in the Russian Republic of Udmurtia showed that homicide was higher in rural areas at least until the end of the Soviet period2 which was also true for Russia as a whole,12 while a more recent study also failed to find an association between urbanism and homicide in Russia.3 As regards Belarus specifically, a study examining differences in all-cause mortality in rural and urban areas of the country in 2002 also reported a much higher homicide rate in rural areas.13 This suggests that the analysis of urban and rural homicide rates and their trends may be particularly instructive when trying to understand the phenomenon of homicide in contemporary Belarus.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
Homicide data for urban and rural areas of Belarus were taken from data files provided by the Belarus Ministry of Statistics. In Belarus, two criteria are used to determine the designation of a settlement as being urban: population density and the structure of employment. Thus, a settlement is defined as urban if it has over 6000 inhabitants or if a majority of its population (more than two-thirds) are not employed in agriculture. All settlements not defined as urban are ipso facto classified as being rural. Data were collected for four points in time—1990, 1995, 2000 and 2005. These years were chosen because they represent equal time intervals across the period and also because they coincide with important historical moments i.e. the period directly before the fall of the Soviet Union, after the implementation of political and socioeconomic reforms in the wake of the founding of the contemporary Belarusian nation state in 1991, the period following the ruble crisis in Russia (1998), and the latest period for which data were available. Data were obtained on urban and rural homicides for both sexes and for all ages and then subsequently recalculated into three main age categories: children (0–14); the adult i.e. working age population (15–59); and those of retirement age and above (60+). Mid-year population data were also acquired from the Belarus Ministry of Statistics in order to calculate homicide rates.
The data were directly standardised using the old European standard population. The small number of homicides where the age of the victim was unknown were omitted from the analysis. To assess relative changes across the study period Poisson regression models were used to calculate rural–urban rate ratios (with 95% CIs) using the STATA 9.0 statistical software package.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
Age- and sex-standardised homicide rates for urban and rural areas are presented in figure 1. In 1990, the homicide rate was significantly higher in rural areas (9.6 vs. 6.4). By 1995, the homicide rate had risen sharply in both urban (+81%) and rural areas (+39%) although the rise was much greater for the urban population. In 2000, there was a slight fall in homicide rates in both urban and rural areas. However, by 2005 a noticeable divergence had occurred. While the rural homicide rate rose slightly (+5%) there was a sharp fall in the urban rate (–36%). This meant that by 2005 homicide rate ratios were significantly higher for rural men and women.
|
Similar urban and rural trends were observed for both men and women when all age groups were combined, however for women, both absolute (except in 2005) and relative urban–rural differences were larger when compared to men (tables 1 and 2).
|
|
The age-specific homicide rates for urban and rural men and women are presented in tables 1 and 2 respectively. Across the whole period the largest relative changes in homicide rates for males and females were observed in the youngest age group because of the very small number of deaths recorded in this group. In 1990, homicide rates were significantly higher among working age rural men and women compared with their urban counterparts while non-significant differences were recorded for the older age group.
By 1995 although rates had risen significantly for all adult male age groups in both urban and rural areas there was a noticeable difference between the age groups—while rates rose much quicker among urban men under 59, for men aged 60 and above the rise in homicide rates was much larger in rural areas (160% vs. 70%). Among women, a small reduction (–3.5%) occurred in the homicide rate of rural women aged 15–59 while a large increase occurred in the rate of their urban counterparts. As with men, the largest absolute rise amongst females was seen in rural women aged 60 and above (+171%).
In contrast, in 2000 homicide rates fell slightly for every adult male and female group, except for urban women aged 60 and above, whose homicide rate increased slightly.
However, by 2005 a clear divergence had taken place between men and women aged 15 and above in rural and urban areas. While homicide rates rose slightly for rural males and females (except for rural women aged 60+), both working-age and retired urban men and women saw their homicide rate fall sharply (ranging between 30% and 40%). This meant that by the end of the period homicide rate ratios were significantly higher amongst rural men and women in both working and retirement ages. In 2005, women in rural areas had a homicide rate that was two times higher than the rate of their counterparts in urban areas.
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
Before discussing the findings of this study, it is necessary to consider its potential limitations. This applies to the quality of the data used. During the Soviet period data relating to violent mortality were not deliberately falsified in Belarus,14 while a recent study has argued that comparisons can be made across time in the country using Soviet and post-Soviet data.15 Nevertheless, several factors could have affected the results. In 2002, Belarus adopted a nomenclature of causes of death based on the WHO's ICD-10 classification that may have affected the classification of homicide deaths in the most recent period. Further, the current study uses unlinked cross-sectional data that can result in a potential numerator-denominator bias16 between population and homicide death counts in urban and rural areas. Thus, to assess whether our results may have been subject to any potential problems we examined cancer mortality in both urban and rural locations across the four time points. It has been previously argued that the relative stability of cancer mortality compared to the sharp fluctuations in other causes of death is one of the main facts supporting the validity of death registration in Russia across time.17 Our analysis showed that the patterns of male and female age-specific mortality from malignant neoplasms were constant over time in both urban and rural areas (data not shown)—suggesting that the results of the current study are not artefactual.
Between 1990 and 1995 homicide rates rose sharply in all regions before falling slightly in 2000 and then more significantly in 2005. Within this general pattern there were important variations. The homicide rate rose much quicker in urban areas between 1990 and 1995. Moreover, although urban and rural trends mirrored each other up until 2000, by 2005 there had been a divergence with the overall homicide rate amongst both rural men and women rising slightly while the urban rate fell substantially. By 2005, homicide rates were significantly higher in rural areas although homicide rates in both urban and rural areas remained higher than their 1990 base level among nearly every group.
To explain these differences, it is necessary to examine the socioeconomic changes that have occurred in Belarus during the post-Soviet period and how these have impacted on the population in rural and urban settings. The initial attempts to introduce a market mechanism into the country in the early 1990s resulted in an acute economic and social crisis. Rising unemployment, falling GDP and sharply increasing inflation18 resulted in social dislocation with a falling number of marriages and births and an increasing rate of divorce.7 The incidence of poverty also rose sharply from under 5% of the population in 1992 to around 22% in 1995.19 This is important, as poverty has been strongly linked to homicide in earlier research through the strains and tensions it exerts on individuals and communities that can lead to violence.3
If increasing levels of poverty do underlie the sharp growth that has occurred in both violent crime9 and violent mortality in post-Soviet Belarus it is possible that its initial effects were stronger in urban areas. Between 1991 and 1995 employment levels in the transport, construction and industrial spheres of the economy fell while a small increase (0.7%) was recorded for the agricultural sector.7 However, this situation was reversed after 1995. While employment patterns stabilised in urban areas, the situation worsened in the countryside with the share of the population employed in the agricultural sector falling by over 40% between 1995 and 2004.7 Even amongst those who retained jobs there was a sharp deterioration in their comparative incomes which now equate to some 50% of those in urban areas.13 This has resulted in higher levels of poverty in rural areas where between 29.4% and 45.6% of rural inhabitants have incomes below the national subsistence minimum9 while 20.1% of rural households compared to 11.6% of urban households were living in poverty in 2004.20 The existence of high levels of concentrated poverty in the countryside may help to explain why rural adult homicide rates either rose or remained stable in 2005 after experiencing a slight fall in 2000.
The effects of the impoverishment of the countryside may also have been exacerbated by its continuing depopulation. Between 1990 and 2005 the share of the population living in the countryside fell from 33.9% to 28.0%9 as the young and better educated sought out opportunities in urban centres. This has resulted in a distorted population structure in rural areas with an excess of elderly people and single men.9,21 Those left in the countryside tend to form a more economically depressed population due to their generally lower levels of education and/or fewer economic skills and greater dependency levels (i.e. the old and the sick). Such a population is more likely to contain a higher percentage of those at risk of violent offending or victimization. Indeed, this situation may have been made worse by the erosion of the traditional (patriarchal) family structure in the countryside that has fed through to a low level of (informal) social control13 which in other contexts has been linked to the occurrence of violence.22
The high levels of alcohol (spirits) consumption in Belarus in recent years23 may also have impacted on the occurrence of violence as a close connection has been established between spirits consumption and the occurrence of lethal violence in the country.24 Thus, it has been demonstrated that a 10% per capita increase in spirits consumption would result in an 11.4% rise in the homicide rate.25 Although it is likely that alcohol has played an important role in the occurrence of lethal violence everywhere, its effects may have been especially strong in rural areas as alcoholism has become endemic in the countryside in recent years8 in part, due to the collapse of customs and traditions regulating drinking.13
Finally, it should be noted that in Belarus the provision of health care is poorer in rural regions where there are fewer doctors and services available.8,9 The effects of this deficit may have been compounded in recent years as there has been a small reduction in the number of emergency medical stations (stantsii skoroi meditsinskoi pomoshchi) in the post-Soviet period.26 This may have been important, as better emergency medical care has been linked to a reduction in the lethality of violent assaults in other contexts.27 Further, if the knife is the weapon of choice when murders are committed in Belarus as it is in neighbouring Russia,28 then it is likely that many violent assaults may be of a type where a properly functioning and wide-ranging system of emergency medical intervention might make an important difference.
In conclusion, in the post-Soviet period Belarus has experienced increasing homicide rates against a backdrop of deteriorating social and economic conditions. During the early transition period the homicide rate rose fastest amongst the urban population, whilst in recent years homicide rates have been significantly higher in rural areas for both sexes and amongst nearly all age groups. While it is likely that some factors associated with comparatively high homicide rates even in the later Soviet period, such as the poor provision of emergency medical services have continued to be important, it is also probable that increasing levels of poverty and high levels of alcohol consumption—especially in rural areas, have underpinned the increasing occurrence of homicide in recent years. In such circumstances a general improvement in living standards is required9 as is a more targeted form of intervention by the authorities—such as introducing anti-alcohol treatment services into rural areas where they are now mostly absent.13
|
Acknowledgements |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
Swedish Foundation for Baltic and East European Studies (for A.S. and M.L.).
Conflicts of interest: None declared.
Key points
|
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionAcknowledgementsReferences |
|---|
1 World Health Organization (WHO). European Mortality Database. Available at: http://data.euro.who.int/hfamdb/ (Accessed 25 May 2008).
2 Chervyakov VV, Shkolnikov VM, Pridemore WA, McKee M. The changing nature of murder in Russia. Soc Sci Med (2002) 55:1713–24.[Medline]
3 Pridemore WA. Social structure and homicide in post-Soviet Russia. Soc Sci Res (2005) 34:732–56.[Web of Science]
4 Gavrilova NS, Gavrilov LA, Semyonova VG, et al. Patterns of violent crime in Russia. In: Ruling Russia. Law, crime, and justice in a changing society—Pridemore WA, ed. (2005) Lanham: Rowman & Littlefield Publishers, INC. 117–45.
5 Rutherford A, Zwi AB, Grove NJ, Butchart A. Violence: a priority for public health? (part 2). J Epidemiol Community Health (2007) 61:764–70.
6 Abbott P. Cultural trauma and social quality in post-Soviet Moldova and Belarus. East Eur Polit Soc (2007) 21:219–58.
7 Ministry of Statistics of the Republic of Belarus and Rosstat. In: Belarus’ i Rossiya 2005: statisticheskii sbornik (2005) Moscow: Author.
8 Marples DR. The demographic crisis in Belarus. Probl post-communism (2000) 47:16–27.
9 UNDP. Belarus: addressing imbalances in the economy and society. National human development report 2004–2005. Minsk: ‘Altiora – Live Colours’, 2005.
10 Weisheit RA, Wells LE. Deadly violence in the heartland: comparing homicide patterns in nonmetropolitan and metropolitan counties. Homicide Stud (2005) 9:55–80.
11 Weisheit RA, Donnermeyer JF. Change and continuity in crime in rural America. In: Criminal justice 2000, Vol 1. The nature of crime: continuity and change—LaFree G, ed. Washington, DC: Department of Justice. 309–57.
12 Goskomstat. Demograficheskii ezhegodnik Rossii (1998) Moscow: Author.
13 Razvodovsky YE. Analiz struktury smertnosti gorodskogo i sel'skogo naseleniya Respubliki Belarus’. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med (2004) 6:10–14.
14 Wasserman D, Värnik A. Reliability of statistics on violent death and suicide in the former USSR, 1970-1990. Acta Psychiatr Scand (1998) 98(Suppl 394):34–41.[Web of Science][Medline]
15 Stickley A, Leinsalu M, Andreev E, et al. Alcohol poisoning in Russia and the countries in the European part of the former Soviet Union, 1970-2002. Eur J Public Health (2007) 17:444–9.
16 Shkolnikov VM, Jasilionis D, Andreev EM, et al. Linked versus unlinked estimates of mortality and length of life by education and marital status: evidence from the first record linkage study in Lithuania. Soc Sci Med (2007) 64:1392–406.[CrossRef][Web of Science][Medline]
17 Leon DA, Chenet L, Shkolnikov VM, et al. Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what? Lancet (1997) 350:383–8.[CrossRef][Web of Science][Medline]
18 World Health Organization (WHO). European Health for All Database. Available at: http://data.euro.who.int/hfadb/ (Accessed 25 May 2008).
19 World Bank. Belarus – an assessment of poverty and prospects for improved living standards. Europe and Central Asia Region: Author, 1996. Available at: http://poverty2.forumone.com/library/view/8615/ (Accessed 21 April 2008).
20 UNDP and the Government of Belarus. Comprehensive poverty assessment in the republic of Belarus (2005) Minsk: Author.
21 Lin D, Predybailo S. Demograficheskaya situatsiya v sovremennoi Belarusi. Narodonaselenie (2005) 1:104–18.
22 Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science (1997) 277:918–24.
23 Razvodovsky YE. Epidemiologiya alkogolizma v Belarusi (2004) Grodno: Author.
24 Razvodovsky YE. Homicide and alcohol poisoning in Belarus, 1970-2005. Drugs-Educ Prev Polic (2008) 15:7–14.
25 Razvodovsky YE. Association between distilled spirits consumption and violent mortality rate. Drugs-Educ Prev Polic (2003) 10:235–50.
26 Health Service Ministry of Belarus. Ofitsial’nyi statisicheskii sbornik. (za 2004; 2005; 2006 gody). Minsk: Author (Various years).
27 Harris AR, Thomas SH, Fisher GA, Hirsch DJ. Murder and medicine: the lethality of criminal assault 1960-1999. Homicide Stud (2002) 6:128–66.[CrossRef]
28 Pridemore WA. An exploratory analysis of homicide victims, offenders and events in Russia. International Criminal Justice Review (2006) 16:5–23.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||