Health care in socialist Romania was provided free of charge by the state and, at least in theory, to all citizens. Indeed, between 1940 and 1980, annual expenditures for public health increased considerably. There was a concurrent rise in the number of physicians and hospital beds available to the population. In 1950 there were 9.1 physicians and 41.6 hospital beds per 10,000 people. By 1971 these numbers had risen to 12.1 and 84.7 respectively. Using officially reported infant mortality rates and life expectancy figures as indicators, public health improved. Infant mortality decreased from 116.7 deaths per 1,000 live births in 1950 to 49.4 per 1,000 in 1970 and to only 23.4 per 1,000 in 1984. It should be noted, however, that infant deaths were officially recorded only if the infant was older than one month. Over the same period, life expectancy rose for men from 61.5 to 67 years and for women from 65 to 72.6 years.

In later years, however, infant mortality apparently rose quite rapidly, particularly after 1984. In 1988 health officials confirmed the rise in infant mortality, blaming the incompetence of medical personnel, geographic remoteness, harsh weather, and even "careless and uncooperative mothers" for the higher rate of mortality. Western observers suggested explanations such as harsh working conditions, especially in the textile industry, environmental pollution, and a food supply that was inadequate for the needs of expectant mothers and infants. Shortages of infant formula and inadequate concentrations of powdered milk resulted in malnutrition and death. Perhaps the greatest factor, however, was the government's demographic policy that forced women who were unwilling or in poor health to bear children. In the first year after the demographic policy was introduced in 1966, infant mortality increased by some 145.6 percent. There were even reports of newborns in hospital incubators dying during government-ordered power shutdowns. In 1989 the death rate of newborns stood at roughly 25 per 1,000 live births.

Although the mortality rate among the elderly decreased during the decades following the war, an unstable food supply, energy shortages, and the increasing cost of living in the 1980s posed grave hardship for the aged, who lived on pensions that averaged only 2,000 lei per month. Staple foods were rationed throughout the 1980s and were often unavailable except at exorbitant prices on the black market. In late 1988, one kilogram of meat was priced at 160 lei, or about 8 percent of the monthly pension. Cheese cost as much as 120 lei and coffee about 1,000 lei per kilogram. Although utility rates rose sharply, most people periodically had no hot water, heat, or electricity. In late 1988, pensions were raised an average 8 percent for some 1,352,000 people. It seemed doubtful, however, that the raise would make an appreciable difference in the face of erratic food and energy supplies and steadily rising inflation.

The elderly, who represented a growing percentage of the population (14.3 percent in 1986), received shoddy treatment from the state. Through regulations issued at 1000 t the local level, they were unable to move to larger cities--where food and health care were more readily available--even when their children offered to care for them. There was also widespread discrimination against the aged in health care. Hospitals responded to emergency calls from citizens over 60 years old slowly, if at all. Physicians routinely avoided treating the elderly in nonemergency cases and reportedly were under strict instructions from the state to reduce drug prescriptions for the aged. Homes for old people, established and run by the state social security system, had appalling reputations. In these institutions, the elderly suffered from inadequate medical care, poor hygienic standards, and the same food and heating shortages that affected the general population. After 1984 the winter months brought many complaints that old people had to go without heat and hot water for as long as a week, and there were regular reports of deaths of elderly men and women because of poor heating.

The disreputable treatment of the elderly was ironic in a country that had a long tradition of geriatrics. After 1952 Romania had an Institute of Geriatrics, directed by Dr. Ana Aslan until her death in 1968. Aslan was known internationally for developing "rejuvenation" drugs and for a philosophy of longevity that stressed social factors and material needs. The First National Congress of Geriatrics and Gerontology, held in Bucharest in 1988, failed to criticize the dire situation of the elderly in Romania.

Medical care was unevenly distributed throughout the country for all citizens, not just the elderly. There were substantial differences between urban and rural standards. In the 1980s, although half the population continued to live in rural areas, only 7,000 (15.7 percent) of the 44,494 physicians worked in the countryside. Consequently, many citizens had to travel great distances to get medical care. The state did not provide free medical care to some 500,000 peasants and 40,500 private artisans. In addition, access to medical care often depended on the gratuities proffered. It was common to offer medical personnel money, food, or Kent cigarettes (see Banking, ch. 3). Moreover the quality of health care depended on social standing. For example, only special health units that served party members, the Securitate, or the upper ranks of the military dispensed Western medications or had modern medical facilities comparable to those in the West.

Although many of the diseases of poverty had disappeared, cancer, cardiovascular disease, alcoholism, and smoking-related illnesses were prominent. Alcoholism, judging by the dramatic increase in production and consumption of alcohol after the 1960s, was a serious problem. By 1985 wine and beer production was twice that of 1950, and hard liquor production was four times higher. In 1980 beer consumption was eleven times that of 1950, brandy use was 2.2 times higher, and consumption of other alcoholic drinks was 5.8 times greater.

Drinking was prominent in all segments of society, but especially in the villages, where almost every occasion for celebration involved consumption of alcohol. Young workers in hostels were notorious for heavy and competitive drinking, which often led to brawls, destruction of public property, and violent crimes.

The deterioration of the standard of living exacerbated the drinking problem. Although food was scarce, the supply of alcohol was ample, and there was little else on which to spend one's wages. Moreover, the use of alcohol was encouraged by the traditional practice of offering bottles of liquor as bribes or gifts. Finally, official pronouncements aside, the sale of alcohol brought considerable profit to the state, and little real progress was made against increased consumption despite its adverse effects on labor productivity and work safety.

After a long official silence on the incidence of AIDS (acquired immune deficiency syndrome) in Romania, the first media references to b02the disesease began to appear in late 1985. Even then the brief articles contained very little information. They gave the technical name and classification of the disease and mentioned that it was fatal but said nothing about how AIDS was transmitted, its symptoms, or what preventive measures could stops its spread. The articles mentioned only two risk groups--drug addicts and hemophiliacs--and made no reference to the prevalence of AIDS among homosexual men. Most likely this omission was due to the fact that homosexuals as a group were never publicly acknowledged. Not only was homosexuality a taboo subject, it was illegal and punishable by one to five years in prison.

By 1987 Romania had reported only two deaths from AIDS and only thirteen carriers of the disease to the World Health Organization. But nothing about the cases, deaths, or carriers appeared in the Romanian press, which continued to emphasize that the highest incidence of AIDS occurred in the West, particularly in the United States. In 1988, however, a committee was established to study the disease, and between 1985 and 1987, thousands of people were tested for AIDS. In mid-1987 an information campaign was initiated. Articles in the press more frankly and factually covered the disease, admitting the existence of fifteen cases and two deaths from AIDS, as well as explaining for the first time that male homosexuals were the highest risk group. The symptoms were also listed. Still, efforts to combat the disease may have been seriously hampered by sexual taboos that persisted in Romanian society. High-risk groups such as homosexuals and prostitutes were unlikely to voluntarily submit to screening for fear of going to jail. In addition, the health service was impaired by the country's economic deterioration, and there was little hard currency available to purchase necessary testing and diagnostic equipment and supplies from the West.

Data as of July 1989