Health and Welfare
The Lithuanian constitution of 1992 provides guarantees of social rights that were earlier provided by the Soviet regime. The constitution puts special emphasis on the maintenance and care of the family. It expresses in detail, for example, the guarantee for working mothers to receive paid leave before and after childbirth (Article 39). The constitution provides for free public education in all state schools, including schools of higher education (Article 41). The constitution forbids forced labor (Article 48); legalizes labor unions and the right to strike (Articles 50 and 51); guarantees annual paid vacations (Article 49); and guarantees old-age and disability pensions, unemployment and sick leave compensation, and support for widows and families that have lost their head of household, as well as for others in situations as defined by law (Article 52). Finally, the constitution guarantees free medical care (Article 53).
All political groups support these guarantees--considered more or less inviolable--although it is not clear to what extent the government will be able to fund the promised services during the continuing economic transition. The amounts of support and the quality of services have declined from the modest, but always predictable, level first established in the Soviet period.
The national system of social security consists of programs of social insurance and social benefits designed to continue the benefits provided by the Soviet system. Social insurance includes old-age retirement; survivor and disability pensions; unemployment compensation; pregnancy, childbirth, and child supplements; certain welfare support; and free medical care. It is cradle-to-grave insurance. According to a 1990 law, payments cannot be lower than necessary for a "minimal" living standard. In 1990 old-age and disability pensions in Lithuania were slightly more generous than in Estonia and Latvia. The budget for the program is separate from the national and local budgets. Only military pensions and some other special pensions are paid from the national budget.
Social insurance is financed, according to a law passed in 1991, from required payments by workers and employers, from income generated by the management of state social insurance activities, and from budgetary supplements by the state if the program threatens to run a deficit. To be eligible for an old-age pension, a male worker must be at least sixty years of age and have at least a twenty-five-year record of employment. A woman must be fifty-five and have a record of twenty years of employment. This category of recipients includes not only factory and government workers but also farmers and farm workers.
A program of social benefits is financed by local governments. It includes support payments for women during pregnancy and childbirth and for expenses after the child's birth. The program features single payments for each newly born child, as well as child support for single parents or families. These latter payments continue up to age limits established by law. The state also maintains a number of orphanages, sanatoriums, and old-age homes.
In the medical field, Lithuania has sufficient facilities to fulfill the guarantee of free medical care. In 1990 the country had more than 14,700 physicians and 2,300 dentists; its ratio of forty-six physicians and dentists combined per 10,000 inhabitants compared favorably with that of most advanced countries. In addition, in 1990 Lithuania had more than 47,000 paramedical personnel, or 127 per 10,000 population and 46,200 hospital beds, or 124 beds per 10,000 population. In the medical profession, Lithuania's cardiologists are among the most advanced in the former Soviet Union. In 1987 the first heart transplant operation was performed at the cardiac surgery clinic of Vilnius University. Hundreds of kidney transplants have been performed as well. One reasonably reliable and generally used indicator of the quality of a country's health services system is infant mortality. In 1990 Lithuania's infant mortality rate of 10.3 per 1,000 population was among the lowest of the Soviet republics but higher than that of many West European countries.
Special features of Lithuania's health status are high alcoholism (191 cases per 100,000 persons), low drug abuse (3.1 cases per 100,000), and few cases of human immunodeficiency virus (HIV) infection. Reported cases of HIV in 1992 were under 100. The main causes of death are cardiovascular diseases, cancer, accidents, and respiratory diseases. In addition to alcoholism, important risk factors for disease are smoking, a diet high in saturated fat, hypertension, and environmental pollution.
Notwithstanding efficient ambulance service and emergency care, medical services and facilities in Lithuania suffer from a lack of equipment, supplies, and drugs, as well as from inertia in the operation and administration of health services. The system is mainly state owned and state run. Private medical practice, begun only in the late 1980s, has not progressed appreciably because of the economic crisis. Since 1989 the government has encouraged church groups and others to enter the field of welfare services and medicine. The best-known such group is the Roman Catholic charitable organization Caritas.
Health care expenditures increased from 3.3 percent of the gross national product (GNP--see Glossary) in 1960 to 4.9 percent of GNP in 1990, but this figure is still low by world standards. Lithuania is unable to afford investments to improve its health care infrastructure at this time. Lithuania needs humanitarian assistance from the world community in importing the most critically needed drugs and vaccines. Disease prevention needs to be emphasized, especially with regard to prenatal, pediatric, and dental care. To reduce the occurrence of prevalent risk factors, the government needs to make fundamental improvements in public education and health programs.
Lithuania's standard of living in the early 1990s was slightly below Estonia's and Latvia's but higher than in the rest of the former Soviet Union. At the end of 1992, the standard of living had declined substantially, however. Energy shortages caused severe limitations in heating apartments and providing hot water and electricity. Before the post-Soviet economic transition, Lithuanians had abundant food supplies and consumed 3,400 calories a day per capita, compared with 2,805 calories for Finns and 3,454 calories for Swedes. But an average Lithuanian had only 19.1 square meters of apartment living space (less in the cities, more in rural areas), which was much less than the 30.5 square meters Finns had in the late 1980s. Housing, moreover, had fewer amenities than in the Scandinavian countries; 75 percent of Lithuanian urban housing had running water in 1989, 62 percent had hot water, 74 percent had central heating, 70 percent had flush toilets, and 64 percent had bathing facilities. Formerly low utility rates skyrocketed in the 1990s. Rents also increased, although by the end of 1992 almost 90 percent of all state-owned housing (there was some privately owned housing under Soviet rule) had been privatized--bought from the state, mostly by those who lived there. In 1989 families were well equipped with radios and televisions (109 and 107 sets, respectively, per 100 families). Most had refrigerators (ninety-one per 100 families), and many had washing machines (seventy), bicycles (eighty-four), vacuum cleaners (sixty), sewing machines (forty-eight), and tape re-corders (forty-four). Every third family had a private automobile (thirty-six automobiles per 100 families). Detracting from the quality of life, however, was the increasing rate of violent crime, especially in the larger cities (see Crime and Law En-forcement, this ch.).
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