Lithuania Health and Welfare
Sources: The Library of Congress Country Studies; CIA World Factbook
In 1995 Lithuania had an estimated population of 3,717,000, which was 44,000 fewer people than in 1992. Of the total, females were in the majority, as in most Central European countries and in Russia. The population group that has increased most quickly in Lithuania, as in many other relatively developed countries, consists of senior citizens and pensioners (those over age sixty) (see fig. 12). For example, pensioners grew in number from 546,000 to 906,000 between 1970 and 1991. This group grew from 17.3 percent of the population in 1980 to 19.5 percent in 1992. The zero-to-fifteen-year-old age-group, by comparison, diminished slightly from 25.2 percent in 1980 to 23.9 in 1992, not as a result of increased mortality but as a result of a continuing decline in the birth rate. The group of working-age people (aged sixteen to fifty-nine for men and fifteen to fifty-four for women) also decreased, from 57.5 percent to 56.6 percent. The birth rate decreased from 17.6 per 1,000 population in 1970 to 12.5 per 1,000 population in 1993 and 12.0 per 1,000 population in 1994. Mortality increased from 10.5 per 1,000 population in 1980 to 10.9 in 1991 and 12.8 in 1994. Life expectancy in 1993 was 63.3 years for males and 75.0 years for females, or an average of 69.1 years. This, too, was on the decline from the peak years of 1986-87, when the average was 72.5 years (67.9 years for males and 76.6 years for females). The decrease coincides with the worsening economic situation and the decline in the quality of health services during the postindependence economic transition.
The average Lithuanian family is still somewhat larger than families in the neighboring Baltic states, but it has been declining. The average family size shrank to 3.2 by 1989. People marry young, but their marriages are often quickly dissolved. The divorce rate has been increasing. In 1989, of 9.3 marriages per 1,000 population, there were 3.3 divorces. The highest divorce rate is among ethnic Russians and in ethnically mixed families. These statistics indicate the existence of social problems with which society has been ill equipped to deal. Churches are not allowed to intervene to address these problems, and the profession of social work is still virtually nonexistent. The postcommunist government must face the formidable task of developing a social work sector.
Under Soviet rule, especially in the last decade, one-half or more of the annual population increase resulted from immigration, primarily from Russia. But this situation has changed. More people emigrate to former Soviet republics than arrive from them, and more people leave for the West than come from there. In 1990 Lithuania's net migration loss to former Soviet republics was 6,345. Loss to the West includes Jewish emigration. Gains from the West include returning Americans and Canadians of Lithuanian descent.
Soviet industrialization brought about fast and sustained urban development. Annually, almost 1 percent of the rural population has moved to cities since the early 1950s. In 1939 only 23 percent of the population lived in cities; in 1992 the urban percentage was 69. Lithuania has five cities with a population of more than 100,000. The largest is the capital, Vilnius, established in 1321 (1994 population 584,000); Kaunas, the capital between the two world wars, founded in 1361 (1994 population 424,000); the port city of Klaipeda, established in 1252 (1994 population 205,000); the center of the electronics industry, Siauliai, founded in 1236 (1994 population 147,000); and the city of chemical and automobile parts industries, Panevezys, founded in 1548 (1994 population 132,000).
In 1994, according to official estimates, 81.1 percent of Lithuania's population consisted of ethnic Lithuanians. The remaining 18.9 percent was divided among Russians (8.5 percent), Poles (7.0 percent), Belarusians (1.5 percent), Ukrainians (1.0 percent), and others, including Jews, Latvians, Tatars, Gypsies, Germans, and Estonians (0.9 percent). Altogether, people of more than 100 nationalities live in Lithuania.
The proportion of the ethnic Lithuanian population--more than 90 percent of whom speak Lithuanian--stayed at 80 percent or a fraction higher until 1989, when it dropped slightly below 80 percent. The decrease resulted in fears that a pattern of decline would develop as a result of increasing Russian immigration, which might endanger the survival of Lithuania's culture and national identity as it did in Estonia and Latvia.
The Russian minority consists of old and new immigrants. Many Russians settled in Lithuania in the nineteenth century or in the early twentieth century, shortly after the Bolsheviks came to power in Moscow. Two-thirds of the Russian minority, however, are immigrants--or their descendants--of the Soviet era, many of whom regard Lithuania as their homeland. They usually live in larger cities. In Vilnius 20.2 percent of the population was Russian in 1989. The same year, in Klaipeda, 28.2 percent of the inhabitants were Russians; in Siauliai, 10.5 percent. Ignalina, where the nuclear power plant is located, had a Russian majority of 64.2 percent. Less than 10 percent of the population in Kaunas and the resort towns of Druskininkai, Palanga, or Neringa was Russian, however. These percentages most likely will decline slightly in the 1990s because some Russians, finding it difficult to accept that they live in a "foreign" country, are leaving Lithuania. The majority of Russians, however, have shown little inclination to leave; 88 percent of those polled in the fall of 1993 described relations between their group and the ethnic Lithuanian population as good, and more than 60 percent felt that economic conditions for people like themselves would be worse in Russia than in Lithuania.
Poles live primarily in the city of Vilnius (18.8 percent of Vilnius's population in 1989) and in three adjacent rural districts. In 1989 the ethnic Polish population in the Salcininkai district constituted 79.6 percent; in the rural district of Vilnius, it was 63.5 percent; and in the district of Trakai, it was 23.8 percent. Small Polish groups also live in a number of other localities. Since the late 1940s, the Polish presence in Lithuania has declined considerably. About 200,000 Poles left Lithuania for Poland in 1946, under an agreement signed between Warsaw and Vilnius. Afterward, the Polish percentage of Lithuania's population declined from 8.5 percent in 1959 to 7.0 percent in 1989, primarily as a result of the influx of Russians. The Polish population of eastern Lithuania is composed of inhabitants whose families settled there centuries ago, of immigrants who came from Poland in the nineteenth and early twentieth centuries when the region was part of Poland, and of many assimilated Lithuanians and Belarusians.
Jews began settling in Lithuania in the fourteenth century. In time, Vilnius and some other cities became centers of Jewish learning, and Vilnius was internationally known as the Jerusalem of the North. Between the two world wars, Jews developed an active educational and cultural life. The Jewish community, which did not experience large-scale persecution until World War II, was almost entirely liquidated during the Nazi occupation. In 1989 only 12,400 Jews were left in Lithuania, and emigration after independence had cut their number to an estimated 6,500 by 1994.
For centuries, Vilnius has been an ethnically diverse city. Historically, the city has served as a cultural center for Lithuanians, Poles, Jews, and Belorussians. In the sixteenth and early seventeenth centuries, it also was a center of Ukrainian religious and cultural life. At the turn of the century, the largest minority ethnic group was Jewish. After World War II, the largest minority ethnic group was Polish. The population of Vilnius in 1989 was 50.5 percent Lithuanian, 20.2 percent Russian, 18.8 percent Polish, and 5.3 percent Belorussian.
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.).
Data as of January 1995
NOTE: The information regarding Lithuania on this page is re-published from The Library of Congress Country Studies and the CIA World Factbook. No claims are made regarding the accuracy of Lithuania Health and Welfare information contained here. All suggestions for corrections of any errors about Lithuania Health and Welfare should be addressed to the Library of Congress and the CIA.