After a period of austerity during which the population's needs were neglected in favor of rapid industrialization, the standard of living of Bulgarians began to improve in the early 1960s as more goods and services became available. The physical well-being of most of the population has been improving steadily since the end of World War II. Morbidity has declined noticeably, and declines in the overall death rate and in the infant mortality rate have resulted in increased life expectancy. Electricity and water supplies have become available even in remote rural areas. In comparison with other Eastern European countries, however, and particularly in comparison with Western Europe, the standard of living in Bulgaria in 1973 was low.

Increasing exposure to living conditions in the rest of Europe and growing incomes of most Bulgarians created pressures to improve their own quality of life. In December 1972 the country's leadership proposed an extensive program for improving the standard of living and satisfying the rising expectations of the population over the next ten years (see ch. 12). An important element of the program is the elimination of the continuing disparity in living conditions of the rural and urban populations.

In keeping with the socialist ideology of the state, the population is entitled to free health care and an extensive system of social benefits. Although these have greatly benefited the population in terms of their physical and material well-being, their bureaucratic and inefficient administration has been a source of considerable frustration and dissatisfaction.

HEALTH

Death and Morbidity

Life expectancy at birth in the late 1960s was about sixty-nine years for males and seventy-three for females. This was a 35-percent increase over pre-World War II figures. Although Bulgarians have had a reputation for longevity, which has been attributed to their diet, a high infant mortality rate and a high incidence of morbidity had combined until the mid-1950s to keep the life expectancy relatively low. Those who survived to middle age tended to become octogenarians or older; but they were in a minority. Proportionately, however, there were more older people in Bulgaria than in most other countries in the world.

The increase in life expectancy since World War II has been brought about by a drop in the death rate from 12.2 per 1,000 in 1939 to seven per 1,000 in 1970 for the urban population and from 13.7 per 1,000 in 1939 to 11.4 per 1,000 in 1970 for the rural population. During the same period, infant mortality dropped from 139 per 1,000 live births to twenty-seven per 1,000 live births. In the late 1960s the incidence of infant mortality was 39 percent higher among rural infants than among urban ones. More than one-half of the deaths of children under one year of age were the result of pneumonia. The second major cause of infant mortality was birth trauma, despite the fact that 98 percent of the births took place in a public health facility under medical supervision.

The three major causes of death in 1970 were diseases of the heart and circulatory system, which accounted for 252 per 1,000 deaths; cerebrovascular diseases, which accounted for 206 per 1,000 deaths; and cancer, which accounted for 146 per 1,000 deaths. A program of systematic treatment and prevention of infectious diseases, which were once widespread, has either brought them under control or eradicated them completely. The law requires that all cases of contagious diseases be registered with the public health service. In 1971 the greatest incidence was reported for influenza, mumps, chicken pox, dysentery, infectious hepatitis, and measles.

The Public Health Service

The public health service, modeled after that of the Soviet Union, is based on the premise that the state has the responsibility to provide free health care for the population and that such care should be uniform and readily available. The health service is financed by the state, supervised by the Ministry of Public Health, and administered by the public health departments of the district people's councils. Free health care is available to all citizens; medicine required for outpatient treatment, however, must be paid for by the patient.