Band 72, Heft 1 - Special Issue: Healthcare: Public Policies, Social Practices, and Individual Experiences; Guest Editors: Gergana Mircheva and Olga Popova

This thematic section focuses on health as a multilayered political, economic, and cultural phenomenon. Based on case studies from Southeastern Europe, the four articles in the section pose research questions that are important for understanding the interplay between personal experiences of using healthcare services, trust in the healthcare system, and the governance of healthcare service provision in the region. The articles build on complementary perspectives on individual experiences of interacting with healthcare providers, social issues, and public health strategies, drawing a multidimensional “health map” with interrelated but sometimes diverging arguments. This allows a better understanding of the issues of health and illness in turbulent times of social crises and provides a conceptual basis for healthcare policies in Southeastern Europe.

The paper argues that vaccines could be viewed as artifacts which communicate various social messages and are used as instruments for fulfilling different sociopolitical goals besides meeting public health needs. It further suggests that such social, cultural and political influences may have real effects on the choices of vaccine technologies or vaccine production, and aims to demonstrate their importance in the area which is normally seen as the domain of objective science. This is demonstrated by using the example of the locally produced oral polio vaccine (OPV) in Serbia during the socialist and post-socialist periods in the country’s history.

The execution of Covid-19 vaccination drives in former Yugoslavia’s successor states has been disappointing. The rapidly evolving literature on the Covid-19 pandemic suggests the levels of support for vaccination are correlated with education, trust in public-health institutions, and exposure to the negative economic and health effects of the pandemic. The explanations of the political foundations of vaccination hesitancy, however, need better empirical grounding. We shed light on this subject by analyzing the results of a survey conducted on more than six thousand respondents from Bosnia-Herzegovina, Croatia, and Serbia, as well as a combination of public-health, economic, and sociodemographic data across more than five hundred municipalities in Croatia. Most notably, we find the political sources of vaccination hesitancy to be strongly related to people’s support for the ideas of political parties committed to nationalist populism.

Thirty years after the transition to democracy in Bulgaria, there is a lack of social and community support for people living with dementia and for their families and caregivers. Both residential and assisted living facilities in the country have remained both unpopular and underdeveloped, and based on in-depth biographical and expert interviews and focus groups, we shall discuss the subjective experience of informal caregivers of people living with dementia, accumulated in the confined space of home and family. We shall try to show how inconsistent application of the European Union’s social policies as well as the existence of enduring socio-cultural stereotypes relating to parental care places caregivers in passive, but over-responsible and implicitly critical positions towards the management both of public and private services for older people in Bulgaria.

In developed European Union (EU) countries, migrants are thought to be less likely to have their children fully vaccinated. To investigate this idea, this study examines parental perceptions of child vaccination during the Covid-19 pandemic. It is based on semi-structured interviews with 42 Serbian migrants in the Netherlands, conducted in the summer of 2020. The aim was to determine if the pandemic changed these parents’ attitudes towards the Dutch healthcare system and vaccination in general. The paper’s theoretical framework juxtaposes a “risk society” approach with a governmentality approach. The majority of the parents surveyed had had their children vaccinated according to the Dutch national vaccination programme. However, the study shows that many Serbian migrants had negative attitudes towards the then forthcoming SARS-CoV-2 vaccine. I therefore conclude that new vaccines, such as the Covid-19 vaccine, act as risk technologies which create a new “risk environment” rather than being perceived as preventive health measures.

This study uses business survey data to analyze firm perceptions of infrastructure systems in transition countries as obstacles to conducting business. Factors that contribute to reported perceptions are modeled, including country macroeconomic conditions, firm characteristics, and measures of overall reforms and infrastructure system reforms. Identified obstacles arise from binding constraints that limit economic growth, reflect implicit shadow costs, and signal areas in need of policy reform or infrastructure investment. The analysis covers electric power, telecommunications, transportation, and water and wastewater infrastructure systems. Also examined is whether transition indicators of reforms, intended to reflect improvements, are associated with perceptions of obstacles. Beyond identifying infrastructure obstacles and the effects of reforms during the transition process, we also explore firm adoptions of new electronic technologies, essentially a new infrastructure system, as they use email, websites, cell phones, and high-speed Internet in their business activity.

This contribution discusses the problem of Covid-19 demographic and economic losses in Moldova. Although the pandemic is now no longer in the headlines, it is essential to understand how severe it was in Southeastern Europe. To illustrate this, the present study uses the example of the Republic of Moldova as a country with relatively high excess mortality. The Covid-19 mortality pattern in Moldova appears typical for the Eastern European and post-Soviet countries, with a decline in life expectancy for 2020–2021 and a more substantial decline for women. One of the main explanations for this pattern is the failure of the vaccination campaign, partly due to the population’s lack of trust in the healthcare system. The National Transfer Accounts approach is suggested to estimate economic losses. As a reference country for comparing the pandemic losses in Moldova, the present study uses Serbia, which was also strongly affected by the pandemic.