Search

In recent years there has been increasing attention to the potentially disruptive influence of disinformation on elections. The most common forms of disinformation in elections include the dissemination of ‘fake news’ in order to discredit opponents or to influence the voting process, the falsification or manipulation of polling data, and the use of fake election monitoring and observation. This article presents an overview of the phenomenon of disinformation in elections in both democratic and undemocratic environments, and discusses measures to reduce its scope and negative impact.

The most notable element of Ukraine’s decentralization reform is a merging of municipalities into amalgamated territorial communities (ATCs). While the implementation of the reform is slower and more chaotic than anticipated, the reform has widely been hailed as one of the country’s biggest success stories since the Euromaidan Revolution. Scholarly literature on decentralization acknowledges its potential to, among other things, increase popular participation, improve service delivery, and strengthen legitimacy, but also warns of the “dangers of decentralization,” including local elite capture. This chapter argues that there is substantial reason to assume that there is a real risk of elite capture in the current decentralization reform, and suggests that not enough is being done by the central government to mitigate this risk.

The 2013–2014 Revolution in Ukraine has spurred a boom in civic anti-corruption initiatives across Ukraine. There is as yet little consolidated understanding of how effective these initiatives are and what explains variation in effectiveness. Insights from academic and practitioner literature suggest that factors associated with success in anti-corruption activism fall under three broad categories: environmental factors, advocacy strategies of civil society organizations, and their organizational characteristics. Drawing on a comprehensive study of anti-corruption activism in the regions of Ukraine, this article asks how these insights relate to anti-corruption activism in the regions of Ukraine. We find that anti-corruption initiatives generally face two key dilemmas: insufficient capacity in terms and financial and human resources, and the absence of a credible base of support. Anti-Corruption organizations that are most effective tend to be those that convincingly solve either one of these two dilemmas. In addition, we find that political will among local authorities is an important conducive factor to the effectiveness of anti-corruption activism. The article also discusses the implications of our findings for practitioners of international assistance.

Nach der Euromaidan-Revolution haben überall im Land Bürger den Kampf gegen die Korruption aufgenommen. Die Aktivitäten reichen von der Überwachung des öffentlichen Auftragswesens und von Vermögensdeklarationen über die Organisation von Demonstrationen und Sensibilisierungskampagnen bis hin zur direkten Konfrontation mit korrupten Akteuren. Was bedeutet diese Welle des regionalen Antikorruptionsaktivismus für den Kampf gegen die Korruption in der Ukraine?

Following the recent deterioration of relations between Russia and the West over crises in the Middle East and Ukraine, the relationship between Moscow and Beijing is growing stronger. In 2014, the two nations signed an unprecedented gas deal worth US$400 billion. In May 2015, Vladimir Putin and Xi Jinping agreed to coordinate the Moscow-led EEU with China’s Silk Road Economic Belt (SREB). Following these developments, authors and journalists heralded a new era in Sino-Russian relations in which the two nations would consolidate their forces to counter a US-led unipolar world. However, the nature of the relationship between China and Russia, the prospects for closer cooperation between the two nations, and the feasibility of integrating the two grand Eurasian projects are topics of fierce debate. This article maintains that while a consensus between Moscow and Beijing with regard to post-Cold War US unilateralism and their convergent interests have pushed China and Russia to cooperate on a range of global and regional issues, relations between the two Eurasian neighbours are complex and multi-faceted and are far from forming an anti-US bloc. Furthermore, the abstract nature of China’s Silk Road initiative and a number of significant obstacles make the feasibility of integration between the two projects a complicated task. Issues explored by this article include the development of mechanisms and agreement on a format for cooperation between the nations involved; the solution of practical issues such as rail gauges and corruption in the region; the prospects for an “equal partnership” in Sino-Russian relations and Moscow’s predicament with regards to its position as “junior partner” in Eurasia; and last but not least, the ever-growing threat of Islamic fundamentalism and regional security.

The Kyrgyzstan–Tajikistan border remains one of the last undefined frontiers in the Commonwealth of Independent States, where the governments are reluctant to act against the wishes of their border communities and force delimitation solutions that may cause social protests. Uncertainty of territorial arrangements persists; however, the era of commonality and interdependence may be at its end due to the establishment of a border as a means of spatial control. Border drawing reflects the divergent development trajectories of the new states, seeking to break out of an interdependence pattern. Borderlands’ interactions become more conflictual. Generation change and a loss of common language work to widen the inter-communal gap. Ethnicity and identity factors grew in significance as association with the nation-states increased, and a border expresses a symbol of nationhood in this paradigm. Crucially, a border justifies a security regime, reinforced by international assistance policies, to project power over the territory. Actions of security structures cause grievances but also signify a protective arm of the state, a role that the border communities appreciate, themselves acting as a collective border guard and projecting their fears of encroachment onto the borders. The expansion of the Eurasian Economic Union became a new factor that could have served to alleviate the pressure to divide territory and assets, but this could work only if two countries joined it at the same period. With this option unavailable, a territorial impasse has been reached.

Flawed electoral legislation in post-Soviet states has facilitated the conduct of undemocratic elections. This article argues that the low quality of electoral legislation in the region results in large part from a process of ‘authoritarian diffusion’, whereby the election laws of the post-Soviet states extensively borrow and adapt from Soviet laws and post-communist Russian laws. The authorities of most post-Soviet states have routinely disregarded recommendations by the Organization for Security and Co-operation in Europe and the Venice Commission to improve electoral legislation. Besides presenting evidence of ‘authoritarian diffusion’ across the post-Soviet area, the article highlights the enduring impact of the Soviet legacy and of Russia's relatively hegemonic position in the region.

The 2011–2012 election cycle in Russia featured an innovation in election monitoring: the crowdsourcing, through the Web-based Karta Narusheniy tool, of information about electoral violations by thousands of individuals across Russia, resulting in a database that contains over 13,000 reports. This study assesses the collective ability of the contributors to the Karta Narusheniy to detect fraud, and looks at what the reports on the Karta Narusheniy reveal about the types and spatial distribution of fraud in the 2011–2012 elections. The article finds that, on the whole, the Karta Narusheniy has been a credible source of information about election fraud. Moreover, the information contained on the Karta Narusheniy, when properly analysed, enhances our insight into how elections in Russia are manipulated.

One of the biggest problem in OSCE election observation methodology concerns the selection of polling stations where the observation is conducted: in practice, polling stations that are visited by observers are disproportionally urban and located in or around the national capital and in regional centers. Because visited polling stations are not representative of all polling stations, the observation mission risks getting an unbalanced picture of the shortcomings in the election. In this article, we present findings from original research that shed light on the scope of the problem of distortion in the selection of polling stations, and discuss potential ways to overcome the problem.

20 Jahre nach der Unabhängigkeit ist das Parteiensystem in der Ukraine nach wie vor instabil. Die jüngsten Verfassungs- und Wahlrechtsänderungen sowie die politische Korruption und die Abhängigkeit der Parteien von Sponsoren haben dies noch verstärkt. Der Beitrag analysiert anhand der wichtigsten ukrainischen Parteien die Probleme einer Verstetigung des Parteienaufbaus.

Flawed electoral legislation in post-Soviet states has facilitated the conduct of undemocratic elections. Many of the flaws in the election laws are not sui generis but, instead, originate from provisions in Soviet and post-communist Russian laws from which the post-Soviet legislators have borrowed. This article traces the origin and evolution of the election laws of nine post-Soviet states that have been perpetually undemocratic until at least 2010. The article demonstrates that most post-Soviet states have routinely disregarded recommendations by the OSCE and the Venice Commission directed towards the improvement of national election laws and that these laws largely continue to be shaped by Soviet and Russian legislation. In addition, the author points to the enduring impact of the Soviet legacy and the relatively hegemonic position of Russia in the region vis-à-vis the legislation of post-Soviet states, and highlights a widespread but occasionally overlooked form of institutional choice: legal borrowing (legal transplants) and adaptation. The present article also carries implications for the efforts of the OSCE and other actors to bring electoral legislation of the post-Soviet states more in line with appropriate international standards.

Election commissions that serve the partisan interests of the authorities are key to the manipulation of election processes in OSCE participating states and beyond. Despite the importance of impartial election administration, OSCE/ODIHR, in its reviews of election laws or in its reports of election observation missions, has so far declined to put forward a comprehensive view on what constitutes best practices regarding the composition and functioning of election commissions. Drawing from a comparative study of the manipulation of rules for the composition and functioning of election commissions, this article develops insights, and formulates recommendations, that could inform a more assertive ODIHR approach to the issue of partisan election commissions..

Hegemonic parties in authoritarian regimes can fulfill important purposes for those regimes and thereby contribute to their survival. Along with the consolidation of authoritarian regimes, hegemonic political parties have emerged in some post-Soviet states, raising questions about the role that these parties play in the survival of the regimes. This article asks which of the purposes that are frequently ascribed to ruling authoritarian parties are fulfilled by United Russia, the Yeni Azerbaijan Party, and Nur Otan of Kazakhstan, the hegemonic parties of the three strongest consolidated authoritarian regimes with a hegemonic party in the former Soviet Union. It is argued that despite the increasing prominence of the hegemonic parties, full-fledged party-based authoritarianism has not yet been established in Russia, Azerbaijan, and Kazakhstan.

Electoral assistance by the OSCE in the undemocratic states of the post-Soviet area is faced with a number of serious challenges: there has been no improvement in the quality of elections over the past decade; recommendations by the OSCE to improve electoral legislation are routinely disregarded in most countries; and, within the framework of the Commonwealth of Independent States, the undemocratic countries have stepped up a range of alternative electoral assistance activities that replicate and in large part contradict comparable OSCE efforts. This article discusses these three challenges and considers possible changes to the practice of OSCE electoral assistance that may contribute to its continued relevance and effectiveness.

Despite a sustained effort, international assistance to political parties has failed to make a significant impact on parties in Georgia and Ukraine: political parties in these countries have remained far removed from the type of stable, democratic, and representative organisation that is commonly aimed for by party assistance. This study argues that domestic constraints on the development of stable and democratic parties have invalidated the assistance effort to such an extent that the assistance has become highly ineffectual. A large degree of volatility in party politics, reflected primarily in a high turnover rate of parties, has rendered much of the assistance provided throughout the years futile. The less-than-democratic political context in Ukraine (until 2005) and in Georgia moreover produced political parties that were inherently unsuitable to receive party assistance, because essentially they were not interested in transforming into stable democratic parties. Since the domestic constraints on par...

The December 2011 legislative election was among the most fraudulent national elections in Russia since the communist period. The fraud, however, was not evenly spread across the country. Precinct-level election returns from the 83 regions of the Russian Federation suggest that the level of fraud ranged from minimal or small in some regions to extreme in some others, with moderate to high fraud levels in many regions in between. We argue that in an electoral authoritarian context like Russia, regional variation in fraud can be explained by differences in (a) the perceived need by regional authorities to signal loyalty to the center by “delivering” desired election results; (b) the capacity of regional authorities to organize fraud; and (c) the vulnerability of citizens to political pressure and manipulation. We test the effect of signaling, capacity, and vulnerability on electoral fraud in the 2011 legislative elections with data on the 83 regions of the Russian Federation. We find evidence for all three mechanisms, finding that the tenure of governors in office, United Russia's dominance in regional legislatures, and the ethnic composition of regions are most important for explaining regional variation in electoral fraud

While international election observations missions often aim to present generalizable claims about the quality and integrity of an election, their findings are rarely based on a representative sample of observations, undermining the credibility of the missions. Bias in the selection of polling stations, among other things, can inflate or deflate the percentage of polling stations where observers find significant flaws. This article uses original data from Organization for Security and Co-operation in Europe (OSCE) election observation missions to illustrate the nature of the problem of selection bias in international election observation, and show how the percentage of ‘bad’ polling stations (in the absence of selection bias) can be estimated through a weighting procedure. The article finds that, while there is a strong degree of selection bias, this does not significantly impact the overall percentage of ‘bad’ polling stations that is reported by OSCE observation missions.

Seit der Unabhängigkeit der Ukraine war ihre Parteienlandschaft immer durch geringe Institutionalisierung gekennzeichnet. Bei jeder Wahl tauchten - scheinbar aus dem Nichts - neue politische Kräfte auf, während andere, vormals einflussreiche, von der politischen Bühne verschwanden. Eines dieser neuen Gesichter der Parlamentswahl im Oktober 2012 war die UDAR-Partei des weltberühmten Boxweltmeisters Witalij Klitschko. Woher stammt diese Partei? Was unterscheidet sie von den etwa 200 anderen formal registrierten Parteien in der Ukraine? Und welche Perspektiven bieten sich für sie in der extrem unbeständigen politischen Landschaft?

It is widely taken for granted that international election observation deters and detects election fraud, but little evidence exists that supports this conventional wisdom. This article employs a unique dataset on the 2011 and 2012 election observation missions by the osce to the legislative and presidential elections in russia, to assess the claim that international election observation deters and detects fraud. The findings suggest that observers may have deterred fraud to some degree during the observation of counting procedures but less so, if at all, during the observation of voting procedures. , and that observers probably did not detect fraud to any significant degree during both voting and counting observations.

Party politics in the former Soviet Union is fundamentally different from party politics in Western democracies in many ways. Since 1991, two crucial aspects of party politics in the less-than-democratic former Soviet republics have been the impact of authoritarian practices on party politics and the volatile nature of party politics. Starting with the observation that the creation and operation of parties in the former Soviet Union is driven by elite actors, the author seeks to better understand these two aspects of party politics by studying the incentive structures for elite actors from both within the political regimes and outside the region.

Sir .—In the March 1991 issue of AJDC , 1 Dr Stiehm described his experience with strict curtailment of his three daughters' TV viewing so that they would devote more time to schoolwork, reading, music, and exercise. This worked out well for his family, but it might not for others who have different interests and/or lack entertainment and learning alternatives. Television has been stigmatized as the "boob tube," yet it also provides fine educational, news, public affairs, sports, music, and general entertainment programs. One must be selective to find good books in a library and good music on the radio; this also applies to TV programs. Thus, rather than proscribe TV, parents might be better advised to review the coming weeks' TV fare, go over it with their children, and help them decide which programs of value to watch. Clearly, there is nothing wrong with children viewing "Sesame Street"; "Mister

To the Editor.— DiGuiseppi et al1note that "bicycling injuries to children account for 300 000 emergency department visits and 500 to 600 deaths each year in the United States." Yet, despite an extensive bicycle helmet campaign in Seattle, Wash, the level of bicycle helmet use by children is only 15.7%. In the control city, Portland, Ore, it was 2.9%. The effect of the campaign was meritorious, but fell far short of levels needed to make much of an impression on bicycle-related head injuries among children. More dramatic action is needed if helmet use is not to flounder at the same level as that found with automobile seat restraints prior to recent stronger measures. We need to make bicycle helmet use by younger children an expected group norm that they and their parents will recognize as sensible and accept as a routine practice. Education by physicians, police, schools

Sir .—I have several comments on the discussion of polio immunization policy for children presented by Marcuse 1 and Katz 2 in the September 1989 issue of AJDC . In the past, the real risk of oral polio virus vaccine (OPV)–related polio has probably been closer to 1 case per 100000 persons immunized. The state of Washington had about 1 case annually for many years. The rate may be lower nationally, but that is most likely a problem of lack of recognition and/or reporting. Additionally, OPV can cause nonparalytic illness, which usually goes unrecognized unless the vaccine virus is picked up inadvertently when spinal fluid is cultured and the patient is then asked about possible OPV exposures (Bruce G. Weniger, MD, MPH; David Remis, MD; Mark Heerema, MD; et al, unpublished case, October 1982). Perhaps the type III component in vaccine is now less apt to revert to neurotoxicity, but can

Sir. —Dr Fulginiti 1 made some good points in his editorial in the May issue of AJDC on standards. Having sat on several committees that grappled with establishing standards, I feel that it also is important to recognize some of the inherent biases of such committees. First, they tend to agree there is a problem requiring the establishment of a standard. Second, they are biased toward a "safe rather than sorry" viewpoint. Third, they do not reflect the universe of those who deal with the problem. Rather, they tend to reflect those who see the worst aspects of the problem and omit those who see the other end of the spectrum

In the past, shigellosis in Seattle-King County has been primarily a disease of children, their parients, and foreign travelers. During the 18 months beginning in July 1975, an outbreak of shigellosis in Seattle's community of gay men involved both Shigella flexneri and Shigella sonnei. They accounted for nearly 30% of all cases of shigellosis reported to the health department. Fellatio and/or oral-anal contact was reported by 90% of the infected homosexual men; this was probably the mechanism of transmission of most infections. Intercity spread was determined by case histories and by the finding of S. flexneri 3, a previously unusual organism in Seattle.

Sir.—Dr Helfer's1 response to Dr Comerci's letter on primary care and pediatrics was not very helpful. First, there are very few tasks in medicine or any other profession that cannot be broken down so that average nonprofessional persons can learn and perform them. I am certain that some of the ladies from the International Ladies Garment Union could learn to perform many cosmetic surgery tasks, and some could learn to do excellent cataract surgery. I know of a nurse's aide who was extremely facile in performing a wide assortment of urologic procedures and could easily have been taught to do cardiac catheterizations. What distinguishes a physician is not his ability to perform various specialized tasks competently but rather his wide knowledge base and his ability to use it to keep people well and to diagnose and treat illness. It is a common act of gross arrogance on the part

To the Editor.— In "Vaccination and Disease Prevention for Adults" (1982; 248:1607), Goodman et al note in the Table thatinactivatedpoliovirus vaccine (IPV) is contraindicated during pregnancy on theoretical grounds. I question use of that rather standard phraseology with regard to either IPV or the oral live-virus vaccine (OPV). During the mid-1950s, when IPV first became available, among those with highest priority for immunization were pregnant women. They were not noted to suffer untoward effects nor did their offspring suffer birth defects. In the case of OPV, it is well known that the vaccine virus often spreads to other family members after being given to children within the family. Consequently, many susceptible pregnant mothers have been "immunized" along with their children. There is no evidence that they or their pregnancy outcomes have been adversely affected as a result. In short, I see no reason to withhold either IPV or

To the Editor.— The recommendations for vaccine injury compensation published in the Dec 7 issue ofThe Journal 1 are both necessary and generally sound. All claims of injury should first be funneled through a no-fault federal compensation program. However, when the claimant finds the disposition of his claim by the program to be unsatisfactory, there probably deserves to be a limited appeals process involving petition for a rehearing or appeal to a federal court, where a contention as to fact could be heard by a judge without jury. This is most apt to be needed when a claim is turned down. In addition, health insurers should not be permitted to exclude these injuries from medical care coverage, and compensation should be limited to cases of serious injury only to the extent that a family's health insurance does not provide such coverage. Pain and suffering compensation should be excluded. In

To the Editor.— In their COMMENTARY "Facilitating the Transitions of Adolescence," Hamburg et al 1 state "one in ten girls becomes pregnant during adolescence, and most of the pregnancies are not intended." Although one in ten is bad enough, that figure is in fact much too low. When abortions are considered along with childbirths, the true figure comes closer to 25% to 30%. Only about half of all teenage pregnancies go to term, and these number about 500 000 newborns annually.

To the Editor.— In their response to my letter on polio vaccination during pregnancy, Goodman et al 1 state, "Use of the number of doses distributed gives a measure of the overall risk of vaccine-associated poliomyelitis and gives a prospective OPV [oral polio vaccine] recipient or contact of a recipient the overall odds of becoming a vaccine-associated case." The courts of the state of Washington have held that this statement was inadequate and misleading and, therefore, awarded judgment to the vaccine-associated polio victim against the vaccine manufacturer. Other parties to the litigation settled out of court, in part because that statement on the signed informed consent was regarded as indefensible. The vast majority of OPV recipients are newborns who are slated to receive four doses of OPV (five in past years) by the time they enter school. Consequently, estimation of "one case of paralytic poliomyelitis in recipients or contacts for

To the Editor.— Dr Schwartz 1 in the article entitled "The Inevitable Failure of Current Cost-Containment Strategies: Why They Can Provide Only Temporary Relief" nicely provides documentary support for "Baumol's disease," a condition that has been used in the past to explain the high cost of hamburgers in New York ( Forbes , Aug 15, 1983, p 92; Forbes , Sept 15, 1977, p 166). William Baumol, an economist at New York University and Princeton (NJ) University, notes that "any service that is inherently labor-intensive will tend to rise in cost faster than the general rate of inflation." He explains that a person can provide only so many units of a labor-intensive service during a day. Since each person must eat and partake of the other basic goods and services of society, each will demand sufficient compensation to permit this. He claims that investment in capital goods, education, and technology is required to

Sir .—I appreciate that medical researchers, other scientists, and some medical specialists will find conversion to SI units useful. 1 Certain of these units might even be adopted with little complaint from the average physician. However, it seems arbitrary to foist all these units off on the general public when 99.9% of the people will obtain no benefit and merely become confused. Calorie is a term that has become a part of our everyday language. Why substitute joule? The general public thinks that a joule is a gem. To avoid confusion, let the scientists adapt rather than vice versa. The same applies to gram and milligram , which the public has finally begun to understand and use to a limited extent. To introduce mole for mass measurement will cause confusion. The public thinks a mole is a nuisance that makes a mess of front lawns. There is no public benefit from

To the Editor.— In "Fatal Occupational Injuries" (1982;248:692), Baker et al analyzed deaths related to work injuries during 1978 in Maryland. Of the 148 deaths, 25% involved road vehicles, 16% involved nonroad vehicles, 11% involved boats, and 5% involved aircraft. Firearms accounted for another 11% of injuries. A similar fatal injury pattern was seen in Oregon during 1980 and 1981, when there were 163 occupational fatalities. Here, deaths occurred as follows: 28.2%, traffic accidents; 4.3%, industrial vehicles; 7.4%, aircraft accidents; and 2.4%, homicides. It is surprising that fatal truck accidents are not more frequent. In Oregon, during 1980, about half of all trucks inspected by the State Police failed to pass routine safety inspections. Many of these vehicles lacked adequate brakes and posed a serious hazard to their drivers. They also represented a danger to the general public because of some of the hazardous cargos carried. This underscores the point

To the Editor.— In discussing "Health Effects of Urban Air Pollution," Mitchell et al (242:1163, 1979) seem to take the view that current national ambient air quality standards, as adopted by the Environmental Protection Agency, for carbon monoxide (CO) are justified for sea level, but that an eight-hour CO standard of 6 ppm should be substituted in high-altitude areas. Adjustment of the basic CO standard to accommodate for high-altitude effects is reasonable, but, for sea level areas, the present 9 ppm, eight-hour CO standard, which may be exceeded only once a year, is already more stringent than can be justified by cost-benefit analysis. The difference between using a 15 ppm, eight-hour CO standard and a 9 ppm, eight-hour CO standard is an increase of 1% in COHb concentration. Can one truly argue that this makes any real difference to a person's health if it happens five to ten times a year

To the Editor.— The points made by Hickman and Barness in their commentary "Immunization Program for Adults" (237:129, 1977) are well taken but deserve some amplification. First, physicians considering administration of tetanus toxoid as part of wound prophylaxis would be well advised in most cases to use tetanusdiphtheria toxoids (adult). No tetanus booster is needed following most wounds where the last booster was given less than five years previously. Thus, since diphtheria toxoid alone is not generally available and most adults never receive any boosters unless they are confronted with this need after a wound, updating against diphtheria at that time is also in order and will not cause excessive reaction to the diphtheria component. Second, when an adult has never been immunized against diphtheria, physicians should regard the booster dose of adult diphtheria-tetanus toxoids as an integral part of the immunization series and establish a reminder system to get

To the Editor.— In "The Changing American Health Scene" (237:1710-1714, 1977), Rogers and Blendon indicate that nationally age-adjusted death rates, infant and maternal mortality, and death rates from coronary artery disease have fallen substantially in recent years. This is also true for Seattle-King County. However, in Seattle-King County coronary heart disease mortality reached its highest rates by the late 1940s. The peak age-adjusted rates (US standard million, 1940) were 270.3 deaths per 100,000 men in 1949 and 91.9 to 93.9 deaths per 100,000 women on several occasions between 1949 and 1965. An international coding change for deaths has made distortions in comparison of coronary heart disease mortality since 1968, causing rates to be only about 87% of what they would be with prior coding. Nevertheless, adjusting for this, Seattle-King County rates declined by about 20% from peak rates. The decline for those under 60 years of age is more striking.

To the Editor.— In "Do Economic Slumps Increase Illness?" (242:1241, 1979), a correlation between ischemic heart disease and economic conditions is suggested. Between 1968 and the end of 1971, the Seattle area's largest employer reduced its work force from more than 100,000 to fewer than 40,000 employees, costing the community a huge proportion of its basic industry jobs. Few communities since the Depression have experienced such severe unemployment so quickly, and many employees with 15 to 20 years' seniority were stunned to find themselves laid off and without any job prospects. Rahe et al 1 and Petrich and Holmes 2 have shown that life crises such as loss of employment are associated with illness development, yet it is surprising how little (if any) effect the Seattle-area recession had on heart disease mortality in men aged 55 to 64 years (Table). Also, in contrast to the Australia experience, coronary heart disease