摘要：The creation of nation-states in Europe has generally been assumed to be intrinsic to modernization and to be irreversible. The disintegration of Czechoslovakia, the Soviet Union, and Yugoslavia demonstrates that the process is not irreversible. I argue that in the case of Yugoslavia, (1) disintegration was caused by the interaction between domestic policies with regard to nationalities and integration into the global economy and (2) the impact of the disintegration of the federation on health care and public health systems has been profound. Improving and converging measures of mortality before the collapse gave way to increasing disparities afterward. The lesson is that processes of individual and social modernization do not result in improvements in health and well-being that are necessarily irreversible or shared equally. SINCE THE LATE 1980S, THE world has witnessed a phenomenon unique in modern European history. For the past several centuries, nation-states in Europe have grown stronger while incorporating large numbers of different peoples within their boundaries. The process has never been entirely successful, of course, as conflicts with incompletely assimilated peoples in the United Kingdom, Belgium, and Spain attest. Nonetheless, most scholars assumed that the building of nation-states was inevitable, irreversible, and part of the very fabric of the process of modernization. And modernization meant secularization, the creation of national identities out of separate ethnic identities, rising living standards, and improvements in health. This version of the growth of the nation-state is based on the western European experience, in which “the nation is a territorially bounded and self-governing collectivity, a collectivity shaped, indeed constituted by its territorial and political frame. Nationhood, on this view, is both conceptually and causally dependent on political territory.” 1 This was not the experience in central and eastern Europe, particularly “in the great multinational empires of the Ottomans, Hapsburgs, and Romanovs.” There, the nation was not territorially based. It was an ethnocultural community, “typically a community of language.” 2 Members of the same ethnocultural community, or nationality, often lived scattered among other ethnocultural communities. In the states that emerged from the ruins of the Ottoman, Hapsburg, and Romanov empires, nationalities continued to refer to such communities. This conception shaped the policies toward nationalities of the communist successor regimes of the Soviet Union and Yugoslavia and ultimately contributed to the collapse of both countries, thus demonstrating that the process of nation-state creation is not irreversible. In this article, I suggest some of the reasons for the breakup of the Yugoslav federation and describe some of the health-related consequences. The association between political institutions and health care and public health institutions is inextricable, and the collapse of the former has profound consequences on the latter and on the health of the population. I argue that it was the economic crisis of the 1980s that let slip the dogs of war that tore apart the country. Nationalism, while real enough during all of Yugoslavia’s brief history, became truly toxic only when economic collapse threatened.
