This study discusses quality of life in post-socialist Mongolia. Yadargaa, a fatigue-related illness in traditional Mongolian medicine, results from lifestyle imbalance. We examine the distribution of yadargaa and its association to socioeconomic changes under capitalism. Ethnographic interviews concerning yadargaa were conducted with health professionals, yadargaa patients, and laypersons. Epidemiological methods were used to identify risk groups, to estimate the point prevalence, and to assess the distribution of meanings and interpretations of yadargaa. The epidemiological sample included 194 individuals, half urban and half rural. Nearly half of the epidemiological sample suffered from yadargaa (49%). These yadargaa sufferers felt that they benefited less than non-yadargaa subjects from the current socioeconomic changes. Among these, perceived change in employment opportunities was one of the best predictors of yadargaa. Additionally, yadargaa sufferers were predominantly women, the elderly, and urban residents. Yadargaa varies greatly in presentation; Western psychiatric categories are only able to explain half of yadargaa cases. In conclusion, yadargaa strongly associates with disenfranchised groups in the capitalist economy. As a culturally constructed indicator of quality of life, yadargaa is a window into the lives of women and men in post-socialist Mongolia.
Post-socialist populations suffered significant shifts in morbidity and mortality following their transition to capitalism. Research in the former Soviet Union and Eastern Europe has enhanced our understanding of the pathways by which these socioeconomic changes alter health and well-being (see special issue of Social Science and Medicine, Vol. 51, issue 9). During socialism, most of these populations putatively experienced moderately good states of health. Recent socioeconomic changes to capitalism, however, have contributed to poor health. This often results from deterioration in public health care, education, and social welfare because the capitalist governments have shifted their emphasis from human to physical capital (Griffin, 1999; Kumsawa & Jones, 1999). Additionally, in the new competitive market, job insecurity has increased and employees are less likely to employ preventative health measures, to seek timely medical care, or to use leisure time because these factors jeopardize employment (Nazarova, 2000). Furthermore, rising income inequality has contributed to depression and subsequently to increased job instability in a downward spiral of well-being (Kopp, Skrabski, & Szedmak, 2000). These studies have also shown that the subjective experience of economic change is an important predictor of health outcome. For example, certain groups, especially the elderly, feel a loss of personal control, which has led to psychological and physical health distress (Bobak, Pikhart, Rose, Hertzman, & Marmot, 2000). Additionally, relative wealth—the incongruity between aspirations and acquisition—in post-socialist countries has strongly influenced men's psychological and physical morbidity (Watson, 1995). This literature illustrates the need to assess both subjective and standard economic indicators to understand well-being.
Mongolians, after seven decades of socialism—a generation longer than most of Eastern Europe, also suffer similar changes in well-being. Some authors have pursued the connection between health changes and standard indicators, such as increased unemployment, more violent crime, or decreased funds for prenatal care (see Griffin, 1995b). However, the area of subjective experience has received little attention. This study highlights the subjective experience of Mongolians a decade after the transition. Unlike most studies in other post-socialist states, which employed self-reports of depression as an indicator of personal experience, we chose, instead, to examine the Mongolian illness label yadargaa. This illness is related to shamanic and Tibetan concepts of life-balance and stability. Through a combination of epidemiologic and ethnographic methods, we examine the relation between yadargaa incidence and disruptions in life-stability resulting from the transition. Socioeconomic transitions throughout the developing world ( Kumsawa & Jones, 1999), underscore the importance of understanding how the subjective experience of inequality impacts morbidity and mortality. Through cultural epidemiology, we can assess the social characteristics of those in suffering and ultimately explore the convergence of social forces that lead to personal distress and disease.
