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.

The cornerstone of the health service is the polyclinic, which provides general and specialized outpatient aid and consultation. Polyclinics may be attached to a hospital or may be independent units serving a designated geographic area. A separate network of polyclinics is attached to industrial mining, transport, and construction enterprises to serve their workers. Each polyclinic is divided into departments for the various specialties in medicine, and each department is staffed by one or more doctors and auxiliary personnel. Not all polyclinics, however, have departments for all the major fields of medicine; many have only sections for internal medicine, obstetrics and gynecology, pediatrics, and surgery. Patients needing consultation or treatment by other specialists are referred to the nearest hospital.

The health care provided by the polyclinic was under serious attack in the early 1970s both from the doctors who work there and from the patients. The main problem seemed to be overburdening and inefficiency imposed by the system of health care. One polyclinic in Sofia, for example, was responsible for the health care of 70,000 inhabitants of its area. Its physicians gave routine examinations to prospective students and job applicants, certified the legitimacy of claims for sick leave, and diagnosed and treated all complaints from the common cold to the most serious illness. During four hours each day, patients were seen on a first-come-first-served basis, except in emergencies. Waiting rooms were jammed, and people often waited for hours without seeing a doctor because the allotted time for office consultations had expired before their turn came.

Studies have indicated that one physician sees an average of thirty to forty patients in the four-hour period of office consultations, and then one-half again as many in a three-hour period of house calls, which often cover a wide geographic area. The average consultation between doctor and patient is six minutes, a time much too short for proper diagnosis. The result has been frequently wrong diagnosis and wrong or inadequate treatment.

A survey of polyclinic physicians conducted in 1970 revealed that over 50 percent of those surveyed considered the outpatient treatment provided by the polyclinic to be ineffective. They blamed poor organization and procedure in handling patients' needs, which resulted in the inefficient use of physicians' time, overloading of physicians, and shortage of drugs and equipment needed for complex treatment. More than two-thirds of the physicians questioned indicated that they would prefer to practice at a hospital or other medical unit and that they planned to leave the polyclinic as soon as another opportunity was available. The physicians recommended that their work schedule and method of handling patients be revised to make the system more efficient; that social workers be assigned to polyclinics to handle some of the patients' social problems that aggravated their medical problems; that polyclinic doctors be given more specialized training in rapid diagnosis and other skills required by them and not by hospital physicians; and that the remuneration of polyclinic physicians be brought in line with their arduous assignment.

The patient's response to the inadequacy and inefficiency of polyclinic health care has been to seek out a physician with a private practice and pay the necessary fee. Approximately one-fourth of the polyclinic physicians have a private practice during nonduty hours, as do almost all specialists. By consulting a private physician rather than the free polyclinic, the patient can choose his own doctor and establish a personal relationship with him, hoping to develop confidence and receive more effective treatment.

The outpatient work of the polyclinics is supplemented by a network of special dispensaries that provide long-term care for persons suffering from tuberculosis, venereal disease, tumors and psychoneurotic disturbances. The sixty-one dispensaries in 1971 also had a total of 3,670 beds for inpatient care.

A network of hospitals provides inpatient treatment and specialized diagnostic and clinical facilities. All hospitals are also teaching centers for physicians, nurses, and auxiliary medical personnel. In 1971 there were 195 hospitals throughout the country, at least one in each district. Certain districts, however, were inadequately equipped with hospital facilities. The total number of beds was 57,053, or 7.6 beds per 1,000 inhabitants. One hundred and fifty-four of the hospitals, with a total of 47,839 beds, were general hospitals. There were also fifteen special tuberculosis hospitals and fifteen psychoneurological hospitals with a total of slightly over 3,000 beds in each category; five pediatric hospitals with a total of 480 beds; four obstetric and gynecological hospitals with a total of 740 beds; one hospital for infectious diseases; and one for orthopedic and plastic surgery. In addition to these district-supported hospitals, the central government operated six hospitals with a total bed capacity of 1,036 in connection with the special medical research institutes. Extended care and physical therapy for patients suffering from chronic ailments were offered by 182 sanatoriums and health spas with a total bed capacity of 16,104.

The Sixth Five-Year Plan (1971-75) envisages increasing the number of hospital beds to 8.4 per 1,000 inhabitants and focusing on those areas of the country that are underserved. An increase in operating funds for the hospitals is to be channeled mostly into improving plant and equipment. Although most hospitals suffer from poor or outmoded plant and equipment, they also suffer seriously from a shortage of staff, particularly of nurses and auxiliary medical personnel. The plan states specifically that alleviation of that shortage will have to be delayed.

In 1971 the country had a total of 16,183 physicians, 1.9 for every 1,000 inhabitants. The number of physicians had more than doubled in the twenty years since 1952; most of them, therefore, were between the ages of twenty-five and forty-five. The number of other medical personnel had expanded along the same lines. In 1971 there were 2,464 pharmacists; 26,381 nurses; 6,016 midwives; and 5,012 feldshers. Feldshers are paramedics trained to perform a variety of medical functions, including simple surgery, in the absence of a fully qualified physician. Many rural health centers are in the charge of feldshers and receive periodic visits from specialized physicians.

Physicians and auxiliary medical personnel are all employed by the state in the national health service. They are classed as nonproductive workers, therefore their salary scales are lower than those for productive workers. This has been causing a great deal of dissatisfaction and is the principal reason for the serious shortage of medical personnel. One Bulgarian newspaper in 1971 reported the case of a hospital administrator trying to recruit women streetcleaners to fill the many vacancies for nurses and aides in the hospital. The streetcleaners refused because their wages and working conditions were better than those for the more highly skilled positions in the hospital.

PERSONAL INCOME AND EXPENDITURES

Cost of Living

Incomes and retail prices are controlled by the government and set in accordance with the overall economic plan. The cost of living, therefore, is also controlled and has been relatively stable. Several increases in the minimum wage during the 1960s were paralleled by price increases for some of the essential commodities and services. In 1973 the minimum monthly wage was raised to 80 leva per month (for value of the lev—see Glossary), and basic wages for the lowest categories of workers and employees were also raised to bring them into line with wages in comparable kinds of work. At the same time, prices of certain foods were reduced, whereas prices of some other essential goods were raised.

Although the incomes of most Bulgarians have generally kept pace with the rise in the cost of living, a chronic scarcity of consumer goods and services and periodic food shortages have forced a comparatively low standard of living on the population. As in other communist countries, the consumer industry has been neglected in favor of other branches of the economy. Even after the government began to place greater emphasis on the production of consumer goods in the 1960s, rising demand outstripped production capabilities. Even the basic needs of the population often could not be met because of poor planning or the inflexibility of the central planning system, which does not react effectively to changing market conditions. It is not uncommon to have excessive inventories of certain sizes of clothing or footwear while other sizes are in short supply. Retail outlets are either unwilling or unable to replenish their supplies of missing sizes until the overall stock of the item is almost depleted, regardless of consumer demand.

The government has for some time indicated concern over the low standard of living in Bulgaria as compared with other Eastern European countries. One of the aims of the Sixth Five-Year Plan is to increase production of consumer goods and meet the needs and rising demands of the population. Limited production capacity, however, and shortages of certain raw materials will seriously restrict the extent of possible improvements.

In December 1972 the Central Committee of the Bulgarian Communist Party held a special plenum on improving the standard of living of the people. This unprecedented move showed the importance that the leadership was attaching to this subject. In an extensive report to the plenum, party chief Todor Zhivkov presented a far-reaching program of steps to be taken, starting in 1973, to improve the standard of living. To implement the decisions of the plenum over the long run, the Commission on the Living Standard was established under prominent Bulgarian Communist Party (BKP—see Glossary) leadership.

As envisaged by the plenum, the standard of living will be raised by pursuing a three-pronged policy: gradually increasing wages; keeping prices stable; and making available an adequate supply of consumer goods and services, including luxury goods and services to satisfy the demand of those who are willing to pay the higher price. In the past, luxury goods and services have been considered superfluous and undesirable in an egalitarian socialist country. Higher incomes and exposure to the living standards in other Eastern European and Western European countries, however, have created pressure for more than just the satisfaction of basic needs. According to some government officials, Bulgarians are no longer satisfied with just any washing machine or electric appliance; they want the latest automatic model and are willing to pay for it.

In the program for increasing wages, special attention will be paid to narrowing the gap between incomes of cooperative peasants and those of workers. In the mid-1950s a cooperative peasant's income was only 60 percent of a worker's income. By 1971 the peasant's income had increased to 85 percent of that of a worker, but this amount was still considered too low by the government. To accelerate the growth of peasants' incomes, a nontaxable minimum income was to be introduced in 1973, and the same system of income tax was to cover both peasants and workers. The system of remuneration on cooperative farms was to be made the same as that on state farms, where agricultural workers are classed as workers, not as farmers. Fringe benefits, such as pensions and supplements for children, were also to be brought into line with those of workers by 1975.

Consumption

According to official figures, consumption has grown steadily since the early 1960s, in spite of continued shortages of some goods. As incomes rose and consumer goods and services became more readily available, a greater percentage of household budgets was being spent on them. All segments of the population spent a greater share of their income in 1971 on household equipment and on cultural and educational pursuits, which included such durable goods as household appliances and radios and television sets, than they did in 1962. Changes in proportionate expenditures for other nonessentials during the 1960s reflected the income differences and taste preferences of the different social categories as well as their rural or urban residence.

The largest share of consumer expenditures in 1971 went for food, ranging from 42.5 percent of total expenditures for peasants to 38.8 percent of total expenditures for white-collar workers (see table 3). In calculating expenditures for food, the value of food production for personal consumption was included. The relative share of expenditures on food has been dropping since 1962. At the same time, the quality of the diet for all population groups has improved.

Table 3. Bulgaria, Percentage Distribution of Household Expenditures by Population Group,
1962 and 1971

Relative expenditures on clothing were roughly the same for all population groups, although peasants spent a somewhat smaller proportion of their budget than families influenced by urban life-styles. The share of the budget spent on clothing has dropped since 1962.

The relative share of expenditures for housing went down between 1962 and 1971 for the two lower income groups, who spent almost the same proportion of their budget for that purpose. The higher income white-collar group, however, spent over 3 percent more on housing in 1971 than it did in 1962. This group has been investing in its own private housing rather than living in state- or industry-supplied housing. Expenditures for household furnishings and equipment were approximately the same for all segments of the population in 1971. They occupied a greater share of the household budget than in 1962, particularly among blue-collar workers.

In addition to devoting a considerably higher portion of their budget to housing than other social groups, white-collar workers also devote more of their budget to culture and entertainment and to health and hygiene. This is clearly a reflection of more sophisticated tastes and a higher standard of living. The life-style of this group includes regular attendance at the theater, operas, and concerts; the purchase of books and records; and a higher education for their children. This, also, is the group that prefers to consult a private physician, who sets his own rates, rather than to use the free public clinic.

Relative expenditures for communication and transportation services have remained stable over the years. They vary by population group, consuming a greater portion of the budget as one rises on the social ladder. The proportionately higher expenditures of blue- and white-collar workers are probably due to the expense of commuting to and from a job. The even higher share of such expenditures in the budgets of white-collar workers is attributable to private telephones and travel.

The greatest variation in consumption patterns between the different population groups is evident in the proportion of expenditures devoted to other than the enumerated categories. Although there is no indication in the statistical material as to what kind of expenditures are included, this entry must certainly include expenses incurred in the cultivation of private plots and the raising of animals in the private sector for domestic consumption and expenses incurred in providing private services. Therefore, these expenditures take a high share of the total expenditures of peasants and workers.

Despite expanding consumption, neither the government nor the population is satisfied with the supply and quality of the goods and services available. Some items, such as meat, housewares, furniture, building materials, and various kinds of clothing and knitwear, are in chronic short supply. Other items, such as fruits, vegetables, and dairy products, are subject to periodic shortages. In addition, the quality and selection of many goods do not meet the desired levels. An official document published in 1972 decried the common practice of producing high-quality goods for export and lower quality goods for the domestic market. The same document also called for changing export priorities so that the domestic needs could be met before scarce goods were exported.

Another factor limiting the satisfaction of demands for goods and services has been the small size and inefficiency of the domestic trade network and of the service industry. Retail outlets are state owned and have received very low priority in the allocation of funds. As a result, they are too few in number and are seriously understaffed, making shopping a time-consuming and frustrating activity. Stores are reluctant to stock new styles in response to consumer demands until their old stocks have been almost completely depleted. High-quality and specialty items are usually available only from private craftsmen at very high prices.

Private craftsmen and artisans provide virtually the only service network in the country. The service sector of the economy has been considered as nonessential and therefore has been neglected by the state (see ch. 12). In order to fill the gap thus created, the government started in the mid-1960s to encourage private individuals to provide the needed services. Many of these people are regularly employed artisans and craftsmen in industry who provide specialized services during their spare time. Others are pensioners or unemployed. Because they are in great demand, they can set their own prices, and many are in the highest income groups. The government has attempted to keep their earnings under control through taxes and has restricted their activities by other administrative measures, but it has made no effort to eliminate their services.

In the report issued by the special plenum on living conditions held by the Central Committee in December 1972, a comparison was made of actual consumption in 1970, desired consumption levels during the next decade, and consumption standards developed by government scientific institutes. In most cases the actual levels were far below the standards (see table 4).

Table 4. Bulgaria, Actual and Desired Annual Consumption Levels

HOUSING

In common with other Eastern European countries, Bulgaria has suffered a serious urban housing shortage since World War II, although large reserves have existed in rural housing. Great numbers of workers have left the villages over the years to find employment in the rapidly expanding industrial centers, but housing construction has not kept pace with this migration. During the early years of communist rule, priority in the allocation of scarce building materials and funds was given to the building of new plants and other industrial installations rather than to new housing. In the 1960s only between 3 and 6 percent of the gross national income was invested in housing construction as compared with 20 percent or more in most Western European countries. Bulgaria has had the lowest housing investment among the communist countries of Eastern Europe.

In 1970 the Politburo and the Council of Ministers adopted a special program for the solution of the housing problem within the next ten to fifteen years. The program stated that the aim of the BKP was to enable every family to have its own apartment, and every member of the family his own room. In 1972 there were some 250,000 more urban families than there were housing units.

Aggravating the housing shortage in the early 1970s was an accelerating deterioration of old buildings. Money and materials for maintenance of existing structures have been even scarcer than for new buildings. In addition, many of the postwar apartment buildings were put up hastily, using inferior materials and workmanship, and soon turned into crumbling slums.

In order to spur housing construction without imposing too great a burden on the state budget, the government was forced to abandon its intention of providing low-rent housing for everyone. Instead, it has encouraged the population to invest in its own housing. As a result, special savings accounts for the purchase of private housing have grown at a more rapid rate than regular savings accounts. During the 1968-70 period approximately one-third of the new housing units made available were financed entirely by state funds, another one-third were financed entirely by private funds, and the last one-third were financed by private funds with the aid of loans from state sources. State enterprises are instructed to grant their employees interest-free, fifteen-year mortgages for the purchase of an apartment or house. Up to 4,000 leva can be borrowed for this purpose in urban areas and up to 3,000 leva in rural areas. This, however, covers less than one-half of the cost of a two-room apartment.

Although the increasing reliance on tenant-financed housing is helping to reduce the overall housing shortage, it has meant that most new housing units are built for the higher income groups. Cooperative apartments and private houses require a substantial initial investment and the assumption of a mortgage, which are beyond the means of most blue-collar and low-income white-collar workers. These groups continue to rely on state-financed or industry-financed low-rent housing, which usually has long waiting lists of prospective tenants. In order to free more of the low-rent housing for those who cannot pay for a private home, persons owning a second home or intending to build one are being asked to vacate their state-supplied housing.

In 1973 the per capita area of usable housing space was 124 square feet. New dwelling units constructed under the Sixth Five-Year Plan were to have an average of 857 square feet each; those constructed during the following Seventh Five-Year Plan (1976-80) will have an average of 911 square feet each. Inasmuch as possible, all new housing units constructed before 1975 will be equipped with running water, electricity, sewage disposal facilities, and central heat. After 1976 such amenities will be mandatory. In the mid-1960s, the latest date available, 30.7 percent of all housing units had running water, 94.7 percent had electricity, 32.7 percent had sewage disposal facilities, and 1.5 percent had central heat. The availability of these amenities in housing units varied a great deal among the different social groups of the population (see table 5).

Table 5. Bulgaria, Percentage of Housing Units Equipped with Various Amenities,
December 1965

SOCIAL BENEFITS

In addition to receiving free medical care, all citizens are entitled to a variety of social benefits, including sickness and disability pay, pensions, maternity benefits, and family allowances. Most of these are administered by the trade unions, but pensions are under the jurisdiction of the Ministry of Finance. They are financed by the central government and by contributions from the employers based on a percentage of gross salaries and wages paid.

All workers are entitled to paid sick leave after three months' service. In the case of accidents at work, there is no waiting period. Lump-sum compensation for temporary disablement because of an accident at work ranges in amount, depending on severity of injury and length of service. During the period of disablement, the worker is entitled to benefits ranging from 30 to 100 percent of his wage, depending on the severity of the disablement and on his income. Prolonged or permanent disability entitles the worker to a pension.

Old-age pensions are based on the years of service and kind of work performed. The pensionable age is fifty-five for women and sixty for men, but earlier retirement is possible for certain categories of work. Pension payments range from 55 to 80 percent of wages based on a scale covering the last five years of employment or, in some cases, three out of the last five years. Higher rates are paid for work years past the usual retirement age. Pensions are payable to dependents after the death of the pensioner. Dependents also receive life insurance payments. Cooperative farm members are entitled to pensions after twenty years of work for women and twenty-five years of work for men provided they worked 100 to 135 days each year. In 1972 it was suggested that 200 to 250 days of work per year should be required for pensions in exchange for higher pension payments to cooperative farm members.

Pensions are collectible even if a person continues working. This system was criticized by Zhivkov in late 1972. He suggested that persons who continued to work after being eligible for a pension should be encouraged to do so without drawing a pension but should, instead, accumulate additional increments to their pension for each year worked.

In addition to old-age pensions there are pensions for special merit payable to persons who have made an exceptional contribution to national life and national pensions payable to fighters against fascism and capitalism. All minimum pension payments were increased in 1972.

Under new provisions announced in March 1973, employed women will be entitled to four months of fully paid maternity leave and six months of leave at minimum wages for the first child; five and seven months, respectively, for the second child; six and eight months for the third child; and four and six months for each subsequent child. Mothers who are students or who do not work for some valid reason will receive minimum wages for corresponding periods. Mothers of children under the age of ten are entitled to special annual leave. All mothers receive a cash payment at the birth of a child; the payments are sharply differentiated to encourage larger families. In early 1973 the payments were 20 leva for the first child, 200 leva for the second child, and 500 leva for the third child. It was planned, however to raise these payments to 100 leva, 250 leva, and 500 leva, respectively.

Another inducement for larger families is a system of monthly family allowance payments for children up to the age of sixteen or until they complete secondary school. Allowances are payable to all families regardless of whether or not the parents work. A variety of other social assistance benefits are available to indigents, persons disabled from childhood, orphans, and the aged with no income.

WORK AND LEISURE

In 1973 the country was in the process of shifting from a forty-six-hour, six-day workweek to a 42.5-hour, five-day workweek. The transition was being carried out district by district according to a set schedule. It was to be completed by 1975. Persons working in agriculture, education, and the health service, however, were to continue to work their forty-six hour workweek, except where the actual work involved was adaptable to a reduced workweek.

The reduction in working hours had been a much debated subject for several years. It was first promised by the government in 1968, but its implementation has been slow because it is predicated on the same level of productivity and output by each enterprise as before implementation. Pressure for reduced working hours has been strong because most Bulgarians have very little time for genuine leisure in their daily life.

The lack of time for genuine leisure is the result not only of long working hours but also of an inadequate trade and service network, a shortage of time-saving household equipment, and an excessive bureaucracy. All the daily chores, such as housekeeping, shopping, and attending to other personal or family matters, are time consuming and cumbersome. Studies have shown that all persons over the age of six devote an average of four hours out of every twenty-four to housework alone. The national leadership feels this is excessive and has proposed measures to develop the service sector.

The favorite leisure-time activity of young and old, urban and rural Bulgarians is to get together with friends for informal socializing. Men congregate at the neighborhood tavern or their favorite cafÉ to drink plum brandy or wine, play cards, and talk about the latest news. Women gather to gossip at each other's homes, at the village pump, or at the neighborhood playground or park. The evening promenade is an important diversion for all ages and social groups. Walking back and forth at some designated public thoroughfare in small groups of friends or relatives, people greet each other and exchange pleasantries.

Sports are a major form of recreation for young people. Soccer is the national sport, and the matches of major teams are followed with great interest. Hiking and picnic excursions are popular among city dwellers who like to get out into the country to enjoy the beauty and tranquillity of nature. In towns and cities, the theater, operas, concerts, and other cultural activities are popular leisure-time diversions. The cinema is extremely popular in both town and village, although increasing television viewing has been reducing cinema audiences.

In addition to sports, young people spend much of their leisure time listening to popular music and also dancing. In fact, they are periodically reprimanded by the BKP leadership for spending too much of their time in leisure activities and not enough in socially useful work.