by Mateusz Zatonski
While the political Iron Curtain dividing Europe has been long gone, the health divide between the two parts of the continent remains still very much in place. While Western European countries have seen their death rates before 65 years of age fall to under 10%, in many countries of the former Soviet Bloc only around 1 in 2 of their male citizens live to this age. In fact, in countries such as Russia premature mortality in young and middle-aged (15-69 years) males is not only much higher than in Western Europe, but also twice higher than in China, India, Latin America, and slightly exceeding sub-Saharan Africa.
Over half a century ago things were very different. As the ideologically-driven state socialist health services were set up in the Communist states, medical care became available to a wider proportion of society than ever. The improvement of standards of hygiene, compulsory free vaccinations, and the development of sanitary-epidemiological services allowed for a very effective control of infant, child and adolescent mortality, maternal mortality, as well as infectious diseases in general. Life expectancy at birth in Poland, for example, increased by almost 10 years in the 1950s. In Western Germany in the same period it increased by only 2.5 years. By the mid-1960s the average life expectancy figures for Eastern Europe and the more advanced market economy countries of Western Europe were separated by only 1-2 years. The health gap between Eastern and Western Europe was almost closed.
However, Eastern Europe was soon to be left behind. Western countries increasingly began to see health not only in terms of hospitals and doctors, but also in the building of the health competences of their populations. Public campaigns encouraging healthy diets and physical activity were launched, and governments actively combated vices such as binge drinking and smoking through the imposition of taxes and the rising of minimum prices. Finland serves as a role model for this transformation – from the country with the poorest health in Europe in the 1960s it transformed into one of Europe’s health leaders by the end of the century.
While populations of Western countries were undergoing the process of building health literacy, in the Soviet sphere health policy remained frozen. The East European states were focused on building medical infrastructure and training curative medicine personnel. Numbers of physicians and hospital beds in Central and Eastern Europe were constantly increasing, as was access to new medical procedures and drugs. At the same time consumption of cigarettes and alcohol was growing – both products were ubiquitous and cheap, and there was no effort to increase the public awareness of risks connected with them. In fact smoking rates were highest among the wealthiest and best educated segment of society, including medical doctors. In 1990, just before the collapse of the Soviet Union, numbers of doctors per 1,000 inhabitants amounted to 4.7 in Socialist economy countries, and 2.5 just in the established market economy countries. In the same year, Poland became the global leader in smoking prevalence.
As Communism released Eastern Europe from its grip, things began to change. In the 1990s, after 25 years of health decline, Poland and the other countries of the region, which were to join the European Union in 2004, began to undergo a process of health gain. As the antiquated Soviet model of healthcare was abandoned, modern health policies modelled on the Western experiences were implemented. The results came quickly. Health indicators such as cardiovascular mortality, which in the late 1980s were among the worst in the world in Central Eastern Europe, began to rapidly decline. The introduction of market economy helped precipitate positive changes in diet, that until the 1990s were impossible due to the limited selection of foodstuffs in the region. A reduction in smoking and alcohol consumption also followed. The region entered a phase of health transformation that took place in Western Europe 20 years earlier.
However, while in absolute terms the health situation in the new EU member states is improving, the gap dividing them from Western Europe has not diminished, since the latter has not stood still either. As the graph above shows, the mortality decline in Poland in the last two decades has been accompanied by a similar fall in the UK. Nonetheless, Central Eastern European states have at least managed to turn away from the course taking them towards a health catastrophe – the same cannot be said about Russia. Despite temporary fluctuations, the mortality of adults in Russia remains frozen on the same levels for the last two decades. Today, alcohol is estimated to be responsible for approximately half of all premature deaths in young men in Russia. This state of ‘perpetual health catastrophe’, in which the country has been frozen for the last 20 years, extols an enormous price in the lives of millions of its citizens. This process is still ongoing and constitutes one of the main obstacles stalling the development of this region.
FAO: Food Balance Sheets, FAOSTAT data 2005. Available from: http://faostat.fao.org
Feachem R. Health decline in eastern Europe. Nature 1994 Jan 27;367(6461):313-4.
Newsholme A, Kingsbury A. Red Medicine: Socialized Health in Soviet Russia. DoubleDay, Doran & Company, inc; Garden City, New York 1933.
Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K, editors. Health in All Policies: Prospects and potentials. Finland, Ministry of Social Affairs and Health, 2006.
Zatoński WA, HEM project team. Epidemiological analysis of health situation development in Europe and its causes until 1990. Ann Agric Environ Med. 2011 Dec;18(2):194-202.
Zatoński WA, Bhala N. Changing trends of diseases in Eastern Europe: Closing the gap. Public Health 2012;126:248-52.