Health in the central and eastern countries of the WHO European Region: an overview

Abstract

The enormous social, political and economic changes that began in the CCEE/NIS in the late 1980s included the revelation and public discussion of a widening health gap between these countries and the other Member States of the European Region. The continuing economic problems and their effects on health increase the urgency of the need for assistance from the international community. Diverging trends in life expectancy became evident in the mid-1970s, and the gap continued to widen in the 1980s for all major causes of death, particularly cardiovascular diseases. The situation is worse in the NIS than in the CCEE, and worst in the central Asian countries. In 1990, the worst infant mortality rate in these countries was eight times the best rate elsewhere in the Region. Non-mortality data, while patchy, confirm the indications given by mortality data. There is no single reason for the health gap, but contributory factors include the increasing prevalence of major risk factors in lifestyles and the environment, and the low efficiency and effectiveness of health care systems. The current situation and short-term prospects are mixed, but the negative trends in mortality and morbidity patterns are likely to continue for some time. While the worst health problems of the transition period in the CCEE/NIS could largely have been avoided, there is no doubt that economizing on health today will exact large costs tomorrow.

PIP: The socioeconomic conditions in eastern European countries are declining. Deterioration began during the mid-1960s. The mortality gap has continued to widen during the 1980s. The Central Asian Republics show mortality patterns similar to ones in developing countries; infant mortality is about 8 times higher than in western Europe. Infant mortality rates in eastern and central Europe are 2-3 times higher than in western Europe. Cardiovascular diseases are the leading cause of death. Another increasing mortality group is lung cancer, and the gap is widening in the West. The NIS (formerly republics of the Soviet Union) have high rates of communicable diseases preventable through immunization. The logistics of vaccine distribution and storage are inadequate. Abortion is the primary means of family planning. 70% of the population of the Russian Federation reported their health as less than good, and only 20% of Russian military personnel are fit based on international standards. Tobacco consumption and high alcohol consumption are the primary health risks. Poor nutrition, stress, and drug abuse add to the risks. The health gap is wide also due to poor housing conditions and environmental pollution. Health care systems, unhealthy lifestyles, and unhealthy environments all contribute to the widening gap in health. The rigid administrative health structures are not conducive to change. The quality of care is low. Decentralization and private sector involvement may produce needed changes in the quality of health services. CCEE countries spend 4.5-7.1% of gross national product on health, compared to 7.3% in the West. In the Czech Republic, Poland, Hungary, and Slovakia, health expenditures per person are 3-4 times less than in OECD countries. Prices are very high for drugs, food, and energy. Although the medical staff-patient ratio is high, there are shortages in particular specialties. Nurses are poorly trained and in low supply. Hospital equipment is very old and poorly maintained. There is overuse of secondary and tertiary hospitals and underuse of general hospitals.