Health services in central and eastern Europe: past problems and future prospects.

The past and the present As the peoples of central and eastern Europea move into the 1990s they are abandoning some of their initial euphoria and coming to terms with the enormity of the task confronting them. During 45 years of authoritarian rule the perceived interests of the state took priority over those of the individual. Uneconomical and environmentally damaging heavy industry swallowed up resources that could otherwise have been used for health care. Throughout this time the governments were able to present their societies as utopian paradises, in which health for all was virtually achieved and everyone was equal. In 1988 the Czech Ministry of Health stated that "there are no principal differences in the level of health status among population categories" (Janeckova H, personal communication). On the contrary, these governments have left a legacy of deteriorating health,' geographical and social inequality,2 3 industrial decay, environmental damage,4 and a deep distrust of central planning and paternalism.