The East-West Health Gap in Europe--what are the causes?

One of the biggest challenges facing Europe is the ‘East-West Health Gap’. Historically, the transition from infectious to chronic diseases came first in Western Europe before occurring in Eastern Europe. However, after World War II, it went much more smoothly in the Former Socialistic Economy (FSE) countries. A quicker increase in life expectancy in the East (e.g. in Poland life expectancy at birth increased by 9 years among males—from 56.1 to 64.9 years—in the period 1950–1960) led to an equalization of the health differences between Eastern and Western Europe during the early 1960s.1 Unexpectedly, the mid-1960s brought to the FSE countries a reversal in health development. During this time, adult mortality after the age of 20 began to increase, especially among men, while childhood mortality and infectious disease mortality continued to decline. All of those countries saw a sudden increase in mortality due to lung cancer, liver cirrhosis and sudden death from injury. The rapid decline in cardiovascular mortality which could be observed from the 1970s onwards in Western Europe did not occur in any of the FSE countries.1,2 On the contrary, in many FSE countries, cardiovascular mortality demonstrated a dramatic increase, especially among men. The divergence of mortality trends among young and middle-aged adults between Western Europe and the FSE countries led to a situation in the late 1980s, before the fall of Communism in Europe, in which the ‘East-West Health Gap’ reached immense proportions.1 Furthermore, during the break up of the Soviet Communist system, the pace of increase of adult mortality rose rapidly in the majority of FSE countries.3 This explosion of adult premature mortality was particularly dramatic in the countries of the former Soviet Union and it reached its peak in the years 1992–1994. In those years more than one million additional premature deaths were observed.4 This increase of adult premature mortality, which was already observed for nearly 50 years in the vast majority of former Soviet Union countries, is relatively well publicized2,5,6 (‘bad news is good news’), even though the public health community was rather powerless and never able to influence this phenomenon. On the other hand, not all news from Eastern Europe is bad. In part of the FSE countries, notably in what we know as Central and Eastern Europe (CEE) (Poland, Czech and Slovak Republics, Hungary, Slovenia), a reversal in health tendencies occurred in the past 15 years, after 1990. Life expectancy began to increase rapidly in all these countries: for example in Polish males it increased by 4.5 years in the period 1991–2002.4 Except for the case of Poland,1,7,8 this phenomenon is poorly described and poorly understood, both by the countries it occurred in, and by the international community (‘good news is no news’). The most fascinating phenomenon is the dramatic decline in morbidity and mortality from cardiovascular diseases.7,8 For example in Poland, this trend applies equally to males and females, all adult age groups, inhabitants of both rural and urban areas and less and better educated groups of population. The pace of this development is among the fastest ever observed in Europe.8 The cause of this spectacular reversal is not entirely clear. However, it seems that the most important candidates are dietary changes, resulting from the introduction of a market economy and changes in prices of various food items.8 The most significant factor could be increased consumption of polyunsaturated fatty acids, such as alpha-linolenic acid.7 The health improvement in Central Europe is just beginning and we still have a long way to close the gap. The dramatic ‘natural experiments’ that are taking place in this region are pertinent to the entire continent, and the key role of the European public health specialists should be explaining them and initiating interventions in this field. The work on this manuscript was conducted within the European Commission Public Health Project: HEM—Closing the Gap—Reducing Premature Mortality. Baseline for Monitoring Health Evolution Following Enlargement (grant agreement no. 2003121) to the Cancer Centre and Institute of Oncology, Cancer Epidemiology and Prevention Division, Warsaw (Principal Investigator: Witold Zatonski).