HEALTH-STATUS DURING THE TRANSITION IN CENTRAL AND EASTERN-EUROPE - DEVELOPMENT IN REVERSE

This paper reports on a study of the cross-national trends in health s tatus during the economic transition and associated health sector refo rms in Central and Eastern Europe (CEE). The central premise is that b efore long-run gains in health status are realized, the transition tow ards a market economy and adoption of democratic forms of government s hould lead to short-run deterioration as a result of: (i) reduction in real income and widening income disparities; (ii) stress and stress-r elated behaviour; (iii) lax regulation of environmental and occupation al risks; and (iv) breakdown in basic health services. Analysis focuse d on three broad indicators of health status: life expectancy at birth , infant mortality rare and the probability of dying between the ages of 15 and 65 years, shown by the notation '50q15'. The study revealed significant new information about health status and the health sector which could nor have been obtained without a proper cross-national stu dy. Infant mortality rates in former socialist economies (FSE) follow the global trend, declining as per capita income rises. However, rates are lower than would be predicted given their income levels. Despite declining infant mortality, life expectancy at birth in the former soc ialist economies decreases as per capita income rises, in marked contr ast to global trends. This is because rising income level is associate d with greater probability of death between the ages of 15 and 65: the wealthier the society, the less healthy is its population, particular ly for its males. Causes of death in the FSE follow global trends: hig her death rates due to infectious and parasitic diseases in poorer cou ntries, and higher death rates due to chronic diseases in wealthier co untries. However, age-standardized death rates for chronic diseases ge nerally associated with unhealthy lifestyles and environmental risk fa ctors are very high when compared with wealthier established market ec onomies (EME). Policies and procedures which alter the effectiveness o f health services have had a demonstrable but mixed impact on health s tatus during the early phase of transition. Effective preventive healt h strategies must be formulated and implemented to reverse the adverse trends observed in Central and Eastern Europe.