Introduction

The study of health and its determinants in Central & Eastern Europe is important both because of the the mortality crisis that has affected the region since the collapse of communism and because of the insights societies in transition bring to the wider investigation of social influences on health.

The levels of mortality and ill health in Central & Eastern Europe are much higher than in western Europe. The striking East-West gradient in mortality is shown in figure below. Life expectancy was comparable in the post-war period but has been diverging since the 1960s, so that in 1990 life expectancy at birth in eastern Europe was, on average, 6 years shorter than in western Europe.

These differences in mortality are only partly explained by lower per capita income or conventional risk factors, such as smoking, obesity, or blood pressure. After the fall of communism in 1989, major social and economic changes, occurred including falling living standards, increased income inequality, and falling birth rates.

This “natural experiments” offers a unique opportunity to study the impact of profound societal changes and societal characteristics on health. The social environment in the former communist countries was different than in western Europe. For example, high education was not rewarded by high income. This allows us to study the effects of different aspects of the socioeconomic status on health and to break the confounding that complicates such analyses in the west. The physical environment was also less favorable, with high levels of industrial pollution, at least until 1990; this, again, offers a good opportunity for environmental health research.  

Mortality for all causes (ICD 001-E999) in males in 1990/1991(Atlas of mortality in Europe. Subnational patterns, 1980/1981 and 1990/1991. WHO Regional Publications, European Series, No. 75. 1997)

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