IJE Advance Access originally published online on April 25, 2006
International Journal of Epidemiology 2006 35(3):796-797; doi:10.1093/ije/dyl075
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Letter to the Editor |
Economy and mortality in Eastern and Western Europe between 1945 and 1990: the largest medical trial of history
1 Department of Health Policy, National Health Insurance Fund Administration (OEP), Budapest, Hungary
2 County Baranya Health Insurance Fund Administration, National Health Insurance Fund Administration (OEP), Pécs, Hungary
* Corresponding author. Department of Health Policy, National Health Insurance Fund Administration (OEP), 1139 Budapest, Váci út 73/A, Hungary. E-mail: boncz.i{at}oep.hu
A previous issue (December 2005) of the Journal was devoted to publications analysing the relationship between economic growth and mortality. The investigations presented in two papers1,2 came to a contradictory outcome in terms of the relation between economic growth and mortality in the United States. We would like to draw the attention of another practical example on this topic.
Between 1945 and 1990 Europe was divided by the ‘iron curtain’ into two different parts: the Western European or capitalist and the Eastern European or socialist countries. The two groups of countries followed a different development pattern regarding many factors including—among others—economy and mortality. This period of 45 years in Europe can be considered as the largest medical ‘trial’ of history.
‘The study design’ was planned during the Second World War in the city of Jalta by the political leaders of the Soviet Union, United Kingdom, and United States of America. The countries (therefore the patients) were assigned into two different groups: the Western European countries and the Eastern European countries. The two groups have been closed for decades, i.e. there was neither any real communication between them nor any flow of patients. The interventions included many factors influencing health status like—among others—lifestyle, health culture, behaviour and habits of the population, health care infrastructure and manpower, health expenditures, regulatory framework, environmental factors, social deprivation, etc. The outcome of the trial can be measured by both economic and epidemiological indicators.
Owing to the limited availability of data from the Eastern European countries, the effect of interventions and the outcome of the ‘trial’ could have been assessed mainly only after the social changes of 1990. The gap in life expectancy between the countries of Central and Eastern Europe and the countries of Western Europe was closing up during the 1950s and early 1960s. In the Eastern European countries mortality rates had increased or were virtually unchanged since the mid-1960s, especially in middle-aged and elderly men. However from the mid-1960s the health status in the former socialist countries stagnated or deteriorated, whereas in the Western countries it improved steadily.3 By 1990 it became clear that on a long term, the Eastern European countries underwent a significant decrease in life expectancy4 and an increase in mortality while the Eastern European economies also experienced a collapse compared with the Western ones.5 Around 1990 we realized that although the political changes destroyed the physical iron curtain made of steel and stone it has remained alive in epidemiological terms (Figure 1).
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The epidemiological and economic indicators showed a further decline after the social and political changes in 1990 on a short term. In Eastern Europe cardiovascular mortality rates reached a maximum in the period 1990–94.6 By 1990 there was a 4 year gap in life expectancy, which, by 1997, in men, had widened to 6 years. The decrease in gross domestic product (GDP) was 3% in the Czech Republic, 13% in Hungary, 42% in Lithuania and Russia, and 60% in Ukraine. Mortality changes after 1989 in Eastern Europe were correlated with changes in GDP and changes in income inequalities.5
The papers by Tapia Granados1 and Brenner2 reveal the importance of within country changes in mortality and economy based on the example of the United States, but we would like to emphasize this relationship between the countries of Eastern and Western Europe.7 The political status and economic background of the two parts of Europe between 1945 and 1990 with the existence of the iron curtain had a significant effect on the health status of the population, which should be investigated more in detail.8
Conflict of interest: None.
References
1 Tapia Granados JA. Increasing mortality during the expansions of the US economy, 1900–1996. Int J Epidemiol 2005;34:1194–202.
2 Brenner MH. Economic growth is the basis of mortality rate decline in the 20th century—experience of the United States 1901–2000. Int J Epidemiol 2005;34:1214–21.
3 Forster DP, Jozan P. Health in Eastern Europe. Lancet 1990;335:458–60.[CrossRef][ISI][Medline]
4 Chenet L, McKee M, Fulop N et al. Changing life expectancy in central Europe: is there a single reason? J Public Health Med 1996;18:329–36.
5 Marmot M, Bobak M. International comparators and poverty and health in Europe. BMJ 2000;321:1124–28.
6 Kesteloot H, Sans S, Kromhout D. Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J 2006;27:107–13.
7 Marmot M. Epidemiology of socioeconomic status and health: are determinants within countries the same as between countries? Ann N Y Acad Sci 1999;896:16–29.
8 Boncz I, Klazinga N, Rutten F. East–west life expectancy and health expenditure gap in Europe: a case study from behind the iron curtain. Presented at the Public Health Association of Australia 32nd Annual Conference, Australia, Canberra, November 26–29, 2000.
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