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The 'European east-west health divide' has been documented both for mortality and for self-rated health. The reason for this divide, however, remains to be explained. The aim of this study is, firstly, to investigate whether in 1995-97 differences in self-rated health persisted between countries in central and eastern Europe, the former Soviet Union, and western Europe. A further aim is to try to explain these differences with reference to people's financial status and social capital. This study found substantial differences in self-rated health between countries in western Europe, in central and eastern Europe, and in the former Soviet Union (where self-rated health seems to be poorest in general). There were also substantial differences between areas in terms of economic and social capital, with western Europe doing better in all the analysed circumstances. In economic terms people in the former Soviet Union seemed to be more dissatisfied than those living in central and eastern Europe. When one looks at differences in social capital between the two post-communist areas the picture is more mixed. Economic satisfaction was demonstrated to have a strong and significant effect on people's self-rated health, with a higher satisfaction reducing the odds of 'poor' health. When this factor was controlled for the area, differences in self-rated health were reduced dramatically, for both men and women. Organisational activity (men only), trust in people, and confidence in the legal system also reduced the odds of 'less than good health', but were not as important in explaining the health differences between areas. One can conclude that economic factors as well as some aspects of social capital play a role for area differences in self-rated health. Of these it would appear that economic factors are the more important. Keywords: Self-rated health; Eastern Europe; Western Europe

The political and economic turmoil that occurred in south-eastern Europe in the last decade of the twentieth century left a legacy of physical damage. This aspect of the conflict has received considerable coverage in the media. However, surprisingly less has been reported about the effects of that turmoil on the health of the people living in the region. In an attempt to identify and synthesize data on these effects, we carried out a systematic review and used the results to put together a searchable online database of documents, reports and published mater at, the majority of which have not previously been easily accessible (http://www.lshtm.ac.uk/ecohost/see/index.php). The database covers the period from the early 1990s to 2003 and will be of considerable interest to policy-makers. It contains 762 items, many of them annotated and available for downloading. This paper synthesizes the main findings obtained from the material in the database and emphasizes the need for concerted action to improve the health of people in south-eastern Europe. Furthermore, we also recommend that agencies working in post-conflict situations should invest in developing and maintaining online databases that would be useful to others working in the area. Keywords Health status; Health status indicators; War; Chronic disease/epidemiology; Communicable diseases/epidemiology; Child welfare; Mental health; Delivery of health care; Review literature; Europe, Eastern (source: MeSH, NLM). Mots cles Etat sanitaire; Indicateur etat sanitaire; Guerre; Maladie chronique/epidemiologie; Maladie transmissible/epidemiologie; Protection enfance; Sante mentale; Delivrance soins; Revue de la litterature; Europe orientale (source: MeSH, INSERM). Palabras clave Estado de salud; Indicadores de salud; Guerra; Enfermedad cronica/epidemiologia; Enfermedades transmisibles/ epidemiologia; Bienestar del nino; Salud mental; Prestacion de atencion de salud; Literatura de revision; Europa Oriental (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.] Bulletin of the World Health Organization 2004;82:539-546., Voir page 544 le resume en francais. En la pagina 545 figura un resumen en espanol. [TEXT NOT REPRODUCIBLE IN ASCII.] Introduction The violence that afflicted south-eastern Europe in the [...]

Life expectancy and other indices of health have deteriorated markedly in the former socialist countries of Eastern Europe over recent decades. The possible roles of lifestyles, knowledge about health and behaviour, emotional well-being and perceptions of control were assessed in a cross-sectional survey of young adults of similar educational status in Eastern and Western Europe. As part of the European Health and Behaviour Survey, data were collected in 1989-1991 from 4170 university students aged 18-30 years from Austria, Belgium, the Federal Republic of Germany, the Netherlands and Switzerland, and from 2293 students from the German Democratic Republic, Hungary and Poland. Measures were obtained of health behaviours, awareness of the role of lifestyle factors in health, depression, social support, health locus of control, and the value placed on health. After adjustment for age and sex, East European students had less healthy lifestyles than Western Europeans according to a composite index of 11 health behaviours, with significant differences for seven activities: regular exercise, drinking alcohol, avoiding dietary fat, eating fibre, adding salt to food, wearing a seat-belt, and using sunscreen protection. East European students were less likely to be aware of the relationship between lifestyle factors (smoking, exercise, fat and salt consumption) and cardiovascular disease risk. In addition, they were more depressed (adjusted odds of elevated scores on the Beck Depression Inventory of 2.46, 95% C.I. 1.95-3.09), reported lower social support, and had higher beliefs in the 'chance' and 'powerful others' locus of control. Internal locus of control levels did not differ across regions, and Eastern Europeans placed a higher valuation on their health. Unhealthy lifestyles associated with lack of information about health and behaviour, greater beliefs in uncontrollable influences, and diminished emotional well-being, may contribute to poor health status in Eastern Europe. [c] 2001 Elsevier Science Ltd. All rights reserved. Keywords.' UK; Health behaviour; Emotional well-being; Risk perception; Eastern Europe; Western Europe

This study examined the association between perceived control and several socioeconomic variables and self-rated health in seven post-communist countries (Russia, Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic). Questionnaire interviews were used to collect data on self-rated health in the last 12 months, education, marital status, perceived control based on nine questions, and material deprivation based on availability of food, clothing and heating. For each population, two ecological measures of material inequalities were available: an inequality score estimated from the survey data as the distance between the 90th and 10th percentiles of material deprivation, and Gini coefficient from published sources. Data on 5330 men and women aged 20-60 were analysed. Prevalence of poor health (worse than average) varied between 8% in Czechs and 19% in Hungarians. The age-sex-adjusted odds ratio for university vs primary education was 0.36 (0.26-0.49); odds ratios per 1 standard deviation increase in perceived control and in material deprivation were 0.58 (95% CI 0.48-0.69) and 1.51 (1.40-1.63), respectively. The odds ratio for an increase in inequality equivalent to the difference between the most and the least unequal populations was 1.49 (0.88-2.52) using the material inequality score and 1.41 (0.91-2.20) using the Gini coefficient. No indication of an effect of either inequality measure was seen after adjustment for individuals' deprivation or perceived control. The results suggest that, as in western populations, education and material deprivation are strongly related to self-rated health. Perceived control appeared statistically to mediate some of the effects of material deprivation. The non-significant effects of both ecological measures of inequality were eliminated by controlling for individuals' characteristics. Keywords: Eastern Europe; Self-rated health; Socioeconomic factors; Psychosocial factors; Perceived control; Inequality

Our objective is to describe recent patterns and trends in HIV and injecting drug use and to explore possible determinants of the epidemics in eastern Europe. The available data confirm a rapid spread of HIV among injecting drug users (IDUs) in the newly independent states (NIS) and suggest that all successor states of the former Soviet Union are now threatened by such epidemics, while central and southeast Europe have so far been spared from large-scale outbreaks and seem at lower risk. The future course of the epidemic in the NIS will largely depend on trends in drug injecting and on the success of harm reduction programs. Furthermore, there is potential for the further spread of HIV, via heterosexual intercourse, into the general population.

This paper compares the experience of health and inequality reviewed in the Bulgarian, Hungarian, Polish and Soviet profiles. With health systems very similar in formal organization and stated aims, health status based on death rates has followed very similar tendencies in each country. Sharp post-war falls in infant death slowed down from the 60s onwards, but continued to fall. Life expectancy also increased but again from the late 60s began to fall, particularly for middle-aged men. Inequalities in health-care provision and access have been paralleled by inequalities in health outcome between areas and socio-economic groups. Comparative analysis, however, suggests that the dysfunctions of the health system have only been contributing factors to more fundamental causes stemming from socio-economic conditions, cultural and collective behaviour and the priorities of the political and economic system. Written before the transforming political events of late 1989, the reviews emphasise the need for change and a search for more effective and equitable systems and policies.

This paper introduces analyses of the state of health and of the health-care system in four Eastern European countries. The analyses focus on the issue of inequality in countries which share many characteristics including non-market economies, rapid urbanization and industrialization, and health systems which formally aim to provide equal access and treatment to all citizens. The measurement of social inequality in a non-market economy dominated by the state economy cannot be based on traditional class divisions; nor is income a good indicator of class position, salaries for professional and non-manual workers being lower than the average. Major relevant variables for which data are available are occupation, educational level and area of residence. Despite many system similarities the countries differ sharply in the level of resources devoted to health care and in health status based on mortality rates.

In his News Focus article 'Stress: The invisible hand in Eastern Europe's death rates' (9 June, p. 1732), Richard Stone highlights the potentially important role that psychosocial stress plays in [...]

The end of communism opened up a life of economic uncertainty in the Eastern Bloc. And that, say scientists, may be exerting a deadly effect on residents BUDAPEST--Soon after the [...]

The low human health status of several Eastern European countries place them at a disadvantage in their efforts to compete with the rest of Europe. Alcohol and tobacco abuse and obesity are the major factors causing deterioration of health in the former socialist countries. The disadvantage of these countries stems from decreased productivity and increased health care costs due to poor health of citizens.

Paris - Until recently, health officials in Russia performed up to 24 million HIV tests a year on pregnant women, hospital patients, soldiers, and just about anyone else they could [...]

Formerly eastern European nations had higher rates of mortality from suicide and tuberculosis in 1990 and 1995 and a greater increase in these rates over the 5-yr. period than western European nations.

In 1980, when WHO's European Member States adopted the Regional strategy for 'Health for All by the Year 2000'. they agreed that their first aim should be a higher level [...]

What is the best way of arriving at a compromise between equity and efficiency in health care? The countries of western Europe and Canada have reached this goal by principles [...]