2. The Health Transformation in Eastern Europe after 1990: Second Look Witold Zatoński Prabhat Jha

3. w Good health of children w Health catastrophe in the adult population At the end of the 80’s, the health picture in Eastern Europe was fairly homogeneous.

4. PROBABILITY (IN %) OF DEATH IN COUNTRIES OF CENTRAL AND EASTERN EUROPE MALES, AGE 0-14FEMALES, AGE 0-14 0.98 - UK 19940.75 - UK 1994 24.3% - Sub-Saharan Africa 1990 21.7% - Sub-Saharan Africa 1990

5. Mortality trends from all causes at age 1-19, Poland and USA 1959-1996 males females

6. World Bank Expertise of 1996 “Infant mortality rates in former socialist countries are lower than would be predicted...This favorable health outcome is largely attributable to superior achievements in... school enrollment among females...immunization... and sanitation.”

7. Health catastrophe in the adult population

8. Mortality trends from all cancers, selected countries 1959-1996 Males, age 45-64Females, age 45-64

9. Mortality trends from lung cancer, selected countries 1959-1996 Males, age 20-44Females, age 20-44

10. Mortality trends from cirrhosis, selected countries 1959-1996 Males, age 20-44Females, age 20-44

11. Sudden deaths from external causes, selected countries 1959-1996 Males, age 45-64Females, age 45-64

12. Mortality trends from cardiovascular diseases, selected countries 1959-1996 Males, age 45-64 Females, age 45-64

13. Mortality trends from all causes at age 45-64, Poland 1950-1991

14. PROBABILITY OF DYING BY REGION, 1990 (data adapted from Murray and Lopez, 1994) EME - Established Market Economies FSE - Formerly Socialist Economies CHN - China LAC - Latin America and the Caribbean OAI - Other Asia and Islands MEC - Middle Eastern Crescent IND - India SSA - Sub-Saharan Africa Males, age 15-59

15. Probability of death (in %) in countries of Central and Eastern Europe, males at age 15-59 11.7 - UK 1994 38.0 - Sub-Saharan Africa 1990

16. w Health in the transformation period: Dramatic changes w Fluctuations in health indicators w Short-term dramatic increase in mortality among adults w Unexpected, rapid decline in cardiovascular diseases in some countries

17. Changes in the health situation: Phase 1. Dramatic worsening of health indicators Phase 2. Changes in the health situation: Phase 1. Dramatic worsening of health indicators Phase 2. Unexpected, rapid improvement in health indicators.

18. Phase 1. Dramatic worsening of health indicators

19. w Short period (1-3 years) w Many countries: former GDR, Poland, Czech, Slovakia, but especially former USSR. Not in Hungary. w Mainly young and middle-aged adults w Dramatic rise in alcohol-related illnesses and deaths?

20. Case: Russia wDramatic fluctuations: 1992-94 wMainly young and middle-aged wAccidents wCirrhosis wCVD wNot cancer wAlso infectious diseases, tuberculosis, and infant mortality

21. Changes in standardized mortality rates from selected causes (expressed as a percentage, 1991=100%), Russia 1982-1994 Males, age 45-64Females, age 45-64

22. Mortality rates from parasitic and infectious diseases, Russia 1980-1996

23. Infant mortality trends, Russia 1982-1995

24. Phase 2. Phase 2. Unexpected, rapid improvement in health indicators.

25. Case: Poland w Unexpected improvement in health indicators after 1991, adults and children w All adult, both sexes, but stronger in men w All age groups, including over 65 wGreatest decline: CVD wSome decline in sudden deaths wRise in cancer rates stopped w Dramatic decline in infant mortality w Liver cirrhosis increased among young adult men and women

26. Decrease in number of deaths from all causes, Poland 1992-1999, (compared to 1991)

27. Changes in standardized mortality rates from cardiovascular diseases, Poland 1990-1996 (expressed as a percentage, 1991=100%), age 20-44 age 45-64age 65 and over malesfemales

28. Sudden deaths from external causes at age 45-64, Poland 1991-1996 (change in 1996 compared to 1991) 12.6% 13.4%

29. Mortality trends from all cancers at age 45-64, Poland 1991-1996 (change in 1996 compared to 1991) 6.2% 2.8%

30. Mortality trends from lung cancer, Poland 1963-1996 Age 20-44Age 45-64

31. Mortality trends from lung cancer, Poland and Hungary 1959-1996 Males, age 20-44Females, age 20-44

32. Mortality rates from cirrhosis at age 20-44 Poland 1959-1996

33. Mortality trends from selected causes Poland 1963-1996 Males, age 20-44Females, age 20-44

34. Infant mortality trends, Poland 1986-1999

35. Low birth weight (in %), Poland 1994-1998 weight < 2500g Early neonatal mortality (per 1000 live births), Poland 1994-1998 weight 500-999g Source: Katarzyna Szamotulska, National Research Institute for Mother and Child

36. Life expectancy has risen by 2.8 years for men and 2 years for women over the last decade.

37. Average expectancy of life, Poland 1991 and 1998 2.8 years 2 years

38. Countries where similar improvement has been seen:  Former GDR  Czech, Slovakia, Slovenia  After 1993, Hungary  After 1994, Russia

39. Average expectancy of life, selected countries 1989-1995 MalesFemales

40. Why ?

41. Production of cigarettes, Poland 1923-1998

42. THE POLISH CIGARETTE MARKET IN BILIONS OF CIGARETTES Sources: Euromonitor (1990), Philip Morris, GN

43. Polyunsaturated / saturated fatty acids ratio in Poland and Great Britain, 1950-1996 Poland GB

44. Risk of cardiovascular and heart diseases according to polyunsaturated / saturated fatty acids ratio (in NHS*) Poland 1990 Poland 1992 Poland 1994 Poland 1996 1 Predicted RR for Poland * W.Willett at al., Nurses Health Study - Personal Comunication 0.8

45. Smoking frequency by age groups, males, Poland 1975

46. Smoking frequency by age groups, males, Poland 1975, 1985

47. Smoking frequency by age groups, males, Poland 1975, 1985, 1999

48. Smoking frequency by age groups, females, Poland 1975

49. Smoking frequency by age groups, females, Poland 1975, 1985

50. Smoking frequency by age groups, females, Poland 1975, 1985, 1999