1. Rural Health in Central and Eastern Europe: an Issue for Contemporary Science and Research I.Ciznar, T.Cook, R.Ungar, G.Gulis

2. Rural “there is no standard definition…. “ -imply rather than explicitly state different criteria different levels of analysis different methodologies

3. POPULATION SIZE -such as areas with “individuals living outside places of more than 1,000 people.” POPULATION DENSITY -such as the OECD definition of rural communities as those having less than 150 persons per square km. LEVEL OF URBANIZATION -such as not having an urban center with a population of more than 50,000 or being outside the commuting distance to an urban center. PRINCIPAL ECONOMIC ACTIVITY -implying an economy based on agriculture. Different Schemes and Thresholds for Defining RURAL

4. Each country: own definitions of urban and rural. - WHO

5. ”…though the characteristics of rural people are different for each definition, in general, each definition provides a similar analytic conclusion.” HIGHER MORTALITY RATES in rural areas, no matter how one chooses to define “rural.” -Du Plesis, et al

6. Life Expectancy at Birth WHO Report 2001

7. Mortality from Cardiovascular Diseases WHO Report 2001 Central/Eastern Europe Western Europe

8. WHO Report 2001 Central/Eastern Europe Western Europe Mortality from Cancer

9. RURAL in our study is defined on the basis of: level of urbanisation. principal economic activity. Nothern region is typical industrial, with high level of urbanisation (commuting zone) and higher population density. Southern region is typical agricultural, with people living in small villages close to working place.

10. Questionnaire Survey ‘94-’97 SK Statistical Office WHO 2002 Report Northern - Urban Southern - Rural

11. Mortality Rates in Two Districts* RURAL URBAN male female male female CVD 696 620 472 402 Cancer 266 259 185 162 *per 100.000

12. Drinking Water Local Wells (20%) - High Contamination (80%)

13. Usage of Local Well Water in Rural Areas Hygiene = 97% Cooking = 95% Drinking = 85% Irrigation = 57%

14. Waste Disposal/ Sewage Lack of Sewage Facilities - Animal Deposits Near Drinking Water Sources - Insect Breeding Sites

15. Waste Water Treatment/Sewage in Rural Areas 50% of the population is using municipal sewage and waste water treatment systems. 90% are located in urban areas. 70% of the local wells users in rural areas also use septic tanks. most septic tanks are emptied into a field, garden, pasture, etc.

16. Air Pollution Local Heating & Burning Household Waste

17. Chemical Exposures Agricultural Workers - Household Gardeners (50-75%)

18. Socio- economic Factors High Unemployment - Poor Diet - Stress - Unhealthy Lifestyles

19. Health Care Limited Health Care Services - Inadequate Preventive Services