Congress report - European Health Forum Gastein

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European Health Forum Gastein 2001
of the EU and pre-accession countries compared to the countries most recently joining the EU
in 1995 also has implications for health systems in both the EU and the pre-accession
countries.
While the candidate countries each differ with respect to health and health care systems,
taken overall the health status of the candidate countries’ population differs negatively on
most key indicators in comparison with that of the EU average. Today, a man living in central
and eastern Europe (CEE) is twice as likely to die before reaching 65 than is a man in the
European Union. Similarly, a woman living in C&E Europe is 70% more likely to die before
reaching 65 than is a woman in the EU.
What are the components of such differences in health? Three leading factors form the basis
for this pattern: heart disease, cancer and injuries. For both heart disease and injuries, the
age-specific death rate in CEE is about double that of the EU. Cancer mortality is about a
quarter higher than the EU rate. Differences between the east and west of Europe were
apparent in the 1980s. However, progress between east and west has been markedly
different since 1990 and provides important clues as to why such a large health gap should
exist. In 1980 the EU average, age-standardised, death rate for ischaemic heart disease was
around 80 per 100,000 males under 65 years. In Romania it was around 55. However, while
the countries of the EU showed steady progress dropping this to below 50 by 1997, in
Romania a reverse of this trend was found and in 1997 there were over 80 deaths per
100,000. A similar trend is found in some other CEE. Causes of death that are more common
in eastern Europe, such as heart disease, stomach cancer and childhood injuries, are also
more common among the poor in the west.
The ‘usual suspects’, diet and smoking, are two of the key causes explaining the differences
between east and west. Alcohol, an ‘unusual suspect’, is also, however, a major factor. High
levels of cirrhosis are found in southern countries (Hungary, Slovenia and Romania) and the
health effects of binge drinking have been shown to be especially serious. Although
governments have undertaken a range of measures to respond to the challenges, the efforts
of implementing health care reform in many countries have preoccupied many
administrations and some countries have failed to develop broad health policies to address
these and other underlying health causes. Some health improvements can be attributed to
government actions, while others are the by-products of improvements such as diet (due to
improvements in retailing) and the emergence of civil society organisations and self-help
groups. In terms of healthcare, some countries have made substantial improvements in
outcomes for cancer survival, low birth-weight baby care and control of hypertension.
However, at the same time, there are growing inequalities in health in the region.
Some of the concerns in terms of health related to enlargement include: the increased
movement of people and related implications for communicable disease control, health care
provision, drug trafficking and increased tobacco smuggling. Other issues that need further
review include the movement of health professionals and enlargement (are there risks of
‘brain-drain’?, is there a need to strengthen regulation of health professionals?), patient
movement and the regulation and manufacture of pharmaceuticals. The European
Observatory has begun a study to look at some of these issues. The study, ‘Health and
Accession: Managing the Transition’, will aim to develop generalisable policy lessons using
surveys, case-studies and literature reviews. Anybody wishing to know more about the study
or with suggestions for contributions should contact Laura MacLehose at the European
Observatory on Health Care Systems at the London School of Hygiene and Tropical Medicine
on: laura.maclehose@lshtm.ac.uk
3. Quality policy in the health care systems of the EU accession countries. Dr Ursula
Fronaschutz, Head of Department VII/B/8, Health Economics and Quality Management,
International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein
Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org