Year 1989, the fall of communism, represents a dramatic watershed. Changes and reforms reflected also upon the quality of health care and the health of populations living on eastern side of the divide. Until then, Eastern Europe had free socialized medicine, albeit troubled by lack of up-to-date medications and absence of modern diagnostic equipment. Noting the admirable progress in health in some regions of the former Soviet empire during its transformation provides invaluable sociological lesson. Furthermore, focusing on health trends in two Central European countries, the Czech republic (CZ) and Slovakia (SK), brings about another quality to such evaluation. Dramatic improvement in the life expectancy (LE) is represented mainly in the decrease of cardiovascular mortality, more in the Czech Republic than in Slovakia. Favorable trend of male LE in the Czech Republic exceeded several established West European countries, while in Russia, Belarus and Ukraine the life expectancy actually deteriorated. When life expectancy in Slovakia is compared with the Czech Republic, its poorer outcome results from a higher cardiovascular mortality, as well as from liver, digestive and respiratory disorders. Root causes of this difference are possibly in a marked difference in funding of health care between SK and CZ, higher consumption of alcohol and cigarettes, as well as in a sizeable disadvantaged Roma minority in Slovakia.
Key words: life expectancy, change after 1989, cardiovascular mortality, Europe, Czech and Slovak republics, Roma minority
The end of communist totality resulted in unexpected changes in life expectancy at birth (LE) in Central and Eastern Europe ( 1 ) . The World Health Organization (WHO) considers these changing trends in European mortality to be one of the ten most remarkable health developments, next to improvement in AIDS, malaria and smoking. However, WHO Annual report for 2008 points out adverse trends in LE of East European males without specifying respective regions.
The aim of this review is to identify trends of male LE in various European countries, paying particular attention to Czech Republic (CZ) and Slovakia (SK). The progress of economy, science and of health care in Western Europe resulted in a steady increase of LE in Switzerland, Italy and Austria (Fig. 1). Very similar increase of male (and also of female) LE was observed in all countries of European Union (EU). On the other side, in communist countries there was evident stagnation of LE between the years 1 970-1990. Data in Fig. 1 for Hungary, Poland and the Czech Republic are similar in all Eastern Europe countries with exception of Soviet Union. Eastern Europe had free socialized medicine which was troubled by lack of up-to-date medications and absence of modern diagnostic equipment. After the fall of iron curtain the situation has changed and LE begin to rise (arrow in Fig. 1). Health trends associated with the transformation of the society to the free market system may certainly be of interest also to the non-Central European countries. Data for this review were obtained from WHO reports (2, 3), from SK and CZ epidemiological studies (4, 5, 6) and from the world-wide databases accessible on the internet (7, 8).
TRENDS OF LIFE EXPECTANCY AFTER THE FALL OF IRON CURTAIN
Table 1 illustrates the changes of male LE in 1990-2005. These data sources are considered reliable. Surprisingly, CZ achieved the highest increase in LE in the whole Europe. Next to CZ, the improvement in LE was reported from Ireland, a country that was transformed from economic inferiority thanks to inclusion into the European Union. In CZ and Ireland the LE increased in that period by more than five years. In this comparable fifteen years period the LE in countries having a well established economy and traditional health system increased by four years. The increase in LE in SK, Hungary and in the two economically successful Baltic republics was 2 to 2. …