Epidemiological analysis of health situation development in Europe and its causes until 1990

Department of Cancer Epidemiology and Prevention, the Maria Skłodowska-Curie Cancer Centre and Institute of Oncology, Warsaw, Poland; European Health Inequalities Observatory, Institute of Rural Health, Lublin, Poland
the HEM project team
Ann Agric Environ Med 2011;18(2):194–202
The enormous health gap between the ‘new’ (eastern) and ‘old’ (western) parts of the EU has evolved over many decades. The epidemiological transition – that is the decrease in the relative importance of infant and early child mortality and the shift in the composition of mortality risks from communicable to non-communicable diseases – which started in the western part of the region at the beginning of the 20 th century, was substantially delayed in most of eastern Europe. However, after the World War II, health improvement in the east initially out-paced the west, such that, by the mid-1960s, only 1-2 years separated the average life expectancy for both sexes between the east and west. This convergence was short-lived and it reversed dramatically between the mid 1960s and 1990. During this period, adult health status in the east stagnated or deteriorated, whereas in the west it improved steadily: by 1990, life expectancy at the age of 20 years was more than five years shorter in the east for men, and more than four years shorter for women. The biggest contributors to the health gap were cardiovascular diseases and injuries. A substantial fraction of the gap can, with confidence, be attributed to the higher volume and more irregular pattern of alcohol consumption in the east, and to the delayed onset of the tobacco smoking epidemics. Much of the remainder of the gap is likely to be attributable to the composition of the diet, but the contribution of different dietary factors cannot be estimated with confidence. Leading candidates are a high consumption of saturated animal fats, a low consumption of fresh fruit and vegetables (especially in winter and spring), a very low consumption of fats supplying omega 3 fatty acids – both vegetable oils and fish oils rich in alpha-linolenic acid – and a high consumption of salt.