EDITOR—With regard to the health problems highlighted by McKee and Fister,1 socioeconomic differences and changes are relevant contributors for health policy makers in Lithuania. Lithuania is characterised not only by a high level of social inequality but also by low social care expenditure. Social care expenditure comprises 25-35% of gross national product in European Union countries, whereas it accounts for only about 15% in Lithuania. The income inequality indicator (Gini coefficient) was 35.4% in 2002.2 Social inequality has been strongly influenced by the fact that even 17% of the working population is engaged in agriculture and nearly one third of the rural population lives in rural districts.

According to our data analysis, the prevalence of self reported health problems is 72.2% in the rural population and 60.3% in the urban population. A higher prevalence of self reported health problems (69.7%) was estimated in women than in men (57.6%). The prevalence of health problems was dependent on social structure: it was higher in women than in men and in the rural population than in the urban population. For the low income rate, the prevalence of health problems was 3.9 times higher in the rural population and 2.4 times higher in the urban population. The prevalence of health problems at low and high income levels was 3.2 times higher in women and 2.3 times higher in men.

Health inequalities between urban and rural populations are predetermined by a different income level related to investments, market opportunities, and social care possibilities.

Differentiation and essential differences in socioeconomic changes between urban and rural populations have the pivotal role in health inequalities in post-communist Lithuania.