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Education And Debate

East-West mortality divide and its potential explanations: proposed research agenda

BMJ 1996; 312 doi: (Published 17 February 1996) Cite this as: BMJ 1996;312:421
  1. Martin Bobak, research fellowa,
  2. Michael Marmot, professor of epidemiology and public healtha
  1. a Department of Epidemiology and Public Health and International Centre for Health and Society, University College London Medical School, London WC1E 6BT
  1. Correspondence to: Dr Bobak.
  • Accepted 17 November 1995

There is a sharp divide in mortality between eastern and western Europe, which has largely developed over the past three decades and is caused mainly by chronic diseases in adulthood. The difference in life expectancy at birth between the best and worst European countries in this respect is more than 10 years for both sexes. The reasons for these differences in mortality are not clear and data currently available permit only speculation. The contributions of medical care and pollution are likely to be modest; health behaviour, diet, and alcohol consumption seem to be more important; smoking seems to have the largest impact. There is also evidence that psychosocial factors are less favourable in eastern Europe. Available data show socioeconomic gradients in all cause mortality within eastern European countries similar to those in the West. Determinants of the mortality gap between eastern and western Europe are probably related to the contrast in their social environments and may be similar to those underlying the social gradients in mortality within countries.

East-West mortality divide

There is a sharp divide in mortality between western Europe and the former socialist countries of central and eastern Europe. The difference in life expectancy between countries with the lowest and highest life expectancies at birth is more than 10 years in both men and women (figs 1 and 2). The gap in mortality has largely developed in the past two or three decades.1 2 3 4 In all western European countries life expectancy increased substantially between 1970 and 1991 (by three to four years on average). By contrast, the increase in central and eastern Europe was at best negligible, and in Hungary, Poland, and Bulgaria there was a decline in male life expectancy at age 15 (figs 3 and 4). No central or eastern European country recorded an increase in …

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