Intended for healthcare professionals

Education And Debate

International comparators and poverty and health in Europe

BMJ 2000; 321 doi: (Published 04 November 2000) Cite this as: BMJ 2000;321:1124
  1. Michael Marmot, professor of epidemiology and public health (,
  2. Martin Bobak, senior lecturer
  1. International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  1. Correspondence to: M Marmot

    Based on a presentation from the Millennium Festival of Medicine

    Social inequalities in health continue to be a major problem in Britain, as in other countries. Much of the focus has been on health differences among social groups within countries,1 and rightly so, as the research evidence suggests that governments can do much to reduce these inequalities.2 Another sort of health inequality, however, also demands attention: inequalities among countries. Concern is expressed, appropriately, about inequalities in health between rich developed countries and poor developing countries. Less attention has been focused on the gap in life expectancy between the countries of eastern and western Europe; by eastern Europe, we mean the former communist countries of central and eastern Europe, including the countries of the former Soviet Union.

    We are conducting a programme of research that addresses two types of question: the reasons for health inequalities between the countries of eastern and western Europe and the reasons for inequalities between social groups within these countries.3 Our starting assumption is that the causes of these two types of inequality may be similar. We contend that expanding research on the social determinants of health beyond one social context helps to understand causal relations. Eastern Europe has experienced much greater social change than western Europe. Such change was occurring in the two decades before the political, economic, and social changes that happened after 1989. Studying the health of societies in transition is a fruitful way to observe how changes in society translate into changes in health and provides an opportunity for understanding. Observing inequalities in health in countries with different forms of social organisation presents the opportunity to understand better why health follows a social gradient. This paper explores both these issues.

    Summary points

    • In 1970 male life expectancy at age 15 was 56 …

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