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Education And Debate

Understanding the toll of premature death among men in eastern Europe

BMJ 2001; 323 doi: (Published 03 November 2001) Cite this as: BMJ 2001;323:1051
  1. Martin McKee, professor of European public health (,
  2. Vladimir Shkolnikov, head of the laboratory of demographic datab
  1. a European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. b Max Planck Institute for Demographic Research, Doberaner Str 114, 18057 Rostock, Germany
  1. Correspondence to: M McKee

    The policies pursued by the Soviet Union and its satellites in central and eastern Europe have had profound implications for health. 1 2 By 1990 the probability of people dying before the age of 65 in the Soviet Union was twice that for western Europe, and for the communist countries of central and eastern Europe it was 70% higher compared with western Europe.3

    Men were especially susceptible to dying prematurely. Although men in all industrialised countries live shorter lives than women, in the Soviet Union the gap between the sexes was especially large. In 1990 the life expectancy of men living in the Soviet Union was only 64 years—nine years less than in western Europe. Soviet women could expect to live to 74 years—10 years longer than men and only six years less than women in western Europe. The disadvantage in life expectancy relative to western Europe was less for countries of central and eastern Europe, but even there the gap was six years for men and five years for women. The travel writer Colin Thubron, after meeting an old woman in a village in western Siberia, observed for himself the reality that “in her experience, men died young.”4

    Summary points

    Young men were especially vulnerable to the consequences of the policies pursued by the communist regimes in eastern Europe before 1990

    The leading causes of the high mortality were injuries and violence and cardiovascular diseases

    High levels of alcohol consumption, especially binge drinking, were an important underlying factor, but smoking and poor nutrition also played a part

    Men who have experienced a rapid economic transition, who have least educational resources and least social support have been affected the most

    The pattern of premature mortality seen among men in eastern Europe is not unique and there are many parallels among …

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