Washington, 21 February 1997 (RFE/RL) - Stark contrasts in public health highlight this week's File On Health, as one report notes a continued decline in life expectancy in the former Soviet Union, while improved treatment methods in the U.S. are saving more lives than ever before.
WHO Reports Declining Life Expectancies in Former Soviet Union
The World Health Organization says life expectancy for both men and women has been decreasing steadily throughout the 1990s in the Baltic states and other states of the former Soviet Union.
The information is reported in the WHO's compendium of health statistics for 1996. The 900-page document, which contains statistics on most United Nations members, was published this week.
The data on the former Soviet Union and the Baltic countries comes as no surprise to public health officials in the region. However, the WHO says in its analysis that the statistics are significant because they reveal, for the first time, "differentials in health within the monolithic former Soviet Union that had not been documented earlier."
The report did not contain an analysis of statistics for the former communist countries of central and eastern Europe.
The WHO says that in most of the industrialized world, life expectancy was increasing throughout the 1980s and into the 1990s. Life expectancy is the number of years a person could be expected to live from birth.
Even in the former Soviet Union, the WHO says life expectancy was increasing until the beginning of the 1980s. However, the report says that:
"By 1991 in Lithuania, 1992 in Azerbaijan, Belarus, Estonia, Latvia and Ukraine, by 1993 in Kazakhstan and the Russian Federation, and by 1994 in Kyrgyzstan and the Republic of Moldova, life expectancy of the male population had fallen to a level below that in 1981."
The WHO report notes dryly that, "it appears that conditions of life are extraordinarily unfavourable to male survival, and have furthermore worsened in recent years."
The WHO says life expectancy for women has also fallen, although not as steeply. The report notes that this trend is true for all the former Soviet republics except Georgia and Tajikistan. However, the report says recent statistics for those countries are not available.
The report offers no explanations for the decline in life expectancy. However, a 1996 report by a group of World Bank experts on health care systems in the former communist countries put some of the blame on communist central planners of the 1980s. They failed to adapt medical systems to the rise in the number of people afflicted with heart and blood vessel diseases, lung cancer and cancers of the colon and stomach.
The WHO report this week said heart disease and diseases of the circulatory system are now the leading cause of death for both men and women in the Baltic states and all the former Soviet republics.
In nine countries: Belarus, Estonia, Georgia, Kazakhstan, Latvia, Lithuania, Moldova, Russia and Ukraine, cancer is the second leading cause of death for men, and external causes -- meaning such causes as accidents and suicides -- ranks third. However, in Armenia, Azerbaijan, Turkmenistan and Uzbekistan, respiratory ailments such as tuberculosis are the third leading cause of male deaths, and in Kyrgyzstan and Tajikistan, respiratory diseases are the second leading cause of death for men.
For women in Estonia, Latvia, Lithuania, Russia and Ukraine, cancers and external causes are the second and third leading causes of death after heart and circulatory diseases. In seven countries, Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Turkmenistan and Uzbekistan, cancer and respiratory diseases are the second and third leading causes of death for women. But in Kyrgyzstan and Tajikistan, respiratory diseases are the second leading cause of death for women, followed by cancer.
Doctors Surprised By Reasons For Heart Disease Decline
While heart disease is on the increase in the former Soviet Union -- and eastern and central Europe as well -- deaths from heart disease have fallen dramatically in the United States since 1980. American doctors are a little surprised about the reason.
A study reported in this week's Journal of the American Medical Association said that a combination of improved medical treatment and disease prevention saved 127,000 people from dying of heart disease in 1990.
The researchers who analyzed records from several sources said better medical treatment accounted for more than 40 percent of the drop in heart disease deaths. Treatment includes drugs and surgeries. What doctors call "management" of patients already diagnosed with heart disease explained about 30 percent of the decrease. Management means prescribing drugs to lower blood pressure or cholesterol.
Prevention of the disease accounted for a little less than one-fourth of the decline in heart disease deaths. Prevention includes removing the risks of getting heart disease by not smoking, eating a balanced diet and exercising. That is the surprising finding, since Americans are told daily that the best way to avoid dying from heart disease is to stop smoking, eat a proper diet and get enough physical activity to keep the heart muscle strong and the blood vessels clear.
The study has some important lessons. Even though heart disease deaths have been dropping for almost 30 years, heart disease still kills more than 400,000 American men and women every year, and it remains the nation's leading cause of death. Treatment is also expensive, costing the nation's health insurers and the U.S. Government about 80,000 million dollars a year. However, the study results show that medical treatment -- not prevention -- is still the best way to save lives.