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Hungary/Poland: One Nation Suffers While Another Grows Healthier

Budapest, 20 May 1997 (RFE/RL) -- Like millions of his fellow Hungarians, Gyula Lorincz has a very unhealthy lifestyle. Now 39, he has smoked up to two packages of cigarettes a day since age 14. As for his diet, he sums it up this way: "I like meat with meat, usually pork."

Since the advent of the free-market system in Hungary after communism faded away in 1989, Lorincz has felt under extreme stress, never knowing whether he would be able to keep his job as a plumber or whether he would be out of work and unable to feed his family.

It's a potentially lethal combination of risk factors that add up to make Hungarians the unhealthiest people in Europe, and as for Gyula Lorincz, it's put him in the hospital with life-threatening ischemia. That's a constriction of the blood supply to the heart and it's the same complaint that put Russian President Boris Yeltsin out of commission for so many months last year.

Dr. Zoltan Szabolcs, one of Hungary's leading cardiologists, stands over Lorincz's bed in one of Budapest's best hospitals. The prognosis, he warns, is "very grave." He adds grimly: "If his veins close up any more, the result could be sudden death."

All over Hungary, a country of 10.6 million people, Hungarians, especially males, are smoking and drinking themselves to death. World bank figures show that the average life expectancy for Hungarian males between the ages of 35 and 69 is the lowest in Europe. Half the men in that age group are not expected to live to the age of 70.

While the situation is better for women, Hungarian doctors and public health officials warn that as more women take up smoking, their death rates from cancer are going to escalate tragically.

By any measure, Hungarians are in atrocious health. The prevalence of cardiovascular disease is higher than any other country except Russia, and is three times higher than in France. Hungary tops the world with prevalence of cancer, especially lung cancer. And the rate of cirrhosis of the liver is 14 times that of Sweden. Life expectancy of Hungarian babies at birth has fallen dramatically since 1970.

A recent report by the Hungarian government said that Hungarians' high mortality rate is more the result of unhealthy lifestyles and environmental factors than the quality of health care services.

Dr. Szabolcs, the cardiologist, pinpoints the factors behind his compatriots' catastrophic state of health: Hungarians smoke too much, drink too much, exercise too little and eat a very unhealthy diet.

Dr. Szabolcs admits that Hungarian food, while delicious, is dangerous for health. It's very high in meat and animal fats that clog the arteries and lead to cardiovascular diseases, and low in fruits and vegetables which many scientists now believe can protect against cancer. Hungarians on average consume an artery-clogging 24 kilograms of lard each year.

Another factor that is hard to measure is stress, which many experts believe has increased since the change of system in 1989, and which many doctors link to heart disease. Dr. Ivan Gyarfas, another cardiologist who is working with the World Bank in Hungary, says that "it's common sense that stress has something to do with this chronic disease."


But the experience of another post-communist Central European country -- Poland -- shows that the picture doesn't have to remain bleak, and that it may be possible to reverse this disastrous trend by simple changes in people's habits.

Poland entered the 1990s with a catastrophic health picture similar to the Hungarians' today. Dr. Witold Zatonski, a leading Polish public health advocate, says that in the early 1990s a 15-year-old boy in India had a better chance of living to age 60 than did a 15-year-old Polish boy.

But unexpectedly, after 1992 there has been an appreciable fall in Polish mortality rates that Zatonski and his fellow researchers trace almost exclusively to changes in the Polish diet and a levelling off of cigarette smoking.

"Poland seems to be a leader in public health changes in Eastern Europe," Zatonski told Radio Free Europe/Radio Liberty in an interview at his Warsaw office. "We have the first signs of an improvement in health."

Guy Ellena, a senior health economist with the World Bank specializing in Central and Eastern Europe, praises Poland's approach to public health as "courageous." He especially lauds Poland for adopting the region's first tough anti-smoking legislation.

And he, like Zatonski, points to the importance of the Polish government's use of economic policy to influence citizens' food choices. Subsidies for animal fats have been cut and taxes imposed, leading to price increases that encourage a shift to healthier vegetable fats. Poles complied by cutting their consumption of animal fat dramatically and increasing the use of margarine and vegetable oils in their diet.

At the same time, the opening up of the market made healthy exotic fruits like oranges, bananas, kiwis and grapefruits available year-round.

The resulting 15 to 20 percent decline in death from cardiovascular disease is of a magnitude unprecedented in peacetime, Zatonski says. The message is clear, he says: "For the first time in a very big population, we are showing that if you improve your diet with very simple improvements, you are able to cut cardiovascular diseases mortality nearly immediately -- not in dozens of years, but in one or two years."

Ellena at the world bank agrees that "Poland seems to be a champion in this area." Barbara Zolty, a public health expert at the World Health Organization in Geneva says the UN body is "very proud of Poland." She says that the WHO can use Poland's experience to encourage other countries in Central and Eastern Europe to adopt similar policies. As she puts it, "It's important to show that countries in this region can help each other."

Back in the cardiovascular ward in the Budapest hospital, young patient Gyula Lorincz says he's determined to follow the lead of the Poles and adopt a healthier lifestyle by giving up smoking and following a better diet, lower in fat and richer in fruits and vegetables. He explains: "I got a serious shock when I learned what the real nature of my illness is. I am absolutely determined to change."

(This is part two of a four-part series about health in Central and Eastern Europe. See Condition: Serious -- Health In The East)