Budapest, 20 May 1997 (RFE/RL) -- An epidemic is sweeping Central and Eastern Europe. Citizens of the former Communist countries -- especially middle-aged men -- are dying in staggering numbers from cardiovascular diseases, lung cancer and cirrhosis of the liver.
In most of these countries, life expectancy is dropping sharply because of the rise of diseases that are largely preventable and mostly self-induced.
A few figures illustrate the catastrophic situation in Central and Eastern Europe.
According to the World Bank and the World Health Organization, the prevalence of cancer in males is the highest ever recorded in the world. Every fifth male is considered an alcoholic and the rate of cirrhosis of the liver is a staggering 14 times that of Sweden, which also has a reputation for heavy drinking.
Lung cancer kills half of all Polish men who died before reaching 65.
Bulgaria and Romania
Life expectancy at birth has been steadily declining since 1989.
The trend began some years ago, but has become more pronounced in most of these countries since the collapse of Communism in 1989 and the transition to market economies. In fact, the marked decline in life expectancy, especially in countries like Hungary and Russia, caused the British magazine "The Economist" to ask in an article last year, "Is capitalism lethal?"
On the contrary, experts on health in the region say the epidemic of chronic diseases is a legacy of the Communist system, which made huge strides in controlling infectious diseases like tuberculosis, but failed to address at all the more modern causes of killer diseases -- individual lifestyles.
Guy Ellena, a senior health economist at the World Bank based in Budapest, explains the explosion of chronic disease in Central and Eastern Europe simply and succinctly. People in these countries, he says, "smoke a lot, drink a lot and have very unhealthy diet habits." Any one of these factors is a risk, but in combination they are deadly.
Dr. David Brandling-Bennett, deputy director of the UN's World Health Organization, says the former communist countries face a double burden of having to fight an explosion of disease with less money.
In these countries, he says, the public health establishment is still struggling to recover from the collapse of the command economy and the switch to free-market economies. The public health systems and the medical establishments can no longer count on government subsidies, and some countries -- like Bulgaria -- are facing gaps in basic medical services.
The roots of the problem lie in the approach of the Communist system to health care. As in many other fields, the Communists stressed quantity over quality. Emphasis was placed on providing ever more hospital beds and training ever more doctors. Little regard was paid to the overall state of health of the population that resulted from such mechanical measures of productivity.
Dr. Ivan Gyarfas, a Hungarian cardiologist co-ordinating cooperation between the Hungarian Ministry of Welfare and the World Bank, says this approach was successful in treating communicable diseases, especially tuberculosis. But he says the old system is largely ineffective in combatting modern diseases caused by unhealthy lifestyles.
The challenge now for the former Communist countries is to treat the huge numbers of sick people with funds that are no longer increasing, or in many cases, are actually decreasing.
Ellena at the World Bank puts it this way: "Most of the countries in Eastern and Central Europe have understood that they cannot afford any more the large health system that they've had."
"However," he continues, "So far, little has been done in most Eastern and Central European countries in effective restructuring of the system."
He says countries must now make a decisive switch to choose quality over quantity in the provision of health care. As Ellena says, it is possible to provide the same level of services -- and probably higher quality services -- with fewer hospital beds and even smaller investments of money.
What countries must also do is to move massively into disease prevention and health education -- banning cigarette smoking, getting people to exercise more, encouraging healthier diets -- with money saved by cutting hospital beds and laying off some doctors.
But it's a difficult program to sell to the public and especially to doctors who would lose their jobs.
"It's extremely difficult to explain why, when health status is declining, that we need less doctors, less hospital beds, though it's the truth," said Ellena.
Experts agree that the emphasis in the future must be on education and changing people's habits to prevent disease. Dr. Zoltan Szabolcs, one of Hungary's leading cardiologists, says that children should begin learning healthy habits in kindergarten.
But even if these steps are taken, Ellena warns pessimistically: "The reform of the health-care systems is an extremely long process."
(This is part one of a four-part series about health in Central and Eastern Europe. See Condition: Serious -- Health In The East