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East: WHO Report Says Decline In Health Due To Rampant Poverty In Former Soviet Bloc

The World Health Organization, or WHO, is warning that poverty in the countries of the former communist bloc has reached alarming levels. In a report published this week, the WHO's Regional Office for Europe says that over the past decade, the number of people living on less than $4 a day has risen from some 3 percent to more than 45 percent. The report makes a direct connection between the drop in income and the decline in life expectancy in the region.

Prague, 20 September 2002 (RFE/RL) -- A report released on 17 September by the World Health Organization, or WHO, says rampant poverty in many former communist countries is the main cause for the worsening of health and the drop in life expectancy over the past decade.

The European Health Report 2002 was presented in Copenhagen during the 52nd session of the WHO's Regional Committee for Europe.

Anca Dumitrescu, director of communication at the WHO's European office, told RFE/RL that the area covered by the report is the WHO's largest. "We cover in the European region 51 member states, and it is the largest region in [the] WHO. What we call the European region stretches from Iceland to Vladivostok [in Russia's Far East]. So you can see that this is a very large geographical area, with a very large population [of some 870 million], and very different in terms of socioeconomic development and also of health problems that these countries are facing," Dumitrescu said.

The report concludes that while the overall level of health in the region remains one of the highest in the world, substantial differences persist throughout its areas. The document says that over the past 10 years, the health gap between the eastern and western parts of Europe has widened, with a significant worsening of the situation in the east.

It says a clear relationship exists between life expectancy and the gross domestic product, or GDP, per capita. Although life expectancy has risen in Europe as a whole, it has fallen in most of the former communist countries, especially in the former Soviet Union, where people die an average of 10 years earlier than those in much richer Western Europe.

The document points out that the decline in life expectancy in Russia and other former Soviet republics has reached a magnitude without precedent in peacetime. Dumitrescu told RFE/RL the drop was most severe in the five years after the fall of communism. "On average, the life expectancy in the newly independent states [of the former Soviet Union] dropped by almost four years, from 69.6 in 1989 to 65.7 in 1994," Dumitrescu said.

Dumitrescu said a decline of one year, on average, was also observed in some Central and Eastern European countries, particularly Bulgaria, Hungary, and Romania.

The report says growing discrepancies in income between the east and west of the continent are the main cause for the health deterioration. While Europe's richest country, Luxembourg, has an annual GDP per capita of more than $45,000, Moldova, the poorest, has a GDP per capita of only $2,037.

In 1998, throughout the region, some 24 million people, or 3 percent of the total, were living in absolute poverty, or on less than $2.15 per day.

According to the report, the number of people who now live below the poverty line of $4 per day in the ex-communist states has risen from just over 3 percent in 1988 to 46 percent, or almost 170 million people.

Dumitrescu said the starting figure of 3 percent may be inaccurate, given the artificial currency-exchange rates during communism and the notoriously falsified statistics. But she told RFE/RL that current calculations, which are much more accurate, show an unquestionable increase in poverty in the former communist countries. "We have to keep in mind the changes in official exchange rates of the national currencies with the U.S. dollar before 1990, which were artificially kept at a certain level, and the current exchange rate. So, indeed, it is difficult to compare. What we are using now for comparisons between countries is the so-called income poverty, expressed in purchasing-power parity. The calculation of the $4 is, in fact, adjusted to the prices in the respective country," Dumitrescu said.

Galloping poverty in the former communist bloc was mainly caused by a prolonged, and sometimes botched, economic and political transition, which resulted in a crumbling social infrastructure and soaring unemployment. The latter is, according to the document, a main cause of both poverty and ill health across the continent.

Substantial differences in annual GDP per capita persist even between former communist countries, with Slovenia and the Czech Republic topping the chart at $16,000 and $14,000, respectively. Besides Moldova, the poorest European countries are Armenia, with $2,200 per capita GDP, and Georgia, at $2,400.

Russia posts a relatively high GDP per capita of almost $7,500, but discrepancies between the poor and the rich in Russia are also among the highest. The report says this is reflected in a gap of as much as 15 years in the life expectancies between the highest and lowest income groups.

Poverty is endemic in the former Soviet republics of Central Asia. The poorest, Tajikistan, has an annual per capita GDP of just over $1,000, while Uzbekistan and Kyrgyzstan have some $2,200 and $2,400, respectively.

The report cites growing urban poverty as a major challenge, since the urban poor are more exposed to disease because of their housing conditions, lack of sanitation, and unbalanced diets. It also singles out homelessness as a serious problem for many cities, with what it calls "alarming consequences" in terms of mortality and alcohol and drug dependence.

More affluent Western Europe has also experienced economic recession and growing unemployment for part of the past decade, while uneven wealth distribution within its countries persisted or even increased.

The report estimates that in Western Europe, too, some 37 million people, or 10 percent of the population, live under the relative poverty line of 60 percent of median income. However, overall living standards and life expectancy in the west of the continent continues to grow. Italy and France are in the lead, with an average life expectancy of 79 and 78.9, respectively.

The reports says that poverty, whether defined by income or education, is the main factor that facilitates the spread of infectious diseases such as tuberculosis or HIV/AIDS, which have seen a dramatic rise, chiefly in the former Soviet Union. Out of 1.5 million people with HIV/AIDS in the entire region, some 1 million are in the Central Asian republics. In the Russian Federation, the number of HIV/AIDS cases has doubled every year since 1995, and the report warns there is potential for major outbreaks.

Noncommunicable diseases remain the main cause of illness in Europe, with cardiovascular diseases, cancer, and neuro-psychiatric disorders, including those due to alcohol use and depression, in the lead.

However, the reports says that while in Western Europe mortality from cardiovascular diseases has dropped to half the 1970 levels, in the former Soviet Union, the level has risen dramatically, and long-term trends are still going upward. The huge increase in tobacco and alcohol consumption in the former Soviet Union is seen as the main causes for the growth.

The report concludes that the growing health gap between rich and poor countries in the region highlights the need for universal access to effective individual health services. Furthermore, Dumitrescu of the WHO's European office says that the report's findings will help governments employ financial resources more usefully. "We should still concentrate our resources on tackling the important diseases, [both] communicable and noncommunicable diseases, and also on the health determinants, like, for example, the relation between socioeconomic factors and health, unhealthy behaviors, psycho-social stress and also health systems and services and the reform of these systems," Dumitrescu said.

She also said the document urges governments to invest more in health care, since health is an issue that "affects the whole society."