East-West mortality gap
Péter Józan, M.D., Ph.D.
Executive summary
The East-West mortality gap has gradually developed
over the last 25 or or 30 years. It has been, deepened (but not
brought about) by the political and socio-economic transition since
1990. As a result of the divergent time trends in mortality, the
difference in terms of life expectancy was 5.3 years between the
established market economies - EME' and formerly Socialist
economies - FSE in 1980. In the next one and a half decade or so
the difference grew further and by the mid-1990s the EME had a
life expectancy eight years higher than the FSE.
In the mid-1990s the number of deaths was about 12 million in
the member states of the Economic Commission for Europe (ECE),
nearly seven million occurred in the EME and five million in the
FSE. The differences in the current level of mortality are
remarkably large: crude death rates vary between 4.7 per thousand
population in Albania and 14.9 in the Russian Federation iper
thousand population in 1996 and 1995, respectively. The highest
life expectancy was 79.1 years in Sweden in 1995, while the
lowest value, 64.0 years, was found in Turkmenistan in 1994. Out
of a total of 51 nations, the 23 top places are held by EME
countries, with the FSE occupying the 24th to 51st places – withTurkey as the sole exception in the 42nd place. The Elbe river divides Europe into high and low life
expectancy regions.
By the mid- 1990s the EME had reached a life expectancy of
76.1 years. In the early 1990s, for the
first time, the Mediterranean countries taken together enjoyed
the highest life expectancy.
Life expectancy in the EME has increased by 2.1 years on
average over the last one and –a half decades; this gain is
fairly impressive considering that the baseline value in 1980 was
already high and that, to a certain extent, it it has been
achieved as a result inof improving old age survival
probabilities of surviving in old age. Life expectancy decreased
from 68.8 years to 68.2 years between 1980 and 1995 in the FSE.
Between 1980 and 1990 life expectancy grewrose in every group
of the FSE, and since 1990 it has decreased in all groups of
countries except the CCEE. Since 1990 by far the largest decrease
in life expectancy occurred in the RF: 3.4 years, but the decline
of 2.7 years in the CAR and 2.6 years in the NIS-6 are also
unprecedented in peacetime during the 20th century. In
the Czech Republic, Hungary and Poland life expectancy has
increased since 1990, and in all the three countries it is now at
a higher level than they have ever been, although they are still
low in comparison comparison with the developed world. In most
countries of the former Soviet Union the health crisis measured
by life expectancy peaked in 1993 and 1994, when it began to
diminish everywhere except in Belarus, Ukraine and the CAR.
Sex mortality differentials in the EME as expressed by
life expectancy were in the six-to-seven year range between 1980
and 1995, with a decreasing trend throughout. In Israel women had
an advantage over men of only four years, whereas in France it
was eight and a half years. In the FSE female life expectancy was
nine years longerhigher than malefor men in 1980, a difference
rising to ten years by 1995.
In Iceland male life expectancy reached 77.2 years by 1994, in
Sweden it was 76.5 years in 1996. On the other hand male life
expectancy was 72.5 years in the United States and 72.8 years in
Denmark in the mid-1990s. Female life expectancy is on average
over eighty years on the average in the European EME; it is
82.3 years in France and 82.1 years in Switzerland according to
the latest available data. Women in the United States live
slightly shorter: they had a life expectancy of 78.9 years in
1995.
After Gorbachev's measures against alcohol in the RF were
revoked male life expectancy decreased by more than seven
years within a period of eight years, reaching the rock-abottomn
all-time low of 57.6 years in 1994. However it is a hopeful
sign that male life expectancy increased by two years in
1995-1996. As a consequence of the decline in male life
expectancy all the countries of the former Soviet Union,
except the three BS, had a life expectancy of shorter thanunder
sixty-four64 years for men in the mid-1990s. Women in the FSE
have experienced a much lesser decline in life expectancy than
men in the period of political and socio-economic transition.
Around 1995 they had a life expectancy of close to 73.5 years
years on the average.
At present in the West there is a 99 per cent or morehigher
probability that a new-born babies will reach theirhis/ her 15th birthday.. About 83 per cent of them will live to see their
6 Likwise, about 83 per cent of the population he/she will
celebrate their 65th birthday, after this, they stand
a 41 per cent probability that they will live to see their 85th birthday, and 41 per cent their 85th .birthday. East
of the river Elbe river the probability for new-born babies to
reach their 15th birthday was about 97 per cent; and
only 64 per cent of them will live to see their 65th birthday is only 64 per cent. In the FSE a 65 year old man or
woman has about a 24 per cent probability to be alive at his or
his/her 85th birthday. The crux of the East-West
life expectancy gap is the steep rise in the probability of dying
between age 35 and 65 in the FSE, when at the same time it fell
substantially in the EME. The rise in middle-age adult
mortality is a consequence of the increase of cause-specific
death rates due to certain chronic diseases, accidents and
violence. Life style-related risk factors which are largely
responsible for these diseases become rooted in adolescence and
young adulthood, death attributable to them are most likely to
occur in middle age; the best example for this is smoking. Accidents
and violence, frequently related to alcoholism, have their
victims in epidemic proportions among young and middle-aged
adults. These are much more conmmon in the male than in the
female population.
Infant mortality dropped from 12.4 to 6.5 per thousand in the
EME and from 26.8 to 17.8 per thousand in the FSE between 1980
and 1995. In the mid-1990s infant mortality was over 20 per 1,000
in the Central Asian Republics, Albania, Romania and Turkey, but
about 10 per 1,000 in the CCEE.
In the member states of the ECE about 150 million people, or
12.5 per cent of the population, is 65 or older and the
oldest-old (80 years and over) account for 2.8 per cent. By 2020,
according to UN estimates, the elderly will be make up 16.4 per
cent, and the over-80s 3.8 per cent, of the population. There are
ageing populations like Sweden where the percentage of older
persons is 17.3 and "young" populations like Tajikistan
where people aged 65 years and older make up only 4.3 per cent of
the total. The increase in life expectancy in old age is a
relatively recent phenomenon. In almost every EME life
expectancy at age 65 standingood at more than seventeen17 years
in the mid-1990s; in Iceland, Spain, Sweden and Switzerland it is
more than 18 years and in France it is 19.3 years. In the FSE
around 1995 life expectancy at age 65 stoodvaried between 13.6
and 14.9 years; in Slovenia it was 16.3 years, but only 12.2
years in Turkmenistan.
In the developed world the level of mortality is determined by cardiovascular diseases (CVD), malignant neoplasms (MN),
accidents and violence. Other lethal diseases are of course
also involved, of whichat present AIDS is at present the
most striking example, but their relative weight in mortality is
insignificant. Diseases of the circulatory system, malignancies
and external causes of injury and poisoning are responsible for
about 78 per cent of all deaths.
Around 1995 the age- standardized death rate due to diseases
of the circulatory system was 297 per 100 000 population in
the EME as a result of a steady decline in mortality over the
last three decades or so, and it was responsible for about 38 per
cent of all deaths. In the FSE between 1980 and 1990 CVD
mortality fell off slightly, then subsequently increased
significantly and reached a very high level by the mid-199O0s: it
was 709 per 100 000 population on the average; nearly every
second death occurred due to diseases of the circulatory system.
Cancer is responsible for about one quarter of all
deaths in the EME, but for only aboutsome 13 per cent in the FSE;
the age -standardized death rates were 195 in the former and 184
per 1 00 000 population in the latter group of countries. The
most that may be said forof the result of efforts at prevention
and cure is that mortality due to cancer is not increasing
further in the EME despite the ageing of society, even though
cancer is mainly a disease of old age. It is on the rise in the
FSE. The highest mortality is due to lung cancer in the
male population and breast cancer in the female
population. About 80-85 per cent of lung cancers are caused by tobacco
smoking.
There is no other main group of diseases where the relative
difference in cause-specific mortality between the EME and the
FSE has been as large between the EME and the FSE as in accident-
and violence- related mortality. In the mid-1990s accident-
and violence-specific death rates were nearly three times as high
in the FSE as in the EME. In fact the extraordinary difference in
accident- and violence-related death rates between the EME and
the FSE is due to the dramatically higher rates in the
post-Soviet states. The ratio of external cause-specific
death rate of the RF to that of the EME was 4.4 in the mid-1990s.
Around 1995 the age -standardized death rate attributable to
accident and violence was 211 per 100 000 population in the RF
and 48 in the EME.