Health changes in the last 15 years in Eastern Europe EE

1
Health changes in the last 15 years in Eastern
Europe (EE)

• Prof. Witold Zatonski
• Maria Sklodowska-Curie Memorial Cancer Center and
  Institute
• POLAND

2
Percentage of death before 40., 70. i 100. year
What is possible?
Great Britain
1880
1990
lt 40
50
3
75
25
lt 70
lt 100
100
100
3
Factors influencing human health

• 5-10 genetic factors
• 5-10 environmental factors
• 20-25 social environmental factors
• 10-20 curative medicine
• 40-60 lifestyle

4
The health catastrophy of the adult
population.It is one of the most important
challenges to progress, including economic
development, in the new democracies of Central
and Eastern Europe
5
Total mortality trends at age 0-14,Poland and
USA 1959-1999
Total mortality trends at age 15-59,Poland and
UK 1965-1991
males
males
6
Infant mortality trends, Poland and Germany
1927-2001
7
Mortality trends from all causes at age
0-14,Poland and USA 1959-1999
melas
females
8
Maternal mortality in Poland in 1951-1999 and
Sweden 1961-1995
9
Mortality trends from infectious and parasitical
diseases, Poland and Sweden 1959-1999
10
Incidence rates for Hepatitis B in Poland in
1980-2001 and in other European Countries
Zródlo Wojtyniak B., Gorynski P. Sytuacja
Zdrowotna ludnosci Polski. PZH Warszawa 2003
11
Incidence trends for AIDS in Poland in 1991-2001
Zródlo Wojtyniak B., Gorynski P. Sytuacja
Zdrowotna ludnosci Polski. PZH Warszawa 2003
12
Health classes in Europe Males Premature
mortality in India lower than in Hungary, not to
mention Russia Ukraine
13
Probability of death (per 1000 persons) at age
15-59 in 1999
14
Probability of death at age 15-59 (in ) in
Sweden and Russia in 1994
15
Mortality trends from all causes at age
45-64,Poland 1950-1991
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Man-made diseases(tobacco, alcohol, diet)
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Trends in mortality from lung cancer, males, age
15-59 selected countries 1959-1990
Liver cirrhosis mortality, males, age
15-59 selected countries 1959-1990
Trends in mortality from injuries, males, age
15-59 selected countries 1986-1994
18
Trends in mortality from injuries, Russian
females and British males aged 45-64
Trends in mortality from lung cancer, Hungarian
females and British males aged 35-54
Liver cirrhosis mortality Hungarian females and
French males aged 45-64
19
PROBABILITY OF DYING BY REGION, 1990(data
adapted from Murray and Lopez, 1994)
Males, age 15-59
Males, age 0-14
EME - Established Market Economies POL -
Poland CHN - China LAC - Latin America and the
Caribbean
OAI - Other Asia and Islands MEC - Middle Eastern
Crescent IND - India SSA - Sub-Saharan Africa
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The health catastrophe of the adult population is
part of the communist heritage in Eastern Europe.
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Factors modelling changes in premature mortality
young and middle age adult in CEE
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In Central and Eastern Europe the number one risk
factor for premature mortality still remains
cigarette smoking
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(No Transcript)
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RISK OF DYING AT AGE 35-69,FORMER SOCIALIST
ECONOMIES 1990
Would have died anyway at age 35-69
Total
Attributed to smoking
Source Peto, Lopez at al. 1999
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Total mortality trends for lung cancer,Poland
1963-1991
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THE LAW ON THE PROTECTION OF PUBLIC HEALTH
AGAINST THE EFFECTS OF TOBACCO USE
Goal ...to prevent tobacco dependence and to
protect health from consequences of the habit...
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(No Transcript)
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Daily smokers by sexPoland 1974-2003
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Lung cancer mortality in Poland by age groups,
males
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Total mortality trends for lung cancer males at
age 20-44, Poland and Hungary 1959-1981
Total mortality trends for lung cancer males at
age 20-44, Poland and Hungary 1959-2001
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Total mortality trends for lung cancer females
at age 20-44, Poland and Hungary 1959-1980
Total mortality trends for lung cancer females
at age 20-44, Poland and Hungary 1959-2001
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Mortality trends from lung cancer at age 35-54,
UK 1950-1995
Prevalence of smoking at age 35-54, UK 1950-1998
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Eastern Europe and Alcohol
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QUALITY OF ALCOHOL
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Rakija, palinka, schnapsvsvodka countries
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Mortality trends from liver cirrhosis, selected
countries 1959-1990
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Structure of mortality in Hungary in 1993
males aged 20-44
females aged 20-44
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Liver cirrhosis mortality, males aged
20-44selected countries - 1989
cirrhosis and other digestive disorders icd-9
570-573, 576, 575.2-579.9, 1991, 1990
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Liver cirrhosis mortality, females aged
20-44selected countries - 1989
cirrhosis and other digestive disorders icd-9
570-573, 576, 575.2-579.9, 1991, 1990
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Style of drinking alcohol
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Binge drinking countries
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Sudden deaths from external causes, Poland
1959-1999
Martial Law
Schnapsgate
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Natural experiment with alcohol in Russia
1985-2000
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Gorbaczov Phenomenon
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Changes in standardized mortality rates from all
causes (expressed as a percentage, 1985100),
Russia 1981-1991
Males, age 45-64
Females, age 45-64
46
Changes in standardized mortality rates from
selected causes (expressed as a percentage,
1985100), Russia 1981-1994
Males, age 45-64
Females, age 45-64
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A reservoir effect
Liver cirrhosis mortality in Paris 1930-1956.
(Data from Ledermann 1964)
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Jelcyn Phenomenon
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Russian yogurt
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Changes in standardized mortality rates from all
causes (expressed as a percentage, 1992100),
Russia 1981-1994
Males, age 45-64
Females, age 45-64
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Changes in standardized mortality rates from
selected causes (expressed as a percentage,
1992100), Russia 1981-1994
Males, age 45-64
Females, age 45-64
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Changes in standardized mortality rates from
selected causes (expressed as a percentage,
1991100), Ukraine 1981-1994
Males, age 45-64
Females, age 45-64
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Rubel crash in 1998, RUSSIA
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Changes in standardized mortality rates from all
causes (expressed as a percentage, 1998100),
Russia 1980-2000
Males, age 45-64
Females, age 45-64
R. c. rubel crash
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Changes in standardized mortality rates from
selected causes (expressed as a percentage,
1991100), Ukraine 1981-2000
Males, age 45-64
Females, age 45-64
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Mortality rates from parasitic and infectious
diseases, Russia 1980-2000
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Infant mortality trends, Russia 1982-2000
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Democracy is healthier
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Overall mortality trends by age group Poland
1950-2001
-27
-22
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All cancers mortality in Poland 1963-2001
Males
Females
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Lung cancer in Poland, males
62
Lung cancer in Poland, females
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Preventing further increases in mortality from
sudden deaths due to external causes (accidents,
injuries, poisoning)
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Sudden deaths from external causes Poland
1959-1999
age 15-59
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Acceleration of decreases in infant mortality
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Infant mortality in Poland 1986-2001
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Infant mortality rates in selected CEE Countries
and UE average, period 1986-2001
68
Unusual phenomenon in transition period in
Central and Eastern Europe is dramatic decrease
of cardiovascular diseases in some countries of
the region
69
Changes in standardized mortality rates from
cardiovascular diseases (expressed as a
percentage, 1991100), selected countries
1983-1999
70
Changes in standardized mortality rates from
cardiovascular diseases, Poland 1990-1999
(expressed as a percentage, 1991100),
age 20-44
age 45-64
age 65 and over
males
females
71
Standardized mortality rates from cardiovascular
diseases by place of living, Poland 1985-1999
females
males
72
Standardized mortality rates from cardiovascular
diseases by education level, Poland 1994-1999,
age 45-64
males
females
73
Mortality trends from cardiovascular
diseases,Poland and Finland 1959-1991
Males, age 15-59
Females, age 15-59
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Consumption of vegetable oils in Poland, years
1970-2000 (kg/capita/year)
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Consumption of vegetable oils and butter in
Poland, years 1970-2000 (kg/capita/year)
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Polyunsaturated / saturated fatty acids ratio in
Poland and Great Britain, 1950-1999
77
Risk of cardiovascular and heart diseases
according to polyunsaturated / saturated fatty
acids ratio (in NHS)
1
Poland 1990
0.8
Predicted RR for Poland
Poland 1992
Poland 1994
Poland 1996
W.Willett at al., Nurses Health Study -
Personal Comunication
78
Consumption of exotic fruit in Poland, 1983-1999
(kg/capita/quarter)
79
Live expectancy in Poland in 1991 and 2002
3.5 years
4.3 years
80
Average expectancy of life, in Poland and Russia
1989-2002
Males
Females
81
Conclusion

• Adult health catastrophe
• The highest premature morbidity, disability and
  mortality heritage of communism not result of
  market economy and democracy
• Public health priority non-communicable diseases
• MMD
• Exposition to tobacco smoke
• Heavy hepatotoxic alcohol
• Binge drinking
• Dietary deficiency !?
• - Vegateble oil
• - Fruit and vegetable