Policy implications of differential health status in East and West Europe. The case of Hungary

Morbidity and mortality trends in Western and Eastern Europe have differed considerably during the past three decades, although the major unfavourable processes have been essentially the same in each of the Central European countries. The most striking feature has been the decline in average life expectancy and deterioration of age-specific mortality rates for the middle-aged, especially men. The former socialist government took no effective action. Due to the denial of social and environmental problems, social, health and environmental policy were underdeveloped and deformed. Partly inherited from previous historical traditions, wishful thinking, victimization and a patronizing attitude were primary ways of dealing with problems. In these circumstances even the few specially supported health education campaigns were doomed to fail. People depended on the omnipotent central state in vain to solve their problems so that health promotion based on the community and self-empowerment did not develop. During the early nineties, in Eastern and Central Europe no central political strategies were initiated or launched to combat the mortality and morbidity tendences. The economic and social prerequisites of a long-term gradual improvement in the health status are missing in Central and Eastern Europe. A declining standard of living due to recession, growing deprivation, poverty, unemployment and migration are unfavourable to improvements in health. In a time of crisis, with stress but without adequate skills of coping, forced adaptation associated with sudden changes and perceived failure have only made matters worse. There are no short-term 'solutions'. Hopefully, the 'second generation' of democratic governments will have the energy in the mid-nineties to work out their strategies and start to implement them.