Professor Witold A. Zatonski was the leader of a three year EU-funded project (June 2004-2007) called Closing the Gap , which studied health inequalities between the EU-15 and the ten new eastern member states.
What are the main results of your project?
We found out what we expected, which is that huge gaps in health exist between eastern and western countries. This gap is characterised by a much higher mortality rate for CDV [cardiovascular] diseases in eastern European countries. This is certainly very strongly connected to access to related medical services but also to lifestyle factors. Tobacco smoking, diet and alcohol seem to be essential factors with regard to decreasing mortality from CDV diseases.
The second big problem in eastern Europe, especially in the Baltic countries (Latvia, Lithuania and Estonia), or the EU 3, is death from injuries. This is not connected to any medical conditions, so you can't improve the situation by improving the health infrastructure or better access to medicine. This is connected to social policy, safety, regulation of alcohol control and education of people. These countries have a huge burden coming from injuries. We need to have some country-specific programmes to control this problem.
One of the big challenges in the EU is alcohol policy. Drinking patterns vary a lot across the EU, from modest regular consumption to occasional binge drinking. There are some studies that show that a modest regular intake of alcohol is good for your health but binge drinking until intoxication is always harmful for health, in particular with regard to injuries but also CDV diseases.
What is the reason for the significant decrease in CDV diseases in the Czech Republic, Hungary, Poland, Slovenia and Slovakia (the EU 5)?
The biggest difference is the decrease in the use of animal fat. After 1990, state subsidies for animal products disappeared and vegetables became relatively cheap, so there was a big change in the consumption of fat as vegetable fat, and in particular seed oil, replaced butter.
Why haven't CDV diseases decreased in the Baltic countries or Bulgaria and Romania?
To be solved, this problem needs a bit more science. In Romania and Bulgaria, they are using nearly 100% sunflower oil, which does not have Omega C fatty acids. So there is a hypothesis that in these countries there is a deficiency of Omega C. Perhaps it would be beneficial to add some other vegetable oils to the oil consumed to change its structure.
Health in eastern Europe seems to be lifestyle-related. Who can do what to change people's lifestyles?
We can look at good examples in the West. Finland, for example, had very similar nutritional habits to eastern countries and a high mortality rate from CDV diseases, but it was able to change. It cost a lot of money and work, but they changed. The change was connected to knowledge, attitude and a change in behaviour. This can only be done by very close co-operation between a government and the population. [With targeted action and awareness raising, Finland has since 1960 managed to reduce mortality from CDV by 80%].
Did your project look at socio-economic factors in health? Does money matter for health?
Yes and no. The worst health indicators were in Hungary and it is not the worst off, economically speaking, of the eastern countries. An improving economy does not necessarily mean improving health. Even if you have money you can still smoke, drink, eat fat and do no exercise. And this will go on as long as you don't have the knowledge to change your attitude - in this regard, obesity is a very good example.
What are the economic implications of socio-economic inequalities in health?
From the macro-economic point of view there are huge implications for the EU economy of the eastern European population's bad health. Human capital is so strongly pressed by bad health that it has very strong economic consequences. Thus, if we find ways to improve health in eastern Europe, we can surely fantastically improve the EU economy and its competitiveness. For the economy, it is extremely important to have a healthy population, and in particular working-age population.
We also need very clear science and evidence-based policies - both social policies but also pricing policies with regard to tobacco, for example, as well as the promotion of healthy foods.