Special Collection 2 - Article 6 | Pages 139–162  

Progress in health care, progress in health?: Patterns of amenable mortality in Central and Eastern Europe before and after political transition

By Ellen Nolte, Rembrandt D. Scholz, Martin McKee

This article is part of the Special Collection 2 „Determinants of Diverging Trends in Mortality“

Abstract

This paper examines the potential impact of changes in medical care on changing population health in Lithuania, Hungary and Romania, with west Germany included for comparison. We used the concept of deaths from certain causes that should not occur in the presence of timely and effective health care (amenable mortality) and calculated the contribution of changes in mortality from these conditions to changes in life expectancy between birth and age 75 [e (0-75)] for the periods 1980/81 to 1988 and 1992 to 1997.
Temporary life expectancy improved consistently in west Germany (men: 2.7 years, women: 1.6 years). In contrast, gains were relatively small in the other countries, except among Hungarian women, who gained 1.3 years. Romanian men lost 1.3 years. In the 1980s, falling infant mortality made a substantial contribution to improvements in temporary life expectancy in all countries, of about a quarter to half a year. Of this, more than half can be attributed to amenable conditions.
At older ages, falling amenable mortality contributed about 40% among those aged over 40 in Germany and, to a lesser extent, Hungary, while causing a loss of life expectancy in Romania.
In the 1990s, improvements in infant mortality continued to make substantial contributions to life expectancy in Lithuania and Hungary but had little impact in either Germany or Romania. Among adults, improvements in amenable mortality continued to benefit Hungarians and west Germans. In Lithuania, up to two-thirds of the gain in temporary life expectancy were attributable to falling mortality from ischaemic heart disease whereas medical care otherwise seems to have had a negative impact. Romanian men and women experienced increases in amenable mortality that contributed up to a half of the overall loss of life expectancy.
Our findings suggest that during the last 20 years changes in medical care had considerable impact, positively as well as negatively, on changing mortality in selected central and eastern European countries.

Author’s Affiliation

• Ellen Nolte - London School of Hygiene and Tropical Medicine, United Kingdom EMAIL
• Rembrandt D. Scholz - Rostocker Zentrum zur Erforschung des Demografischen Wandels, Germany EMAIL
• Martin McKee - London School of Hygiene and Tropical Medicine, United Kingdom EMAIL

Other articles by the same author/authors in Demographic Research

Health sector reforms in Central and Eastern Europe: How well are health services responding to changing patterns of health?
Special Collection 2 - Article 7

Components and possible determinants of decrease in Russian mortality in 2004-2010
Volume 28 - Article 32

Differential mortality by lifetime earnings in Germany
Volume 17 - Article 4

Official population statistics and the Human Mortality Database estimates of populations aged 80+ in Germany and nine other European countries
Volume 13 - Article 14

Russian mortality beyond vital statistics: Effects of social status and behaviours on deaths from circulatory disease and external causes - a case-control study of men aged 20-55 years in Urdmurtia, 1998-99
Special Collection 2 - Article 4

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