Why life expectancy is lower in eastern Europe

FROM Stettin in the Baltic to Trieste in the Adriatic, a health divide has fallen across Europe. Although in global terms citizens of the EU live long (2.5 years more than in America and 4.6 years more than in China), the continent is divided. At the farthest ends of the spectrum, Spaniards from Madrid can expect to live to 85, but Bulgarians from the region of Severozapaden are predicted to live just past their 73rd birthday—a gap of almost 12 years. The only exceptions are Slovenia, which scrapes in above the EU average, and Denmark, which falls a fraction below.

It was not always that way. In the mid-1960s Latvians and Lithuanians still blew out as many birthday candles as the citizens of Cyprus and France. But “the political division of Europe is important,” says Denny Vagero, a professor of medical sociology at Stockholm University. After a long period of convergence caused by reductions in child mortality, the east of the continent gradually fell behind after the iron curtain descended.

According to Zoltan Massay-Kosubek of the European Public Health Alliance (EPHA), an NGO, eastern Europe is home to more smokers and more heavy drinkers. “This is the major source of the gap,” he says. Bad habits and unhealthy environments are contributory factors to chronic illnesses such as cancer, diabetes and heart disease. Hungarians face the poorest odds when it comes to chronic ill-health, but rates are also high in much of Poland, Slovakia, and Croatia.

Money might be thought to be at the root of the problem, but the facts do not bear out this view. Portugal, southern Italy and large parts of Spain have incomes per head similar to parts of eastern Europe, yet enjoy higher life expectancy. Scotland and the north-east of England also have high death rates from chronic disease. “What you do with GDP is important,” says Mr Vagero. Some countries prefer to spend their money on social policy, others on weapons. But in general, health systems in eastern Europe are simply “not comparable to western Europe,” says Mr Massay-Kosubek.

“Health inequalities are unjust because they can be prevented,” he goes on. Education, access to clean air and improvements in mental health could help. But prevention policies are hard to get right, even if they save money in the long run. With more low-emission cars in western Europe, older, more polluting models end up in eastern European markets. EU-wide measures to reduce smoking, like plain packaging and bans on public smoking, have had some success. Alcohol consumption could be tackled in a similar way. But those who have kicked the smoking habit often belong to the well-educated, richer part of society. Improvements in health do not always lead to greater equality.

Almost all EU members are collaborating on an action plan on health, and the European Commission is running projects to tackle the root of the health problem in groups vulnerable to sickness. But not everyone in Brussels supports such collaboration. Nationalist MEPs might seek to take back control of public-health reform after the European Parliament elections next year by limiting the interpretation of the EU’s mandate on health, some warn. That could hinder bringing Europeans closer, in sickness and in health.