سهم مراقبت های پزشکی برای تغییر امید به زندگی در آلمان و لهستان

This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e(0–75)] for the periods 1980/1983–1988 and 1991/1992–1996/1997. Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial east–west gap by the late 1980s and early 1990s. In the 1980s, in east Germany, 50–60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30–40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality. In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35+ in Poland and 55+ in Germany. A persisting east–west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997. The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of ‘unnecessary untimely deaths’ appear to contribute to a persisting east–west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west.

During the 1980s the health of the peoples of central and eastern Europe lagged increasingly far behind that of their western neighbours. In some countries, such as the German Democratic Republic (GDR), this was due to a failure to achieve the improvements in adult mortality seen in the west (Nolte, Shkolnikov, & McKee, 2000a). In others, such as Poland, there was an actual increase in adult mortality. The political transition in the early 1990s also had a considerable impact on health although, again, there were both similarities and differences. A short-lived worsening in mortality in all countries was followed by improvements in health, which were rapid in some countries and delayed in others (Zatoñski & Boyle, 1996; McKee & Zatoñski, 1998).