شرایط سیاسی و امید به زندگی در اروپا، 1900-2008

The rise of life expectancy in Europe has been a very uneven process, both in time and space. This paper aims to identify instances in which major political conditions are likely to have influenced the rise of life expectancy, focusing on formation and dissolution of states and supranational blocs and on differences between political regimes (democratic vs. authoritarian non-communist and communist rule). Data on life expectancy, cause-specific mortality and political conditions were compiled from existing data sources. Possible relations between political conditions and life expectancy were studied by direct comparisons of changes in life expectancy in countries with different political conditions but similar starting levels of life expectancy. We found that formation and dissolution of states often went together with convergence and divergence of life expectancy, respectively, and that otherwise similar countries that did or did not become part of the Soviet bloc had distinctly different life expectancy trajectories. Democratically governed states had higher life expectancies than authoritarian states throughout the 20th century. The gap narrowed between 1920 and 1960 due to rapid catching up of infectious disease control in both non-communist and communist authoritarian states. It widened again after 1960 due to earlier and more rapid progress in democratic states against cardiovascular disease, breast cancer, motor vehicle accidents and other causes of death that have become amenable to intervention. We conclude that the history of life expectancy in Europe contains many instances in which political conditions are likely to have had a temporary or more lasting impact on population health. This suggests that there is scope for further in-depth studies of the impact of specific political determinants on the development of population health in Europe.

The idea that public health needs politics to improve population health is more popular than ever. Politics, loosely defined as the process of making and executing collective decisions (Hague & Harrop, 2010), may affect risks of mortality in various ways. It may have an impact on levels of prosperity, by fostering economic growth, and thereby influence living conditions that are essential for population health (e.g. nutrition). Political decisions on the collective provision of education, social security, housing etc. may influence population health by providing protection against health hazards and increasing resilience. Finally, politics may influence population health directly through decisions on public health measures (safe drinking water, vaccinations, road traffic safety, air pollution control, etc.) and on health care provision (Bambra, Fox, & Scott-Samuel, 2005). On the other hand, politics may also have negative impacts on population health, for example by creating major disruptions of social life, such as armed conflicts, or by oppression of certain population groups.