Adeyi O, Chellaraj G, Goldstein E, Preker A, Ringold D
World Bank, Washington, DC, USA.
Health Policy Plan. 1997 Jun;12(2):132-45. doi: 10.1093/heapol/12.2.132.
This paper reports on a study of the cross-national trends in health status during the economic transition and associated health sector reforms in Central and Eastern Europe (CEE). The central premise is that before long-run gains in health status are realized, the transition towards a market economy and adoption of democratic forms of government should lead to short-run deterioration as a result of: (i) reduction in real income and widening income disparities; (ii) stress and stress-related behaviour; (iii) lax regulation of environmental and occupational risks; and (iv) breakdown in basic health services. Analysis focused on three broad indicators of health status: life expectancy at birth, infant mortality rate and the probability of dying between the ages of 15 and 65 years, shown by the notation '50q15'. The study revealed significant new information about health status and the health sector which could not have been obtained without a proper cross-national study. Infant mortality rates in former socialist economies (FSE) follow the global trend, declining as per capita income rises. However, rates are lower than would be predicted given their income levels. Despite declining infant mortality, life expectancy at birth in the former socialist economies decreases as per capita income rises, in marked contrast to global trends. This is because rising income level is associated with greater probability of death between the ages of 15 and 65: the wealthier the society, the less healthy is its population, particularly for its males. Causes of death in the FSE follow global trends: higher death rates due to infectious and parasitic diseases in poorer countries, and higher death rates due to chronic diseases in wealthier countries. However, age-standardized death rates for chronic diseases generally associated with unhealthy lifestyles and environmental risk factors are very high when compared with wealthier established market economies (EME). Policies and procedures which alter the effectiveness of health services have had a demonstrable but mixed impact on health status during the early phase of transition. Effective preventive health strategies must be formulated and implemented to reverse the adverse trends observed in Central and Eastern Europe.
本文报告了一项关于中东欧（CEE）经济转型期间健康状况的跨国趋势以及相关卫生部门改革的研究。核心前提是，在实现健康状况的长期改善之前，向市场经济的转型以及民主政府形式的采用，由于以下原因，应会导致短期恶化：（i）实际收入减少和收入差距扩大；（ii）压力及与压力相关的行为；（iii）对环境和职业风险的监管宽松；（iv）基本卫生服务的崩溃。分析聚焦于健康状况的三个广泛指标：出生时预期寿命、婴儿死亡率以及15至65岁之间死亡的概率，用“50q15”表示。该研究揭示了有关健康状况和卫生部门的重要新信息，若没有适当的跨国研究，这些信息是无法获得的。前社会主义经济体（FSE）的婴儿死亡率遵循全球趋势，随着人均收入的增加而下降。然而，鉴于其收入水平，该死亡率低于预期。尽管婴儿死亡率在下降，但前社会主义经济体的出生时预期寿命随着人均收入的增加而降低，这与全球趋势形成鲜明对比。这是因为收入水平的提高与15至65岁之间更高的死亡概率相关：社会越富裕，其人口越不健康，尤其是男性。前社会主义经济体的死因遵循全球趋势：较贫穷国家因传染病和寄生虫病导致的死亡率较高，较富裕国家因慢性病导致的死亡率较高。然而，与更富裕的成熟市场经济体（EME）相比，通常与不健康生活方式和环境风险因素相关的慢性病的年龄标准化死亡率非常高。在转型初期，改变卫生服务有效性的政策和程序对健康状况产生了明显但喜忧参半的影响。必须制定和实施有效的预防性健康策略，以扭转中东欧观察到的不利趋势。
