Rural Health in Central and Eastern Europe:

an Issue for Contemporary Science and Research

I.Ciznar, T.Cook, R.Ungar, G.Gulis

Rural“there is no standard definition…. “

-imply rather than explicitly state

• different criteria

• different levels of analysis

• different methodologies

• POPULATION SIZE

-such as areas with “individuals living outside places of more than 1,000 people.”

• POPULATION DENSITY

-such as the OECD definition of rural communities as those having less than 150 persons per square km.

• LEVEL OF URBANIZATION

-such as not having an urban center with a population of more than 50,000 or being outside the commuting distance to an urban center.

• PRINCIPAL ECONOMIC ACTIVITY

-implying an economy based on agriculture.

Different Schemes and Thresholds for Defining RURAL

Each country: own definitions of urban and rural. -WHO

”…though the characteristics of rural people are different for each definition, in general, each definition provides a similar analytic conclusion.”

HIGHER MORTALITY RATES in rural areas, no matter how one chooses to define “rural.”

-Du Plesis, et al

Life Expectancy at Birth

65

70

75

80

1975 1980 1985 1990 1995 2000

Years

Year

sCCEE EU

WHO Report 2001

Mortality from Cardiovascular Diseases

0 100 200 300 400 500 600 700 800

FRA

NETH

BEL

FIN

SLE

CZE

SLO

HUN

BUL

ROM

RUS

Disease deaths / 100 000

WHO Report 2001

Central/Eastern Europe

Western Europe

0 50 100 150 200 250 300

AUS

FIN

SWIZ

BUL

ROM

RUS

SLE

SLO

CZE

HUN

Disease deaths / 100 000WHO Report 2001

Central/Eastern Europe

Western Europe

Mortality from Cancer

RURAL in our study is defined on the basis of:

• level of urbanisation.

• principal economic activity.

Nothern region is typical industrial, with high level of urbanisation (commuting zone) and higher population density.

Southern region is typical agricultural, with people living in small villages close to working place.

Questionnaire Survey ‘94-’97

SK Statistical Office WHO 2002 Report

Northern - Urban

Southern - Rural

Mortality Rates in Two Districts*

RURAL URBAN

male female male female

CVD 696 620 472 402 Cancer 266 259 185 162

*per 100.000

DrinkingWater

Local Wells (20%) - High Contamination (80%)

Usage of Local Well Water

in Rural Areas

• Hygiene = 97%

• Cooking = 95%

• Drinking = 85%

• Irrigation = 57%

Waste Disposal/Sewage

Lack of Sewage Facilities - Animal Deposits Near Drinking Water Sources - Insect Breeding Sites

Waste Water Treatment/Sewage

in Rural Areas

• 50% of the population is using municipal sewage and waste water treatment systems.

• 90% are located in urban areas.

• 70% of the local wells users in rural areas also use septic tanks.

• most septic tanks are emptied into a field, garden, pasture, etc.

AirPollution

Local Heating

&

Burning Household Waste

ChemicalExposures

Agricultural Workers - Household Gardeners (50-75%)

Socio-economicFactors

High Unemployment - Poor Diet - Stress - Unhealthy Lifestyles

HealthCare

Limited Health Care Services - Inadequate Preventive

Services