Economic Shocks, Impoverishment and Poverty-Related Mortality during the Eastern European Transition
This paper aims to assess the impact that the impoverishment process has had on IPD health dynamics and micronutrient-related morbidity via the changes which have occurred in food consumption in terms of average intake, its distribution and the quality of diets.The paper offers a description of the impoverishment process, the determinants of poverty (mainly income distribution) and the groups most affected (children, the unemployed and single-parent families).The paper then provides an analysis of the impact of the impoverishment process on the consumption of food and of nutrients like K-calories and protein. The analysis indicates that the process has been characterized by low food-income elasticity on average. Nonetheless, the process has provoked sharp variations in the distribution of food consumption amongst income classes that have increased gaps in intake and worsened the situation of the poorest people in countries which have experienced a profound and severe poverty crisis (mainly the former Soviet Union and Romania). Among these people, the problem of malnutrition is gradually becoming one of undernutrition. For micronutrient intake, the pattern is the same. The (scattered) evidence points to persistent and increasing micronutrient deficiencies among populations in Central and Eastern Europe.The consequences for health dynamics are quite clear. Although IPD-related mortality accounts for only around 2 per cent of the overall surge in mortality in the region, it is steadily rising in those countries which have been most affected by the impoverishment process, thereby reversing a 20-year-long declining trend. Particularly worrisome is the sudden and sharp climb in morbidity linked to tuberculosis and diphtheria, which were thought to be nearly eradicated. The morbidity related to micronutrient deficiency has also mounted. The effects of micronutrient deficiency in terms of cognitive performance, physical capacity, mental disease, cretinism and premature death are well documented. This must be considered one of the worst aspects of the crisis in nutrition.The widening polarization in health status shows that the decline in the health stock below a critical minimum among the poorest segment of the population is continuing. Nutrient deficiency leads to a rise in problems in immuno-competence that is reinforced by the deterioration in hygiene, housing conditions and the general environment. The initial positive condition of the health stock has acted as a damper on the negative effects of impoverishment, but, if the severity of poverty persists, this protective barrier will disappear. There is strong evidence that extreme and expanding poverty in terms both of the HCR and of the poverty gap in some countries (especially the former Soviet Union and South-eastern Europe) may explain a significant portion of the variance in the rising IPD mortality.Decisive offset variables (like health care services) have not halted the negative trend in the health stock. The possibility of reducing disease exposure among populations has been undermined because of substantial cuts in public health care budgets, while the accessibility of health care services is being affected by a regressive policy in medical service fees. This latter phenomenon has had a particularly noxious impact on personal disease control, which is steadily declining among the poor. As a result, the inherited health assets, even though they have often proved ineffective, are gradually being dismantled.These facts support the use of the Mosley-Chen/Cornia-Jolly-Stewart model as a good analytical framework for the explanation of the deterioration in health status that is mostly related to the process of impoverishment such as IPD mortality and morbidity. However, in Central and Eastern Europe concurrent mortality/morbidity models are operating that are affecting the different parts of the population as viewed according to socio-economic situation and degree of vulnerability. Thus, if a model based on psychosocial stress is able to explain the mortality due to CVD among middle-aged men, the recession model could provide a good analytical framework for the description of the deterioration in health status among the poor strata of populations mainly caused by the severity of the process of impoverishment and the effect of this process on nutrition.