Socioeconomic inequalities in health and health care access in central and eastern Europe and the CIS: a review of the recent literature
Since 1989 countries in eastern Europe and the former Soviet Union have experienced a period of rising income inequality and structural change in health and social security systems. Concerns have arisen that inequalities in health may have accompanied these reforms. In light of this, the main purpose of this report is to assess socioeconomic inequalities in health and health care access in the region. We review studies published between 2001-2005 that examined the association between socioeconomic status and health and health care access over the period of transition across the region. We focus primarily on morbidity and mortality from noncommunicable disease because this has become the main burden of ill-health in the region. The studies present overwhelming evidence that socioeconomic inequalities in health exist in the region and that the poor are disadvantaged in terms of self-rated health status, mortality, noncommunicable disease, health behaviours and access to health care. Where data are available there is also evidence that the trend in inequality in health and in health care access rose over the course of economic transition. There are significant gaps in the literature and in the data sources for research on this topic in central and eastern Europe and the CIS. These include a shortage of longitudinal data that would facilitate monitoring of trends and a shortage of standardized data collection instruments that would facilitate cross-country comparative research.