Health and Demography: The Achilles Heel of Post-Socialist Development in Europe Nicholas Eberstadt Henry Wendt Chair in Political Economy American Enterprise Institute (AEI) Advancing Economic Growth: Investing In Health Chatham House, London June 22-23, 2005

Health and Demography Limit The Development Possibilities for Post-Socialist Europe Today: Inter-Linked Development-Impeding Characteristics Include: Pervasive Population Decline (Driven by Sharp Imbalance between Births and Deaths) Fertility Collapse (Portending Youth Drought and Rapid Ageing) Extreme and Rapid Population Ageing at Low Levels of GDP/Capita Serious and Enduring Health Problems, Concentrated in Economically Active Age GroupsProblems Resistant to Rapid Melioration

Post-Socialist Europes Demography: When Abnormal Becomes The Norm Post-Socialist Europes Health and Demographic Challenges are without Historical Precedent They characterize the Whole Region (not just some States) These Dem/Health Problems are Deeply Embedded: i.e., Policy Interventions to address them may result in unusually Slow and Limited Gains

Source: UN World Population Prospects: The 2004 Revision Population Database Female

Source: UN World Population Prospects: The 2004 Revision Population Database, (medium variant projection) NOTE: UNDPs definition of Eastern Europe excludes the Baltic countries, Albania, and most of former Yugoslavia

Population Profiles, Post-Socialist Europe vs. Western Europe: Fundamental Differences Today

Basic Demographic Indicators For Europe By Region (UNPD Projections) W.EuropeRussia E.Europe (w/o Russia) Population (million) Pop Growth %/yr 2000/ Net Reproduction Rate 2000/ Life Expectancy 2000/2005 (Years) NOTE: UNDPs definition of Eastern Europe excludes the Baltic countries, Albania, and most of former Yugoslavia

Source: Calculated from Recent Demographic Developments in Europe, Council of Europe: Belgium, January 2005.

Projected Population Change, : Russia, Rest of Eastern Europe, and West. Europe RussiaRest E.Eur. W.Eur Total Population-11.8%-12.7%+ 3.8% Population %-15.1%- 2.3% (Population 15-24)(-36.3%)(-45.3%)(-12.7%) Population %+30.4%+44.0% Source: UN Population Division, World Population Prospects, 2004 Revisions, NOTE: UNDPs definition of Eastern Europe excludes the Baltic countries, Albania, and most of former Yugoslavia

Extreme Sub-Replacement Fertility: Status and Future Implications For Post-Socialist Europe

Total Fertility Rate: U.S. (by state), Russia, and Europe, 2000 Notes: U.S. TFR includes the 50 and the District of Columbia; blue bars indicate TFRs for European countries outside of the EU-15. Sources: Institut National d'etudes demographiques, "Population en chiffres," available at developpes/index.html (accessed August 4, 2004); National Vital Statistics Report Vol 52, No. 19 (May 10, 2004).

Source: United Nations Population Division, World Population Prospects: The 2004 Revision.

Source: UN World Population Prospects: The 2004 Revision NOTE: UNDPs definition of Eastern Europe excludes the Baltic countries, Albania, and most of former Yugoslavia

Rapid Population Ageing for Low- Income Populations: Post-Socialist Europes Unstoppable Wave

Changes in 65+ Population As Percentage of Total Population: 2000 vs (US Census Bureau Projections) Difference Western Europe Bulgaria Czech Republic Estonia Hungary Latvia Lithuania Poland Romania Russian Federation Slovakia Ukraine

Percentage of the Population Aged 65+ vs. GDP per Capita: Developed Countries vs. Emerging Economies 2000 Sources: Maddison (2003); UNDP (2004)

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2004 Revision and World Urbanization Prospects: The 2004 Revision, Maddison, Angus. The World Economy: Historical Statistics. (Development Centre Studies, Organization for Economic Cooperation and Development: Paris, 2003), pp

Premature Mortality and Allied Health Problems: An Anchor on Economic Development in Post-Socialist Europe

Source: World Development Indicators, 2003

Estimated Changes in Life Expectancy at Birth in Europe, by Region: 1960/65 to 2000/2005 (years) Overall LE Male LE Western Europe Eastern Europe (without Russia) Russian Federation Note: UN definition of "Eastern Europe" excludes the Baltic countries, Albania, and most of the former Yugoslavia. Source: Derived from UN Population Division, World Population Prospects: The 2004 Revision, available electronically at.

Sources: The Demographic Yearbook of Russia: 1993 (State Committee of the Russian Federation on Statistics, Moscow, 1993), Table 2.5; The Demographic Yearbook of Russia: 2004 (State Committee of the Russian Federation on Statistics, Moscow, 2004), Table 2.6; Human Mortality Database, available online at accessed January 20,

Sources: The Demographic Yearbook of Russia: 1993 (State Committee of the Russian Federation on Statistics, Moscow, 1993), Table 2.5; The Demographic Yearbook of Russia: 2004 (State Committee of the Russian Federation on Statistics, Moscow, 2004), Table 2.6; Human Mortality Database, available online at accessed January 20,

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Changes in Life Expectancy at Age 30: 1970 vs. 2000, Male plus Female (Years) Italy+5.59 East Germany*+4.62 Czech Republic+3.77 Lithuania-0.21 Latvia-0.87 Hungary*-1.01 Bulgaria-1.02 Russian Federation*-3.06 Source: *= www.mortality.org

Note: Calculations based upon current "life tables" for the year "Europe" includes countries outside of the EU-15. Source: World Health Organization Life Tables, 2000, available at (accessed on September 20, 2004).

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Deaths from diseases of the circulatory system, years: Russia and Selected European Countries Source: Atlas of Health in Europe, The World Heath Organization at www. Euro.who.int/document/E79876.pdf Post-communist countries Countries which have never been communist

Deaths from external causes of injury and poisoning, 0-64 years: Russia and Selected European Countries Source: Atlas of Health in Europe, The World Heath Organization at www. Euro.who.int/document/E79876.pdf Post-communist countries Countries which have never been communist

Source: accessed on 11 April 2005www.mortality.org

Source: accessed on 11 April 2005www.mortality.org

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Source: U.S. Census Bureau International Data Base

What Is To Be Done?