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

2. 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

3. 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

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

5. 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

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

7. Basic Demographic Indicators For Europe By Region (UNPD Projections) W.EuropeRussia E.Europe (w/o Russia) Population (million) 2005431145143 Pop Growth %/yr 2000/20050.33-0.46-0.52 Net Reproduction Rate 2000/20050.720.620.58 Life Expectancy 2000/2005 (Years)77.665.470.5 NOTE: UNDPs definition of Eastern Europe excludes the Baltic countries, Albania, and most of former Yugoslavia

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

9. Projected Population Change, 2000-2025: Russia, Rest of Eastern Europe, and West. Europe RussiaRest E.Eur. W.Eur Total Population-11.8%-12.7%+ 3.8% Population 15-64-15.4%-15.1%- 2.3% (Population 15-24)(-36.3%)(-45.3%)(-12.7%) Population 65++25.7%+30.4%+44.0% Source: UN Population Division, World Population Prospects, 2004 Revisions, www.unpopulation.org.www.unpopulation.org NOTE: UNDPs definition of Eastern Europe excludes the Baltic countries, Albania, and most of former Yugoslavia

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

11. 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 http://www.ined.fr/population-en-chiffres/pays- developpes/index.html (accessed August 4, 2004); National Vital Statistics Report Vol 52, No. 19 (May 10, 2004).

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

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

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

15. Changes in 65+ Population As Percentage of Total Population: 2000 vs. 2025 (US Census Bureau Projections) 20002025Difference Western Europe16.322.7+ 6.4 Bulgaria16.623.2+ 6.6 Czech Republic13.822.9+ 9.1 Estonia15.022.7+ 7.7 Hungary14.621.3+ 6.7 Latvia14.720.7+ 6.0 Lithuania13.721.0+ 7.3 Poland12.321.6+ 9.3 Romania13.319.0+ 5.7 Russian Federation12.519.8+ 7.3 Slovakia11.419.3+ 7.9 Ukraine14.120.6+ 6.5

16. Percentage of the Population Aged 65+ vs. GDP per Capita: Developed Countries 1950-2000 vs. Emerging Economies 2000 Sources: Maddison (2003); UNDP (2004)

17. 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, http://esa.un.org/unpp.http://esa.un.org/unpp Maddison, Angus. The World Economy: Historical Statistics. (Development Centre Studies, Organization for Economic Cooperation and Development: Paris, 2003), pp. 110-111.

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

19. Source: World Development Indicators, 2003

20. Estimated Changes in Life Expectancy at Birth in Europe, by Region: 1960/65 to 2000/2005 (years) Overall LE Male LE Western Europe +7.3 +6.8 Eastern Europe (without Russia) +1.1 -0.8 Russian Federation -2.5 -4.2 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.

21. 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 www.mortality.org, accessed January 20, 2005.www.mortality.org

22. 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 www.mortality.org, accessed January 20, 2005.www.mortality.org

23. Source:www.mortality.org

25. 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; *=1970-1999www.mortality.org

26. Note: Calculations based upon current "life tables" for the year 2000. "Europe" includes countries outside of the EU-15. Source: World Health Organization Life Tables, 2000, available at http://www3.who.int/whosis/life_tables/life_tables.cfm?path=evidence,life_tables&language=english (accessed on September 20, 2004).

27. Source:www.mortality.org

28. Deaths from diseases of the circulatory system, 25-64 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

29. 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

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

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

32. Source:www.mortality.org

35. Source: U.S. Census Bureau International Data Base

36. What Is To Be Done?