Europe and Central Asia: Launching a Cardiovascular Revolution and Other Health Improvements

June 3, 2013

  • Europe and Central Asia lags behind its EU-15 counterparts in the health sector, with cardiovascular disease and neonatal mortality among the top sources of concern.
  • Better public health systems, primary care, more rapid progress on the financing agenda and broader institutional reforms are needed to improve the health system in these countries.


Smoking, high blood pressure, and heart disease.

While these may be health related issues found the world over, they are of particular focus in Europe and Central Asia (ECA) [1]. For example, rates of tobacco use are among the highest in the world.  Countries in the region must explore a broad reform agenda to tackle these issues, increase life expectancy and bring the health care system on par with the world, according to a new World Bank Group report.

“Getting Better: Improving Health System Outcomes in Europe and Central Asia” explores the development challenges for the heath sector in the region, and highlights three areas of improvement – public health and primary care interventions, financing arrangements, and broader institutional reforms -- to overhaul the health system.

The report implemented household surveys in six countries with a focus on health-related behavior and utilization of medical care, a survey on quality of care in five countries, and drew upon existing surveys in 11 countries to analyze out-of-pocket spending on health care, leading to the identification of the three areas of improvement.

Getting Better

In the 1960s, the average lifespan in the region was only five years less than that in Western Europe, but 10 years more than that in Latin America and 20 years over East Asia and the Middle East. Now, the life expectancy gap with the EU-15 [2] has widened significantly, while other regions have surpassed Europe and Central Asia.

But there have been exceptions – Turkey, for example, saw solid improvement in this period, while the Balkan countries performed on par with the global standard. However, several other countries have fallen behind in the process.

One of the top areas of concern is heart disease. This alone explains over half of the gap in life expectancy between ECA and the EU-15.  A few ways of reducing its occurrence would be to introduce measures like banning smoking in public areas and increasing cigarette taxes, and monitor risk factors such as high blood pressure and cholesterol regularly, the report recommends.

Death of infants less than 28 days old is yet another problem, along with alcohol use-related road injuries, mental health, and HIV/AIDS and tuberculosis. All of these can be combated by concerted policy reforms. 

Financing Health Systems

Old or young, men or women, rich or poor – survey respondents across the region emphasized that health care should be the top priority for additional government investment, which along with out-of-pocket spending by households is how health care is financed in ECA. But the growing demand for health care must be financed without putting too much burden on either source.

This is because depending heavily on out-of-pocket spending could mean squeezing certain households that cannot afford to spend too much on health care, while excessive government spending can affect fiscal sustainability. Moreover, spending on excess hospital infrastructure and pharmaceuticals should be curbed as well, the report found.

Institutional Reforms and Health System Design

Measures such as making payments follow the patient rather than the medical facility, giving health care providers decision making rights, and enabling policymakers to use information aggregated from hundreds of facilities across the country are important to support the ongoing system improvement.

Still, there is no one ideal health system that the region can adopt. Multiple areas of improvement, several of which are closely tied to accountability in service provision, can be identified, but they will have to be tailored to fit each country’s needs. That is, the report proposes ingredients, not recipes, for health system reform.


[1] The Europe and Central Asia region includes Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kosovo, Kyrgyz Republic, Latvia, Lithuania, FYR Macedonia, Moldova, Montenegro, Poland, Romania, Russia, Slovak Republic, Slovenia, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan.

[2] EU-15 includes Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, United Kingdom.