Eu enlargement: major public health issues in the acceding countries

Abstract

Debrecen, Debrecen, Hungary The accession of the ten candidate countries to the European Union in 2004 will result in extremely high diversity in the health status of the EU population as well as in country-specific public health priorities in the Community. Among the acceding countries Malta and Cyprus, where life expectancy is already close to the current EU average, are in much more favourable situation than the Central and Eastern European (CEE) countries and the Baltic states. Although the health status indicators vary in a wide range even in the candidate countries which were locked into Soviet bloc during the post-war period, they show certain common characteristics and consequently they are facing common public health challenges. The concept of new public health and health promotion is relatively new to these countries, prior to 1990 their public health services were mostly organized following the Soviet model with a high priority on infectious diseases and carrying out authorities hygienic and sanitary control measures. Consequently today the major public health problems are the very high rate of premature mortality (especially in males aged 35–64 years) caused by chronic non-communicable, mainly cardiovascular and malignant, diseases; the large regional and ethnical inequalities in health status of the population within the countries; missing health monitoring systems and registries; the unfavourable health behavior of the population; missing multidisciplinary theoretical approach and its translation into effective inter-sectorial practice; the lack of well-trained public health professionals and in general, the low level of professionalization in public health; the communication gap between public health professionals and health policy makers. Public health problems of the acceding countries need special attention within the EU, but an important aim should be to train specialists who are capable of monitoring the health status of the population; analyzing the factors influencing it; exploring and priorising health needs and demands; drafting local, national and regional health policy; planning and organizing services to promote health; implementing and managing health-promoting and diseasepreventing actions and analyzing/evaluating the effectiveness of those services and interventions.