Social determinants of health: Health disparities in emerging democracies of Eastern Europe

Background: Twenty years ago the change from communism to capitalism in the emerging Democracies of Eastern Europe had a profound impact on the social determinants of health for vulnerable populations in this region. The social determinants of health include nine factors that interact: income inequality, social inclusion and exclusion, employment, working conditions, the social economy, early childhood care, education, food security, and housing. Objectives: Through an analysis of field notes and literature this paper will 1) examine social factors that impact health in emerging democracies, 2) identify vulnerable populations, and 3) discuss the implications for public health and implications for other nations. Methods: Field notes gathered during a visit to three Eastern European countries during 2008 and data from the literature are used to explore the social determinants of health in these countries. Field notes are based on observations and interviews gathered during visits with NGOs, homes for elderly, shelters for homeless, a school for Roma children and a representative of Parliament. Results identify three vulnerable groups: the elderly, the mentally ill and social minorities, especially the Roma people. Poverty and social exclusion resulted in homelessness, unemployment, untreated health problems and limited access to education. Conclusions show that major changes in economic and political systems without planning for the social factors that determine health can have a significant impact on the health and well-being of vulnerable populations. The lessons learned may be useful for policy makers and public health planners during periods of changing social and economic conditions, and for developing public health policy and services to impact the social determinants of health. Public health nurses in many countries who are faced with ever growing health inequities can be aided by examination of the social determinants of health. These social and economic factors are the genesis of health disparities and that create barriers to the vision of “Health for All”.