The shift to free-market capitalism has
left the health of older Hungarians in a very
precarious state. Paul N Casgoly reports.

Bela is a homeless 66-year-old man living among the benches of a city park. His acute lung cancer will almost certainly end his life within three years. He doesn’t mind much. He doesn’t think anybody cares about him anymore, aside from the other alcoholics in the park who share cheap local wine and cigarettes with him.

The life of Attila, 58, has also just been threatened with a recent diagnosis of cardiovascular disease. Unlike Bela, however, he does care. His wife and three kids depend on him for support. If he dies, he feels he will have failed them.

Bela and Attila are only two of the many victims of the country with the lowest life expectancy in all of Western and Central Europe – Hungary – especially for males between 40 and 60 years of age. The life expectancy of Hungarian males in 1999 was 66 years. The mortality rates (chances of dying) for Hungarian males aged 40-59 years rose by 45 per cent from 1970 to 1997.

Hungary has the highest rates of cancer for men and women in all of Europe in the following categories: all malignant tumors combined, bronchus and lung cancer, breast cancer and female brain cancer. Cancer rates for men rose 28 per cent from 1980 to 1998; for women the rise was 19 per cent. The leading cause of death in Hungary, cardiovascular heart disease, has fared no better, with related mortality rates some 55 per cent above the European Union’s average in 1996 and mortality rates from ischaemic heart disease the highest in Central and Eastern Europe.

A key to understanding why this is so is the experience of economic transition and the powerful effects of globalization. Hungary, along with many of its former Communist Central European neighbours, was quick to dismantle its former system of trade ties and barriers in an attempt to compete for Western markets. As a result, numerous former state-owned companies went bankrupt, leaving countless middle-aged men such as Attila – an engineer by profession – unemployed.

It took years for Attila to recover. Using his small savings he retrained, selling warehouses on a commission basis. He also took on a night job driving a taxi. With inflation high and income small Attila’s working hours increased, as did the stress. That same stress has hit many middle-aged family men ill-prepared to compete in a market favouring the young.

Chris Stowers / Panos Pictures

Transition has also led to the evolution of a new and ever-expanding army of unemployed, garbage-picking, stressed-out, homeless men like Bela.

‘Stress-related disorders are known to wear down the body’s immunity system, especially the central nervous system, leaving it a target for disease – especially cancers and heart disease,’ according to Dr Bela Lelkes, a Budapest surgeon. For urbanites in Budapest, increased pollution from traffic hasn’t helped either.

The system has yet to deal effectively with non-communicable diseases such as those caused by stress. Dr Barnabas, a chief medical officer and surgeon for over 25 years, does not have adequate resources from the state to do his job. ‘The state does not fund tests for prostate cancer,’ he says. As a result he often finds cancers in their later stages which end up costing the state much more in treatment and give patients shorter lives and more discomfort. In response, Dr Barnabas has created his own foundation to raise funds externally – mainly from drug companies and individuals. ‘It will cost about $33,000 to test the whole district – about the same as treating eight cancer patients,’ he says.

Another part of the problem is Hungarian society itself. Urban Hungary has traditionally been a very hierarchical society, where strict rules and discipline called for uncritical loyalty to those ‘above’ – parents, teachers, priests, employers or leaders. But those ‘above’ were often known to be unfair and over-demanding, giving little support and encouragement and adding to the stress of those ‘below’. Mutual co-operation has never been a main Hungarian characteristic. Neither has racial tolerance, especially towards gypsies (or Roma) who, in Hungary, have a life expectancy ten years lower than the rest of the population according to the World Health Organization.

Of course, Communism took hierarchical structures to a new extreme. But Hungarian history is full of tragic stories where the lives of ordinary citizens were lost or shattered in countless invasions and wars, including failed revolutions against the Hapsburgs and the Soviets, and major losses during the Holocaust. The result has often been cynicism and a turning-in of emotion, which can lead to manic-depressive behaviour and major stress. A self-abusing release through heavy drinking and smoking often follows; death from chronic liver diseases and cirrhosis was over four times the 1996 European Union average. When alcohol fails, many Hungarians traditionally turn to suicide, as did some of their greatest heroes. Hungary’s suicide rate is also among the highest in the world.

Then there’s poor lifestyle. The Hungarian diet is heavy on sweets and fat and low on vegetables and grains. A dinner of liquor, beer, pork fried in fat, potatoes, and chocolate-filled pancakes is common. Nor do many Hungarians regularly exercise, with only 21 per cent of males and 14 per cent of females engaging in regular physical exercise.

Sadly, the poor health of individuals is taking a great toll on the nation. As cancers, heart and liver disease and suicides send more Hungarians to their graves, there are also fewer children being born. Divorces and abortions are at a phenomenal level and live births dropped by almost 36 per cent between 1980 and 1999, causing the population to fall from 10.7 million to 10 million. By 1999, the annual natural decrease was nearly 50,000 people.

Are things better or worse than they were before transition? True, under Communism everyone benefited somewhat. But the old system also privileged some over others. And stress came from lack of personal freedom. Under capitalism only the fittest survive, the fittest being the younger generation. ‘Those who did well before the changes are also doing fantastically now,’ says Dr Barnabas. He adds soberly that he would never wish Communism back, but that the cost of transition is two generations at least who will suffer.

Perhaps. But maybe transition didn’t have to come so fast. The fittest could have been more sympathetic. Stress could have been reduced. Deaths could be fewer. And relationships and children could be more important. As for incoming economic globalization, it has its own foundations in Adam Smith’s age-old law – that every individual working solely on their own behalf will benefit all. In Hungary, this does not yet seem to be the case. It may never be.

writes on environmental and health matters from Budapest. casgoly@mail.datanet.hu