Costs and benefits are vulnerable to changes

Health inequities and the human and economic costs associated with them are projected to increase due to the current financial crisis, the impact of new trade agreements, globalization and commercialization of health services. During the 1990s, many countries in eastern Europe and central Asia witnessed increases in poverty at unparalleled speed (World Bank, 2005a). Since 1999, nearly 90 million of the 480 million people in eastern Europe and central Asia – about 18 percent of the population – have moved out of poverty and vulnerability. These gains are at risk as a result of the financial crisis. Today, almost 40 percent of the 480 million people in eastern Europe and central Asia are still considered poor or vulnerable. This number is expected to increase by about 5 million people for every 1 percent decline in GDP. By the end of 2009, poverty and vulnerability is expected to rise by 5 percent – 25 million more poor or vulnerable. And this is likely to increase by an additional 10 million by the end of 2010 (World Bank, 2009b). Countries in eastern Europe and central Asia that entered the global crisis with weaker macroeconomic fundamentals are at risk of being most severely hit by the financial crisis, with average growth in the region in 2009 now projected to be negative (World Bank, 2009a).

The past 25 years of intensified global market integration have seen a slowdown or reversal in health improvements, and growing health inequalities. In the WHO European Region this has been felt most strongly in the transition economies (a loss of 1.42 LEB) and the former Soviet Republics (with a loss of 3.57 LEB) due to a marked recession, rising inequality and volatility and the collapse of public institutions and safety nets which was compounded by lack of access to improvements afforded by health technology (GKN 2008).

Health sector reform that views private provision of health care and the purchase of health care or health insurance on the open market as the normative baseline has mostly resulted in increased commercialization of services, inequity of health care access and increasingly fragmented and ineffective health systems (GKN 2008).

Analysis of data from nearly 80 countries undertaken by WHO shows that, every year, more than 150 million individuals in 44 million households face financial catastrophe as a direct result of having to pay for health care (Xu et al. 2005). In Europe, catastrophic health expenditures threaten to impoverish households  and, estimates suggest, will increase the size of the poor population by 3–9% (Habicht et al., 2006; Suhrcke et al., 2007; Xu et al., 2009). Current trends towards commercialization are projected to make things worse.