Public-health experts caution that the widening of the EU could have adverse effects on public health

Public-health experts writing in this week's issue of THE LANCET caution that the widening of the European Union (EU) to the east could have potentially adverse effects on public health-both for the new member countries, many of whom have poor health-care infrastructure, and for existing EU members.

In May, 2004, ten new member states (Slovenia, Hungary, Slovakia, Czech Republic, Poland, Lithuania, Latvia, Estonia, Cyprus, and Malta) will join the European Union. Eight of these are former communist countries in central and eastern Europe; the new frontier will be made up by Ukraine, Belarus, and a longer Russian border.

Richard Coker from the London School of Hygiene and Tropical Medicine, UK, and colleagues discuss three pertinent issues relevant to public health: the factors that have contributed to the growth of communicable disease in Russia, Ukraine, and Belarus; how public health systems have responded to these challenges; and the implications for the EU as a whole. Since the break-up of the Soviet Union, Russia, Ukraine, and Belarus have witnessed substantial political, social, and economic changes. These events have been reflected in changes in the epidemiology of communicable diseases, including tuberculosis and HIV.

Dr Coker comments: "The changing patterns of communicable diseases east of the EU's new border has implications for how the EU aids the strengthening of public health systems east of the new frontier. Transborder spread of communicable diseases also challenges communicable disease control systems within the EU. Concerted action is needed by member states and the EU, building on models of cooperation between institutions that have been successful in areas beyond health, if public health systems are to meet the emerging challenges to communicable disease control".

In an accompanying Commentary (p 1339) David N Durrheim and Rick Speare from James Cook University, Townsville, Australia, state that a global response is required to strengthen health systems and to prevent the spread of communicable diseases across nations. Dr Durrheim concludes: "Investments in improving communicable disease surveillance and response capacity are certainly required beyond the leading eastern edge of the expanded EU, and must extend to all developing countries with poor sub-national capacity".