Is east-west life expectancy gap narrowing in the enlarged European Union?

The fall of the Berlin Wall in 1990 and EU enlargement in 2004 are two major political events in the recent history of the Central and Eastern European region. By systematically comparing the changes and differences in life expectancy at birth between the seven new member countries from Central and Eastern Europe and more advanced countries of the EU-15, this article attempts to identify the vanguards and laggards in the health convergence process before and after the 2004 EU enlargement. The results of decomposition analysis highlight the changing patterns of age- and cause-specific contributions to the differences in life expectancy. Finally, we focus on the variations in the progress in reducing the burden of cardiovascular diseases and external causes of death, which were known to be responsible for the long-term mortality crisis during the period of communist rule. Our findings suggest that the collapse of the communist regimes led to immediate positive changes in the Central European countries. At the same time, health disadvantages persisted and even worsened in the Baltic countries. Later on, joining the EU in 2004 was not accompanied by immediate systematic convergence of life expectancy. However, very rapid progress in the initially worst performing Baltic countries after 2007 and especially during the 2010s, may suggest a delayed positive impact of EU enlargement leading to decreasing longevity disadvantage. The convergence process after 2004 was generally slower in the initially better-performing four Central European countries. Despite these country-specific variations, Czechia, Poland, and, especially, Estonia remain clear health vanguards in the region. Further progress requires much more systematic efforts to combat cardiovascular diseases and the persisting burden of excess male mortality at adult working ages.