Objective and subjective determinants of self-rated health in Central and Eastern Europe: a multilevel approach.

Objectives: Determinants of health in Central and Eastern Europe (CEE) have been discussed primarily in relation to the transition of the 1990's and early 2000's, citing lifestyles as the main culprit. This paper tries to draw a bigger picture of the health determinants in CEE in the first decade of the 21st century. To do so, the two main analytical approaches to health are united in one setting. One of them is based on the definition of health as a personal commodity relying mostly on micro-level subjective data. The other views health as a public commodity analysing objective societal characteristics and health care interventions with often a macro-level perspective. The current study incorporates these different approaches (subjective and objective) in a multi-level setting in CEE. Methods: The analysis concentrates on health care, social, political, and economic factors as determinants of self-rated health. Multilevel analysis is carried out on a dataset of Life in Transition Survey (LiTS), conducted in 2006 and 2010, pooled cross-sectional data on 46,546 individuals in 27 CEE states. They are accompanied by macro-level data. Results: The findings demonstrate that a complex mix of determinants influences subjective health in CEE. There are clear differences in the way objective and subjective indicators influence self-rated health. While societal economic prosperity does not influence health, there are strong country-specific differences in the effect of individual prosperity on health. Conclusions: The study adds to the recent literature on health in CEE by introducing an encompassing systematic approach to analysing health, as no leading cause for self-rated health variation was found. This paper also contributes to research on the determinants of health by fusing objective and subjective determinants in a hierarchical setting. Both subjective and objective determinants matter for health.