We carried out the initial survey in 1983, starting with a cohort of 6,000 people. This was increased to 24,000 in 1988, and it was 12,600 in both 1995 and 2000, and then roughly 5,000 in 2006. Everyone was interviewed for at least an hour and was presented a questionnaire. This helped us to examine the correlations between social status, lifestyle and various psychological and health factors. My husband was trained as a computer engineer before he turned to sociology, so we were among the first to carry out detailed statistical analyses on computer databases covering large samples, which is the reason we were quick to get results that could be evaluated quantitatively. Over the intervening years, behavioural scientists have corroborated this unexpected and disturbing finding in other countries of the Central and East European region and initiated their own research programmes at one centre after another. It is nowadays accepted that one may justifiably speak about this as an East and Central European health paradox.

But is it not natural that, at a relatively high level of modernisation, with growing standards of living, one should find a slowing down or halt in the trend of improving general health and increasing average life expectancy? Isn't the explanation explanation that the countries of East and Central Europe have reached that stage in recent decades?

No, that's precisely why it is a paradox. What has occurred in this region is the exact opposite to what is found everywhere else in the world. Now, it's true that once you reach a certain level of development, it is not quite so clear-cut that health indicators will improve in step with improvements in economic conditions. In the USA the health indicators are relatively poor, especially in those states where there are particularly large differences within society. But, interestingly, this is seen not just among the more disadvantaged but also among the best-off. Even then, however, the correlation still holds that health indicators get better in some respects as living standards improve. What has happened in Hungary and in the non-Muslim states of the former Soviet Union is precisely the opposite: from the 1960s until the mid-1990s there was a fall in the mean life expectancy of males, while at the same time-in Hungary up until 1988-89-the economic position of the population as a whole was improving. Everywhere in the former Soviet bloc, then, the correlation went into reverse. That is to say, the positive change that was occurring in regard to living standards was leading to negative consequences for middle-aged men in particular.

How widespread is this in the region?

The same was observable among Poles, Czechs and Romanians, but it was in Hungary that the process reversed the earliest, switching from improvement to deterioration, and it is in Hungary too where it went the furthest, and the country's mortality rates are still very bad. The only reason that we cannot "boast" about having the very worst indicators is that far more worrisome processes have kicked in, after a slight time lag, among the Russians, the Ukrainians and in the three Baltic states. Still, it is a shocking fact that according to the latest data from the Central Statistical Office, more men in the 50-65-year age group are dying annually today in Hungary than in 1930.

That was at the very beginning of the Great Depression. Is the trend holding, are things still getting worse?

The deterioration was especially severe until the mid-Nineties; since then a slight improvement has been detected, but we are still not back where we were in the 1930s. In other words, in absolute terms, more men are dying today, and only about 60 per cent of men are reaching the age of sixtyfive. Among the less skilled, the figure is even worse, barely 50 per cent; one in two of them dies before he is sixty-five.

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Mortality rates among women are much better. Eighty out of every hundred women now reach their sixty-fifth birthday. Even here, though, there is little cause for rejoicing. If we compare ourselves to neighbouring Austria, for example, during the Sixties the mortality rates there were worse than in Hungary but now they are far better. There 82 per cent of men reach the age of sixty-five, for women the figure is not far off 100 per cent. The worsening trend was also perceptible in most of the other former socialist countries during the Nineties, but their indicators are now improving. The exception is Russia itself, where they are still a good deal worse than here, though quite how bad we don't know because of the unreliability of earlier statistics.

To what degree is the Hungarian average pulled down by the growth in its very poor, low-skilled and predominantly Roma population, or by widening differences in wealth and income?

The correlation is clear, and it does not apply just to the Roma. Our research shows that the health indicators are as bad as they are, not because of any ethnic factor but because of the huge educational handicaps the Roma face. This is an area, incidentally, in which there has been a particularly big change. Mortality statistics showed that higher educational attainment conferred no advantage in the Sixties-one had the same probability of dying prematurely; indeed, being better qualified was often a distinct disadvantage. Today anyone who has not completed their secondary school education is twice as likely to die before the age of sixty-five as someone who has passed the school-leaving exams.

We have found that the decisive factor is chronic stress, encountered when someone feels unable to overcome problems, to find a role. That is intriguing, because having to face major challenges, to overcome

difficult circumstances, is not harmful in itself; we actually need these impulses both physically and mentally.

But only if we are able to cope.

Yes, and that may be the reason for the relative protection enjoyed by the more highly qualified: they are able to meet challenges that loom as insurmountable obstacles for someone unqualified. Nowadays, the mental state that accompanies the threat of unemployment plays a decisive role in premature death, but it is much less of a threat to a more highly qualified person than to someone who is less skilled. The real question here is why is the same threat a lesser risk factor for women? Why does it not have such severe consequences for their health?

Is the absence of qualifications a risk factor for them too?

We have been looking into that over recent years. There is no question that higher educational qualifications also offer women a degree of protection, but the correlation is much less marked than for men. When it comes to mortality due to malignant tumours, the position is actually reversed: higher educational qualifications actually put women at greater risk of dying prematurely because of these illnesses. But this only holds for women, and only for deaths due to certain kinds of tumours.

Has any explanation been found?

We started a special project in our Institute to examine gender-dependent differences. We came to the conclusion that the expectation that women should fulfil multiple roles, and the chronic stress associated with this, can lead to increased demands on the immune system and that heightens the risk of certain malignant tumours.

Does that correlation hold for cardiovascular diseases?

No.

Even though it is the leading cause of mortality among men?

Yes, but with cardiovascular diseases there is no question that higher qualifications mean better protection, and more so for men than for women. One of the teams at the Institute has obtained a very intriguing finding in this regard: the mortality rates from cardiovascular diseases among women doing "men's jobs" is very close to that of men.

Then let's look at the possible reasons for the differences between men and women in terms of health status and mortality rates.

The chief reason seems to be that Hungarian society is still tradition-bound. Men feel that the responsibility for their family's standard of living is theirs alone, even though the wife is generally also employed. Indeed, these days it is the woman who usually pulls the family out of a sticky situation should the husband be laid off work. However, that sense of responsibility seriously threatens men and is a factor inducing chronic stress.

Is that not the case in other countries?

Not everywhere. In Norway, for example, Dr Gro Harlem Brundtland, who was the country's first woman prime minister and who went on to be Director-General of the World Health Organization, brought in equal rights legislation which has had the effect of increasing life expectancy not only for women but also for men. In Norway there is no difference between men and women in risks attributable to levels of education, perhaps because men there are taking on many of the far more variegated and richer tasks that women used to do. In Hungary it is the other way round: many women seek to be more "male" than the men, and that may explain the paradox. Our studies have demonstrated that the average Hungarian male perceives anyone else's success, including that of his friends, as a sign of his own failure. For him, rivalry is a further major risk factor.

Do women compete less?

Women compete every bit as much and yet they don't make themselves ill or kill themselves on that account, because they don't take things so much to heart-and I mean that quite literally. In their case a considerable protective factor lies in the fact that their self-esteem is not determined solely by their career, financial success or social recognition; women operate in a much richer social context. For them social contacts are more important, to give just one example, and they are much better at them- though that in itself, like the differences in male and female scales of values, is a consequence of social expectations.

I read in one interview you gave that for women social networking, gossiping for example, may also be a protective factor.

Yes, women are able to pour their hearts out, to share their feelings with others. The same cannot be said generally of Hungarian men, unlike southern European males, who enjoy much better health indicators than might be expected on the basis of their economic situation-one might term this the South-European health paradox. This probably has something to do with their lifestyle: in Mediterranean countries the menfolk sit outside on a café terrace, chatting and arguing. In Hungary, sadly, a man only starts talking when he has had a lot to drink, flops onto a friend's shoulder and loosens his tongue. Acquired inhibitions are themselves risk factors.