Adverse health effects of effort-reward imbalance - Applying the model to Eastern Europe

This article develops a conceptual framework to explain excess morbidity and mortality in midlife in Central and Eastern European countries. It focuses on prolonged stressful experience and addictive behavior following states of "social reward deficiency." Social reward deficiency is associated with failures to acquire or successfully act through core social roles in adult life, in particular the work role, the marital and family role, and civic roles. The deficiency also applies to confinement to roles where social reciprocity is violated (the model of effort-reward imbalance). Empirical evidence supporting this conceptual framework is presented, and prospects and limitations of applying this framework to trends in population health in Central and Eastern Europe are discussed.