Health at a Glance: Europe

2305-6088 (online)
2305-607X (print)
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This biennial publication presents a set of key indicators of health status, determinants of health, health care resources and activities, quality of care, health expenditure and financing in 35 European countries, including the 27 European Union member states, 5 candidate countries and 3 EFTA countries. The selection of indicators is based largely on the European Community Health Indicators (ECHI) shortlist, a set of indicators that has been developed to guide the reporting of health statistics in the European Union.  It is complemented by additional indicators on health expenditure and quality of care, building on the OECD expertise in these areas. Each indicator is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, a brief descriptive analysis highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability.

Health at a Glance: Europe 2010

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01 Dec 2010
9789264090316 (PDF) ;9789264090309(print)

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This special edition of Health at a Glance focuses on health issues across the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland) and Turkey. It gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries. Its 42 indicators present comparable data covering a wide range of topics, including health status, risk factors,  health workforce and health expenditure.

Each indicator in the book is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicators and any limitations in data comparability. An annex provides additional information on the demographic and economic context within which health systems operate.   

This publication is the result of collaboration between the OECD and the European Commission, with the help of national data correspondents from the 31 countries.

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  • Foreword
    This first edition of Health at a Glance: Europe presents a set of key indicators on health and health systems across 31 countries – the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland), and Turkey. The selection of indicators is based on the European Community Health Indicators (ECHI) shortlist – a set of indicators used by the European Commission to guide the development of health information systems in Europe. In addition, the publication provides detailed information on health expenditure trends across countries, building on the OECD’s established expertise in this area.
  • Acronyms
  • Executive Summary
    European countries have achieved major gains in population health over recent decades. Life expectancy at birth in European Union (EU) countries has increased by six years since 1980, while premature mortality has reduced dramatically. Improvements in living and working conditions and in some health-related behaviours have contributed greatly to these longevity gains, but progress in medical care also deserves much credit. Health systems are of growing size and complexity in European countries, and spending on health care has never been higher, consuming an ever-increasing share of national income.
  • Résumé
    Les pays européens ont accompli d’importants progrès en matière de santé au cours des dernières décennies. Dans les pays de l’Union européenne, l’espérance de vie à la naissance a augmenté de six ans depuis 1980, tandis que la mortalité précoce a fortement reculé. Si l’amélioration des conditions de vie et de travail, ainsi que de certains comportements vis-à-vis de la santé, a joué un rôle majeur dans l’augmentation de la longévité, les progrès de la médecine doivent également être salués. Les systèmes de santé dans les pays européens occupent une place de plus en plus importante et les dépenses consacrées aux soins de santé n’ont jamais été aussi élevées, représentant une part croissante du revenu national.
  • Introduction
    Health at a Glance: Europe 2010 presents key indicators of health and health systems in 31 European countries, including the 27 European Union member states, three EFTA countries (Iceland, Norway and Switzerland), and Turkey. It builds on the format used in the OECD’s previous editions of Health at a Glance to provide comparable information on important public health issues in Europe. The indicators have been selected on the basis of the European Community Health Indicators (ECHI) shortlist (European Commission, 2010a; ECHIM, 2010). However, in some instances, this report deviates from the formal ECHI definitions because of issues related to data availability and comparability. Detailed information is also provided in this publication on health expenditure and financing trends, based on the OECD’s long-standing data collection in this area. All indicators are presented in the form of easy-to-read figures and explanatory text.
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  • Expand / Collapse Hide / Show all Abstracts Health Status

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    • Life Expectancy and Healthy Life Expectancy at Birth
      Life expectancy at birth continues to increase remarkably in EU countries, reflecting reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors, including rising living standards, improved lifestyle and better education, as well as greater access to quality health services. Other factors, such as better nutrition, sanitation and housing also play a role, particularly in countries with developing economies (OECD, 2004).
    • Life Expectancy and Healthy Life Expectancy at Age 65
      Life expectancy at age 65 has increased significantly among both women and men over the past several decades in all EU countries. Some of the factors explaining the gains in life expectancy at age 65 include advances in medical care combined with greater access to health care, healthier lifestyles and improved living conditions before and after people reach age 65.
    • Mortality from all Causes
      Mortality rates are one of the most common measures of population health. Statistics on deaths remain one of the most widely available and comparable sources of information on health. Registering deaths is compulsory in all European Union countries, and the data collected through the process of registration can be used by statistical and health authorities to monitor diseases and health status, and to plan health services. In order to compare levels of mortality across countries and over time, the data need to be aggregated in suitable ways and standardised for differences in age-structure.
    • Mortality from Heart Disease and Stroke
      Cardiovascular diseases are the main cause of mortality in almost all European Union countries, accounting for 40% of all deaths in the region in 2008. They cover a range of diseases related to the circulatory system, including ischemic heart disease (known as IHD, or heart attack) and cerebro-vascular disease (or stroke). Together, IHD and stroke comprise 60% of all cardiovascular deaths, and caused one-quarter of all deaths in EU countries in 2008.
    • Mortality from Cancer
      Cancer is the second leading cause of mortality in EU countries (after diseases of the circulatory system), accounting for 26% of all deaths in 2008. Cancer mortality rates for the total population were the lowest in Cyprus, Finland, Switzerland and Sweden, at under 150 deaths per 100 000 population. They were the highest in central and eastern European countries (Hungary, Poland, the Czech and Slovak Republics, Slovenia) and Denmark, above 200 deaths per 100 000 population.
    • Mortality from Transport Accidents
      Worldwide, an estimated 1.2 million people are killed in transport accidents each year, mostly due to road traffic accidents, and as many as 50 million people are injured or disabled (WHO, 2009b). In EU countries alone, they were responsible for approximately 48 000 deaths in 2008. In 2008, Italy, Poland, France and Germany each experienced around 5 000- 6 000 transport accident deaths.
    • Suicide
      The intentional killing of oneself is evidence not only of personal breakdown, but also of a deterioration of the social context in which an individual lives. Suicide may be the end-point of a number of different contributing factors. It is more likely to occur during crisis periods associated with divorce, alcohol and drug abuse, unemployment, clinical depression and other forms of mental illness. Because of this, suicide is often used as a proxy indicator of the mental health status of a population. However, the number of suicides in certain countries may be under-estimated because of the stigma that is associated with the act, or because of data issues associated with reporting criteria (see "Definitions and deviations").
    • Infant Mortality
      Infant mortality, the rate at which babies of less than one year of age die, reflects the effect of economic and social conditions on the health of mothers and newborns, as well as the quality of medical care and preventive services.
    • Infant Health
      Low birth weight – defined here as newborns weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004).
    • Self-Reported Health and Disability
      Most European countries conduct regular health surveys which allow respondents to report on different aspects of their health. A commonly-asked question relates to self-perceived health status, of the type: "How is your health in general?". Despite the subjective nature of this question, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (for instance, see Miilunpalo et al., 1997). For the purpose of international comparisons however, cross-country differences in perceived health status are difficult to interpret because responses may be affected by social and cultural factors.
    • Incidence of Selected Communicable Diseases
      Communicable diseases such as measles, pertussis and hepatitis B still pose a major threat to the health of European citizens. Measles, a highly infectious disease of the respiratory system, is caused by a virus. Symptoms include fever, cough, runny nose, red eyes and a characteristic rash. It can lead to severe health complications, including pneumonia, encephalitis, diarrhoea and blindness. Pertussis (or whooping cough) is also highly infectious, and is caused by the bacterium Bordetella pertussis. The disease derives its name from the sound made from the intake of air after a cough. Hepatitis B is an infection of the liver caused by the hepatitis B virus. The virus is transmitted by contact with blood or body fluids of an infected person. A small proportion of infections become chronic, and these people are at high risk of death from cancer or cirrhosis of the liver. Protection against each of these diseases is available through vaccination (see Indicator 3.3).
    • HIV/AIDS
      The first cases of Acquired Immunodeficiency Syndrome (AIDS) were diagnosed almost 30 years ago. The onset of AIDS is normally caused as a result of HIV (human immunodeficiency virus) infection and can manifest itself as any number of different diseases, such as pneumonia and tuberculosis, as the immune system is no longer able to defend the body. There is a time lag between HIV infection, AIDS diagnosis and death due to HIV infection, which can be any number of years depending on the treatment administered. Despite worldwide research, there is no cure currently available.
    • Cancer Incidence
      Around 2.4 million new cases of cancer (excluding non-melanoma skin cancers) were diagnosed in EU countries in 2008 (Ferlay et al., 2010), with 55% occurring among males and 45% among females. The most common forms of the disease were prostate, colorectal, breast and lung cancer. The risk of getting cancer before the age of 75 years is 26.5%, or around one in four. However, because the population of Europe is ageing, the rate of new cases of cancer is also expected to increase (European Commission, 2008b).
    • Diabetes Prevalence and Incidence
      Diabetes is a chronic metabolic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (type 1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (type 2 diabetes). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke if the disease is left undiagnosed or poorly controlled. They also have elevated risks for sight loss, foot and leg amputation due to damage to the nerves and blood vessels, and renal failure requiring dialysis or transplantation.
    • Dementia Prevalence
      Dementia describes a variety of brain disorders which progressively damage and destroy brain cells. Affecting mainly people over the age of 60 years, dementia results in the deterioration of mental ability characterised by impairments in memory and cognition. It is one of the most important causes of disability in the elderly. The most common cause of dementia in the European Union is Alzheimer’s disease (around 50-70%), followed by successive strokes that lead to multi-infarct dementia (around 30%). There is no cure for dementia, but drugs exist to alleviate and temporarily delay the symptoms.
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  • Expand / Collapse Hide / Show all Abstracts Determinants of Health

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    • Smoking and Alcohol Consumption among Children
      Regular smoking or excessive drinking in adolescence has both immediate and long-term health consequences. Children who establish smoking habits in early adolescence increase their risk of cardiovascular diseases, respiratory illnesses and cancer. They are also more likely to experiment with alcohol and other drugs. Alcohol misuse is itself associated with a range of social, physical and mental health problems, including depressive and anxiety disorders, obesity and accidental injury (Currie et al., 2008).
    • Nutrition among Children
      Nutrition is important for children’s development and long-term health. Eating fruit during adolescence, for example, in place of high-fat, sugar and salt products, can protect against health problems such as obesity, diabetes, and heart problems. Moreover, eating fruit when young can be habit forming, promoting healthy eating behaviours for later life.
    • Physical Activity among Children
      Undertaking physical activity in adolescence is beneficial for health, and can set standards for adult physical activity levels, thereby influencing health outcomes in later life. Research supports the role that physical activity in adolescence has in the prevention and treatment of a range of youth health issues including asthma, mental health, bone health and obesity. More direct links to adult health are found between physical activity in adolescence and its effect on overweight and obesity and related diseases, breast cancer rates and bone health in later life. The health effects of adolescent physical activity are sometimes dependent on the activity type, e.g. water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis (Hallal et al., 2006; Currie et al., 2008).
    • Overweight and Obesity among Children
      Children who are overweight or obese are at greater risk of poor health in adolescence and also in adulthood. Being overweight in childhood increases the risk of developing cardiovascular disease or diabetes, as well as related social and mental health problems. Excess weight problems in childhood are associated with an increased risk of being an obese adult, at which point certain forms of cancer, osteoarthritis, a reduced quality of life and premature death can be added to the list of health concerns (OECD, 2010c; Currie et al., 2008).
    • Supply of Fruit and Vegetables for Consumption
      Nutrition is an important determinant of health. Inadequate consumption of fruit and vegetables is one factor that can play a role in increased morbidity and premature death. A recent European Commission White Paper advocated increasing the consumption of fruit and vegetables as one of a number of tools to offset a worsening trend of poor diets and low physical activity. Proper nutrition assists in preventing a number of obesity-related chronic conditions, including cardiovascular disease, hypertension, type 2 diabetes, stroke, certain cancers, musculoskeletal disorders and a range of mental health conditions (European Commission, 2007).
    • Tobacco Consumption among Adults
      Tobacco is directly responsible for about one in ten adult deaths worldwide, equating to about 6 million deaths each year (Shafey et al., 2009). It is a major risk factor for at least two of the leading causes of premature mortality – circulatory diseases and a range of cancers. In addition, it is an important contributory factor for respiratory diseases, while smoking among pregnant women can lead to low birth weight and illnesses among infants. It remains the largest avoidable risk to health in EU countries.
    • Alcohol Consumption among Adults
      The global health burden related to excessive alcohol consumption, both in terms of morbidity and mortality, is considerable (Rehm et al., 2009; WHO, 2004). It is associated with numerous harmful health and social consequences. High alcohol intake increases the risk for heart, stroke and vascular diseases, as well as liver cirrhosis and certain cancers. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairments. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide, and is estimated to cause more than 2 million deaths annually.
    • Overweight and Obesity among Adults
      The growth in overweight and obesity rates among adults is a major public health concern. Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, respiratory problems (asthma), musculoskeletal diseases (arthritis) and some forms of cancer. Mortality also increases sharply once the overweight threshold is crossed (OECD, 2010c).
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  • Expand / Collapse Hide / Show all Abstracts Health Care Resources, Services and Outcomes

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    • Practising Physicians
      Access to high-quality services depends crucially on the size, skill mix, geographic distribution and productivity of the health workforce. Health workers, and in particular doctors and nurses, are the cornerstone of health systems.
    • Practising Nurses
      Nurses are usually the most numerous health profession, outnumbering physicians in most European countries. Nurses play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions but increasingly in primary care (especially in offering care to the chronically ill) and in patients’ homes. However, there are concerns in many countries about shortages of nurses, and these concerns may well intensify in the future as the demand for nurses continues to increase and the ageing of the "baby boom" generation precipitates a wave of retirements among nurses. These concerns have prompted many countries to increase the training of new nurses combined with efforts to increase retention rates in the profession (OECD, 2008b).
    • Childhood Vaccination Programmes
      Childhood vaccination continues to be one of the most cost-effective public health interventions. All European countries, or in some cases sub-national jurisdictions, have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine.
    • Influenza Vaccination for Older People
      Influenza is a common infectious disease worldwide and affects persons of all ages. Most people with the illness recover quickly, but elderly people and those with chronic medical conditions are at higher risk for complications and even death. For example, between 2000 and 2008, influenza along with other acute upper respiratory infections accounted for about 44 000 hospitalisations per year in France and 77 000 in Germany. The impact of influenza on the employed population is substantial, even though most influenza morbidity and mortality occurs among the elderly and those with chronic conditions (e.g. 85-90% of people who die from influenza in France and Germany are over 65 years of age).
    • Medical Technologies
      New medical technologies are improving diagnosis and treatment, but they are also increasing health spending. This section presents data on the availability and use of two diagnostic technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT scanners and MRI units help physicians diagnose a range of conditions by producing images of internal organs and structures of the body. Unlike conventional radiography and CT scanning, newer imaging technology used in MRI units do not expose patients to ionising radiation.
    • Hospital Beds
      The number of hospital beds provides an indication of the resources available for delivering services to in-patients in hospitals. This section presents data on the total number of hospital beds, including those allocated for curative, psychiatric, long-term and other types of care. It does not capture the capacity of hospitals to furnish same-day emergency or elective interventions.
    • Hospital Discharges
      Hospital discharges measure the number of people who need to stay overnight in a hospital each year. Together with the average length of stay, they are important indicators of hospital activities. Hospital activities are affected by a number of factors, including the demand for hospital services, the capacity of hospitals to treat patients, the ability of the primary care sector to prevent avoidable hospital admissions, and the availability of post-acute care settings to provide rehabilitative and long-term care services.
    • Average Length of Stay in Hospitals
      The average length of stay in hospitals is often regarded as an indicator of efficiency, since a shorter stay may reduce the cost per discharge and shift care from in-patient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also have adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a rising readmission rate, costs per episode of illness may fall little, or even rise.
    • Cardiac Procedures (Coronary Angioplasty)
      Heart diseases are a leading cause of hospitalisation and death in OECD countries (see Indicator 1.4). Coronary angioplasty is a revascularisation procedure that has revolutionised the treatment of ischemic heart diseases over the past twenty years. It involves the threading of a catheter with a balloon attached to the tip through the arterial system, usually started in the femoral artery in the leg, into the diseased coronary artery. The balloon is inflated to distend the coronary artery at the point of obstruction. The placement of a stent to keep the artery open accompanies the majority of angioplasties. Drug-eluting stents (a stent that gradually releases drugs) are increasingly being used to stem the growth of scar-like tissue surrounding the stent.
    • Cataract Surgeries
      In the past 20 years, the number of surgical procedures carried out on a day care basis has steadily grown in European countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions, and better anaesthetics have made this development possible. These innovations have improved effectiveness and patient safety. They also help to reduce the unit cost of interventions by shortening the length of stay. However, the overall impact on cost depends on the extent to which any greater use of these procedures may be offset by a reduction in unit cost, taking into account the cost of post-acute care and community health services.
    • Hip And Knee Replacement
      Significant advancements in surgical treatment have provided effective options to reduce the pain and disability associated with certain musculoskeletal conditions. Joint replacement surgery (hip and knee replacement) is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to near normal function.
    • Screening, Survival and Mortality for Cervical Cancer
      Cervical cancer is largely preventable. Screening by regular pelvic exam and pap smears can identify premalignant lesions, which can be effectively treated before the occurrence of the cancer. Regular screening also increases the probability of diagnosing early stages of the cancer and improving survival. Consequently, the Council of the European Union and the European Commission promote population based cancer screening programmes among member states (European Union, 2003; European Commission, 2008c) and European countries have instituted screening programmes with specific periodicity and target groups. In addition, promising cancer preventing vaccines have been developed based on the discovery that cervical cancer is caused by sexual transmission of certain forms of the Human Papilloma Virus. The efficacy and safety of those vaccines is now well established, but debates about cost-effectiveness and the implications of vaccination programmes for teenagers for a sexually transmitted disease continue in a number of countries (Huang, 2008).
    • Screening, Survival and Mortality for Breast Cancer
      Breast cancer is the most common form of cancer among women in all EU countries, accounting for 31% of cancer incidence, and 17% of cancer deaths among women in 2008 (see Indicator 1.5). Overall spending for breast cancer care typically amounts to about 0.5-0.6% of total health care expenditure (OECD, 2003).
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  • Expand / Collapse Hide / Show all Abstracts Health Expenditure and Financing

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    • Health Expenditure Per Capita
      In 2008, Norway recorded the highest spending per person on health goods and services among European countries at about EUR 4 300 (Figure 4.1.1) – almost twice the average of European Union countries. This was nonetheless far below the health spending per capita in the United States. Switzerland, Luxembourg and Austria were the next highest spending countries in Europe. Most northern and western European countries spent between EUR PPP 2 500 and 3 500 per person, that is, between 10% and 60% more than the EU average. Those countries spending below the EU average are eastern and southern European countries such as Turkey, Romania, Bulgaria, Poland and Hungary.
    • Health Expenditure In Relation To GDP
      In 2008, European Union countries devoted 8.3% of their GDP on average to health spending (Figure 4.2.1), up from 7.3% in 1998. The ratio of health spending to GDP among European countries in 2008 ranged from around 6% in Cyprus and Romania to more than 11% of GDP in France (Figure 4.2.1). This compares with 16% in the United States. Of the other European countries, Switzerland, Austria, Germany and Belgium all allocated more than 10% of their national economies to health spending.
    • Health Expenditure By Function
      The allocation of health spending across the different types of health services and goods is influenced by a range of factors, including the availability of resources such as hospital beds, physicians and access to new technology, the financial and institutional arrangements for health care delivery, as well as by national clinical guidelines and the disease burden within a country.
    • Pharmaceutical Expenditure
      Spending on pharmaceuticals account for a significant proportion of total health spending in European countries. Increased consumption of pharmaceuticals due to the introduction of new drugs and the ageing of populations has been an important factor contributing to increased overall heath expenditure (OECD, 2008a). However, the relationship between pharmaceutical spending and total health spending is a complex one, in that increased expenditure on pharmaceuticals to tackle diseases may reduce the need for costly hospitalisation and intervention now or in the future.
    • Financing of Health Care
      All European countries use a mix of public and private financing of health care, but to differing degrees. Public financing is confined to government revenues in countries where central and/or local governments are primarily responsible for financing health services directly (e.g. Sweden and the United Kingdom). It consists of both general government revenues and social contributions in countries with social insurance based-funding (e.g. France and Germany). Private financing, on the other hand, covers households’ out-of-pocket payments (either direct or as co-payments), third-party payment arrangements effected through various forms of private health insurance, health services such as occupational health care directly provided by employers, and other direct benefits provided by charities and the like.
    • Trade in Health Services
      The trend towards globalisation, reinforced by the relaxation of regulatory obstacles in Europe, has fuelled a steady growth in international trade in health services in recent years, albeit from relatively low levels. However, despite much attention from health analysts, the medical professions and health policy makers, discussions on the opportunities and challenges related to such trade have so far been conducted with relatively little data to inform them.
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