Indicators of avoidable mortality can provide a general “starting point” to assess the effectiveness of public health and health care systems in reducing deaths before 75 years of age from various diseases and injuries. However, further analysis is required to assess more precisely different causes of potentially avoidable deaths and interventions to reduce them.

All EU countries have established childhood vaccination programmes to reduce the spread of many infectious diseases and related deaths, although the number and type of compulsory or recommended vaccines vary to some extent across countries.

Depending on the year, seasonal influenza affects between 4 and 50 million people across EU countries, Iceland, Norway, Switzerland and the United Kingdom, and 15 000 to 70 000 people die every year of causes associated with influenza (ECDC, 2020). Older people are at higher risk of serious complications and death from influenza. With the new coronavirus, older people will face an increased risk of viral infection during the 2020/21 winter season. Although influenza vaccination is never fully effective in preventing all influenza viruses that may spread in a given year, it does offer protection and can effectively reduce the burden of seasonal influenza.

Promoting more people-centred care has become a growing priority across EU countries in recent years to improve the quality of care and the responsiveness to patients’ expectations. This has been accompanied by national and European efforts to develop and implement patient-reported experience measures (PREMs) and patient-reported outcomes measures (PROMs) to monitor progress for individual providers and at the national level. For example, Norway collects patient-reported measures through regular surveys and reports them at a provider level to inform the public on patient-reported provider performance and to increase accountability. The United Kingdom has been reporting PREMs at a provider level since 2002 for hospitals and since 2004 for GP practices (Fujisawa and KIazinga, 2017; OECD, 2020).

Asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes are four widely prevalent long-term conditions. About 30 million children and adults under 45 years of age in Europe have asthma, and 5‑10% of adults over age 40 have COPD (European Respiratory Society, 2020), It is estimated that more than 15 million people are affected by CHF (European Heart Network, 2019). And about 32 million adults have been diagnosed with diabetes in the EU (IDF, 2019). Common to all these four conditions is the fact that the evidence base for effective treatment is well established, and much of it can be delivered in primary care. Primary care is expected to serve as the first point of contact for people in health systems and to provide continuous and coordinated care over time, notably for people having chronic diseases. A well-performing primary care system should therefore reduce acute deterioration in people living with chronic conditions like asthma, COPD, CHF or diabetes, thereby preventing costly avoidable hospital admissions (OECD, 2020).

Mortality due to coronary heart diseases has declined substantially over the past few decades (see indicator “Mortality from circulatory diseases” in Chapter 3). Reductions in smoking (see indicator “Smoking among adults” in Chapter 4) and improvements in treatment for heart diseases have contributed to these declines. Despite this progress, acute myocardial infarction (AMI or heart attack) remains the leading cause of cardiovascular deaths in Europe, highlighting the need for further reductions in risk factors and care quality improvements (OECD/The King’s Fund, 2020).

Stroke is the second leading cause of death after heart disease in Europe (see the indicator “Mortality from circulatory diseases” in Chapter 3). Across EU countries, stroke accounted for 375 000 deaths in 2017, and the number is expected to rise by one‑third by 2035 due to population ageing and increases in some risk factors (OECD/The King’s Fund, 2020). Of the two types of stroke, about 85% are ischaemic (caused by clotting) and 15% are haemorrhagic (caused by bleeding).

Hip fractures are common health problems and causes of hospitalisation among older people, often related to falls and the loss of skeletal strength from osteoporosis. With increasing life expectancy, hip fractures will likely have an even greater public health impact in the coming years.

Breast cancer is the most frequent cancer among women in Europe, and it is expected that more than 355 000 new cases will be diagnosed in the EU in 2020 (see indicator “Cancer incidence and mortality” in Chapter 3). The main risk factors for breast cancer are age, genetic predisposition, estrogen replacement therapy, and lifestyle factors including obesity, physical inactivity, nutrition habits and alcohol consumption.

In Europe, lung cancer is the second most commonly diagnosed form of cancer after prostate cancer among men, and the third most common cancer after breast and colorectal cancer among women. In 2020, about 320 000 people in EU countries are expected to be newly diagnosed with lung cancer, and it is expected to continue to be the leading cause of cancer death with over 257 000 deaths across the EU (JRC, 2020). The main risk factors for lung cancer are tobacco smoking and environmental factors, particularly air pollution.

Colorectal cancer is the third most common cause of cancer death after prostate and lung cancers among men, and the second most common cause after breast cancer among women. It is estimated that about 190 000 men and 150 000 women will be diagnosed with colorectal cancer in the EU in 2020, and 156 000 people will die from it (see indicator “Mortality from cancer” in Chapter 3; JRC, 2020). The main risk factors for colorectal cancer include age; ulcerative colitis; a personal or family history of colorectal cancer or polyps; lifestyle factors, such as a diet high in fat and low in fibre, physical inactivity, obesity, tobacco and alcohol consumption.

The ECDC estimates that 3.1‑4.6 million people acquire a health care-associated infection (HAI) each year in acute care hospitals in EU countries, Iceland, Norway and the United Kingdom (Suetens et al., 2018). HAIs can lead to significant increases in patient morbidity, mortality and cost for the health system. More than 90 000 people die each year in EU countries, Iceland, Norway and the United Kingdom due to the six most common infections in health care settings (Cassini, 2016). HAIs are the single most deadly and costly adverse event, representing up to 6% of public hospital budgets (Slawomirski et al, 2018).

The safety and adequacy of prescribing guidelines and practices can be analysed to develop indicators of health care quality, supplementing consumption and expenditure information (see indicator “Pharmaceutical expenditure” in Chapter 5). The overuse, underuse or misuse of prescription medicines can cause significant hazards to health and lead to wasteful expenditure (OECD, 2017). These risks apply notably to the use of antibiotics, opioids and benzodiazepines.