Health At A Glance: Europe 2016 - European Commission
Health at a Glance:Europe 2016STATE OF HEALTH IN THE EU CYCLE
Health at a Glance: Europe2016STATE OF HEALTH IN THE EU CYCLE
This work is published under the responsibility of the Secretary-General of the OECD. Thispublication has been produced with the financial and substantive assistance of theEuropean Union. The contents of this report are the sole responsibility of the OECD and canin no way be taken to reflect the views of the European Union.This document and any map included herein are without prejudice to the status of orsovereignty over any territory, to the delimitation of international frontiers and boundariesand to the name of any territory, city or area.Please cite this publication as:OECD/EU (2016), Health at a Glance: Europe 2016 – State of Health in the EU Cycle, OECD Publishing, BN 978-92-64-26558-5 (print)ISBN 978-92-64-26559-2 (PDF)ISBN 978-92-64-26564-6 (epub)Series: Health at a Glance: EuropeISSN 2305-607X (print)ISSN 2305-6088 (online)European UnionISBN 978-92-79-63142-9 (print)ISBN 978-92-79-63142-9 (PDF)Catalogue number: EW-01-16-980-EN-C (print)Catalogue number: EW-01-16-980-EN-N (PDF)Note by Turkey: The information in this document with reference to Cyprus relates to the southern part of the Island.There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey recognises theTurkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of theUnited Nations, Turkey shall preserve its position concerning the Cyprus issue.Note by all the European Union Member States of the OECD and the European Union: The Republic of Cyprus is recognisedby all members of the United Nations with the exception of Turkey. The information in this document relates to thearea under the effective control of the Government of the Republic of Cyprus.Photo credits: Cover wavebreakmedia/Shutterstock.com; goodluz/Shutterstock.com; Monkey BusinessImages/Shutterstock.com.Corrigenda to OECD publications may be found on line at: www.oecd.org/about/publishing/corrigenda.htm. OECD/European Union 2016You can copy, download or print OECD content for your own use, and you can include excerpts from OECD publications, databases andmultimedia products in your own documents, presentations, blogs, websites and teaching materials, provided that suitableacknowledgement of OECD as source and copyright owner is given. All requests for public or commercial use and translation rights shouldbe submitted to rights@oecd.org. Requests for permission to photocopy portions of this material for public or commercial use shall beaddressed directly to the Copyright Clearance Center (CCC) at info@copyright.com or the Centre français d’exploitation du droit de copie (CFC)at contact@cfcopies.com.
FOREWORDForewordEnsuring universal access to quality care demands greater efforts to improve the effectiveness, accessibilityand resilience of health systems in all EU countries. This new edition of Health at a Glance: Europe stressesthat more should be done to improve the health of populations in EU countries and, in particular, to reduceinequalities in access and quality of services. This is necessary to achieve more inclusive economic growth andto deliver on the Sustainable Development Goals (SDGs), in particular SDG 3 to ensure healthy lives andpromote well-being for all at all ages.We need more effective health systems. Policy action is needed to reduce the number of people dyingprematurely and increase the number of years that people live in good health. Public health policies and thequality of care have undoubtedly improved over the past two decades, contributing to steady gains in lifeexpectancy. In most EU countries, people can now expect to live beyond the age of 80, a gain of six years onaverage since the early 1990s. Moreover, the proportion of people dying after being admitted to hospital after aheart attack has dropped by nearly 40% across EU countries over the past decade alone. Yet, despite these gains,in 2013 more than 1.2 million people in EU countries died from a range of communicable and non-communicablediseases, as well as injuries that could have been avoided through better public health and prevention policiesand the provision of more effective health care. Many lives could be saved if the standards of care were raised tothe best level across EU countries.Globally, one of the health-related targets of the SDGs is to reduce the number of premature deaths due tonon-communicable diseases (NCDs). This report looks at the impact that NCDs have not only on people’s health,but also on the economy in terms of lower labour market participation and productivity. NCDs lead to thepremature death of more than 550 000 people of working age each year across EU countries, resulting in the lossof 3.4 million potentially productive life years. This amounts to an annual loss of EUR 115 billion for EUeconomies, a figure which does not even include the loss from the lower employment rates and the lowerproductivity of people living with such chronic conditions.Broad and coherent strategies are needed to address the many socioeconomic determinants of health andrisk factors that are leading to many chronic diseases and premature deaths, particularly among disadvantagedgroups. Notable progress has been achieved in reducing tobacco consumption in most EU countries, through amix of public awareness campaigns, regulations and taxation. Still, more than one in five adults in EU countriescontinues to smoke every day. It is also crucial to step up efforts to tackle obesity and the harmful use of alcohol.More than one in five adults in EU countries report drinking heavily on a regular basis. And one in six adultsacross EU countries is obese, up from one in nine in 2000. Greater efforts are needed to tackle these major publichealth issues.We need more accessible health systems. Universal health coverage is a goal that has been embedded inthe European Pillar of Social Rights and is another key objective of the Sustainable Development Goals. Most EUcountries ensure that the whole population is covered for a core set of health services and goods, but some stillneed to address current coverage gaps for some segments of their population. In addition, too many Europeans,particularly those from the most vulnerable and disadvantaged groups, have difficulties in accessing necessaryhealth care because of cost. In 2014, on average across EU countries, poor people were ten times more likely toreport unmet medical needs for financial reasons than rich people. Any increase in unmet care needs may resultin poorer health status for the population affected and contribute to even greater health inequalities.HEALTH AT A GLANCE: EUROPE 2016 OECD/EUROPEAN UNION 20163
FOREWORDUniversal access to care also relies on the right number of health workers, with the right skills, working inthe right places to deliver health services to the population, wherever they live and whatever their ability to pay.While the number of doctors per capita has increased over the past decade in nearly all EU countries, the numberof specialists grew more rapidly than generalists, so that there are now more than two specialists for everygeneralist across EU countries. This threatens access to primary care, particularly for people living in rural andremote areas.We also need more resilient health systems. Greater flexibility and innovation, including finding betterways to address the health needs of ageing populations and reaping the benefits of new technologies, requireschanges in how we deliver health services. Following the global economic crisis in 2008, health spending growthhas slowed significantly across Europe. This has triggered a wide range of initiatives to increase efficiency inpublic spending on health, notably by reducing the lengths of stays in hospital and pharmaceutical costs, andalso by lowering administrative costs.Looking ahead, more pressures on health systems will come from population ageing and from newtechnologies. The latter promise better and earlier diagnoses and a greater range of treatment options, but alsocome at a cost. These changes can be afforded, but only if European health systems become more efficient atchannelling resources where they have the most impact on health outcomes. In particular, a greater focus onprimary care can help to promote more integrated and patient-centred care.Health at a Glance: Europe 2016 is part of the renewed co-operation between the OECD and the EuropeanCommission to implement the Commission’s two-year State of Health in the EU cycle. We will be working closelywith our partners at the national and international level to support EU Member States to deliver effective,accessible and resilient health systems in the EU, so that all European citizens can enjoy longer, healthier andmore active lives.Angel GurríaSecretary-GeneralOrganisation for Economic Co-operationand Development4Vytenis AndriukaitisEuropean Commissionerfor Health and Food SafetyHEALTH AT A GLANCE: EUROPE 2016 OECD/EUROPEAN UNION 2016
ACKNOWLEDGEMENTSAcknowledgementsThis publication is the result of a close co-operation between the OECD and the European Commissionand is the first step in the Commission’s “State of Health in the EU” initiative to strengthencountry-specific and EU-wide knowledge on health issues. The content, including the selection of keyindicators of health and health systems, was agreed upon by the OECD and the Commission, basedmainly on the European Core Health Indicators (ECHI), the Joint Assessment Framework on Health, andusing the 2014 Commission Communication on effective, accessible and resilient health systems asreference framework. Its preparation was led by the OECD, but the Commission provided supportthroughout its preparation.This publication would not have been possible without the effort of national datacorrespondents from the 36 countries who have provided most of the data and the metadatapresented in this report, as well as the useful comments from members of the Commission’s ExpertGroup on Health Information. The OECD and the European Commission would like to sincerely thankthem for their contribution.A large part of the data comes from the two annual data collections on health accounts andnon-monetary health care statistics carried out jointly by the OECD, Eurostat and WHO. The OECDwould like to recognise the work of colleagues from Eurostat (Giuliano Amerini, Justyna Gniadzik,Arja Kärkkäinen, Margarida Domingues de Carvalho and Marie Clerc), WHO Headquarters(Nathalie van de Maele, Veneta Cherilova, Chandika Indikadahena and Callum Brindley) andWHO Europe (Ivo Rakovac, Alena Usava, Omid Fekri and Stefanie Praxmarer) who have contributed tothe collection and validation of the data from these two joint questionnaires, to ensure that theymeet the highest standards of quality and comparability. Several indicators in Chapters 3 and 4 usedata from the second wave of the European Health Interview Survey which was carried out in mostEU countries in 2014; sincere thanks to Lucian Agafitei and Jakub Hrkal from Eurostat for makingthese data available in time for the preparation of this publication.This report was prepared by a team from the OECD Health Division under the co-ordination ofGaétan Lafortune. Chapter 1 was prepared by Marion Devaux, with assistance from Eileen Rocard;Chapter 2 by Caroline Berchet; Chapter 3 by Gaétan Lafortune, Nelly Biondi, Marie-Clémence Canaudand Felicity Foster; Chapter 4 by Marion Devaux and Sahara Graf (thanks also to Joao Matias from theEuropean Monitoring Centre for Drugs and Drug Addiction who prepared the indicator on illegal drugconsumption); Chapter 5 by Michael Mueller, Michael Gmeinder and David Morgan; Chapter 6 byIan Brownwood, Michael Padget and Nelly Biondi; Chapter 7 by Gaétan Lafortune, Gaëlle Balestat,Marie-Clémence Canaud and Michael Mueller; Chapter 8 by Gaétan Lafortune, David Morgan,Luke Slawomirski, Gaëlle Balestat and Marie-Clémence Canaud. This publication also benefited fromuseful comments from Francesca Colombo, Michele Cecchini, Ian Forde and Barbara Blaylock fromthe OECD Health Division.Many useful comments were also received from Philippe Roux, Giulio Gallo, Stan van Alphenand Fabienne Lefebvre from the European Commission (DG SANTE). Special thanks go toMatthias Schuppe who provided useful guidance and advice throughout the project and alsoco-ordinated the inputs and comments from different officials in DG SANTE and across theCommission on a draft version of this report.HEALTH AT A GLANCE: EUROPE 2016 OECD/EUROPEAN UNION 20165
TABLE OF CONTENTSTable of contentsExecutive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Readers’ guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Chapter 1. The labour market impacts of ill-health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Chronic diseases cause many premature deaths and a huge loss in potential productivelife years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Chronic diseases and related behavioural risk factors reduce employment . . . . . . . . . . . . . . .Chronic diseases and related behavioural risk factors also lead to lower productivity,hours worked and wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ill-health leads workers to premature labour market exit, resulting in increasedexpenditures on social benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Conclusions and policy implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17181819253033Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3434Chapter 2. Strengthening primary care systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Introduction: Addressing the changing demographic and epidemiological context . . . . . . . . .Organisation and provision of primary care in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Evaluation of primary care in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Policy levers to improve primary care access and quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373839424751References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Chapter 3. Health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Life expectancy and healthy life expectancy at birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Life expectancy and healthy life expectancy at age 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Mortality from all causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Mortality from heart disease and stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Mortality from cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Mortality from respiratory diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Self-reported health and disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Notified cases of vaccine-preventable diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .New reported cases of HIV, tuberculosis, and sexually-transmitted infections . . . . . . . . . . . . .Cancer incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diabetes prevalence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Asthma and COPD prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dementia prevalence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55565860626466687072747678808284HEALTH AT A GLANCE: EUROPE 2016 OECD/EUROPEAN UNION 20167
TABLE OF CONTENTS8Chapter 4. Determinants of health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Smoking among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Smoking among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Alcohol consumption among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Alcohol consumption among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Overweight and obesity among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Overweight and obesity among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fruit and vegetable consumption among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fruit and vegetable consumption among adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Physical activity among children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Physical activity among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Use of illicit drugs among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Air pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87889092949698100102104106108110Chapter 5. Health expenditure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Health expenditure per capita . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Health expenditure in relation to GDP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Health expenditure by function.
Health at a Glance: Europe 2016 STATE OF HEALTH IN THE EU CYCLE Health at a Glance: Europe 2016 . in 2013 more than 1.2 million people in EU countries died from a range of communicable and non-communicable diseases, as well as injuries that could have been avo
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