Europeans live almost 7 years more compared to 1990, but this does not necessarily mean that these years are healthy, a new report has found.
The Health at a Glance: Europe 2016 report published today (23 November) by the European Commission and the Organisation for Economic Co-operation and Development (OECD), thoroughly analysed the state of healthcare across Europe, focusing on risk factors, health expenditure, and access to care in 36 European countries.
Health inequality and enormous disparities in access to quality healthcare, especially due to the economic crisis, question both the effectiveness and viability of EU healthcare systems.
According to the report, life expectancy in the European Union has increased by more than 6 years since 1990, from 74.2 years in 1990 to 80.9 years in 2014 but significant disparities were recorded in Western and Eastern Europe.
17 member states are above the EU average, including Greece, while Central and Eastern Europe countries are below the EU average. Bulgaria and Latvia recorded the lowest life expectancy (74.5 years) while the highest was marked in Spain (83.3) and in Italy (83.2).
The report claims that this record-high life expectancy could be attributed to the reduction in mortality from cardiovascular diseases, particularly among people aged 50 to 65.
However, this “extra life” is not always matched by healthy years, the report notes, pointing out that access to quality healthcare systems should be improved.
Alarming “avoidable deaths”
More than 1.2 million Europeans died in 2013 from illnesses and injuries that might have been avoided if public health and prevention policies had been more effective or timelier, the report underlined. This is a considerably high number that puts the performance of member states’ health systems in question.
Health Commissioner Vytenis Andriukaitis recently told euractiv.com that a number of risk factors were disregarded at the expense of EU citizens’ health.
“In the EU and beyond, too many risk factors – tobacco, unhealthy nutrition, lack of exercise, alcohol abuse, stress as well as broader social issues such as unhealthy housing or working conditions – are ignored, too many deaths are avoidable and too many lives are unnecessarily lost,” he noted, adding that instruments to fight these risk factors exist.
“They are in the hands of all the decision-makers at all levels. Therefore, promoting good health and preventing diseases is the responsibility of all of us,” Andriukaitis emphasised.
According to statistics, 16% of adults are obese (up from 11% in 2000) and one in five is still smoking every day despite the fact that most EU countries have experienced reduced tobacco consumption. Regarding alcohol consumption, more than one in five adults reported in 2014 “heavy alcohol drinking” at least once a month.
Cardiovascular diseases are the main cause of mortality in nearly all EU member states, accounting for almost 40% of all deaths across the EU in 2013, followed by cancer, which accounts for 26% of all deaths in 2013.
The lowest cancer mortality rates were marked in Cyprus, Finland, Sweden and Spain, while the highest were found in Hungary, Croatia, the Slovakia, Slovenia, and Denmark.
Access to healthcare and crisis
The report highlights the need for more accessible and quality healthcare systems, urging the member states to make efforts to reduce financial barriers to healthcare and strengthen access to primary care.
“Almost 27% of patients go to the emergency department due to the lack of availability of primary care and an average of 15% of health spending is paid directly out-of-pocket by patients with large disparities between countries,” the report notes, adding that poor Europeans are on average 10 times more likely to have problems in getting proper healthcare for financial reasons than more affluent ones.
Around 3.6% of the population in 2014 reported some unmet needs for medical care due to cost, traveling distance, and waiting time. The problem was particularly apparent in Latvia, Estonia, and Greece (with a share above 10%), while less than 1% of the population reported unmet needs in Luxembourg, Spain, the Netherlands, Slovenia and Austria in 2014.
The report emphasised that due to the economic crisis in 2008 the proportion of people in low-income groups reporting unmet needs for financial reasons increased in several countries.
For instance, in Italy and France, the proportion of people reporting unmet needs due to financial reasons among the low-income population increased by more than 50% between 2008 and 2014.
In crisis-hit Greece, for the same period, the proportion more than doubled between 2008 and 2014, while it tripled in Portugal.
“Increasing unmet care needs, particularly among low-income groups, raise concerns as they may result in poorer health status and increased health inequalities,” the report reads.
The report says that across the EU, the share of the population over 65 has increased from less than 10% in 1960 to nearly 20% in 2015 and is projected to increase to nearly 30% by 2060.
A growing elderly population, combined with increasing rates of chronic diseases and budgetary constraints, will require shifts in how we deliver healthcare, the report suggests, focusing on developing eHealth, reducing hospital stays and spending “more wisely” on pharmaceuticals, including making full use of opportunities for generic substitutions.
All EU countries see the development of generic markets as a good opportunity to increase efficiency in pharmaceutical spending, but many do not fully exploit the potential of generics. In 2014, generics accounted for more than 70% of the volume of pharmaceuticals sold in the United Kingdom, Germany, the Netherlands and Slovakia, while they represented less than 20% of the market in Luxembourg, Italy, and Greece.
In an interview with euractiv.com, Andriukaitis stressed that national healthcare systems should enter the digital era in order to ensure their sustainability and be truly cost-effective.
“A key tool to support member states make smarter, more cost-effective investments, is EU cooperation on Health Technology Assessment (HTA), and I hope to make great strides in the coming years,” the Commissioner said.
The HTA is a multidisciplinary process to assess the added value and effectiveness of a given health technology – for example medicine, medical devices, diagnostic tools or surgical procedures, over and above existing ones.
European Commissioner for Health and Food Safety Vytenis Andriukaitis said: “The Health at a Glance report provides useful information for Member States to shape their actions on health across all policies. It shows that in the EU many people die every year from potentially avoidable diseases linked to risk factors such as smoking or obesity. It also highlights the need to continue our efforts in making sure that healthcare becomes more accessible.”
“The report represents the flagship of the partnership between the Commission and the OECD to develop country-specific and cross-country knowledge on health and health systems, as the first step of the 'State of Health in the EU',” he added.
Angel Gurría, Secretary-General of the Organisation for Economic Co-operation and Development (OECD), commented: “Many more lives could be saved if the standards of care were raised to the best level across EU countries. More needs to be done to reduce inequalities in access and quality of care, and European health systems must become more efficient in channelling resources where they have the most impact on health outcomes, including on prevention.”