The latest European health report shows a Europe that has achieved striking successes and is on track to hit several targets, such as reducing premature mortality and setting further national targets for health. The report, which is the WHO Regional Office for Europe's analytical account of the health of the European Region and its progress towards the targets set by Health 2020, WHO's overarching health policy, also reveals a need to find and examine new kinds of evidence to understand the complex relationship between health, well-being and culture.
"This report shows heartening progress," said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. "Our Member States have embraced the opportunity of Health 2020 and we are beginning to see real results. But there is a very real risk that these gains will be lost if smoking and alcohol consumption continue at the current rate. This is especially relevant to young people, who may not live as long as their grandparents."
Europeans are living longer
Life expectancy is steadily increasing but the report also sounds the alarm, noting that the Region has the highest levels of tobacco and alcohol consumption in the world. These risks, combined with rising obesity, could mean that life expectancy falls in future generations. Moreover, the gap in life expectancy at birth between countries still stands at more than 10 years, with Israel and Switzerland topping the chart for longevity. Tobacco use and alcohol consumption play a significant role in shortening lives, although progress has been made in reducing these risk factors. The greatest successes in reducing tobacco use have occurred in Belarus, Georgia, Kazakhstan, the Russian Federation and Ukraine, and significant reductions have also been achieved in some western European countries. Policy interventions on alcohol consumption, such as controlling the availability and pricing of alcohol, are also slowly bearing fruit.
The report shows that Europe is on track to achieve a relative reduction in premature mortality of 1.5% annually until 2020. This means that the number of people whose lives are cut short by cardiovascular diseases, cancer, diabetes mellitus and chronic respiratory diseases is steadily declining.
Marked improvements have been seen in rates of death from external causes, such as road traffic accidents and suicides. The biggest reductions have occurred in the eastern part of the Region, especially in Estonia, Latvia, the Russian Federation and Ukraine. The Russian Federation has reduced mortality rates from road traffic accidents by more than 20% in the last 10 years, thanks to measures such as modernization of road infrastructure, mechanisms to ensure that drivers comply with traffic regulations and law enforcement.
Gaps in vaccination coverage are resulting in outbreaks of vaccine preventable diseases Average vaccination coverage for poliomyelitis (polio) in the European Region was 94.7% in 2010 (Health 2020 baseline), 94.4% in 2011 and 95.4% in 2012. This represents a high level of protection for most populations in the Region, but constant vigilance is needed, as suboptimal immunization coverage in a few areas of the European Region and polio outbreaks in some WHO regions still pose a threat.
Average vaccination coverage for measles in the European Region rose from 93.4% in 2010 (Health 2020 baseline) to 93.7% in 2011 and 94.6% in 2012 and is steadily increasing. Despite generally high vaccination coverage in Europe, immunity gaps still account for ongoing endemic transmission and have led to a number of outbreaks of measles and rubella in recent years. In 2015 four deaths from measles have been reported and one child has died of diphtheria - the first case in three decades.
Countries are shining a spotlight on inequality
Inequalities are elaborated in detail in the report, showing that substantial progress has been made in reducing inequalities in all areas. This shows that the increase in countries that have adopted policies to address health inequities is having a beneficial effect: 86% of the 36 reporting countries had policies or strategies of this kind. Much remains to be done, however. In the case of infant mortality, for example, the difference between the highest and lowest rates in the Region has reduced considerably but still represents 20 infant deaths per 1000 live births each year.
Only 12 of 53 European Member States indicated that out-of-pocket expenditure was below 15% of total health expenditure. This means that in the remaining 41 countries people are vulnerable to catastrophic health care expenses that can plunge them into poverty if they become ill. This category has seen no improvement since 2010.
There's more to health than preventing or treating disease
Well-being, which was first introduced as an indicator in the 2012 European health report, is measured with a combination of subjective (life satisfaction) and objective (employment, sanitation, housing and primary school enrolment) indicators. The experience of well-being, however, is strongly influenced by cultural context and the report calls for more research to understand this connection.
"There is more to health than preventing and treating disease - this is something we have known for some time," said Dr Claudia Stein, Director of the Regional Office's Division of Information, Evidence, Research and Innovation. "The European health report makes a brave call for the use of new forms of evidence to better understand health and well-being. In the future we will increasingly be looking beyond traditional disciplines to deepen our understanding of health and well-being and to consider new forms of evidence, such as qualitative research and narrative evidence. These will not be a substitute but rather a complement to traditional forms of health monitoring. We have an exciting journey ahead of us in health information."