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Subject: WHO European report links poverty to widening gaps
in health
Press Release from WHO Europe 17/09/02
The European Health Report 2002 is available freely on-line at
http://www.who.dk/eprise/main/who/progs/ehr/home
David McDaid
LSE Health and Social Care
Press release EURO/15/02 Copenhagen, 17 September 2002
Press release available on-line at
http://www.who.dk/eprise/main/WHO/MediaCentre/PR/2002/20020916_1
The WHO Regional Office for Europe released The European Health Report 2002 at
the fifty-second session of the WHO Regional Committee for Europe, which began
yesterday in Copenhagen, Denmark. The report confirms the strong links between
socioeconomic development, health and equity in the WHO European Region: "The
great differences in health status observed across countries and among groups
within countries have highlighted the fact that all major determinants of health
are linked to social and economic factors".
The report analyses a decade of evidence on health in the Region, which embraces
51 WHO Member States with some 870 million people. While overall levels of
health in the Region are among the highest in the world, the report describes
widening gaps between and within countries.
The report builds on the view that health policies cannot be isolated from other
policy sectors: "One central task in improving health is to reduce socioeconomic
inequalities, thus placing health in the context of human development". The link
between health and employment, income maintenance, social welfare, housing and
education is crucial in all European Member States.
"Governments need comparative evidence on which to build policy to protect the
health and wellbeing of their people. That is what this report provides," stated
Dr Marc Danzon, WHO Regional Director for Europe, introducing the report.
"Investment in health and an equitable society is an investment that pays off,
for health affects the whole society."
The European health report 2002 describes trends in health and the most
important health problems, lifestyle and environmental determinants of health,
and health care systems. The full report in English, including the annex of
statistical tables comparing all countries in the European Region, can be found
on and ordered from the Regional Office Web site. The French, German and Russian
versions are in press.
Health in Europe
The European health report 2002 shows a clear relationship between life
expectancy and gross domestic product (GDP) per head. The most striking example
is the widening gap in life expectancy between and within high- and low-income
countries. The gap between the highest and lowest life expectancy is only 2
years in Sweden but as much as 15 in the Russian Federation.
In the last decade, life expectancy has risen in the Region as a whole, but
fallen in most of the newly independent states of the former USSR (NIS). On
average, people in the NIS die 10 years younger than those in western European
countries. Premature mortality has been most marked in middle-aged men, and men
die 11 years younger than women in the NIS. As to expectancy of years of healthy
life, the average is only 56 years in the NIS, in contrast to 70 years in the
western countries. Describing the dramatic decline in life expectancy in the NIS
during the past decade, the report says, "There is practically no precedent for
changes of this magnitude in peacetime".
The data on poverty mirror these figures. In the central and eastern European
countries and the NIS, the share of the population living on less than US $4 a
day exploded from 3.3% in 1988 to 46% at the end of the 1990s. In western
Europe, about 10% of the total population are estimated to live below the
poverty line (income of less than half the median). The poverty reflected by
these statistics, associated both with industrial and post-industrial societies,
directly affects the variations in health indicators.
The report points out that the single largest determinant of ill health due to
communicable diseases is poverty, whether defined by income, living conditions
or education. Living in poverty is associated with higher rates of infectious
diseases, notably tuberculosis. The incidence of communicable diseases such as
HIV/AIDS and tuberculosis has risen dramatically in the NIS. The number of new
HIV/AIDS cases in the NIS has doubled every year since 1995, and there is
potential for massive outbreaks. Multidrug-resistant tuberculosis in "hot spots"
should be addressed as an international emergency. The great efforts underway to
reduce communicable diseases in countries remain a public health priority.
According to The European health report 2002, noncommunicable diseases account
for about 75% of the burden of ill health and constitute a "pan-European
epidemic". This figure is rising. The report lists cardiovascular diseases,
cancer, neuropsychiatric disorders (including those due to alcohol use and
depression) among the major causes of the disease burden in the Region.
Mortality from cardiovascular diseases (CVD) is steadily falling in western
European countries; it is now around half the level it was in 1970. The average
CVD mortality in the NIS is almost three times that in western countries, and
the long-term trends are still increasing. Cancer is responsible for nearly 20%
of all deaths. Cancer mortality is falling in the European Union and NIS but
rising in the countries of central and eastern Europe.
In many countries, more than half the adult population is overweight, with
20-30% of adults categorized as clinically obese. For example, in Finland,
Germany and the United Kingdom, 20% of adults are obese. The European health
report 2002 calls obesity a spreading chronic disease and risk factor. The major
consequences for health include hypertension, diabetes, CVD and certain types of
cancer.
Diabetes affects about 22.5 million adults in the European Region and is
increasing rapidly in most countries. Moreover, it has changed from affecting
mainly older people to also afflicting people in the first half of their lives.
Mental health problems are increasing significantly. Some European countries
register up to 6% of the population as having serious mental disorders. Mental
ill health accounts for up to 30% of consultations with general practitioners in
Europe.
The European Region has the highest alcohol consumption in the world. One in
four deaths among European men aged 15-29 years is related to alcohol.
Major determinants of health
The European health report 2002 reviews evidence on health determinants related
to lifestyle, stressing the trends in unhealthy behaviour, such as the use of
tobacco and alcohol. Each year, tobacco consumption causes 1.2 million deaths
and alcohol use plays a role in the deaths of 55 000 adolescents.
Environmental factors supplement the list of major health risk factors. Some 21
000 deaths per year in Austria, France and Switzerland could be attributed to
air pollution from traffic; this figure is more that twice that for deaths from
traffic accidents in those countries.
Health systems
The European health report 2002 also provides an overview of countries' health
systems, including financing, national insurance strategies, the
cost-effectiveness of service provision, the performance of primary care, the
restructuring and decentralization of hospital services, and pharmaceutical
polices. The report points out that all European countries are reforming their
health care systems to varying degrees.
The differences in the structure and functioning of health systems in countries
make comparative analysis difficult. Nevertheless, some data can clearly
indicate the disparities within the Region. For example, the number of doctors
in western Europe ranges from 5.5 per 1000 population in Italy, to 1.5 per 1000
in the United Kingdom. Austria, Belgium, France, Germany, Iceland and
Switzerland spend more than US $300 per person on medicines; the corresponding
figure for Azerbaijan, Kyrgyzstan, the Republic of Moldova, Tajikistan,
Turkmenistan and Uzbekistan is less than US $10.
For more information contact:
Ms Liuba Negru
Press and Media Relations
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen
Ø, Denmark
Tel.: +45 39 17 13 44; fax: +45 39 17 18 80; e-mail: [log in to unmask] <
mailto:[log in to unmask]>
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