Health statistics at regional level
- Data extracted in January 2017. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: September 2018.
This article forms part of Eurostat’s annual flagship publication, the Eurostat regional yearbook. Health is an important priority for Europeans, who expect to be protected against illness and accident and to receive appropriate healthcare services. The competence for the organisation and delivery of healthcare services largely resides with the 28 individual Member States of the European Union (EU).
This article presents recent statistics on health for the regions of the EU, providing information concerning some of the most common causes of death, notably cancer and diseases of the circulatory and respiratory systems. It also looks at healthcare services through an analysis of the number of hospital beds and healthcare professionals (physicians) and concludes with a range of statistics relating to health determinants according to the degree of urbanisation: six of the seven biggest risk factors for premature death — blood pressure, cholesterol, obesity and overweight, inadequate fruit and vegetable intake, physical inactivity and alcohol abuse — relate to how we eat, drink and move; the seventh is smoking.
- 1 Main statistical findings
- 2 Data sources and availability
- 3 Context
- 4 See also
- 5 Further Eurostat information
- 6 External links
Main statistical findings
- All 32 regions where the standardised death rates from ischaemic heart disease reached or exceeded 270 per 100 000 inhabitants in 2011–2013 were in the Baltic Member States or eastern EU Member States.
- Five of the six regions in the EU with the highest standardised death rates for cancer of the trachea, bronchus and lung in 2011–2013 were located in Hungary (which is composed of seven regions at this level of detail).
- In 2014, the number of hospital beds relative to population size was high in nearly all German regions.
- The Greek capital city region had, by far, the highest number of physicians relative to population size of any region in the EU, 870 per 100 000 inhabitants; the number of professionally active physicians in Attiki was 240 per 100 000 inhabitants higher in 2014 than in 2004.
- More than half of the population (aged 15 and over) living in the urban areas of the Nordic Member States and Austria spent an average of at least 150 minutes per week on health-enhancing (non-work-related) aerobic physical exercises.
Causes of death
Many factors determine mortality patterns — intrinsic ones, such as age and sex, as well as extrinsic ones, such as environmental or social factors and living/working conditions — while individual factors, such as lifestyle, exercise, diet, alcohol consumption, smoking or driving behaviour also play a role.
Collecting and using statistics on the causes of death
The medical certification of death is an obligation in all EU Member States. Causes of death statistics are based on two pillars: medical information on death certificates, which may be used as a basis for ascertaining the cause of death; and the coding of causes of death following the International Statistical Classification of Diseases and Related Health Problems (ICD).
Statistics on causes of death provide information about diseases (and other eventualities, such as suicide or transport accidents) that lead directly to death; they can be used to help plan health services. These statistics refer to ‘the underlying disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of an accident or an act of violence which produced a fatal injury’; they are classified according one of 86 different causes as defined by the European shortlist for causes of death (2012), itself based on the ICD, developed and maintained by the World Health Organisation (WHO).
Slightly fewer than five million people died in the EU-28 in 2014, which equates to almost 1 % of the total population. The three leading causes of death in the EU were: diseases of the circulatory system (1.8 million deaths); cancer (1.3 million deaths); and diseases of the respiratory system (382 thousand deaths).
The three-year average standardised death rate for 2011 to 2013 in the EU-28 was 1 028 deaths per 100 000 inhabitants. Rates for the most common causes of death over the same period are presented in Figure 1 for various subpopulations. These confirm that the three leading causes of death for the whole population — diseases of the circulatory system, cancer and diseases of the respiratory system — were also the most common causes of death for men, women and for persons aged 65 or over. For people aged less than 65, death from diseases of the respiratory was less common while death from external causes (which includes traffic accidents) was the third most common cause (after cancer and diseases of the circulatory system).
Figure 1 shows that standardised death rates were higher for men than for women for each of four common principal causes of death — diseases of the circulatory system, cancer, diseases of the respiratory system and diseases of the digestive system. Among men, external causes of death was the fourth highest cause of death (but did not feature among the five principal causes of death for women), while diseases of the nervous system and sense organs was the fifth most common cause of death among women (but did not feature in the five principal causes of death for men). The differences by age were even clearer, with all of the standardised death rates below the age of 65 relatively low.
Standardised death rates
In Figures 1 to 3 and Maps 1 and 2, standardised death rates are presented. Standardised death rates, in comparison with crude death rates, are regarded as being more comparable between different populations. Crude rates are compiled by calculating a simple ratio of deaths to the population for individual five-year age groups and then combining these using weights based on the age structure of the population concerned. While these are simple to understand, the population structure strongly influences the crude rates as, for example, in a population with a relatively high proportion of older people there will be more deaths than in one with a higher proportion of younger people, because mortality is higher for older people (see Figure 1). This difference in age structures between various populations (for example, across countries/regions or across time) can be taken into account by using weights based on the structure of a standard population to combine the age-specific mortality rates, so allowing the resulting standardised rates to be compared more meaningfully.
Regional standardised death rates are provided in the form of three-year averages, in order to smooth out some of the relatively large fluctuations that might occur from year to year in some of the smaller regions; for consistency and comparison the rates for the EU-28 in Figure 1 are also presented as three-year averages.
Causes of death: ischaemic heart disease
There are a range of medical problems that affect the circulatory system (the heart, blood and blood vessels), with one of the most common being ischaemic heart disease (also known as coronary artery disease). Exercise, diet, smoking and stress can all have a positive or negative impact upon death rates from heart disease. Indeed, diet is thought to play an important role, as death rates tend to be higher in those regions where people consume large amount of saturated fats, dairy products and (red) meat.
Regional statistics on the causes of death are available for 2011–2013, during which time there was an average of 655 thousand deaths per year from ischaemic heart disease in the EU-28, equivalent to 13.2 % of all deaths. The standardised death rate in the EU-28 for ischaemic heart disease during this period was 136 deaths per 1 000 inhabitants. Map 1 shows there was an east–west split in standardised death rates from ischaemic heart disease across EU regions. The highest death rates were often recorded in regions located in one of the Member States that joined the EU in 2004 or later (with the exception of the Mediterranean island of Cyprus).
Lithuania and two Romanian regions had the highest death rates attributed to ischaemic heart disease
Looking in more detail, there were three NUTS level 2 regions in the EU-28 where the standardised death rate for ischaemic heart disease was close to or in excess of 500 deaths per 100 000 inhabitants (in other words, more than 0.5 % of the standardised population died from these diseases on average each year between 2011 and 2013): Lithuania (which is one region at this level of detail) and the two Romanian regions of Nord-Vest and Centru. Looking more broadly, all 32 regions where the standardised death rate from ischaemic heart disease reached or exceeded 270 per 100 000 inhabitants (shown with the darkest shade of yellow in Map 1) were in the Baltic Member States or eastern EU Member States (the Czech Republic, Croatia, Hungary, Romania or Slovakia). Elsewhere, the highest standardised death rate in the Nordic Member States was in Pohjois- ja Itä-Suomi (Finland; 266), the highest in the southern Member States was in Malta (a single region at this level of analysis; 258), and the highest in the western Member States was in Burgenland (Austria; 241).
The lowest death rates from ischaemic heart disease were recorded in French and Portuguese regions
Two factors other than diet that are often cited as an explanation for patterns of regional death rates from ischaemic heart disease are access to and the availability of hospital treatment. The lowest death rates from ischaemic heart disease are often registered in capital city and other urban regions, where patients in need of rapid medical assistance — for conditions such as heart attacks — can expect to travel relatively short distances to receive attention in relatively well-equipped hospitals.
Across NUTS level 2 regions, 13 of the 15 lowest standardised death rates from ischaemic heart disease were recorded in France, the other two being Norte and Centro (both Portugal). The French capital city region (Île de France) reported the lowest average rate between 2011 and 2013, at 45 deaths per 100 000 inhabitants. As such, there was a considerable difference between the highest and lowest standardised death rates from ischaemic heart disease across NUTS level 2 regions within the EU, with the death rate in Lithuania 13 times as high as that recorded for Île de France.
Standardised death rates for ischaemic heart disease were higher for men than for women in all regions
In the EU-28 as a whole, the annual average standardised death rate for ischaemic heart disease between 2011 and 2013 was 102.5 deaths per 100 000 inhabitants for women while it was 181.0 per 100 000 for men, a difference of 78.5 deaths per 100 000 inhabitants.
Figure 2 shows the standardised death rates for ischaemic heart disease for men and women across all regions of the EU and it is clear that, without exception, rates were consistently higher for men than for women. Among the 267 NUTS level 2 regions in the EU for which data are available, Lithuania recorded the highest death rates for both men and women, while the lowest rates were in two different regions, Île de France for women and Norte for men.
The largest absolute gender gaps for the standardised death rate for ischaemic heart disease were recorded in the three Baltic Member States (each one region at this level of detail), where the rates for men were at least 200 deaths per 100 000 inhabitants higher than for women and this was also the case in the Hungarian region of Észak-Magyarország. The narrowest gender gaps in absolute terms were recorded for three Portuguese regions, namely, Alentejo, Norte and Centro.
Causes of death: cancer (malignant neoplasms) of the trachea, bronchus and lung
Although significant advances have been made in the fight against cancer of the trachea, bronchus and lung, it remains a key public health concern and a considerable burden on society. Between 2011 and 2013 there was an average of 268 thousand deaths per year from cancer of the trachea, bronchus and lung in the EU-28, equivalent to 5.4 % of all deaths. The standardised death rate in the EU-28 for cancer of the trachea, bronchus and lung during this period was 56 deaths per 1 000 inhabitants.
All of the regions in Hungary recorded very high standardised death rates for cancer of the trachea, bronchus and lung
The regional distribution of standardised death rates for cancer of the trachea, bronchus and lung was more mixed than that for ischaemic heart disease, both across EU Member States and between regions of the same Member State. Among the 38 regions where the annual average (between 2011 and 2013) standardised death rate was 70 deaths per 100 000 inhabitants or higher (the darkest shade of yellow in Map 2), the vast majority (all but two regions) were concentrated in Hungary and Poland (among the eastern EU Member States), Belgium, the Netherlands and the United Kingdom (among the western EU Member States), and Denmark (among the northern Member States); in addition there was one region each from the Czech Republic and Portugal. Not only were all seven Hungarian regions in this group, five of them were among the six regions with the highest standardised death rates for cancer of the trachea, bronchus and lung in the EU. However, the highest rate of all was recorded in the British region of South Western Scotland (99 deaths per 100 000 inhabitants).
Centro in Portugal recorded an annual average standardised death rate for cancer of the trachea, bronchus and lung for the period 2011 to 2013 that was 26 per 100 000 inhabitants, in other words less than half the EU-28 average and only just over a quarter of the rate recorded for South Western Scotland. As such, the range of regional rates for cancer of the trachea, bronchus and lung was far narrower than for ischaemic heart disease. Most regions with particularly low rates for cancer of the trachea, bronchus and lung were in Germany, Sweden, Portugal or Italy, with the remainder in Austria, Cyprus (one region at this level of detail), Finland and Slovenia (only national data available).
North–south divide in standardised death rates from cancer of the trachea, bronchus and lung within Italy and the United Kingdom
Within some of the EU Member States there were relatively large differences in standardised death rates from cancer of the trachea, bronchus and lung. In Italy, there was a broad north–south divide, with higher death rates in the north (except for Provincia Autonoma di Trento and Provincia Autonoma di Bolzano/Bozen) and lower rates in the south (except for Campania). There was also a broad north—south divide in the United Kingdom, with higher rates in Scotland, Northern Ireland and northern England (with a few exceptions) and lower rates in much of southern England. In Germany, the highest rates were reported in some of the westernmost regions of Germany (especially within Nordrhein-Westfalen and Saarland) and the three city regions of Berlin, Bremen and Hamburg, while relatively low rates were reported in several southern regions within Baden-Württemberg and Bayern. Poland and Portugal presented relatively homogenous rates, but with one exception in each case: all Polish regions reported high death rates except for the south-eastern region of Podkarpackie; all Portuguese regions reported low rates except for Região Autónoma dos Açores.
The annual average standardised death rate for cancer of the trachea, bronchus and lung between 2011 and 2013 in the EU-28 was 89.2 deaths per 100 000 inhabitants for men while it was 30.2 per 100 000 for women, a difference of 58.9 deaths per 100 000 inhabitants. Figure 3 shows a gender analysis of the standardised death rate for cancer of the trachea, bronchus and lung for 264 regions in the EU-28 for which data are available; as with the information presented for ischaemic heart disease, every region in the EU reported higher death rates for men than for women.
The largest gender gap was in Região Autónoma dos Açores which had a relatively low standardised death rate for cancer of the trachea, bronchus and lung for women (16.4 deaths per 100 000 inhabitants) but the sixth highest rate (147.1 deaths per 100 000 inhabitants) for men. Other regions where the gender gap was more than 100 deaths per 100 000 inhabitants included Anatoliki Makedonia, Thraki and Dytiki Ellada (both Greece), Észak-Magyarország and Észak-Alföld (both Hungary), Extremadura (Spain) and Warminsko-Mazurskie (Poland); all of these had high standardised death rates for cancer of the trachea, bronchus and lung for men, the lowest being 117.7 deaths per 100 000 inhabitants in Extremadura and the highest being 169.2 deaths per 100 000 inhabitants in Észak-Alföld.
The eight regions with the narrowest gender gaps for standardised death rates for cancer of the trachea, bronchus and lung were all Swedish, reflecting the fact that these regions were all among the nine regions with the lowest rates for men; Mellersta Norrland recorded the lowest rate for men across all regions of the EU, at 33.9 deaths per 100 000 inhabitants. Whereas the range between the highest and lowest rates for men was 5.0 : 1, for women it was 8.2 : 1, with a standardised death rate for cancer of the trachea, bronchus and lung of 84.5 deaths per 100 000 inhabitants reported for South Western Scotland and 10.3 deaths per 100 000 inhabitants in Alentejo (Portugal).
Maps 3 and 4 present indicators related to healthcare provision, the first concerning access to hospital beds and the second access to doctors. These two maps reflect country-specific ways of organising health care and the types of service provided to patients.
Statistics on the availability of hospital beds cover general and speciality hospitals. Hospital beds are defined as those which are regularly maintained and staffed and immediately available for the care of patients admitted to hospitals.
For many years, the number of hospital beds available across the EU has decreased: this may be linked to a range of factors, including a reduction in the average length of hospital stays, the introduction of minimally invasive surgery and procedures, and an expansion of day care and outpatient care. During the last decade the number of hospital beds in the EU-28 continued to decline: available beds fell from 2.93 million in 2004 to 2.65 million by 2014, a relative decrease of 9.6 %. At the same time, the EU’s population grew and so relative to population size the number of beds per 100 000 inhabitants fell from 592 in 2004 to 521 in 2014, a decline of 12.0 %.
German regions had relatively high numbers of hospital beds relative to population size
Map 3 shows a high density of available hospital beds across all German regions (NUTS level 1) in 2014, the capital city region being the only one where there were not at least 700 beds per 100 000 inhabitants (the darkest shade in Map 3). More generally, the highest densities of hospital beds (at least 700 per 100 000 inhabitants) in 2014 were rarely in regions in northern or southern Member States, the only cases being Lithuania (one region at this level of detail) and the Portuguese Região Autónoma da Madeira (2013 data). As such, the vast majority of the regions with high densities of hospital beds were in western and eastern Member States: aside from Germany, the highest densities were recorded in Austria, Poland, France; Hungary and Romania (three to five regions each), as well as two regions in Belgium and one region in each of Bulgaria, the Czech Republic and Slovakia. The highest density of hospital beds in any region was recorded in the north eastern German region of Mecklenburg-Vorpommern with an average of 1 308 beds per 100 000 inhabitants.
By contrast, the lowest densities of hospital beds — less than 250 per 100 000 inhabitants (as shown by the lightest shade in Map 3) in 2014 — were often recorded in the northern and southern EU Member States, as well as in one Irish region. In the northern Member States, very low ratios were recorded for three regions in Sweden and one in Denmark, while this was also the case in five Spanish regions, two Greek regions (2013 data) and one region in each of Italy and Portugal (both 2013 data). The lowest density of hospital beds was recorded in the Greek region of Sterea Ellada, at 165 hospital beds per 100 000 inhabitants.
An analysis of the density of hospital beds within individual EU Member States reveals that France and Portugal had quite diverse regional ratios. In the case of France this was due to notably lower ratios recorded in the overseas regions of Guyane and La Réunion, while in Portugal this was due to notably higher ratios recorded for the Regiões Autónomas dos Açores e da Madeira and a relatively low ratio in Alentejo.
Physicians or (medical) doctors have a degree in medicine and provide services directly to patients as consumers of healthcare. In the context of comparing health care services across EU Member States, Eurostat gives preference to the concept of practising physicians, although data are only available for professionally active or licensed physicians in some Member States (see Map 4 for coverage). A practising physician provides services directly to patients as consumers of healthcare. These services include: conducting medical examinations and making diagnoses; prescribing medication and treating diagnosed illnesses, disorders or injuries; giving specialised medical or surgical treatment for particular illnesses, disorders or injuries; giving advice on and applying preventive medical methods and treatments. A professionally active physician is a practising physician or any other physician for whom medical education is a prerequisite for the execution of the job (for example, verifying medical absences from work, drug testing, medical research). A licensed physician is a physician licensed to practise; this category includes practising physicians, professionally active physicians, as well as any other registered physicians who are entitled to practise as healthcare professionals.
The number of physicians per head of population increased by 30 % or more between 2004 and 2014 in in many regions of Greece, Spain, Portugal and Romania
In 2014, there were approximately 1.78 million physicians in the EU-28, approximately 350 per 100 000 inhabitants. The number of physicians increased by approximately 240 thousand between 2004 and 2014, equivalent to an overall increase of around 16 % on the basis of absolute numbers and 12 % in terms of the per head ratio.
Regions of the EU where the ratio of physicians to population increased by 30 % or more between 2004 and 2014 (the darkest shade in Map 4) were mainly concentrated in Portugal, Spain and Greece (2004–2013 for some regions) in the south and Romania in the east, although this pattern was also apparent within a few regions of the Netherlands and Austria. In contrast to these 22 regions with relatively high increases, there were 33 regions (out of a total of 192 EU regions for which data are available) where the ratio of physicians to population fell. It should however be noted that in many of these regions that reported lower accessibility in 2014, there was a break in series, namely regions in France, Italy, Hungary and Poland. Focusing on regions where there was not a break in series, the ratio of physicians to population fell between 2004 and 2014 in six Spanish regions, two Dutch regions and a single region each in the Czech Republic (2004–2013), Greece and Slovakia.
By 2014 the Greek capital city region had by far the highest number of physicians relative to population size, 870 per 100 000 inhabitants. This region recorded one of the highest percentage increases in its number of physicians per 100 000 inhabitants between 2004 and 2014 (rising 38.1 %) and also the highest absolute increase, with an additional 240 physicians per 100 000 inhabitants in 2014 compared with 2004. The three regions with the next highest ratios in 2014 were also capital city regions, those of the Czech Republic (2013 data), Austria and Slovakia, all with ratios in the range 678–695 physicians per 100 000 inhabitants. The list of regions with more than 600 physicians per 100 000 inhabitants in 2014 was completed by Hamburg (Germany), and two more Greek regions (Kriti and Kentriki Makedonia (2013 data)).
Six regions in the EU reported less than 200 physicians per 100 000 inhabitants in 2014: there were two regions from each of the Netherlands (which had the two lowest rates of all), Poland and Romania. Interestingly, among these six regions was the Sud-Est region of Romania which reported a high rate of increase (31.5 %) between 2004 and 2014.
Issues related to diet, exercise, alcohol and tobacco consumption play a major role in a person’s health and significantly impact on the likelihood of many chronic diseases; these diseases in turn have substantial costs for society as a whole. Figures 4 to 8 present various health determinants with an analysis by degree of urbanisation (more information on this classification is provided in the introductory chapter).
Large variation by degree of urbanisation in the share of adults in the Czech Republic who were obese
Weight problems and obesity are increasing at a rapid rate in most of the EU Member States. As well as increasing the risk of chronic diseases, obesity may be linked to a wide range of psychological problems. The proportion of adults — defined here as people aged 18 and over — in the EU-28 who were obese in 2014 was 15.9 %, about one in six of the adult population. Among the EU Member States, the prevalence of obesity ranged from 9.4 % in Romania (which was the only Member State where the rate was below 10.0 %) to 20–22 % in the United Kingdom, Estonia, Hungary and Latvia, and peaked at 26.0 % in Malta.
Body mass index
The body mass index (BMI) is a measure of a person’s weight relative to their height that links fairly well with body fat. The BMI is accepted as the most useful measure of obesity for adults when only weight and height data are available. It is calculated as a person’s weight (in kilograms) divided by the square of his or her height (in metres).
BMI = weight (kg) / height (m2)
The following subdivision (according to the WHO) is used to classify results for the BMI:
- < 18.50: underweight;
- 18.50 – < 25.00: normal weight;
- 25.00 – < 30.00: pre-obese;
- >= 30.00: obese.
The prevalence of obesity in the EU-28 in 2014 was slightly lower in cities (15.0 %) than in towns and suburbs (15.6 %) and higher in rural areas (17.3 %). This basic pattern — lower prevalence in cities and higher in rural areas — was observed in the vast majority of EU Member States (see Figure 4). In Belgium, the lowest prevalence was observed in towns and suburbs rather than cities, while in Poland, Austria and Romania the reverse was true, with the highest prevalence in towns and suburbs. The two remaining exceptions were Sweden and the United Kingdom, where the situation was the direct opposite of the general pattern observed for the EU-28, as the highest prevalence of obesity was in cities and the lowest in rural areas.
The range in the prevalence of obesity between the three different degrees of urbanisation was less than 5.0 percentage points in most EU Member States, with the most homogeneous situation in Austria where there was just 0.7 percentage points difference between the rates observed. By contrast, in the Czech Republic the share of adults who were obese in rural areas (23.8 %) was 9.7 percentage points higher than the share in cities (14.1 %).
Varied patterns in regular exercise between Member States when analysed by degree of urbanisation
Exercise strengthens the body and improves mental well-being as well as helping to reduce or maintain a person’s weight. The data presented in Figure 5 are based on self-reported levels of regular physical exercise and show the proportion of persons (aged 15 and over) who undertook at least 150 minutes (two and a half hours) of health-enhancing aerobic physical exercise (including walking and cycling for transportation, and sports, fitness and leisure physical activities; excluding physical activities at work) per week; data are not available for Belgium and the Netherlands.
In the EU-28, the share of regular exercisers was just less than one third (30.8 %). People in the Nordic Member States were the most likely (around 54–55 %) to undertake such regular exercise, while the lowest shares (less than 25.0 %) of regular exercise were observed in several eastern and southern Member States and in the Baltic Member States, dropping below 10.0 % in Bulgaria and Romania.
The share of the population aged 15 and over undertaking regular exercise in the EU-28 in 2014 was slightly higher in towns and suburbs (32.8 %) than in cities (31.7 %) and lower in rural areas (27.3 %). This basic pattern — a lower share in rural areas and a higher share in towns and suburbs — was observed in only six of the EU Member States (Greece, France, Italy, Hungary, Austria and Finland). The Czech Republic and Estonia were unusual in that the lowest share of their populations aged 15 and over undertaking regular exercise was observed in cities and the highest in towns and suburbs. By contrast, the highest share of regular exercisers was recorded among those people living in cities in 13 of the Member States (and in all of these cases the lowest share was in rural areas). In five Member States — Luxembourg, Malta, Romania, Sweden and the United Kingdom — the highest share of the population undertaking regular exercise was in rural areas.
Based on an analysis by degree of urbanisation, there was a particularly large range in terms of the share of the population aged 15 and over undertaking regular exercise in Slovenia and Denmark (as shown in Figure 5); in both cases, the lowest shares were recorded for rural areas and the highest for cities. The share of the population that exercised regularly was more homogenous (across the three degrees of urbanisation) in Sweden, the Baltic Member States, the Czech Republic and Austria.
One in three people aged 15 and over in the United Kingdom ate at least five portions of fruit and vegetables per day
Alongside exercise, another issue linked with being overweight and with obesity is diet, which also plays a role in reducing the risk of a number of chronic illnesses, including circulatory diseases, diabetes and some cancers. The main components of diet are carbohydrates, proteins, unsaturated fats, vitamins, minerals, fibre and water; the levels of consumption of meat, fish, dairy products, cereals (grains), and fruit and vegetables play an important role in achieving a balanced and healthy diet.
The proportion of persons aged 15 and over in the EU-28 who ate at least five portions of fruit and vegetables per day in 2014 was 14.3 %, equivalent to one in seven of the population. Among the EU Member States, this share ranged from less than 5.0 % in Bulgaria and Romania to a quarter or more in the Netherlands, Denmark and Ireland, peaking at close to one third (33.1 %) in the United Kingdom.
The share of the population aged 15 and over who ate five or more portions of fruit and vegetables per day in the EU-28 in 2014 was higher in cities (15.7 %) than in towns and suburbs (14.0 %), which in turn was higher than in rural areas (12.5 %) — see Figure 6. This basic pattern was observed in half (14) of the EU Member States. By contrast, the highest proportion of people aged 15 and over who ate five or more portions of fruit and vegetables per day was recorded for rural areas in Belgium, Bulgaria, Ireland, Lithuania, Malta, Sweden (joint highest with towns and suburbs) and the United Kingdom. Belgium and Lithuania were also unusual in that their lowest shares of the population aged 15 and over who ate five or more portions of fruit and vegetables per day were observed in towns and suburbs, which was also the case in the Czech Republic, Cyprus and Latvia. The reverse was true in Greece, France, Portugal and Slovakia, where their highest shares were recorded for town and suburbs (with their lowest shares often observed in cities).
An analysis by degree of urbanisation reveals that the consumption of five or more portions of fruit and vegetables per day was fairly uniform in Sweden and Slovakia, whereas there were large differences observed in Malta and to a lesser extent Cyprus and Lithuania: in Malta and Lithuania the share of the population aged 15 and over who ate five or more portions of fruit and vegetables per day was substantially higher in rural areas than elsewhere, whereas in Cyprus it was substantially lower in towns and suburbs.
Weekly drinking of alcohol consistently high across the three degrees of urbanisation in Belgium
Alcohol abuse is associated with a number of medical conditions as well as posing further health risks through an increased likelihood of accidents, violence and suicide. Nearly two fifths (38.8 %) of people aged 15 and over in the EU-28 consumed alcohol every week in 2014. This proportion was generally lower in the Baltic Member States as well as the eastern and southern Member States, with the notable exception of the Czech Republic and to a lesser extent Portugal. By contrast, the proportion of people consuming alcohol on a weekly basis was generally higher in western (no data available for France or the Netherlands) and Nordic Member States, with more than half of people aged 15 and over drinking alcohol on a weekly basis in Luxembourg, Denmark, Belgium and the United Kingdom.
Just over two fifths (40.2 %) of people aged 15 and over living in tows and suburbs in the EU-28 consumed alcohol every week, with the share slightly lower in cities (39.7 %) and notably lower in rural areas (35.9 %) — see Figure 7. These averages for the EU-28 reflect quite different situations among the EU Member States, as in only four cases — the Czech Republic, Spain, Lithuania and Portugal — was a similar pattern found. It was generally more common for the highest share of weekly drinkers of alcohol to be found in cities, which was the case in 13 Member States, with seven of these reporting the lowest share in rural areas and six in towns and suburbs. The next most common pattern was for the highest share of weekly drinkers to be found for people living in rural areas which was the case in six Member States, four reporting their lowest share in cities and two in towns and suburbs.
The share of weekly drinkers of alcohol varied by less than 1.0 percentage points between the three degrees of urbanisation in Slovakia, Lithuania, Belgium and Greece: in Belgium the shares were consistently high (with more than half of the population consuming alcohol at least once every week for all three degrees of urbanisation), whereas in Slovakia and Lithuania the proportion of people consuming alcohol on a weekly basis was consistently low (less than one fifth of the population for all three degrees of urbanisation). Malta and Ireland showed the greatest diversity, but with opposite patterns: in Ireland the share of weekly drinkers of alcohol was particularly high in cities (51.0 %) and relatively low (38.2 %) in rural areas, while in Malta the share of weekly drinkers peaked in rural areas (43.8 %) where it was 50 % higher than in cities (29.1 %).
Prevalence of daily cigarette consumption in the EU fairly similar when analysed by degree of urbanisation
The final part of this analysis of health determinants presents statistics on the proportion of persons aged 15 and over who were daily smokers of cigarettes (see Figure 8). In many developed countries the prevalence of smoking has stabilised or declined in recent decades. According to the World Health Organisation (WHO), tobacco is one of the biggest public health threats, killing nearly six million people a year. The European Commission’s Directorate-General for Health and Food Safety describes tobacco consumption as ‘the single largest avoidable health risk in the European Union’ and many forms of cancer, cardiovascular and respiratory diseases are linked to tobacco use. Around half of all smokers are estimated to die prematurely, while smokers may raise the burden of health care considerably.
In 2014, just fewer than one in five (19.2 %) people aged 15 and over in the EU-28 were daily smokers, with this share ranging from just under one tenth (9.8 %) in Sweden to a quarter or more of the population in Croatia, Cyprus, Hungary, Greece and Bulgaria. More generally, the lowest shares of daily smokers were observed in the Nordic Member States with relatively low shares also found in most western EU Member States, with the exception of Austria (24.3 %) and to a lesser extent France (22.4 %).
Within the EU-28 as a whole there was relatively little variation in the extent of daily smoking between the three degrees of urbanisation (as presented in Figure 8): whereas 19.0 % of people aged 15 and over in towns and suburbs reported that they were daily smokers in 2014, the share in rural areas was only 0.5 percentage points higher (19.5 %), with the share in cities (19.2 %) lying between these two values; none of the EU Member States displayed the same pattern as that observed for the EU-28 as a whole. In only eight Member States (mainly in the east or north) was the share of daily smokers highest in rural areas, as it was in the EU-28 as a whole. The other 20 Member States were split evenly between those where cities had the highest share of daily smokers and those where towns and suburbs had the highest share. The lack of a dominating pattern reflects the fact that the share of daily smokers was relatively homogeneous across the three different degrees of urbanisation. This was particularly the case in two of the largest Member States — Germany and Italy — as well as in Sweden and Poland, where the range between the highest and lowest shares was less than 1.0 percentage points. By contrast, the greatest diversity for the share of daily smokers was recorded in Hungary and Austria, although they had opposing patterns: in Hungary, the highest share of daily smokers was recorded in rural areas (and the lowest in cities), whereas this pattern was reversed in Austria (with the highest share recorded in cities and the lowest in rural areas).
Data sources and availability
Causes of death
Since reference year 2011, data for causes of death have been provided under a specific legal basis, Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work and implementing Regulation (EU) No 328/2011 of 5 April 2011 on Community statistics on public health and health and safety at work, as regards statistics on causes of death. The information presented on causes of death relates to standardised death rates, averaged over the three-year period of 2011–2013.
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Causes of death
Non-expenditure healthcare data, shown here for hospital beds and the number of physicians, are submitted to Eurostat on the basis of a gentlemen’s agreement, as there is currently no implementing legislation covering statistics on healthcare resources as specified within Regulation (EC) No 1338/2008. These data are mainly based on national administrative sources and therefore reflect country-specific ways of organising health care and may not always be completely comparable; a few countries compile their statistics from surveys.
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Non-expenditure healthcare data
The data presented for health determinants are derived from the European health interview survey (EHIS). It aims to provide harmonised statistics across the EU Member States in relation to the health status, lifestyle (health determinants) and use of and access to healthcare services. The general coverage of the EHIS is the population living in private households (who are residents at the time of data collection); it therefore excludes people living in collective households and institutions. Data generally refer to the population aged 15 years or over (although information pertaining to obesity cover those aged 18 years and over).
For more information:
European health interview survey
The data presented in this article are based exclusively on the 2013 version of NUTS.
The data presented on causes of death are generally available for NUTS level 2 regions, covering the resident population of each territory. Only national data are available for Slovenia, while there are no data available for the French Départements d'outre-mer (FRA), nor for London (UKI).
The data concerning regional healthcare resources (hospital beds and physicians) are generally available for NUTS level 2 regions; they were converted from NUTS 2010. This conversion has had the following consequences: data for the French regions of Guadeloupe (FRA1) and Mayotte (FRA5) are not available; only national data are available for Slovenia. Non-expenditure healthcare data are generally presented for NUTS level 2 regions, with some exceptions.
Glossary entries on Statistics Explained are available for a wide range of health-related concepts/indicators, including: causes of death, death, healthcare, hospital beds, life expectancy, physicians and the standardised death rate (SDR).
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Dedicated section on health
In the coming decades, population ageing will be a major challenge for the EU’s health sector. The demand for healthcare will likely increase at a rapid pace as a result of an ageing population, while demographic changes could also result in staff shortages for certain medical specialisations or specific geographic areas — according to the Directorate-General for Health and Food Safety, more than 60 thousand doctors (or 3.2 % of the workforce) are expected to retire/leave the profession each year during the period up to 2020.
The European Commission works with EU Member States using an open method of coordination for health issues, a voluntary process based on agreeing common objectives and helping national authorities cooperate. At an EU level, policy actions generally fall under the remit of the Directorate-General for Health and Food Safety and the Directorate-General for Employment, Social Affairs and Inclusion: they are focused on protecting people from health threats and disease (flu or other epidemics), consumer protection (food safety issues), promoting lifestyle choices (fitness and healthy eating), or workplace safety. The legal basis for the EU’s third health programme is provided by Regulation (EU) No 282/2014 on the establishment of a third Programme for the Union’s action in the field of health (2014–2020). It aims to:
- facilitate access to better and safer healthcare for EU citizens;
- contribute to innovative, efficient and sustainable healthcare systems;
- improve the health of EU citizens and reduce health inequalities;
- prevent disease and foster supportive environments for healthy lifestyles;
- protect citizens from cross-border health threats.
As well as being a value in itself, health is a precondition for economic prosperity. Efficient and smart spending on health can promote economic growth through more sustainable health systems, health promotion programmes, or investments to break the cycle of poor health contributing to and resulting from inequalities, poverty and social exclusion. By doing so, Investing in health (SWD(2013) 43 final) may contribute towards the Europe 2020 objectives of ‘smart, sustainable and inclusive growth’.
The EU’s cohesion policy provides a powerful instrument to help EU Member States and their regions to invest in sustainable, innovative and reformed health systems. Structural and investment funds for non-direct investments such as urban regeneration, transport, the environment, employment, social inclusion and housing can also have a considerable impact on a population’s health. During the period 2014–2020 the EU seeks to: invest in health infrastructure, in particular reinforcing the shift from a hospital-centred model to community-based care and integrated services; reduce health inequalities between regions and give disadvantaged groups and marginalised communities better access to healthcare; support the adaptation, up-skilling and lifelong learning of the health workforce; foster active, healthy ageing to promote employability and enable people to stay active for longer.
A healthy diet can protect against diseases and health conditions such as diabetes, circulatory diseases, strokes and some forms of cancer, as well as reducing the likelihood of obesity. Exercise from an early age can influence adult physical activity which in turn leads to a lower likelihood of being overweight or obese or suffer from circulatory diseases or chronic conditions such as diabetes. Obesity is associated with various health issues, including hypertension, high cholesterol, diabetes, circulatory diseases and cancer, and may lead to increased risks of respiratory and musculoskeletal problems. In March 2005, the European Commission launched a European platform for action on diet, physical activity and health. This was followed in May 2007 by a White paper concerning a Strategy for Europe on nutrition, overweight, and obesity-related health issues (COM(2007) 279 final), which aimed to contribute to reducing the risks associated with poor nutrition and limited physical activity in the EU. An EU Action Plan on Childhood Obesity was adopted in 2014 that aims to halt the rise in overweight and obese children (aged up to 18) by 2020; in June 2014, the Council adopted its Conclusions on Nutrition and Physical Activity and in September 2015 a Joint Action on Nutrition and Physical Activity started. Alcohol use and abuse is associated with a number of health and social issues, including accidents and violence, as well as negative long-term health consequences: it one of the leading health risk factors in the EU and has been linked to increased risks of circulatory diseases, liver cirrhosis and cancer. In 2006, the European Commission adopted its strategy to support Member States in reducing alcohol related harm (COM(2006) 0625 final), which had five priorities: protect young people, children and unborn children; reduce injuries and deaths from alcohol-related road traffic accidents; prevent alcohol-related harm among adults and reduce the negative impact on the workplace; inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patterns; develop, support and maintain a common evidence base. The implementation of the strategy was assessed in 2009 and again in 2013.
Smoking has a number of hazardous consequences for health, such as increasing the risk of respiratory and circulatory diseases and many forms of cancer, as well as impacting on physical fitness. The EU’s main policy measures related to tobacco and tobacco consumption aim to protect people from the hazardous effects of smoking and other forms of tobacco consumption, including against second-hand smoke. These include measures related to packaging, labelling and ingredients, advertising restrictions, the creation of smoke-free environments, tax measures, activities against illicit trade, and anti-smoking campaigns.
- Health in the European Union – facts and figures - online publication
- Causes of death statistics
- Functional and activity limitations statistics
- Mortality and life expectancy statistics
- Self-perceived health statistics
- Unmet health care needs statistics
Further Eurostat information
- Eurostat regional yearbook
- Atlas on mortality in the European Union, 2009
- 1 in 4 deaths caused by cancer in the EU-28 — Lung cancer main fatal cancer — News release 179/2014
- Causes of death in the EU-28 in 2010 — Circulatory diseases main cause of death for men and women aged 65 years and over — News release 178/2013
- Circulatory diseases — Main causes of death for persons aged 65 and more in Europe, 2009 — Issue number 7/2012
- Regional health statistics (t_reg_hlth)
- All causes of death by NUTS 2 regions (tgs00057)
- Death due to cancer by NUTS 2 regions (tgs00058)
- Death due to ischaemic heart diseases by NUTS 2 regions (tgs00059)
- Death due to accidents by NUTS 2 regions (tgs00060)
- Death due to transport accidents by NUTS 2 regions (tgs00061)
- Physicians or doctors by NUTS 2 regions (tgs00062)
- Dentists by NUTS 2 regions (tgs00063)
- Available beds in hospitals by NUTS 2 regions (tgs00064)
- Health status and determinants (health_state), see:
- Health status (hlth_state)
- Self-perceived health and well-being (hlth_sph)
- Functional and activity limitations (hlth_fal)
- Self-reported chronic morbidity (hlth_srcm)
- Health care (hlth_care), see:
- Health care resources (hlth_res)
- Heath care staff (hlth_staff)
- Health personnel by NUTS 2 regions (hlth_rs_prsrg)
- Health care facilities (hlth_facil)
- Hospital beds by NUTS 2 regions (hlth_rs_bdsrg)
- Heath care staff (hlth_staff)
- Unmet needs for health care (hlth_unm)
- Regional health statistics (reg_hlth)
- Causes of death (reg_hlth_cdeath)
- Health care: resources and patients (non-expenditure data) (reg_hlth_care)
Source data for figures and maps (MS Excel)
- Cohesion policy and health
- European Commission Directorate General for Health and Food Safety — Public health
- Health at a glance (OECD)
- World Health Organisation (WHO)