Being young in Europe today - health
Data extracted in July 2020.
Planned article update: September 2022.
Between 2008 and 2018, life expectancy at birth in the EU-27 increased by 1.7 years, from 79.3 to 81.0 years (rising by 1.3 years on average for females and by 2.1 years on average for males).
Between 2008 and 2018, the crude death rate for children and young people decreased by 26 %; from 42 to 32 deaths per 100 000 inhabitants for children aged 0-14 years and from 49 to 36 deaths per 100 000 inhabitants for young people aged 15-29 years.
Health is important for citizens in the European Union (EU), who expect to lead long and healthy lives, to be protected against illness and accident, as well as to receive appropriate healthcare services. Health is also a key measure of the quality of life and a healthy population is an important factor that may underpin economic growth and prosperity.
Health is clearly a topic of high interest both for EU citizens and policymakers. According to the Treaty on the Functioning of the European Union, one of the EU’s roles is to ensure that human health is taken into consideration in all of its policies. The EU also supports its Member States in their actions aimed at improving public health, preventing human illness and eliminating sources of danger to physical and mental health.
This article presents a range of health indicators on children and young people in the EU. In order to get a clear picture of the health of young EU citizens, indicators such as life expectancy, mortality rates and causes of death are analysed. Indicators on health status and health determinants are also presented, as they are highly relevant and necessary to establish fact-based health policies.
The most important drivers of health inequality originate in socioeconomic differences. Poorer people tend to be in worse health and die younger than people who are better off. Other factors, which are often linked to overall economic circumstances, may also play an important role. These factors include living and working conditions, diet, physical activity, tobacco use, harmful alcohol consumption, provision and quality of health services, and related public policies, including social protection.
Life expectancy and mortality rates
Today’s young people may expect to live longer than ever before
The indicator most commonly used to analyse mortality levels is life expectancy at birth. In the EU-27, life expectancy at birth is higher than in most regions of the world and continues to increase most years, reflecting falling mortality rates at all ages. Economic developments, changes in education and lifestyle, as well as changes in access to health services across the EU have contributed to this increase. The life expectancy of a new-born baby in the EU-27 was 81.0 years (83.7 years for females and 78.2 years for males) in 2018. During the 10 years from 2008 to 2018, life expectancy at birth in the EU-27 increased by 1.7 years, from 79.3 to 81.0 years (rising by 1.3 years on average for females and by 2.1 years on average for males).
Life expectancy rose in all EU Member States (see Figure 1), although there were major differences between their levels. With averages of 83.5 and 83.4 years in 2018, Spain and Italy were the EU Member State with the highest life expectancy at birth; this figure was also above 82 years in France, Cyprus, Sweden, Malta, Ireland and Luxembourg. In total, 17 EU Member States recorded a life expectancy at birth above 80 years in 2018. By contrast, Bulgaria, Latvia and Romania reported the lowest levels of life expectancy at birth in 2018, at 75.0-75.3 years.
The gender gap in life expectancy also varies between Member States, even if the life expectancy at birth for women was always higher than that for men (see Figure 2). In all of the EU Member States, women, on average, lived longer than men: this difference may be explained by both biological and behavioural factors. As well as the gender-specific disease of prostate cancer, men are more likely than women to die from lung cancer, tuberculosis, cirrhosis of the liver and coronary heart disease as well as from injuries, whether unintentional or intentional (suicide and homicide). The higher death rates from these causes of death for men far outweigh the female mortality rates for breast and cervical cancer. In 2018, the gender gap in life expectancy at birth in the EU-27 was 5.5 years in favour of women. In the Baltic Member States, female new borns were expected to outlive male new borns by around nine years. The largest difference in life expectancy at birth between the sexes was found in Lithuania (9.8 years), followed by Latvia (9.6 years) and Estonia (8.7 years), whereas the smallest gaps were found in the Netherlands (3.1 years), Sweden (3.4 years), Ireland (3.6 years), Denmark (3.8 years) and Cyprus (3.9 years). However, the gap in life expectancy at birth narrowed between 2008 and 2018: the gap for the EU-27 fell from 6.3 years in 2008 to 5.5 years in 2018 (note that there is a break in series).
Mortality rates for children and young people declined in the EU-27
WHAT IS THE CRUDE DEATH RATE?
The crude death rate is the ratio of the number of deaths during the year (in general, or due to a specific cause) to the average population in that year. It is expressed as the number of deaths per 100 000 inhabitants.
Historically, the crude death rate for the EU-27 population generally followed a downward trend over recent decades. Rising living standards, lifestyle changes, changes in safety at work and transport safety, better education, as well as advances in healthcare and medicine may explain the gradual reduction of mortality rates and the relatively rapid increase in life expectancy at birth. However, there was a modest increase in the EU-27 crude death rate since a relative low was recorded in 2006.
Figure 3 illustrates the development of the crude death rates for children (0-14 years) and young people (15-29 years), during the period 2008-2018. Since the number of deaths in a population generally increases with age, the crude death rates for children and young people were relatively low compared with the rate for the total population of the EU-27, while the mortality of young people was slightly higher than that of children.
In absolute terms, 21.7 thousand children and 26.9 thousand young people died in the EU-27 during 2018, which corresponded to a crude death rate for children and young people of 32 and 36 deaths per 100 000 inhabitants respectively. Between 2008 and 2018, the crude death rate for children and young people followed a significant downward path, with a decline of 24.6 % for children (from 42 to 32 deaths per 100 000 inhabitants) and of 27.0 % for young people (from 49 to 36 deaths per 100 000 inhabitants).
Looking at the death rates by gender, male mortality in the EU-27 exceeds female mortality for children and young people (see Table 1). In 2018, boys (0-14 years) and young men (15-29 years) accounted for 56.2 % and 72.6 % of the total number of deaths among children and young people respectively.
Mortality rates for children and young people of all ages have fallen substantially in recent years across the EU-27. However, disparities by age group, sex and EU Member State persist. Among the Member States, Romania (61.8 deaths per 100 000 children), Bulgaria (57.9), Slovakia (49.8) and Malta (46.4) had the highest crude death rates for children in 2018, whereas Finland (19.1) and Slovenia (19.9) had the lowest rates (see Figure 4). Across all of the EU Member States except for Luxembourg (note that there is a break in series), the crude death rate for children decreased between 2008 and 2018. The largest falls — where the crude death rates for children more than halved — were registered in Estonia (down 60.5 %; note that there is a break in series) and Latvia (down 55.0 %); there were also relatively large reductions — between 40 and 50 % — recorded in Bulgaria, Lithuania, Romania and Hungary.
Looking at the crude death rates for young people (15-29 years), Cyprus (23.5 deaths per 100 000 young people), Spain (24.3) and Luxembourg (24.9) recorded the lowest rates in 2018, while Latvia (with 76.2 deaths per 100 000 young people), Lithuania (76.1), Bulgaria (58.8), Poland (56.4) and Romania (53.3) recorded the highest rates (see Figure 5). The largest decreases between 2008 and 2018 in crude death rates for young people were seen in Estonia (down 56.4 %; note that there is a break in series), Luxembourg (down 51.7 %; note that there is also a break in series) and Cyprus (also down 51.7 %). By contrast, Sweden registered a relatively small reduction (1.7 %) in the crude death rate for young people during the 10 years to 2018.
Between 1961 and 2018 the EU-27 infant mortality rate decreased by more than 90 %
INFANT MORTALITY RATE
The infant mortality rate represents the ratio of the number of deaths of live-born children aged less than one year to the number of live births in a given year. The value is expressed per 1 000 live births.
The infant mortality rate in the EU-27 decreased by 91.1 % between 1961 and 2018 reflecting a number of factors, in particular improvements in healthcare. Scientific advancements in medical treatment, higher quality in the delivery of healthcare services, and more personalised pre- and post-natal accompaniment have resulted in better prevention of premature deaths.
In 2018, some 14.6 thousand children died before reaching one year of age in the EU-27, resulting in an infant mortality rate of 3.4 deaths per 1 000 live births. Among the EU Member States, Estonia and Slovenia had the lowest infant mortality rates in 2018, at 1.6 and 1.7 deaths per 1 000 live births respectively (see Figure 7). By contrast, the highest infant mortality rates were found in Romania (6.0 deaths per 1 000 live births), Bulgaria (5.8), Malta (5.6) and Slovakia (5.0).
In the last 30 years for which data are available (comparing 2018 with 1988), the infant mortality rate in the EU-27 fell by more than two-thirds from 11.4 deaths per 1 000 live births to 3.4, while in the last 50 years it fell by 88.4 %. Note that the intervals between the years shown in Figure 7 are not regular, with the gap between the two most recent years being 10 years whereas between the earlier years the gaps are 20 years.
In percentage terms, the largest falls in the infant mortality rate between 1968 and 2018 were recorded in Portugal (down 94.6 %, from 61.1 to 3.3 deaths per 1 000 live births) and Slovenia (down 93.7 %, from 27.1 to 1.7 deaths per live births).
Looking at more recent developments, there were still some considerable falls in infant mortality rates during the last decade for which data are available (between 2008 and 2018). The rate more than halved in Estonia (down 68.0 ) and Latvia (down 51.5 %), while there were reductions within the range of 40-50 % in Romania and Hungary.
Causes of death
External factors are the main cause of death for children and young people
Causes of death vary substantially according to age groups. For instance, the most frequent causes of death for people over the age of 45 years are cancer (neoplasms), circulatory and respiratory diseases, while most deaths among young people are related to external causes, such as transport accidents, intentional self-harm, accidental falls and assault, while for children cancers are a more significant cause as are some causes related to illnesses or conditions that are already present at childbirth.
The broad category of other causes of death had the highest share (49.0 %) of deaths among children aged 1-4 years in the EU-27 (see Figure 8). This category includes — among many other causes — congenital (inborn) malformations, deformations and chromosomal abnormalities, which accounted for 16.2 % of all deaths in this age group. The most common causes of death among the more specific causes that are presented in Figure 8 were external factors (23.5 % in 2016) and neoplasms (13.5 %).
Neoplasms were the main individual cause of death among children aged 5-9 years (accounting for more than one quarter (27.4 %) of all deaths for this age group in 2016), followed by external causes of death (22.5 %). For children aged 10-14 years, this situation was reversed, as external factors were the most common cause of death (29.4 % of deaths in 2016), followed by neoplasms (25.8 %).
In 2016, external causes accounted for 55.8 %, 60.4 % and 51.1 % of deaths among young people aged 15-19, 20-24 and 25-29 years respectively. One of the main types of deaths from external causes was deaths from transport accidents, with 24.7 %, 24.5 % and 15.6 % of deaths respectively in these three five-year age groups. Another common cause of external deaths for young people was intentional self-harm, which accounted for 16.9 % of all deaths for those aged 15-19 years, 19.5 % of all deaths for young people aged 20-24 years and 18.2 % for those aged 25-29 years; as such, the death rate from intentional self-harm for young people aged 25-29 years was greater than that from transport accidents.
In absolute terms, some 5.7 thousand young people aged 15-29 years died in 2016 in the EU-27 as a result of transport accidents. Examining the numbers by age group and gender (see Table 2), young men aged 20-24 years were the age group most involved in fatal transport accidents (1.8 thousand deaths).
In 2016, 5.1 thousand young people aged 15-29 years died due to intentional self-harm, almost the same number as due to transport accidents. Once again a majority of deaths were recorded among young men, with those aged 25-29 years accounting for the highest count (1.8 thousand); this figure was slightly higher than the number of male deaths from transport accidents for this age group (1.6 thousand).
Certain perinatal conditions and congenital malformations are the most common causes of infant mortality
Looking at the cause of infant deaths, it appears that certain conditions originating in the perinatal period  are the most common cause of death for infants aged less than one year (see Figure 9). In 20 EU Member States, at least 50.0 % of infant deaths were caused by such conditions in 2017. In Luxembourg these conditions accounted for nearly three quarters (73.3 %; 2014 data) of all cases of infant mortality and this share peaked at 78.6 % in Cyprus.
Congenital malformations and chromosomal abnormalities are another common cause of death for infants aged less than one year. They were the most frequently recorded cause of death for this age group in Lithuania (32.9 % of infant deaths), where certain conditions originating in the perinatal period had an identical share of infant deaths. Deaths from congenital malformations and chromosomal abnormalities were more common in Ireland (39.9 %), Poland (37.3 %), Croatia (33.8 %) and Malta (33.3 %; 2014 data), although in all four cases a higher number of deaths could be attributed to certain conditions originating in the perinatal period. The other causes of infant deaths that are presented in Figure 9 were relatively uncommon across the EU-27 as a whole (each accounted for less than 5.0 % of all deaths among children aged less than one year), but were relatively common in a few of the Member States. For example, deaths resulting from diseases of the respiratory system were relatively common in Romania and to a lesser extent in Bulgaria, while sudden infant death syndrome (also known as cot death) was relatively common in Luxembourg (2013 data), Czechia and Ireland, and deaths from external causes were relatively common in Slovenia. It should be noted that the overall number of infant deaths is relatively small and so changes in the causes of death can vary greatly from one year to the next, particularly in Member States with relatively small numbers of newborns.
Transport accidents are the leading cause of death among young people
TRANSPORT, TRAFFIC AND VEHICLE ACCIDENTS
A transport accident is any accident involving a device designed primarily for, or being used at the time primarily for, conveying persons or goods from one place to another.
A traffic accident is any vehicle accident occurring on the public highway (in other words originating on, terminating on, or involving a vehicle partially on the highway).
A vehicle accident is assumed to have occurred on the public highway unless another place is specified, except in the case of accidents involving only off-road motor vehicles, which are classified as non-traffic accidents unless the contrary is stated.
Source: WHO International Classification of Death Causes
Transport accidents are a major cause of death, especially for young people. The main risk factors for fatal transport accidents are speed, alcohol or drug abuse, exposing vulnerable road users to motorised traffic, poor visibility and not using protective equipment .
As noted above, the number of deaths of young people aged 15-29 years from transport accidents in the EU-27 amounted to 5.7 thousand in 2016, meaning that on average around one in 15 500 young people died as a consequence of a transport accident. The number of deaths of young people from transport accidents in 2016 corresponded to a decrease of 68.2 % compared with the 17.8 thousand such deaths in 2000. Looking at age groups, the number of deaths of young people aged 15-19 years decreased by 72.3 %, while the numbers for those aged 20-24 and 25-29 years decreased by 67.6 % and 65.0 % (see Figure 10).
For children and for young people, crude death rates from transport accidents were higher in 2016 for boys or young men than for girls or young women (see Figure 11). The differences between the sexes were nevertheless more pronounced among young people than children. The biggest gender gaps were observed for the age groups 20-24 and 25-29 years.
Among the EU Member States, the lowest crude death rates from transport accidents for children and young people in 2017 were generally recorded in Sweden, the Netherlands and Ireland. By contrast, the highest rates were in Romania, Greece, Croatia, Poland and Latvia. Looking at the age group for 20-24 years, which had the highest crude death rate from transport accidents in the EU-27, the highest rates were recorded in Croatia, Romania, Cyprus, Poland and Greece (see Figure 12).
Intentional self-harm remains a challenge in several northern EU Member States
Intentional self-harm implies purposely self-inflicted poisoning or injury and (attempted) suicide.
Suicide is the act of deliberately killing oneself. Risk factors for suicide include mental disorder (such as depression, personality disorder, alcohol dependence or schizophrenia), and some physical illnesses, such as neurological disorders, cancer, and HIV infection.
Source: WHO International Classification of Death Causes
The most important risk factors for suicidal behaviour are psychological and social in nature. Social factors may include discrimination (for example, bullying at school), social isolation, relationship conflicts with family and friends, unemployment or poverty. Mental and psychological problems play a key role in the emergence of suicidal behaviour, with depression and hopelessness being associated with 9 out of 10 cases of suicide. Drug abuse and alcohol use are also determinants; indeed, almost one quarter of suicides involve alcohol abuse. Intentional self-harm may also be the consequence of severe painful and dissembling physical illnesses, in combination with social isolation. Note that suicide rates tend to increase during periods of economic recession and unemployment .
In 2016, young people were especially vulnerable to the risk of suicide, as intentional self-harm was the second most frequent cause of death — behind transport accidents — among young people (aged 15-29 years) in the EU-27. In absolute numbers, the cases of intentional self-harm dropped from 254 to 142 for children aged 0-14 years and from 7 936 to 5 061 for young people aged 15-29 years (see Figure 13). The age group for young people aged 25-29 years had the highest number of deaths from intentional self-harm, some 2.3 thousand cases in 2016.
Young women tend to be substantially less likely to die from suicide and intentional self-harm, with crude death rates for boys (0-14 years) being 1.4 times as high as for girls and rates for young men (for five-year age groups between 15 and 29 years) being 2.3 to 4.2 times as high as those for young women in the EU-27 (see Figure 14).
Among the EU Member States, several northern Member States (Lithuania, Finland, Latvia, Estonia and Sweden) as well as Slovenia had the highest crude death rates from intentional self-harm in 2017 among young people aged 25-29 years (see Figure 15), although it should be noted that the rate was much lower in the other northern Member States, Denmark. By contrast, several southern Member States (Portugal, Greece, Cyprus, Italy, Spain and Malta) figured at the other end of the ranking, with the lowest crude death rates from intentional self-harm for this age group.
People in their twenties were generally more likely to die from intentional self-harm than their younger peers in most EU Member States in 2016. The only exceptions were Luxembourg, where death rates for intentional self-harm were higher among young people aged 15-19 years than among those aged 20-24 years, and Malta, where death rates for intentional self-harm were higher among young people aged 15-19 years than among those aged 20-24 years and those aged 25-29 years.
The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’, which points to its multidimensional nature. It also implies different ways of measuring health, such as collecting objective data from health care providers or more subjective data on physical functioning, emotional well-being, pain or discomfort, and overall perception of health from respondents participating in surveys. This section focuses on three key indicators describing the levels and distribution of health status: self-perceived health, long-standing illnesses or health problems and activity limitations.
The vast majority of young people perceived themselves to be in good or very good health
Self-perceived health gives an overall assessment by the respondent of their health in general. It is by definition subjective and is expected to include different dimensions of health such as psychological and physical symptoms.
Generally, young people are in a better health condition and feel healthier than older age groups. However, this period of life requires special attention since health-related behaviour establishes itself during adolescence and is strongly influenced by social and environmental factors. In 2018, 91 % of the EU-27’s young population aged 16-29 years declared that they were in good or very good health.
Self-perceived health status varies to some extent between EU Member States (see Figure 16). The lowest proportions of young people aged 16-29 years who declared themselves to be in good or very good health in 2018 were registered in Estonia (80 %), Portugal and Lithuania (both 83 %), Denmark (84 %) and Latvia (85 %). In Greece, Romania, Malta and Bulgaria, 96-97 % of young people perceived their health as being good or very good. Ireland, Italy, Spain, Cyprus and Hungary were also near the top of the list, as 95% of young people in each of these Member States perceived themselves to be in good or very good health.
Generally, young men were more likely than young women to perceive themselves to be in good or very good health: in the EU-27 as a whole, 92 % of young men were of this opinion in 2018 compared with 90 % of young women. Among the EU Member States, Denmark recorded the biggest gender gap for self-perceived health among young people, with the proportion of young men perceiving themselves to be in good or very good health some 13 percentage points higher than for young women; the next largest gaps were recorded in Luxembourg (7 points difference) and Slovenia (6 points). In Lithuania and Bulgaria, the share of young women perceiving their health as being good or very good was higher than the share recorded among young men, a difference of 7 points in Lithuania and 2 points in Bulgaria. In Poland, Croatia, Cyprus, Greece, Malta and Sweden, the share of young women perceiving their health as being good or very good was higher than the share recorded among young men, but the difference was less than 1.0 points.
Besides the objective health status, these differences across EU Member States in self-perceived health may relate to general health standards in a Member States, and to cultural differences, for example how people evaluate their personal health or how they disclose their health problems.
Looking at the relationship between self-perceived health status and an individual’s income situation (see Figure 17), a clear pattern can be observed in almost all of the EU Member States: the higher the income of a young individual, the higher the probability of that young person reporting good or very good health.
HOUSEHOLD INCOME AND INCOME QUINTILES
Statistics by income quintile are based on the distribution of (equivalised disposable) income across the population of a given geographical entity. The total income of a household, after tax and other deductions, which is available for spending or saving, is divided by the number of household members converted into ‘equivalised’ adults. Household members are equivalised or made equivalent by weighting each of them according to their age, using the so-called modified OECD equivalence scale: the scale gives a weight of 1.0 to the first adult, 0.5 to any other household member aged 14 years and over and 0.3 to each child below the age of 14 years.
Income quintiles refer to the position in the frequency distribution. Quintiles divide a distribution into five parts so that 20 % of total observations are present in each quintile. The quintile cut-off value is obtained by sorting all observations by equivalised income from lowest to highest, and then choosing the value of income under which 20 % (lower limit), 40 %, 60 % and 80 % (upper limit) of the observations are located. A quintile group refers to the observations below the lower limit, between two cut-off values, or above the upper limit. When distributing a population by income quintiles, the first quintile group includes the one fifth of the population which has income below the lower limit (0-20 % of the population) and the fifth quintile group includes the one fifth of the population which has income greater than upper limit (80-100 % of the population), in other words the richest fifth of the population.
On average in the EU-27, 89 % of young people aged 16-29 years in the first income quintile perceived their health as good or very good in 2018 compared with 95 % in the fifth income quintile. An income gap was observed in all but one of the EU Member States (see Figure 17). The largest difference in self-perceived health status between young people with the highest and lowest incomes was recorded in Latvia (23 percentage points), followed by Portugal, Estonia, Finland, Sweden and Austria (with income gaps in the range of 10-16 points). By contrast, the difference between the first and the fifth income quintiles was a single percentage point in Greece, Romania and Italy. Lithuania was the only Member State to report that a higher share of young people in the first income quintile (rather than the fifth income quintile) perceived their health as good or very good.
Long-standing health problems vary according to gender and income level
According to the WHO, long-standing health problems or chronic illnesses (hereafter referred to as long-standing health problems), such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality and disability worldwide, representing 60 % of all deaths. Some long-standing health problems can be positively influenced through a healthy lifestyle. Their consequences, such as premature death and disability, could be reduced by an adequate and timely diagnosis/treatment as well as preventative actions. Although the prevalence of long-standing health problems is lower in young people, the psychological burden may be more serious and this could have important implications on social integration.
In 2018, 17 % of young people aged 16-29 years in the EU-27 reported that they suffered from a long-standing health problem. The lowest prevalence of long-standing health problems among this age group was observed in Romania (2017 data), Italy, Greece and Bulgaria (all less than 5.0 %). The highest rates of young people having long-standing health problems — between one fifth and one quarter of all young people — were registered in Estonia, Finland, Germany, Sweden and Austria. These differences between EU Member States could also be related to cultural differences in self-perception and in practices for diagnosis, management and treatment of long-standing health problems.
Some 15 % of young men aged 16-29 years in the EU-27 declared suffering from a long-standing illness or health problem in 2018; this was four percentage points lower than the corresponding share recorded among young women of the same age group (19 %). This pattern — a higher share of young women (than young men) suffering from a long-standing illness or health problem was repeated in a majority (19) of the EU Member States. The biggest gender gap was observed in Finland, where the share of young women was 10 percentage points higher than the share for young men, followed by Denmark (9 points), Germany and Slovenia (both 5 points). In six of the remaining Member States, young men were more likely than young women to report long-standing health problems; this was most notably the case in Estonia and Lithuania (where the share for young women was 3 and 4 points below that recorded for young men). In Belgium and Hungary, identical shares of young men and young women declared suffering from a long-standing illness or health problem.
Like self-reported health, the frequency of long-standing health problems among young people varies according to income level. On average, 20 % of young people in the EU-27 aged 16-29 years and in the first income quintile reported a long-standing health problem in 2018 compared with 13 % for the fifth income quintile (see Figure 19). This pattern of a higher proportion of young people in the first income quintile reporting long-standing health problems than in the fifth quintile was repeated in each of the EU Member States, although the differences were very small (less than 0.5 percentage points) in Cyprus, Italy and Greece. The largest gaps were observed in Germany, Estonia and Sweden, where the proportion of people suffering from a long-standing health problem was 9.0-9.6 percentage points higher among young people in the first income quintile than among those in the fifth income quintile.
Limitations in usual activities also vary according to gender and income level
People with long-standing health problems can experience difficulties in accomplishing everyday activities, which affects their quality of life. Data on the degree of limitation in usual activities due to health problems are used as a proxy measure for disability.
In 2018, 8 % of people aged 16-29 years living in the EU-27 reported health-related long-standing (longer than six months) limitations in usual activities (hereafter referred to as activity limitation) — see Figure 20. The prevalence of activity limitation among young people was highest in Finland and Estonia (both 19 %), Denmark (18 %), Slovenia (17 %), the Netherlands and Austria (both 16 %). The lowest prevalence of activity limitation among this age group were reported in Malta and Greece (both 3 %) and Bulgaria (4 %).
As for long-standing health problems, young women in the EU-27 tended to report activity limitations more frequently than young men (a gender gap of 2 percentage points). A higher share for young women than for young men was observed in 19 of the EU Member States. In 2018, the greatest gender gaps were observed in Denmark, Finland and the Netherlands, where the difference in the shares for young women and men was 9-11 points. Nevertheless, in eight Member States, proportionally more young men reported activity limitations than young women: in Estonia and Cyprus this difference stood at 3 points.
The incidence of long-standing limitations in usual activities due to health problems among young people aged 16-29 years fluctuated over the period 2010-2018 (see Figure 21). This was particularly notable for young people with some (rather than severe) limitations. The share of young women in the EU-27 with some activity limitations peaked in 2013 and 2014, while the share of young men with some activity limitations peaked in 2014. Having fallen during consecutive years, both the share of young men and young women reporting some limitations rose again in 2017. This development continued for young women in 2018 (rising to 7.3 %), whereas the share for young men remained unchanged (5.6 %). For young men in the EU-27 the proportion with severe limitations was within the range of 1.7-2.1 % during the period 2010-2018, while for young women the range was 1.4-1.8 %.
Young people aged 16-29 years with long-standing limitations in usual activities due to health problems were more likely to report some rather than severe limitations; this pattern was repeated across all but one of the EU Member States in 2018 (see Figure 22). The only exception was Greece, where a higher share of young people reported severe (1.9 %) rather than some limitations (1.4 %). In Poland, Croatia, Slovakia, Cyprus, France, Belgium and Luxembourg, between a quarter and a third of all young people with activity limitations experienced severe limitations, while a relatively low proportion of the young people reporting activity limitations in Latvia, Czechia, Lithuania and Spain were impacted by severe limitations (10.0-12.2 %).
Figure 23 presents information on the incidence of activity limitations according to age. In the EU-27, the share of young people aged 16-24 years with some or severe limitations in 2018 was 7.8 %, while the corresponding share for young people aged 25-29 years was 1.0 percentage points higher (8.8 %). This pattern — a higher proportion of young people aged 25-29 years reporting activity limitations — was repeated in a majority (20) of the EU Member States. The gap between these two age groups was largest in Estonia (where the share reporting activity limitations was 8.2 points higher among those aged 25-29 years), Czechia (5.4 points), Austria (4.2 points) and Portugal (4.1 points). By contrast, there were six Member States where the proportion of young people aged 16-24 years reporting activity limitations was higher than for those aged 25-29 years. This was most notably the case in Finland (4.2 points higher) and the Netherlands (3.1 points), while the difference between these two age groups for this proportion was no more than 1.0 points for the remaining four Member States.
Income level was again a differentiating factor for activity limitations in almost all EU Member States (see Figure 24). For the EU-27, 6 % of young people among the top (fifth) income quintile compared with 10 % of young people from the bottom (first) quintile declared activity limitations in 2018. This income gap varied considerably across EU Member States: the largest difference between the first and fifth quintiles was registered in Estonia — where the share of young people in the first income quintile with activity limitations was 13 percentage points higher than the corresponding share for young people in the fifth income quintile. Relatively large income gaps (differences of 8-9 points) were also recorded in Portugal, Denmark and Austria. Lithuania was the only Member State where the share of young people in the first income quintile with activity limitations was lower than the corresponding share for young people in the fifth income quintile, a difference of 3 points, while in Italy the shares were the same in the top and bottom quintiles.
Medical needs of young people in the EU-27 are not always covered
Differences in health status may be partly related to access to healthcare. Within the EU-27, 2 % of young people aged 16-29 years declared in 2018 having had unmet needs for medical examination during the previous 12 months (see Figure 25). For most of these, the reasons were that the medical services were too expensive or that they preferred to wait (for example, to see if their medical issue resolved itself).
However, the situation varied widely between EU Member States. While in Malta, Austria, Spain, the Netherlands, Luxembourg, Germany, Italy, Lithuania, Cyprus and Croatia almost all (at least 99 %) young people did not face any unmet needs for medical examination in the previous 12 months, more than 15 % of young people in Estonia declared having experienced unmet needs. Denmark followed (8 % of young people had unmet needs), while in Greece, Poland and Sweden this share was 5 %. In Estonia, the main barrier for unmet needs for medical examination was waiting lists, while in Denmark it was because young people preferred to wait and in Greece it was cost.
The health status of an individual results from a combination of several factors: genetic and biological characteristics, personal behaviour, socioeconomic background (income and education level) and physical environment. This section focuses on some health determinants that are linked to lifestyle related behaviours like obesity, drug and alcohol consumption.
Obesity increases with age
Obesity is a serious public health problem, as it significantly increases the risk of chronic diseases such as cardiovascular disease, type-2 diabetes, hypertension, coronary-heart diseases and certain cancers. Moreover, obesity is linked to a higher risk for psychological problems. For society, obesity has substantial direct and indirect costs that put a strain on national healthcare systems, economic productivity and social resources.
In 2017, 4 % of young people aged 16-24 years were classified as obese according to the body mass index (BMI), which can be a consequence of their dietary habits and lifestyles. This proportion increased with age, to 9 % among people aged 25-34 years and stood at an average of 15 % across the whole of the adult population (aged 16 years or more).
BODY MASS INDEX EXPLAINED
The body mass index (BMI) is a measure of a person’s weight relative to height that correlates fairly well with body fat. The BMI is accepted as the most useful indicator of obesity in adults when only weight and height data are available.
The BMI is calculated by dividing body weight (in kilograms) by height (in metres) squared.
The following subdivisions are used to categorise the BMI into four categories:
- < 18.5: underweight;
- ≥ 18.5 and < 25: normal weight;
- ≥ 25 and < 30: pre-obese (overweight excluding obese);
- ≥ 30: obese.
As noted above, the share of obese young people in the EU-27 tends to increase with age (see Figure 26). In 2017, every EU Member State conformed to this pattern, with the share of obesity increasing between those aged 16-24 years and those aged 25-34 years. In a similar vein, the share of obesity for young people (both age groups) was less than the share recorded across the whole of the adult population (aged 16 years or more) in each of the Member States.
The highest shares of obese young people in 2017 were registered in Malta: 11 % among young people aged 16-24 years, rising to 21 % for those aged 25-34 years. Finland and Luxembourg recorded the second and third highest obesity rates for both groups of young people. The lowest shares of obese young people were registered in Slovakia and Lithuania among those aged 16-24 years (both 2 %), while the lowest rate for those aged 25-34 years was recorded in Lithuania (4 %).
In 14 of the 22 EU Member States for which 2017 data are available, more young men than young women aged 16-24 years were classified as obese (see Figure 27). The largest gender differences were observed in Estonia, Bulgaria, Slovakia and Slovenia, where the share of obese young men exceeded the share for young women by 3-4 percentage points. In eight Member States, more young women than young men were classified as obese, the difference between the sexes being 2-3 points in Ireland, Portugal, the Netherlands, Malta and France.
Drugs are a complex social and health problem that affects millions of people across the EU. The human and social costs of drug addiction are high: such additions generates costs for public health, public safety, the environment and labour productivity.
The use of illicit drugs or psychoactive substances may affect an individual’s physical and mental health, as well as their relationships and integration in society. In particular among young people, who undergo a period of neurological development, consumption of illicit substances may have more serious effects as it can impact the brain maturation processes.
EU DRUGS STRATEGY
In 2012, the European Council endorsed an EU Drugs Strategy (2013-2020). In addition to the two traditional aims of reducing both the supply and demand of drugs, this strategy introduced the ‘reduction of the health and social risks and harms caused by drugs’ as a policy objective. This was further strengthened through the EU Action Plan on Drugs (2017-2020) which provided a response to emerging health and security challenges in the area of illicit drug use and trafficking. The plan identified priority areas for action, including improved monitoring of new psychoactive substances, the use of information and communication technologies for the prevention of drug abuse, and potential connections between drug trafficking and terrorist groups, migrant smuggling and trafficking in human beings.
Young men are more likely to use cannabis than young women, except in Sweden
Cannabis is the most commonly used illicit drug. Data coming from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) show that cannabis consumption amongst young people aged 15-24 years varied greatly between EU Member States in 2015 (see Figure 28). The lowest rate of use was reported in Romania (3 %; 2013 data), followed by Cyprus (2016 data), Portugal (2012 data), Hungary and Lithuania (2012 data), all with rates within the range of 5-6 %. The highest rates of cannabis use among young people were reported in Czechia (27 %) and France (also 27 %; 2014 data), followed by Denmark (24 %; 2013 data) and Italy (22 %; 2014 data).
Looking at the issue from a gender perspective, it is interesting to note that in all EU Member States, except Sweden, the rate of cannabis use was higher among young men than it was among young women. In Czechia, which had the highest share of young men who had used cannabis during the previous year, the rate of use among young men (39 %) was 23 points higher than that among young women (15 %).
Data coming from the 2015 ESPAD report  shed light on the patterns of drug consumption among young people aged 15-16 years (see Table 3). The highest shares of these young people who had not used cannabis during the year preceding the survey were found in Sweden, Cyprus, Romania, Greece and Finland (93-95 %), while the lowest rates were registered in Czechia and France (both 73 %). France accounted for the highest share of young people who had used cannabis on 20 or more occasions during the previous year (7 %). As for the rate of young people who had used cannabis only once or twice during the previous year (so-called experimental users), the highest proportion was observed in Czechia (13 %). At the other end of the scale, Cyprus, Romania and Sweden had the lowest rates of experimental users, all 3 %.
Austria, Estonia, Germany and Slovenia had the highest rates of young people having consumed alcohol in 2015
In many societies, the consumption of alcoholic beverages is a regular feature of social gatherings. However, alcohol is a psychoactive substance with dependence-producing properties. Contingent on drinking patterns and the strength of the alcohol being consumed it can have serious negative consequences on health (such as toxic effects on organs and tissues, intoxication, dependency), while the consumption of alcohol may also increase the chances of being involved in situations resulting in injuries. For adolescents, alcohol consumption may play a role in social interaction and impact on a person’s image among peers. According to the WHO, children, adolescents and elderly people are more vulnerable to alcohol-related harm than other age groups. Furthermore, the early onset of alcohol consumption is associated with increased risk of alcohol abuse and addiction at later ages.
Data for 2015 (or earlier years) gathered by the EMCDDA show that in all 20 EU Member States for which data are available (see Figure 29), the majority of young people aged 15-24 years had consumed alcohol during the previous year. The proportion of those who had consumed alcohol ranged from 85-90 % in Austria, Germany, Slovenia (2012 data) and Malta (2013 data), down to 58 % in Portugal (2012 data).
In general, young men tend to be more likely to have consumed alcohol than young women. The largest differences between the shares recorded for young men and women aged 15-24 years in 2015 — both 17 percentage points — were recorded in Bulgaria (2012 data) and Latvia, closely followed by Romania (2013 data), Hungary and Portugal (2012 data) where the difference was 14-16 points. In two of the EU Member States where the shares were higher for young men than for young women — Croatia and Finland (2014 data) — the gender gap for the shares of young men and young women who had used alcohol was almost non-existent (below 1.0 points). By contrast, in Czechia (2012 data), Sweden (2013 data) and Germany, the share of young women who had consumed alcohol during the previous 12 months was higher than the share recorded among young men, with the difference less than 1.0 points in Germany.
Alcohol intoxication or drunkenness occurs when the quantity of alcohol consumed leads to the impairment of a person’s mental and physical abilities (for example, staggering when walking, not being able to speak properly, vomiting or loss of memory). Data collected through the ESPAD survey (see Table 4) reveal that in most EU Member States between one fifth and two fifths of pupils aged 15-16 years had been drunk at least once during the 12 months preceding the 2015 survey. Across the EU — based on a simple average for those Member States for which data are available — almost one third of pupils had been drunk at least once. Almost two thirds of those who had been drunk at least once were drunk only once or twice, whereas 3 % of this subgroup (who had been drunk at least once) experienced drunkenness on 20 or more occasions.
Portugal and Sweden were the EU Member States where alcohol consumption in harmful quantities was the least common among pupils aged 15-16 years: 78 % of them declared not to have been drunk during the previous 12 months, with shares above three quarters also reported in Belgium (Flanders only), Cyprus and Romania. At the other end of the spectrum, more than half (55 %) of pupils aged 15-16 years in Denmark declared that they had been drunk at least once during the previous 12 months, more than half of whom declared that they had been drunk three or more times.
Source data for tables and graphs
Eurostat provides information on a wide range of demographic data, at national and regional level on an annual basis. These include statistics on the number of deaths by age, by year of birth, as well as by sex, educational attainment, legal marital status, citizenship and country of birth. Statistics are also collected for life expectancy, infant mortality and late foetal deaths. The completeness of information depends on the availability of data reported by the national statistical authorities. A series of mortality indicators are produced, which may be used to derive a range of information on subjects such as crude death rates by age, gender or educational attainment.
Health statistics collected during the period up to and including reference year 2010 were submitted by EU Member States to Eurostat on the basis of a gentleman’s agreement. 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 provides the legal basis for compiling statistics on: causes of death; healthcare; health status and health determinants; accidents at work; occupational diseases and other work-related health problems. Within the context of this regulation, an implementing Regulation (EU) No 328/2011 on Community statistics on public health and health and safety at work, as regards statistics on causes of death was adopted by the European Parliament and the Council on 5 April 2011; it provides a legal basis for the collection of statistics in each EU Member State from reference year 2011 onwards and has resulted in a broader range of statistics being collected.
A wide range of statistics, for example, on healthcare systems, health-related behaviour, diseases and causes of death and a common set of EU health indicators, upon which there is EU-wide agreement regarding definitions, data collection and use has been established within the framework of the open method of coordination for health issues.
The causes and groups of medical causes of death chosen have been selected from the summary list of 86 causes compiled by Eurostat in the European shortlist 2012, which is based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) developed and maintained by the World Health Organisation (WHO).
Statistics on causes of death are based on information derived from death certificates. The medical certification of death is an obligation in all EU Member States. All deaths are identified by the underlying cause of death, in other words, the disease or injury which initiated the train of morbid events leading directly to death (a definition adopted by the World Health Assembly). Although definitions are harmonised amongst Member States, the statistics may not be fully comparable as classifications may vary when the cause of death is multiple or difficult to evaluate and because of different notification procedures.
Health interview surveys are the source of information for describing the health status and the health-related behaviours of the European population. The European Health Interview Survey (EHIS) aims at measuring, in a harmonised way and with a high degree of comparability among EU Member States, the health status, lifestyle (health determinants) and use of healthcare services among people in the EU.
WHAT IS THE ‘HEALTH PROGRAMME’?
The main instrument for implementing the EU’s public health strategy is the ‘Health programme’, which contributes to funding projects on health promotion, health security and health information.
In March 2014, the third ‘Multi-annual programme of EU action in the field of health for the period 2014-2020’ was adopted (Regulation (EU) No 282/2014). The programme has four overarching objectives:
- promote health, prevent diseases and foster supportive environments for healthy lifestyles taking into account the ‘health in all policies’ principle;
- protect EU citizens from serious cross-border health threats;
- contribute to innovative, efficient and sustainable health systems;
- facilitate access to better and safer healthcare for EU citizens.
EU action in public health is mainly linked to incentives and cooperation measures. The European Commission has an important supporting role, providing guidance and tools to promote cooperation and help national systems operate more effectively. Priority actions for the period 2016-2020 focused on:
- achieving greater cost-effectiveness;
- competitiveness together with safety;
- tackling emerging global threats such as antimicrobial resistance;
- evidence-based policymaking;
- addressing the risk factors of non-communicable diseases;
- promoting vaccination.
EUROPEAN CORE HEALTH INDICATORS
The European Core Health Indicators (ECHI) project established a list of 88 indicators which focus on general public health issues and are designed to provide a comprehensive overview on health.
EUROPEAN HEALTH INTERVIEW SURVEY
Most data on health determinants come from the European Health Interview Survey (EHIS), which consists of four modules on health status, health care use, health determinants and socioeconomic background variables. The first wave of EHIS (EHIS wave 1) was conducted under a gentlemen’s agreement between 2006 and 2009. A total of 19 EU Member States took part in this first survey but not all of them implemented all modules and variables. The second wave (EHIS wave 2, 2013-2015) was undertaken on the basis of a European Commission regulation, which made the survey compulsory for all EU Member States. The third wave (EHIS wave 3) took place in 2019 and was based on a European Commission Implementing Regulation (EU) No 2018/255 of 19 February 2018, with a methodological manual designed to serve as a handbook for more detailed planning and information on how to conduct the survey according to a fixed set of the rules and recommendations.
- Population (t_demo_pop)]
- Mortality (t_demo_mor)
- Population (demo_pop)
- Mortality (demo_mor)]
- Youth (yth), see:
- Youth health (yth_health)
- Regulation (EU) No 282/2014 of 11 March 2014 on the establishment of a third programme for the Union’s action in the field of health (2014-2020)
- Regulation (EU) No 328/2011 of 5 April 2011 implementing Regulation (EC) No 1338/2008 on Community statistics on public health and health and safety at work, as regards statistics on causes of death
- Regulation (EC) No 1338/2008 of 16 December 2008 on Community statistics on public health and health and safety at work
- Conditions include, for example, birth trauma, respiratory and cardiovascular disorders, infections specific to the perinatal period.
- Young drivers, the road to safety, OECD and ECMT, 2006.
- Health statistics — Atlas on mortality in the European Union, Eurostat, 2009 edition and WHO — suicide data.
- European School Survey Project on Alcohol and Other Drugs.