Archive:Sustainable development - public health
- Data from July 2011, most recent data: Further Eurostat information, Database.
This article provides an overview of statistical data on sustainable development in the area of public health. They are based on the set of sustainable development indicators the European Union (EU) agreed upon for monitoring its sustainable development strategy. Together with similar indicators for other areas, they make up the report 'Sustainable development in the European Union - 2011 monitoring report of the EU sustainable development strategy', which Eurostat draws up every two years to provide an objective statistical picture of progress towards the goals and objectives set by the EU sustainable development strategy and which underpins the European Commission’s report on its implementation.
The table below summarises the state of affairs of in the area of public health. Quantitative rules applied consistently across indicators, and visualised through weather symbols, provide a relative assessment of whether Europe is moving in the right direction, and at a sufficient pace, given the objectives and targets defined in the strategy.
Overview of main changes
The developments in the public health theme since 2000 present a generally favourable picture. The headline indicator shows that in general people are living longer. Improvements are visible in the reduction of deaths due to chronic diseases, suicides, the production of toxic chemicals, annoyance by noise, and serious accidents at work. On the other hand, not all have benefitted from the improvements and there are still important inequalities in health and access to healthcare. Furthermore there remain challenges related to the environmental determinants of health. Since 2000, people in the EU have been more exposed to ozone as well as to particulate matter.
Main statistical findings
Headline indicator
Life expectancy and healthy life years
Between 2002 and 2008 life expectancy at birth of women and men in the EU rose moderately. The faster growth rate for men indicates a closing of the gap in life expectancy between women and men
- Life expectancy at birth is six years higher for women than men, but the gap is closing
Average life expectancy at birth in the EU is some six years higher for women than men. A girl born in 2008 is expected to live 82.4 years on average; a boy 76.4 years. For 65-year-olds, in 2008 there was an expectation of a further 20.7 years for women and 17.2 years for men.
- Healthy life expectancy is generally stable
Over the period from 2002 to 2008 life expectancies at birth in the EU grew at an annual average rate of 0.3 % for women and 0.4 % for men (respectively 3 and 4 months per year). The growth rates at age 65 were somewhat higher, representing 1.1 % on average for women and 1.3 % for men. The different growth rates for women and men mean that the gap between the two sexes has narrowed.
Due to the lack of sufficiently robust figures for healthy life years it is only possible to draw the overall conclusion that for the EU as a whole the situation is stable.
- Life expectancy is lowest in most Central and Eastern European Member States
Growing life expectancy reflects improved living conditions in the EU in terms of economic welfare, social security and health care resources. Nevertheless, there are differences between Member States. Some of the Central and Eastern European Member States tend to have shorter life expectancies mostly due to poorer socio-economic conditions in these countries, especially higher unemployment rates.
Health and health inequalities
Deaths due to chronic diseases
Between 2000 and 2008 deaths due to chronic diseases fell considerably for under 65s in the EU
- Deaths due to lifestyle-inflicted chronic diseases have been decreasing steadily for many years
The majority of the population in high- and middle-income countries dies from chronic diseases. In the population aged under 65 years, deaths due to chronic diseases can be considered as premature and occur much less frequently than in the older population even if they account for nearly 60 % of all causes of death [1]. Such deaths decreased by 2.0 % on average per year between 2000 and 2008. This trend has been steady for EU-15 countries since at least 1994 when the data series began.
- Chronic diseases are more common in men but decreasing at a higher rate than for women
Reasons for the improvement could be the increasing public awareness assisted by efforts at both national and EU level to promote healthier lifestyles, such as healthy eating, taking regular exercise, better managing stress and combating risk factors such as smoking and excessive alcohol consumption. Increasing efforts in implementing chronic disease management programs in primary care, which have been active now for almost 10 years in some countries, could be another reason.
Deaths due to chronic diseases are almost twice as common in the EU for men than for women, but the gap has slowly narrowed between 2000 and 2008 (average annual declines: men 2.3 %, women 1.7 %).
- Differences remain between lower and higher income Member States
During the period 2000 to 2002 death rates rose in several Member States, as is particularly evident from the small peak in 2002. One reason for this short-lived phenomenon could be the economic downturn at that time [2]. However, between 2000 and 2009, death rates due to chronic diseases have declined in almost all countries in the EU. Nevertheless in some lower-income Member States death rates due to chronic diseases remain high and still more than 150 people out of 100 000 people died from these diseases.
Suicides
Deaths through suicide in the EU declined substantially between 2000 and 2008. Progress is visible amongst the youngest and, most notably, oldest age groups
- Suicide is more common amongst men than women and amongst older age groups
Although cultural factors can influence the official rate of deaths by suicide, it may be considered an indicator of mental health. Overall, suicides in the EU declined by an annual average of 1.9 % between 2000 and 2008.
Suicide death rates vary between the sexes [3] and between age groups. Suicides are roughly three times more common amongst men than women in the young and middle-age group and five times more common in the oldest age group. However, the gap between men and women has been closing slowly.
- Economic crisis has had an impact on suicides among the working age group
Overall, since 2000 suicide rates fell in the young group aged 15-19 years by 1.9 % per year and in the oldest group aged over 85 years suicides by 3.6 % per year. On the other hand, there has been a slight increase in suicides of 0.1 % per year among people aged 50-54 years. This development has closed the gap between the older two age groups. However since 2006 the decrease in suicides of people over 85 years has slowed down while in the middle age group the increase in suicides has accelerated. The increase in the middle age group has been linked to the impact of the economic crisis on unemployment [4], which had already started to exert its negative effects in 2007 and 2008 [5].
Unmet needs for healthcare
The proportion of people in the EU reporting that they needed a medical examination or treatment but could not afford is higher in the lower income groups, which is indicative of inequalities in access to health care between socioeconomic groups
- The cost of medical treatment is an obstacle to the poorest people in some Member States
This indicator highlights the inequalities in access to medical care across income classes. Only 0.5 % of the highest income group perceive themselves as unable to afford a medical examination or treatment when they need it. In general this is also the case at the Member State level. As income decreases, the proportion of those who consider expense as an obstacle to seeking medical care increases. Of the lowest income group over 4 % report that they are not always able to meet their needs for healthcare. The extent of this gradient across income groups varies considerably by country.
Between 2005 and 2009 the proportion of people reporting unmet needs for healthcare fell for all income groups. In addition, over the same period the gap between the lowest and the highest income group decreased. At the same time there has been an increasing trend of cost sharing by patients, in particular out-of-pocket payments which would be expected to put an increasing pressure on accessibility to health care, especially for low-income groups.
Determinants of health
Production of toxic chemicals
Between 2002 and 2009 the production of toxic chemicals decreased in the EU. The situation compared with 2002 is, however, completely due to significant reductions in 2008 and 2009
- Production of toxic chemicals has decreased slightly since 2002 and there has been a shift towards less toxicity
Overall the production of toxic chemicals in the EU decreased by 1.8 % per year on average, between 2002 and 2009, although this decrease was entirely due to the drop in 2008 and 2009. Even if the two most toxic groups, the CMR-chemicals and the chronic-toxic chemicals, both experienced sharp drops in production, falling by 13.5 % and 25 % respectively between 2007 and 2009, their shares in production remained unchanged. The share of total toxic chemicals in the total production of chemicals also remained approximately the same at 62 %.
The decline in 2008 and 2009, which went against the trend of the previous years, is likely to be at least partly a result of the economic crisis, which led to a fall in industrial production. In addition, the [regulation] for the registration, evaluation, authorisation and restriction of chemicals (REACH) which entered into force in June 2007, may also have contributed to a reduction in the production of chemicals.
Exposure to air pollution by particulate matter
Exposure to air pollution by particulate matter in the EU was only slightly lower in 2008 than in 2000. Levels remained significantly above the target of 20 micrograms per cubic metre to be met by 2010 in the EU
- Exposure to airborne particulate matter has not decreased sufficiently to reach the 2010 target
Between 2000 and 2008 air pollution by particulate matter decreased by 0.9 micrograms per cubic metre, although given the substantial year-on-year variations it is difficult to discern any clear trend. The so-called first daughter directive, adopted in 1999, sets annual limit targets for 2005 and 2010 regarding the annual mean concentrations of particulate matter in micrograms per cubic metre. While the 2005 target of 40 micrograms per cubic metre was easily met, reaching the 2010 target of 20 micrograms will require strong reductions.
The main source of particulates in urban areas is from diesel-engined road vehicles, although industrial, public, commercial and residential combustion also contributes. The peaks in 2003 and 2006 were partially due to severe heat waves during those summers. The hot, dry conditions led to stagnant air in which pollutants accumulated. In 2003, at least, conditions were exacerbated by the prevalence of wildfires in south-western Europe producing large quantities of particulates which were then transported to the northern and eastern parts of Europe. Furthermore the El Niño phenomenon might have had an impact on particulate matter concentration and contributed to the peaks in 2003 and 2006.
Urban exposure to particulates varies from country to country. In addition to sporadic wildfires, the Member States bordering the Mediterranean also suffer from dust blown from North Africa.
Exposure to air pollution by ozone
Despite considerable variation observable from one year to the next, overall exposure to ozone in the EU increased between 2000 and 2008
- Exposure to ozone is generally rising, with two peaks in 2003 and 2006
Although exposure to ozone varies considerably from year to year, overall it rose at an annual average rate of 2.8 % between 2000 and 2008. The high exposure in the year 2003 is related to the heat wave in that summer [6]. A lesser peak also occurred in 2006 for similar reasons.
Urban exposure to ozone widely varied between countries, partly due to differences in climate and vegetation. In general, southern countries with higher summer temperatures show higher exposure levels than the cooler northern countries. Nevertheless, peaks occurred throughout the EU in 2003 and 2006 due to exceptionally high temperatures in those years. This increase was most pronounced in the northern countries, which showed higher relative increases compared to the southern countries.
Annoyance by noise
Over the short period from 2005 to 2009 the share of people in the EU feeling annoyed by noise declined considerably
- The share of population who feel annoyed by noise is favourably declining
Between 2005 and 2009 the percentage of the population who declared that they suffer from noise declined by 1.5 % per year on average. Possible explanations for this decline are closedowns of heavy industry, quieter cars resulting from [EU legislation], and the replacement of tramways by subways and buses. Nevertheless there remain high levels of noise in working places, which is not measured by this indicator.
Available data for the country split shows that large reductions in noise annoyance have mostly been driven by eastern countries, which show higher levels of noise perceptions at the starting point and this fell dramatically in the following four years.
Serious accidents at work
The incidence of serious accidents at work decreased substantially between 2000 and 2008
- Serious accidents at work are still at a high level but on track to meet the target for 2012
The incidence of serious accidents at work decreased in the EU by 5.1 % per year on average between 2000 and 2008. This rate of decrease is slightly higher than that needed in order to meet the target of an overall reduction of 25 % over the period 2007 to 2012. This decline should be seen in the light of the decline in heavy industry in the EU and the increasing use of automation.
Despite this strong downward trend, serious accidents at work remain at a high level, and in 2008 there were about 3.7 million serious accidents at work in the EU-15 countries.
Further Eurostat information
Publications
- Sustainable development in the European Union - 2011 monitoring report of the EU sustainable development strategy
- Health statistics - Atlas on mortality in the European Union Luxembourg, 2009
- Health and safety at work in Europe (1999-2007) – A statistical portrait, Luxembourg, 2010
- Perception of health and access to health care in the EU-25 in 2007, Luxembourg, 2009
Main tables
- Indicators
- Public Health
Dedicated section
Methodology
- More detailed information on public health indicators, such as indicator relevance, definitions, methodological notes, background and potential linkages, can be found on page 191-213 of abovementioned publication.
Other information
- Commission communication COM(2009) 567 - Solidarity in health: Reducing health inequalities in the EU
- European Commission - Major and chronic diseases - Report 2007
- European Commission - White paper - together for health: a strategic approach for the EU 2008-2013
External links
- World Health Organization - WHO
- Commission on Social Determinants of Health (WHO) - Closing the gap in a generation: Health equity through action on the social determinants of health, Geneva
See also
Notes
- ↑ Source:Table ‘Causes of death - Absolute number (Annual data) [hlth_cd_anr]’ on Eurostat website
- ↑ See the indicator ‘real GDP per capita’ in the ‘socioeconomic development’ chapter.
- ↑ Hawton, K., ‘Sex and suicide: Gender differences in suicidal behaviour’, British Journal of Psychiatry, Vol. 177, pp. 484-485
- ↑ Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., and McKee, M., The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis, The Lancet, Vol. 374, pp. 315-323, 2009
- ↑ European Commission Employment in Europe 2009, Luxembourg, Office for Official Publications of the European Union, 2009
- ↑ Johnson H., Kovats S., McGregor, G., Stedman, J., Gibbs, M., and Walton, H., [The impact of the 2003 heatwave on daily mortality in England and Wales and the use of rapid weekly mortality estimates], Euro Surveillance, 2005, Vol. 10, pp. 168-171