Health statistics at regional level



Data extracted in March 2021.

Planned article update: September 2022.

Highlights

During the initial stages of the COVID-19 pandemic, some of the highest death rates in the EU were recorded in Italian and Spanish regions. By the end of 2020, the highest death rates were recorded in Bulgarian regions.

In 2017, diseases of the circulatory system accounted for more than half of all deaths in every region of Bulgaria, Hungary, Romania and the three Baltic Member States.

Source: Eurostat (demo_r_mwk2_ts) and (demo_r_pjangrp3)

The COVID-19 pandemic has resulted in severe human suffering and a considerable loss of life. As governments attempted to slow the spread of the virus — closing down economic sectors and imposing restrictions on personal mobility that were unprecedented in modern times — a public health crisis was accompanied by a major socioeconomic crisis, with rising unemployment and growing inequality. At the time of writing, the COVID-19 pandemic continues to affect the European Union (EU). EU Member States have worked to: slow down the spread of the virus, reinforce/protect healthcare systems, mitigate the social and economic effects of the pandemic, support workers, businesses and fellow Member States, and put in place measures to stimulate an economic recovery. The European Commission is also participating in the COVAX facility designed to provide equitable access to affordable COVID-19 vaccines. At the time of writing (April 2021), the EU had contributed EUR 1.0 billion to this facility, which should result in millions of COVID-19 vaccines being provided to low and middle-income countries.

More generally, health is an important priority for most Europeans, who expect to receive efficient healthcare services — for example, if contracting a disease or being involved in an accident — alongside timely and reliable public health information. The overall health of the EU population is closely linked to that of the planet through — among other influences — the quality of the air we breathe, the water we drink and the food we eat.

Full article

Mortality

Every region of the EU has been touched by the COVID-19 pandemic; however, its impact has been unevenly spread, in both geographic and socioeconomic terms. While there have been considerable differences in terms of the timing and the impact of the pandemic between EU Member States, a regional analysis confirms widespread disparities between regions within individual Member States. Among other reasons, some of these differences may be linked to:

  • the ability of regional health care facilities to cope with a sudden rush of cases and differential access to well-equipped hospitals;
  • the health status of regional populations, such as the incidence and/or severity of pre-existing health conditions (particularly those affecting the respiratory system);
  • regional population structures, for example the number and share of elderly people, the proportion of elderly persons living in care homes, the share of disadvantaged and minority ethnic groups in regional populations;
  • a variety of other socioeconomic factors, such as the average number of people living alone and within extended families, or the share of people able to work from home during the pandemic;
  • the timing, speed and severity of national and regional government measures that were put in place to slow the spread and mitigate the impact of the virus, coupled with public awareness, vigilance and adherence to rules/restrictions.

From a statistical perspective, the COVID-19 pandemic has also impacted on the ability of statistical authorities to collect and process data using established methods. There has also been a surge in demand for statistics that measure the impact of the pandemic, with particular interest in data covering the number of infections and mortality.

With this in mind, Eurostat set-up a new data collection exercise for weekly death statistics; these data are classified by sex, five-year age groups and NUTS level 3 regions. Excess mortality is measured as the difference between the number of deaths in a particular period (such as a week or month) compared with the average number of deaths in the same period (week or month) during a baseline period; the latter has been defined as the average for 2016-2019. Statistics on excess deaths provide information about the burden of mortality potentially related to the COVID-19 pandemic, thereby covering not only deaths that are directly attributed to the virus but also those indirectly related to it. Weekly counts of deaths are compared with historical trends to determine whether the number of deaths is significantly higher (or lower) than expected.

Figure 1 shows the development of excess mortality during 2020. The first wave of the COVID-19 pandemic contributed to the total number of deaths in the EU in April 2020 being 25.1 % higher when compared with the average for the baseline period. The initial stage of the pandemic saw a rapid increase in excess mortality rates in Italy, Spain and Belgium, whereas most eastern Member States of the EU were relatively untouched by this first wave of infections. After comparatively low levels of infections and deaths during the summer months, a second wave established itself across much of the EU during autumn as death rates accelerated again. A peak was recorded in November 2020 when the number of deaths in the EU was 40.7 % higher than average (during the baseline period). Excess mortality rates were particularly high towards the end of 2020 in eastern Member States, for example Bulgaria, Poland and Romania, with excess mortality significantly higher than during the first wave.

Figure 1: Monthly excess mortality, 2020
(% change compared with 2016-2019 average, by EU Member States)
Source: Eurostat (demo_mexrt)

During the first wave of the pandemic, the average number of weekly deaths in Comunidad de Madrid was almost three times as high as the norm …

Maps 1 and 2 show the situation for the average number of weekly deaths during the first and second waves of the COVID-19 pandemic (note this analysis excludes information for Ireland). By tracking all causes of mortality, statistics on weekly deaths provide a measure for the direct and indirect impacts of the COVID-19 pandemic. This is particularly valuable when: i) COVID-19 mortality is undercounted (for example, if COVID-19 was not mentioned on the death certificate as the cause of death); or ii) when there are high numbers of deaths that are indirectly related to COVID-19 (for example deaths from other causes that may be attributed to a shortage of health care resources caused/worsened by the pandemic).

At the start of 2020, the average number of weekly deaths was generally lower than that observed in previous years (2016-2019). However, while mortality normally starts to decline in March of each year, in 2020 the number of deaths started to increase. The first cases of COVID-19 in Europe were recorded in Italy and the number of deaths was soon rising at a rapid pace in northern Italian regions, especially in Lombardia. As they witnessed scenes of hospitals struggling to cope, European governments adopted a series of unprecedented measures. These included restrictions on movement, rules on physical distancing, mandatory face covering in closed public settings, and the introduction of various elements of test, track, trace, isolate and support systems.

During weeks 10-19 of 2020 (in other words, from 2 March to 10 May 2020), there were, on average, a total of 106 thousand deaths every week across the EU; this was 18.7 % higher than the average recorded during the same period in 2016-2019. The initial stages of the pandemic saw the virus being largely concentrated in a small number of predominantly urban regions, many of which were characterised by relatively high numbers of international travellers. This was particularly observable in Italy and Spain: for example, in Lombardia and Comunidad de Madrid the average number of weekly deaths in weeks 10-19 of 2020 was 2.5 times (245.7 %) and 2.9 times (294.0 %) as high as the norm recorded during 2016-2019. Regional data (generally for NUTS level 2 regions) show how some areas, such as the north of Italy, central Spain, the east of France and the Paris region, saw a large increase in their average number of weekly deaths during the first wave of the pandemic. By contrast, approximately 15 % of EU regions recorded a lower than average number of weekly deaths during the first wave. These regions were predominantly located in the eastern regions of the EU and the Baltic Member States, but also included a number of rural, sparsely-populated regions in other parts of the EU where it took longer for the virus to become established.

… while during the second wave of the pandemic the average number of weekly deaths in Podkarpackie (south-east Poland) was almost twice as high as the norm

Map 2 shows the impact of the second wave of the pandemic during weeks 43-52 of 2020 (in other words, from 19 October to 27 December 2020). There were, on average, 120 thousand deaths each week across the EU during this period, which was one third (33.4 %) higher than the norm recorded for the same period in 2016-2019. In contrast to the first wave — when many regions were relatively unaffected by the health impacts of the virus — the second wave of the pandemic impacted almost all regions. More than three quarters of EU regions recording a higher extent of excess deaths during the second wave than during the first wave. The biggest increases in excess deaths between the first and second waves were predominantly registered in the Baltic Member States and several eastern Member States.

The difference between the first and second waves of the pandemic may be contrasted by looking at the number of regions where the average number of weekly deaths was at least 65.0 % above its normal level (as shown by the darkest shades in Maps 1 and 2). This count progressed from 11 regions during the first wave of the pandemic to reach 31 regions during the second wave. Although the count of regions increased, the virus became more uniformly distributed over time, with relatively small inter-regional variations within Member States and fewer highly irregular regional peaks during the second wave (possibly reflecting governments and health care services being better prepared and far more being known about the virus).

Map 1: Average weekly deaths, start of 2020
(2016-2019 = 100, weeks 10-19 (2 March to 10 May), by NUTS 2 regions)
Source: Eurostat (demo_r_mwk2_ts)


Map 2: Average weekly deaths, end of 2020
(2016-2019 = 100, weeks 43-52 (19 October to 27 December), by NUTS 2 regions)
Source: Eurostat (demo_r_mwk2_ts)

Health care personnel and health care facilities

Hospital bed numbers and/or the number of medical doctors are indicators that may be used to measure the capacity of health care system in regular times and also their resilience to pandemics such as COVID-19.

Hospital beds are defined as those which are regularly maintained and staffed and immediately available for the care of patients admitted to hospitals; these statistics cover beds in general hospitals and in speciality hospitals. There were 2.40 million hospital beds in the EU in 2018, which meant that the total number of beds fell overall by 7.6 % during the most recent decade for which data are available.

In 2018, there were, on average, 537 hospital beds per 100 000 inhabitants; expressed in a different way, this equates to an average of one hospital bed for every 186 people. The falling number of hospital beds across much of the EU during the last decade may reflect, to some degree: cuts to health care spending in the aftermath of the global financial and economic crisis; medical and technological developments; changes in healthcare policies. For example, the need for hospital beds may be reduced through a greater provision of day-care and outpatient services as well as reductions in the average length of hospital stays; such changes may result from the introduction of new treatments and less-invasive forms of surgery.

Map 3 reflects country-specific ways of organising health care and the types of service provided to patients. It confirms a relatively high density of hospital beds across much of Germany (NUTS level 1 regions), Austria and Poland, as well as several capital regions in eastern EU Member States (as shown by the darkest shade of orange). Among these, there were four regions that recorded ratios in excess of 1 000 hospital beds per 100 000 inhabitants in 2018. The predominantly rural, northern German region of Mecklenburg-Vorpommern had the highest density of hospital beds in the EU, at slightly less than 1 300 hospital beds per 100 000 inhabitants (2017 data). The other three were the northern Polish region of Zachodniopomorskie and the capital regions of Hungary (Budapest) and Romania (Bucureşti-Ilfov).

While it was commonplace in eastern EU Member States for the capital region to record the highest density of hospital beds — perhaps reflecting a concentration of resources and specialist services — this pattern was often reversed in western and northern Member States, where the highest density of hospital beds was frequently recorded in predominantly rural regions.

Aside from the outermost region of Mayotte (France), the lowest ratios of hospital beds relative to population size were recorded in the southern Danish region of Syddanmark (156 beds per 100 000 inhabitants) and the central Greek region of Sterea Ellada (158 beds per 100 000 inhabitants).

Map 3: Number of hospital beds, 2018
(per 100 000 inhabitants, by NUTS 2 regions)
Source: Eurostat (hlth_rs_bdsrg)

On average there were 262 inhabitants for every doctor in the EU

Medical doctors include generalists (such as general practitioners) as well as medical and surgical specialists. They provide services to patients as consumers of healthcare, including: giving advice, conducting medical examinations and making diagnoses; applying preventive medical methods; prescribing medication and treating diagnosed illnesses; giving specialised medical or surgical treatment.

In 2018, there were approximately 1.7 million medical doctors in the EU; this equated to an average of 382 medical doctors per 100 000 inhabitants. Map 4 shows the regional distribution of medical doctors, with:

  • a very high number of medical doctors relative to the size of the population across several regions in Greece — note that Greek data refer to medical doctors licensed to practice, which is a broader measure than practising doctors (as reported by a majority of EU Member States);
  • a very high number of medical doctors relative to population size in several capital regions — this was particularly notable for Attiki (Greece), Praha (Czechia), Wien (Austria), Bratislavský kraj (Slovakia), Área Metropolitana de Lisboa (Portugal), Bucureşti-Ilfov (Romania), Budapest (Hungary) and Berlin (Germany; 2017 data) where there were in excess of 525 doctors per 100 000 inhabitants;
  • a relatively high number of medical doctors relative to population size across a wide range of other urban regions (as health care services — including those provided by physicians — are more likely to be concentrated in regions that are characterised by relatively high population density);
  • a relatively low number of medical doctors relative to population size across much of Poland (2017 data), as well as several regions in each of Hungary, the Netherlands and Romania.

Leaving aside the atypical Spanish region of Ciudad Autónoma de Ceuta, the highest number of medical doctors relative to population size was recorded in the Greek capital, Attiki (792 medical doctors licensed to practice per 100 000 inhabitants). This peak value was more than 10 times as high as the lowest ratio (77 practising doctors per 100 000 inhabitants), as recorded in the outermost French region of Mayotte.

Map 4: Medical doctors, 2018
(per 100 000 inhabitants, by NUTS 2 regions)
Source: Eurostat (hlth_rs_prsrg) and (hlth_rs_prs1)

Causes of death

Health inequalities have been brought into stark contrast during the COVID-19 pandemic, with the number of deaths disproportionately high among elderly persons, those already suffering from pre-existing health conditions and disadvantaged groups within society. However, a wide range of factors determine regional mortality patterns, with deaths linked, among other issues, to: age structures, gender, access to healthcare services, living/working conditions and the surrounding environment.

Statistics on causes of death are based on two pillars: medical information from death certificates which are used as the basis for determining the cause of death and the coding of causes of death following the International Statistical Classification of Diseases and Related Health Problems (ICD). These data provide information about diseases (and other eventualities, such as suicide or accidents) that lead directly to death; they can be used to help plan health services. Statistics on causes of death are classified according to the European shortlist for causes of death (2012), which has 86 different causes.

Maps 5 and 6 show information for standardised death rates, whereby age-specific mortality rates are adjusted to reflect the structure of a standard population. This removes the influence of different age structures between regions (as elderly persons are more likely to die than younger persons, or are more likely to catch/contract a specific illness/disease) and results in a more comparable measure across space and/or over time.

Some of the most economically disadvantaged regions in the EU recorded the highest death rates

In 2016, there were 4.53 million deaths in the EU, while the standardised death rate was 999 deaths per 100 000 inhabitants. Map 5 shows information both for the relative number and for the main causes of death across NUTS level 1 regions. There were four regions in the EU where standardised death rates were above 1 500 deaths per 100 000 inhabitants in 2017. All four recorded relatively low living standards, with their GDP per inhabitant (in purchasing power standards (PPS)) less than two thirds of the EU average. This situation was most notable in Severna i yugoiztochna (Bulgaria), which had the highest standardised death rate in the EU (1 695 deaths per 100 000 inhabitants) and the lowest level of GDP per inhabitant (at 38 % of the EU average). The other three regions were: Yugozapadna i yuzhna tsentralna Bulgaria, Alföld És Észak (Hungary) and Macroregiunea Doi (Romania).

A similar pattern was apparent between regions within individual EU Member States. For example, the highest standardised death rates in the four largest Member States were recorded in Sachsen-Anhalt (eastern Germany), Sur (southern Spain), Nord-Pas-De-Calais-Picardie (northern France) and Isole (the islands of Italy). All four regions were relatively disadvantaged, as they recorded levels of GDP per inhabitant that were considerably lower than their respective national averages.

In 2016, more than one third of all deaths in the EU were attributed to diseases of the circulatory system

In 2016, the three principal causes of death in the EU were: diseases of the circulatory system, malignant neoplasms (hereafter referred to as cancer) and diseases of the respiratory system. Diseases of the circulatory system accounted for more than one third (37.1 %) of all deaths; a more detailed analysis is provided below. Cancer accounted for just over one quarter (25.7 %) of the total number of deaths, while the proportion of deaths resulting from diseases of the respiratory system was much lower, at 7.5 %. The remaining 29.7 % of deaths in the EU had a variety of other causes.

Map 5 shows the main causes of death for NUTS level 1 regions in 2017. In Severna i yugoiztochna (Bulgaria) — the region with the highest standardised death rate — 7 out of every 10 deaths (69.4 %) were attributed to diseases of the circulatory system. The 12 regions across the EU where more than half of all deaths were caused by diseases of the circulatory system included every region of Bulgaria, Hungary and Romania, as well as the three Baltic Member States.

The French capital region, Île-de-France, had the highest share of deaths attributed to cancer (30.6 %; 2016 data for all French regions). Three more French regions — Pays de la Loire, Aquitaine-Limousin-Poitou-Charentes and Centre-Val de Loire — also recorded more than 30.0 % of deaths being caused by cancer, as did Slovenia.

In 2017, the Região Autónoma da Madeira in Portugal had, by far, the highest share (20.5 %) of deaths caused by diseases of the respiratory system. The next highest shares were recorded in the Spanish capital region, Comunidad De Madrid (14.5 %) and in Ireland (14.2 %). Diseases of the respiratory system accounted for less than 10.0 % of all deaths in the more than three quarters of regions across the EU.

Map 5: Main causes of death, 2017
(by NUTS 1 regions)
Source: Eurostat (hlth_cd_asdr2)

Focus on deaths from diseases of the circulatory system

As noted above, diseases of the circulatory system are the leading cause of death in the EU, placing a considerable burden on healthcare systems and government budgets. These diseases cover a broad group of medical problems that affect the circulatory system (the heart and blood vessels), often resulting from atherosclerosis, the abnormal build-up of plaque. The latter is made of, among other constituents, cholesterol or fatty substances. Some of the most common diseases that affect the circulatory system include ischaemic heart disease (heart attacks) and cerebrovascular diseases (strokes). Despite medical advances, there were 1.68 million deaths across the EU from diseases of the circulatory system in 2016.

On average there were 370 deaths per 100 000 inhabitants from diseases of the circulatory system in the EU

The EU’s standardised death rate from diseases of the circulatory system was 370 per 100 000 inhabitants in 2016. Map 6 shows a clear east–west split in terms of the distribution of regional death rates, with the eastern and Baltic Member States as well as many German regions recording relatively high death rates, while the lowest death rates were principally recorded in France and Spain. The highest death rates among NUTS level 2 regions were concentrated in Bulgaria, Hungary and Romania, as well as the three Baltic Member States, as in 2017 every region (except for Budapest, the Hungarian capital region) within these six Member States recorded a death rate that was above 685 per 100 000 inhabitants (as shown by the darkest shade of orange). The standardised death rate from diseases of the circulatory system peaked at 1 223 deaths per 100 000 inhabitants in Severozapaden (north-west Bulgaria); this was more than three times as high as the EU average.

The lowest standardised death rates from diseases of the circulatory system in 2017 — less than 215 deaths per 100 000 inhabitants (as shown by the darkest shade of blue) — were exclusively located in France (17 out of the 27 French regions; 2016 data) and Spain (five regions). The lowest rates in France were recorded in the capital region (Île-de-France) and in Provence-Alpes-Côte d’Azur, while the lowest rate in Spain was also in the capital region (Comunidad de Madrid). This pattern — relatively low death rates from diseases of the circulatory system in capital regions — was repeated across most of the EU Member States and may be linked to the speed with which hospital treatment is made available. In other words, access to and the availability of services for those suffering a heart attack or a stroke appears to play a role in survival chances.

Map 6: Standardised death rates from diseases of the circulatory system, 2017
(per 100 000 inhabitants, by NUTS 2 regions)
Source: Eurostat (hlth_cd_asdr2)

Men had a higher standardised death rate for diseases of the circulatory system than women in all but one region across the EU

Figure 2 provides a more detailed analysis of standardised death rates for diseases of the circulatory system by introducing a gender dimension. Within the EU, the death rate for men was 443 deaths per 100 000 male inhabitants in 2016, which was 129 deaths higher than the corresponding rate for women (314 deaths per 100 000 female inhabitants).

For men and for women, the highest death rates for diseases of the circulatory system were recorded in regions of Bulgaria. There were only three NUTS level 2 regions across the EU where the female death rate from diseases of the circulatory system stood at more than 1 000 deaths per 100 000 female inhabitants. All three of these were located in Bulgaria — Severozapaden, Yugoiztochen and Severen tsentralen — with the first of these recording the highest rate (1 062 deaths per 100 000 female inhabitants).

A similar analysis for men reveals there were 15 NUTS level 2 regions across the EU where the male death rate from diseases of the circulatory system stood at more than 1 000 deaths per 100 000 male inhabitants in 2017. The highest death rates were recorded in the six regions of Bulgaria, with a peak of 1 470 deaths per 100 000 male inhabitants in Yugoiztochen. Very high male death rates were also recorded in six out of the eight Romanian regions (Bucureşti-Ilfov and Centru being the exceptions), Latvia, Vidurio ir vakarų Lietuvos regionas (Lithuania) and Észak-Magyarország (Hungary).

Across the 240 NUTS level 2 regions for which data are available, the outermost French region of Mayotte (2016 data) was the only region where the standardised death rate from diseases of the circulatory system was higher for women from than for men. In 2017, the gender gap for death rates from diseases of the circulatory system was smallest (in absolute terms) in several Greek, Spanish, French and Dutch regions. By contrast, the widest gaps between the sexes were recorded in regions characterised by some of the highest overall death rates, including several regions from Bulgaria and the Baltic Member States.

Figure 2: Standardised death rates from diseases of the circulatory system for women and men, 2017
(per 100 000 inhabitants, by NUTS 2 regions)
Source: Eurostat (hlth_cd_asdr2)

Source data for figures and maps

Excel.jpg Health at regional level

Data sources

Excess mortality and weekly death statistics

In April 2020, at the height of the first wave of the COVID-19 pandemic within the EU, Eurostat set up a new data collection exercise to respond to the needs of policymakers and researchers by providing statistics on weekly deaths to monitor the rapidly changing situation. Monthly data for excess mortality are also based on this exercise.

National statistical authorities transmit these data — on a voluntary basis — for weekly deaths, classified by sex, five-year age groups and NUTS level 3 regions (note that less detailed data may be available for some of these analyses). The initial dataset was requested with a historic time series back to the start of 2000 in order to make it possible for analysts to compare and model the most recent developments with baseline scenarios from before the COVID-19 pandemic. As statistics on weekly deaths are transmitted on a voluntary basis, data availability reflects the idiosyncrasies of each country. For example, in practice regional data for Germany are only available for NUTS level 1 regions.

These mortality statistics are continuously updated with the most recent information for the latest week available. Data are preliminary and it should be noted that the freshest data for the most recent weeks may be under-reported (as the actual number of deaths is revised once a broader set of information has been processed).

At the end of 2020, this dataset was released as part of Eurostat’s European Statistical Recovery Dashboard. The dashboard may be used to track a range of socioeconomic indicators — including some related to health — during the COVID-19 pandemic.

Healthcare resources

Non-expenditure data on healthcare resources, such as the data shown here for the number of hospital beds or the number of medical doctors, are submitted to Eurostat on the basis of a gentlemen’s agreement; in other words, there is currently no binding legislation. These data are mainly based on national administrative sources and therefore reflect country-specific ways of organising healthcare and may not be completely comparable; a few countries compile their statistics from surveys. Annual national and regional data for healthcare resources are provided in absolute numbers and in population-standardised rates (per 100 000 inhabitants).

Causes of death

Data on causes of death provide information on mortality patterns and form a major element of public health information. This dataset refers to the underlying cause of death, which — according to the World Health Organization (WHO) — is ‘the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury’.

Since reference year 2011, data for causes of death have been provided under a specific legal basis, Commission 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.

Causes of death statistics are based on information derived from the medical certificate of cause of death. The medical certification of death is an obligation in all EU Member States. Countries code information on the cause of death (as provided on the medical certificate) into ICD codes. The dataset is built upon standards laid out in the World Health Organization’s (WHO’s) International Statistical Classification of Diseases and Related Health Problems (ICD). The ICD provides codes, rules and guidelines for mortality coding. Statistics presented in this publication are based on the 10th edition of the ICD (ICD-10). Eurostat’s causes of death statistics are classified according to 86 different causes that together compose a European shortlist (2012) of causes of death. Note that ICD-11 has already been adopted and will come into effect as of 1 January 2022.

Statistics on causes of death are available analysed by cause of death, sex, five-year age group, residency and country of death. Annual data are provided in absolute numbers, as crude death rates and as standardised death rates. While the majority of regional data published for causes of death is presented in the form of three-year averages (to smooth the impact of outliers), the information presented in this article refers to death rates for NUTS level 2 regions of residence for the latest reference year.

As the population structure of a region (or country) can strongly influence crude death rates, regional (and national) comparisons are normally made on the basis of standardised death rates, where age effects can be taken into account. The standardised death rate is computed as a weighted average of age-specific mortality rates (where the weighting factor is the age distribution of a standard reference population). As most causes of death vary significantly with people’s age and sex, the use of standardised death rates improves comparability over time and between regions (and countries).

Indicator definitions

Excess mortality

Excess mortality provides a means for identifying and monitoring atypical mortality patterns, for example during the COVID-19 pandemic. The monthly excess mortality indicator draws attention to the magnitude of the COVID-19 crisis, as the number of deaths (from all causes) is compared with the expected number of deaths (the baseline) during a certain period based on an analysis of the time series . Excess mortality is the number or rate of additional deaths in one month compared with the average number or rate of deaths recorded during the same month over the baseline period.

The indicator of excess mortality is considered to be a more comprehensive measure of the total impact of the COVID-19 pandemic than a simple count of confirmed COVID-19 deaths alone. In addition to the confirmed number of deaths, excess mortality also captures deaths from COVID-19 that were not diagnosed and reported as such, as well as excess deaths from other causes that may be attributed to the overall crisis.

Deaths

A death, according to the United Nations definition, is the ‘permanent disappearance of all vital functions without possibility of resuscitation at any time after a live birth has taken place’; this definition therefore excludes foetal deaths (stillbirths).

Available beds in hospitals

Hospital bed numbers provide information on healthcare capacities, in this case the maximum number of patients who can be treated in hospitals. The total number of hospital beds includes all hospital beds which are regularly maintained and staffed and immediately available for the care of admitted patients. This count is equal to the sum of the following four categories: i) curative (acute) care beds; ii) rehabilitative care beds; iii) long-term care beds; and iv) other hospital beds.

Medical doctors

A medical doctor (or physician) has a degree in medicine. Practising physicians are those who have completed successfully studies in medicine at university level and who are licensed to provide services to individual patients (conducting medical examinations, making diagnoses, performing operations). Excluded from the count of practising physicians are students who have not yet graduated, unemployed physicians, retired physicians or physicians working abroad, as well as physicians working in administration, research or other posts that do not involve direct contact with patients.

Eurostat gives preference to the concept of ‘practising physicians’, although some data may be presented for ‘professionally active physicians’ (a practising physician or any other physician for whom a medical education is a prerequisite for the execution of their job), or for ‘licensed physicians’ (a broader concept, encompassing the other two types of physician as well as other registered physicians who are entitled to practise as healthcare professionals).

Causes of death

The underlying cause of death is defined as the disease or injury which started the train (sequence) of morbid (disease-related) events which led directly to death, or the circumstances of the accident or violence which produced the fatal injury. Although international definitions are harmonised, the resulting statistics on causes of death may not be fully comparable across countries, as classifications may vary when the cause of death is multiple or difficult to evaluate, and because of different notification procedures.

Within this publication, data are presented for the main cause of death (according to the ICD-10):

  • all causes of death (as defined by ICD-10 A-R and V-Y);
  • cancer (malignant neoplasms) (ICD-10 C);
  • diseases of the circulatory system (ICD-10 I);
  • diseases of the respiratory system (ICD-10 J);
  • other causes of death (ICD-10 A-R and V-Y minus (C+ I+J)).

Context

Within the European Commission, policy actions within the health domain generally fall under the responsibility of the Directorate-General for Health and Food Safety and the Directorate-General for Employment, Social Affairs and Inclusion. Such actions are focused on protecting people from health threats and disease, providing consumer protection (food safety issues), promoting lifestyle choices (fitness and healthy eating), as well as workplace safety.

The EU’s main policy objectives include: improving access to healthcare for all through effective, accessible and resilient health systems, fostering health coverage as a way of reducing inequalities and tackling social exclusion; promoting health information and education, healthier lifestyles and individual well-being; investing in health through disease prevention; improving safety standards for patients, pharmaceuticals/drugs and medical devices; guaranteeing/recognising prescriptions in other EU Member States.

Health systems across the EU are organised, financed and managed in very different ways and the competence for the delivery of these services largely resides with individual EU Member States. Policy developments in this area are based on an open method of coordination, a voluntary process based on agreeing common objectives and helping national authorities cooperate. The COVID-19 pandemic underlined the issue of cooperation on health matters within the EU and the ability of the EU to respond to shocks and health crises.

Regulation (EU) 2021/522 of the European Parliament and of the Council of 24 March 2021 establishing a Programme for the Union’s action in the field of health (‘EU4health programme’) for the period 2021-2027 will provide funding to EU Member States, health organisations and non-governmental organisations (NGOs) and is designed to boost the EU’s preparedness for major cross-border health threats by creating:

  • reserves of medical supplies for crises;
  • a reserve of healthcare staff and experts that can be mobilised to respond to crises across the EU;
  • increased surveillance of health threats.

Another strand of EU4Health will support a longer-term vision of improving health outcomes via efficient and inclusive health systems across the EU Member States, by encouraging:

  • disease prevention and health promotion in an ageing population;
  • the digital transformation of health systems;
  • access to health care for vulnerable groups;
  • the availability and affordability of medicines and medical devices, advocating the prudent and efficient use of antimicrobials, while promoting medical and pharmaceutical innovation and greener manufacturing.

Alongside EU4Health, the EU’s civil protection mechanism — rescEU — will be expanded and reinforced to prepare for and respond to future crises, for example, through direct crisis response, stockpiles, deployment and dispatching of equipment and staff in emergency situations. Furthermore, the research framework programme — Horizon Europe — will also be reinforced to fund vital research in health. This will include initiatives to scale-up the research effort for challenges such as those experienced during the COVID-19 pandemic, for example, the extension of clinical trials, innovative protective measures, virology, vaccines, treatments and diagnostics, and the translation of research findings into public health policy measures.

Total funding for the EU4Health programme under the multiannual financial framework will amount to EUR 2.2 billion (in 2018 prices) during the period between 2021 and 2027 (along with a EUR 2.9 billion share of additional ‘top-up’ funding), while funding for emergency response and disaster risk management (rescEU) will amount to EUR 3.0 billion, of which EUR 1.9 billion has been allocated as part of the European Recovery Instrument (COM(2020) 441 final), also known as Next Generation EU.

EU cohesion policy also funds health as a key asset for regional development and competitiveness in order to reduce economic and social disparities. Support may address a number of different areas such as the EU’s ageing population, healthcare infrastructure and sustainable systems, e-health, health coverage, and health promotion programmes.

The European Centre for Disease Prevention and Control in Sweden is an EU agency that provides surveillance of emerging health threats so that the EU can respond rapidly. It pools knowledge on current and emerging threats, and works with national counterparts to develop disease monitoring across the EU.

The European Medicines Agency (EMA), which is located in Amsterdam (the Netherlands), helps national regulators by coordinating scientific assessments concerning the quality, safety and efficacy of medicines used across the EU. All medicines in the EU must be approved at a national level or by the EU before being placed on the market. The safety of pharmaceuticals that are sold in the EU is monitored throughout a product’s life cycle and individual products may be banned, or their sales/marketing suspended.

On a more practical level, the European Health Insurance Card (EHIC) allows travellers from one EU Member State to obtain medical treatment if they fall ill whilst temporarily visiting another Member State or EFTA country. The EU has also introduced legislation on the application of patients’ rights in cross-border healthcare (Directive 2011/24/EU), which allows patients to go abroad for treatment when this is either necessary (specialist treatment is only available abroad) or easier (if the nearest hospital is just across a border). In March 2021, the European Commission proposed to create a Digital Green Certificate to facilitate safe, free movement within the EU during the COVID-19 pandemic. The certificate is intended to be a proof that a person has been vaccinated against COVID-19, has received a recent negative test result or has recovered from COVID-19.

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Health status (t_hlth_state)
Health care (t_hlth_care)
Causes of death (t_hlth_cdeath)
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)
Physicians or doctors by NUTS 2 regions (tgs00062)
Available beds in hospitals by NUTS 2 regions (tgs00064)


Health care (hlth_care)
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)
Causes of death (hlth_cdeath)]
General mortality (hlth_cd_gmor)
Causes of death - standardised death rate by NUTS 2 region of residence (hlth_cd_asdr2)
Regional health statistics (reg_hlth)
Causes of death (reg_hlth_cdeath)
Health care: resources and patients (non-expenditure data) (reg_hlth_care)


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This article forms part of Eurostat’s annual flagship publication, the Eurostat regional yearbook.