Health statistics introduced
Latest update of text: June 2020.
Planned article update: June 2021.
Health is an important priority for Europeans, who expect to have a long and healthy life, to be protected against illnesses and accidents, and to receive appropriate healthcare. Health issues cut across a range of topics — including consumer protection (food safety issues), workplace safety, environmental or social policies. As such, health policy within the European Union (EU) is principally under the remits of the Directorate-General for Health and Food Safety and of the Directorate-General for Employment, Social Affairs and Inclusion.
The competence for the organisation and delivery of health services and healthcare within the EU is largely held by the EU Member States. The European Commission has a mandate to complement national action on health, by proposing legislation, providing financial support, promoting healthy lifestyles, coordinating and facilitating the exchange of best practice.
The European Commission has coordinated EU-wide efforts in response to the coronavirus outbreak. Firstly, this has concerned public health measures, such as supporting the healthcare sector, supporting research for diagnosis, treatment and vaccines, and developing guidelines for travel and border management. Secondly, actions have been taken to mitigate the social and economic consequences, for example through a recovery plan.
EU actions in the field of health
A first programme for Community action in the field of public health covered the period from 2003 to 2008. In October 2007, the European Commission adopted a second programme Together for health: a strategic approach for the EU 2008-2013 (COM(2007) 630 final). 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) under the title Health for Growth. This programme emphasises the link between health and economic prosperity, as the health of individuals directly influences economic outcomes such as productivity, labour supply and human capital. The programme foresees expenditure of almost EUR 450 million over the seven-year period in the form of grants and public procurement contracts. It has a focus on:
- the challenging demographic context that is threatening the sustainability of healthcare systems;
- the increasing health inequalities between EU Member States;
- the prevalence of chronic diseases; and
- the fragile economic recovery that is limiting the resources available for investment in healthcare.
The EU’s third health programme aims to:
- facilitate access to better and safer healthcare for EU citizens;
- contribute to innovative, efficient and sustainable healthcare systems;
- improve the health of the EU population and reduce health inequalities;
- prevent disease and foster supportive environments for healthy lifestyles;
- protect the EU population from cross-border health threats.
People’s health influences economic outcomes in terms of productivity, labour supply, human capital and public spending. Besides being a value in itself, health is also a precondition for economic prosperity, as recognised in the European Commission staff working document Investing in health (SWD(2013 043 final). In the aftermath of the global financial and economic crisis, one of the key challenges faced by many of the EU Member States was the ability of their health systems to provide effective and resilient healthcare in the face of budget constraints and associated reforms. In April 2014, a European Commission Communication On effective, accessible and resilient health systems (COM(2014) 215 final) outlined three principals for consideration: to strengthen the effectiveness of health systems so they produce positive health outcomes (improve the overall health of the population); to increase the accessibility of healthcare (access to medical treatment and adequate resources so as not to exclude parts of the population from receiving healthcare services); and to improve the resilience of health systems (remaining fiscally sustainable, adapting to changing environments and identifying innovative solutions to tackle challenges with limited resources).
Thereafter, the European Commission’s Directorate-General for Health and Food Safety released a strategic plan covering the period 2016-2020, which highlighted a number of key challenges, including:
- achieving greater cost-effectiveness by encouraging efficient spending on health to promote economic growth, through smart investments in, for example, sustainable health systems, health promotion campaigns, or health coverage to reduce inequalities and tackle social exclusion;
- the need to maintain high standards of safety whilst encouraging a flexible environment to sustain competitiveness;
- tacking emerging global threats that may impact on health issues (such as climate change, globalisation, human, animal and plant diseases);
- supporting evidence-based policymaking.
In an effort to support EU Member States better in their policymaking and to boost analytical capabilities, the EU has brought together internationally renowned expertise in a two-year exercise that is designed to gauge its progress towards providing effective, accessible and resilient health systems. Health at a glance: Europe (OECD and the European Commission, 2018) provides a neutral, descriptive comparison of the health status of the EU’s population and the performance of health systems.
The EU’s third programme for health in the EU is complemented by research framework programmes (for example, supporting initiatives in areas such as biotechnology), cohesion funds (for example, supporting investment in healthcare infrastructure, e-health services, or initiatives to promote active ageing) and the European fund for strategic investments.
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 Europe, strengthening the EU’s defences against infectious diseases. During 2020, it has provided information — including statistical information — on Coronavirus disease and the COVID-19 pandemic.
The European Medicines Agency (EMA), located in Amsterdam (the Netherlands), helps national regulators by coordinating scientific assessments concerning the quality, safety and efficacy of medicines that are used across the EU. All medicines in the EU must be approved nationally 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.
Having started in 2005 as the Public Health Executive Agency, after several transformations the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) emerged at the end of 2014. CHAFEA is involved in the implementation of four programmes for the European Commission (for example managing relations with beneficiaries): the EU Health Programme, the Consumer Programme, the Better Training for Safer Food initiative and the Promotion of Agriculture Products Programme.
Technological developments can impact on all stages of health care, from prevention, diagnosis and monitoring to treatment. In 2018, the European Commission adopted a Communication on enabling the digital transformation of health and care in the digital single market, empowering citizens and building a healthier society (COM(2018) 0233). This identified three pillars for future work in this area:
- providing citizens with secure access to their health data and sharing health data;
- better data to promote research, disease prevention and personalised health and care;
- digital tools for citizen empowerment and for person-centred care.
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, the United Kingdom (at least during the transition period up to the end of 2020) 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).
Healthcare and health workforce
Population ageing is expected to become an even greater challenge for the EU’s health sector in the coming decades. The demand for healthcare is expected to increase dramatically as a result of an ageing population. At the same time, the proportion of people in work will often stagnate or, at least in some of the EU Member States, decline. As a result, there may be staff shortages in certain medical specialisations or geographic areas. In 2016, close to two fifths (39 %) of doctors in the EU  were aged 55 years or over, with 8 % aged 65 years or over. Other external issues affecting the healthcare workforce include technological innovation, changing care demands, and migration patterns, while internal issues, other than simply workforce ageing, include issues of recruitment and retention, skills and geographic mismatches.
An action plan for the EU health workforce (SWD(2012 093 final) seeks to help EU Member States tackle these challenges, by: improving workforce planning and forecasting; anticipating future skills’ needs; improving the recruitment and retention of health professionals; mitigating the negative effects of migration on health systems. Between 2013 and 2016 there was a joint action on health workforce planning and forecasting with 30 associated partners and 34 collaborative partners from 28 European countries working together on advancing the issue of planning and forecasting. Since 2017, this work has been continued through SEPEN — Support for the health workforce planning and forecasting expert network.
Health and safety at work
Concerning health and safety at work, the Treaty on the functioning of the European Union states that ‘[...] the Union shall support and complement the activities of the Member States in the following fields: (a) improvement in particular of the working environment to protect workers' health and safety [...]’. The European Commission’s policy agenda for the period 2014-2020 was set out in the Communication EU strategic framework on health and safety at work for 2014-2020 (COM(2014) 332 final), which outlines three major challenges: to improve implementation of existing health and safety rules; to improve the prevention of work-related diseases by tackling new and emerging risks without neglecting existing risks; to take account of the EU’s ageing workforce.
Actions in the field of health and safety at work are supported under the working conditions (rights at work) section of the progress axis of the EU’s programme for employment and social innovation (EaSI). EaSI is a financing instrument designed to promote a high level of quality and sustainable employment, guaranteeing adequate and decent social protection, combating social exclusion and poverty and improving working conditions. The proposed budget for the progress axis of the EaSI is around EUR 500 million for the period 2014-2020.
In January 2017, the European Commission adopted the Communication Safer and Healthier Work for All — Modernisation of the EU Occupational Safety and Health Legislation and Policy (COM(2017) 12 final). This proposed three key actions to bring new impetus to the existing framework:
- stepping up the fight against occupational cancer through legislative proposals accompanied by increased guidance and awareness-raising;
- helping businesses, in particular small and medium-sized enterprises (SMEs) comply with occupational safety and health rules;
- cooperating with EU Member States and social partners to remove or update outdated rules and to refocus efforts on ensuring better and broader protection, compliance and enforcement on the ground.
The European Agency for Safety and Health at Work is the EU’s information agency for occupational safety and health. The agency promotes a culture of risk prevention to improve working conditions, endeavouring to make workplaces safer, healthier and more productive for the benefit of businesses, employees and governments.
Statistics on public health and health and safety at work
The EU gathers statistical information in order to assess health issues, effectively design policies and target future actions. This statistical information needs to be based on a set of common EU health indicators, for which there is Europe-wide agreement regarding definitions, collection and use; examples include the European core health indicators (ECHI), sustainable development indicators and EU social indicators.
In December 2008, the European Parliament and the Council adopted Regulation (EC) No 1338/2008 on Community statistics on public health and health and safety at work. The Regulation is designed to ensure that health statistics provide adequate information for all EU Member States to monitor EU actions in the field of public health and health and safety at work. The Regulation lists five domains: health status and health determinants; healthcare; causes of death; accidents at work; and occupational diseases and other work-related health problems and illnesses. A number of European Commission Regulations were subsequently adopted specifying in detail the variables, breakdowns and metadata that EU Member States should deliver:
- Regulation (EU) No 328/2011 on statistics on causes of death,
- Regulation (EU) No 349/2011 on statistics on accidents at work,
- Regulation (EU) No 141/2013 on the implementation of the European health interview survey (wave 2),
- Regulation (EU) No 2015/359 on the implementation of statistics on healthcare expenditure and financing, and
- Regulation (EU) No 2018/255 on the implementation of the European health interview survey (wave 3).
European statistics on health are derived from two types of sources: administrative data and surveys. Administrative data sources are the basis for important statistical data collections such as human and technical resources and activities, healthcare expenditure, causes of death, and accidents at work; these data therefore reflect, to some degree, country-specific ways of organising healthcare and may not always be completely comparable. General population surveys in health statistics include the minimum European health module integrated within the annual EU statistics on income and living conditions survey (EU-SILC), the five-yearly European health interview survey (EHIS) and specific ad-hoc modules of the labour force survey (LFS), such as the 1999, 2007 and 2013 modules on accidents at work and other work-related health problems or the 2002 and 2011 modules on the employment of disabled persons.
- Health (t_hlth), see:
- Health status (t_hlth_state)
- Health care (t_hlth_care)
- Causes of death (t_hlth_cdeath)
- Health (hlth), see:
- Health status (hlth_state)
- Health determinants (hlth_det)
- Health care (hlth_care)
- Disability (hlth_dsb)
- Causes of death (hlth_cdeath)
- Health and safety at work (hsw)
- A System of Health Accounts 2011 — Revised edition March 2017
- European Health Interview Survey (EHIS wave 3) — Methodological manual — 2018 edition
- European Statistics on Accidents at Work (ESAW) — Summary methodology — 2013 edition
- Morbidity statistics in the EU — Report on pilot studies — 2014 edition
- Revision of the European Standard Population — Report of Eurostat's task force — 2013 edition
- Based on available data: excluding Czechia, Denmark, Greece, Poland, Portugal, Finland and Sweden.