SDG 3 - Good Health and well-being

Ensure healthy lives and promote well-being for all at all ages

Data extracted in August 2018

Planned article update: September 2019

Highlights


EU trend of SDG 3 on good health and well-being

This article provides an overview of statistical data on SDG 3 ‘Good health and well-being’ in the European Union (EU). It is based on the set of EU SDG indicators for monitoring of progress towards the UN Sustainable Development Goals (SDGs) in an EU context.

This article is part of a set of statistical articles, which are based on the Eurostat publication ’Sustainable development in the European Union — Monitoring report - 2018 edition’. This report is the second edition of Eurostat’s series of monitoring reports on sustainable development, which provide a quantitative assessment of progress of the EU towards the SDGs in an EU context.

Goal 3 aims to ensure health and promote well-being for all at all ages by improving reproductive, maternal and child health; ending the epidemics of major communicable diseases; and reducing non-communicable and mental diseases. It also calls for reducing behavioural and environmental health-risk factors.

Full article

Good health and well-being in the EU: overview and key trends

Monitoring SDG 3 in an EU context focuses on the topics healthy lives, health determinants, causes of death and access to healthcare. As shown in Table 1, the EU has made significant progress in almost all health-related spheres analysed in this article over the past few years. However, slightly unfavourable trends have occurred in self-perceived health and in road transport deaths.

The European Commission conducts the State of Health in the EU [1] initiative in close collaboration with the OECD and the European Observatory on Health Systems and Policies. The recurring, two-year cycle of monitoring comprises the Health at a Glance: Europe series, Country Health Profiles for each Member State and a Companion Report with the European Commission’s own assessment of policy levers and priorities.


Healthy Lives

Over the past century, people around the world have generally been enjoying increasing lifespans. This surge in life expectancy is a result of various factors, including reductions in infant mortality, rising living standards, improved lifestyles and better education, as well as advances in healthcare and medicine [2]. Rising life expectancy is an indicator of a population’s improved general health and lower mortality rates. EU countries have some of the highest life expectancy rates in the world. While life expectancy gives an objective assessment of how long people can expect to live, it does not show whether people live their lives in good health. Thus, indicators providing insights into the (subjective) well-being of individuals are complementing the information on life expectancy.

Life expectancy at birth has increased since 2011, but fewer people perceive themselves to be in good or very good health

Figure 2: Life expectancy at birth, by sex, EU-28, 2002–2016 (years)
Source: Eurostat (sdg_03_10)


Figure 3: People perceiving themselves to be in good or very good health, EU-27 and EU-28, 2005–2016 (% of population aged 16 or over)
Source: Eurostat (sdg_03_20)

A child born in 2016 could on average expect to live 81.0 years, which is 3.3 years longer than in 2002. In the short term, life expectancy increased by 0.8 years between 2011 and 2016. During this period, life expectancy increased in all Member States. However, it varied by 8.6 years between the different EU countries in 2016.

Despite the increase in life expectancy, the share of people perceiving themselves to be in good or very good health has fallen. In 2016, more than two thirds of the people in the EU judged their health as being either good or very good (67.5 %), slightly fewer than in 2011 (67.9 %). There seems to be no straightforward explanation for the developments in the last five years, which might be an indication of the complexities underlying self-perceived health.

The share of people who perceive themselves to be in good or very good health varied strongly across Member States, between 82.8 % and 43.4 % in 2016. However, caution is needed when making cross-country comparisons of perceived general health because of the subjective nature of this assessment, which can be affected by social and cultural backgrounds. In addition, older people report poor health more often than younger people. Thus, countries with a larger proportion of elderly people may have a lower proportion of people reporting good or very good health.

Women had higher live expectancies than men, but they assessed their health less often to be good or very good

Between 2002 and 2016, the life expectancy of women increased by 2.7 years, from 80.9 years to 83.6 years. In the same timespan, the life expectancy of men went up by 3.7 years, from 74.5 years to 78.2 years. Thus, men’s life expectancy saw a bigger increase than that for women, indicating a closing of the life expectancy gender gap. This can at least partly be attributed to women adopting similar risk-increasing life-styles as men, such as smoking, and to a sharp reduction in deaths from cardiovascular diseases among men [3].

Although women are expected to live longer than men, they are less likely to rate their health as being very good or good. In 2016, 65.2 % of women and 70.1 % of men considered their health to be good or very good (a gender gap of 4.9 percentage points). In all Member States, except Ireland, men gave a more favourable assessment in 2016 [4].

Self-perceived health also shows a distinct age pattern, with fewer people in the older age groups tending to rate their health as being very good or good. Furthermore, the gender gap increases with age, peaking among people aged 75 to 84. In 2016, the gender gap was 6.0 percentage points in favour of men for people aged 75 to 84, while it only amounted to 2.8 percentage points for 16 to 64 year olds.

Finally, there are also large disparities in self-reported health between people with different income. In 2016, on average, 78.3 % of people in the highest income group reported good or very good health, while only 60.0 % of people in the lowest income group did so [5]. The disparities may be explained by differences in living and working conditions, as well as in lifestyles [6]. In addition, people on low incomes have less access to health services for financial or other reasons, as discussed further below.

The number of healthy life years increased for people at age 65

The Healthy Life Years (HLY) indicator is a health-expectancy indicator that combines information on mortality and morbidity. The information on health condition is collected through survey questions on self-perceived disability. With respect to the increase in life expectancy at birth, it is interesting to have a closer look at the older generations to find out whether people live longer and better or whether they only gain additional years of life in bad health. Life expectancy at age 65 is defined as the mean number of years still to be lived by a 65-year-old person, if subjected to the current mortality conditions throughout the rest of his or her life. In other words, the HLY indicator at age 65 measures the number of years that a person at age 65 is still expected to live in a self-perceived healthy condition [7].

In 2016, life expectancy at age 65 was estimated to be on average at 21.6 years for women and 18.2 years for men in the EU. In the same year, HLY at age 65 was on average 10.1 years for women and 9.8 years for men in the EU. Given that healthy life expectancy does not differ much between men and women aged 65, but women’s overall life expectancy considerably exceeds that of men, 65-year-old women can on average be assumed to spend a greater share of their remaining lives with a disability or a disease. More precisely, women at the age of 65 were expected to spend 46.8 % of their remaining lives free from any limitations in 2016, compared with 54.0 % of their remaining lives for men. There are also considerable differences between Member States. Depending on the country, women at age 65 could expect to live between 77.3 % and 21.7 % of their remaining lives free from any limitation in 2016, men between 79.1 % and 29.4 %.

Health Determinants

Many factors together affect the health of individuals and populations. These include socio-economic aspects, the state of the environment, the design of our cities, opportunities of access and use of health services, and a person’s individual characteristics and behaviour [8]. The health determinants discussed in the following sections are obesity rate, smoking prevalence, noise and air pollution. Roughly speaking, the first determinants focus on a person’s individual characteristics and behaviours and the second look at external factors. However, multi-dimensional aspects such as changing lifestyles, consumption patterns or mobility influence all the considered determinants.

More than half of the adult EU population was overweight in 2014

Obesity is a serious public health problem, as it significantly increases the risk of chronic diseases, such as cardiovascular disease, type-2 diabetes, hypertension and certain types of cancer. For specific individuals, obesity may further be linked to a wide range of psychological problems. For society as a whole, it has substantial direct and indirect costs that put a considerable strain on healthcare and social resources.

In 2014, 15.9 % of people over the age of 18 in the EU were obese [9], and an additional 35.7 % were pre-obese. This means more than half of the population above the age of 18 in the EU was overweight. The share of the population that is obese generally increases with age, peaking at age 65 to 74 in 2014 and decreasing again for people at age 75 and older. While for women obesity seems to be negatively correlated with educational attainment (i.e. highly-educated women tending to be less obese), there was no such clear-cut pattern for men.

In 2014, the obesity rate of EU countries ranged from 9.4 % to 26.0 % for people over the age of 18. According to the World Health Organisation (WHO), Europe had the second highest proportion of overweight or obese people in 2014, behind the Americas [10].

Fewer and fewer people in the EU are smoking, and the gender gap is shrinking

Figure 4: Smoking prevalence, by sex, EU-28, 2007–2017 (% of population aged 15 or over)
Source: European Commission services (sdg_03_30)

Tobacco consumption is considered to be ‘the single largest avoidable health risk in the European Union’ [11]. Many types of cancer, cardiovascular and respiratory diseases are linked to tobacco use. Around half of all smokers die prematurely, depriving their families of income and raising the burden of healthcare.

Smoking prevalence among the population aged 15 or over decreased between 2007 and 2017, from 32 % to 26 %. Nevertheless, this means that still more than a quarter of adults in the EU was smoking in 2017. More men were smoking than women in 2017 (30 % vs. 22 %). However, the gender gap has slightly decreased over time, from 10 percentage points in 2007 to 8 percentage points in 2017. This development can partially explain the decreasing gender gap in life expectancy [12].

While smoking prevalence decreased in most EU countries over the past five years, it still varied greatly across Member States in 2017, between 7 % and 37 %. The reasons for the differences in smoking rates between EU countries are complex. A research paper from 2016 found an association between tobacco-control policies, which include restrictions on smoking in public places or public information campaigns, and smoking cessation mostly among higher socioeconomic groups [13].

External factors affecting health, such as air pollution and exposure to noise, have on average been declining, but hotspots remain

Air pollution is the number-one environmental cause of death in Europe, responsible for more than 400 000 premature deaths per year [14]. Air pollution can lead to or aggravate many chronic and acute respiratory and cardiovascular diseases. In addition, it reduces life satisfaction and perception of well-being. Air pollution has been one of Europe’s main environmental policy concerns since the late 1970s. Air pollutants are emitted both naturally and as a result of human activities, mainly fuel combustion. Urban populations are particularly exposed to air pollution because of the high concentration of human activities and industry in EU cities and the daily flow of commuters.

In the EU, exposure to air pollution by fine particulate matter (PM2.5) — one of the most harmful components of air pollution for human health [15] — had been increasing in urban areas until 2011. This negative trend has reversed in the short term, from 18.1 μg/m3 in 2010 to 14.5 μg/m3 in 2015, a decrease of almost 20 %. Nevertheless, substantial air pollution hotspots remain. While the annual mean for PM2.5 is below the EU target value (25 μg/m3 annual mean), it continues to be above the level recommended by the WHO (10 μg/m3 annual mean).

The WHO [16] identified noise as the second most significant environmental cause of ill health after air pollution [17]. Environmental noise causes approximately 16 600 cases of premature deaths per year in Europe [18]. Road traffic is the dominant source of environmental noise; railways, airports and industry are also important sources of noise [19]. The harmful effects of noise arise mainly from the stress reactions it causes in the human body, and these can potentially lead to premature deaths [20].

The EU has made substantial progress in this area, with the share of the population feeling affected by noise from neighbours or from the street being reduced from 23.0 % in 2007 to 17.9 % in 2016. However, because the assessment of noise pollution is a subjective measure, a fall in the value of the indicator may not necessarily indicate a similar reduction in actual noise-pollution levels.

The estimated number of people exposed to levels of environmental noise in Europe that are above the noise indicator levels set by the EU Environmental Noise Directive (2002/49/EC) provides a more objective view on the matter. According to the most recent EEA assessment from 2018 [21], 71.7 million people in urban areas were estimated as being exposed to noise from road traffic above 55 decibel (dB) on an annual average for day, evening and night. In addition, 9.8 million people were estimated to be subjected to excessive noise from railways, 3.1 million from airports, and 1.0 million from industry.

In addition to these two major environmental factors, the exposure to and possible health impact of toxic chemicals found in the environment and food are under increasing scrutiny by the scientific and regulatory communities worldwide (see the article on SDG 12 ‘Responsible consumption and production’ and the further reading section below).

Causes of Death

Causes of death are among the oldest medical statistics available and play a key role in the general assessment of health in the EU. The data can be used to determine which preventive and medical curative measures or investments in research might increase a population’s life expectancy. The indicators selected for this sub-theme look at deaths due to chronic and communicable diseases, as well as at fatal accidents on roads and at work. The overall trends in these areas are quite favourable, with fewer people in the EU dying due to monitored diseases and accidents.

Developments on chronic diseases and selected communicable diseases are positive, but gender gaps remain

Figure 5: Death rate due to chronic diseases, EU-28, 2002–2015 (number per 100 000 persons aged less than 65)
Source: Eurostat (sdg_03_40)


Figure 6: Death rate due to tuberculosis, HIV and hepatitis, by gender, EU-28, 2002–2015 (number per 100 000 persons)
Source: Eurostat (sdg_03_41)

Chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are the leading cause of mortality in the EU [22]. They are evoked or worsened by a number of risk factors, including smoking, obesity, lack of physical activity, poor diet and high alcohol consumption. In addition, air pollution and noise are also associated with premature mortality from certain chronic diseases [23]. High mortality due to chronic diseases, combined with the fact that many cases are preventable, has led to increasing efforts to avoid lifestyle-related risk factors. Awareness initiatives on health promotion and disease prevention have been carried out at national and EU-levels. Chronic-disease management programmes in primary care have also been implemented.

In the EU, deaths due to chronic diseases before the age of 65 fell steadily between 2002 and 2015. While there were 164.4 deaths per 100 000 people under the age of 65 due to chronic diseases in 2002, this rate had fallen by more than 25 % to 122.1 in 2015.

Communicable diseases such as HIV, tuberculosis and hepatitis are highlighted as targets in the Sustainable Development Goals. The EU has also committed to eliminating tuberculosis and HIV by 2020 and reducing hepatitis [24]. In the EU, deaths due to these three communicable diseases fell rather steadily between 2002 and 2015: while 4.8 out of 100 000 people died as a result of one of them in 2002, this was down to 2.9 per 100 000 people by 2015.

However, while the number of deaths due to HIV, tuberculosis and hepatitis is decreasing, deaths due to other infectious and parasitic diseases are on the rise in the EU. Overall, deaths due to communicable diseases were increasing in the short and long term. In 2002, 13.8 out of 100 000 people died because of certain infectious and parasitic diseases. This number went up to 15.0 in 2010 and reached 17.4 in 2015.

There is a gender gap for both chronic and communicable diseases. The death rates were higher for men than for women, overall in the EU as well as in almost all Member States. This can partially explain the gender gap in the life expectancy indicator.

With regard to communicable diseases, differences in the immune responses of the two sexes contribute to the gender gap [25]. Exposure and behaviour may also explain certain gender differences. For example, substantially more than three quarters of HIV cases were among men. The predominant mode of transmission of HIV was through men having sex with men, followed by heterosexual intercourse [26].

With regard to the gender difference in chronic diseases, there are a number of explanations. First, in all countries, death rates for ischemic heart diseases (IHD) are much higher for men than for women [27]. The IHD mortality rates have declined in all countries since 2000, due to reductions in tobacco use and improved medical care [28]. Second, cancer mortality rates are also higher for men than for women, also in all countries [29]. This gap can be explained partly by men being more exposed to risk factors, as well as the reduced availability or use of screening programmes for cancers affecting men [30]. Finally, in most countries, more men than women die from respiratory diseases, which is partly due to higher smoking rates among men [31].

Fewer people are killed in accidents at work or on roads, but progress has stalled in the past few years

Accidents were one of the most common causes of death within the EU, leading to almost 162 000 deaths or 3.1 % of all deaths in 2015 [32]. These accidents may happen at different places such as home, leisure venue, transport or workplace. Improving the working environment to protect workers’ health and safety is recognised as an important objective by the EU and its Member States in the Treaty on the Functioning of the European Union [33].

Halving the number of deaths from road-traffic accidents is not only a global goal, but also a goal of EU policies [34]. Road safety was made a priority of the EU common transport policy in 2001, in response to the growing concern shown by European citizens [35]. In 2016, some 25 651 people were killed in road accidents, which is 53.3 % fewer than in 2001 and 16.4 % down from 2011. Nevertheless, the stagnation in road casualties since 2013 has put the EU off track from reaching its target of halving the number of people killed in road accidents by 2020 compared with 2010.

Fatal accidents also occur at work, meaning accidents during the course of work that lead to the death of the victim within one year. The EU made progress between 2011 and 2016, reducing the number of fatal accidents at work per 100 000 employed persons from 2.05 to 1.52. Non-fatal accidents can also cause considerable harm, for example by forcing people to live with a permanent disability, leave the labour market or change job. These happened considerably more often than fatal accidents, with an incidence rate of 1 402.85 per 100 000 employed persons in 2016 [36].

Access to Health Care

Achieving universal health coverage is a fundamental objective for the EU, and all European countries endorse equity of access to healthcare for all people as an important policy objective [37]. A decrease in self-perceived unmet healthcare needs would result in better health status for the affected population, particularly for low-income groups [38]. This would reduce health inequalities, which in turn would contribute to higher economic and social cohesion.

Only few people report unmet need for medical care and the share is further decreasing

Figure 7: Self-reported unmet need for medical care, EU-27 and EU-28, 2008-2016 (% of population aged 16 and over)
Source: Eurostat (sdg_03_60)

In 2016, 2.5 % of the EU population reported an unmet need for medical care because of financial reasons, long waiting lists or the distance to travel. This share was lower than five years earlier (3.4 %). However, in ten countries the proportion of the population facing unmet needs for medical care increased between 2011 and 2016, indicating that access to healthcare remains a challenge, in particular for low-income households.

The trend in reported unmet needs was not uniform over time, with unmet needs for medical care actually increasing between 2009 and 2014. This might have been caused by reduced financial resources for the healthcare system due to the economic crisis [39]. While there are still unanswered questions about the mechanism leading to a rise in unmet needs, several studies suggest that reasons include changes in entitlement to free healthcare coverage, higher user charges, the de-listing of some publicly financed benefits, large and sustained cuts in public spending on health, the closure of facilities and reduced opening hours [40]. In addition, non-health system factors such as rising unemployment and reduced incomes are also highly likely to have played a part [41].

Financial constraints are the most common reason why people would report unmet needs for medical examination. For 1.6 % of the total population in 2016, ‘too expensive’ was the most prominent reason for reporting unmet medical examination. A further 0.8 % of people reported unmet medical examination because of ‘waiting lists’, and another 0.1 % because it was ‘too far to travel’. It is worth noting that costs were not the main issue across all Member States; in 11 countries, the majority of people reporting unmet medical examination named long waiting lists as the main reason.

With costs being on average the most important reason for unmet needs, people’s income obviously has a distinct impact on the accessibility of medical care. In 2016, only 1.1 % of people from the highest income group [42] in the EU reported unmet needs for medical examination due to one of the three reasons mentioned above. In contrast, about 4.5 times as many people (5.0 %) from the lowest income group [43] reported unmet needs for medical examination. Differences between other disadvantaged groups also exist. In 2016, more women, older people and people with low education levels reported unmet needs for medical examination than men, younger people and people with higher education levels.

Context

The World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ [44]. Good health is not only of value to the individual as a major determinant of quality of life, well-being and social participation, it also contributes to general social and economic growth. Besides the general availability of healthcare, health can be determined by individual characteristics and behaviour, such as smoking, and by external socio-economic and environmental factors, such as living conditions, air quality and noise. Research is also essential to ensuring health and tackling diseases. Thus, the achievement of the SDG on good health and well-being is strongly linked to other areas related to sustainable development. Ensuring that people can live a long and healthy life also means to reduce the causes of premature deaths, such as unhealthy lifestyles or accidents, to improve the external health determinants and to ensure access to healthcare for all.

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More detailed information on EU SDG indicators for monitoring of progress towards the UN Sustainable Development Goals (SDGs), such as indicator relevance, definitions, methodological notes, background and potential linkages, can be found in the introduction of the publication ’Sustainable development in the European Union — Monitoring report - 2018 edition’.

Further reading on good health and well-being

Notes

  1. European Commission, State of Health in the EU.
  2. Eurostat (2018), Statistics explained: Mortality and life expectancy statistics.
  3. OECD/EU (2014), Health at a Glance: Europe 2014, Paris: OECD Publishing, p. 16.
  4. A study on Spain shows that being a woman with complete dedication to domestic work is associated with a worse state of self-perceived health. See: Pino-Domínguez, Lara, Patricia Navarro-Gil, Abel E. González-Vélez, Maria-Eugenia Prieto-Flores, Alba Ayala, Fermina Rojo-Pérez, Gloria Fernández-Mayoralas, Pablo Martínez-Martín & Maria João Forjaz (2016), Self-perceived health status, gender, and work status, Journal of Women & Aging, 28:5, 386-394. In addition, another study on Spain shows that the gender difference is only statistically significant in the group of people with lower educational level. See: Pinillos-Franco S, García-Prieto C (2017), The gender gap in self-rated health and education in Spain, A multilevel analysis, PLoS ONE 12(12).
  5. For the highest income group, the fifth income quintile is considered (the 20 % of the population with the highest income). For the lowest income group, the first income quintile group is considered (the 20 % of the population with the lowest income).
  6. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 72.
  7. The data required for HLY are the age-specific prevalence (proportions) of the population in healthy and unhealthy conditions and age-specific mortality information. A healthy condition is defined by the absence of limitations in functioning/disability. The indicator is calculated separately for males and females. The indicator is also called disability-free life expectancy (DFLE).
  8. WHO (2017), The determinants of health, Introduction.
  9. The indicator measures the share of obese people based on their body mass index (BMI). BMI is defined as the weight in kilo divided by the square of the height in metre. People aged 18 years or over are considered obese with a BMI equal or greater than 30. Other categories are: underweight (BMI less than 18.5), normal weight (BMI between 18.5 and less than 25), and pre-obese (BMI between 25 and less than 30). The category overweight (BMI equal or greater than 25) combines the two categories pre-obese and obese.
  10. Eurostat (2014), Statistics explained: Overweight and obesity – BMI statistics.
  11. European Commission, Tobacco.
  12. OECD/EU (2014), Health at a Glance: Europe 2014, Paris: OECD Publishing, p. 16-17.
  13. J. R. Bosdriesz et al. (2016), Tobacco control policy and socio-economic inequalities in smoking in 27 European countries, Drug & Alcohol Dependence, Vol. 165, p. 79.
  14. European Environment Agency (2017), Air quality in Europe — 2017 report, EEA Report No 13/2017, Copenhagen: EEA, p. 9. Estimates of the health impacts attributable to exposure to air pollution indicate that PM2.5 concentrations in 2014 were responsible for about 428 000 premature deaths originating from long‑term exposure in Europe (over 41 countries), of which around 399 000 were in the 28 Member States.
  15. World Health Organization (2016), World Health Statistics 2016: Monitoring Health for the SDGs, p. 37.
  16. World Health Organization (2011), Burden of disease from environmental noise — Quantification of healthy life years lost in Europe, Copenhagen: World Health Organization Regional Office for Europe, p. 1.
  17. European Environment Organisation (2017), Environmental noise.
  18. European Environment Organisation (2017), Environmental noise. The estimates cover the 28 Member States as well as the five member countries of the European Environment Agency (Iceland, Liechtenstein, Norway, Switzerland and Turkey).
  19. European Environment Organisation (2017), Managing exposure to noise in Europe.
  20. European Environment Organisation (2017), Managing exposure to noise in Europe.
  21. European Environment Organisation (2018), Population exposure to environmental noise.
  22. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing.
  23. European Environment Organisation (2017), Environmental noise; European Environment Organisation (2017), Air quality in Europe — 2017 report, EEA Report No 13/2017, Copenhagen: EEA, p. 50 and 55.
  24. European Commission (2016), Next steps for a sustainable European future: European action for sustainability, Communication of 22 November 2016 from the Commission to the European Parliament, the Council, the European and Social Committee and the Committee of the Regions, COM(2016) 739 final, Strasbourg.
  25. J. van Lunzen and M. Altfeld (2014), Sex Differences in Infectious Diseases – Common but Neglected, The Journal of Infectious Diseases, Volume 209, Issue suppl_3, 15 July 2014, p. S79-S80.
  26. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 76.
  27. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 62.
  28. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 62.
  29. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 64.
  30. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 64.
  31. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 66.
  32. Source: Eurostat (online data code: (hlth_cd_aro)).
  33. Treaty on the Functioning of the European Union, Article 153.
  34. European Commission (2010), Commission outlines measures to halve road deaths by 2020. Between 2000 and 2010, the total road death number was cut by 44 %. The target of halving the 2000 number was reached in 2012. The Commission adopted a follow-up target of cutting road death in Europe by half between 2010 and 2020.
  35. European Commission (2001), White Paper on European transport policy for 2010: time to decide, COM(2001) 370 final, p. 64.
  36. Source: Eurostat (online data code: (hsw_n2_01)).
  37. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 154.
  38. OECD/EU (2016), Health at a Glance: Europe 2016 — State of Health in the EU Cycle, Paris: OECD Publishing, p. 154.
  39. Expert Panel on effective ways of investing in health (EXPH) (2016), Access to health services in the European Union, final opinion approved at the 14th plenary meeting of 3 May 2016 after public consultation, p. 18.
  40. Expert Panel on effective ways of investing in health (EXPH) (2016), Access to health services in the European Union, final opinion approved at the 14th plenary meeting of 3 May 2016 after public consultation, p. 19.
  41. Expert Panel on effective ways of investing in health (EXPH) (2016), Access to health services in the European Union, final opinion approved at the 14th plenary meeting of 3 May 2016 after public consultation, p. 19.
  42. For the highest income group, the fifth income quintile is considered (the 20 % of the population with the highest income).
  43. For the lowest income group, the first income quintile group is considered (the 20 % of the population with the lowest income).
  44. World Health Organization (1946), Constitution of the World Health Organization.