Europe is not alone in facing challenges from an ageing population, but as the EU’s citizens live longer they are not always doing so in good health.
That was the conclusion from a new report, which found that life expectancy has now reached a record 80 years-plus – a rise of six years compared to 1990. In fact, the proportion of the European population aged over 65 has increased from less than 10% in 1960 to nearly 20% in 2015 and is predicted to hit 30% by 2060.
But that increase is not always matched by healthy life years. Around 50 million people in the EU still suffer from several chronic diseases and more than half a million people of working age die prematurely from them every year.
The Health at a Glance: Europe 2016 document from the Organisation for Economic Co-operation and Development (OECD) and European Commission (EC) also found huge inequalities between – and within – countries.
There are further stark gaps in life expectancy between the least and most educated, and the poorest and richest, says the report. On average across EU countries, the life expectancy of people with the lowest level of education is seven years shorter than for the most educated. The gap is particularly large in Central and Eastern European countries, and especially for men.
Someone with a particularly keen interest in public health is the European Commission’s health and food safety commissioner Dr Vytenis Andriukaitis, a trained surgeon and former health minister for Lithuania.
Vytenis told PME he was particularly concerned by the lack of health workers in some Member States and by the large inequalities in health and life expectancy between people with higher levels of education and income and the more disadvantaged.
“Such challenges are the result of rapid changes in healthcare due to the impact of demography, new technologies and the increasingly interconnected world. Whether these challenges take the form of antibiotic resistance or obesity, I believe they need to be tackled in a holistic manner.”
Chronic diseases
One of the standout findings of the Health at a Glance report concerned the impact of chronic diseases in Europe. It found they currently cause more than half a million people to die early and cost EU economies €115bn per year.
Vytenis told PME he is “very concerned” about the rising burden of chronic non-communicable diseases, such as cardiovascular diseases, cancer and type 2 diabetes.
“The risk of developing these diseases is very much increased due to some of our habits. These risk factors, such as unbalanced diets, inactivity, excessive alcohol consumption and smoking need to be addressed. We need to support Member States’ action to address all the risk factors and to focus more on promoting good health to keep healthy people healthy for as long as possible,” he said.
All told, 50 million people in the EU are afflicted by conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease and asthma, and in 2013 more than 1.2m people died from avoidable illnesses, it says.
Among the key causes? One in five adults in Europe are smokers despite progress in reducing tobacco consumption, while a similar proportion are heavy drinkers and one in six are obese, up from one in nine in 2000.
Meanwhile some countries – including the UK, Ireland and certain Central and Eastern European countries – continue to lag behind in terms of cancer survival rates.
Prevention could be a cure
The report calls for ‘better public health and prevention policies as well as more effective health care [which] could save hundreds of thousands of lives and billions of euros each year in Europe’.
Further investment in prevention, along with measures making it easier for people with disabilities to work, would bring significant economic and social benefits to EU countries. Member States currently allocate only around 3% on average of their health budgets to public health and prevention, pointed out OECD Secretary-General Angel Gurria in a speech introducing the new report.
Meanwhile, pressure on health budgets is increasing, and public demand for new and expensive technologies that offer better and earlier diagnoses and treatment options is growing, added Gurria.
There are rapid changes in healthcare that need to be tackled in a holistic manner
“Achieving further efficiency gains in hospital pharmaceutical spending, administration and other health-spending items will be critical in managing these pressures with limited resources,” he said.
Adding to this, Vytenis told PME he believes health systems need to be made more resilient to cope with the combined effects of the ageing population, increasing rates of chronic diseases and budgetary constraints.
“[These] will require changes in how we deliver healthcare, including developing eHealth, reducing hospital stays by organising services better in primary and community care, and spending more wisely on pharmaceuticals, including making full use of opportunities for generic substitutions,” he said.
“We all know that the impact of chronic diseases can be greatly reduced if diseases are diagnosed early and managed with an integrated approach. Indeed, we need to overcome the fragmentation and isolation of prevention, diagnosis, treatment and care. The report shows that expanding the role of primary care nurses and community pharmacists for instance is very important. A body of evidence shows that changing the scope of practice for nurses brings several advantages, specifically for the management of long-term conditions.”
Access to care
Access to healthcare can also be a factor. While most EU countries have almost universal coverage, there are shortfalls – in Cyprus, Greece, Bulgaria and Romania more than 10% of their populations still were not regularly covered for healthcare costs in 2014.
“Accessibility of health services must be increased in Europe. Indeed, as the report shows, 27% of patients go to the emergency department due to the lack of availability of primary care and an average of 15% of health spending is paid directly out-of-pocket by patients, with large disparities between countries.
“Also poor Europeans are on average 10 times more likely to have problems in getting proper healthcare for financial reasons than more affluent ones. To fight this situation, Member States’ policies should focus on reducing financial barriers to healthcare, strengthening access to primary care, and reducing excessive waiting times.”
Vytenis said ensuring universal access to high-quality care is critical and sees the Commission’s role as one that encourages Member States to adopt policies in that direction.
To that end it is hoped that the State of Health in the EU report itself can be one mechanism by which underperforming Member States can learn from those that are leading the way in health. Primarily it will do this, Vytenis said, “by offering them better knowledge and stronger evidence-based policymaking”.
“Under the Health Programme, the Commission supports a wide range of Joint Actions with Member States aimed at fostering the exchange of knowledge and best practice, so that the Member States facing particular difficulties can take inspiration and learn from best practices developed in other countries,” he added.
Next steps
The Health at a Glance report is part of the EC’s ‘State of Health in the EU’ project cycle and was structured in alignment with the Commission’s objectives to raise the effectiveness, accessibility and resilience of Member States’ health systems.
The next step in the joint OCED/EC project is to produce country health profiles of all 28 EU countries, highlighting the particular characteristics and challenges of each of them, by November 2017. These will be followed in December 2017 by exchanges between individual EU countries and the Commission, the OECD and the Observatory to discuss concrete implications of country findings and help Member States make the best use of gathered evidence.
Ultimately the Health at a Glance findings highlight the need, Vytenis said, “to put health at the centre of the policy debates and demonstrate opportunities for future health policies in Europe”.