Health status and living conditions in an enlarged Europe : monitoring report prepared by the European Observatory on the Social Situation : Health Status and Living Conditions Network

Abstract

Improvements have been seen over the past few decades in both health status and living and working conditions in Europe. However, the level of heterogeneity in living conditions characteristics has and will continue to widen tremendously in the EU as it goes through enlargement. Inequalities in income, education, housing, and employment affect population health, both directly (for example good housing reduces risks associated with poor health) and indirectly through psychosocial factors (such as stress). The diversity in living conditions has translated into a diversity in patterns of health across the region. Good health can be considered one of the most fundamental resources for social and economic prosperity. While the goal to improve average levels of population health is important for any government, there has been an increasing focus on disparities at the national and European level. Investigating differences in health status within and between European countries provides the focus of this report. The relationship between living conditions, socioeconomic factors and heath will be discussed and analysed with the objective of stimulating a debate and policy action for creating a healthier and more equitable society. We aim to present an overview of key issues and not a comprehensive literature review or exhaustive analysis of the topics. The report is in two parts. Part One provides a descriptive analysis of trends and living conditions across the EU and accession and candidate countries (ACC). It highlights the diversity in health status across Europe, attempting to identify current differences between countries, historical trends and possible future directions. In light of these differences and similarities, at the risk of oversimplification, four broad categories are discerned in terms of levels of health and accompanying risk factors in this report. These comprise: (1) the EU-15 plus Cyprus and Malta (2) central European EU member states plus Croatia (3) Baltic states and (4) the four remaining southeast European ACC (Bulgaria, TFYR Macedonia, Romania, and Turkey). The report begins with an overview of mortality indicators, comparing the different groups. The focus then turns to disease patterns, beginning with an examination of trends in chronic conditions. The chronic diseases covered comprise: cardiovascular diseases, cancer, diabetes, respiratory diseases (focusing on chronic obstructive pulmonary disease and asthma), chronic liver disease and liver cirrhosis. Trends in mental health are also reported. Then follows an outline of communicable diseases in Europe, beginning with sexually transmitted infections, including HIV/AIDS. After this, trends in tuberculosis, pneumonia and influenza are described. Next, mortality and morbidity caused by injuries and road traffic accidents are reported. Following this outline of the main causes of mortality and morbidity in Europe, the section turns to the major underlying factors for observed patterns. These comprise tobacco use, unhealthy diet, including excessive alcohol consumption and excessive energy intake and physical inactivity. Next, socioeconomic inequalities are discussed briefly, although a full exploration of these issues is beyond the scope of this report. Part Two is concerned with the policies pursued by governments to address the health issues described in the first section. Sections on the following topics are presented: controlling two important risk factors for chronic diseases - tobacco consumption and obesity; screening for TB and HIV, two communicable diseases that are resurging in some parts of Europe; mental health problems; and finally, socioeconomic inequalities in health. The aim of these sections is to present new information and to draw contrasts and comparisons between countries in order to highlight possible areas of policy that are particularly successful, unsuccessful or underdeveloped. Policies at the EU level are also considered. Public health experts from a selection of EU countries were consulted in order to obtain topical and current information. This has been supplemented with published reports, academic papers and grey literature.