Core Health Indicators in the WHO European Region
Special focus: Noncommunicable diseases
Preface
I am pleased to present the second edition of one of our key publications, presenting the core health indicators for the WHO European Region. Health in the Region continues to improve in several areas: life expectancy is steadily increasing; child and maternal health are continuously improving, and the burden of some noncommunicable and communicable diseases is declining in many countries. New health technologies, more integrated health care, stronger public health practice and programmes, improved reporting and surveillance of health events and new, more inclusive policies have all contributed to these changes. Nevertheless, this is no time for complacency; important challenges remain: more adequately addressing health inequities, the social determinants of health and common risk factors such as tobacco, poor nutrition and physical inactivity. Other problems – the continuing financial and economic crises in many countries in the Region, social unrest, natural disasters and disease outbreaks or re-emergence – necessitate the continuous monitoring of health trends. To protect past achievements and foster further progress, WHO’s European Member States approved Health 2020, a policy framework to support action for health and well-being in Europe, including a set of targets, in 2012. Within the Health 2020 framework, Member States confirmed that timely and highquality health information is essential to monitor trends and evaluate policy. Core health indicators in the WHO European Region 2013 contributes to these efforts by providing basic country and Region-wide information that is collected annually from WHO Member States. The WHO Regional Office for Europe is committed to continuing this work. Following the example of previous editions, Core health indicators in the WHO European Region 2013 presents comparable key health statistics on
Demographic and socioeconomic context
demographic and socioeconomic factors, health status, risk factors and health systems. Its special theme is noncommunicable diseases (NCDs), to which additional subsets of indicators have been dedicated. NCDs remain the leading cause of premature death, disease and disability in the WHO European Region. The publication also includes figures and tables illustrating country trends in cardiovascular disease mortality, child overweight and obesity as one of its risk factors and Member States’ work to limit the effects of risk factors. Monitoring NCDs is an important task in reaching key Health 2020 targets, and thus for implementing and evaluating the new European health policy. This process is further supported by the global monitoring framework on NCDs adopted by the World Health Assembly in May 2013. The global framework is expected to drive progress in prevention and control of NCDs and provide the foundation for advocacy, raising awareness, reinforcing political commitment and promoting global action. The indicators on NCDs and their risk factors that are included in this succinct indicator list show the diversity and magnitude of the challenges for public health in Europe, as well as some positive trends in mortality. We at the WHO Regional Office for Europe are pleased to present this leaflet to you, and look forward to continued work with countries to support the generation of high-quality health information for monitoring progress in implementing Health 2020 and reaching its NCDs targets. Zsuzsanna Jakab WHO Regional Director for Europe
Country Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan MKD* Turkey Turkmenistan Ukraine United Kingdom Uzbekistan WHO European Region
1
2
3
4
5
6
7
8
9
10
Mid-year population (thousands)
Population aged ≥ 65 years (% of total)
Total fertility rate
Natural population growth per 1000
Urban population (%)
Crude death rate per 1000 population
Unemployment rate (%)
Real GDP, PPP$ per capita
Annual growth rate of GDP (%)
Life expectancy at birth (years)
2011
2011 1.6 1.2 1.5 1.4 2.4 a 1.5 1.8 d 1.2 1.5 1.4 1.4 1.4 1.8 1.5 1.8 2.0 c 1.7 1.4 1.5 d 1.2 2.0 2.0 3.0 1.4e 2.6 3.1 1.3 1.6 1.6 c 1.5
2011
2011
2011
2011 8866
8.6 9.1
6.2 4.2 0.9 c 0.6 7.1 27.6 11.2 13.4 7.7 6.7 7.6 12.5 7.8 9.3
5789 42 173 10 062 14 938 38 723 9076 15 083 19 487 32 254 26 332 40 933 21 997 37 455 35 247 5465 39 456 25 858 21 661 36 483 40 868 28 809 32 672 13 099 2402 18 951 21 480 88 797 27 504
2.3 d 3.0 3.8 0.3 -0.6 -0.0 a -2.2 c -1.9 c
2012 0.8 3.6e 7.1 0.8 4.5 1.5 -0.3 -0.7 0.8 -2.0 -2.4 -1.3 -0.5 3.2 -0.2 0.0 6.0 0.7 -6.4 -1.7 1.6 0.9 4.7 b -2.4 5.0 -0.9 5.6 3.7 0.3 1.0 10.0e 0.5 -1.0 3.1 1.9 -3.2 -0.8 3.7 3.4 1.9e -1.7 2.0 -2.3 -1.4 0.7 1.0 8.0 -0.3 2.2 11.1 0.2 0.3 8.2
2011
1.7 1.8 1.9 1.3 1.4 c 1.3 1.3 c
2010 52 88 64 68 52 75 97 49 71 58 70 74 87 69 85 85 53 74 61 68 93 62 92 68 59 35 68 67 85 95 100 61 83 79 61 61 47 57 73 94 56 55 50 77 85 74 26 59 70 50 69 80 36 70
2012 3227 68 3107 8418 9418 9537 10 770 3747 7401 4389 862 10 548 5589 1340 5397 63 418 4306 81 964 11 419 9947 328 4580 7673 60 820 16 407 5464 2234 3296 531 419 38 633 16 695 4951 38 315 10 686 3560 21 397 142 668 29 7259 5478 2040 46 657 9478 7724 7086 2066 74 547 5164 44 992 62 807 28 125 899 020
* The former Yugoslav Republic of Macedonia GDP = gross domestic product PPP = purchasing power parity
10.3 d 17.7 13.9 c 17.1 d 15.1 18.7 17.2 12.8 15.9 17.1 17.1 17.8 16.7 d 13.8 c 20.6 19.5 16.8 11.8 d 11.1 c 10.1 20.3 c 6.7 c 4.5 c 17.4 c 16.3 c 14.0 a 16.1 12.9 d 15.9 15.3 13.6 19.2 a 9.9 c 14.9 c 12.8
4.7 0.2 -2.5 d 2.2 d -0.8 -5.1 -2.2 4.9 0.2 1.8 -0.4 1.8 4.1 d 2.2 c -2.1 -0.4 -4.1 7.8 d 10.2 c 16.2 c -0.5 c 13.6 c 20.5 c -4.5 c -2.1 c 3.7 2.4
16.8 12.4 c 16.6 c 17.2 18.3 c 16.9 c
1.5 1.4 1.5 1.6 1.4 1.9 1.5
-5.1 1.3 c 1.5 c 1.8 2.2 c 2.3 c
11.7 c 7.3
1.5 2.0
2.5 c 11.5
15.3 16.6 c
1.5
-3.6 4.0 c
15.3
2.2 1.6
1.5
14.0 d 9.6 d 9.1 14.7 11.6 6.3 10.2 9.4 11.4 9.4 8.6 d 10.7 c 10.4 9.8 12.9 6.3 d 6.1 c 5.2 c 9.7 c 8.9 c 6.6 c 13.4 c 12.8 c 7.2 7.9 9.3 d 8.1 8.3 9.8 9.8 11.1 a 12.1 c 14.2 c
5.9 17.7 10.9 7.1 14.4 5.6 8.4 5.4 2.5 16.2 15.4 4.9 6.5
14.2 9.8 c 9.1 c 8.4 9.7 c 8.0 c
19.7 4.4 3.2 12.5 12.7 3.6 7.4 6.6 4.8 23.6 13.5 8.2 21.6 7.6 4.1
9.3 c 5.1
31.4 9.8
14.6 9.0 c
8.1 c 8.0
10.5
8.8
13 432 42 779 60 392 21 085 25 564 3369 15 983 21 921 11 887 24 095 26 943 32 087 41 484 51 227 2324 11 561 17 110 9420 7208 35 598 3287 25 800
73.9 d 81.3 70.6 d 80.3 d 76.7 74.3 77.3 81.7 78.1 80.1 76.6 80.8 81.8 d 74.7 c 80.6 c 80.9 75.2 81.9 d 80.8 c 82.2 c 82.5 c 68.6 c 69.5 c 73.7 c 73.6 c 81.7 81.0 75.6 d 81.2 c 81.5 77.0 80.9 71.1 a 73.8 c 69.0 c 74.6 75.7 c 80.0 c 82.5 81.8 c 82.8 c 75.1 c 74.5 71.1 80.8 c 76.7
Note: a=2012 b=2011 c=2010 d=2009 e=2008
Health status: mortality and morbidity indicators 11
Country Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan MKD* Turkey Turkmenistan Ukraine United Kingdom Uzbekistan WHO European Region
12
13
14
15
16
17
18
19
21
22
23
25
27
MDG 4
MDG 5
Infant Child mortality mortality rate before age per 1000 5 years live births per 1000 live births
Maternal mortality ratio per 100 000 live births
All cause mortality
Circulatory system
Malignant neoplasms
Diseases of the respiratory system
External causes of injury and poisoning
Infectious and parasitic diseases
Mental and behavioural disorders
Ill defined** causes of death (%)
Newly diagnosed HIV cases per 100 000
TB incidence per 100 000
All forms
Female breast
Cervix uteri
2011 5.8 0.0 13.8 2.6 15.7 c 0.9 4.7 d 6.3 2.8 9.7 10.2 c 1.8 3.2 13.6 4.9 c 9.4 d 27.6 5.5 c 3.8 10.2 0.0 c 2.7 2.4 2.9 c 17.7 47.5 5.4 5.8 0.0 0.0
2011
2011
2011
2011
2011
2011
2011
2011
2011 20.8 c
2011 5.9 c
532.2 d 196.4
189.9 d 154.6
73.4 d 26.4
39.4 d 36.7
9.2 d 5.2
5.2 d 24.5
3.5 d 2.2
1160.8 d 577.3 d 803.6 932.9 761.3 518.3 708.4 597.3 759.7 554.4 508.5 d 858.7 c 549.4 547.9 875.4 507.4 d 554.0 c 489.8 c 478.1 c 1270.1 c 1195.6 c 939.2 c 950.6 c 520.0 538.6
601.1 d 164.7 d 426.8 592.0 351.0 198.7 331.5 139.2 369.2 203.7 118.9 d 247.7 c 196.6 220.1 402.1 172.8 d 181.5 c 119.1 c 159.8 c 621.1 c 701.9 c 477.6 c 494.5 c 163.8 231.4
162.9 d 166.9 d 156.9 155.9 212.2 115.6 186.7 185.7 186.5 135.2 165.5 d 56.0 c 157.9 147.3 238.7 155.9 d 172.4 c 142.5 c 156.8 c 157.0 c 113.9 c 193.8 c 187.3 c 157.4 149.1
36.0 d 56.4 d 27.8 36.1 28.7 33.8 37.1 61.0 21.7 21.5 27.5 d 9.7 c 36.2 46.6 44.5 42.4 d 61.5 c 34.3 c 27.6 c 59.6 c 92.6 c 22.3 c 28.2 c 40.6 35.5
133.6 d 48.7 d 28.1 32.7 48.3 28.5 47.2 30.5 77.2 57.3 44.1 d 21.9 c 27.7 26.3 54.1 34.7 d 35.2 c 26.0 c 25.3 c 116.4 c 86.8 c 84.9 c 113.1 c 40.4 19.5
11.5 d 13.3 d 6.7 5.6 4.4 8.0 9.0 8.6 8.6 4.4 10.0 d 4.2 c 10.5 4.7 4.5 2.8 d 5.4 c 19.4 c 8.6 c 16.7 c 20.1 c 10.0 c 12.5 c 12.4 4.5
19.6 d 42.7 d 13.0 9.8 28.9 23.1 20.5 52.9 22.5 73.5 41.2 d 7.8 c 31.5 8.9 29.2 51.7 d 32.2 c 27.4 c 27.2 c 15.5 c 11.9 c 17.8 c 16.3 c 33.1 37.6
11.0 d 2.1 d 7.1 2.3 0.6 1.3 1.2 6.6 1.5 0.7 6.3 d 53.6 c 2.9 9.0 0.1 0.7 d 0.3 c 5.1 c 1.0 c 13.6 c 1.0 c 1.5 c 1.5 c 2.5 0.2
240.4 437.9 c 93.0 a 446.7 578.6 c 215.5 448.7 472.8 c 356.7 e 769.3 d 645.5 c 531.2 e 544.4 c 560.6 94.8 572.1 e
67.8 117.6 c 31.0 a 73.3 181.3 c 43.5 98.2 109.0 c 109.1 e 111.9 d 182.0 c 87.1 e 171.3 c 157.8 31.1 171.1 e
17.1 8.8 c 7.2 a 18.6 10.8 c 20.6 27.3 14.1 c 5.9 e 19.19 d 13.0 c 27.0 e 5.1 c 8.1 9.2 11.65 e
949.7 441.0 d 733.8 361.8 c 421.6 c 183.0 90.4 557.9 554.3 421.3 d 480.0
140.1 129.4 d 116.3 115.3 c 123.0 c 41.1 21.7 111.4 89.3 135.2 d 183.5
22.1 10.8 d 13.6 6.2 c 11.6 c 16.9 15.3 23.4 26.2 7.2 d 7.7
846.2 d 528.2 521.2 747.7 546.6 1135.0 a 948.0 c 1223.1 c
461.6 d 139.2 147.0 317.8 148.6 659.0 a 539.8 c 673.8 c
128.7 d 180.6 154.9 190.9 152.5 163.2 a 180.1 c 177.9 c
38.7 d 48.3 47.0 38.5 54.5 49.7 a 49.0 c 45.8 c
35.2 d 26.3 40.3 54.9 29.0 85.1 a 53.3 c 140.8 c
0.9 d 8.0 11.0 6.6 14.0 14.8 a 10.4 c 22.0 c
8.0 d 44.6 43.2 14.9 17.1 12.7 a 10.8 c 16.2 c
13.6 d 2.9 4.5 4.2 8.2 0.7 a 0.9 c 5.1 c
2011 13.1 3.7 38.6 4.8 70.8 49.6 6.6 35.4 29.6 14.1 3.6 5.4 6.5 22.1 5.8 4.1 101.4 4.4 4.0 12.8 2.5 6.1 5.3 3.3 115.6 100.3 42.0 54.2 2.1 5.3 2.9 c 17.7 5.8 6.3 20.6 22.8 118.2 79.2 79.1
2011 107.8
1045.1 d 530.9
2011 2.2 2.5 5.5 3.5 6.0 12.6 11.0 0.7 2.7 1.7 6.3 1.5 4.8 27.3 3.3 6.3 9.5 3.5 7.4 1.6 7.2 7.0 5.9 5.7 12.1 10.7 14.5 5.2 8.5 5.1
647.0 c 578.2 c 364.9 c
181.8 c 116.1 c 79.4 c
8.6 c 13.2 c 15.5 c
930.4 849.7 c 599.7 c 481.5 514.1 c 464.1 c
473.5 440.2 c 218.4 c 132.5 182.2 c 144.9 c
204.2 196.7 c 196.0 c 152.1 141.2 c 137.9 c
44.5 52.0 c 32.3 c 46.0 27.3 c 25.4 c
37.6 50.1 c 56.3 c 22.6 35.4 c 32.4 c
4.4 6.0 c 2.8 c 8.7 10.4 c 5.5 c
24.0 12.0 c 16.1 c 37.6 44.1 c 49.1 c
4.3 1.2 c 1.5 c 2.6 3.7 c 3.1 c
227.0 266.3 364.4 549.5 358.7 c
47.8 53.1 c 74.5 c 0 83.8 c
17.3 28.9 c 19.2 c 0 26.5 c
597.2 e
111.6 e
12.7 e
590.1 c 478.4 d 36.6 d
168.1 c 139.6 d
9.1 c 6.7 d
939.5 c
553.0 c
171.5 c
34.4 c
28.3 c
3.1 c
8.4 c
6.6 c
147.2 e 70.4 349.3 522.5 c 65.9 397.9 c
31.7 e 15.9 c 66.3 156.8 c 18.1
4.2 e 10.4 c 20.4 9.0 c 8.4
Females 2011
2011
2011
70.6 d 78.4
76.9 d 84.0
11.7 3.6
12.1 4.3
64.8 d 77.5 d 74.2 70.8 74.0 79.8 74.9 78.0 71.3 77.5 78.2 d 70.2 c 78.1 c 78.6 71.3 79.9 d 78.5 c 80.2 c 79.8 c 63.7 c 65.5 c 68.6 c 68.0 c 79.2 78.8
76.6 d 83.0 d 79.0 77.9 80.4 83.5 81.2 82.1 81.4 84.0 85.2 d 79.0 c 83.1 c 83.2 78.8 83.9 d 83.0 c 84.1 c 85.0 c 73.5 c 73.7 c 78.4 c 79.0 c 83.9 83.1
4.7 d 3.5 d 5.8 8.5 4.7 2.8 2.7 3.4 2.4 2.4 3.5 d 11.2 c 3.4 c 3.4 4.9 1.8 d 3.8 c 3.7 c 3.4 c 16.5 c 22.3 c 5.7 c 4.3 c 2.8 6.3
6.3 d 4.4 d 6.6 10.2 5.2 3.6 3.4 3.9 3.1 3.0 4.2 d 13.0 c 4.1 c 4.1 5.8 2.2 d 4.5 c 4.5 c 3.9 c 19.9 c 26.1 c 7.2 c 5.4 c 3.3 7.1
73.3 d 79.1 c 79.3 72.7 77.6 67.2 a 70.2 c 63.1 c
78.0 d 83.1 c 83.7 81.2 84.1 75.1 a 77.6 c 75.0 c
5.8 d 3.8 c 2.3 4.7 3.1 9.8 a 9.8 c 7.6 c
6.2 d 4.5 c 2.9 5.5 3.9 12.1 a 11.7 c 9.8 c
72.0 71.8 c 76.6 c 79.4 79.7 c 80.4 c
77.3 79.4 c 83.2 c 85.5 83.7 c 85.0 c
6.3 5.7 c 2.5 c 3.2 2.5 c 3.8 c
7.1 6.8 c 3.4 c 3.9 3.1 c 4.3 c
73.0 c 72.0
77.3 c 77.1
7.6 c 7.7
8.4 c 11.3
66.0 78.8 c
76.0 82.7 c
73.1
80.3
9.0 4.3 c 10.5 7.0
10.7 5.1 c 14.2 8.8
* The former Yugoslav Republic of Macedonia ** See technical notes for more information TB = tuberculosis
2.2 c 5.0 2.3 5.2 30.4 a 25.5 16.9 c 0.0 10.7 9.9 4.6 d 3.0 0.9 3.7 c 46.5 d 4.4 15.9 5.9 16.9 5.0 c 23.1 11.5
1102.0 553.1 c 789.1
MDG 6
26
Life expectancy at birth (years)
2011
(SDR) PER 100 000 POPULATION
24
LIFE EXPECTANCY
Males
AGE-STANDARDIZED DEATH RATES
20
682.8 164.2 c
157.5 170.4 c
30.5 67.6 c
85.1 26.3 c
29.2 6.1 c
14.7 39.7 c
2.5 0.5 c
369.5
162.0
43.5
60.4
13.1
25.9
4.2
1.5 6.1 5.4 2.5 8.5 20.3 1.8 43.8 c 25.0 1.8 0.9 2.7 6.0 3.9 7.3 13.5 0.0 0.9 0.0 38.1 10.0 13.1 c 15.8
CANCER INCIDENCE PER 100 000
29.9 6.4 8.8 13.1 4.8 4.9 90.1 16.2 20.2 64.1 c 75.2 12.6 49.4 33.3
Note: a=2012 b=2011 c=2010 d=2009 e=2008
Health system coverage and utilization and the environment 28
29
30
31
32
33
34
AS % OF TOTAL HEALTH EXPENDITURE Total health Government Public sector Private Total inpatient Total expenditure expenditure health households’ expenditure pharmaas % on health as % of expenditure out of pocket ceutical of GDP total government expenditure expenditure expenditure
Country Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan MKD* Turkey Turkmenistan Ukraine United Kingdom Uzbekistan WHO European Region
2011 6.3 7.2 4.3 10.6 5.2 5.3 10.6 10.2 7.3 7.8 7.4 7.4 11.2 6.0 8.9 11.6 9.4 11.1 9.0 7.8 9.1 9.4 7.7 9.5 3.9 6.5 6.2 6.6 7.7 8.7 4.3 9.3 12.0 9.1 6.7 10.4 11.4 5.8 6.2 7.2 10.4 8.7 9.1 9.4 9.4 10.9 5.8 6.6 6.7 2.7 7.3 9.3 5.4 8.3
2011 9.9 21.3 5.8 15.9 3.7 13.0 15.1 16.2 11.3 17.7 6.9 14.2 16.4 12.3 12.1 15.9 5.4 18.5 11.5 10.2 15.4 13.5 10.7 14.7 10.5 11.6 9.3 12.6 15.5 13.3 18.8 13.6 20.6 17.7 11.0 13.4 13.3 11.9 10.1 13.6 14.1 14.5 13.0 15.4 14.8 21.0 6.2 11.7 12.8 9.8 12.8 15.9 8.5 13.4
2011 44.9 73.5 35.8 75.6 21.5 70.7 76.0 68.0 55.3 84.7 43.3 83.5 85.2 78.9 74.8 76.7 18.1 75.9 65.7 64.8 80.4 70.4 61.5 77.3 57.9 59.7 58.5 71.3 84.3 64.0 88.6 67.0 85.7 85.6 71.2 64.1 45.6 80.2 59.7 84.7 62.2 63.8 72.8 73.6 80.9 65.4 29.6 61.4 74.9 60.8 55.7 82.7 51.4 69.0
2011 55.0 19.6 57.4 16.4 70.1 26.7 19.1 31.3 43.3 14.6 49.4 15.1 13.2 18.6 19.2 7.5 64.9 12.4 29.8 26.2 18.2 14.5 21.4 19.9 41.5 34.4 39.6 27.9 11.5 33.9 7.0 30.0 5.1 13.6 22.9 27.3 45.0 19.4 35.4 14.7 36.2 26.2 13.0 20.1 16.9 25.0 60.1 38.3 16.1 39.2 41.5 9.2 43.9 24.1
2011 48.0
40.2 74.0 d 43.0 42.3
32.6 37.9 32.2 35.1 37.1 17.1 34.8 36.4 26.9 43.7 33.1 d 46.6
28.7 d 25.0 c 38.1 e
46.4 44.9 a 32.0 19.8 29.2
2011
11.7 26.2 c 18.0 15.5 30.5 d
20.0 6.8 21.5 13.2 15.6 44.1 c 14.1 28.5 33.4 15.4 17.5 15.7 a
22.2 d 26.4 c 9.1 e 28.5
9.4 6.6 a 22.5 17.9 34.6
Hospitals
2011 1.4 a 2.4 d 4.1 a 3.2 5.8 a 6.9 1.8 a 1.0 4.7 1.3 10.2 2.4 4.1 5.1 4.1 5.1 a 4.0 2.8 d 1.7 2.4 a 2.1 a 1.2 a 2.0 5.7 a 2.6 a 3.4 3.3 2.3 a 1.9 a 7.9 a 1.8 1.6 1.3 2.5 2.1 2.4 a 2.3 3.4 a
31.1 c 21.0 35.7 30.2 28.4 45.2
32.6 d
30.9 c 27.4 19.5 17.4 12.1 9.4
4.2 d 11.4 e
* The former Yugoslav Republic of Macedonia DTP = diphtheria, tetanus, poliomyelitis PM = particulate matter, measured as particles with aerodynamic diameter < 2.5 µm (PM2.5) or < 10 µm (PM10)
35
36
37
38
39
40
41
PER 100 000 POPULATION
2.6 1.4 a 1.7 3.9 6.4 3.2 1.9 2.3 a 5.3 a 2.6 c 3.3
Physicians
2011 115 a 316 d 269 a 483 350 a 379 300 173 c 386 284 296 364 348 d 326 272 e 318 a 424 a 382 614 296 348 a 272 a 326 410 358 a 196 a 314 385 278 a 349 a 665 a 202 296 c 372 219 398 283 a 239 556 a 307 a 250 370 a 394 190 274 169 228 a 353 a 279 a 238 a 334
General practitioners
2011 50 a 49 d 50 a 78 29 a 45 114 28 c 64 51 70 74 161 a 97 a 66 30 56 a 72 a 26 a 76 32 a 32 a 67 83 a 80 a 37 a 30 73 c 90 20 51 52 a 68
71 a 45 75 63 c 26 56 58 a 37 a 81 a 28 a 61
Nurses
2011 369 d 491 a 791 682 a 1062 1585 c 529 c 475 579 443 846 1573 d 647 1072 c 971 a 328 a 1154 354 d 638 1562 a 1215 502 659 823 a 611 a 516 736 1229 a 709 a 1614 535 855 e 1332 580 633 642 a 551 963 a 627 a 619 839 548 1738 447 421 237 459 a 759 a 883 a 1195 a 766
Outpatient contacts per person per year
Inpatient care discharges per 100 population
Abortions per 1000 live births
2011 2.2
2011 7.5
2011 205.3
3.5 6.9 4.5 a 13.1 7.4 5.3
10.6 27.4 6.4 a 31.0 17.0 c 10.9 26.7 17.0 9.0 20.5 13.6 c 18.0 17.6 19.0 d 7.5 24.3 19.8 e 20.4 d 13.5 13.1 19.1 11.8 a 15.8 15.7 19.0 23.1 15.2 14.6
279.9
6.0 2.3 11.1 4.6 c 6.3 4.2 6.8 2.1 9.7 11.8 6.1 3.8 c 6.2 d 7.1 3.5 6.3 7.2 6.6
4.4 c 6.6 5.2 d 6.8 4.2 6.4 4.5 9.4 8.1 c 11.0 6.5 7.4 3.1 4.2 d 6.1 8.2 3.6 10.7 5.0 d 9.1 7.7
12.9 c 11.7 c 18.7 d 16.2 10.8 18.5 21.6 22.0 12.5 15.8 c 18.5 17.5 11.3 16.5 17.5 11.3 d 11.4 15.1 16.8 22.6 13.6 15.7 17.9
164.9 a 293.5 147.8 c 447.7 105.5 221.4 256.5 c 455.7 175.0 263.8 d 537.5 162.9 c 138.2 e 436.6 215.7 115.9 203.3 d 255.8 104.4 384.3 180.5 0.0 114.1 150.7 c 254.8 1.6 c 209.5 401.0 526.8 598.8 c 322.5 277.4 196.1 232.3 c 337.8 137.1 51.2 d 233.8 c 56.1 106.5 223.8 250.6 59.8 274.3
42
43
MDG 4
MDG 6
Children immunized (%) against
Treatment success rate (%) for new laboratoryconfirmed TB cases
DTP
measles
2011 99 99 95 83 95 99 98 88 95 96 99 99 91 93 99 98 95 99 99 99 95 95 94 96 99 96 94 92 99 96 99 95 97 94 99 97 93 89 97 86 94 99 96 97 98 95 96 96 97 97 50 95 99 94
2011 99 99 97 76 98 99 95 89 94 96 87 98 87 94 97 89 94 96 99 99 94 92 98 90 99 97 99 94 96 84 99 91 96 93 98 97 91 93 98 83 93 98 96 97 96 92 98 97 98 99 67 90 99 94
2010 91.0 71.7 64.6 76.6 66.3 75.3 98.4 86.3 75.1 25.5 69.0 64.7 67.2 74.6 76.3 76.6 68.9 87.5 72.6 75.8
44
45
Air quality PM10 in PM2.5 in capital capital (µg/m3) (µg/m3)
2011
19.0
2011 38.5 d
27.3
41.2
26.0 e 26.5 48.5 c 65.2
23.2 21.2 16.2 6.9 7.4 18.1
26.2 12.5 c 12.5 13.1 23.6
17.2
24.5
26.5
33.2 10.8 c 17.9
17.7
8.9 25.2
32.1
13.7
23.0 23.5 18.3
16.7 8.3 26.9 11.9
24.7 22.9 34.7 27.9
57.1 83.8 53.1
19.6
39.5 26.0 d
85.8 84.2 86.0 70.4 85.1
26.3 24.1 12.4
87.2 77.7 91.4 65.8
15.8 d
14.9 d 80.1 89.5 91.3 59.8 80.9 81.1
47
48
ENVIRONMENT
60.9 75.7 68.4 0.0 80.0
46
50.9 30.8 29.4 d 21.8 14.7 20.3
58.1
14.4
21.8
Water Sanitation Population Population with with improved improved drinking water sanitation (%) sources (%)
2011 82 100 96 100 51 91 100 82 97 87 d 100 95 d 100 90 d 99 100 78 100 99 94 d 100 100 100 100 55 54 82 d 90 100 100 100 91 100 100 98 100 53 62 82
2011 94 100 90 100 82 93 100 96 100 98 100 100 100 98 100 100 93 100 99 100 100 99 100 97 93 79 d 87 d 100 100 100 90 100 100 89 e 100 86 72 e 70
86 94 d 100 99 100 100 48 90 99 45 66 100 47 89
97 100 100 100 100 100 95 91 91 99 94 100 100 92
Impact Leukaemia incidence ages 0–14 years per 100 000 population
2008 3.2
3.8 4.0 4.2 2.5 4.2 5.3 5.1 3.2 4.1 3.5 6.4 4.0 3.4 3.8 3.5 6.1 3.4 7.3
4.8 3.9 0.0 4.6 2.5 4.7 4.6 1.8 3.8 1.6 2.5 3.7 2.6 4.1 3.9 5.6 3.4 4.2 3.5
4.1 4.2 4.0
Note: a=2012 b=2011 c=2010 d=2009 e=2008
Noncommunicable diseases and risk factors 49
50
51
52
53
54
55
RISK FACTORS Tobacco Alcohol Age-standardized Prevalence (%) Yearly prevalence (%) of current of current*** consumption per tobacco smoking** among tobacco smoking among adult ≥15 years adults ≥ 15 years adolescents (litres of pure alcohol equivalent) Males Females Males Females Country Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan MKD* Turkey Turkmenistan Ukraine United Kingdom Uzbekistan
2011 48
2011 5
2011 17.6 d
2011 6.3 d
47 46 34 50 31 44 48 36 41 40 30 43 27 39 55 35 46 35 19
2 47 <1 11 23 27 31 30 18 32 27 21 20 32 3 25 34 27 18
11.0 c 25.2 c 11.4 31.2 f
1.4 c 29.3 c 2.1 21.7 f
35 31 40 45 46 43 22 31
17 18 9 2 20 25 25 20
29 28 38 30 43 38 59
23 26 27 15 5 18 25
38 39 28 33 25 31
27 19 21 27 24 22
42 49 22 22
14.3 e 24.4 e 26.7 20.7 28.0 14.1 c 22.0 c 4.0 20.4 c 15.2 e 11.1 17.5 c 30.8 a 8.8 c 11.8 c 12.0 f 19.4 c 9.7 d 6.8 e 29.2 34.4 c 8.0 c 23.0
9.4 e 31.6 e 27.0 7.5 33.1 13.0 c 16.3 c 6.0 20.3 c 2.8 e 12.4 13.2 c 23.7 a 6.8 c 13.7 c 7.0 f 21.6 c 6.0 d 2.2 e 33.8 21.4 c 10.0 c 20.0
13
5.7 e 15.0 c 8.8 c 15.7 c 11.4 c 18.5 e 25.2 c 19.2 c 10.9 c 9.3 e 23.2 13.3 14.8 c 12.6 c 18.7 c 1.1 f 14.0 c 10.2 d
4.4 e 16.8 c 8.2 c 12.1 c 10.1 c 5.6 e 15.4 c 15.3 c 11.6 c 8.9 e 23.0 20.3 22.6 c 15.3 c 15.0 c 0.6 f 9.3 c 5.3 d
14 22 3
30.8 c 10.0 c 2.4 e
12.9 c 15.0 c 1.2 e
2009 5.2 f 11.8 f 3.5 12.2 1.5 f 13.8 f 10.8 e 13.5 e 10 10.1 8.4 15 10.7 12.5 c 10 12.3 6 11.7 8.2 11.5 7.5 f 11.9 c 6.9 7 7f 5.5 f 13.2 e 12.6 15.3 7.7 8.3 9.2 6.7 10.1 11.4 f 20.6 e 12.7 11.5 e 7.3 11.4 11.9 11.4 7.4 10.2 0.3 e 3.7 1.3 2.3 f 9.8 f 10.7 1.8 f
Overweight and obesity Age-standardized prevalence (%) among adults ≥ 20 years Overweight Obesity BMI≥25 BMI≥30
56
Trends in mortality from circulatory diseases 57
58
NATIONAL SYSTEMS RESPONSE Tobacco Alcohol Price of most Taxes**** Excise sold brand of as % tax as % of cigarette of price total retail in Intl. dollars price for 1 (pack of 20) litre of pure alcohol
SDR, circulatory diseases, all ages, per 100,000, 1980–2015 ALBANIA
ANDORRA
ARMENIA
AUSTRIA
AZERBAIJAN
BELARUS
BELGIUM
BOSNIA AND HERZEGOVINA
BULGARIA
CROATIA
CYPRUS
CZECH REPUBLIC
DENMARK
ESTONIA
FINLAND
FRANCE
GEORGIA
GERMANY
GREECE
HUNGARY
ICELAND
IRELAND
ISRAEL
ITALY
KAZAKHSTAN
KYRGYZSTAN
LATVIA
LITHUANIA
LUXEMBOURG
MALTA
MONACO
MONTENEGRO
NETHERLANDS
NORWAY
POLAND
PORTUGAL
REPUBLIC OF MOLDOVA
ROMANIA
RUSSIAN FEDERATION
SAN MARINO
SERBIA
SLOVAKIA
SLOVENIA
SPAIN
SWEDEN
SWITZERLAND
TAJIKISTAN
MKD*
TURKEY
TURKMENISTAN
UKRAINE
UNITED KINGDOM
UZBEKISTAN
1000 500 0
2008 54.2
2008 21.1
2012 3.2
2012 60.7
2008
55.1 49.6 57.4
23.4 18.3 24.7 19.1 24.2 21.4 21.3 23.4 28.7 16.2 18.9 19.9 15.6
54.8 49.1 57.7 56.4 60.9 60.1 49.2 56.7 46.6 53.6 56.9 56.7 61.6
21.3 17.5 24.8 21.9 24.5 25.5 17.2 24.4 17.2 22.0 24.7 23.4 26.6
25.0 74.2 18.6 42.5 76.1 74.8 83.6 71.0 75.9 77.6 79.3 76.9 79.9 79.9 58.1 73.0 82.2 83.7 57.0 79.0 83.5 75.2 30.0 65.8 79.1 75.3 70.6 76.9
17.7
51.5 57.6 54.3 53.2 55.9 61.7 48.4 51 53 45.9
2.7 5.2 2.0 2.4 5.8 3.5 6.1 4.6 4.9 5.0 4.6 5.2 5.0 6.8 1.4 6.3 5.1 5.2 7.4 10.6 6.2 5.8 1.0 1.1 4.4 4.9 4.5 7.0
47.8 55 55.7 55.3 49.2 48.6 57.8
16.2 19.8 23.2 21.6 20.4 17.7 24.9
2.2 6.6 8.3 5.9 6.1 1.8 6.1 1.9
80.5 72.2 72.8 79.6 76.0 43.7 73.3 40.5
55.9
23.0
58.2 50 44.3 33.8 52.8 63.6 43.6 51.8 61.5 48.1
24.1 16.6 14.9 9.9 20.3 29.3 14.3 20.1 24.9 17.3
3.0 4.8 4.6 5.6 5.6 4.8 1.5 2.6 4.9 5.0 1.8 9.8 1.8
75.9 83.9 80.1 79.3 73.8 62.2 30.8 71.2 80.3 30.0 67.0 80.1 29.3
1000
2.6 26.4
500 0 1000
7.0
500 24.0 22.5 15.6 37.9 5.7
0 1000 500
10.9 38.5 24.7
0 1000
0.3 30.6
500 0
1.0
1000
29.5 44.9 18.2 6.2
500
1.4
1000
8.1
0
500
12.5
0
25.4 10.2
1000
30.4 17.5
500 0
19.5
* The former Yugoslav Republic of Macedonia ** Smoking of any form of tobacco, including cigarettes, cigars and pipes and excluding smokeless tobacco, at the time of the survey including daily and non-daily smoking. *** At least once in the past week. Data for Finland apply to daily cigarette use. **** Excise taxes, import duties if applicable, value-added tax and other taxes not elsewhere specified. Note: a=2012 b=2011 c=2010 d=2009 e=2008 f=2007 or earlier BMI = body mass index
1000
NATIONAL TREND
500
EUROPEAN REGION AVERAGE
0
1990 2000 2010
1990 2000 2010
1990 2000 2010
1990 2000 2010
1990 2000 2010
* The former Yugoslav Republic of Macedonia
Policies and action networks
Overweight and obesity among children
59
Prevalence of overweight (including obesity) among 7-year-olds, 2008
60
61
62
TOBACCO POLICY
BOYS
GIRLS
ITALY*
50%
PORTUGAL 40% MALTA**
SLOVENIA
IRELAND BULGARIA
30% BELGIUM
LATVIA
20%
NORWAY*
LITHUANIA
CZECH REPUBLIC
SWEDEN
10%
0%
Prevalence of obesity among 7-year-olds, 2008
ITALY*
BOYS
GIRLS
25%
20% PORTUGAL MALTA** 15%
BULGARIA
IRELAND LATVIA
10%
NORWAY*
SLOVENIA
BELGIUM 5%
Ratified WHO Signed Protocol Framework to Eliminate Convention on Illicit Trade Tobacco Control in Tobacco (FCTC)** Products***
LITHUANIA CZECH REPUBLIC
0% * 8-year-olds ** 6-year-olds Source: Wijnhoven TM et al. WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6–9-year-old children. Pediatric Obesity, 2013, 8(2):79–97.
SWEDEN
Country Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan MKD* Turkey Turkmenistan Ukraine United Kingdom Uzbekistan
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
•
Childhood obesity surveillance
Reducing marketing pressure on children
•
•
•
•
•
•
• • •
• • •
• •
• • • •
•
•
63
64
65
66
Hospital nutrition
Obesity and health inequalities
• •
• •
NUTRITION (Member States action networks) Reducing salt intake in the population
• • • •
• •
•
• •
•
• •
• • •
•
• •
•
• • • • • •
School nutrition
• • •
•
•
•
• •
• • •
•
• • •
• • • • • •
• • • • •
•
•
•
•
•
• • •
•
• •
•
•
• • •
• • • •
• •
• •
• •
• •
• •
•
•
• = Policies and action networks to which Member States are signed up * The former Yugoslav Republic of Macedonia ** Adopted by the World Health Assembly on 21 May 2003 and entering into force on 27 February 2005. *** Adopted on 12 November 2012 at the fifth session of the Conference of the Parties in Seoul, Republic of Korea, and currently open for signature by the Parties to the WHO FCTC.
•
Technical notes and sources
The data for the core health indicators were compiled, validated and processed in a standard way by WHO, the Organisation for Economic Co-operation and Development (OECD), EUROSTAT, other United Nations agencies and international networks, in order to improve the international comparability of the statistics. Nevertheless, many factors may influence the accuracy and comparability of national statistics, such as variation in definitions, incomplete registration, and other national specificities in data recording and processing. The international comparison of indicators should therefore always be interpreted with caution.
Data were retrieved from the WHO European Health for All Database (HFA-DB), unless specified in the tables. The range of data presented was limited to the years 2008–2012 for the sake of actuality and comparability. Additional indicators and more detailed data can be found in the databases on the websites of the WHO Regional Office for Europe (http://www.euro.who.int/ en/what-we-do/data-and-evidence/databases) and WHO headquarters (www.who.int).
Indicator
Data Source
1, 2, 3, 4
The national data reported by countries directly to WHO or, when unavailable, World population prospects: the 2010 revision, from the United Nations Department of Economic and Social Affairs, Population Division
3
Reports of the World Bank, the United Nations Development Programme and country statistical yearbooks
5
World urbanization prospects: the 2009 revision from the United Nations Department of Economic and Social Affairs, Population Division
7
Yearbook of labour statistics from the International Labour Organization, Department of Statistics
9
The World Development Indicators database of the World Bank
29
The WHO Global Health Observatory
28, 30
WHO estimates based on nationally reported data and data or estimates from the International Monetary Fund, the World Bank, the United Nations and OECD
32, 33
OECD Health Data
46, 47
Progress on sanitation and drinking-water. 2013 update from the WHO/ UNICEF Joint Monitoring Programme for Water Supply and Sanitation
The bottom row in the data tables, the WHO European Region, gives the population-weighted average for all countries in the Region for which data are available. The exception is indicator 1, midyear population, where the value is the sum of the countries’ populations.
49–52, 56, 57
WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship (Appendix IX, X, XI)
51, 52
Depending on the country, various studies with differing adolescent age groups: Global Youth Tobacco Survey (13–15 years), Health Behaviour in School-aged Children survey (15 years), national surveys and The European School Survey Project on Alcohol and Other Drugs (between 12 and 18 years)
54, 55, 58
The WHO Global Health Observatory
Indicators related to the Millennium Development Goals (MDGs) are indicated as such.
61–66
The WHO Regional Office for Europe website (http://www.euro.who.int), though information not necessarily available for certain participants
Four mortality-based indicators (life expectancy and rates for infant, child (under 5 years) and maternal mortality) are presented, based on official mortality data from countries. Cause-specific mortality rates (indicators 15–21) are age-standardized death rates, calculated using the European standard population structure (see the European Mortality Database (http://data.euro. who.int/hfamdb/help/mTechnical.htm)). Agestandardization improves international comparability by removing the effects in mortality rates of intercountry differences in population age structures. The proportion of ill-defined causes of death is used as an indication of the quality of the certification and coding of causes of death.
© World Health Organization 2013 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this
publication do not imply the expression of any opinion whatsoever on the part if the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
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