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Health at a Glance
Europe 2010
Health at a Glance:
Europe 2010
This work is published on the responsibility of the Secretary-General of the OECD.
The opinions expressed and arguments employed herein do not necessarily reflect the
official views of the OECD or of the governments of its member countries or those of the
European Union.

Please cite this publication as:

OECD (2010), Health at a Glance: Europe 2010, OECD Publishing.
http://dx.doi.org/10.1787/health_glance-2010-en

ISBN 978-92-64-09030-9 (print)

ISBN 978-92-64-09031-6 (PDF)

Photo credits: Cover © Tiut Lucian/Shutterstock.com.

Corrigenda to OECD publications may be found on line at: www.oecd.org/publishing/corrigenda.

© OECD 2010

You can copy, download or print OECD content for your own use, and you can include excerpts from OECD publications, databases and
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addressed directly to the Copyright Clearance Center (CCC) at [email protected] or the Centre français d’exploitation du droit de copie (CFC)
at [email protected].
 FOREWORD

Foreword
T his first edition of Health at a Glance: Europe presents a set of key indicators on health and
health systems across 31 countries – the 27 European Union member states, three European Free
Trade Association countries (Iceland, Norway and Switzerland), and Turkey. The selection of
indicators is based on the European Community Health Indicators (ECHI) shortlist – a set of
indicators used by the European Commission to guide the development of health information
systems in Europe. In addition, the publication provides detailed information on health expenditure
trends across countries, building on the OECD’s established expertise in this area.
This publication is a concrete example of the long and fruitful collaboration between the OECD
and the European Commission in the development and reporting of health statistics. This collaboration
also involves the World Health Organization (WHO).
The preparation of this report has been greatly facilitated by the increased co-operation in the
collection of health statistics at the international level in recent years. A joint data collection between
the OECD, Eurostat (the European statistical agency) and WHO was launched at the end of 2005 to
improve the availability and comparability of data on health expenditure and financing, based on the
System of Health Accounts. Building on the success of the joint Health Accounts collection, a new
joint data collection between the three organisations was launched in 2010 to gather data on
non-monetary health care statistics. These joint data collections are improving the comparability of
data across countries, while reducing the data collection burden on national administrations.
Health at a Glance: Europe 2010 would not have been possible without the effort of national
data correspondents from the 31 countries who have provided most of the data and the metadata
presented in this report. The OECD and the European Commission would like to sincerely thank them
for their contribution.
This publication was prepared by a team from the OECD Health Division under the
co-ordination of Gaétan Lafortune and Michael de Looper. Chapter 1 and Chapter 2 were prepared by
Michael de Looper and Valerie Moran, with a contribution from Carol Jagger and Jean-Marie Robine
(Network on Health Expectancy, REVES) for the indicators related to life expectancy and healthy life
years. Chapter 3 was prepared by Gaétan Lafortune and Gaëlle Balestat, with a contribution from
Vladimir Stevanovic and Rie Fujisawa for the two indicators related to cancer care. Chapter 4 was
written by David Morgan and Rebecca Bennetts. It is important to recognise the contribution of
colleagues from Eurostat (in particular Elodie Cayotte and Albane Gourdol) and WHO-European
Office (in particular Ivo Rakovac), who have shared some of the data presented in this publication.
This publication benefited from comments from Mark Pearson (Head of OECD Health Division) and
Nick Fahy, Fabienne Lefebvre and Federico Paoli (European Commission – DG Sanco).

Aart De Geus Paola Testori Coggi

Deputy Secretary-General Director-General
Organisation for Economic Co-operation Directorate-General for Health and Consumers
and Development European Commission

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 3

 TABLE OF CONTENTS

Table of Contents
Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Résumé . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Chapter 1. Health Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

1.1. Life expectancy and healthy life expectancy at birth . . . . . . . . . . . . . . . . . . . . . 26
1.2. Life expectancy and healthy life expectancy at age 65 . . . . . . . . . . . . . . . . . . . 28
1.3. Mortality from all causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1.4. Mortality from heart disease and stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
1.5. Mortality from cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
1.6. Mortality from transport accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
1.7. Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
1.8. Infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
1.9. Infant health: Low birth weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
1.10. Self-reported health and disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
1.11. Incidence of selected communicable diseases . . . . . . . . . . . . . . . . . . . . . . . . . . 46
1.12. HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
1.13. Cancer incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
1.14. Diabetes prevalence and incidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
1.15. Dementia prevalence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Chapter 2. Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

2.1. Smoking and alcohol consumption among children . . . . . . . . . . . . . . . . . . . . . 58
2.2. Nutrition among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
2.3. Physical activity among children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
2.4. Overweight and obesity among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
2.5. Supply of fruit and vegetables for consumption . . . . . . . . . . . . . . . . . . . . . . . . . 66
2.6. Tobacco consumption among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.7. Alcohol consumption among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
2.8. Overweight and obesity among adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Chapter 3. Health Care Resources, Services and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . 75

3.1. Practising physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
3.2. Practising nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
3.3. Childhood vaccination programmes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
3.4. Influenza vaccination for older people. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
3.5. Medical technologies: CT scanners and MRI units . . . . . . . . . . . . . . . . . . . . . . . 84

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 5

TABLE OF CONTENTS

3.6. Hospital beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

3.7. Hospital discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
3.8. Average length of stay in hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
3.9. Cardiac procedures (coronary angioplasty) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
3.10. Cataract surgeries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
3.11. Hip and knee replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
3.12. Screening, survival and mortality for cervical cancer . . . . . . . . . . . . . . . . . . . . 98
3.13. Screening, survival and mortality for breast cancer. . . . . . . . . . . . . . . . . . . . . . 100

Chapter 4. Health Expenditure and Financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

4.1. Health expenditure per capita . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
4.2. Health expenditure in relation to GDP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
4.3. Health expenditure by function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.4. Pharmaceutical expenditure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
4.5. Financing of health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
4.6. Trade in health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Annex A. Additional Information on Demographic and Economic Context . . . . . . . . . 122

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6 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 ACRONYMS

Acronyms

AIDS Acquired immunodeficiency syndrome

ALOS Average length of stay
AMI Acute myocardial infraction
BMI Body mass index
CAT (or CT) Computed axial tomography (scanner)
EFTA European Free Trade Association
EU European Union
EU-SILC European Union Statistics on Income and Living Conditions survey
GALI Global activity limitation indicator
GDP Gross domestic product
GP General practitioner
HBSC Health Behavior in School-aged Children survey
HIV Human immunodeficiency virus
HLY Healthy life years
IHD Ischemic heart disease
ISIC International Standard Industrial Classification
MRI Medical resonance imaging
PPP Purchasing power parities
SHA System of Health Accounts
SIDS Sudden infant death syndrome

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 7

Health at a Glance: Europe 2010
© OECD 2010

Executive Summary

E uropean countries have achieved major gains in population health over recent decades.
Life expectancy at birth in European Union (EU) countries has increased by six years
since 1980, while premature mortality has reduced dramatically. Improvements in living
and working conditions and in some health-related behaviours have contributed greatly to
these longevity gains, but progress in medical care also deserves much credit. Health
systems are of growing size and complexity in European countries, and spending on health
care has never been higher, consuming an ever-increasing share of national income.
This first edition of Health at a Glance: Europe, the result of a long-standing collaboration
between the OECD and the European Commission, presents a set of key indicators of health
and health systems in 31 European countries – the 27 member states of the European Union,
and Iceland, Norway, Switzerland and Turkey. The selection of indicators has been based on
the European Community Health Indicators (ECHI) shortlist, a list of indicators that has been
developed by the European Commission to guide the development and reporting of health
statistics (European Commission, 2010a). However, a number of indicators in this report
differ from ECHI definitions because of data availability or constraints, or in some instances
because ECHI indicators are not yet ready for implementation. The publication also provides
detailed information on health expenditure and its financing, building on the OECD’s
established data collection and expertise in this area. The data presented in the publication
come mainly from official national statistics, as gathered in OECD Health Data, the Eurostat
Statistics Database and WHO-Europe’s Health for All Database.
Health at a Glance: Europe 2010 presents evidence of wide variations across European
countries in population health status, risk factors for health, the inputs, outputs and
outcomes of health care systems, and levels of health expenditure and financing sources.
It offers some explanation for these variations, providing a background to understand
more fully the causes underlying such variations and to develop policy options to reduce
gaps across countries. It should also be noted that while basic population breakdowns by
sex and age are presented, this publication does not generally provide detail by
sub-national regions, by socio-economic groups or by ethnic/racial groups. For many
indicators, readers should keep in mind that there may be as much variation within a
country as there is across countries.

9
EXECUTIVE SUMMARY

Health status has improved dramatically

in European countries, although large gaps persist

● Life expectancy at birth in EU countries has increased by six years since 1980, reaching
78 years in 2007. On average across the 27 EU countries, life expectancy at birth for the
three-year period 2005-07 stood at 74.3 years for men and 80.8 years for women. France had
the highest life expectancy at birth for women (84.4 years), while Sweden had the highest
life expectancy for men (78.8 years). Life expectancy at birth in the European Union was
lowest in Romania for women (76.2 years) and Lithuania for men (65.1 years). The gap
between countries with the highest and lowest life expectancies at birth is around
eight years for women and 14 years for men.
● Whether the gains in life expectancy involve additional years of life lived in good health
has important implications for health and long-term care systems in Europe. Healthy life
years at birth is defined as the number of years of life in which a person’s day-to-day
activities are not limited by a condition or health problem. In 2005-07, healthy life years
stood at 61.3 years for women and 60.1 years for men, on average, in the European Union.
The gender gap is much smaller than for life expectancy, reflecting the fact that a higher
proportion of women’s lives are spent with activity limitations. Healthy life years at birth
in 2005-07 was greatest in Malta for both men and women, and shortest in Latvia for
women and Estonia for men.
● Life expectancy at age 65 has also increased substantially over the past decades in
European countries. The average in 2005-07 for the 27 EU countries was 15.9 years for
men and 19.5 years for women. As for life expectancy at birth, France had the highest life
expectancy at age 65 for women (22.6 years) but also for men (18.1 years). Life expectancy
at age 65 was lowest in Eastern Europe – in Latvia for men (12.7 years) and in Bulgaria for
women (16.3 years).
● As is the case at birth, the gender gap for healthy life years at age 65 is much narrower
than for life expectancy. In 2005-07, men were slightly favoured, at 8.4 years versus
8.1 years for women.
● It is difficult to estimate the relative contribution of the numerous medical and
non-medical factors that might affect variations in (healthy) life expectancy. Higher
national income is generally associated with higher life expectancy across European
countries, although the relationship is less pronounced at higher levels of national
income, suggesting a “diminishing return” after a certain level. Other determinants of
health also play an important role.

Risk factors to health are changing

● Many EU countries have achieved remarkable progress in reducing tobacco consumption,

although it is still a leading cause of early death. Much of this decline can be attributed to
policies at national and EU level promoting public awareness campaigns, advertising bans
and increased taxation. Less than 18% of adults in Sweden and Iceland now smoke daily,
down from over 30% in 1980. However, almost 40% of adults in Greece continue to smoke
on a daily basis. Smoking rates are also relatively high in Bulgaria, Ireland and the
Netherlands.

10 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 EXECUTIVE SUMMARY

● Alcohol consumption has also fallen in many European countries over the past three
decades. Curbs on advertising, sales restrictions and taxation have proven to be effective
measures to reduce alcohol consumption. Traditional wine-producing countries such
as Italy, France and Spain have seen their alcohol consumption per capita drop
substantially since 1980. On the other hand, consumption rose significantly in a number
of countries including Ireland, the United Kingdom and some Nordic countries.
● More than half of the total adult population across the European Union are now
overweight or obese. This is also true in 15 of the 27 EU countries. The prevalence of
obesity – which presents greater health risks than overweight – varies from less than
10% in Romania, Switzerland and Italy to over 20% in the United Kingdom, Ireland, Malta
and Iceland. On average across EU countries, 15.5% of the adult population is obese.
● The rate of obesity has more than doubled over the past 20 years in most EU countries
for which data are available. The rapid increase occurred regardless of what the levels of
obesity were two decades ago. Obesity more than doubled in both the Netherlands and
the United Kingdom between 1988 and 2008, even though the rate in the Netherlands is
currently less than half that of the United Kingdom.
● Because obesity is associated with higher risks of chronic illnesses, it is linked to
significant additional health care costs. A recent study in England estimated that total
costs linked to overweight and obesity could increase by as much as 70% between 2007
and 2015, and be 2.4 times higher by 2025 (Foresight, 2007).

Shortages of health workers is a concern

in many countries

● There are concerns in many European countries about shortages of doctors. The number
of doctors per capita varies greatly, and is lowest in Turkey, followed by Poland and
Romania. Doctor numbers are also relatively low in the United Kingdom and Finland.
● Since 2000, the number of physicians per capita has however increased in all European
countries, except the Slovak Republic. On average, the number grew from 3.0 doctors per
1 000 population in 2000 to 3.3 in 2008. It increased particularly rapidly in Ireland, rising
by nearly 50%. A large part of this increase was due to the recruitment of foreign-trained
physicians, with the share of foreign-trained doctors tripling during that period.
Similarly, the number of doctors per capita in the United Kingdom increased by 30%
between 2000 and 2008, rising from 2.0 per 1 000 population to 2.6.
● In contrast, there has been virtually no growth in the number of doctors per capita in
France and Italy since 2000. Following a reduction in the number of new entrants in
medical schools during the 1980s and 1990s, the number of doctors per capita in Italy
peaked in 2002, and has declined since then. In France, the number peaked in 2005, and
the decline is expected to continue over the next ten years.
● In nearly all countries, the balance between general practitioners and specialists has
changed over past decades, with the number of specialists increasing much more
rapidly. As a result, there are more specialists than generalists in most countries, except
Romania and Portugal. This may be explained by a reduced attractiveness in the
traditional mode of practice of general/family practitioner, as well as a growing
remuneration gap. The slow growth or reduction in the number of generalists per capita

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 11

EXECUTIVE SUMMARY

raises concerns about access to primary care. Many countries are considering ways to
improve the attractiveness of general practice as well as developing new roles for other
health care providers, such as nurses.
● There are also concerns about shortages of nurses in many European countries. Nurses
play an important role in providing health care not only in traditional settings such as
hospitals and long-term care institutions but increasingly in primary care, especially in
offering care to the chronically ill, and in patients’ homes. In 2008, there were about
15 nurses per 1 000 population in Finland, Iceland, Ireland and Switzerland, and slightly
fewer in Denmark and Norway. Turkey had the fewest nurses, followed by Greece,
Bulgaria and Cyprus, at less than five per 1 000 population.
● Since 2000, the number of nurses per capita has increased in all European countries,
except Lithuania and the Slovak Republic. The increase was particularly large in
Portugal, Spain, France and Switzerland.

Growing health expenditure puts pressure

on government budgets

● Health expenditure has risen in all European countries, often increasing at a faster rate
than economic growth, resulting in a rising share of GDP allocated to health. In 2008,
EU countries spent, on average, 8.3% of their GDP on health, up from 7.3% in 1998.
However, the share of GDP allocated to health spending varies considerably across
countries, ranging from less than 6% in Cyprus and Romania to more than 10% in France,
Switzerland, Germany and Austria.
● In some countries, the recent economic downturn resulted in a marked increase in the
ratio of health spending to GDP. In Ireland, the percentage of GDP devoted to health
increased from 7.5% in 2007 to 8.7% in 2008. In Spain, it rose from 8.4% to 9.0%.
● In 2008, Norway spent the most on health per capita among European countries, with
spending of about EUR 4 300. Switzerland, Luxembourg and Austria were the next
highest spending countries. Most northern and western European countries spend
between EUR PPP 2 500 and 3 500 per person, that is, 10% to 60% more than the EU
average. Those countries spending below the EU average are eastern and southern
European countries such as Turkey, Romania, Bulgaria, Poland and Hungary.
● Health expenditure per capita tends to be positively correlated with GDP per capita,
although the association is stronger among European countries with low GDP per capita.
Even for countries with similar levels of GDP per capita, there can be substantial
differences in health expenditure. For example, Spain and France have similar GDP per
capita, but Spain spends less than 80% of the level of France on health.
● Health systems are sometimes criticised for being overly focused on “sick care”: for
treating the ill, but not doing enough to prevent illness. Only around 3% of current health
expenditure is spent on prevention and public health programmes on average in
EU countries.
● The public sector is the main source of health financing in all European countries, except
Cyprus. On average, nearly three-quarter of all health spending was publicly financed
in 2008, through general taxation or social security contributions. In Luxembourg, the
Czech Republic, the Nordic countries (except Finland), the United Kingdom and
Romania, public financing accounted for more than 80% of all health expenditure.

12 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 EXECUTIVE SUMMARY

● The size and composition of private financing differs across countries. In most
countries, it is in the form of out-of-pocket payments by patients. Private health
insurance accounts for only around 3-4% of total health expenditure on average across
EU countries. However, in some countries, it plays a significant role. In Germany, it
provides primary coverage for certain population groups. In France, private health
insurance finances 13% of overall spending, but provides complementary and
supplementary coverage in a universal public system.
● Given the current need to reduce budget deficits in many countries, governments may be
faced with difficult policy choices in the short-term. They may either have to curb the
growth of public spending on health, cut spending in other areas, or raise taxes or social
security contributions to reduce their deficits. Improving productivity within the health
sector may help to reconcile these pressures, for example through more rigorous
assessment of health technologies or increased used of information and communication
technologies (“eHealth”). These initiatives may also have the added benefit of improving
the quality of care, which is another area of collaboration between the OECD and the
European Commission.

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 13

Health at a Glance: Europe 2010
© OECD 2010

Résumé

L es pays européens ont accompli d’importants progrès en matière de santé au cours des
dernières décennies. Dans les pays de l’Union européenne, l’espérance de vie à la naissance a
augmenté de six ans depuis 1980, tandis que la mortalité précoce a fortement reculé. Si
l’amélioration des conditions de vie et de travail, ainsi que de certains comportements
vis-à-vis de la santé, a joué un rôle majeur dans l’augmentation de la longévité, les progrès de
la médecine doivent également être salués. Les systèmes de santé dans les pays européens
occupent une place de plus en plus importante et les dépenses consacrées aux soins de santé
n’ont jamais été aussi élevées, représentant une part croissante du revenu national.
Cette première édition de Panorama de la santé : Europe, fruit d’une collaboration de longue
date entre l’OCDE et la Commission européenne, propose un ensemble d’indicateurs clés de
la santé et des systèmes de santé dans 31 pays européens, à savoir les 27 États membres de
l’Union européenne, l’Islande, la Norvège, la Suisse et la Turquie. La sélection d’indicateurs
s’appuie sur la liste des indicateurs de santé de la Communauté européenne (European
Community Health Indicators – ECHI), élaborée par la Commission européenne pour étayer la
production et la publication de statistiques sur la santé (Commission européenne, 2010a).
Certains des indicateurs diffèrent parfois des définitions retenues pour la liste ECHI pour des
questions de disponibilité des données. Dans d’autres cas, les indicateurs ECHI ne sont pas
encore prêts à être mis en œuvre. Par ailleurs, la publication fournit également des
informations détaillées sur les dépenses de santé et leur financement, en s’appuyant sur
l’expérience de l’OCDE en matière de collecte de données dans ce domaine. Les informations
présentées dans Panorama de la santé : Europe sont essentiellement issues de sources
statistiques nationales officielles, notamment d’Éco-Santé OCDE, de la base de données
statistique Eurostat et de la base de données Santé pour tous de l’OMS-Europe.
Panorama de la santé : Europe 2010 montre qu’il existe d’importants écarts entre les pays
européens en termes d’état de santé de la population, de facteurs de risques pour la santé,
d’intrants, d’extrants et de résultats des systèmes de santé, et de niveaux des dépenses de
santé et des sources de financement. L’étude propose des explications à ces écarts, en
fournissant le contexte nécessaire pour mieux comprendre leurs causes sous-jacentes. Il
convient aussi de noter que si des disparités par sexe et par âge sont présentées, cette
publication ne fournit généralement pas d’informations sur les disparités par région, par
groupe socioéconomique ou par groupe ethnique. Pour de nombreux indicateurs, le lecteur
doit garder à l’esprit que les variations peuvent être aussi importantes au sein d’un même
pays qu’entre les pays.

15
RÉSUMÉ

L’état de santé s’est amélioré de manière

remarquable dans les pays européens,
même si des écarts importants persistent

● Dans les pays de l’UE, l’espérance de vie à la naissance s’est allongée de six ans depuis 1980,
pour atteindre 78 ans en 2007. En moyenne dans les 27 pays de l’UE, l’espérance de vie à la
naissance pour la période 2005-07 s’élevait à 74.3 ans pour les hommes et à 80.8 ans pour les
femmes. La France affiche l’espérance de vie à la naissance la plus longue pour les femmes
(84.4 ans), tandis que l’espérance de vie la plus longue pour les hommes est observée en
Suède (78.8 ans). Au sein de l’Union européenne, c’est en Roumanie que l’espérance de vie à
la naissance est la plus courte pour les femmes (76.2 ans) et en Lituanie pour les hommes
(65.1 ans). L’écart entre les pays à l’espérance de vie la plus longue et ceux où l’espérance de
vie est la plus courte s’établit à 8 ans environ pour les femmes et à 14 ans pour les hommes.
● Il importe de savoir si l’allongement de l’espérance de vie implique des années de vie
supplémentaires en bonne santé, parce que cela a des répercussions majeures sur les
systèmes de santé et de soins de longue durée en Europe. L’espérance de vie en bonne
santé à la naissance est définie ici comme le nombre d’années de vie au cours desquelles
les activités quotidiennes de l’individu ne sont pas limitées par une maladie ou un
problème de santé. En 2005-07, l’espérance de vie en bonne santé s’établissait à 61.3 ans
pour les femmes et 60.1 ans pour les hommes en moyenne dans l’Union européenne.
L’écart hommes-femmes est donc bien moindre qu’en ce qui concerne l’espérance de
vie, ce qui tient au fait qu’une plus forte proportion de la vie des femmes est marquée
par des limitations de leur activité. En 2005-07, c’est à Malte que l’espérance de vie en
bonne santé était la plus longue à la fois pour les hommes et pour les femmes, tandis
que la Lettonie affichait l’espérance de vie en bonne santé la plus courte pour les
femmes et l’Estonie pour les hommes.
● L’espérance de vie à l’âge de 65 ans s’est aussi considérablement accrue en Europe au
cours des dernières décennies. En 2005-07, elle s’élevait en moyenne dans les 27 pays de
l’UE à 15.9 ans pour les hommes et 19.5 ans pour les femmes. Comme pour l’espérance
de vie à la naissance, la France se distingue par l’espérance de vie à 65 ans la plus longue
pour les femmes (22.6 ans) mais aussi pour les hommes (18.1 ans). Au contraire, c’est en
Europe de l’Est que l’espérance de vie à 65 ans est la plus courte : en Lettonie pour les
hommes (12.7 ans) et en Bulgarie pour les femmes (16.3 ans).
● Comme pour l’espérance de vie à la naissance, l’écart hommes-femmes s’agissant de
l’espérance de vie en bonne santé à 65 ans est bien plus restreint que pour l’espérance de
vie : en 2005-07, les hommes étaient légèrement avantagés, avec 8.4 ans contre 8.1 ans
pour les femmes.
● Il est difficile d’estimer la contribution relative des multiples facteurs médicaux et non
médicaux susceptibles d’influencer les écarts dans l’espérance de vie (en bonne santé).
Un revenu national élevé est généralement associé à une meilleure espérance de vie
dans les pays européens, quoique cette corrélation soit moins prononcée pour les
niveaux de revenu élevés, ce qui suggère un « rendement décroissant » à partir d’un
certain seuil. D’autres déterminants de la santé jouent également un rôle clé.

16 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 RÉSUMÉ

Les facteurs de risques évoluent

● De nombreux pays de l’UE ont accompli des progrès remarquables dans la lutte contre le
tabagisme, même s’il demeure l’une des principales causes de mortalité précoce. Cette
réussite peut en grande partie être attribuée aux mesures mises en œuvre à l’échelle
nationale et européenne pour promouvoir les campagnes de sensibilisation publique,
les interdictions de publicité et la hausse des taxes. En Suède et en Islande, moins de
18 % des adultes fument désormais quotidiennement, contre plus de 30 % en 1980. En
revanche, près de 40 % des adultes continuent de fumer quotidiennement en Grèce. Le
taux de tabagisme demeure également élevé en Bulgarie, en Irlande et aux Pays-Bas.
● La consommation d’alcool a également diminué dans nombre de pays européens ces
30 dernières années. Les restrictions sur la publicité et les ventes et la hausse des taxes
se sont avérées des outils efficaces pour réduire la consommation d’alcool. Les pays
traditionnellement producteurs de vin, comme l’Italie, la France et l’Espagne, ont vu la
consommation d’alcool par habitant chuter fortement depuis 1980. À l’inverse, la
consommation a sensiblement augmenté dans plusieurs pays comme l’Irlande, le
Royaume-Uni et certains pays nordiques.
● Plus de la moitié de la population adulte totale de l’Union européenne est désormais en
situation de surpoids ou d’obésité. C’est également le cas dans 15 des 27 pays de l’UE. La
prévalence de l’obésité – qui présente des risques pour la santé supérieurs à ceux du
surpoids – est comprise entre moins de 10 % en Roumanie, en Suisse et en Italie à plus
de 20 % au Royaume-Uni, en Irlande, à Malte et en Islande. En moyenne dans les pays de
l’UE, 15.5 % de la population adulte est obèse.
● Le taux d’obésité a plus que doublé ces 20 dernières années dans la plupart des pays de
l’UE pour lesquels des données sont disponibles. Cette progression rapide est intervenue
indépendamment des taux d’obésité observés il y a 20 ans. L’obésité a plus que doublé
aux Pays-Bas et au Royaume-Uni entre 1988 et 2008, même si le taux observé aux
Pays-Bas est actuellement inférieur de plus de moitié à celui du Royaume-Uni.
● L’obésité étant associée à une augmentation des risques de maladie chronique, elle
entraîne un coût supplémentaire important au niveau des soins de santé. Selon une
étude récente réalisée en Angleterre, la hausse du coût représenté par le surpoids et
l’obésité pourrait aller jusqu’à 70 % entre 2007 et 2015 et il pourrait être 2.4 fois plus
élevé d’ici à 2025 (Foresight, 2007).

La pénurie de professionnels de santé est un sujet

d’inquiétude dans de nombreux pays

● De nombreux pays européens s’inquiètent d’une pénurie de médecins. Le nombre de

médecins par habitant varie fortement entre les pays; il atteint son niveau le plus bas en
Turquie, suivie par la Pologne et la Roumanie. Il est également relativement bas au
Royaume-Uni et en Finlande.
● Depuis 2000, le nombre de médecins par habitant a néanmoins augmenté dans tous les
pays européens, à l’exception de la Slovaquie. En moyenne, il est passé de 3.0 médecins
pour 1 000 habitants en 2000 à 3.3 en 2008. Cette progression a été particulièrement
rapide en Irlande, avec une hausse de près de 50 %. Ceci s’explique en grande partie par
le recrutement de médecins formés à l’étrangers : le nombre de médecins formés à

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 17

RÉSUMÉ

l’étranger a en effet triplé sur la période. De la même façon, le nombre de médecins par
habitant au Royaume-Uni a progressé de 30 % entre 2000 et 2008, passant de 2.0 pour
1 000 habitants à 2.6.
● À l’inverse, le nombre de médecins par habitant est resté pratiquement inchangé en
France et en Italie depuis 2000. Après une baisse du nombre de nouveaux inscrits en
école de médecine dans les années 80 et 90, le nombre de médecins par habitant a
atteint son point le plus haut en 2002 en Italie, pour s’orienter ensuite à la baisse. En
France, il a touché son plus haut niveau en 2005 et la baisse devrait se poursuivre au
cours des dix prochaines années.
● Dans la quasi-totalité des pays, le rapport entre médecins généralistes et spécialistes a
évolué au cours des dernières décennies, le nombre de spécialistes ayant progressé bien
plus rapidement. Par conséquent, les spécialistes sont aujourd’hui plus nombreux que les
généralistes dans la plupart des pays, à l’exception de la Roumanie et du Portugal. Ce
phénomène peut s’expliquer par une diminution de l’attrait offert par le mode traditionnel
de la pratique du médecin généraliste/de famille, ainsi que par un écart de rémunération
croissant. La hausse limitée, voire la baisse, du nombre de généralistes par habitant
suscite des inquiétudes quant à l’accès aux soins primaires. De nombreux pays étudient
des moyens pour renforcer l’attractivité de la médecine générale et pour concevoir de
nouveaux rôles pour d’autres professionnels de santé, comme le personnel infirmier.
● Par ailleurs, de nombreux pays européens sont touchés par une pénurie de personnel
infirmier. Les infirmiers jouent un rôle important dans la prestation des soins de santé non
seulement dans le cadre traditionnel de l’hôpital ou des établissements de soins de longue
durée mais aussi, de plus en plus, dans les soins primaires, notamment auprès des malades
chroniques et dans les traitements à domicile. En 2008, on comptait environ 15 infirmières
pour 1 000 habitants en Finlande, en Islande, en Irlande et en Suisse, et un peu moins au
Danemark et en Norvège. La Turquie est le pays où l’on compte le moins d’infirmiers, suivie
par la Grèce, la Bulgarie et Chypre, avec moins de 5 pour 1 000 habitants.
● Depuis 2000, le nombre de personnel infirmier par habitant a progressé dans tous les
pays européens, à l’exception de la Lituanie et de la Slovaquie. Cette progression est
particulièrement importante au Portugal, en Espagne, en France et en Suisse.

L’augmentation des dépenses de santé pèse

sur les budgets nationaux

● Les dépenses de santé ont augmenté dans tous les pays européens, la plupart du temps
à un rythme supérieur à celui de la croissance économique, ce qui se traduit par une
augmentation de la part du PIB allouée à la santé. En 2008, les pays de l’UE ont consacré
en moyenne 8.3 % de leur PIB aux dépenses de santé, contre 7.3 % en 1998. Néanmoins,
la part du PIB allouée aux dépenses de santé varie considérablement entre les pays, de
moins de 6 % à Chypre et en Roumanie à plus de 10 % en France, en Suisse, en Allemagne
et en Autriche.
● Dans certains pays, la récession récente a provoqué une hausse notable de la part des
dépenses de santé dans le PIB. Ainsi, en Irlande, la part du PIB consacrée à la santé a
progressé de 7.5 % en 2007 à 8.7 % en 2008. En Espagne, elle est passée de 8.4 % à 9.0 %.

18 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 RÉSUMÉ

● En 2008, la Norvège est le pays qui affiche les dépenses de santé par habitant les
plus élevées parmi les pays européens, à 4 300 EUR environ, suivie par la Suisse, le
Luxembourg et l’Autriche. La plupart des pays d’Europe du Nord et de l’Ouest ont
dépensé entre 2 500 et 3 500 EUR par habitant, ce qui est supérieur de 10 à 60 % à la
moyenne de l’UE. Les pays où les dépenses de santé sont inférieures à la moyenne de
l’UE sont les pays d’Europe de l’Est et du Sud comme la Turquie, la Roumanie, la Bulgarie,
la Pologne et la Hongrie.
● Les dépenses de santé par habitant présentent généralement une corrélation positive
avec le PIB par habitant, même si celle-ci est plus étroite dans les pays européens
caractérisés par un PIB par habitant relativement bas. Cependant, même dans les pays
au PIB par habitant équivalent, on peut observer des écarts importants en matière de
dépenses de santé. Par exemple, l’Espagne et la France affichent un PIB par habitant
assez proche, mais les dépenses de santé de l’Espagne représentent moins de 80 % de
celles de la France.
● On déplore parfois que les systèmes de santé soient trop tournés sur les soins aux malades,
c’est-à-dire qu’ils sont davantage axés sur le traitement des maladies plutôt que sur leur
prévention. En moyenne dans les pays de l’UE, seulement 3 % environ des dépenses de santé
sont consacrées à la prévention et aux programmes de santé publique.
● Le secteur public représente la principale source de financement de la santé dans tous les
pays européens, à l’exception de Chypre. En moyenne, près de 75 % des dépenses de santé
totales étaient financées par les fonds publics en 2008, au moyen des recettes fiscales ou
des cotisations de sécurité sociale. Au Luxembourg, en République tchèque, dans les pays
nordiques (hors Finlande), au Royaume-Uni et en Roumanie, le financement public couvre
les dépenses de santé à hauteur de plus de 80 %.
● L’ampleur et la composition du financement privé varient selon les pays. Généralement, il
prend la forme d’une participation financière par les patients. L’assurance maladie privée
ne représente que 3-4 % seulement des dépenses de santé totales en moyenne dans les
pays de l’UE. Toutefois, dans certains pays, elle a un rôle de financement important. Ainsi,
elle assure une couverture primaire à certaines catégories de population en Allemagne. En
France, l’assurance maladie privée finance 13 % des dépenses totales mais elle fournit une
couverture complémentaire et supplémentaire dans le cadre d’un régime public universel.
● De nombreux pays étant actuellement soucieux de réduire leurs déficits budgétaires, les
pouvoirs publics seront confrontés à des choix difficiles à court terme. Ils pourraient en
effet être contraints soit de freiner la croissance des dépenses publiques de santé, soit de
réduire les dépenses dans d’autres secteurs, ou soit d’augmenter les impôts ou les
cotisations de sécurité sociale, pour réduire leurs déficits. Des gains de productivité et
d’efficience dans le secteur de la santé pourraient contribuer à alléger les pressions, par
exemple au moyen d’une évaluation plus rigoureuse des technologies de santé ou d’un
recours accru aux technologies de l’information et de la communication. Ces initiatives
pourraient en outre permettre d’améliorer la qualité des soins, ce qui constitue un autre
axe important de collaboration entre l’OCDE et la Commission européenne.

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 19

 Health at a Glance: Europe 2010
© OECD 2010

Introduction
H ealth at a Glance: Europe 2010 presents key indicators of health and health systems in
31 European countries, including the 27 European Union member states, three EFTA
countries (Iceland, Norway and Switzerland), and Turkey. It builds on the format used in
the OECD’s previous editions of Health at a Glance to provide comparable information on
important public health issues in Europe. The indicators have been selected on the basis of
the European Community Health Indicators (ECHI) shortlist (European Commission, 2010a;
ECHIM, 2010). However, in some instances, this report deviates from the formal ECHI
definitions because of issues related to data availability and comparability. Detailed
information is also provided in this publication on health expenditure and financing
trends, based on the OECD’s long-standing data collection in this area. All indicators are
presented in the form of easy-to-read figures and explanatory text.

Structure of the publication

The structure of Health at a Glance: Europe 2010 generally reflects the structure of the
European Community Health Indicators. It is divided into four chapters:
● Chapter 1 on Health Status highlights the variations across countries in life expectancy
and healthy life expectancy, and also presents other indicators of causes of mortality
and morbidity, including both communicable and non-communicable diseases.
● Chapter 2 on Determinants of Health focuses on non-medical determinants of health related
to modifiable lifestyles and behaviours among children and adults, such as smoking and
alcohol drinking, nutrition habits, physical activity, and overweight and obesity.
● Chapter 3 on Health Care Resources, Services and Outcomes reviews some of the inputs,
outputs and outcomes of health care systems, including the supply of doctors and
nurses, different types of equipment used for diagnosis or treatment, and the provision
of a range of services to prevent the transmission of communicable diseases or to treat
acute conditions. It concludes with a review of care related to cancer, focusing on the
coverage of screening programmes and survival rates for two types of cancer: breast and
cervical cancer.
● Chapter 4 on Health Expenditure and Financing examines trends in health spending across
European countries, both overall and for different types of health services and goods,
including pharmaceuticals. It also looks at how these health services and goods are paid
for and the different mix between public funding, private health insurance, and direct
out-of-pocket payments by households.
An annex provides some additional tables on the demographic and economic context
within which different health systems operate.

21
INTRODUCTION

Presentation of indicators
Each of the topics covered in this publication is presented over two pages. The first
provides a brief commentary highlighting the key findings conveyed by the data, defines
the indicator(s) and discloses any significant national variations from that definition which
might affect data comparability. On the facing page is a set of figures. These typically show
current levels of the indicator and, where possible, trends over time. In some cases, an
additional figure relating the indicator to another variable is included. The average in the
figures includes only European Union (EU) countries, and is calculated as the unweighted
average of those EU countries presented (up to 27, if there is full data coverage).

Data limitations
Limitations in data comparability are indicated both in the text (in the box related to
“Definition and deviations”) as well as in footnotes to charts.
Readers interested in using the data presented in this publication for further analysis
and research are encouraged to consult the full documentation of definitions, sources and
methods contained in OECD Health Data 2010 for all OECD member countries. This
information is available at www.oecd.org/health/healthdata.
For the six non-OECD member countries (Bulgaria, Cyprus, Latvia, Lithuania, Malta and
Romania), readers should consult the Eurostat Database at http://epp.eurostat.ec.europa.eu/
portal/page/portal/statistics/search_database.
Readers interested in an interactive presentation of the ECHI indicators can also consult
the SANCO health indicators tool at www.ec.europa.eu/health/indicators/indicators/index_en.htm.

Population figures
The population figures presented in the annex and used to calculate rates per capita
in this publication come from the OECD Labour Force Statistics Database (as of May 2010) for
OECD member countries, and refer to mid-year estimates. For the six non-OECD member
countries, the data come from the Eurostat Demographics Database (as of July 2010), and refer
to estimates at the beginning of the year. Population estimates are subject to revision, so
they may differ from the latest population figures released by national statistical offices.
Note that some countries such as France and the United Kingdom have overseas
colonies, protectorates and territories. These populations are generally excluded. The
calculation of GDP per capita and other economic measures may, however, be based on a
different population in these countries, depending on the data coverage.

22 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 INTRODUCTION

Country codes (ISO codes)

Austria AUT Lithuania LTU
Belgium BEL Luxembourg LUX
Bulgaria BGR Malta MLT
Cyprus1 CYP Netherlands NLD
Czech Republic CZE Norway NOR
Denmark DNK Poland POL
Estonia EST Portugal PRT
Finland FIN Romania ROM
France FRA Slovak Republic SVK
Germany DEU Slovenia SVN
Greece GRC Spain ESP
Hungary HUN Sweden SWE
Iceland ISL Switzerland CHE
Ireland IRL Turkey TUR
Italy ITA United Kingdom GBR
Latvia LVA

1. Note by Turkey: The information in this document with reference to “Cyprus” relates to the Southern part of the
Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey
recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within
the context of United Nations, Turkey shall preserve its position concerning the “Cyprus” issue.
Note by all the European Union member states of the OECD and the European Commission: The Republic of
Cyprus is recognised by all members of the United Nations with the exception of Turkey. The information in this
document relates to the area under the effective control of the Government of the Republic of Cyprus.

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 23

Health at a Glance: Europe 2010
© OECD 2010

Chapter 1

Health Status

1.1. Life expectancy and healthy life expectancy at birth . . . . . . . . . . . . . 26

1.2. Life expectancy and healthy life expectancy at age 65. . . . . . . . . . . . 28
1.3. Mortality from all causes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1.4. Mortality from heart disease and stroke. . . . . . . . . . . . . . . . . . . . . . . . 32
1.5. Mortality from cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
1.6. Mortality from transport accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
1.7. Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
1.8. Infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
1.9. Infant health: Low birth weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
1.10. Self-reported health and disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
1.11. Incidence of selected communicable diseases . . . . . . . . . . . . . . . . . . 46
1.12. HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
1.13. Cancer incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
1.14. Diabetes prevalence and incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
1.15. Dementia prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

25
1.1. LIFE EXPECTANCY AND HEALTHY LIFE EXPECTANCY AT BIRTH

Life expectancy at birth continues to increase 1.9 years more HLY for men at birth than women in
remarkably in EU countries, reflecting reductions in the Netherlands. Of the remaining countries, Poland
mortality rates at all ages. These gains in longevity had the largest gender gap in HLY at birth favouring
can be attributed to a number of factors, including women.
rising living standards, improved lifestyle and better Higher national income (as measured by GDP per
education, as well as greater access to quality health capita) is generally associated with higher life expec-
services. Other factors, such as better nutrition, tancy at birth, although the relationship between GDP
sanitation and housing also play a role, particularly in and HLY is less obvious (Figure 1.1.2). There is a
countries with developing economies (OECD, 2004). modest positive relationship, with increasing GDP per
Ave ra g e l i f e e x p e c t a n cy a t b i r t h f o r t h e capita associated with increasing HLY, although it is
years 2005-07 across the 27 countries of the European less pronounced at higher levels of national income.
Union reached 74.3 years for men and 80.8 years for There are also notable differences in HLY between EU
women (Figure 1.1.1), a rise of approximately three countries with similar income per capita. Sweden and
years for men and two years for women over the the United Kingdom have higher, and Finland and
decade from 1995-97. In around 70% of EU countries, Estonia lower HLY than would be predicted by their
life expectancy at birth in 2005-07 exceeded 80 years GDP alone. Similarly, Figure 1.1.3 shows the relation-
for women and 77 years for men. France had the high- ship between HLY at birth and health spending per
est life expectancy at birth for women (84.4 years), capita. Higher health spending per capita is generally
while Sweden had the highest life expectancy at birth associated with higher HLY.
for men (78.8 years). At the other end of the scale, life
expectancy at birth in the European Union was lowest
in Romania for women (76.2 years) and Lithuania for
Definition and deviations
men (65.1 years). The gap between EU countries with
the highest and lowest life expectancies at birth is Life expectancy measures how long, on
around eight years for women and 14 years for men. average, people would live based on a given set
The gender gap in life expectancy at birth of age-specific death rates. However, the actual
in 2005-07 stood at 6.5 years, almost one year less age-specific death rates of any particular birth
than a decade earlier. However, this average hides a cohort cannot be known in advance. If age-
huge range among countries with the smallest gender specific death rates are falling (as has been the
gap in life expectancy at birth in the United Kingdom case over the past decades in EU countries),
and Cyprus (4.1 years) and the largest in Lithuania actual life spans will be higher than life expec-
(12.1 years). The recent narrowing of the gender gap in tancy calculated with current death rates.
life expectancy can be attributed at least partly to the Healthy life years (HLY) at a particular age are
narrowing of differences in risk-increasing behaviours the number of years spent free of activity limita-
between men and women, such as smoking, accom- tion. They are calculated by Eurostat for each EU
panied by sharp reductions in mortality rates from country using the Sullivan method (Sullivan,
cardio-vascular diseases among men. 1971). The underlying health measure is the
On average for EU countries healthy life years Global Activity Limitation Indicator (GALI) which
(HLY) at birth in 2005-07 was 61.3 years for women comes from the European Union Statistics on
and 60.1 years for men. HLY at birth in 2005-07 was Income and Living Conditions (EU-SILC) survey.
greatest in Malta for both men and women, and The GALI measures limitation in usual activities.
shortest in Latvia for women and Estonia for men The questionnaire responses used in Denmark
(Figure 1.1.1). The spread of values for HLY at birth differ slightly, resulting in an under-estimation
among EU countries were much greater than for of activity limitation. Data are not available for
life expectancy, being 17.0 years for women and Bulgaria, Switzerland and Turkey.
19.5 years for men, but there was a much smaller Comparing trends in HLY and life expectancy
absolute difference between men and women can show whether extra years of life are healthy
(2.5 years). Since the HLY indicator has only recently years. However, valid comparisons depend on
been developed, there is as yet no long time series. the underlying health measure being truly
In contrast to the 6.5 year gap in life expectancy comparable. While HLY is the most comparable
at birth for EU countries on average, the gender gap in indicator to date, there are still problems with
HLY at birth was 1.2 years in 2005-07. For life expec- translation of the GALI question, although it
tancy at birth the gender gap is always in favour of does appear to satisfactorily reflect other health
women. However, eight countries had a gender gap in and disability measures (Jagger et al., 2010).
HLY at birth which favoured men, the greatest being

26 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

 1.1. LIFE EXPECTANCY AND HEALTHY LIFE EXPECTANCY AT BIRTH

1.1.1. Life expectancy and healthy life years (HLY) at birth, by gender, 2005-07
HLY LE with activity limitation

Females Males
84.4 France 77.2
84.2 Switzerland 79.1
84.1 Spain 77.5
84.0 Italy 78.4
83.3 Iceland 79.5
83.0 Sweden 78.8
82.9 Finland 75.8
82.8 Norway 78.1
82.7 Austria 77.1
82.3 Germany 77.1
82.2 Belgium 76.6
82.1 Netherlands 77.7
82.1 Luxembourg 76.7
82.0 Ireland 77.4
82.0 Portugal 75.5
81.9 Cyprus 77.8
81.8 Greece 77.0
81.7 Malta 77.2
81.6 Slovenia 74.3
81.4 United Kingdom 77.3
80.8 EU 74.3
80.6 Denmark 76.1
79.8 Czech Republic 73.4
79.6 Poland 70.9
78.5 Estonia 67.3
78.3 Slovak Republic 70.4
77.6 Hungary 69.1
77.2 Lithuania 65.1
76.4 Latvia 65.5
76.4 Bulgaria 69.2
76.2 Romania 69.2
75.3 Turkey 71.0

90 80 70 60 50 40 30 30 40 50 60 70 80 90
Years Years

Source: European Health and Life Expectancy Information System (EHLEIS); OECD Health Data 2010; Eurostat Statistics Database.
1 2 http://dx.doi.org/10.1787/888932335400

1.1.2. Healthy life years (HLY) at birth, 2005-07 1.1.3. Healthy life years (HLY) at birth, 2005-07
and GDP per capita, 2007 and health spending per capita, 2007
HLY (years) HLY (years)
70 70
ISL
R 2 = 0.31 R 2 = 0.33 ISL
DNK DNK
GRC GRC
SWE GBR SWE
GBR
65 ITA
NLD NOR 65 ITA NLD
NOR
FRA IRL IRL
ESP ESP
FRA
ROU BEL LUX ROU LUX
CYP CYP BEL
POL POL
60 CZE 60 CZE
SVN AUT SVN AUT
PRT PRT
DEU DEU

SVK HUN
55 HUN 55 SVK
LTU FIN FIN
LTU
LVA LVA
EST EST
50 50
0 10 000 20 000 30 000 40 000 50 000 60 000 0 1000 2000 3000 4000 5000
GDP per capita (EUR PPP) Health spending per capita (EUR PPP)

Source: European Health and Life Expectancy Information System Source: European Health and Life Expectancy Information System
(EHLEIS); OECD Health Data 2010; Eurostat Statistics Database; WHO. (EHLEIS); OECD Health Data 2010; Eurostat Statistics Database; WHO.
1 2 http://dx.doi.org/10.1787/888932335419 1 2 http://dx.doi.org/10.1787/888932335438

HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010 27

1.2. LIFE EXPECTANCY AND HEALTHY LIFE EXPECTANCY AT AGE 65

Life expectancy at age 65 has increased signifi- women than for men. Longer life expectancy at age
cantly among both women and men over the past 65 does not necessarily imply more HLY.
several decades in all EU countries. Some of the Contrary to life expectancy where the rankings
factors explaining the gains in life expectancy at age for men and women are different, there is a close
65 include advances in medical care combined with association between HLY at age 65 for men and
greater access to health care, healthier lifestyles and women. At the overall EU level, this consistency
improved living conditions before and after people between the number of years spent free of activity
reach age 65. limitation (HLY) between men and women at birth
The average life expectancy at age 65 years and at age 65 is true also for intermediate ages.
in 2005-07 for the 27 countries of the European Union Women’s longer life expectancy at all ages are more
was 15.9 years for men and 19.5 years for women often years spent with activity limitation. Lower HLY
(Figure 1.2.1). As for life expectancy at birth, France at age 50 across EU countries has been shown to be
had the highest life expectancy at age 65 for women associated with lower GDP and with higher long-term
(22.6 years) but also for men (18.1 years). Life expec- unemployment and lower life-long learning for men
tancy at age 65 in the European Union was lowest in (Jagger et al., 2008).
Eastern Europe – in Latvia for men (12.7 years) and in
Bulgaria for women (16.3 years).
The average gender gap in life expectancy at age 65
in 2005-07 stood at 3.6 years, down from the previous Definition and deviations
decade by 0.4 years. Greece had the smallest gender gap Life expectancy measures how long, on
of two years and Estonia the largest at 5.1 years. average, people would live based on a given set
Gains in longevity at older ages in recent decades of age-specific death rates. However, the actual
in EU countries, combined with the trend reduction in age-specific death rates of any particular birth
fertility rates are contributing to a steady rise in the cohort cannot be known in advance. If age-
proportion of older persons in EU countries (see specific death rates are falling (as has been the
Annex Tables A.2 and A.4). Whether longer life expec- case over the past decades in EU countries),
tancy is accompanied by good health and functional actual life spans will be higher than life expec-
status among ageing populations has important tancy calculated with current death rates.
implications for health and long-term care systems. Healthy life years (HLY) at a particular age are
As is the case for HLY at birth, HLY at age 65 the number of years spent free of activity limita-
in 2005-07 for EU countries was similar for men and tion. They are calculated by Eurostat for each
women, being 8.4 years for men and 8.1 years for EU country using the Sullivan method (Sullivan,
women. HLY at age 65 in 2005-07 was greatest in 1971). The underlying health measure is the
Denmark and shortest in Estonia for both men and Global Activity Limitation Indicator (GALI) which
women (Figure 1.2.1). It should be noted though, that comes from the European Union Statistics on
the question used to measure activity limitation in Income and Living Conditions (EU-SILC) survey.
Denmark differs slightly from that used in other The GALI measures limitation in usual activities.
countries, resulting in an over-estimation of HLY. HLY The questionnaire responses used in Denmark
is based on the Global Activity Limitation (GALI) differ slightly, resulting in an under-estimation
question, which is one of three indicators included in of activity limitation. Data are not available for
the Minimum European Health Module along with Bulgaria, Switzerland and Turkey.
global items on self-perceived health and chronic Comparing trends in HLY and life expectancy
morbidity. Health expectancies based on these alter- can show whether extra years of life are healthy
native questions would rank the countries differently. years. However, valid comparisons depend on
In addition, since the HLY indicator has only been the underlying health measure being truly
developed relatively recently, there is as yet no long comparable. While HLY is the most comparable
time series. indicator to date, there are still problems with
The relationship between life expectancy and translation of the GALI question, although it
HLY at age 65 is not clear-cut (Figure 1.2.2). Higher life does appear to satisfactorily reflect other health
expectancy at age 65 is generally associated with and disability measures (Jagger et al., 2010).
higher HLY, but the relationship is less pronounced for

28 HEALTH AT A GLANCE: EUROPE 2010 © OECD 2010

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