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Atlas of health in Europe

1 janvier 2003 Organisation mondiale de la santé

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The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organization seeks to support national health strategies and address the most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health.

Atlas of health in Europe

WHO Library Cataloguing in Publication Data Atlas of health in Europe. 1. Health surveys – statistics – atlases 2. Health status 3. Morbidity – statistics 4. Mortality – statistics 5. Europe ISBN 92 890 1370 2 (NLM Classification : WA 17)

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Atlas of health in Europe

Atlas of health in Europe ISBN 92 890 1370 2 Address requests for copies of publications of the WHO Regional Office to publicationrequests@euro.who.int; for permission to reproduce them to permissions@euro.who.int; and for permission to translate them to pubrights@euro.who.int; or contact Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark (tel.: +45 3917 1717; fax: +45 3917 1818; web site: http://www.euro.who.int). © W orld Health Or ganization 2003 World Organization 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 of 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. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization.

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Contents

Contents Foreword ........................................................................... Technical notes ................................................................. 1. Demography .......................................................... Notes ................................................................................. Population Mid-year population, 2002 ............................................ Natural population growth ............................................. Age pyramid, 2000 ....................................................... Young population, 0–14 years ...................................... Old population, 65 years and over ................................ Births Birth rate ....................................................................... Low-weight births, under 2500 g .................................. Births to young mothers, under 20 years ..................... Births to older mothers, 35 years and over .................. Abortions Abortions ....................................................................... 2. Life and death ........................................................ Notes ................................................................................. Life expectancy Conventional and estimated life expectancy ................ Life expectancy at birth and at 65 years ....................... Estimated disability-adjusted life expectancy, 2001 ..... Life expectancy at birth ................................................. Deaths Deaths from all causes .................................................. Infant deaths ................................................................. Perinatal deaths ............................................................ Maternal deaths ............................................................ Causes of death Main causes of death by age group ............................. Deaths from: diseases of the circulatory system ............................ ischaemic heart diseases .......................................... 1 3 7 7 9 10–11 11 12 13–14 15–16 16–17 18 18 19 21 21 26 27 28 29 29–31 32–33 34 35–36 36 37–38 39–40

Atlas of health in Europe cerebrovascular diseases ......................................... cancer ....................................................................... lung cancer ............................................................... female breast cancer ................................................ cervical cancer .......................................................... external causes of injury and poisoning .................... motor vehicle traffic accidents .................................. suicide ....................................................................... diseases of the respiratory system ........................... diseases of the digestive system .............................. 3. Diseases ................................................................ Notes ................................................................................. Some infectious diseases New cases of: tuberculosis ............................................................... viral hepatitis B .......................................................... syphilis ...................................................................... clinically diagnosed AIDS .......................................... HIV infection .............................................................. Selected outbreaks of infectious diseases, 2002 ......... Some noncommunicable diseases Prevalence of diabetes mellitus ..................................... Lung cancer incidence and deaths ............................... Female breast cancer incidence and deaths ................ Cervical cancer incidence and deaths .......................... Hospitalization Hospital discharges for: cancer ....................................................................... diseases of the circulatory system ............................ diseases of the respiratory system ........................... diseases of the digestive system .............................. diseases of the musculoskeletal system ................... injury and poisoning .................................................. Teeth Decayed, missing or filled teeth in 12-year-olds ........... 40–41 42–44 44–46 47–48 48–49 50–51 52–53 53–54 55–56 57–58 59 59

61–62 63–64 65–66 67–68 68–69 70 71 72 73 74

75–76 76–77 78–79 79–80 81–82 82–83 84

Contents 4. Lifestyles and envir onment ..................................... environment Notes ................................................................................. Smoking Smokers among adults and 15-year-olds ..................... Smokers among adult males ........................................ Cigarette consumption .................................................. Alcohol Total alcohol consumption ............................................ Consumption of spirits, 2000 ........................................ Foodborne disease Cases of microbiological foodborne disease ................ Work and traffic accidents Deaths from work-related accidents ............................. Motor vehicle traffic accidents and deaths ................... 85 85 87 88 88 89–90 91 92 93–94 95

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5. Health car e ............................................................ care 97 Notes ................................................................................. 97 Health personnel Number of: physicians ................................................................. 99–100 dentists ..................................................................... 100–101 nurses ....................................................................... 102 Hospitals Hospital beds ................................................................ 103 Length of stay in hospital .............................................. 103 Number of beds and length of stay in hospital ............. 104 Psychiatric hospital beds .............................................. 105 Inpatient hospital admissions ........................................ 106–107 Some procedures Caesarean sections ....................................................... 107–108 Children vaccinated against measles and diphtheria .... 109 Health expenditure Total health expenditure as a percent of GDP .............. 110–111 Total health expenditure per person .............................. 111–112

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Foreword

Foreword Decisions in the area of public health are based on a profound understanding of a wide range of factors, health statistics among them. Policy-makers consider all the available data on the health status in their countries, and shape their policies and design their actions accordingly. The comparison of national with international health data is a major part of the complex picture of public health: statistics backed up by in-depth analyses can be a powerful resource to help health authorities identify failures and successes, constraints and good practices. The WHO Regional Office for Europe offers this atlas to a wide range of public health and medical professionals, as well as to a broader audience. Rich and elaborate data from various sources have been gathered, systematized, grouped and formatted to present readers with the most complete picture of the health of Europe that can be expressed through figures. We hope this statistical atlas will be useful for those committed to the improvement of public health Europe-wide.

Mar c Danzon Marc Regional Director WHO Regional Office for Europe

Atlas of health in Europe

Technical notes

Technical notes This publication contains basic health-related statistics for the 51 Member States of the WHO European Region. The data cover the main aspects of health and its determinants, i.e. basic demographic data, health status in terms of mortality and morbidity, and some indicators on lifestyles and the environment, health care resources and their utilization. The period covered runs from 1980 at the earliest to 2001 at the latest, depending on the data available in the various countries. The only exception is the mid-year population graph, which shows data for 2002. Most of the data used in this publication come from the Member States themselves, usually from statistical units of ministries of health or public health institutions, and national statistical institutions. These data are systematically collected by the technical units of WHO (at the Regional Office for Europe or in headquarters) or by WHO collaborating centres. All these data, and more, are available in databases accessible on the WHO/Europe web site (http://www.euro.who.int) Information sources > Data > European health for all database; and on the WHO headquarters web site (http://www.who.int) Research tools > WHOSIS. For the sake of completeness, some publicly available data collected and published by other international organizations (such as the International Labour Office (ILO), the United Nations Economic Commission for Europe (UNECE), the Organisation for Economic Co-operation and Development (OECD), and the Food and Agriculture Organization of the United Nations (FAO)) have also been included when appropriate, with the information source acknowledged. Data were compiled, validated and processed in a uniform way in order to improve the international comparability of statistics. Nevertheless, many factors, such as variations in national definitions, incomplete registration in some countries or other national specificities in data recording and processing, may influence the accuracy and comparability of the national statistics.

Atlas of health in Europe Therefore, statistics, particularly in international comparisons, should always be interpreted with caution. The same applies to statistics for countries with very small populations (figures tend to “jump” up and down purely because of the small numbers registered). On the other hand, the “statistical noise” from possible data inaccuracies or random fluctuations due to small figures is usually not so high as to mask completely what the statistics show. Most of the data in this publication are presented in three standard graphic forms. The ranked bar -char t shows the relative position of each country bar-char -chart in relation to other countries. The data used are from 2001, or the latest available year. But as the timing of data reporting to WHO varies a lot, data from different years often have to be used. As more recent data are provided, rankings may change. Serbia and Montenegro is still referred to as Yugoslavia, because that was the name that pertained at the time the data apply. The map aims to reveal specific geographical patterns in the data, such as the east–west mortality gradient. Again, data from different years may have to be used, although 2001 is the most common year. The line char t shows health trends over the last 20 years, in chart different parts of the Region. Technically, it is difficult to present trends separately for each of the 51 countries on one line chart. On the other hand, had only the average trends for the whole Region been given, some important sub-regional differences in health trends would not have been visible. Therefore, sub-regional population-weighted averages for each indicator are calculated for three groups of countries, representing the trends in the eastern, central and western parts of the Region. The first (eastern) group consists of the 12 countries of the former USSR that now constitute the Commonwealth of Independent States (CIS). The second (central) group is the 15 central and south-eastern European countries (CSEC) in rapid transition, including the three Baltic states. The third (western) group represents the western part of the Region, consisting of the 15 member states of the European Union (EU).

Technical notes

Unless otherwise stated, death rates are age-standardized death rates (SDR), i.e. the number of deaths per 100 000 people in a “standard” population. This facilitates international comparability by removing differences in rates caused by different population age structures between countries. The European standard population (see the table below) was used to calculate the SDR. The mortality rates used cover all age groups: those aged under 65 (so called premature mortality) or aged 25–64 (representing the working age). Readers interested in other or more detailed age groups may consult the European health for all database.

The European standard population structure Age (years) 0 1–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 Percent of population 1.6 6.4 7 7 7 7 7 7 7 7 Age (years) 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+ All ages Percent of population 7 7 6 5 4 3 2 1 1 100

Atlas of health in Europe

Demography

1. Demography Notes Population (p. 9) In mid-2002, the population of the 51 countries of the WHO European Region totalled 874.6 million. The six largest countries (the Russian Federation, Germany, Turkey, France, United Kingdom, and Italy) make up more than half of the Region’s population. The data are estimates published by United Nations Statistical Division. Natural population growth (pp.10–11) In the 1990s, the decline in the number of births and the increase in the number of deaths reached a cross-over point for several countries, mostly in the central and eastern part of the Region. Deaths now exceed births in the European Region as a whole. Age structure (pp.11–14) European countries generally have an ageing population. Every seventh person is aged 65 years or more and this proportion is growing while the proportion of children is declining. The ageing process is more advanced in the western part of the Region. The graphs are based on population data by age, as most recently reported by countries to WHO. Births (pp.15–18) Live birth rates are declining in European countries and this decline is particularly sharp in eastern, central and south-eastern parts of the Region. This is most likely due to the profound socioeconomic changes and economic crises in this group of European countries. The proportion of infants with low birth weight (below 2500 g) is growing throughout the entire Region. The worst situation seems to be in the central and south-eastern parts of the Region, although

Atlas of health in Europe low-weight births may also be high but underreported in some countries of the eastern part of the Region. While births to young mothers are most common in the eastern part of the Region, births to mothers over 35 years of age are most frequent in western countries. Abortions (p. 19) The legal requirements for abortion vary between countries. The dramatic increase in the average rate of abortions in the central and south-eastern part of the Region in 1990 was caused by a six-fold increase in the number of abortions in Romania after a change in the law.

Demography Population

Mid-year population, 2002 Russian Federation Germany Turkey France United Kingdom Italy Ukraine Spain Poland Uzbekistan Romania Kazakhstan Netherlands Greece Yugoslavia Belgium Czech Republic Belarus Portugal Hungary Sweden Azerbaijan Austria Bulgaria Switzerland Israel Tajikistan Slovakia Denmark Georgia Finland Kyrgyzstan Turkmenistan Croatia Norway Republic of Moldova Bosnia and Herzegovina Ireland Armenia Lithuania Albania Latvia TFYR Macedoniaa Slovenia Estonia Luxembourg Malta Iceland Andorra Monaco San Marino 0 a

143752 81990 68569 59670 59657 57450 48652 39924 38543 25618 22332 16026 15990 10631 10523 10275 10250 10106 10048 9867 8823 8147 8070 7790 7168 6303 6177 5408 5342 5213 5183 5047 4930 4657 4506 4273 4127 3878 3790 3681 3164 2392 2051 1984 1360 447 394 283 64 30 27 50 000 100 000 150 000

Population (thousands) The former Yugoslav Republic of Macedonia

10 Population

Atlas of health in Europe

Natural population growth Tajikistan (1999) Israel (1998) Turkey (1998) Uzbekistan (2001) Turkmenistan (1998) Kyrgyzstan (2001) Albania (2000) Iceland (1997) Azerbaijan (2001) Bosnia and Herzegovina (1991) Ireland (2000) TFYR Macedonia (2000) Kazakhstan (2001) Netherlands (2000) Luxembourg (2001) San Marino (2000) France (1999) Norway (1999) Armenia (2000) Malta (2001) Switzerland (1999) Finland (2001) Denmark (1999) Portugal (2000) Georgia (2001) Belgium (1996) United Kingdom (2000) Yugoslavia (2000) Slovakia (2000) Poland (2000) Spain (1999) Austria (2001) Greece (1999) Slovenia (2001) Italy (1999) Sweden (1999) Germany (1999) Republic of Moldova (2001) Czech Republic (2001) Romania (2001) Croatia (2001) Lithuania (2001) Hungary (2001) Estonia (2001) Belarus (2001) Bulgaria (2001) Latvia (2001) Russian Federation (2001) Ukraine (2000) -15 15.6 15.5 15.2 14.8 13.3 10.8 8.5 8.0 7.6 6.2 6.0 4.9 4.2 4.0 3.8 3.5 3.2 2.7 2.5 2.2 1.5 1.4 1.4 1.2 1.2 1.2 0.7 0.5 0.3 0.2 0.1 -0.3 -0.6 -0.8 -0.8 -0.9 -1.0 -1.7 -1.8 -1.9 -2.5 -3.5 -4.3 -4.9 -5.6 -5.7 -6.6 -7.6 -5 5 15 25 Rate per 1000 population 25.7

Demography Population

Natural population growth 15 CIS CSEC EU

Rate per 1000 population

-5 1980 1985 1990 Year 1995 2000

Age pyramid, 2000 CIS CSEC EU 85+ 80–84 75–79 70–74 65–69 60–64 55–59 Males Females

Age group (years)

50–54 45–49 40–44 35–39 30–34 25–29 20–24 15–19 10–14 5–9 0–4 15 000 10 000 5000 0 5000 Population (thousands) 10 000 15 000

12 Population

Atlas of health in Europe

Young population, 0–14 years 30 CIS CSEC EU

Percent of population

15 1980 1985 1990 Year 1995 2000

< 42 – < 30 – < 25 – < 18 – < 17 – % of population

Demography Population

Old population, 65 years and over 20 CIS CSEC EU

Percent of population

5 1980 1985 1990 Year 1995 2000

< 18 – < 16 – < 14 – < 10 – < 5 – % of population

14 Population

Atlas of health in Europe

Old population, 65 years and over Italy (1999) Sweden (1999) Greece (1999) Bulgaria (2001) Spain (1999) Belgium (1997) San Marino (2000) Germany (1999) France (1999) Croatia (2001) United Kingdom (2000) Austria (2001) Portugal (2000) Latvia (2001) Norway (1999) Estonia (2001) Switzerland (2000) Hungary (2001) Finland (2001) Denmark (1999) Slovenia (2001) Georgia (2001) Lithuania (2001) Luxembourg (2001) Ukraine (2000) Czech Republic (2001) Yugoslavia (2000) Romania (2001) Belarus (2001) Netherlands (2000) Russian Federation (2001) Malta (2001) Poland (2000) Iceland (1998) Slovakia (2000) Ireland (2000) TFYR Macedonia (2000) Israel (1998) Republic of Moldova (2001) Armenia (2000) Kazakhstan (2001) Bosnia and Herzegovina (1991) Azerbaijan (2001) Albania (2000) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1998) Tajikistan (2001) 0 17.8 17.3 17.1 16.8 16.7 16.4 16.2 16.1 16.0 15.6 15.6 15.5 15.5 15.4 15.4 15.3 15.3 15.2 15.1 14.9 14.3 14.2 14.1 14.0 13.9 13.8 13.7 13.6 13.6 13.6 12.8 12.5 12.2 11.6 11.4 11.2 10.1 9.9 9.5 9.4 6.8 6.3 6.1 6.1 5.5 4.3 3.8 3.8 5 10 15 Percent of population 20

Demography Births

Birth rate Tajikistan (2001) Israel (2000) Turkey (2000) Turkmenistan (1998) Uzbekistan (2001) Kyrgyzstan (2001) Albania (2000) Iceland (2000) Kazakhstan (2001) Ireland (2000) TFYR Macedonia (2000) Azerbaijan (2001) Norway (2000) Netherlands (2000) France (1999) Denmark (2000) Luxembourg (2001) Yugoslavia (2000) Portugal (2000) Andorra (2000) Belgium (2000) United Kingdom (2000) Switzerland (2000) Finland (2001) San Marino (2000) Bosnia and Herzegovina (2000) Slovakia (2000) Sweden (2000) Georgia (2001) Republic of Moldova (2001) Malta (2001) Spain (2000) Romania (2001) Poland (2000) Greece (1999) Hungary (2001) Italy (2000) Germany (2000) Austria (2001) Estonia (2001) Croatia (2001) Belarus (2001) Russian Federation (2001) Lithuania (2001) Armenia (2000) Czech Republic (2001) Slovenia (2001) Bulgaria (2001) Latvia (2001) Ukraine (2000) 0 5 27.2 21.7 21.5 21.1 20.6 19.9

16.1 15.4 14.9 14.5 14.5 13.6 13.3 13.0 12.7 12.7 12.4 11.8 11.8 11.5 11.4 11.4 10.9 10.8 10.8 10.4 10.2 10.2 10.1 10.0 10.0 10.0 9.8 9.8 9.6 9.5 9.4 9.3 9.3 9.3 9.2 9.2 9.1 9.1 9.0 8.8 8.7 8.6 8.4 7.8

10 15 20 25 Live births per 1000 population

16 Births

Atlas of health in Europe

Birth rate 25 CIS CSEC EU

Per 1000 population

5 1980 1985 1990 Year 1995 2000

Low-weight births, under 2500 g 8

Percent of live births

CIS 4 1980 1985

CSEC

1990 Year

1995

2000

Demography Births

Low-weight births, under 2500 g Bulgaria (2001) Romania (2001) Hungary (2001) Israel (2001) Greece (1999) Portugal (2001) Armenia (2001) Luxembourg (2000) Belgium (1997) Andorra (2001) United Kingdom (1997) Slovakia (2001) Georgia (2001) Albania (1990) Tajikistan (2001) France (1998) Austria (2001) Azerbaijan (2001) Germany (1999) Switzerland (1999) Croatia (2001) Malta (2001) Russian Federation (2001) Poland (2000) Czech Republic (2001) Spain (1997) Italy (1998) Ireland (1999) Slovenia (2001) Denmark (2000) Kyrgyzstan (2001) Ukraine (2001) Kazakhstan (2001) Republic of Moldova (2001) Belarus (2001) Latvia (2001) Yugoslavia (1999) Turkmenistan (1997) Norway (2000) Uzbekistan (2001) Lithuania (2001) Sweden (1999) Finland (2001) Estonia (2001) Iceland (2001) 0 1 2 9.1 8.8 8.5 8.2 8.1 7.9 7.9 7.5 7.5 7.3 7.3 7.0 6.9 6.9 6.7 6.7 6.7 6.6 6.5 6.3 6.2 6.1 6.1 6.1 6.0 6.0 5.9 5.7 5.7 5.5 5.5 5.4 5.3 5.2 5.2 5.1 5.0 4.9 4.9 4.7 4.5 4.4 4.3 4.3 3.8 3 4 5 6 7 Percent of live births 8 9 10

18 Births

Atlas of health in Europe

Births to young mothers, under 20 years

< 18 – < 12 – < 9 – < 5 – < 2 – No data % of all births

Births to older mothers, 35 years and over

< 22 – < 17 – < 14 – < 10 – < 6 –

No data % of all births

Demography Abortions

Abortions 1500 CIS CSEC EU

1000 Per 1000 live births

500

0 1980 1985 1990 Year 1995 2000

< 1500 – < 1000 – < 700 – < 400 – < 200 – No data Per 1000 live births

Atlas of health in Europe

Life and death

2. Life and death Notes Life expectancy (pp. 26–29) Life expectancy, or the average number of years that a newborn baby can expect to live if mortality patterns remain unchanged, is one of the most common measurements of the health status of a population. As it is calculated using mortality statistics, its accuracy depends on the accuracy and completeness of official national mortality data. The table on p.26 shows two different estimates of life expectancy. One is the conventional life expectancy based on reported official mortality statistics. The other estimate is calculated using special demographic techniques to counteract possible underreporting of deaths (see The world health report 20001 for details on methodology). Countries with the largest differences between these two estimates most probably have life expectancies well below the level calculated from official statistics. This problem occurs mainly in central Asia, the Caucasus and the Balkans, which were affected by armed conflicts and severe socioeconomic difficulties during the 1990s. Many countries’ national vital statistics systems (registration of marriages, births and deaths) were damaged. This should be kept in mind when comparing the life expectancy in these areas with other countries. The trends in life expectancy show a dramatic increase in the gap between the western and eastern parts of the Region. The average trend for the CIS is particularly complex, as it reflects the effects of both the anti-alcohol campaign introduced in the USSR in 1985 and the deep socioeconomic crisis of the 1990s. The same pattern can be seen in the cause-specific mortality trends: a relatively sharp improvement in 1985–1986, a sharp deterioration in the first half of the 1990s, a gradual improvement in 1995–1998 and a 1 The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000.

Atlas of health in Europe deterioration again in 1999–2000. The latest deterioration may have some association with the financial crisis that hit the Russian Federation and other CIS countries in the autumn of 1998. Disability-adjusted life expectancy (often also called healthy life expectancy) shows the estimated number of years of life expected to be lived in full health. These estimates were calculated by WHO using special techniques (see The world health report 20002 for details on methodology). Deaths from all causes (pp. 29–31) Mortality is gradually increasing from the western to the eastern part of the Region. The level of premature mortality (i.e. below 65 years of age) varies particularly dramatically. East–west differences in the mortality of the elderly population (i.e. those aged 65 years or over) are relatively less pronounced. Excess male mortality is presented as the ratio of male death rates to female death rates on the left side of the bar charts on pp. 30–31. Particularly high premature male mortality in eastern countries makes the largest contribution proportionally to the east–west gap in total mortality. Infant deaths (pp. 32–33) Infant mortality shows the number of deaths of children under 1 year of age per 1000 live births. Unfortunately, some countries cannot ensure the complete registration of infant deaths and live births, in accordance with the WHO definition of live births. The infant mortality rates they report are therefore lower than they actually are and intercountry comparisons should be treated with caution. As mentioned above, particularly high levels of under-registration occur in central Asia and the Caucasus, and possibly in countries of the former Yugoslavia and Albania. Special household surveys carried out in the 1990s by the United States Agency for International Development (USAID) and the United Nations Children’s Fund (UNICEF) in some of these countries produced much higher estimates of infant mortality rates 2

The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000.

Life and death than the official figures based on national vital statistics systems. For example, differences between reported infant mortality and survey-based estimates were: for Azerbaijan 19.9 vs. 79.0, Kazakhstan 25.2 vs. 61.9, Tajikistan 47.0 vs. 89.0, Uzbekistan 30.7 vs. 43.5, Kyrgyzstan 29.1 vs. 66.2.3 Although, for methodological reasons, survey-based estimates are not directly comparable with registration-based data, these differences indicate the possible size of under-registration. Infant mortality is higher in the eastern part of the Region, with the highest levels in some south-eastern countries. Given the likely under-registration, the real infant mortality in these countries is probably even higher. Perinatal deaths (p. 34) The rate shows the number of deaths of fetuses weighing 1000 g or more and of newborn babies aged 0–6 full days per 1000 births (live and stillborn). Where weight-specific data were not available, calculations were based on the data provided by countries whatever the national criteria. Maternal deaths (pp. 35–36) A maternal death is the death of a woman while pregnant or within 42 days of the end of a pregnancy, from any cause related to or aggravated by the pregnancy or its management. Maternal mortality (deaths per 100 000 live births) was calculated using mortality data from routine vital statistics reported to WHO and hospital data reported by ministries of health, taking the larger figure where they differed. Even in countries with good vital statistics systems, however, maternal mortality is believed to be higher than reported. WHO, UNICEF and the United Nations Population Fund (UNFPA) have estimated that maternal mortality in these countries may actually be some 50% higher.4 The drop in the average rate in the central and south-eastern part of the Region in 1990 is attributable to the sharp reduction in 3 4

A decade of transition. New York, UNICEF, 2002 (Regional Monitoring Report, No.8). WHO, UNICEF, UNFPA. Maternal mortality in 1995: estimates developed by WHO, UNICEF, UNFPA. Geneva, World Health Organization, 2001 (WHO/RHR/01.9).

Atlas of health in Europe maternal mortality in Romania after the change in the anti-abortion law. Deaths by cause and age (p. 36) The importance of specific causes of death differs significantly in the different phases of the life span. Respiratory and some other diseases are leading causes of death in childhood, replaced by accidents and other external causes of death among adolescents and young adults. Cancer and diseases of the circulatory system become leading causes of death in older age groups. Deaths from diseases of the circulatory system (pp. 37–41) The average trends in mortality from these diseases show a decline in the western and central parts of the Region. The average for the CIS shows the specific trend pattern noted under life expectancy during the 1990s. A clear east–west gradient contributes a large part of the east–west difference in total mortality and life expectancy. The patterns of trends and differences in death rates from ischaemic heart diseases and cerebrovascular diseases are similar to those for all diseases of the circulatory system. Deaths from cancer (pp. 42–49) Trends in cancer death rates show some general improvement in the EU and the CIS, while in the central part of the Region the overall situation is deteriorating. The average cancer mortality in western countries is relatively low in younger age groups and relatively high among the older population. The opposite is true in the CIS while, in the central part of the Region, mortality is high in both younger and older age groups. Female mortality from lung cancer is steadily increasing in the western and central parts of the Region. Deaths from external causes of injury and poisoning (pp.50–54) External causes of death from injury and poisoning include accidents, homicide, suicide and other causes that are not diseases. A remarkable increase in mortality in the eastern part of the Region, in the first half of the 1990s, is attributable to the

Life and death combined effect of the end of the anti-alcohol campaign that started in the USSR in 1985 and the socioeconomic crisis of the 1990s. Deaths from diseases of the respiratory system (pp. 55–56) Generally, there is a downward trend in all parts of the Region. The average for the CIS follows the specific trend pattern described above for diseases of the circulatory system and for life expectancy. Deaths from diseases of the digestive system (pp. 57–58) Deaths from chronic liver disease and cirrhosis are responsible for about half of all deaths from this group of diseases. Mortality is steadily declining in the western part of the Region and is stable or slightly increasing in the central part. The average for the CIS follows the specific trend pattern as described above for diseases of the respiratory and circulatory systems, and for life expectancy.

26 Life expectancy

Atlas of health in Europe

Conventional and estimated life expectancy Males Conventional Estimated life life expectancy expectancy, 2001 (years) (years) Albania (2000) Andorra Armenia (2000) Austria (2001) Azerbaijan (2001) Belarus (2001) Belgium (1996) Bosnia and Herzegovina (1991) Bulgaria (2001) Croatia (2001) Czech Republic (2001) Denmark (1999) Estonia (2001) Finland (2001) France (1999) Georgia (2001) Germany (1999) Greece (1999) Hungary (2001) Iceland (1997) Ireland (2000) Israel (1998) Italy (1999) Kazakhstan (2001) Kyrgyzstan (2001) Latvia (2001) Lithuania (2001) Luxembourg (2001) Malta (2001) Monaco Netherlands (2000) Norway (1999) Poland (2000) Portugal (2000) Republic of Moldova (2001) Romania (2001) Russian Federation (2001) San Marino (2000) Slovakia (2000) Slovenia (2001) Spain (1999) Sweden (1999) Switzerland (1999) Tajikistan (1999) TFYR Macedonia (2000) Turkey Turkmenistan (1998) Ukraine (2000) United Kingdom (2000) Uzbekistan (2001) Yugoslavia (2000) 72.03 73.46 76.10 69.66 62.79 73.97 69.49 68.55 71.03 72.18 74.13 64.91 74.72 75.17 72.44 74.89 75.82 68.32 76.41 74.01 76.21 76.28 60.57 64.53 64.48 65.89 75.48 76.37 75.65 75.71 69.80 72.63 64.54 67.69 59.08 77.93 69.26 72.32 75.24 77.13 76.97 69.99 71.18 62.48 62.30 75.69 67.57 70.36 66.3 76.2 66.2 75.9 60.7 62.9 74.8 69.3 68.4 68.9 71.9 74.8 65.7 74.5 75.6 65.4 75.1 75.5 67.3 78.2 73.8 76.1 76.2 58.8 60.1 65.2 67.7 74.9 75.8 76.5 75.8 76.1 69.9 72.7 64.2 67.8 58.9 77.6 69.3 72.1 75.3 77.7 77.3 59.9 68.9 67.0 58.9 62.2 75.1 62.7 69.7 Females Conventional Estimated life life expectancy expectancy, 2001 (years) (years) 78.04 78.11 81.95 75.01 74.55 80.76 75.98 75.44 78.17 78.71 78.87 76.44 81.81 82.83 78.48 81.02 81.03 76.76 81.61 79.31 80.59 82.62 71.40 72.97 75.68 77.49 81.13 81.19 80.76 81.32 78.09 79.67 71.94 75.01 72.28 86.58 77.64 80.52 82.35 82.08 82.80 73.98 75.74 69.84 73.62 80.51 72.64 75.18 73.2 82.9 73.0 81.8 66.6 74.2 81.2 76.4 74.8 77.1 78.8 79.5 76.5 81.2 82.9 72.4 81.1 80.8 76.1 81.3 79.2 80.9 82.2 67.2 68.2 76.0 77.9 81.8 80.3 84.0 80.7 81.4 78.1 80.1 71.7 74.5 72.3 83.9 77.4 79.5 82.6 82.3 82.8 66.9 74.9 71.2 66.5 73.3 79.9 68.5 74.8

Life and death Life expectancy

Life expectancy at birth and at 65 years San Marino (2000) Switzerland (1999) Sweden (1999) Italy (1999) Austria (2001) France (1999) Iceland (1997) Malta (2001) Spain (1999) Norway (1999) Israel (1998) Greece (1999) Luxembourg (2001) Finland (2001) Netherlands (2000) United Kingdom (2000) Germany (1999) Belgium (1996) Ireland (2000) Denmark (1999) Slovenia (2001) Portugal (2000) Armenia (2000) Czech Republic (2001) Georgia (2001) Albania (2000) Croatia (2001) Poland (2000) Slovakia (2000) TFYR Macedonia (2000) Bosnia and Herzegovina (1991) Yugoslavia (2000) Hungary (2001) Azerbaijan (2001) Tajikistan (1999) Bulgaria (2001) Lithuania (2001) Romania (2001) Estonia (2001) Latvia (2001) Uzbekistan (2001) Kyrgyzstan (2001) Belarus (2001) Republic of Moldova (2001) Ukraine (2000) Turkmenistan (1998) Kazakhstan (2001) Russian Federation (2001) 21.3 19.1 18.4 18.7 18.8 19.2 18.3 17.4 18.4 17.8 17.9 18.0 18.3 18.2 17.6 17.7 17.9 17.5 16.5 16.8 17.2 16.7 17.3 16.0 17.4 15.3 15.6 15.9 15.2 14.5 15.0 14.7 15.5 15.5 15.3 14.5 16.0 14.9 15.5 15.2 14.4 14.6 13.9 13.1 13.8 13.8 13.2 13.6 82.3 80.0 79.6 79.5 79.2 79.0 79.0 78.9 78.8 78.5 78.5 78.4 78.4 78.4 78.3 78.2 78.1 77.4 76.6 76.5 76.5 76.2 75.7 75.5 75.4 74.9 74.7 74.0 73.5 73.4 72.7 72.7 72.6 72.4 72.0 71.9 71.7 71.3 70.7 70.1 70.1 68.7 68.5 68.3 67.9 66.1 65.9 65.3

40 30 20 10 0 10 20 30 40 50 60 70 80 90 Years at 65 Years at birth

28 Life expectancy

Atlas of health in Europe

Estimated disability-adjusted life expectancy, 2001 Switzerland San Marino Sweden Monaco France Iceland Italy Austria Spain Andorra Norway Luxembourg Greece Germany Finland Denmark Netherlands Belgium United Kingdom Israel Malta Ireland Slovenia Portugal Czech Republic Poland Slovakia Croatia Bulgaria Bosnia and Herzegovina TFYR Macedonia Yugoslavia Estonia Hungary Lithuania Romania Latvia Turkey Georgia Albania Belarus Armenia Republic of Moldova Ukraine Russian Federation Uzbekistan Azerbaijan Kazakhstan Kyrgyzstan Turkmenistan Tajikistan 72.8 72.2 71.8 71.3 71.3 71.2 71.0 71.0 70.9 70.9 70.8 70.6 70.4 70.2 70.1 70.1 69.9 69.7 69.6 69.4 69.2 69.0 67.7 66.8 66.6 64.3 64.1 63.3 63.0 62.5 62.2 62.1 62.0 61.8 61.1 60.9 60.0 59.8 59.8 58.7 58.4 58.3 57.5 57.4 56.7 53.5 52.8 52.4 51.5 50.3 50.1 50 55 60 Years 65 70 75

Life and death Life expectancy

Life expectancy at birth 80 CIS CSEC EU

Years

65 1980 1985 1990 Year 1995 2000

Deaths

Deaths from all causes

< 1500 – < 1300 – < 1100 – < 800 – < 650 – No data Per 100 000 population

30 Deaths

Atlas of health in Europe

Deaths from all causes, 0–64 years Russian Federation (2001) Kazakhstan (2001) Turkmenistan (1998) Ukraine (2000) Belarus (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Latvia (2001) Estonia (2001) Lithuania (2001) Uzbekistan (2001) Romania (2001) Hungary (2001) Tajikistan (1999) Bulgaria (2001) Azerbaijan (2001) Bosnia and Herzegovina (1991) Yugoslavia (2000) Slovakia (2000) Poland (2000) TFYR Macedonia (2000) Georgia (2001) Croatia (2001) Armenia (2000) Czech Republic (2001) Slovenia (2001) Denmark (1999) Portugal (2000) Belgium (1996) Albania (2000) Ireland (2000) France (1999) Germany (1999) Finland (2001) Luxembourg (2001) United Kingdom (2000) Austria (2001) Spain (1999) Greece (1999) Netherlands (2000) Israel (1998) Norway (1999) Iceland (1997) Italy (1999) Switzerland (1999) Sweden (1999) Malta (2001) San Marino (2000) 600 303 250 183 292 308 199 216 288 297 309 165 222 243 146 230 181 230 188 271 255 175 245 247 203 225 246 154 229 196 186 172 231 201 232 186 160 200 248 222 155 179 173 162 204 188 164 176 302 400 200 0 771.2 703.9 629.7 621.5 604.2 571.6 570.9 539.4 523.0 476.6 474.9 443.9 433.6 406.5 400.5 391.8 376.4 371.4 361.7 360.2 320.7 319.4 305.2 299.4 285.2 283.1 262.2 254.3 236.7 234.7 230.8 229.1 223.3 222.5 218.7 210.7 205.4 204.7 203.5 201.4 200.3 196.2 195.5 182.4 178.4 173.2 163.3 152.5 200 400 600 800 1000

Ratio males / females (%)

Per 100 000 population

Life and death Deaths

Deaths from all causes, 65 years and over Republic of Moldova (2001) Kazakhstan (2001) Russian Federation (2001) Albania (2000) Ukraine (2000) Belarus (2001) Turkmenistan (1998) Bulgaria (2001) TFYR Macedonia (2000) Uzbekistan (2001) Kyrgyzstan (2001) Romania (2001) Yugoslavia (2000) Bosnia and Herzegovina (1991) Slovakia (2000) Latvia (2001) Tajikistan (1999) Estonia (2001) Hungary (2001) Croatia (2001) Azerbaijan (2001) Czech Republic (2001) Poland (2000) Lithuania (2001) Portugal (2000) Ireland (2000) Denmark (1999) Slovenia (2001) Armenia (2000) Malta (2001) Georgia (2001) Belgium (1996) Netherlands (2000) United Kingdom (2000) Norway (1999) Israel (1998) Germany (1999) Greece (1999) Finland (2001) Iceland (1997) Luxembourg (2001) Spain (1999) Sweden (1999) Italy (1999) Austria (2001) Switzerland (1999) France (1999) San Marino (2000) 400 139 156 157 169 147 161 134 134 128 120 136 132 112 119 151 159 122 171 152 147 125 147 151 163 156 147 140 169 114 140 114 168 159 145 159 129 154 129 161 152 152 162 152 163 148 159 170 174 200 0 8014 7695 7267 7242 7239 7117 7005 6810 6628 6562 6468 6383 6355 6122 6070 6067 6009 5914 5906 5903 5821 5677 5640 5589 5469 5297 5042 4850 4819 4762 4749 4696 4666 4580 4547 4502 4495 4428 4360 4304 4294 4276 4243 4100 4089 3910 3872 3085 2000 4000 6000 8000 10 000

Ratio males / females (%)

Per 100 000 population

32 Deaths

Atlas of health in Europe

Infant deaths 30

Per 1000 live births

5 CIS 0 1980 CSEC EU

1985

1990 Year

1995

2000

< 40 – < 20 – < 15 – < 10 – < 5 – Per 1000 live births

Life and death Deaths

Infant deaths Turkey (1999) Turkmenistan (1998) Tajikistan (2001) Kyrgyzstan (2001) Kazakhstan (2001) Romania (2001) Uzbekistan (2001) Republic of Moldova (2001) Armenia (2000) Bosnia and Herzegovina (1999) Russian Federation (2001) Bulgaria (2001) Yugoslavia (2000) Azerbaijan (2001) Ukraine (2000) TFYR Macedonia (2000) Albania (2000) Latvia (2001) Georgia (2001) Belarus (2001) Estonia (2001) Slovakia (2000) Hungary (2001) Poland (2000) Lithuania (2001) Croatia (2001) Ireland (2000) Greece (1999) Andorra (1999) Israel (1998) United Kingdom (2000) Portugal (2000) Iceland (1997) Belgium (1996) Italy (1999) Netherlands (2000) Monaco (1999) Luxembourg (2001) Austria (2001) Switzerland (1999) Germany (1999) Spain (1999) Malta (2001) France (1999) Slovenia (2001) Denmark (1999) Norway (1999) Czech Republic (2001) Sweden (1999) Finland (2001) 0 32.8 21.6 19.2 18.4 18.4 16.4 15.8 15.0 14.6 14.4 13.3 12.5 12.0 11.8 11.6 11.0 10.4 9.2 8.8 8.6 8.1 8.1 7.9 7.7 6.2 6.2 6.0 6.0 5.6 5.5 5.5 5.3 5.2 5.1 5.0 5.0 4.8 4.6 4.5 4.5 4.3 4.3 4.3 4.2 4.0 4.0 3.4 3.2 10 20 27.9 40.0

Per 1000 live births

34 Deaths

Atlas of health in Europe

Perinatal deaths Tajikistan (2001) Georgia (2001) Turkmenistan (1997) Armenia (2001) TFYR Macedonia (2001) Kazakhstan (2001) Republic of Moldova (2001) Yugoslavia (1998) Kyrgyzstan (2001) Bulgaria (2001) Romania (2001) Russian Federation (2001) Albania (1992) Azerbaijan (2001) Uzbekistan (2001) Poland (2000) Hungary (2001) Latvia (2001) Greece (1999) Ukraine (2001) United Kingdom (2000) Netherlands (2001) Belarus (2001) Croatia (2001) France (1998) Belgium (1995) Slovakia (2001) Switzerland (1999) Italy (1998) Luxembourg (2001) Germany (2000) Ireland (1999) Estonia (2001) Lithuania (2001) Sweden (2000) Spain (1999) Denmark (1999) Portugal (2000) Israel (1998) Malta (2001) Slovenia (2001) Norway (2000) Czech Republic (2001) Iceland (2001) Austria (2001) Finland (2001) Andorra (2001) 0 21.2 20.7 17.1 16.4 16.4 15.5 14.7 13.6 13.2 12.3 11.8 11.7 11.5 11.3 10.0 9.7 9.5 9.0 8.8 8.8 8.2 7.9 7.4 7.3 7.0 7.0 6.5 6.5 6.4 6.2 6.1 5.9 5.8 5.7 5.6 5.6 5.4 5.2 5.2 5.1 4.5 4.5 3.8 3.7 3.6 3.4 1.3 5 10 15 Per 1000 births 20 25

Life and death Deaths

Maternal deaths, three-year average Turkey (1998) Tajikistan (1999) Georgia (2000) Kyrgyzstan (2000) Turkmenistan (1995) Kazakhstan (2000) Armenia (2000) Russian Federation (2000) Romania (2000) Azerbaijan (2000) Uzbekistan (2000) Republic of Moldova (2000) Latvia (2000) Malta (2000) Ukraine (2000) Iceland (2000) Estonia (2000) Belarus (2000) Albania (2000) Bosnia and Herzegovina (1990) Bulgaria (2000) Slovenia (2000) Lithuania (2000) TFYR Macedonia (2000) Netherlands (1999) Slovakia (2000) France (1998) Poland (1995) Czech Republic (2000) Belgium (1996) Yugoslavia (1999) Croatia (2000) Hungary (2000) United Kingdom (1999) Luxembourg (1997) Norway (1998) Israel (2000) Denmark (1998) Germany (1999) Portugal (1999) Switzerland (1998) Finland (2000) Greece (1998) Italy (1998) Austria (2000) Sweden (1999) Spain (1998) Ireland (2000) Andorra (2000) 0 55.0 53.0 47.5 45.5 43.1 42.6 40.2 35.9 35.5 33.3 33.2 30.5 24.7 24.6 24.4 20.8 19.7 19.6 19.2 19.1 15.2 13.6 11.9 9.9 9.4 9.1 8.6 7.8 7.8 6.9 6.8 6.5 6.3 6.2 5.7 5.5 5.5 5.3 5.2 5.1 4.7 4.3 3.5 3.5 3.4 2.9 1.2 0.0 50 100 130.0

150

Per 100 000 live births

36 Deaths

Atlas of health in Europe

Maternal deaths 60 CIS 50 CSEC EU

Per 100 000 live births

0 1980 1985 1990 Year 1995 2000

Causes of death

Main causes of death by age group Infectious and parasitic diseases Diseases of the circulatory system Other diseases 100 Cancer Diseases of the respiratory system External causes of injury and poisoning

Percent of all deaths in each group

0 0 1–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85+

Age group (years)

Life and death Causes of death

Deaths from diseases of the circulatory system 800 CIS CSEC EU

700

Per 100 000 population

600

500

400

300

200 1980 1985 1990 Year 1995 2000

< 900 – < 750 – < 600 – < 400 – < 250 – No data Per 100 000 population

38 Causes of death

Atlas of health in Europe

Deaths from diseases of the circulatory system, 25–64 years Russian Federation (2001) Turkmenistan (1998) Kazakhstan (2001) Belarus (2001) Ukraine (2000) Kyrgyzstan (2001) Uzbekistan (2001) Republic of Moldova (2001) Latvia (2001) Bulgaria (2001) Azerbaijan (2001) Tajikistan (1999) Estonia (2001) Romania (2001) Georgia (2001) Yugoslavia (2000) Lithuania (2001) Bosnia and Herzegovina (1991) Hungary (2001) TFYR Macedonia (2000) Slovakia (2000) Poland (2000) Armenia (2000) Croatia (2001) Czech Republic (2001) Albania (2000) Ireland (2000) Slovenia (2001) Greece (1999) United Kingdom (2000) Finland (2001) Germany (1999) Luxembourg (2001) Austria (2001) Denmark (1999) Belgium (1996) Netherlands (2000) Malta (2001) Portugal (2000) San Marino (2000) Israel (1998) Sweden (1999) Norway (1999) Iceland (1997) Italy (1999) Spain (1999) Switzerland (1999) France (1999) 0 442.7 441.9 419.8 378.1 361.4 344.0 320.4 293.9 290.5 288.8 272.6 254.9 254.1 250.2 233.3 220.1 217.5 215.3 209.7 189.9 188.1 175.5 172.8 153.1 135.9 115.9 102.9 98.0 97.5 91.2 91.0 87.7 85.6 84.1 83.7 79.3 76.6 76.0 74.7 72.0 71.3 70.1 69.9 67.6 65.0 63.6 56.8 55.2 100 200 300 400 500

Per 100 000 population

Life and death Causes of death

Deaths from ischaemic heart diseases, 25–64 years Russian Federation (2001) Belarus (2001) Ukraine (2000) Kazakhstan (2001) Turkmenistan (1998) Azerbaijan (2001) Latvia (2001) Republic of Moldova (2001) Uzbekistan (2001) Kyrgyzstan (2001) Georgia (2001) Estonia (2001) Lithuania (2001) Armenia (2000) Tajikistan (1999) Romania (2001) Hungary (2001) Slovakia (2000) Bulgaria (2001) Bosnia and Herzegovina (1991) TFYR Macedonia (2000) Poland (2000) Yugoslavia (2000) Czech Republic (2001) Croatia (2001) Ireland (2000) United Kingdom (2000) Greece (1999) Finland (2001) Malta (2001) Albania (2000) Iceland (1997) Germany (1999) Austria (2001) Norway (1999) Slovenia (2001) Sweden (1999) Belgium (1996) Denmark (1999) Netherlands (2000) Israel (1998) Luxembourg (2001) Spain (1999) Switzerland (1999) Italy (1999) Portugal (2000) France (1999) San Marino (2000) 0 225.6 221.9 214.4 204.7 199.3 175.6 156.8 147.0 141.8 139.4 133.6 127.1 119.4 113.5 110.2 106.2 103.0 95.7 85.7 79.5 76.9 76.3 74.7 69.6 66.5 61.1 57.0 54.2 52.2 50.7 46.5 44.8 44.0 43.8 42.5 41.1 40.4 37.8 36.9 36.1 35.4 34.3 30.3 29.1 27.5 27.2 20.7 13.1 50 100 150 200 Per 100 000 population 250

40 Causes of death

Atlas of health in Europe

Deaths from ischaemic heart diseases, 25–64 years 250 CIS 200 Per 100 000 population

CSEC

150

100

0 1980 1985 1990 Year 1995 2000

Deaths from cerebrovascular diseases, 25–64 years 125 CIS 100 CSEC EU

Per 100 000 population

0 1980 1985 1990 Year 1995 2000

Life and death Causes of death

Deaths from cerebrovascular diseases, 25–64 years Kyrgyzstan (2001) Russian Federation (2001) Republic of Moldova (2001) Kazakhstan (2001) Belarus (2001) Ukraine (2000) Romania (2001) Uzbekistan (2001) Georgia (2001) Latvia (2001) Bulgaria (2001) Yugoslavia (2000) TFYR Macedonia (2000) Bosnia and Herzegovina (1991) Estonia (2001) Hungary (2001) Azerbaijan (2001) Lithuania (2001) Turkmenistan (1998) Croatia (2001) Armenia (2000) Poland (2000) Albania (2000) Tajikistan (1999) Portugal (2000) Slovakia (2000) Czech Republic (2001) Slovenia (2001) Luxembourg (2001) Greece (1999) Denmark (1999) San Marino (2000) Finland (2001) Ireland (2000) United Kingdom (2000) Belgium (1996) Austria (2001) Iceland (1997) Malta (2001) Netherlands (2000) Spain (1999) Germany (1999) Sweden (1999) Italy (1999) Norway (1999) France (1999) Israel (1998) Switzerland (1999) 0 149.5 120.5 116.4 106.4 99.0 91.0 82.7 80.9 72.8 71.4 71.2 65.1 60.3 57.1 56.3 53.6 51.7 42.1 41.6 41.2 40.1 39.6 32.9 31.8 30.4 25.5 25.5 24.0 21.1 20.5 20.2 18.3 18.1 16.6 15.2 15.0 14.6 14.4 13.8 13.5 13.5 13.3 13.2 12.5 11.9 11.8 11.8 7.9 30 60 90 120 150 180

Per 100 000 population

42 Causes of death

Atlas of health in Europe

Deaths from cancer, 25–64 years Hungary (2001) Slovakia (2000) Ukraine (2000) Russian Federation (2001) Poland (2000) Latvia (2001) Belarus (2001) Czech Republic (2001) Romania (2001) Lithuania (2001) Croatia (2001) Kazakhstan (2001) Estonia (2001) Republic of Moldova (2001) Yugoslavia (2000) Denmark (1999) Slovenia (2001) Bosnia and Herzegovina (1991) France (1999) TFYR Macedonia (2000) Belgium (1996) Bulgaria (2001) Iceland (1997) Ireland (2000) Netherlands (2000) Spain (1999) Germany (1999) Armenia (2000) United Kingdom (2000) Portugal (2000) Italy (1999) Austria (2001) Norway (1999) Kyrgyzstan (2001) Greece (1999) San Marino (2000) Israel (1998) Azerbaijan (2001) Luxembourg (2001) Switzerland (1999) Sweden (1999) Turkmenistan (1998) Malta (2001) Finland (2001) Albania (2000) Georgia (2001) Uzbekistan (2001) Tajikistan (1999) 0 50 230.1 180.3 178.6 178.3 174.6 172.0 169.9 169.8 167.3 166.8 166.1 165.3 162.9 159.4 157.7 152.4 149.4 145.6 145.0 144.1 142.0 141.9 138.8 133.4 128.8 127.7 127.2 124.3 123.6 120.4 118.6 115.9 114.0 112.1 111.8 111.6 109.8 107.5 107.1 102.9 98.8 96.7 95.8 93.5 85.7 84.5 81.9 65.3 100 150 200 250

Per 100 000 population

Life and death Causes of death

Deaths from cancer, 0–64 years

< 140 – < 105 – < 95 – < 80 – < 70 – No data Per 100 000 population

Deaths from cancer, 65 years and over

< 1300 – < 1100 – < 900 – < 800 – < 600 – No data Per 100 000 population

44 Causes of death

Atlas of health in Europe

Deaths from cancer 210

200

Per 100 000 population

190

180

170 CIS 160 1980 1985 1990 Year 1995 2000 CSEC EU

Deaths from lung cancer, males, 25–64 years 90

80 Per 100 000 population

50 CIS 40 1980 1985 1990 Year 1995 2000 CSEC EU

Life and death Causes of death

Deaths from lung cancer, females, 25–64 years 16 CIS 14 CSEC EU

Per 100 000 population

6 1980 1985 1990 Year 1995 2000

Deaths from lung cancer, 65 years and over 225

200 Per 100 000 population

175

150

125 CIS 100 1980 1985 1990 Year 1995 2000 CSEC EU

46 Causes of death

Atlas of health in Europe

Deaths from lung cancer, 25–64 years Hungary (2001) Poland (2000) Croatia (2001) Bosnia and Herzegovina (1991) Czech Republic (2001) Yugoslavia (2000) Romania (2001) Slovakia (2000) Belgium (1996) Latvia (2001) Russian Federation (2001) Denmark (1999) Ukraine (2000) Slovenia (2001) Kazakhstan (2001) Belarus (2001) Estonia (2001) Iceland (1997) France (1999) TFYR Macedonia (2000) Lithuania (2001) Bulgaria (2001) Netherlands (2000) Greece (1999) Spain (1999) Republic of Moldova (2001) Armenia (2000) Germany (1999) Luxembourg (2001) Italy (1999) Austria (2001) Ireland (2000) United Kingdom (2000) Norway (1999) Switzerland (1999) Albania (2000) San Marino (2000) Portugal (2000) Malta (2001) Israel (1998) Sweden (1999) Azerbaijan (2001) Finland (2001) Georgia (2001) Kyrgyzstan (2001) Turkmenistan (1998) Uzbekistan (2001) Tajikistan (1999) 0 67.0 46.9 42.3 41.9 40.9 40.8 40.0 37.8 37.5 37.4 37.1 35.5 35.3 34.7 34.6 34.2 34.2 34.1 33.8 32.9 32.8 32.2 31.5 31.1 30.6 30.0 28.2 27.8 27.5 26.9 26.5 26.0 25.7 24.3 23.3 20.5 20.3 19.9 18.7 18.5 18.1 17.7 16.8 16.6 15.5 11.7 9.8 6.3 10 20 30 40 50 60 70 80

Per 100 000 population

Life and death Causes of death

Deaths from female breast cancer, 25–64 years Belgium (1996) Ireland (2000) Iceland (1997) Denmark (1999) Armenia (2000) Netherlands (2000) Yugoslavia (2000) Hungary (2001) Ukraine (2000) Estonia (2001) United Kingdom (2000) Israel (1998) Latvia (2001) France (1999) TFYR Macedonia (2000) Germany (1999) Russian Federation (2001) Slovenia (2001) Republic of Moldova (2001) Lithuania (2001) Croatia (2001) Romania (2001) Italy (1999) Slovakia (2000) Austria (2001) Kazakhstan (2001) Portugal (2000) Luxembourg (2001) Malta (2001) Czech Republic (2001) Georgia (2001) Bulgaria (2001) Switzerland (1999) Belarus (2001) Finland (2001) Norway (1999) Poland (2000) Spain (1999) Sweden (1999) Greece (1999) Azerbaijan (2001) Bosnia and Herzegovina (1991) Kyrgyzstan (2001) Uzbekistan (2001) Albania (2000) Turkmenistan (1998) Tajikistan (1999) 0 38.4 38.4 38.2 35.3 34.5 33.2 32.8 32.4 32.3 32.1 31.7 30.4 30.2 30.0 29.9 29.1 28.9 28.9 28.8 28.7 28.2 25.8 25.6 25.2 25.2 25.2 24.7 24.7 24.6 24.4 24.4 23.9 23.8 23.7 23.6 23.5 23.5 22.9 22.5 21.4 19.9 19.0 17.2 14.5 14.2 11.3 8.8 10 20 30 40

Per 100 000 females

48 Causes of death

Atlas of health in Europe

Deaths from female breast cancer 30

Per 100 000 females

15 CIS 10 1980 1985 1990 Year 1995 2000 CSEC EU

Deaths from cervical cancer 10 9 8 Per 100 000 females

7 6 5 4 3 CIS 2 1980 1985 1990 Year 1995 2000 CSEC EU

Life and death Causes of death

Deaths from cervical cancer, 25–64 years Romania (2001) Republic of Moldova (2001) Lithuania (2001) Poland (2000) Yugoslavia (2000) Kyrgyzstan (2001) Hungary (2001) Bulgaria (2001) Ukraine (2000) Kazakhstan (2001) Slovakia (2000) Latvia (2001) Russian Federation (2001) Czech Republic (2001) Estonia (2001) TFYR Macedonia (2000) Georgia (2001) Belarus (2001) Denmark (1999) Uzbekistan (2001) Armenia (2000) Tajikistan (1999) Ireland (2000) Norway (1999) Portugal (2000) Luxembourg (2001) Germany (1999) Turkmenistan (1998) Slovenia (2001) United Kingdom (2000) Bosnia and Herzegovina (1991) Iceland (1997) Croatia (2001) Azerbaijan (2001) Sweden (1999) Israel (1998) Belgium (1996) Netherlands (2000) Spain (1999) France (1999) Greece (1999) Austria (2001) Albania (2000) Switzerland (1999) Finland (2001) Italy (1999) Malta (2001) 0 20.0 15.1 14.6 11.9 10.9 10.7 10.6 10.2 9.9 9.6 9.4 8.7 8.5 8.5 8.0 7.5 7.1 6.8 6.8 6.6 6.0 5.7 5.2 5.1 4.8 4.6 4.3 4.2 4.1 4.0 3.9 3.8 3.5 3.5 3.3 3.2 3.1 2.9 2.7 2.6 2.5 2.5 2.3 1.9 1.7 1.2 1.0 5 10 15 20 25

Per 100 000 females

50 Causes of death

Atlas of health in Europe

Deaths from external causes of injury and poisoning 200

150 Per 100 000 population

100

CIS 0 1980 1985

CSEC

1990 Year

1995

2000

< 250 – < 150 – < 80 – < 60 – < 40 – No data Per 100 000 population

Life and death Causes of death

Deaths from external causes of injury and poisoning, 0–64 years Russian Federation (2001) Belarus (2001) Estonia (2001) Lithuania (2001) Kazakhstan (2001) Ukraine (2000) Latvia (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Hungary (2001) Romania (2001) Poland (2000) Turkmenistan (1998) Finland (2001) Slovenia (2001) Slovakia (2000) Uzbekistan (2001) Czech Republic (2001) Bulgaria (2001) Luxembourg (2001) Albania (2000) Croatia (2001) Belgium (1996) France (1999) Tajikistan (1999) Austria (2001) Greece (1999) Portugal (2000) Ireland (2000) Iceland (1997) Denmark (1999) Yugoslavia (2000) Spain (1999) TFYR Macedonia (2000) Switzerland (1999) Armenia (2000) Georgia (2001) Norway (1999) Germany (1999) Azerbaijan (2001) Sweden (1999) Israel (1998) Italy (1999) United Kingdom (2000) Malta (2001) Netherlands (2000) 200 82.0 56.0 57.3 52.1 61.0 49.4 52.6 41.7 32.7 22.1 23.7 18.5 29.4 24.9 17.8 17.1 23.7 17.9 16.8 25.1 17.5 16.4 23.6 21.4 13.6 16.8 15.4 13.2 13.7 13.6 19.2 14.8 12.5 11.7 15.2 9.1 7.9 14.6 13.8 11.3 15.3 10.1 9.9 11.7 10.9 11.7 100 0 278.5 270.3 264.7 263.8 246.8 246.3 162.2 134.2 94.2 94.0 92.5 92.3 91.7 87.1 86.6 78.2 70.3 70.2 69.9 69.5 68.8 63.0 62.9 57.1 55.2 54.4 53.1 52.9 52.4 52.0 51.6 48.0 45.4 44.6 44.2 43.9 43.6 41.5 40.3 40.1 39.9 37.5 35.9 30.0 28.8 100 200 300 400 500 369.6

Per 100 000 population, females

Per 100 000 population, males

52 Causes of death

Atlas of health in Europe

Deaths from motor vehicle traffic accidents Latvia (2001) Lithuania (2001) Russian Federation (1998) Greece (1999) Luxembourg (2001) Poland (2000) Belarus (2001) Republic of Moldova (2001) Spain (1999) Belgium (1996) Slovenia (2001) Croatia (2001) Estonia (2001) Romania (2001) France (1999) Slovakia (2000) Portugal (2000) Hungary (2001) Kyrgyzstan (2001) Italy (1999) Czech Republic (2001) Kazakhstan (2001) Ukraine (2000) Bulgaria (2001) Austria (2001) Ireland (2000) Israel (1998) Denmark (1999) Uzbekistan (2001) Germany (1999) Turkmenistan (1998) San Marino (2000) Finland (2001) Norway (1999) Yugoslavia (2000) Switzerland (1999) Netherlands (2000) Azerbaijan (2000) Armenia (2000) United Kingdom (2000) TFYR Macedonia (2000) Sweden (1999) Iceland (1997) Malta (2001) Georgia (2001) Tajikistan (1999) Albania (2000) 0 23.48 21.52 19.71 19.30 17.62 15.67 14.75 14.20 14.18 13.92 13.75 13.51 13.49 13.31 12.99 12.96 12.47 12.39 12.30 12.14 11.64 11.48 10.96 10.67 9.72 9.70 9.34 9.22 9.19 8.93 8.47 8.45 7.77 7.31 6.75 6.64 6.47 5.67 5.57 5.50 5.37 5.37 4.63 4.33 3.99 3.82 2.14 5 10 15 20 25 30

Per 100 000 population

Life and death Causes of death

Deaths from motor vehicle traffic accidents 25 CIS CSEC EU Per 100 000 population

10 1980 1985 1990 Year 1995 2000

Deaths from suicide 35 CIS 30 CSEC EU

Per 100 000 population

10 1980 1985 1990 Year 1995 2000

54 Causes of death

Atlas of health in Europe

Deaths from suicide Lithuania (2001) Russian Federation (2001) Kazakhstan (2001) Belarus (2001) Latvia (2001) Ukraine (2000) Estonia (2001) Hungary (2001) Slovenia (2001) Finland (2001) Republic of Moldova (2001) Belgium (1996) Croatia (2001) Switzerland (1999) Austria (2001) France (1999) Luxembourg (2001) Yugoslavia (2000) Poland (2000) Czech Republic (2001) Bulgaria (2001) Kyrgyzstan (2001) Slovakia (2000) Denmark (1999) Iceland (1997) Norway (1999) Sweden (1999) Ireland (2000) Romania (2001) Germany (1999) Turkmenistan (1998) Bosnia and Herzegovina (1991) Uzbekistan (2001) Netherlands (2000) TFYR Macedonia (2000) Malta (2001) United Kingdom (2000) Spain (1999) Italy (1999) Israel (1998) Tajikistan (1999) Portugal (2000) Azerbaijan (2001) San Marino (2000) Greece (1999) Albania (2000) Georgia (2001) Armenia (2000) 0 43.7 37.9 32.6 32.4 28.6 28.2 28.1 26.6 26.5 22.0 18.3 18.3 17.8 16.3 16.3 16.1 16.0 15.1 14.8 14.4 14.3 14.2 13.4 13.3 13.2 13.0 12.7 12.1 11.9 11.9 10.9 9.9 9.2 8.9 7.6 7.4 7.0 7.0 6.0 5.9 4.5 4.4 4.4 3.6 3.3 2.3 2.1 1.8 10 20 30 40 50 Per 100 000 population

Life and death Causes of death

Deaths from diseases of the respiratory system CIS 100 CSEC EU

Per 100 000 population

40 1980 1985 1990 Year 1995 2000

< 150 – < 100 – < 75 – < 60 – < 40 – No data Per 100 000 population

56 Causes of death

Atlas of health in Europe

Deaths from diseases of the respiratory system Kyrgyzstan (2001) Ireland (2000) Turkmenistan (1998) United Kingdom (2000) Tajikistan (1999) Kazakhstan (2001) Malta (2001) Republic of Moldova (2001) Uzbekistan (2001) Portugal (2000) Spain (1999) Denmark (1999) Belgium (1996) Ukraine (2000) Netherlands (2000) Azerbaijan (2001) Albania (2000) Russian Federation (2001) Romania (2001) Belarus (2001) Iceland (1997) Norway (1999) Slovenia (2001) Slovakia (2000) Finland (2001) Luxembourg (2001) Armenia (2000) Poland (2000) Yugoslavia (2000) France (1999) Greece (1999) Sweden (1999) Switzerland (1999) Germany (1999) Bulgaria (2001) Israel (1998) Italy (1999) Czech Republic (2001) Bosnia and Herzegovina (1991) Lithuania (2001) TFYR Macedonia (2000) Estonia (2001) Croatia (2001) Hungary (2001) Austria (2001) Latvia (2001) San Marino (2000) Georgia (2001) 0 128.0 115.3 111.8 104.6 104.6 94.4 81.2 79.8 79.8 77.5 73.0 71.8 70.1 67.4 67.3 65.6 65.5 63.4 63.1 60.2 59.9 58.4 54.9 54.5 50.3 49.3 47.4 46.2 45.4 44.8 44.3 40.9 40.5 39.7 39.1 38.7 38.2 37.7 37.6 37.2 36.8 36.7 35.2 33.6 30.9 28.5 27.7 21.0 25 50 75 100 125 150

Per 100 000 population

Life and death Causes of death

Deaths from diseases of the digestive system 50

45 Per 100 000 population

CIS 30 1980 1985

CSEC

1990 Year

1995

2000

< 130 – < 60 – < 45 – < 35 – < 30 – No data Per 100 000 population

58 Causes of death

Atlas of health in Europe

Deaths from diseases of the digestive system Republic of Moldova (2001) Hungary (2001) Kyrgyzstan (2001) Romania (2001) Turkmenistan (1998) Uzbekistan (2001) Azerbaijan (2001) Kazakhstan (2001) Slovenia (2001) Slovakia (2000) Russian Federation (2001) Tajikistan (1999) Croatia (2001) Estonia (2001) Ukraine (2000) Denmark (1999) Lithuania (2001) Latvia (2001) Luxembourg (2001) Poland (2000) Czech Republic (2001) Bosnia and Herzegovina (1991) Germany (1999) Spain (1999) Portugal (2000) France (1999) Austria (2001) United Kingdom (2000) Belgium (1996) Belarus (2001) Finland (2001) Bulgaria (2001) Italy (1999) Yugoslavia (2000) Ireland (2000) Georgia (2001) Netherlands (2000) Armenia (2000) Switzerland (1999) Malta (2001) Norway (1999) Israel (1998) Albania (2000) Sweden (1999) TFYR Macedonia (2000) Greece (1999) Iceland (1997) San Marino (2000) 0 128.2 81.6 67.8 67.4 64.8 62.7 56.6 56.5 55.9 50.9 46.1 45.2 44.8 42.8 42.1 41.3 38.9 38.5 38.0 37.4 37.3 36.9 35.6 34.3 33.9 32.0 31.9 31.9 30.9 30.4 29.9 29.7 28.8 28.1 26.6 25.9 25.8 25.0 22.8 21.5 20.7 20.0 20.0 19.6 18.8 16.1 15.2 9.2 50 100 150

Per 100 000 population

Diseases

3. Diseases Notes Tuberculosis (pp. 61–62) The figures present rates of newly diagnosed tuberculosis cases, including relapses, of all forms and in all organs. Syphilis (pp. 65–66) Syphilis is considered a good indicator of the trends in all sexually transmitted diseases. In the 1990s, the eastern part of the Region suffered an epidemic-like increase in the incidence of syphilis. HIV/AIDS (pp. 67–69) The data for HIV/AIDS are collected by the European Centre for the Epidemiological Monitoring of AIDS in Paris (a UNAIDS/WHO collaborating centre on AIDS). While the AIDS data for the most recent years are adjusted for reporting delays, the data for HIV infections are as reported by countries. Reported new HIV infections have increased dramatically in some countries in the eastern and central parts of the Region, particularly in the Russian Federation and the Baltic states. Cancer (pp. 72–74) The right side of each bar chart shows the number of people newly diagnosed with cancer during the given year per 100 000 population. Data sources are usually national cancer registers. The incidence of lung cancer is clearly correlated with the death rate. This correlation is less clear in the case of female breast and cervical cancer. Hospital discharges (pp. 75–83) The rates represent the total number of patients per 100 000 population discharged from all hospitals (including through death) during the year, categorized by the principal diagnosis. The intercountry comparability of hospital discharge data is limited,

Atlas of health in Europe owing to the differences in how hospital data collection systems are organized in different countries, and the differences in health care systems in general. Particular caution should therefore be applied when discharge data are used as an estimate of morbidity. Teeth (p. 84) The average number of decayed, missing or filled teeth among 12year-old children is the commonly used index to assess the oral health situation. The data are collected by the WHO oral health programme and the WHO Collaborating Centre for Education, Training and Research in Oral Health, at Malmö University, Sweden.

Diseases Some infectious diseases

New cases of tuberculosis 80 CIS CSEC EU

Per 100 000 population

0 1980 1985 1990 Year 1995 2000

< 180 – < 100 – < 70 – < 40 – < 20 – Per 100 000 population

62 Some infectious diseases

Atlas of health in Europe

New cases of tuberculosis, 2001 Kazakhstan Kyrgyzstan Romania Russian Federation Georgia Latvia Republic of Moldova Turkmenistan Ukraine Lithuania Uzbekistan Bosnia and Herzegovina Azerbaijan Tajikistan Belarus Estonia Bulgaria Yugoslavia Portugal Armenia TFYR Macedonia Croatia Hungary Poland Turkey Slovakia Albania Slovenia Spain Andorra Belgium Austria Czech Republic Ireland United Kingdom France Denmark Finland Netherlands Germany Israel Switzerland Italy Luxembourg Norway Greece Sweden Iceland Malta 0 176.5 135.1 127.5 92.2 88.1 84.9 84.8 81.7 74.9 74.6 69.7 65.7 60.5 55.6 55.2 49.7 48.8 43.2 40.8 36.7 31.8 31.0 28.7 26.3 25.5 18.3 18.1 18.0 17.2 15.1 12.9 12.7 12.6 10.2 10.1 9.8 9.2 8.9 8.8 8.5 8.5 7.5 7.5 7.0 6.2 4.7 4.5 4.3 4.1 50 100 Per 100 000 population 150 200

Diseases Some infectious diseases

New cases of viral hepatitis B 40

Per 100 000 population

CIS 10

CSEC

0 1980 1985 1990 Year 1995 2000

< 40 – < 25 – < 15 – < 10 – < 5 – Per 100 000 population

64 Some infectious diseases

Atlas of health in Europe

New cases of viral hepatitis B Russian Federation (2001) Latvia (2001) Estonia (2001) Uzbekistan (2001) Iceland (2001) Ukraine (2001) Kyrgyzstan (2001) Luxembourg (2001) Kazakhstan (2001) Republic of Moldova (2001) Bulgaria (2001) Romania (2001) Turkmenistan (2001) Georgia (2001) Lithuania (2001) Netherlands (2001) Belarus (2001) Ireland (2001) France (1998) Turkey (2001) TFYR Macedonia (2001) Poland (2001) Belgium (2001) Croatia (2001) Yugoslavia (2001) Norway (2001) Czech Republic (2001) Tajikistan (2001) Bosnia and Herzegovina (1999) Armenia (2001) Andorra (2001) Germany (2001) Slovakia (2001) Austria (2001) Finland (2001) Sweden (2001) Azerbaijan (2001) Portugal (2001) Greece (2001) Albania (2000) Spain (2001) Switzerland (2001) Israel (2001) United Kingdom (2001) Hungary (2001) Italy (2001) Malta (2001) Slovenia (2001) Denmark (2001) 0 23.7 21.7 19.4 19.1 18.6 16.0 15.9 14.3 12.0 11.9 11.0 11.0 10.2 9.7 8.9 8.7 8.3 7.6 6.2 5.2 4.5 4.5 4.5 4.4 3.6 3.5 3.2 3.0 3.0 2.8 2.6 2.5 2.4 2.1 2.1 2.1 2.0 2.0 1.7 1.7 1.6 1.6 1.5 1.3 0.9 0.8 10 20 Per 100 000 population 30 35.7 35.6 32.9

Diseases Some infectious diseases

New cases of syphilis 200 CIS CSEC EU

150 Per 100 000 population

100

0 1980 1985 1990 Year 1995 2000

< 170 – < 90 – < 30 – < 10 – < 4 – No data Per 100 000 population

66 Some infectious diseases

Atlas of health in Europe

New cases of syphilis Kazakhstan (2000) Russian Federation (2001) Ukraine (2000) Republic of Moldova (2001) Belarus (2001) Kyrgyzstan (2001) Romania (2001) Turkmenistan (1999) Estonia (2001) Uzbekistan (2001) Lithuania (2001) Latvia (2001) Georgia (2001) Bulgaria (2001) Tajikistan (2001) Iceland (2001) Czech Republic (2000) Azerbaijan (1999) Armenia (2001) Israel (2001) Slovakia (2000) Turkey (2001) Hungary (2001) Finland (2000) Austria (2001) United Kingdom (2000) Poland (2001) Switzerland (1998) Yugoslavia (2001) Spain (2000) Germany (1999) Portugal (2001) Ireland (2000) Slovenia (2001) Denmark (2001) Luxembourg (2000) Norway (2000) Belgium (2000) Sweden (2001) Netherlands (1998) Croatia (2001) Bosnia and Herzegovina (1999) Albania (1999) Italy (2000) TFYR Macedonia (2001) Greece (2001) Malta (2000) Andorra (2000) 0 161.4 144.1 91.6 86.5 80.5 60.6 56.0 47.7 29.9 27.6 25.3 25.2 25.2 18.4 11.7 11.4 9.4 7.2 5.8 5.8 5.7 5.0 4.2 3.9 3.9 3.0 2.7 2.4 1.9 1.7 1.4 1.3 1.2 1.2 1.0 0.9 0.9 0.9 0.9 0.8 0.5 0.4 0.3 0.2 0.1 0.0 0.0 0.0 50 100 150 200

Per 100 000 population

Diseases Some infectious diseases

New cases of clinically diagnosed AIDS Portugal (2001) Spain (2001) Italy (2001) France (2001) Switzerland (2001) Latvia (2001) Ukraine (2001) Belgium (2001) Denmark (2001) United Kingdom (2001) Romania (2001) Germany (2001) Israel (2001) Luxembourg (2001) Greece (2001) Austria (2001) Yugoslavia (2001) Norway (2001) Sweden (2001) Poland (2001) Iceland (2001) Ireland (2001) Finland (2001) Lithuania (2001) Netherlands (2001) Slovenia (2001) Georgia (2001) Azerbaijan (2001) Republic of Moldova (2001) Hungary (2001) Bulgaria (2001) Bosnia and Herzegovina (2001) Croatia (2001) Estonia (2001) TFYR Macedonia (2001) Armenia (2001) Albania (2000) Slovakia (2001) Czech Republic (2001) Turkey (2001) Belarus (2001) Russian Federation (2000) Tajikistan (2001) Uzbekistan (2001) Kazakhstan (1999) Kyrgyzstan (2001) Malta (2001) 0 10.25 5.95 3.07 2.77 2.37 1.74 1.72 1.53 1.46 1.19 0.95 0.94 0.92 0.91 0.84 0.66 0.65 0.60 0.54 0.37 0.36 0.34 0.33 0.29 0.28 0.25 0.24 0.21 0.21 0.20 0.18 0.16 0.16 0.15 0.15 0.11 0.10 0.09 0.06 0.06 0.05 0.02 0.02 0.02 0.01 0.00 0.00 1 2 3 4 5 6 7 8 9 10 11 12

Per 100 000 population

68 Some infectious diseases

Atlas of health in Europe

New cases of clinically diagnosed AIDS 7 CIS 6 CSEC 5 EU

Per 100 000 population

0 1980 1985 1990 Year 1995 2000

New cases of HIV infection 40 CIS CSEC EU

30 Per 100 000 population

0 1980 1985 1990 Year 1995 2000

Diseases Some infectious diseases

New cases of HIV infection, 2001 Estonia Russian Federation Latvia Portugal Ukraine San Marino Belgium Luxembourg Switzerland Kazakhstan Ireland United Kingdom Belarus Denmark Israel Republic of Moldova Greece Iceland Norway Sweden Kyrgyzstan Malta Finland Uzbekistan Lithuania Georgia Romania Germany Azerbaijan Poland Hungary Slovenia Armenia Albania Croatia Yugoslavia Tajikistan Bulgaria Czech Republic Turkey TFYR Macedonia Bosnia and Herzegovina Slovakia 0 108.1 60.6 34.3 25.1 14.3 11.5 9.4 9.1 8.8 7.9 7.8 7.3 5.8 5.6 5.6 5.5 4.1 3.9 3.6 3.1 3.1 2.8 2.5 2.2 2.1 2.1 2.0 1.6 1.6 1.5 0.8 0.8 0.8 0.7 0.7 0.6 0.5 0.5 0.5 0.3 0.3 0.2 0.2 25 50 75 100

Per 100 000 population

70 Some infectious diseases

Atlas of health in Europe

Selected outbreaks of infectious diseases, 2002 United Kingdom February Legionnaires' disease: 116 cases, 3 deaths September–December Salmonellosis: 19 outbreaks, almost 1000 cases, 10 deaths Sweden May Salmonellosis (imported): 342 cases Lithuania February Measles: 102 cases Russian Federation January Haemorrhagic fever with renal syndrome: 55 cases

Czech Republic February Cholera (imported): 2 cases

Belarus May Shigellosis: 606 cases

Tajikistan November–December Measles: 715 cases, 7 deaths

Spain February Trichinellosis: 26 cases

France August Q fever: 79 cases

Italy June Measles: 368 cases, 3 deaths

Albania December Hepatitis A: over 200 cases

Greece April Acute respiratory infection: 53 cases, 3 deaths

Yugoslavia (Kosovo) February Tularemia: 1462 cases

Diseases Some noncommunicable diseases

Prevalence of diabetes mellitus Malta (2001) Czech Republic (2001) Hungary (2001) Slovakia (2001) Portugal (1996) Italy (1995) Slovenia (1993) Belgium (2000) Israel (2000) France (2000) Sweden (1995) Finland (2001) Denmark (1999) Netherlands (1995) Norway (1995) Turkey (1998) TFYR Macedonia (1998) Ukraine (2001) Bulgaria (2000) Romania (2001) Latvia (2001) Lithuania (2001) Russian Federation (2001) Belarus (2001) Yugoslavia (1999) Bosnia and Herzegovina (2001) Georgia (2001) Armenia (2001) Republic of Moldova (2001) Kazakhstan (2001) Azerbaijan (2001) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1997) Tajikistan (2001) Greece (1998) Iceland (1995) 0 6.6 6.4 4.9 4.9 4.8 3.7 3.5 3.2 3.2 3.0 2.9 2.7 2.4 2.0 2.0 2.0 2.0 1.9 1.7 1.6 1.5 1.5 1.5 1.4 1.3 1.1 1.0 0.9 0.7 0.6 0.6 0.4 0.4 0.4 0.2 0.2 0.2 1 2 3 4 5 6 7

Percent of population

72 Some noncommunicable diseases

Atlas of health in Europe

Lung cancer incidence and deaths Hungary (2001) Croatia (2000) United Kingdom (1997) Italy (1995) Denmark (1998) Czech Republic (1999) Netherlands (1998) Estonia (2000) Poland (1996) Slovenia (1999) Germany (1997) Belgium (1996) TFYR Macedonia (1998) Latvia (2001) Lithuania (2001) Bulgaria (2001) Austria (1999) Norway (1999) Iceland (1997) Belarus (2001) Russian Federation (2001) Ukraine (2000) Ireland (2000) Slovakia (1999) Luxembourg (1999) France (1995) Malta (2000) Romania (1999) Sweden (1999) Finland (2000) Kazakhstan (2001) Armenia (2000) Israel (1998) Republic of Moldova (2001) Portugal (1993) Georgia (2001) Albania (2000) Kyrgyzstan (2001) Azerbaijan (2001) Uzbekistan (2001) Turkmenistan (1997) Tajikistan (1999) 150 77.6 56.6 59.1 53.9 61.6 54.7 55.0 50.2 48.9 49.0 45.4 64.2 29.3 47.6 41.6 36.9 40.1 38.3 42.8 37.1 39.7 38.2 41.4 40.2 46.0 41.2 31.4 35.4 33.9 35.7 24.4 22.2 19.7 22.4 26.1 18.1 19.0 8.1 9.8 3.9 5.3 2.3 100 50 0 Crude death rate per 100 000 population 95.4 74.1 65.9 63.9 63.5 58.0 55.9 54.0 53.6 52.5 51.8 49.4 47.4 46.5 45.1 44.7 44.5 44.1 43.9 43.8 43.2 43.0 41.4 40.5 39.3 37.6 37.3 33.8 32.7 32.0 27.0 23.5 22.0 17.1 16.5 16.0 13.3 12.1 7.4 4.9 3.8 2.2 50 100 150 New cases per 100 000 population

Diseases Some noncommunicable diseases

Female breast cancer incidence and deaths 33.1 Sweden (1999) Denmark (1998) 50.7 31.0 Luxembourg (1999) 31.0 Finland (2000) 44.6 Netherlands (1998) 44.6 United Kingdom (1997) 36.2 France (1995) 43.1 Hungary (2001) 35.0 Ireland (2000) Malta (2000) 52.4 32.6 Iceland (1997) 42.1 Germany (1998) 29.9 Israel (1998) 37.5 Austria (1999) 31.3 Norway (1999) Belgium (1996) 48.0 38.7 Slovenia (1999) 37.0 Croatia (2000) 35.9 Czech Republic (1999) 38.4 Italy (1995) 26.3 Bulgaria (2001) 37.5 Estonia (2000) 32.2 Latvia (2001) 29.5 Lithuania (2001) 28.8 Slovakia (1999) 28.7 Portugal (1993) 20.8 TFYR Macedonia (1998) 28.2 Russian Federation (2001) 30.3 Ukraine (2000) 24.0 Belarus (2001) 23.9 Poland (1996) 25.3 Romania (1999) 22.5 Georgia (2001) 22.7 Armenia (2000) 16.7 Kazakhstan (2001) 22.1 Republic of Moldova (2001) 8.3 Albania (2000) 9.1 Azerbaijan (2001) 7.7 Kyrgyzstan (2001) 5.4 Uzbekistan (2001) 4.5 Turkmenistan (1997) 2.6 Tajikistan (1999) 80 40 0 Crude death rate per 100 000 population 140.9 136.6 133.5 133.2 129.9 125.6 113.5 112.7 112.7 112.0 110.3 110.1 106.1 105.5 105.0 104.5 98.0 96.1 94.9 94.9 82.1 72.9 70.2 66.3 66.3 62.2 59.4 59.1 56.1 53.9 48.8 41.3 39.2 35.1 34.4 33.3 22.9 19.1 16.8 11.9 9.4 8.2 40 80 120 160 New cases per 100 000 population 200

74 Some noncommunicable diseases

Atlas of health in Europe

Cervical cancer incidence and deaths Bulgaria (2001) Lithuania (2001) Hungary (2001) Estonia (2000) TFYR Macedonia (1998) Czech Republic (1999) Slovenia (1999) Poland (1996) Slovakia (1999) Croatia (2000) Ukraine (2000) Portugal (1993) Germany (1998) Russian Federation (2001) Denmark (1998) Belarus (2001) Latvia (2001) Kazakhstan (2001) Republic of Moldova (2001) Norway (1999) Armenia (2000) Kyrgyzstan (2001) Austria (1999) Luxembourg (1999) France (1995) Ireland (2000) United Kingdom (1997) Georgia (2001) Sweden (1999) Iceland (1997) Netherlands (1998) Belgium (1996) Uzbekistan (2001) Israel (1998) Turkmenistan (1997) Tajikistan (1999) Azerbaijan (2001) Finland (2000) Albania (2000) Malta (2000) 8.9 12.4 10.1 8.3 4.2 7.4 5.1 10.2 8.0 4.0 9.3 3.8 4.7 8.2 6.6 6.6 8.7 7.0 9.7 5.2 4.4 4.9 4.1 4.1 2.6 3.4 4.6 5.8 3.6 3.7 3.5 3.4 2.6 1.8 3.4 1.5 1.6 2.9 1.2 2.6 30 25 20 15 10 5 0 26.7 26.1 23.2 22.0 21.4 21.4 19.9 19.6 19.3 19.2 17.9 17.8 16.7 15.9 15.8 14.9 14.3 13.7 12.7 12.6 12.2 11.8 11.6 11.4 11.0 10.9 10.8 10.5 10.0 9.6 9.2 9.1 8.7 6.1 5.7 4.8 4.7 4.6 3.9 3.1 5 10 15 20 25 30 35 New cases per 100 000 population

Crude death rate per 100 000 population

Diseases Hospitalization

Hospital discharges for cancer Austria (2000) Finland (2001) Germany (1999) Denmark (2000) France (2000) Hungary (2000) Czech Republic (2001) Belgium (1998) Norway (2001) Slovenia (2001) Sweden (2001) Lithuania (2001) Slovakia (2001) Estonia (2001) Belarus (2001) Greece (1998) Romania (2001) Italy (2000) Iceland (1994) Latvia (2001) Croatia (2001) Poland (1996) United Kingdom (1994) Russian Federation (2001) Bulgaria (2001) Israel (1999) Spain (1999) Ireland (2001) Portugal (2001) Netherlands (2001) TFYR Macedonia (2000) Ukraine (2001) Kazakhstan (2001) Republic of Moldova (2001) Turkey (2000) Andorra (2001) Malta (2001) Albania (2000) Armenia (2001) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1997) Georgia (2001) Azerbaijan (2001) Tajikistan (2001) 0 3636 2415 2315 1981 1963 1919 1908 1883 1775 1743 1665 1614 1608 1585 1503 1442 1411 1377 1306 1269 1171 1147 1076 1039 994.5 973.7 882.3 828.0 795.6 772.6 652.5 623.8 549.9 430.0 373.0 363.2 325.2 291.3 280.9 248.0 222.8 199.2 190.4 103.4 88.3 500 1000 1500 2000 2500 3000 3500 4000

Per 100 000 population

76 Hospitalization

Atlas of health in Europe

Hospital discharges for cancer CIS 1500 CSEC EU Per 100 000 population

1250

1000

750

500 1980 1985 1990 Year 1995 2000

Hospital discharges for diseases of the circulatory system 2500 CIS CSEC EU

2250 Per 100 000 population

2000

1750

1500 1980 1985 1990 Year 1995 2000

Diseases Hospitalization

Hospital discharges for diseases of the circulatory system Belarus (2001) Hungary (2000) Lithuania (2001) Austria (2000) Finland (2001) Czech Republic (2001) Germany (1999) Estonia (2001) Latvia (2001) Russian Federation (2001) Sweden (2001) Ukraine (2001) Romania (2001) Denmark (2000) Belgium (1998) Slovakia (2001) Italy (2000) Norway (2001) France (2000) Greece (1998) Iceland (1994) Israel (1999) Poland (1996) Bulgaria (2001) Slovenia (2001) Croatia (2001) United Kingdom (1994) Ireland (2001) Kazakhstan (2001) Netherlands (2001) Spain (1999) Republic of Moldova (2001) Yugoslavia (1996) TFYR Macedonia (2000) Portugal (2001) Uzbekistan (2001) Kyrgyzstan (2001) Turkey (2000) Turkmenistan (1997) Malta (2001) Andorra (2001) Tajikistan (2001) Albania (2000) Armenia (2001) Azerbaijan (2001) Georgia (2001) 0 4749 4239 4163 4074 3653 3410 3367 3237 3136 3020 2812 2774 2741 2658 2609 2569 2544 2371 2244 2214 2181 2181 2122 2013 1738 1691 1607 1522 1389 1374 1363 1310 1300 1267 1193 1059 1036 983.6 875.1 664.6 609.8 560.6 539.9 508.4 483.7 411.6 1000 2000 3000 4000 5000 6000

Per 100 000 population

78 Hospitalization

Atlas of health in Europe

Hospital discharges for diseases of the respiratory system Belarus (2001) Romania (2001) Ukraine (2001) Russian Federation (2001) Lithuania (2001) Finland (2001) Latvia (2001) Uzbekistan (2001) Hungary (2000) Estonia (2001) Austria (2000) Bulgaria (2001) Kazakhstan (2001) Turkmenistan (1997) Kyrgyzstan (2001) Belgium (1998) Denmark (2000) Israel (1999) Iceland (1994) Republic of Moldova (2001) Ireland (2001) Czech Republic (2001) Slovakia (2001) France (2000) Norway (2001) Poland (1996) Greece (1998) Germany (1999) Slovenia (2001) Tajikistan (2001) Italy (2000) United Kingdom (1994) Albania (2000) TFYR Macedonia (2000) Spain (1999) Croatia (2001) Sweden (2001) Andorra (2001) Turkey (2000) Yugoslavia (1996) Azerbaijan (2001) Portugal (2001) Georgia (2001) Netherlands (2001) Malta (2001) Armenia (2001) 0 4310 3087 2973 2942 2892 2257 2239 2231 2159 2104 2045 2027 2016 1950 1941 1750 1609 1596 1522 1485 1470 1468 1418 1370 1357 1309 1305 1264 1227 1211 1203 1198 1187 1148 1100 1078 1025 879.1 865.2 864.3 838.1 740.2 694.7 620.7 565.9 483.6 1000 2000 3000 4000 5000

Per 100 000 population

Diseases Hospitalization

Hospital discharges for diseases of the respiratory system CIS 3500 CSEC EU 3000

Per 100 000 population

2500

2000

1500

1000 1980 1985 1990 Year 1995 2000

Hospital discharges for diseases of the digestive system 2300 CIS CSEC 2100 EU Per 100 000 population

1900

1700

1500

1300 1980 1985 1990 Year 1995 2000

80 Hospitalization

Atlas of health in Europe

Hospital discharges for diseases of the digestive system Belarus (2001) France (2000) Belgium (1998) Romania (2001) Austria (2000) Lithuania (2001) Russian Federation (2001) Ukraine (2001) Czech Republic (2001) Latvia (2001) Slovakia (2001) Germany (1999) Hungary (2000) Estonia (2001) Finland (2001) Italy (2000) Greece (1998) Denmark (2000) Republic of Moldova (2001) Slovenia (2001) Kazakhstan (2001) Ireland (2001) Poland (1996) Iceland (1994) Israel (1999) Uzbekistan (2001) Kyrgyzstan (2001) Croatia (2001) Sweden (2001) Spain (1999) Albania (2000) Bulgaria (2001) United Kingdom (1994) Turkmenistan (1997) Norway (2001) Portugal (2001) Andorra (2001) Yugoslavia (1996) TFYR Macedonia (2000) Tajikistan (2001) Netherlands (2001) Malta (2001) Turkey (2000) Azerbaijan (2001) Armenia (2001) Georgia (2001) 0 3204 2936 2647 2418 2323 2200 2191 2105 2084 2056 1917 1911 1835 1834 1778 1724 1702 1661 1561 1524 1422 1384 1362 1361 1337 1319 1315 1298 1291 1289 1264 1257 1253 1201 1157 1061 1042 928.3 926.3 923.3 817.9 758.5 729.9 573.9 503.9 466.0 1000 2000 Per 100 000 population 3000 4000

Diseases Hospitalization

Hospital discharges for diseases of the musculoskeletal system Austria (2000) Finland (2001) Belarus (2001) Belgium (1998) Hungary (2000) France (2000) Germany (1999) Czech Republic (2001) Estonia (2001) Latvia (2001) Iceland (1994) Lithuania (2001) Norway (2001) Russian Federation (2001) Romania (2001) Denmark (2000) Ukraine (2001) Italy (2000) Slovakia (2001) Slovenia (2001) Sweden (2001) United Kingdom (1994) Bulgaria (2001) Andorra (2001) Greece (1998) Spain (1999) Netherlands (2001) Poland (1996) Kyrgyzstan (2001) Croatia (2001) Republic of Moldova (2001) Ireland (2001) Israel (1999) Uzbekistan (2001) Kazakhstan (2001) TFYR Macedonia (2000) Portugal (2001) Turkmenistan (1997) Tajikistan (2001) Turkey (2000) Yugoslavia (1996) Malta (2001) Armenia (2001) Albania (2000) Azerbaijan (2001) Georgia (2001) 0 2834 2127 2054 2001 1730 1550 1449 1437 1315 1250 1238 1136 1108 1103 1082 1016 987.4 928.3 908.0 879.3 830.0 761.7 738.4 687.0 661.9 646.8 643.8 601.9 601.2 600.3 572.0 566.1 476.9 459.7 407.5 402.2 323.9 307.1 301.0 281.7 234.4 167.2 124.0 118.1 89.8 62.2 500 1000 1500 2000 2500 3000 3500

Per 100 000 population

82 Hospitalization

Atlas of health in Europe

Hospital discharges for diseases of the musculoskeletal system CIS 1100 CSEC EU Per 100 000 population

900

700

500 1980

1985

1990 Year

1995

2000

Hospital discharges for injury and poisoning 1750 CIS CSEC EU

Per 100 000 population

1500

1250

1000 1980 1985 1990 Year 1995 2000

Diseases Hospitalization

Hospital discharges for injury and poisoning Austria (2000) Latvia (2001) Lithuania (2001) Finland (2001) Belarus (2001) Belgium (1998) France (2000) Germany (1999) Russian Federation (2001) Denmark (2000) Norway (2001) Czech Republic (2001) Ireland (2001) Ukraine (2001) Slovenia (2001) Sweden (2001) Kazakhstan (2001) Hungary (2000) Italy (2000) Iceland (1994) Greece (1998) Andorra (2001) Romania (2001) United Kingdom (1994) Israel (1999) Slovakia (2001) Estonia (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Poland (1996) Bulgaria (2001) Croatia (2001) Spain (1999) Uzbekistan (2001) Netherlands (2001) Turkmenistan (1997) Portugal (2001) TFYR Macedonia (2000) Tajikistan (2001) Albania (2000) Yugoslavia (1996) Malta (2001) Turkey (2000) Georgia (2001) Armenia (2001) Azerbaijan (2001) 0 3159 2211 2210 2126 2093 2087 2054 1993 1916 1909 1708 1697 1656 1608 1591 1560 1489 1487 1472 1467 1460 1346 1345 1325 1324 1321 1268 1219 1210 1112 1056 946.3 878.1 752.2 744.5 730.6 719.4 588.6 455.6 441.6 432.4 400.0 396.8 335.9 318.3 208.7 1000 2000 Per 100 000 population 3000 4000

84 Teeth

Atlas of health in Europe

Decayed, missing or filled teeth in 12-year-olds Romania (1998) Bosnia and Herzegovina (2001) Lithuania (1994) Ukraine (1992) Slovakia (1999) Bulgaria (1998) Latvia (1998) Poland (1999) Hungary (1996) Russian Federation (1995) San Marino (1990) Croatia (1999) Czech Republic (1998) Belarus (1999) Portugal (1999) TFYR Macedonia (1999) Albania (1996) Estonia (1998) Greece (1998) Turkmenistan (1990) Turkey (1996) Armenia (1990) Georgia (1990) Spain (1994) Italy (1996) Kazakhstan (1990) France (1998) Slovenia (1998) Austria (1997) Belgium (1998) Malta (1991) Iceland (1996) Norway (1999) Israel (1994) Republic of Moldova (1995) Germany (2000) Tajikistan (1990) Finland (1997) Ireland (1997) Kyrgyzstan (1993) Denmark (2001) Sweden (2001) United Kingdom (2001) Uzbekistan (2001) Switzerland (1996) Luxembourg (1999) Netherlands (1998) 0 7.3 6.1 4.9 4.4 4.3 4.2 4.2 4.1 3.8 3.7 3.7 3.5 3.4 3.3 3.1 3.0 2.9 2.7 2.7 2.6 2.5 2.4 2.4 2.3 2.1 2.1 1.9 1.8 1.7 1.6 1.6 1.5 1.5 1.4 1.3 1.2 1.2 1.1 1.1 1.1 0.9 0.9 0.9 0.9 0.8 0.7 0.6 1 2 3 4 5 6 7 8 9

Average number per child

Lifestyles and environment

4. Lifestyles and environment Notes Smoking (pp. 87–88 ) Countries estimate the percentage of regular daily smokers aged 15 years and over on the basis of health interview surveys. The tobacco-free Europe programme, at the WHO Regional Office for Europe, collates the data. Most of the estimates are based on multiple sources, however, and population samples are not always representative of a whole country. Intercountry comparisons should therefore be made with caution. Smoking prevalence among young people (15-year-olds) is estimated in a more uniform way across the European Region, through the WHO Health Behaviour in School-aged Children Study. The Study does not collect data for all countries, however. Average cigarette consumption is estimated on the basis of data published by the Tobacco journal international. Alcohol (pp. 89–91) The data show the estimated amount of pure ethanol consumed in the form of spirits, wine, beer and other alcoholic drinks, per person per year. This estimate is calculated from official statistics on local production, sales, imports and exports, taking into account stocks and home production whenever possible. The alcohol and drugs programme, at the WHO Regional Office for Europe, collects data and makes calculations mainly from three sources: World drink trends (published regularly by Productschap voor Gedistilleerde Dranken, Schiedam, Netherlands), the FAO and data reported directly by countries. In the Republic of Moldova, and probably in some other countries too, the total consumption of alcohol, particularly spirits, is likely to be somewhat overestimated, owing to the low reported export

Atlas of health in Europe figures. As no data were available on stocks, it was assumed that all spirits produced and not otherwise accounted for were “consumed”. Foodborne disease (p. 92) Infections or intoxications due to microbiologically contaminated food include such diseases as trichinellosis, salmonellosis, and Campylobacter enteritis. National definitions and registration practices vary significantly, therefore intercountry comparability is limited. Work-related deaths (pp. 93–94) The data source is the ILO. Motor vehicle traffic accidents (p. 95) The main data source for accidents is Statistics of road traffic accidents in Europe and North America regularly published by the UNECE, in Geneva. Data on deaths from traffic accidents come from the WHO mortality database. Traffic accident registration practices vary significantly among countries, thus limiting international comparisons. The available data show that the number of registered accidents per 100 000 population is lowest in the eastern and some central European countries, but the number of people killed per 1000 accidents in these countries is the highest. This correlation is most likely partially the result of incomplete registration of all accidents in these countries, but also of the really low traffic safety precautions in the eastern part of the Region.

Lifestyles and environment Smoking

Smokers among adults and 15-year-olds Bosnia and Herzegovina (1995) Yugoslavia (2000) Hungary (2000) Albania (2000) Poland (1993) Greece (2000) Russian Federation (1998) TFYR Macedonia (1999) Andorra (1997) Bulgaria (1996) Turkey (1993) Germany (2000) Netherlands (2001) Spain (2001) Ukraine (2000) Switzerland (1997) Georgia (1998) Lithuania (2000) Ireland (1998) Croatia (2000) Belgium (2000) Denmark (2000) Kyrgyzstan (1999) Luxembourg (2000) Norway (2001) Estonia (2000) Latvia (1999) Armenia (1998) Austria (2000) Slovakia (1998) Kazakhstan (2000) France (2000) Israel (2000) United Kingdom (2000) Azerbaijan (1997) Belarus (2001) Italy (2000) Czech Republic (2002) Finland (2001) Slovenia (2001) Iceland (2001) Romania (2000) Portugal (1999) Sweden (2001) Republic of Moldova (2001) Turkmenistan (1990) Malta (1995) 40 a

48 47 19.1 16.3 9.9 15.8 9.8 42 39 39 38 36 36 36 36 35 35 35 34 34 33 33 32 31 30 30 30 30 30 30 29 29 29 29 29 28 27 27 27 27 26 25 24 24 24 24 21 21 19 18 14 8.5 30 20 10 0 9 10 20 30 40 50

27.5 19.2 20.1 24.4 17.1 19.1 15.8 16.9 18.5 14.8 17.8 17.3 17.6 22.1 19.8 9.7 17.7 16.1 21.6 22.7 22.9 16.5 9.8

Percent of 15-year-oldsa Data refer to 2001 / 2002

Percent of adults (age 15+)

88 Smoking

Atlas of health in Europe

Smokers among adult males

< 65 – < 55 – < 50 – < 40 – < 30 – No data % of adult male population

Cigarette consumption 2250

2000 Number per person per year

1750

1500

1250 CIS 1000 1980 1985 1990 Year 1995 2000 CSEC EU

Lifestyles and environment Alcohol

Total alcohol consumption 12

Litres (pure alcohol equivalent) per person per year

11 10 9 8 7 6 5 4 1980 1985

CIS

CSEC

1990 Year

1995

2000

< 16 – < 11 – < 9 – < 7 – < 5 – Litres (pure alcohol equivalent) per person per year

90 Alcohol

Atlas of health in Europe

Total alcohol consumption, 2000 Republic of Moldova Portugal Luxembourg Ireland Czech Republic France Slovenia Croatia Germany Austria Lithuaniaa Slovakia Spain Switzerland Denmark Hungary Russian Federation Finland Belgium United Kingdom Italy Greece Netherlands Latvia Estonia Yugoslavia Belarus Poland Romania Bulgaria Sweden Azerbaijan Bosnia and Herzegovina Georgia Iceland Norway Malta TFYR Macedonia Ukraine Kyrgyzstan Kazakhstan Israel Albania Armenia Turkey Uzbekistan Turkmenistan Tajikistan 0 a

15.9 14.0 13.8 13.3 12.6 10.8 10.6 10.4 10.4 10.1 10.0 9.9 9.6 9.4 9.4 9.1 8.1 8.1 8.0 7.9 7.9 7.8 7.7 7.5 7.2 6.8 6.7 6.6 6.5 6.1 5.4 5.2 5.1 4.8 4.2 4.2 3.7 3.2 3.1 2.5 1.7 1.4 1.4 1.3 1.1 0.9 0.8 0.7 5 10 15

2001

Litres (pure alcohol equivalent) per person

Lifestyles and environment Alcohol

Consumption of spirits, 2000 Republic of Moldova Latvia Russian Federation Belarus Slovakia Portugal Azerbaijan Lithuaniaa Bosnia and Herzegovina Czech Republic Poland Hungary Slovenia Estonia France Spain Ireland Bulgaria Ukraine Finland Yugoslavia Greece Germany Netherlands Luxembourg United Kingdom Switzerland Austria Croatia Belgium Kazakhstan Denmark Romania Iceland Armenia Sweden Malta Norway Israel Turkey Georgia Italy Tajikistan Albania 0 a

11.4 5.6 5.5 5.3 4.6 4.5 4.2 4.0 4.0 3.4 3.2 2.8 2.8 2.6 2.4 2.4 2.4 2.3 2.2 2.2 2.1 1.9 1.9 1.7 1.6 1.6 1.5 1.4 1.3 1.2 1.2 1.2 1.1 1.1 1.0 1.0 0.9 0.7 0.6 0.6 0.5 0.5 0.5 0.4 1 2 3 4 5 6 7 8 9 10 11 12

2001

Litres (pure alcohol equivalent) per person

92 Foodborne disease

Atlas of health in Europe

Cases of microbiological foodborne disease Czech Republic (2001) Slovakia (2001) Georgia (2001) Germany (2000) United Kingdom (2000) Denmark (2001) Austria (1992) Switzerland (2001) Norway (2001) Ireland (2001) Luxembourg (2001) Lithuania (1998) Tajikistan (1992) Turkmenistan (1992) Malta (2001) Iceland (2001) Finland (2001) Hungary (2001) Bosnia and Herzegovina (2001) Slovenia (2001) Albania (1998) Spain (1996) Belgium (1999) TFYR Macedonia (2001) Croatia (2001) France (1992) Israel (2001) Turkey (2000) Romania (2001) Andorra (2001) Republic of Moldova (2001) Estonia (2001) Russian Federation (1999) Belarus (2001) Ukraine (2000) Greece (2001) Armenia (2001) Kazakhstan (2001) Azerbaijan (2001) Kyrgyzstan (2001) Uzbekistan (2001) 0 595.0 374.9 259.6 238.5 164.1 146.0 140.4 131.0 125.8 100.2 82.8 76.6 73.6 67.0 61.3 50.9 48.7 45.4 36.7 35.7 35.0 28.3 28.1 27.4 25.5 19.1 17.3 14.7 12.5 12.1 6.9 6.3 5.5 2.2 2.1 2.1 1.3 0.5 0.1 0.1 0.1 100 200 300 400 500 600 700

Per 100 000 population

Lifestyles and environment Work and traffic accidents

Deaths from work-related accidents 6

Per 100 000 population

1 CIS 0 1980 1985 1990 Year 1995 2000 CSEC EU

<4 – <2 – < 1.5 – <1 – < 0.5 – No data Per 100 000 population

94 Work and traffic accidents

Atlas of health in Europe

Deaths from work-related accidents Russian Federation (1999) Latvia (2001) Portugal (2000) Ukraine (2001) Spain (2001) Luxembourg (2001) Italy (2000) Belarus (2001) Lithuania (2001) Estonia (2001) Czech Republic (2001) Romania (2001) Slovakia (2001) Kazakhstan (1999) Austria (2000) Slovenia (2001) Bulgaria (2000) Ireland (2001) Israel (2001) Andorra (1997) Malta (2001) Turkey (2001) Poland (2001) Germany (2000) Hungary (2001) Belgium (2001) France (1999) Switzerland (1999) Denmark (2001) Republic of Moldova (2001) Norway (2001) Finland (1999) Kyrgyzstan (2001) Yugoslavia (1999) Greece (1998) Sweden (2000) Netherlands (2000) Croatia (2001) Armenia (2001) United Kingdom (2000) Iceland (2001) Azerbaijan (2001) Tajikistan (2001) TFYR Macedonia (2001) 0 2.9 2.9 2.8 2.7 2.6 2.5 2.5 2.4 2.3 2.2 2.0 1.9 1.9 1.9 1.8 1.7 1.7 1.7 1.6 1.5 1.5 1.5 1.4 1.4 1.3 1.2 1.2 1.2 0.9 0.9 0.8 0.8 0.8 0.8 0.7 0.7 0.6 0.6 0.4 0.4 0.4 0.3 0.3 0.2 1 2 Per 100 000 population 3

Lifestyles and environment Work and traffic accidents

Motor vehicle traffic accidents and deaths Austria (2000) Germany (1999) Belgium (1996) Portugal (2000) Slovenia (2000) Israel (1998) United Kingdom (2000) Iceland (1997) Italy (1999) Switzerland (1999) Croatia (1999) Netherlands (1997) Czech Republic (2000) Spain (1999) Greece (1999) France (1999) Luxembourg (2000) Ireland (2000) Latvia (2000) Norway (1999) Sweden (1999) Hungary (2000) Malta (1998) Lithuania (2000) Poland (2000) Slovakia (2000) Denmark (1999) Finland (2000) Russian Federation (1998) Estonia (2000) Bulgaria (2000) TFYR Macedonia (2000) Yugoslavia (2000) Kazakhstan (2000) Ukraine (2000) Belarus (2000) Republic of Moldova (2000) Kyrgyzstan (2000) Uzbekistan (1999) Georgia (2000) Turkmenistan (1998) Romania (2000) Azerbaijan (2000) Armenia (2000) Tajikistan (1999) Albania (2000) 20 19 30 31 36 21 15 13 35 21 50 27 54 63 92 63 92 51 141 41 32 75 23 118 109 91 65 58 184 146 125 63 87 123 167 238 168 152 155 101 205 387 196 217 100 122 519 482 480 432 428 424 391 384 380 327 285 263 248 247 230 212 206 205 189 187 179 171 171 166 148 146 143 128 110 110 84 84 80 76 68 64 60 55 49 38 34 34 25 25 24 14

500 400 300 200 100 0 100 200 300 400 500 600 Deaths per 1000 accidents Accidents per 100 000 population

Atlas of health in Europe

Health care

5. Health care Notes Physicians (pp. 99–100) The data show the number of practising physicians working in public or private health services. Not all countries report the data strictly according to the recommended definitions. Countries also differ in the way they compile national statistics on employment in the health sector. The number of physicians per head of population is steadily increasing in western and, to a lesser extent, in central parts of the Region. Previously high and increasing ratios in the eastern part began to decline in the early 1990s. Dentists (pp. 100–101) The data include dentists who have completed university level studies in dentistry and are actually working in dental care. Nurses (p. 102) The data show nurses who have completed a programme of nursing education (either basic or at university level), and are qualified and authorized in their country to practice nursing in all settings for the promotion of health, the prevention of illness, the care of the sick and rehabilitation. The international comparability of statistics on nurses is particularly limited, owing to the variations in national definitions and practices. Hospital beds (pp.103–105) The number of available beds includes beds in all hospitals, regardless of specialty. The main limitation on intercountry comparability is that some countries count nursing homes and similar institutions as hospitals while others do not.

Atlas of health in Europe The number of hospital beds per 100 000 population and the average length of stay are clearly declining throughout the Region, with the highest levels still in the eastern part. A number of countries have seen a remarkable reduction in psychiatric beds. Inpatient hospital admissions (pp. 106–107) The inpatient hospital admissions rate is steadily increasing in western and central parts of the Region. Previously high rates in the eastern part dropped during the 1990s and averages for all three parts of the Region are currently very close. Nevertheless, the hospital admissions rates vary significantly from country to country. Caesarean sections (pp. 107–108) The number of Caesarean sections performed is increasing throughout the Region. The highest rates are currently in the western part of the Region, and the lowest in the eastern part. Childhood vaccination (p. 109) The data show the percentage of infants reaching their first birthday in the given year who have been fully vaccinated (with three doses) against diphtheria, and the percentage of children reaching their second birthday who have been vaccinated against measles. Health expenditure (pp. 110–112) The data source for OECD countries is the OECD health database. The remaining countries reported the data directly. Health expenditure in some of these countries, particularly in the eastern part of the Region, is likely to be underestimated, owing to the exclusion of the private sector and out-of-pocket payments. The health expenditure, both as a percentage of gross domestic product (GDP) and in international dollars (purchasing power parities expressed in US $ (US $PPP)) per person, varies significantly between countries. In the western part of the Region, expenditure is steadily increasing while in the eastern part it is stable or increasing much more slowly, thus further increasing the east–west gap.

Health care Health personnel

Number of physicians Italy (1999) Belarus (2001) Greece (1999) Georgia (2001) Russian Federation (2001) Belgium (2001) Lithuania (2001) Israel (2001) Norway (2002) Germany (2001) Azerbaijan (2001) Hungary (1999) Iceland (2001) Switzerland (2000) Kazakhstan (2001) Bulgaria (2001) Czech Republic (2001) France (2001) Spain (2000) Netherlands (2001) Slovakia (2001) Austria (2001) Portugal (2000) Estonia (2001) Finland (2001) Turkmenistan (1997) Ukraine (2001) Uzbekistan (2001) Malta (2001) Latvia (2001) Armenia (2001) Sweden (1999) Denmark (1999) Kyrgyzstan (2001) Republic of Moldova (2001) Andorra (2001) Luxembourg (2001) San Marino (1990) Ireland (2001) Croatia (2001) Poland (2000) TFYR Macedonia (2001) Slovenia (2001) Yugoslavia (1999) Tajikistan (2001) Romania (2001) United Kingdom (1993) Bosnia and Herzegovina (2001) Albania (2000) Turkey (2001) 0 100 567 450 438 430 420 419 403 375 367 363 359 355 352 350 345 344 342 330 329 328 326 323 318 313 311 300 298 293 291 291 287 287 284 272 271 265 254 252 239 238 220 219 219 213 212 189 164 145 139 123 200 300 400 500 600 700

Per 100 000 population

100 Health personnel

Atlas of health in Europe

Number of physicians 400

350 Per 100 000 population

300

250

CIS 200 1980 1985 1990 Year

CSEC

1995

2000

Number of dentists 70 CIS 60 CSEC EU

Per 100 000 population

20 1980 1985 1990 Year 1995 2000

Health care Health personnel

101

Number of dentists Sweden (1997) Norway (2001) Monaco (1995) Greece (1999) Israel (2001) Iceland (2000) Finland (2001) Denmark (1999) Bulgaria (2001) Estonia (2001) Germany (2001) Lithuania (2001) Belgium (1998) Croatia (2001) France (2001) Czech Republic (2001) Luxembourg (2001) Andorra (2001) Slovenia (2001) Italy (2000) Hungary (1999) TFYR Macedonia (2001) Latvia (2001) Ireland (2001) Austria (2001) Netherlands (2001) Switzerland (2001) Spain (2000) Slovakia (2001) Belarus (2001) Portugal (2000) Albania (1998) Malta (2001) United Kingdom (1992) Ukraine (2001) Yugoslavia (1999) San Marino (1984) Georgia (2001) Russian Federation (2001) Republic of Moldova (2001) Poland (2000) Kazakhstan (2001) Azerbaijan (2001) Turkey (2000) Romania (2001) Kyrgyzstan (2001) Turkmenistan (1997) Uzbekistan (2001) Armenia (2001) Bosnia and Herzegovina (2001) Tajikistan (2001) 0 125.4 121.4 115.3 114.7 100.7 91.2 85.6 81.9 80.2 77.9 71.5 69.7 68.1 68.0 65.1 64.1 63.6 59.1 57.4 56.9 55.2 52.9 52.3 47.2 46.8 44.5 44.3 44.2 44.1 42.8 41.4 40.2 39.8 39.3 38.5 36.4 32.6 32.1 31.2 30.4 29.2 26.1 24.3 22.6 21.9 21.6 21.2 18.7 18.1 16.7 30 60 90 120 152.1

150

180

Per 100 000 population

102 Health personnel

Atlas of health in Europe

Number of nurses Finland (2001) Norway (2001) Ireland (2000) Monaco (1995) Netherlands (2001) Belarus (2001) Belgium (1996) Uzbekistan (2001) Germany (2001) Czech Republic (2001) Denmark (1999) Iceland (1999) Sweden (1999) Lithuania (2001) Russian Federation (2001) Switzerland (1990) Ukraine (2001) Luxembourg (2001) Slovakia (2000) Azerbaijan (2001) Slovenia (2001) Kyrgyzstan (2001) France (2001) Republic of Moldova (2001) Estonia (2001) Kazakhstan (2001) Israel (2001) Turkmenistan (1997) Austria (2000) Poland (1990) TFYR Macedonia (2001) San Marino (1990) Latvia (2001) Croatia (2001) Bulgaria (2001) Yugoslavia (1999) Bosnia and Herzegovina (2001) Tajikistan (2001) Georgia (2001) Romania (2001) Albania (2001) Armenia (2001) Malta (2001) Spain (2000) Portugal (2000) Andorra (2001) Hungary (2000) Greece (1992) Turkey (2000) 0 1676 1621 1328 1236 1075 1011 955 944 937 869 843 798 793 779 768 768 748 738 715 684 669 629 623 593 591 587 583 527 518 508 508 500 450 449 445 426 423 403 391 386 375 372 367 309 281 257 244 500 1000 1500 2000 2500 2171 2068

Per 100 000 population

Health care Hospitals

103

Hospital beds 1300 1200 1100

Per 100 000 population

1000 900 800 700 600 500 1980 1985 1990 Year 1995 2000

CIS

CSEC

Length of stay in hospital

15 Average number of days

CIS 9 1980 1985

CSEC

1990 Year

1995

2000

104 Hospitals

Atlas of health in Europe

Number of beds and length of stay in hospital Belarus (2001) Luxembourg (1996) Russian Federation (2001) Lithuania (2001) Germany (2000) Iceland (1996) Ukraine (2001) Austria (2000) Czech Republic (2001) Azerbaijan (2001) Hungary (2001) Latvia (2001) France (2000) Slovakia (2001) Romania (2001) Finland (2001) Bulgaria (2001) Turkmenistan (1997) Belgium (2001) Kazakhstan (2001) Estonia (2001) Tajikistan (2001) Switzerland (2000) Israel (2001) Kyrgyzstan (2001) Croatia (2001) Republic of Moldova (2001) Poland (2000) Yugoslavia (1999) Uzbekistan (2001) Sweden (2001) Slovenia (2001) TFYR Macedonia (2001) Greece (1998) Netherlands (2001) Italy (2000) Norway (2001) Denmark (2000) Georgia (2001) Armenia (2001) United Kingdom (1997) Spain (2001) Portugal (1999) Ireland (2001) Albania (2000) Bosnia and Herzegovina (2001) Turkey (2001) 50 13.3 15.3 15.2 10.9 11.9 13.7 14.6 7.6 11.5 17.5 8.7 11.3 10.8 10.0 8.6 10.3 10.7 13.4 11.5 14.1 8.7 14.0 13.0 11.1 13.3 11.8 12.5 8.9 11.0 11.6 6.3 8.3 11.8 8.3 12.5 7.6 7.7 6.6 9.7 11.7 9.8 9.7 9.0 7.5 6.9 10.5 5.8 25 0 1258 1100 1083 922 912 903 874 861 852 851 825 820 820 779 749 737 720 711 699 697 672 640 618 616 615 600 589 556 541 534 522 516 493 488 466 450 440 434 430 427 417 401 392 357 326 322 236 250 500 750 1000 1250 1500

Average number of days

Beds per 100 000 population

Health care Hospitals

105

Psychiatric hospital beds Netherlands (2001) Latvia (2001) Malta (2001) Germany (2000) Lithuania (2001) Iceland (1995) Russian Federation (2001) Belgium (2001) Switzerland (2000) Czech Republic (2001) Ireland (2001) France (2000) Croatia (2001) Finland (2001) Belarus (2001) Luxembourg (1998) Ukraine (2001) Greece (1999) Slovakia (2001) Israel (2001) United Kingdom (1997) Yugoslavia (1999) Denmark (1999) Romania (2001) Slovenia (2001) Portugal (1998) Estonia (2001) TFYR Macedonia (2001) Poland (2000) Norway (2001) Kazakhstan (2001) Bulgaria (2001) Sweden (2000) Austria (2000) Kyrgyzstan (2001) Republic of Moldova (2001) Spain (1997) Azerbaijan (2001) Turkmenistan (1997) Bosnia and Herzegovina (2001) Hungary (2000) Armenia (2001) Uzbekistan (2001) Albania (2000) Tajikistan (2001) Georgia (2001) Andorra (2001) Italy (2000) Turkey (2001) 0 153.9 150.1 143.3 127.6 122.4 117.9 117.3 116.1 115.6 113.7 110.2 107.1 102.7 100.4 99.3 97.1 96.3 92.1 87.0 85.0 81.9 80.0 78.0 76.0 75.1 69.8 68.4 68.1 67.4 67.2 65.3 64.3 62.5 61.3 59.2 58.4 56.7 49.8 44.7 44.5 43.4 40.3 31.3 29.4 26.8 26.2 18.2 14.2 12.3 50 Latest value 1980

100 150 200 250 300 Per 100 000 population

350

400

106 Hospitals

Atlas of health in Europe

Inpatient hospital admissions Belarus (2001) Austria (2000) Hungary (2001) Finland (2001) Romania (2001) Lithuania (2001) Germany (2000) France (1999) Russian Federation (2001) Iceland (1995) Latvia (2001) Czech Republic (2001) Slovakia (2001) Belgium (1998) Ukraine (2001) Estonia (2001) Luxembourg (1994) Denmark (2001) Israel (2001) Norway (2001) Switzerland (1998) Slovenia (2001) Sweden (2001) Italy (2000) Croatia (2001) Poland (2000) Kazakhstan (2001) Greece (1998) Bulgaria (2001) United Kingdom (1998) Ireland (2001) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1997) Republic of Moldova (2001) Portugal (1998) Spain (1997) Yugoslavia (1999) Netherlands (2001) Tajikistan (2001) TFYR Macedonia (2001) Albania (2001) Turkey (2001) Bosnia and Herzegovina (2001) Armenia (2001) Azerbaijan (2001) Georgia (2001) 0 30.0 29.2 26.1 26.0 24.4 24.0 23.5 23.0 22.5 21.6 20.7 20.2 19.7 19.7 19.7 19.7 19.4 18.9 18.7 17.6 16.9 16.6 16.6 16.5 15.8 15.5 15.5 15.4 15.3 15.1 14.8 14.5 13.8 13.0 12.5 12.0 11.5 10.6 9.3 9.0 9.0 8.8 7.8 7.8 4.9 4.9 4.5 10 20 Per 100 population 30

Health care Hospitals

107

Inpatient hospital admissions CIS 24 CSEC EU

Per 100 population

15 1980 1985 1990 Year 1995 2000

Some procedures

Caesarean sections 200 CIS CSEC EU

150

Per 1000 live births

100

50 1980 1985 1990 Year 1995 2000

108 Some procedures

Atlas of health in Europe

Caesarean sections Italy (1999) Portugal (1998) Malta (2001) Greece (1991) Andorra (1999) Hungary (2001) Germany (2000) Spain (1997) Austria (2001) Ireland (2000) Switzerland (1991) Iceland (2001) Slovakia (2001) Belarus (2001) Finland (2001) Latvia (2001) Poland (1997) France (1999) Belgium (1999) Romania (2001) Estonia (2001) Denmark (2000) Israel (2000) Russian Federation (2001) Bulgaria (2001) Sweden (1999) United Kingdom (1995) Norway (2000) Netherlands (2001) Turkey (1998) Lithuania (2001) Albania (2001) Czech Republic (2001) Slovenia (2001) Croatia (2001) Ukraine (2001) Georgia (2001) TFYR Macedonia (2001) Armenia (2001) Kazakhstan (2001) Republic of Moldova (2001) Yugoslavia (1998) Kyrgyzstan (2001) Uzbekistan (2001) Azerbaijan (2001) Turkmenistan (1997) Luxembourg (1998) Tajikistan (2001) 0 319.3 275.3 243.2 240.0 237.3 211.8 208.9 198.0 188.6 185.5 177.0 167.7 166.5 164.0 163.6 163.5 161.2 161.1 159.2 156.3 155.1 152.7 150.1 147.6 147.0 144.0 141.5 136.6 136.4 136.0 135.1 130.3 129.5 125.2 119.1 114.1 103.6 102.2 78.6 74.2 67.4 53.3 40.9 33.2 31.0 28.8 18.1 13.9 50 100 150 200 250 300 350

Per 1000 live births

Health care Some procedures

109

Children vaccinated against measles and diphtheria Iceland (1999) Hungary (2001) Slovakia (2001) Belarus (2001) Ukraine (2001) Sweden (1997) Finland (1999) Latvia (2001) Kyrgyzstan (2001) Czech Republic (2000) Poland (2001) Portugal (2001) France (1998) Luxembourg (1997) Monaco (1991) Albania (2001) Yugoslavia (2001) Azerbaijan (2001) Romania (1999) Belgium (1999) Republic of Moldova (2001) Denmark (2001) Netherlands (1998) Uzbekistan (2001) Tajikistan (2001) San Marino (2000) Russian Federation (2001) Kazakhstan (2001) Turkmenistan (2001) Spain (2000) Italy (1999) Switzerland (1991) Israel (2001) Lithuania (2001) Croatia (2001) Armenia (2001) Bulgaria (2001) Estonia (2001) United Kingdom (2001) Slovenia (2001) Norway (2001) TFYR Macedonia (2001) Greece (1997) Andorra (1998) Georgia (2001) Germany (1997) Bosnia and Herzegovina (2000) Ireland (2001) Austria (2001) Turkey (2001) Malta (1999) 99.9 99.9 99.4 100 98.8 96.0 98.0 98.3 98.9 97.1 97.2 86.8 83.0 91.0 98.0 95.0 95.1 98.9 98.2 82.4 94.1 94.0 96.0 98.9 96.8 74.2 98.4 99.0 97.6 95.2 70.0 83.0 94.0 97.4 93.6 95.5 90.0 94.7 84.7 94.0 90.0 92.2 90.0 90.0 55.0 75.0 73.9 73.2 78.5 84.0 87.0 0 99.9 99.8 99.4 99.3 99.1 99.0 99.0 99.0 98.7 98.4 98.3 98.1 98.0 98.0 98.0 97.8 97.8 97.5 97.3 97.1 97.1 97.0 97.0 96.9 96.7 95.8 95.8 95.8 95.4 95.2 95.0 95.0 95.0 94.6 94.4 93.7 93.6 93.5 93.3 92.3 91.0 90.5 90.0 89.0 85.7 85.0 84.9 84.3 83.6 83.0 81.0 25 50 75 100 125 150 Percent of infants (diphtheria)

150 125 100 75 50 25 Percent of children (measles)

110 Health expenditure

Atlas of health in Europe

Total health expenditure as a percent of GDP Switzerland (2000) Germany (2000) France (2000) Greece (2001) Croatia (1994) Malta (2001) Iceland (2000) Israel (2001) Belgium (2000) Denmark (2001) Slovenia (2001) Portugal (2000) Netherlands (2000) Italy (2001) Austria (2000) Sweden (1998) Spain (2000) Yugoslavia (2000) Norway (2000) Czech Republic (2001) United Kingdom (2000) Ireland (2000) Finland (2000) Slovakia (2000) Poland (1999) Luxembourg (1999) Lithuania (2001) Hungary (2001) Estonia (2001) Georgia (2000) Latvia (2001) Bulgaria (1994) Belarus (2001) TFYR Macedonia (2000) Romania (1999) Turkey (2000) Armenia (1993) Turkmenistan (1996) Ukraine (2001) Russian Federation (2000) Republic of Moldova (2001) Uzbekistan (2001) Kyrgyzstan (2001) Albania (2000) Kazakhstan (2001) Tajikistan (1998) Azerbaijan (2001) 0 a

10.7 10.6 9.5 9.2 9.0 8.9 8.9 8.8 8.7 8.4 8.2 8.2 8.1 8.0 8.0 7.9 7.7 7.6 7.5 7.4 7.3 6.7 6.6 6.5 6.2 6.0 5.7 5.7 5.5 5.1 4.8 4.7 4.6 4.5 4.5 4.3 4.2 3.5 3.4 2.9 2.9 2.6 2.3 1.9 1.6 1.2 0.8 2 4 6 Percent of GDP 8

Latest value 1991a

1992 in Germany

Health care Health expenditure

111

Total health expenditure as a percent of GDP 9 8 7 6 Percent of GDP

5 4 3 2 1 0 1980 1985 1990 Year 1995 2000 CIS CSEC EU

Total health expenditure per person 2000 CIS CSEC EU

US $PPP per person

1500

1000

500

0 1980 1985 1990 Year 1995 2000

112 Health expenditure

Atlas of health in Europe

Total health expenditure per person Switzerland (2000) Germany (2000) Luxembourg (1999) Iceland (2000) Denmark (2000) France (2000) Belgium (2000) Norway (2000) Netherlands (2000) Austria (2000) Italy (2000) Ireland (2000) United Kingdom (2000) Sweden (1998) Israel (2000) Finland (2000) Spain (2000) Malta (2000) Portugal (2000) Greece (2000) Slovenia (2000) Czech Republic (2000) Hungary (2000) Slovakia (2000) Estonia (2000) Poland (1999) Lithuania (2000) Croatia (1994) Latvia (2000) Belarus (2000) Turkey (2000) Romania (1999) Russian Federation (2000) TFYR Macedonia (2000) Bulgaria (1994) Ukraine (2000) Georgia (2000) Kazakhstan (2000) Armenia (1993) Uzbekistan (2000) Albania (2000) Republic of Moldova (2000) Kyrgyzstan (2000) Turkmenistan (1994) Azerbaijan (2000) Tajikistan (1998) 0 a 1992

3222 2748 2613 2608 2420 2349 2269 2268 2246 2162 2032 1953 1763 1748 1671 1664 1556 1522 1441 1399 1389 1031 841 690 594 557 426 358 338 332 297 272 243 229 214 160 136 112 86 73 67 63 52 49 26 12 1000 2000 US $PPP per person

Latest value 1991a

3000

4000

in Germany

The WHO Regional Ofﬁce for Europe The World Health Organization (WHO) is a specialized agencyof the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Ofﬁce for Europe is one of six regional ofﬁces throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan

ATLAS OF HEALTH IN EUROPE

This statistical atlas presents key health ﬁgures for the WHO European Region. They cover basic data on populations, births, deaths, life expectancy and diseases, lifestyle and environmental indicators such as drinking, smoking and trafﬁc accidents, and types and levels of health care. All indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. Using the WHO Regional Ofﬁce for Europe’s unique health for all database, combined with the best alternative sources of data around the Region, this atlas offers the most comprehensive overview of health in Europe. In a handy size, this atlas is designed to be an easily accessible resource at all times, in the ofﬁce or on the road.

92 890 1370 2 Sw.fr. 20.-

World Health Organization Regional Ofﬁce for Europe Scherﬁgsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-Mail: postmaster@euro.who.int Web site: www.euro.who.int

The WHO Regional Offi ce for Europe The World Health Organization (WHO) is a specialized agencyof the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Offi ce for Europe is one of six regional offi ces throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan 92 890 1370 2 Sw.fr. 20.- ATLAS OF HEALTH IN EUROPE This statistical atlas presents key health fi gures for the WHO European Region. They cover basic data on populations, births, deaths, life expectancy and diseases, lifestyle and environmental indicators such as drinking, smoking and traffi c accidents, and types and levels of health care. All indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. Using the WHO Regional Offi ce for Europe’s unique health for all database, combined with the best alternative sources of data around the Region, this atlas offers the most comprehensive overview of health in Europe. In a handy size, this atlas is designed to be an easily accessible resource at all times, in the offi ce or on the road. World Health Organization Regional Offi ce for Europe Scherfi gsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-Mail: postmaster@euro.who.int Web site: www.euro.who.int iThe World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organization seeks to support national health strategies and address the most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health. Atlas of health in europa_inside cover.p65 14-05-2003, 14:081 iAtlas of health in Europe Atlas of health in europa_start.p65 14-05-2003, 14:091 ii WHO Library Cataloguing in Publication Data Atlas of health in Europe. 1. Health surveys – statistics – atlases 2. Health status 3. Morbidity – statistics 4. Mortality – statistics 5. Europe ISBN 92 890 1370 2 (NLM Classification : WA 17) Atlas of health in europa_start.p65 14-05-2003, 14:092 iii Atlas of health in Europe Atlas of health in europa_start.p65 14-05-2003, 14:093 Atlas of health in Europeiv ISBN 92 890 1370 2 Address requests for copies of publications of the WHO Regional Office to publicationrequests@euro.who.int; for permission to reproduce them to permissions@euro.who.int; and for per- mission to translate them to pubrights@euro.who.int; or contact Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark (tel.: +45 3917 1717; fax: +45 3917 1818; web site: http://www.euro.who.int). © World Health Organization 2003 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 of 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. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN ITALY Atlas of health in europa_start.p65 14-05-2003, 14:094 Contents v Contents Foreword ........................................................................... 1 Technical notes ................................................................. 3 1. Demography .......................................................... 7 Notes ................................................................................. 7 Population Mid-year population, 2002 ............................................ 9 Natural population growth............................................. 10–11 Age pyramid, 2000 ....................................................... 11 Young population, 0–14 years ...................................... 12 Old population, 65 years and over ................................ 13–14 Births Birth rate ....................................................................... 15–16 Low-weight births, under 2500 g.................................. 16–17 Births to young mothers, under 20 years ..................... 18 Births to older mothers, 35 years and over .................. 18 Abortions Abortions ....................................................................... 19 2. Life and death ........................................................ 21 Notes ................................................................................. 21 Life expectancy Conventional and estimated life expectancy ................ 26 Life expectancy at birth and at 65 years ....................... 27 Estimated disability-adjusted life expectancy, 2001 ..... 28 Life expectancy at birth ................................................. 29 Deaths Deaths from all causes .................................................. 29–31 Infant deaths ................................................................. 32–33 Perinatal deaths ............................................................ 34 Maternal deaths ............................................................ 35–36 Causes of death Main causes of death by age group ............................. 36 Deaths from: diseases of the circulatory system ............................ 37–38 ischaemic heart diseases .......................................... 39–40 Atlas of health in europa_start.p65 14-05-2003, 14:095 Atlas of health in Europevi cerebrovascular diseases ......................................... 40–41 cancer ....................................................................... 42–44 lung cancer ............................................................... 44–46 female breast cancer ................................................ 47–48 cervical cancer .......................................................... 48–49 external causes of injury and poisoning .................... 50–51 motor vehicle traffic accidents .................................. 52–53 suicide ....................................................................... 53–54 diseases of the respiratory system ........................... 55–56 diseases of the digestive system .............................. 57–58 3. Diseases ................................................................ 59 Notes ................................................................................. 59 Some infectious diseases New cases of: tuberculosis ............................................................... 61–62 viral hepatitis B .......................................................... 63–64 syphilis ...................................................................... 65–66 clinically diagnosed AIDS .......................................... 67–68 HIV infection .............................................................. 68–69 Selected outbreaks of infectious diseases, 2002 ......... 70 Some noncommunicable diseases Prevalence of diabetes mellitus ..................................... 71 Lung cancer incidence and deaths ............................... 72 Female breast cancer incidence and deaths ................ 73 Cervical cancer incidence and deaths .......................... 74 Hospitalization Hospital discharges for: cancer ....................................................................... 75–76 diseases of the circulatory system ............................ 76–77 diseases of the respiratory system ........................... 78–79 diseases of the digestive system .............................. 79–80 diseases of the musculoskeletal system ................... 81–82 injury and poisoning .................................................. 82–83 Teeth Decayed, missing or filled teeth in 12-year-olds ........... 84 Atlas of health in europa_start.p65 14-05-2003, 14:096 Contents vii 4. Lifestyles and environment ..................................... 85 Notes ................................................................................. 85 Smoking Smokers among adults and 15-year-olds ..................... 87 Smokers among adult males ........................................ 88 Cigarette consumption .................................................. 88 Alcohol Total alcohol consumption ............................................ 89–90 Consumption of spirits, 2000 ........................................ 91 Foodborne disease Cases of microbiological foodborne disease ................ 92 Work and traffic accidents Deaths from work-related accidents ............................. 93–94 Motor vehicle traffic accidents and deaths ................... 95 5. Health care ............................................................ 97 Notes ................................................................................. 97 Health personnel Number of: physicians ................................................................. 99–100 dentists ..................................................................... 100–101 nurses ....................................................................... 102 Hospitals Hospital beds ................................................................ 103 Length of stay in hospital .............................................. 103 Number of beds and length of stay in hospital ............. 104 Psychiatric hospital beds .............................................. 105 Inpatient hospital admissions ........................................ 106–107 Some procedures Caesarean sections ....................................................... 107–108 Children vaccinated against measles and diphtheria .... 109 Health expenditure Total health expenditure as a percent of GDP .............. 110–111 Total health expenditure per person .............................. 111–112 Atlas of health in europa_start.p65 14-05-2003, 14:097 viii Atlas of health in europa_start.p65 14-05-2003, 14:098 1Foreword Decisions in the area of public health are based on a profound understanding of a wide range of factors, health statistics among them. Policy-makers consider all the available data on the health status in their countries, and shape their policies and design their actions accordingly. The comparison of national with international health data is a major part of the complex picture of public health: statistics backed up by in-depth analyses can be a powerful resource to help health authorities identify failures and successes, constraints and good practices. The WHO Regional Office for Europe offers this atlas to a wide range of public health and medical professionals, as well as to a broader audience. Rich and elaborate data from various sources have been gathered, systematized, grouped and formatted to present readers with the most complete picture of the health of Europe that can be expressed through figures. We hope this statistical atlas will be useful for those committed to the improvement of public health Europe-wide. Marc Danzon Regional Director WHO Regional Office for Europe Foreword Atlas of health in europa.p65 14-05-2003, 14:111 2 Atlas of health in Europe Atlas of health in europa.p65 14-05-2003, 14:112 3Technical notes This publication contains basic health-related statistics for the 51 Member States of the WHO European Region. The data cover the main aspects of health and its determinants, i.e. basic demographic data, health status in terms of mortality and morbidity, and some indicators on lifestyles and the environment, health care resources and their utilization. The period covered runs from 1980 at the earliest to 2001 at the latest, depending on the data available in the various countries. The only exception is the mid-year population graph, which shows data for 2002. Most of the data used in this publication come from the Member States themselves, usually from statistical units of ministries of health or public health institutions, and national statistical institutions. These data are systematically collected by the technical units of WHO (at the Regional Office for Europe or in headquarters) or by WHO collaborating centres. All these data, and more, are available in databases accessible on the WHO/Europe web site (http://www.euro.who.int) Information sources > Data > European health for all database; and on the WHO headquarters web site (http://www.who.int) Research tools > WHOSIS. For the sake of completeness, some publicly available data collected and published by other international organizations (such as the International Labour Office (ILO), the United Nations Economic Commission for Europe (UNECE), the Organisation for Economic Co-operation and Development (OECD), and the Food and Agriculture Organization of the United Nations (FAO)) have also been included when appropriate, with the information source acknowledged. Data were compiled, validated and processed in a uniform way in order to improve the international comparability of statistics. Nevertheless, many factors, such as variations in national definitions, incomplete registration in some countries or other national specificities in data recording and processing, may influence the accuracy and comparability of the national statistics. Technical notes Atlas of health in europa.p65 14-05-2003, 14:113 4 Atlas of health in Europe Therefore, statistics, particularly in international comparisons, should always be interpreted with caution. The same applies to statistics for countries with very small populations (figures tend to “jump” up and down purely because of the small numbers registered). On the other hand, the “statistical noise” from possible data inaccuracies or random fluctuations due to small figures is usually not so high as to mask completely what the statistics show. Most of the data in this publication are presented in three standard graphic forms. The ranked bar-chart shows the relative position of each country in relation to other countries. The data used are from 2001, or the latest available year. But as the timing of data reporting to WHO varies a lot, data from different years often have to be used. As more recent data are provided, rankings may change. Serbia and Montenegro is still referred to as Yugoslavia, because that was the name that pertained at the time the data apply. The map aims to reveal specific geographical patterns in the data, such as the east–west mortality gradient. Again, data from different years may have to be used, although 2001 is the most common year. The line chart shows health trends over the last 20 years, in different parts of the Region. Technically, it is difficult to present trends separately for each of the 51 countries on one line chart. On the other hand, had only the average trends for the whole Region been given, some important sub-regional differences in health trends would not have been visible. Therefore, sub-regional population-weighted averages for each indicator are calculated for three groups of countries, representing the trends in the eastern, central and western parts of the Region. The first (eastern) group consists of the 12 countries of the former USSR that now constitute the Commonwealth of Independent States (CIS). The second (central) group is the 15 central and south-eastern European countries (CSEC) in rapid transition, including the three Baltic states. The third (western) group represents the western part of the Region, consisting of the 15 member states of the European Union (EU). Atlas of health in europa.p65 14-05-2003, 14:114 5Unless otherwise stated, death rates are age-standardized death rates (SDR), i.e. the number of deaths per 100 000 people in a “standard” population. This facilitates international comparability by removing differences in rates caused by different population age structures between countries. The European standard population (see the table below) was used to calculate the SDR. The mortality rates used cover all age groups: those aged under 65 (so called premature mortality) or aged 25–64 (representing the working age). Readers interested in other or more detailed age groups may consult the European health for all database. The European standard population structure Age Percent of Age Percent of (years) population (years) population 0 1.6 45–49 7 1–4 6.4 50–54 7 5–9 7 55–59 6 10–14 7 60–64 5 15–19 7 65–69 4 20–24 7 70–74 3 25–29 7 75–79 2 30–34 7 80–84 1 35–39 7 85+ 1 40–44 7 All ages 100 Technical notes Atlas of health in europa.p65 14-05-2003, 14:115 Atlas of health in Europe6 Atlas of health in europa.p65 14-05-2003, 14:116 Demography 7 1. Demography Notes Population (p. 9) In mid-2002, the population of the 51 countries of the WHO European Region totalled 874.6 million. The six largest countries (the Russian Federation, Germany, Turkey, France, United Kingdom, and Italy) make up more than half of the Region’s population. The data are estimates published by United Nations Statistical Division. Natural population growth (pp.10–11) In the 1990s, the decline in the number of births and the increase in the number of deaths reached a cross-over point for several countries, mostly in the central and eastern part of the Region. Deaths now exceed births in the European Region as a whole. Age structure (pp.11–14) European countries generally have an ageing population. Every seventh person is aged 65 years or more and this proportion is growing while the proportion of children is declining. The ageing process is more advanced in the western part of the Region. The graphs are based on population data by age, as most recently reported by countries to WHO. Births (pp.15–18) Live birth rates are declining in European countries and this decline is particularly sharp in eastern, central and south-eastern parts of the Region. This is most likely due to the profound socioeconomic changes and economic crises in this group of European countries. The proportion of infants with low birth weight (below 2500 g) is growing throughout the entire Region. The worst situation seems to be in the central and south-eastern parts of the Region, although Atlas of health in europa.p65 14-05-2003, 14:117 Atlas of health in Europe8 low-weight births may also be high but underreported in some countries of the eastern part of the Region. While births to young mothers are most common in the eastern part of the Region, births to mothers over 35 years of age are most frequent in western countries. Abortions (p. 19) The legal requirements for abortion vary between countries. The dramatic increase in the average rate of abortions in the central and south-eastern part of the Region in 1990 was caused by a six-fold increase in the number of abortions in Romania after a change in the law. Atlas of health in europa.p65 14-05-2003, 14:118 Demography 9 a The former Yugoslav Republic of Macedonia 27 30 64 283 394 447 1360 1984 2051 2392 3164 3681 3790 3878 4127 4273 4506 4657 4930 5047 5183 5213 5342 5408 6177 6303 7168 7790 8070 8147 8823 9867 10048 10106 10250 10275 10523 10631 15990 16026 22332 25618 38543 39924 48652 57450 59657 59670 68569 81990 143752 0 50 000 100 000 150 000 San Marino Monaco Andorra Iceland Malta Luxembourg Estonia Slovenia TFYR Macedoniaa Latvia Albania Lithuania Armenia Ireland Bosnia and Herzegovina Republic of Moldova Norway Croatia Turkmenistan Kyrgyzstan Finland Georgia Denmark Slovakia Tajikistan Israel Switzerland Bulgaria Austria Azerbaijan Sweden Hungary Portugal Belarus Czech Republic Belgium Yugoslavia Greece Netherlands Kazakhstan Romania Uzbekistan Poland Spain Ukraine Italy United Kingdom France Turkey Germany Russian Federation Population (thousands) Population Mid-year population, 2002 Atlas of health in europa.p65 14-05-2003, 14:119 Atlas of health in Europe10 -7.6 -6.6 -5.7 -5.6 -4.9 -4.3 -3.5 -2.5 -1.9 -1.8 -1.7 -1.0 -0.9 -0.8 -0.8 -0.6 -0.3 0.1 0.2 0.3 0.5 0.7 1.2 1.2 1.2 1.4 1.4 1.5 2.2 2.5 2.7 3.2 3.5 3.8 4.0 4.2 4.9 6.0 6.2 7.6 8.0 8.5 10.8 13.3 14.8 15.2 15.5 15.6 25.7 -15 -5 5 15 25 Ukraine (2000) Russian Federation (2001) Latvia (2001) Bulgaria (2001) Belarus (2001)Estonia (2001) Hungary (2001)Lithuania (2001) Croatia (2001)Romania (2001) Czech Republic (2001) Republic of Moldova (2001)Germany (1999) Sweden (1999)Italy (1999) Slovenia (2001)Greece (1999) Austria (2001) Spain (1999)Poland (2000) Slovakia (2000)Yugoslavia (2000) United Kingdom (2000)Belgium (1996) Georgia (2001) Portugal (2000)Denmark (1999) Finland (2001)Switzerland (1999) Malta (2001)Armenia (2000) Norway (1999) France (1999)San Marino (2000) Luxembourg (2001)Netherlands (2000) Kazakhstan (2001) TFYR Macedonia (2000) Ireland (2000)Bosnia and Herzegovina (1991) Azerbaijan (2001) Iceland (1997)Albania (2000) Kyrgyzstan (2001)Turkmenistan (1998) Uzbekistan (2001) Turkey (1998)Israel (1998) Tajikistan (1999) Rate per 1000 population Population Natural population growth Atlas of health in europa.p65 14-05-2003, 14:1210 Demography 11 Population Natural population growth -5 0 5 10 15 R at e pe r 1 00 0 po pu lat io n CIS CSEC EU Year 1980 1985 1990 1995 2000 15 000 10 000 5000 0 5000 10 000 15 000 Population (thousands) 0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+ Ag e gr ou p (ye ar s) EUCIS CSEC Males Females Ag e gr ou p (ye ar s) Ag e gr ou p (ye ar s) Ag e gr ou p (ye ar s) Age pyramid, 2000 Atlas of health in europa.p65 14-05-2003, 14:1211 Atlas of health in Europe12 15 20 25 30 1980 1985 1990 1995 2000 Year Pe rc en t o f p op ul at io n CIS CSEC EU Population Young population, 0–14 years 42 30 25 18 17 % of population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1212 Demography 13 5 10 15 20 1980 1985 1990 1995 2000 Year Pe rc en t o f p op ul at io n CIS CSEC EU Population Old population, 65 years and over 18 16 14 10 5 % of population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1213 Atlas of health in Europe14 Population Old population, 65 years and over 3.8 3.8 4.3 5.5 6.1 6.1 6.3 6.8 9.4 9.5 9.9 10.1 11.2 11.4 11.6 12.2 12.5 12.8 13.6 13.6 13.6 13.7 13.8 13.9 14.0 14.1 14.2 14.3 14.9 15.1 15.2 15.3 15.3 15.4 15.4 15.5 15.5 15.6 15.6 16.0 16.1 16.2 16.4 16.7 16.8 17.1 17.3 17.8 0 5 10 15 20 Tajikistan (2001) Turkmenistan (1998) Uzbekistan (2001) Kyrgyzstan (2001) Albania (2000) Azerbaijan (2001) Bosnia and Herzegovina (1991) Kazakhstan (2001) Armenia (2000) Republic of Moldova (2001)Israel (1998) TFYR Macedonia (2000) Ireland (2000) Slovakia (2000) Iceland (1998) Poland (2000) Malta (2001) Russian Federation (2001) Netherlands (2000)Belarus (2001) Romania (2001) Yugoslavia (2000) Czech Republic (2001) Ukraine (2000) Luxembourg (2001) Lithuania (2001) Georgia (2001) Slovenia (2001) Denmark (1999)Finland (2001) Hungary (2001) Switzerland (2000) Estonia (2001) Norway (1999) Latvia (2001) Portugal (2000) Austria (2001) United Kingdom (2000)Croatia (2001) France (1999) Germany (1999) San Marino (2000) Belgium (1997) Spain (1999) Bulgaria (2001) Greece (1999) Sweden (1999) Italy (1999) Percent of population Atlas of health in europa.p65 14-05-2003, 14:1214 Demography 15 7.8 8.4 8.6 8.7 8.8 9.0 9.1 9.1 9.2 9.2 9.3 9.3 9.3 9.4 9.5 9.6 9.8 9.8 10.0 10.0 10.0 10.1 10.2 10.2 10.4 10.8 10.8 10.9 11.4 11.4 11.5 11.8 11.8 12.4 12.7 12.7 13.0 13.3 13.6 14.5 14.5 14.9 15.4 16.1 19.9 20.6 21.1 21.5 21.7 27.2 0 5 10 15 20 25 30 Ukraine (2000)Latvia (2001) Bulgaria (2001)Slovenia (2001) Czech Republic (2001) Armenia (2000)Lithuania (2001) Russian Federation (2001)Belarus (2001) Croatia (2001)Estonia (2001) Austria (2001) Germany (2000)Italy (2000) Hungary (2001)Greece (1999) Poland (2000)Romania (2001) Spain (2000)Malta (2001) Republic of Moldova (2001)Georgia (2001) Sweden (2000) Slovakia (2000)Bosnia and Herzegovina (2000) San Marino (2000)Finland (2001) Switzerland (2000)United Kingdom (2000) Belgium (2000) Andorra (2000)Portugal (2000) Yugoslavia (2000)Luxembourg (2001) Denmark (2000)France (1999) Netherlands (2000) Norway (2000)Azerbaijan (2001) TFYR Macedonia (2000)Ireland (2000) Kazakhstan (2001)Iceland (2000) Albania (2000)Kyrgyzstan (2001) Uzbekistan (2001)Turkmenistan (1998) Turkey (2000) Israel (2000)Tajikistan (2001) Live births per 1000 population Births Birth rate Atlas of health in europa.p65 14-05-2003, 14:1215 Atlas of health in Europe16 5 10 15 20 25 1980 1985 1990 1995 2000 Year Pe r 10 00 p op ul at io n CIS CSEC EU Births Birth rate 4 5 6 7 8 1980 1985 1990 1995 2000 Year Pe rc en t o f l iv e bi rth s CIS CSEC EU Low-weight births, under 2500 g Atlas of health in europa.p65 14-05-2003, 14:1216 Demography 17 3.8 4.3 4.3 4.4 4.5 4.7 4.9 4.9 5.0 5.1 5.2 5.2 5.3 5.4 5.5 5.5 5.7 5.7 5.9 6.0 6.0 6.1 6.1 6.1 6.2 6.3 6.5 6.6 6.7 6.7 6.7 6.9 6.9 7.0 7.3 7.3 7.5 7.5 7.9 7.9 8.1 8.2 8.5 8.8 9.1 0 1 2 3 4 5 6 7 8 9 10 Iceland (2001) Estonia (2001) Finland (2001) Sweden (1999) Lithuania (2001) Uzbekistan (2001) Norway (2000) Turkmenistan (1997) Yugoslavia (1999) Latvia (2001) Belarus (2001) Republic of Moldova (2001) Kazakhstan (2001) Ukraine (2001) Kyrgyzstan (2001) Denmark (2000) Slovenia (2001) Ireland (1999) Italy (1998) Spain (1997) Czech Republic (2001) Poland (2000) Russian Federation (2001) Malta (2001) Croatia (2001) Switzerland (1999) Germany (1999) Azerbaijan (2001) Austria (2001) France (1998) Tajikistan (2001) Albania (1990) Georgia (2001) Slovakia (2001) United Kingdom (1997) Andorra (2001) Belgium (1997) Luxembourg (2000) Armenia (2001) Portugal (2001) Greece (1999) Israel (2001) Hungary (2001) Romania (2001) Bulgaria (2001) Percent of live births Births Low-weight births, under 2500 g Atlas of health in europa.p65 14-05-2003, 14:1217 Atlas of health in Europe18 Births Births to young mothers, under 20 years 22 17 14 10 6 No data % of all births – < – < – < – < – < Births to older mothers, 35 years and over 18 12 9 5 2 No data % of all births – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1218 Demography 19 0 500 1000 1500 1980 1985 1990 1995 2000 Year Pe r 10 00 li v e bi rth s CIS CSEC EU Abortions Abortions 1500 1000 700 400 200 No data Per 1000 live births – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1219 Atlas of health in Europe20 Atlas of health in europa.p65 14-05-2003, 14:1220 Life and death 21 2. Life and death Notes Life expectancy (pp. 26–29) Life expectancy, or the average number of years that a newborn baby can expect to live if mortality patterns remain unchanged, is one of the most common measurements of the health status of a population. As it is calculated using mortality statistics, its accuracy depends on the accuracy and completeness of official national mortality data. The table on p.26 shows two different estimates of life expectancy. One is the conventional life expectancy based on reported official mortality statistics. The other estimate is calculated using special demographic techniques to counteract possible underreporting of deaths (see The world health report 20001 for details on methodology). Countries with the largest differences between these two estimates most probably have life expectancies well below the level calculated from official statistics. This problem occurs mainly in central Asia, the Caucasus and the Balkans, which were affected by armed conflicts and severe socioeconomic difficulties during the 1990s. Many countries’ national vital statistics systems (registration of marriages, births and deaths) were damaged. This should be kept in mind when comparing the life expectancy in these areas with other countries. The trends in life expectancy show a dramatic increase in the gap between the western and eastern parts of the Region. The average trend for the CIS is particularly complex, as it reflects the effects of both the anti-alcohol campaign introduced in the USSR in 1985 and the deep socioeconomic crisis of the 1990s. The same pattern can be seen in the cause-specific mortality trends: a relatively sharp improvement in 1985–1986, a sharp deterioration in the first half of the 1990s, a gradual improvement in 1995–1998 and a 1 The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000. Atlas of health in europa.p65 14-05-2003, 14:1221 Atlas of health in Europe22 deterioration again in 1999–2000. The latest deterioration may have some association with the financial crisis that hit the Russian Federation and other CIS countries in the autumn of 1998. Disability-adjusted life expectancy (often also called healthy life expectancy) shows the estimated number of years of life expected to be lived in full health. These estimates were calculated by WHO using special techniques (see The world health report 20002 for details on methodology). Deaths from all causes (pp. 29–31) Mortality is gradually increasing from the western to the eastern part of the Region. The level of premature mortality (i.e. below 65 years of age) varies particularly dramatically. East–west differences in the mortality of the elderly population (i.e. those aged 65 years or over) are relatively less pronounced. Excess male mortality is presented as the ratio of male death rates to female death rates on the left side of the bar charts on pp. 30–31. Particularly high premature male mortality in eastern countries makes the largest contribution proportionally to the east–west gap in total mortality. Infant deaths (pp. 32–33) Infant mortality shows the number of deaths of children under 1 year of age per 1000 live births. Unfortunately, some countries cannot ensure the complete registration of infant deaths and live births, in accordance with the WHO definition of live births. The infant mortality rates they report are therefore lower than they actually are and intercountry comparisons should be treated with caution. As mentioned above, particularly high levels of under-registration occur in central Asia and the Caucasus, and possibly in countries of the former Yugoslavia and Albania. Special household surveys carried out in the 1990s by the United States Agency for International Development (USAID) and the United Nations Children’s Fund (UNICEF) in some of these countries produced much higher estimates of infant mortality rates 2 The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000. Atlas of health in europa.p65 14-05-2003, 14:1222 Life and death 23 than the official figures based on national vital statistics systems. For example, differences between reported infant mortality and survey-based estimates were: for Azerbaijan 19.9 vs. 79.0, Kazakhstan 25.2 vs. 61.9, Tajikistan 47.0 vs. 89.0, Uzbekistan 30.7 vs. 43.5, Kyrgyzstan 29.1 vs. 66.2.3 Although, for methodological reasons, survey-based estimates are not directly comparable with registration-based data, these differences indicate the possible size of under-registration. Infant mortality is higher in the eastern part of the Region, with the highest levels in some south-eastern countries. Given the likely under-registration, the real infant mortality in these countries is probably even higher. Perinatal deaths (p. 34) The rate shows the number of deaths of fetuses weighing 1000 g or more and of newborn babies aged 0–6 full days per 1000 births (live and stillborn). Where weight-specific data were not available, calculations were based on the data provided by countries whatever the national criteria. Maternal deaths (pp. 35–36) A maternal death is the death of a woman while pregnant or within 42 days of the end of a pregnancy, from any cause related to or aggravated by the pregnancy or its management. Maternal mortality (deaths per 100 000 live births) was calculated using mortality data from routine vital statistics reported to WHO and hospital data reported by ministries of health, taking the larger figure where they differed. Even in countries with good vital statistics systems, however, maternal mortality is believed to be higher than reported. WHO, UNICEF and the United Nations Population Fund (UNFPA) have estimated that maternal mortality in these countries may actually be some 50% higher.4 The drop in the average rate in the central and south-eastern part of the Region in 1990 is attributable to the sharp reduction in 3 A decade of transition. New York, UNICEF, 2002 (Regional Monitoring Report, No.8). 4 WHO, UNICEF, UNFPA. Maternal mortality in 1995: estimates developed by WHO, UNICEF, UNFPA. Geneva, World Health Organization, 2001 (WHO/RHR/01.9). Atlas of health in europa.p65 14-05-2003, 14:1223 Atlas of health in Europe24 maternal mortality in Romania after the change in the anti-abortion law. Deaths by cause and age (p. 36) The importance of specific causes of death differs significantly in the different phases of the life span. Respiratory and some other diseases are leading causes of death in childhood, replaced by accidents and other external causes of death among adolescents and young adults. Cancer and diseases of the circulatory system become leading causes of death in older age groups. Deaths from diseases of the circulatory system (pp. 37–41) The average trends in mortality from these diseases show a decline in the western and central parts of the Region. The average for the CIS shows the specific trend pattern noted under life expectancy during the 1990s. A clear east–west gradient contributes a large part of the east–west difference in total mortality and life expectancy. The patterns of trends and differences in death rates from ischaemic heart diseases and cerebrovascular diseases are similar to those for all diseases of the circulatory system. Deaths from cancer (pp. 42–49) Trends in cancer death rates show some general improvement in the EU and the CIS, while in the central part of the Region the overall situation is deteriorating. The average cancer mortality in western countries is relatively low in younger age groups and relatively high among the older population. The opposite is true in the CIS while, in the central part of the Region, mortality is high in both younger and older age groups. Female mortality from lung cancer is steadily increasing in the western and central parts of the Region. Deaths from external causes of injury and poisoning (pp.50–54) External causes of death from injury and poisoning include accidents, homicide, suicide and other causes that are not diseases. A remarkable increase in mortality in the eastern part of the Region, in the first half of the 1990s, is attributable to the Atlas of health in europa.p65 14-05-2003, 14:1224 Life and death 25 combined effect of the end of the anti-alcohol campaign that started in the USSR in 1985 and the socioeconomic crisis of the 1990s. Deaths from diseases of the respiratory system (pp. 55–56) Generally, there is a downward trend in all parts of the Region. The average for the CIS follows the specific trend pattern described above for diseases of the circulatory system and for life expectancy. Deaths from diseases of the digestive system (pp. 57–58) Deaths from chronic liver disease and cirrhosis are responsible for about half of all deaths from this group of diseases. Mortality is steadily declining in the western part of the Region and is stable or slightly increasing in the central part. The average for the CIS follows the specific trend pattern as described above for diseases of the respiratory and circulatory systems, and for life expectancy. Atlas of health in europa.p65 14-05-2003, 14:1225 Atlas of health in Europe26 Life expectancy Conventional and estimated life expectancy Estimated life expectancy, 2001 (years) Males Conventional life expectancy (years) Albania (2000) 72.03 66.3 78.04 73.2 Andorra 76.2 82.9 Armenia (2000) 73.46 66.2 78.11 73.0 Austria (2001) 76.10 75.9 81.95 81.8 Azerbaijan (2001) 69.66 60.7 75.01 66.6 Belarus (2001) 62.79 62.9 74.55 74.2 Belgium (1996) 73.97 74.8 80.76 81.2 Bosnia and Herzegovina (1991) 69.49 69.3 75.98 76.4 Bulgaria (2001) 68.55 68.4 75.44 74.8 Croatia (2001) 71.03 68.9 78.17 77.1 Czech Republic (2001) 72.18 71.9 78.71 78.8 Denmark (1999) 74.13 74.8 78.87 79.5 Estonia (2001) 64.91 65.7 76.44 76.5 Finland (2001) 74.72 74.5 81.81 81.2 France (1999) 75.17 75.6 82.83 82.9 Georgia (2001) 72.44 65.4 78.48 72.4 Germany (1999) 74.89 75.1 81.02 81.1 Greece (1999) 75.82 75.5 81.03 80.8 Hungary (2001) 68.32 67.3 76.76 76.1 Iceland (1997) 76.41 78.2 81.61 81.3 Ireland (2000) 74.01 73.8 79.31 79.2 Israel (1998) 76.21 76.1 80.59 80.9 Italy (1999) 76.28 76.2 82.62 82.2 Kazakhstan (2001) 60.57 58.8 71.40 67.2 Kyrgyzstan (2001) 64.53 60.1 72.97 68.2 Latvia (2001) 64.48 65.2 75.68 76.0 Lithuania (2001) 65.89 67.7 77.49 77.9 Luxembourg (2001) 75.48 74.9 81.13 81.8 Malta (2001) 76.37 75.8 81.19 80.3 Monaco 76.5 84.0 Netherlands (2000) 75.65 75.8 80.76 80.7 Norway (1999) 75.71 76.1 81.32 81.4 Poland (2000) 69.80 69.9 78.09 78.1 Portugal (2000) 72.63 72.7 79.67 80.1 Republic of Moldova (2001) 64.54 64.2 71.94 71.7 Romania (2001) 67.69 67.8 75.01 74.5 Russian Federation (2001) 59.08 58.9 72.28 72.3 San Marino (2000) 77.93 77.6 86.58 83.9 Slovakia (2000) 69.26 69.3 77.64 77.4 Slovenia (2001) 72.32 72.1 80.52 79.5 Spain (1999) 75.24 75.3 82.35 82.6 Sweden (1999) 77.13 77.7 82.08 82.3 Switzerland (1999) 76.97 77.3 82.80 82.8 Tajikistan (1999) 69.99 59.9 73.98 66.9 TFYR Macedonia (2000) 71.18 68.9 75.74 74.9 Turkey 67.0 71.2 Turkmenistan (1998) 62.48 58.9 69.84 66.5 Ukraine (2000) 62.30 62.2 73.62 73.3 United Kingdom (2000) 75.69 75.1 80.51 79.9 Uzbekistan (2001) 67.57 62.7 72.64 68.5 Yugoslavia (2000) 70.36 69.7 75.18 74.8 Estimated life expectancy, 2001 (years) Females Conventional life expectancy (years) Atlas of health in europa.p65 14-05-2003, 14:1226 Life and death 27 Bosnia and Herzegovina (1991) 13.6 13.2 13.8 13.8 13.1 13.9 14.6 14.4 15.2 15.5 14.9 16.0 14.5 15.3 15.5 15.5 14.7 15.0 14.5 15.2 15.9 15.6 15.3 17.4 16.0 17.3 16.7 17.2 16.8 16.5 17.5 17.9 17.7 17.6 18.2 18.3 18.0 17.9 17.8 18.4 17.4 18.3 19.2 18.8 18.7 18.4 19.1 21.3 65.3 65.9 66.1 67.9 68.3 68.5 68.7 70.1 70.1 70.7 71.3 71.7 71.9 72.0 72.4 72.6 72.7 72.7 73.4 73.5 74.0 74.7 74.9 75.4 75.5 75.7 76.2 76.5 76.5 76.6 77.4 78.1 78.2 78.3 78.4 78.4 78.4 78.5 78.5 78.8 78.9 79.0 79.0 79.2 79.5 79.6 80.0 82.3 40 30 20 10 0 10 20 30 40 50 60 70 80 90 Russian Federation (2001) Kazakhstan (2001) Turkmenistan (1998) Ukraine (2000) Republic of Moldova (2001) Belarus (2001) Kyrgyzstan (2001) Uzbekistan (2001) Latvia (2001) Estonia (2001) Romania (2001) Lithuania (2001) Bulgaria (2001) Tajikistan (1999) Azerbaijan (2001) Hungary (2001) Yugoslavia (2000) TFYR Macedonia (2000) Slovakia (2000) Poland (2000) Croatia (2001) Albania (2000) Georgia (2001) Czech Republic (2001) Armenia (2000) Portugal (2000) Slovenia (2001) Denmark (1999) Ireland (2000) Belgium (1996) Germany (1999) United Kingdom (2000) Netherlands (2000) Finland (2001) Luxembourg (2001) Greece (1999) Israel (1998) Norway (1999) Spain (1999) Malta (2001) Iceland (1997) France (1999) Austria (2001) Italy (1999) Sweden (1999) Switzerland (1999) San Marino (2000) Years at birthYears at 65 Life expectancy Life expectancy at birth and at 65 years Atlas of health in europa.p65 14-05-2003, 14:1227 Atlas of health in Europe28 50.1 50.3 51.5 52.4 52.8 53.5 56.7 57.4 57.5 58.3 58.4 58.7 59.8 59.8 60.9 61.1 61.8 62.1 62.2 62.5 63.3 64.1 64.3 66.6 66.8 67.7 69.2 69.4 69.6 69.7 69.9 70.1 70.1 70.2 70.4 70.6 70.8 70.9 70.9 71.2 71.3 71.3 71.8 72.2 72.8 50 55 60 65 70 75 Tajikistan Turkmenistan Kyrgyzstan Kazakhstan Azerbaijan Uzbekistan Russian Federation Ukraine Republic of Moldova Armenia Belarus Albania Georgia Turkey Latvia Romania Lithuania Hungary Estonia Yugoslavia TFYR Macedonia Bosnia and Herzegovina Bulgaria Croatia Slovakia Poland Czech Republic Portugal Slovenia Ireland Malta Israel United Kingdom Belgium Netherlands Denmark Finland Germany Greece Luxembourg Norway Andorra Spain Austria Italy Iceland France Monaco Sweden San Marino Switzerland Years 71.0 71.0 69.0 63.0 62.0 60.0 Life expectancy Estimated disability-adjusted life expectancy, 2001 Atlas of health in europa.p65 14-05-2003, 14:1228 Life and death 29 65 70 75 80 1980 1985 1990 1995 2000 Year Ye ar s CIS CSEC EU Life expectancy Life expectancy at birth 1500 1300 1100 800 650 No data Per 100 000 population – < – < – < – < – < Deaths from all causes Deaths Atlas of health in europa.p65 14-05-2003, 14:1229 Atlas of health in Europe30 302 176 164 188 204 162 173 179 155 222 248 200 160 186 232 201 231 172 186 196 229 154 246 225 203 247 245 175 255 271 188 230 181 230 146 243 222 165 309 297 288 216 199 308 292 183 250 303 152.5 163.3 173.2 178.4 182.4 195.5 196.2 200.3 201.4 203.5 204.7 205.4 210.7 218.7 222.5 223.3 229.1 230.8 234.7 236.7 254.3 262.2 283.1 285.2 299.4 305.2 319.4 320.7 360.2 361.7 371.4 376.4 391.8 400.5 406.5 433.6 443.9 474.9 476.6 523.0 539.4 570.9 571.6 604.2 621.5 629.7 703.9 600 400 200 0 200 400 600 800 San Marino (2000) Malta (2001) Sweden (1999)Switzerland (1999) Italy (1999) Iceland (1997)Norway (1999) Israel (1998) Netherlands (2000)Greece (1999) Spain (1999) Austria (2001)United Kingdom (2000) Luxembourg (2001) Finland (2001)Germany (1999) France (1999) Ireland (2000)Albania (2000) Belgium (1996) Portugal (2000)Denmark (1999) Slovenia (2001) Czech Republic (2001)Armenia (2000) Croatia (2001) Georgia (2001)TFYR Macedonia (2000) Poland (2000) Slovakia (2000)Yugoslavia (2000) Bosnia and Herzegovina (1991) Azerbaijan (2001)Bulgaria (2001) Tajikistan (1999) Hungary (2001)Romania (2001) Uzbekistan (2001) Lithuania (2001)Estonia (2001) Latvia (2001) Kyrgyzstan (2001)Republic of Moldova (2001) Belarus (2001) Ukraine (2000)Turkmenistan (1998) Kazakhstan (2001) Russian Federation (2001) Per 100 000 population 771.2 Ratio males / females (%) 1000 Deaths Deaths from all causes, 0–64 years Atlas of health in europa.p65 14-05-2003, 14:1230 Life and death 31 174 170 159 148 163 152 162 152 152 161 129 154 129 159 145 159 168 114 140 114 169 140 147 156 163 151 147 125 147 152 171 122 159 151 119 112 132 136 120 128 134 134 161 147 169 157 156 139 3085 3872 3910 4089 4100 4243 4276 4294 4304 4360 4428 4495 4502 4547 4580 4666 4696 4749 4762 4819 4850 5042 5297 5469 5589 5640 5677 5821 5903 5906 5914 6009 6067 6070 6122 6355 6383 6468 6562 6628 6810 7005 7117 7239 7242 7267 7695 8014 200 0 2000 4000 6000 8000 San Marino (2000) France (1999) Switzerland (1999) Austria (2001) Italy (1999) Sweden (1999) Spain (1999) Luxembourg (2001) Iceland (1997) Finland (2001) Greece (1999) Germany (1999) Israel (1998) Norway (1999) United Kingdom (2000) Netherlands (2000) Belgium (1996) Georgia (2001) Malta (2001) Armenia (2000) Slovenia (2001) Denmark (1999) Ireland (2000) Portugal (2000) Lithuania (2001) Poland (2000) Czech Republic (2001) Azerbaijan (2001) Croatia (2001) Hungary (2001) Estonia (2001) Tajikistan (1999) Latvia (2001) Slovakia (2000) Bosnia and Herzegovina (1991) Yugoslavia (2000) Romania (2001) Kyrgyzstan (2001) Uzbekistan (2001) TFYR Macedonia (2000) Bulgaria (2001) Turkmenistan (1998) Belarus (2001) Ukraine (2000) Albania (2000) Russian Federation (2001) Kazakhstan (2001) Republic of Moldova (2001) Per 100 000 populationRatio males / females (%) 10 000400 Deaths Deaths from all causes, 65 years and over Atlas of health in europa.p65 14-05-2003, 14:1231 Atlas of health in Europe32 0 5 10 15 20 25 30 1980 1985 1990 1995 2000 Year Pe r 10 00 liv e bir th s CIS CSEC EU Deaths Infant deaths 40 20 15 10 5 Per 1000 live births – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1232 Life and death 33 3.2 3.4 4.0 4.0 4.2 4.3 4.3 4.3 4.5 4.5 4.6 4.8 5.0 5.0 5.1 5.2 5.3 5.5 5.5 5.6 6.0 6.0 6.2 6.2 7.7 7.9 8.1 8.1 8.6 8.8 9.2 10.4 11.0 11.6 11.8 12.0 12.5 13.3 14.4 14.6 15.0 15.8 16.4 18.4 18.4 19.2 21.6 27.9 32.8 40.0 0 10 20 30 40 Finland (2001)Sweden (1999) Czech Republic (2001)Norway (1999) Denmark (1999)Slovenia (2001) France (1999)Malta (2001) Spain (1999)Germany (1999) Switzerland (1999)Austria (2001) Luxembourg (2001)Monaco (1999) Netherlands (2000) Italy (1999)Belgium (1996) Iceland (1997)Portugal (2000) United Kingdom (2000)Israel (1998) Andorra (1999)Greece (1999) Ireland (2000)Croatia (2001) Lithuania (2001)Poland (2000) Hungary (2001)Slovakia (2000) Estonia (2001)Belarus (2001) Georgia (2001)Latvia (2001) Albania (2000)TFYR Macedonia (2000) Ukraine (2000)Azerbaijan (2001) Yugoslavia (2000)Bulgaria (2001) Russian Federation (2001) Bosnia and Herzegovina (1999)Armenia (2000) Republic of Moldova (2001)Uzbekistan (2001) Romania (2001)Kazakhstan (2001) Kyrgyzstan (2001)Tajikistan (2001) Turkmenistan (1998)Turkey (1999) Per 1000 live births Deaths Infant deaths Atlas of health in europa.p65 14-05-2003, 14:1233 Atlas of health in Europe34 Deaths Perinatal deaths 1.3 3.4 3.6 3.7 3.8 4.5 4.5 5.1 5.2 5.2 5.4 5.6 5.6 5.7 5.8 5.9 6.1 6.2 6.4 6.5 6.5 7.0 7.0 7.3 7.4 7.9 8.2 8.8 8.8 9.0 9.5 9.7 10.0 11.3 11.5 11.7 11.8 12.3 13.2 13.6 14.7 15.5 16.4 16.4 17.1 20.7 21.2 0 5 10 15 20 25 Andorra (2001) Finland (2001) Austria (2001) Iceland (2001) Czech Republic (2001) Norway (2000) Slovenia (2001) Malta (2001) Israel (1998) Portugal (2000) Denmark (1999) Spain (1999) Sweden (2000) Lithuania (2001) Estonia (2001) Ireland (1999) Germany (2000) Luxembourg (2001) Italy (1998) Switzerland (1999) Slovakia (2001) Belgium (1995) France (1998) Croatia (2001) Belarus (2001) Netherlands (2001) United Kingdom (2000) Ukraine (2001) Greece (1999) Latvia (2001) Hungary (2001) Poland (2000) Uzbekistan (2001) Azerbaijan (2001) Albania (1992) Russian Federation (2001) Romania (2001) Bulgaria (2001) Kyrgyzstan (2001) Yugoslavia (1998) Republic of Moldova (2001) Kazakhstan (2001) TFYR Macedonia (2001) Armenia (2001) Turkmenistan (1997) Georgia (2001) Tajikistan (2001) Per 1000 births Atlas of health in europa.p65 14-05-2003, 14:1234 Life and death 35 0.0 1.2 2.9 3.4 3.5 3.5 4.3 4.7 5.1 5.2 5.3 5.5 5.5 5.7 6.2 6.3 6.5 6.8 6.9 7.8 7.8 8.6 9.1 9.4 9.9 11.9 13.6 15.2 19.1 19.2 19.6 19.7 20.8 24.4 24.6 24.7 30.5 33.2 33.3 35.5 35.9 40.2 42.6 43.1 45.5 47.5 53.0 55.0 130.0 0 50 100 150 Andorra (2000) Ireland (2000)Spain (1998) Sweden (1999)Austria (2000) Italy (1998)Greece (1998) Finland (2000) Switzerland (1998)Portugal (1999) Germany (1999)Denmark (1998) Israel (2000)Norway (1998) Luxembourg (1997)United Kingdom (1999) Hungary (2000)Croatia (2000) Yugoslavia (1999)Belgium (1996) Czech Republic (2000)Poland (1995) France (1998)Slovakia (2000) Netherlands (1999) Lithuania (2000) Slovenia (2000)Bulgaria (2000) Albania (2000) Belarus (2000)Estonia (2000) Iceland (2000)Ukraine (2000) Malta (2000)Latvia (2000) Uzbekistan (2000) Azerbaijan (2000)Romania (2000) Armenia (2000)Kazakhstan (2000) Turkmenistan (1995)Kyrgyzstan (2000) Georgia (2000)Tajikistan (1999) Turkey (1998) Per 100 000 live births Russian Federation (2000) Republic of Moldova (2000) Bosnia and Herzegovina (1990) TFYR Macedonia (2000) Deaths Maternal deaths, three-year average Atlas of health in europa.p65 14-05-2003, 14:1235 Atlas of health in Europe36 Causes of death Main causes of death by age group 0 20 40 60 80 100 0 1–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85+ Infectious and parasitic diseases Cancer Diseases of the circulatory system Diseases of the respiratory system Other diseases External causes of injury and poisoning Age group (years) Pe rc en t o f a ll d ea th s in e ac h gr ou p Deaths Maternal deaths 0 10 20 30 40 50 60 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 liv e bi rth s CIS CSEC EU Atlas of health in europa.p65 14-05-2003, 14:1236 Life and death 37 200 300 400 500 600 700 800 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Causes of death Deaths from diseases of the circulatory system 900 750 600 400 250 No data Per 100 000 population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1237 Atlas of health in Europe38 Causes of death Deaths from diseases of the circulatory system, 25–64 years 55.2 56.8 63.6 65.0 67.6 69.9 70.1 71.3 72.0 74.7 76.0 76.6 79.3 83.7 84.1 85.6 87.7 91.0 91.2 97.5 98.0 102.9 115.9 135.9 153.1 172.8 175.5 188.1 189.9 209.7 215.3 217.5 220.1 233.3 250.2 254.1 254.9 272.6 288.8 290.5 293.9 320.4 344.0 361.4 378.1 419.8 441.9 442.7 0 100 200 300 400 500 France (1999) Switzerland (1999) Spain (1999) Italy (1999) Iceland (1997) Norway (1999) Sweden (1999) Israel (1998) San Marino (2000) Portugal (2000) Malta (2001) Netherlands (2000) Belgium (1996) Denmark (1999) Austria (2001) Luxembourg (2001) Germany (1999) Finland (2001) United Kingdom (2000) Greece (1999) Slovenia (2001) Ireland (2000) Albania (2000) Czech Republic (2001)Croatia (2001) Armenia (2000) Poland (2000) Slovakia (2000) TFYR Macedonia (2000) Hungary (2001) Bosnia and Herzegovina (1991) Lithuania (2001) Yugoslavia (2000) Georgia (2001) Romania (2001) Estonia (2001) Tajikistan (1999) Azerbaijan (2001) Bulgaria (2001) Latvia (2001) Republic of Moldova (2001) Uzbekistan (2001) Kyrgyzstan (2001) Ukraine (2000) Belarus (2001) Kazakhstan (2001) Turkmenistan (1998) Russian Federation (2001) Per 100 000 population Atlas of health in europa.p65 14-05-2003, 14:1238 Life and death 39 Causes of death Deaths from ischaemic heart diseases, 25–64 years 13.1 20.7 27.2 27.5 29.1 30.3 34.3 35.4 36.1 36.9 37.8 40.4 41.1 42.5 43.8 44.0 44.8 46.5 50.7 52.2 54.2 57.0 61.1 66.5 69.6 74.7 76.3 76.9 79.5 85.7 95.7 103.0 106.2 110.2 113.5 119.4 127.1 133.6 139.4 141.8 147.0 156.8 175.6 199.3 204.7 214.4 221.9 225.6 0 50 100 150 200 250 San Marino (2000) France (1999) Portugal (2000) Italy (1999) Switzerland (1999) Spain (1999) Luxembourg (2001) Israel (1998) Netherlands (2000) Denmark (1999) Belgium (1996) Sweden (1999) Slovenia (2001) Norway (1999) Austria (2001) Germany (1999) Iceland (1997) Albania (2000) Malta (2001) Finland (2001) Greece (1999) United Kingdom (2000) Ireland (2000) Croatia (2001) Czech Republic (2001) Yugoslavia (2000) Poland (2000) TFYR Macedonia (2000) Bosnia and Herzegovina (1991) Bulgaria (2001) Slovakia (2000) Hungary (2001) Romania (2001) Tajikistan (1999) Armenia (2000) Lithuania (2001) Estonia (2001) Georgia (2001) Kyrgyzstan (2001) Uzbekistan (2001) Republic of Moldova (2001) Latvia (2001) Azerbaijan (2001) Turkmenistan (1998) Kazakhstan (2001) Ukraine (2000) Belarus (2001) Russian Federation (2001) Per 100 000 population Atlas of health in europa.p65 14-05-2003, 14:1239 Atlas of health in Europe40 0 50 100 150 200 250 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Causes of death Deaths from ischaemic heart diseases, 25–64 years 0 25 50 75 100 125 1980 1985 1990 1995 2000 Year Pe r 1 00 0 00 p op ul at io n CIS CSEC EU Deaths from cerebrovascular diseases, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1240 Life and death 41 7.9 11.8 11.8 11.9 12.5 13.2 13.3 13.5 13.5 13.8 14.4 14.6 15.0 15.2 16.6 18.1 18.3 20.2 20.5 21.1 24.0 25.5 25.5 30.4 31.8 32.9 39.6 40.1 41.2 41.6 42.1 51.7 53.6 56.3 57.1 60.3 65.1 71.2 71.4 72.8 80.9 82.7 91.0 99.0 106.4 116.4 120.5 149.5 0 30 60 90 120 150 180 Switzerland (1999) Israel (1998) France (1999) Norway (1999) Italy (1999) Sweden (1999) Germany (1999) Spain (1999) Netherlands (2000) Malta (2001) Iceland (1997) Austria (2001) Belgium (1996) United Kingdom (2000) Ireland (2000) Finland (2001) San Marino (2000) Denmark (1999) Greece (1999) Luxembourg (2001) Slovenia (2001) Czech Republic (2001) Slovakia (2000) Portugal (2000) Tajikistan (1999) Albania (2000) Poland (2000) Armenia (2000) Croatia (2001) Turkmenistan (1998) Lithuania (2001) Azerbaijan (2001) Hungary (2001) Estonia (2001) Bosnia and Herzegovina (1991) TFYR Macedonia (2000) Yugoslavia (2000) Bulgaria (2001) Latvia (2001) Georgia (2001) Uzbekistan (2001) Romania (2001) Ukraine (2000) Belarus (2001) Kazakhstan (2001) Republic of Moldova (2001) Russian Federation (2001) Kyrgyzstan (2001) Per 100 000 population Causes of death Deaths from cerebrovascular diseases, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1241 Atlas of health in Europe42 65.3 81.9 84.5 85.7 93.5 95.8 96.7 98.8 102.9 107.1 107.5 109.8 111.6 111.8 112.1 114.0 115.9 118.6 120.4 123.6 124.3 127.2 127.7 128.8 133.4 138.8 141.9 142.0 144.1 145.0 145.6 149.4 152.4 157.7 159.4 162.9 165.3 166.1 166.8 167.3 169.8 169.9 172.0 174.6 178.3 178.6 180.3 230.1 0 50 100 150 200 250 Tajikistan (1999) Uzbekistan (2001) Georgia (2001) Albania (2000) Finland (2001) Malta (2001) Turkmenistan (1998) Sweden (1999) Switzerland (1999) Luxembourg (2001) Azerbaijan (2001) Israel (1998) San Marino (2000) Greece (1999) Kyrgyzstan (2001) Norway (1999) Austria (2001) Italy (1999) Portugal (2000) United Kingdom (2000) Armenia (2000) Germany (1999) Spain (1999) Netherlands (2000) Ireland (2000) Iceland (1997) Bulgaria (2001) Belgium (1996) TFYR Macedonia (2000) France (1999) Bosnia and Herzegovina (1991) Slovenia (2001) Denmark (1999) Yugoslavia (2000) Republic of Moldova (2001) Estonia (2001) Kazakhstan (2001) Croatia (2001) Lithuania (2001) Romania (2001) Czech Republic (2001) Belarus (2001) Latvia (2001) Poland (2000) Russian Federation (2001) Ukraine (2000) Slovakia (2000) Hungary (2001) Per 100 000 population Causes of death Deaths from cancer, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1242 Life and death 43 Causes of death Deaths from cancer, 0–64 years 140 105 95 80 70 No data Per 100 000 population – < – < – < – < – < 1300 1100 900 800 600 No data Per 100 000 population – < – < – < – < – < Deaths from cancer, 65 years and over Atlas of health in europa.p65 14-05-2003, 14:1243 Atlas of health in Europe44 Causes of death Deaths from cancer 160 170 180 190 200 210 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU 40 50 60 70 80 90 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Deaths from lung cancer, males, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1244 Life and death 45 6 8 10 12 14 16 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Causes of death Deaths from lung cancer, females, 25–64 years 100 125 150 175 200 225 1980 1985 1990 1995 2000 Year Pe r 1 00 0 00 p op ul at io n CIS CSEC EU Deaths from lung cancer, 65 years and over Atlas of health in europa.p65 14-05-2003, 14:1245 Atlas of health in Europe46 6.3 9.8 11.7 15.5 16.6 16.8 17.7 18.1 18.5 18.7 19.9 20.3 20.5 23.3 24.3 25.7 26.0 26.5 26.9 27.5 27.8 28.2 30.0 30.6 31.1 31.5 32.2 32.8 32.9 33.8 34.1 34.2 34.2 34.6 34.7 35.3 35.5 37.1 37.4 37.5 37.8 40.0 40.8 40.9 41.9 42.3 46.9 67.0 0 10 20 30 40 50 60 70 80 Tajikistan (1999) Uzbekistan (2001) Turkmenistan (1998) Kyrgyzstan (2001) Georgia (2001) Finland (2001) Azerbaijan (2001) Sweden (1999) Israel (1998) Malta (2001) Portugal (2000) San Marino (2000) Albania (2000) Switzerland (1999) Norway (1999) United Kingdom (2000) Ireland (2000) Austria (2001) Italy (1999) Luxembourg (2001) Germany (1999) Armenia (2000) Republic of Moldova (2001) Spain (1999) Greece (1999) Netherlands (2000) Bulgaria (2001) Lithuania (2001) TFYR Macedonia (2000) France (1999) Iceland (1997) Estonia (2001) Belarus (2001) Kazakhstan (2001) Slovenia (2001) Ukraine (2000) Denmark (1999) Russian Federation (2001) Latvia (2001) Belgium (1996) Slovakia (2000) Romania (2001) Yugoslavia (2000) Czech Republic (2001) Bosnia and Herzegovina (1991) Croatia (2001) Poland (2000) Hungary (2001) Per 100 000 population Causes of death Deaths from lung cancer, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1246 Life and death 47 8.8 11.3 14.2 14.5 17.2 19.0 19.9 21.4 22.5 22.9 23.5 23.5 23.6 23.7 23.8 23.9 24.4 24.4 24.6 24.7 24.7 25.2 25.2 25.2 25.6 25.8 28.2 28.7 28.8 28.9 28.9 29.1 29.9 30.0 30.2 30.4 31.7 32.1 32.3 32.4 32.8 33.2 34.5 35.3 38.2 38.4 38.4 0 10 20 30 40 Tajikistan (1999) Turkmenistan (1998) Albania (2000) Uzbekistan (2001) Kyrgyzstan (2001) Azerbaijan (2001) Greece (1999) Sweden (1999)Spain (1999) Poland (2000) Norway (1999) Finland (2001) Belarus (2001)Switzerland (1999) Bulgaria (2001) Georgia (2001) Czech Republic (2001) Malta (2001)Luxembourg (2001) Portugal (2000) Kazakhstan (2001) Austria (2001) Slovakia (2000)Italy (1999) Romania (2001) Croatia (2001) Lithuania (2001)Republic of Moldova (2001) Slovenia (2001) Russian Federation (2001) Germany (1999) TFYR Macedonia (2000)France (1999) Latvia (2001) Israel (1998) United Kingdom (2000) Estonia (2001)Ukraine (2000) Hungary (2001) Yugoslavia (2000) Netherlands (2000)Armenia (2000) Denmark (1999) Iceland (1997) Ireland (2000) Belgium (1996) Per 100 000 females Bosnia and Herzegovina (1991) Causes of death Deaths from female breast cancer, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1247 Atlas of health in Europe48 10 15 20 25 30 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 fe m al es CIS CSEC EU Causes of death Deaths from female breast cancer 2 3 4 5 6 7 8 9 10 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 fe m al es CIS CSEC EU Deaths from cervical cancer Atlas of health in europa.p65 14-05-2003, 14:1248 Life and death 49 1.0 1.2 1.7 1.9 2.3 2.5 2.5 2.6 2.7 2.9 3.1 3.2 3.3 3.5 3.5 3.8 3.9 4.0 4.1 4.2 4.3 4.6 4.8 5.1 5.2 5.7 6.0 6.6 6.8 6.8 7.1 7.5 8.0 8.5 8.5 8.7 9.4 9.6 9.9 10.2 10.6 10.7 10.9 11.9 14.6 15.1 20.0 0 5 10 15 20 25 Malta (2001) Italy (1999) Finland (2001) Switzerland (1999) Albania (2000) Austria (2001) Greece (1999) France (1999) Spain (1999) Netherlands (2000) Belgium (1996) Israel (1998) Sweden (1999) Azerbaijan (2001) Croatia (2001) Iceland (1997) Bosnia and Herzegovina (1991) United Kingdom (2000) Slovenia (2001) Turkmenistan (1998) Germany (1999) Luxembourg (2001) Portugal (2000) Norway (1999) Ireland (2000) Tajikistan (1999) Armenia (2000) Uzbekistan (2001) Denmark (1999) Belarus (2001) Georgia (2001) TFYR Macedonia (2000) Estonia (2001) Czech Republic (2001) Russian Federation (2001) Latvia (2001) Slovakia (2000) Kazakhstan (2001) Ukraine (2000) Bulgaria (2001) Hungary (2001) Kyrgyzstan (2001) Yugoslavia (2000) Poland (2000) Lithuania (2001) Republic of Moldova (2001) Romania (2001) Per 100 000 females Causes of death Deaths from cervical cancer, 25–64 years Atlas of health in europa.p65 14-05-2003, 14:1249 Atlas of health in Europe50 0 50 100 150 200 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Causes of death Deaths from external causes of injury and poisoning 250 150 80 60 40 No data Per 100 000 population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1250 Life and death 51 Per 100 000 population, females Per 100 000 population, males 11.7 10.9 11.7 9.9 10.1 15.3 11.3 13.8 14.6 7.9 9.1 15.2 11.7 12.5 14.8 13.6 13.7 13.2 15.4 16.8 13.6 21.4 23.6 16.4 17.5 25.1 16.8 17.9 23.7 17.1 17.8 24.9 29.4 18.5 23.7 22.1 32.7 41.7 52.6 49.4 61.0 52.1 57.3 56.0 82.0 28.8 30.0 35.9 37.5 39.9 40.1 40.3 41.5 43.6 43.9 44.2 44.6 45.4 48.0 51.6 52.0 52.4 52.9 53.1 54.4 55.2 57.1 62.9 63.0 68.8 69.5 69.9 70.2 70.3 78.2 86.6 87.1 91.7 92.3 92.5 94.0 94.2 134.2 162.2 246.3 246.8 263.8 264.7 270.3 278.5 369.6 200 100 0 100 200 300 400 500 Netherlands (2000)Malta (2001) United Kingdom (2000)Italy (1999) Israel (1998)Sweden (1999) Azerbaijan (2001)Germany (1999) Norway (1999)Georgia (2001) Armenia (2000)Switzerland (1999) TFYR Macedonia (2000)Spain (1999) Yugoslavia (2000) Denmark (1999)Iceland (1997) Ireland (2000)Portugal (2000) Greece (1999)Austria (2001) Tajikistan (1999)France (1999) Belgium (1996)Croatia (2001) Albania (2000)Luxembourg (2001) Bulgaria (2001)Czech Republic (2001) Uzbekistan (2001)Slovakia (2000) Slovenia (2001)Finland (2001) Turkmenistan (1998)Poland (2000) Romania (2001) Hungary (2001)Kyrgyzstan (2001) Republic of Moldova (2001)Latvia (2001) Ukraine (2000)Kazakhstan (2001) Lithuania (2001)Estonia (2001) Belarus (2001)Russian Federation (2001) 19.2 Causes of death Deaths from external causes of injury and poisoning, 0–64 years Atlas of health in europa.p65 14-05-2003, 14:1251 Atlas of health in Europe52 2.14 3.82 3.99 4.33 4.63 5.37 5.37 5.57 5.67 6.47 6.64 6.75 7.31 7.77 8.45 8.47 8.93 9.19 9.22 9.34 9.72 10.67 10.96 11.48 11.64 12.14 12.39 12.47 12.96 12.99 13.31 13.49 13.51 13.75 13.92 14.18 14.75 15.67 17.62 19.71 21.52 23.48 0 5 10 15 20 25 30 Albania (2000) Tajikistan (1999) Georgia (2001) Malta (2001) Iceland (1997) Sweden (1999) TFYR Macedonia (2000) United Kingdom (2000) Armenia (2000) Azerbaijan (2000) Netherlands (2000) Switzerland (1999) Yugoslavia (2000) Norway (1999) Finland (2001) San Marino (2000) Turkmenistan (1998) Germany (1999) Uzbekistan (2001) Denmark (1999) Israel (1998) Ireland (2000) Austria (2001) Bulgaria (2001) Ukraine (2000) Kazakhstan (2001) Czech Republic (2001) Italy (1999) Kyrgyzstan (2001) Hungary (2001) Portugal (2000) Slovakia (2000) France (1999) Romania (2001) Estonia (2001) Croatia (2001) Slovenia (2001) Belgium (1996) Spain (1999) Belarus (2001) Poland (2000) Luxembourg (2001) Greece (1999) Russian Federation (1998) Lithuania (2001) Latvia (2001) Per 100 000 population Republic of Moldova (2001) 19.30 14.20 12.30 9.70 5.50 Causes of death Deaths from motor vehicle traffic accidents Atlas of health in europa.p65 14-05-2003, 14:1252 Life and death 53 10 15 20 25 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU 10 15 20 25 30 35 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Deaths from suicide Causes of death Deaths from motor vehicle traffic accidents Atlas of health in europa.p65 14-05-2003, 14:1253 Atlas of health in Europe54 1.8 2.1 2.3 3.3 3.6 4.4 4.4 4.5 5.9 6.0 7.0 7.0 7.4 7.6 8.9 9.2 9.9 10.9 11.9 11.9 12.1 12.7 13.0 13.2 13.3 13.4 14.2 14.3 14.4 14.8 15.1 16.0 16.1 16.3 16.3 17.8 18.3 18.3 22.0 26.5 26.6 28.1 28.2 28.6 32.4 32.6 37.9 43.7 0 10 20 30 40 50 Armenia (2000) Georgia (2001) Albania (2000) Greece (1999) San Marino (2000) Azerbaijan (2001) Portugal (2000)Tajikistan (1999) Israel (1998) Italy (1999) Spain (1999) United Kingdom (2000) Malta (2001) TFYR Macedonia (2000)Netherlands (2000) Uzbekistan (2001) Bosnia and Herzegovina (1991) Turkmenistan (1998) Germany (1999) Romania (2001) Ireland (2000)Sweden (1999) Norway (1999) Iceland (1997) Denmark (1999) Slovakia (2000) Kyrgyzstan (2001)Bulgaria (2001) Czech Republic (2001) Poland (2000) Yugoslavia (2000) Luxembourg (2001) France (1999) Austria (2001)Switzerland (1999) Croatia (2001) Belgium (1996) Republic of Moldova (2001) Finland (2001) Slovenia (2001) Hungary (2001)Estonia (2001) Ukraine (2000) Latvia (2001) Belarus (2001) Kazakhstan (2001) Russian Federation (2001) Lithuania (2001) Per 100 000 population Causes of death Deaths from suicide Atlas of health in europa.p65 14-05-2003, 14:1254 Life and death 55 40 60 80 100 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU No data Per 100 000 population 75 150 100 60 40 – < – < – < – < – < Causes of death Deaths from diseases of the respiratory system Atlas of health in europa.p65 14-05-2003, 14:1255 Atlas of health in Europe56 21.0 27.7 28.5 30.9 33.6 35.2 36.7 36.8 37.2 37.6 37.7 38.2 38.7 39.1 39.7 40.5 40.9 44.3 44.8 45.4 46.2 47.4 49.3 50.3 54.5 54.9 58.4 59.9 60.2 63.1 63.4 65.5 65.6 67.3 67.4 70.1 71.8 73.0 77.5 79.8 79.8 81.2 94.4 104.6 104.6 111.8 115.3 128.0 0 25 50 75 100 125 150 Georgia (2001) San Marino (2000) Latvia (2001) Austria (2001) Hungary (2001) Croatia (2001) Estonia (2001) TFYR Macedonia (2000) Lithuania (2001) Czech Republic (2001) Italy (1999) Israel (1998) Bulgaria (2001) Germany (1999) Switzerland (1999) Sweden (1999) Greece (1999) France (1999) Yugoslavia (2000) Poland (2000) Armenia (2000) Luxembourg (2001) Finland (2001) Slovakia (2000) Slovenia (2001) Norway (1999) Iceland (1997) Belarus (2001) Romania (2001) Russian Federation (2001) Albania (2000) Azerbaijan (2001) Netherlands (2000) Ukraine (2000) Belgium (1996) Denmark (1999) Spain (1999) Portugal (2000) Uzbekistan (2001) Republic of Moldova (2001) Malta (2001) Kazakhstan (2001) Tajikistan (1999) United Kingdom (2000) Turkmenistan (1998) Ireland (2000) Kyrgyzstan (2001) Per 100 000 population Bosnia and Herzegovina (1991) Causes of death Deaths from diseases of the respiratory system Atlas of health in europa.p65 14-05-2003, 14:1256 Life and death 57 30 35 40 45 50 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Causes of death Deaths from diseases of the digestive system 130 60 45 35 30 No data Per 100 000 population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1257 Atlas of health in Europe58 9.2 15.2 16.1 18.8 19.6 20.0 20.0 20.7 21.5 22.8 25.0 25.8 25.9 26.6 28.1 28.8 29.7 29.9 30.4 30.9 31.9 31.9 32.0 33.9 34.3 35.6 36.9 37.3 37.4 38.0 38.5 38.9 41.3 42.1 42.8 44.8 45.2 46.1 50.9 55.9 56.5 56.6 62.7 64.8 67.4 67.8 81.6 128.2 0 50 100 150 San Marino (2000) Iceland (1997) Greece (1999) TFYR Macedonia (2000) Sweden (1999) Albania (2000) Israel (1998) Norway (1999) Malta (2001) Switzerland (1999) Armenia (2000) Netherlands (2000) Georgia (2001) Ireland (2000) Yugoslavia (2000) Italy (1999) Bulgaria (2001) Finland (2001) Belarus (2001) Belgium (1996) United Kingdom (2000) Austria (2001) France (1999) Portugal (2000) Spain (1999) Germany (1999) Bosnia and Herzegovina (1991) Czech Republic (2001) Poland (2000) Luxembourg (2001) Latvia (2001) Lithuania (2001) Denmark (1999) Ukraine (2000) Estonia (2001) Croatia (2001) Tajikistan (1999) Russian Federation (2001) Slovakia (2000) Slovenia (2001) Kazakhstan (2001) Azerbaijan (2001) Uzbekistan (2001) Turkmenistan (1998) Romania (2001) Kyrgyzstan (2001) Hungary (2001) Republic of Moldova (2001) Per 100 000 population Causes of death Deaths from diseases of the digestive system Atlas of health in europa.p65 14-05-2003, 14:1258 Diseases 59 3. Diseases Notes Tuberculosis (pp. 61–62) The figures present rates of newly diagnosed tuberculosis cases, including relapses, of all forms and in all organs. Syphilis (pp. 65–66) Syphilis is considered a good indicator of the trends in all sexually transmitted diseases. In the 1990s, the eastern part of the Region suffered an epidemic-like increase in the incidence of syphilis. HIV/AIDS (pp. 67–69) The data for HIV/AIDS are collected by the European Centre for the Epidemiological Monitoring of AIDS in Paris (a UNAIDS/WHO collaborating centre on AIDS). While the AIDS data for the most recent years are adjusted for reporting delays, the data for HIV infections are as reported by countries. Reported new HIV infections have increased dramatically in some countries in the eastern and central parts of the Region, particularly in the Russian Federation and the Baltic states. Cancer (pp. 72–74) The right side of each bar chart shows the number of people newly diagnosed with cancer during the given year per 100 000 population. Data sources are usually national cancer registers. The incidence of lung cancer is clearly correlated with the death rate. This correlation is less clear in the case of female breast and cervical cancer. Hospital discharges (pp. 75–83) The rates represent the total number of patients per 100 000 population discharged from all hospitals (including through death) during the year, categorized by the principal diagnosis. The intercountry comparability of hospital discharge data is limited, Atlas of health in europa.p65 14-05-2003, 14:1259 Atlas of health in Europe60 owing to the differences in how hospital data collection systems are organized in different countries, and the differences in health care systems in general. Particular caution should therefore be applied when discharge data are used as an estimate of morbidity. Teeth (p. 84) The average number of decayed, missing or filled teeth among 12- year-old children is the commonly used index to assess the oral health situation. The data are collected by the WHO oral health programme and the WHO Collaborating Centre for Education, Training and Research in Oral Health, at Malmö University, Sweden. Atlas of health in europa.p65 14-05-2003, 14:1360 Diseases 61 0 20 40 60 80 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Some infectious diseases New cases of tuberculosis Per 100 000 population 180 100 70 40 20 – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1361 Atlas of health in Europe62 4.1 4.3 4.5 4.7 6.2 7.0 7.5 7.5 8.5 8.5 8.8 8.9 9.2 9.8 10.1 10.2 12.6 12.7 12.9 15.1 17.2 18.0 18.1 18.3 25.5 26.3 28.7 31.0 31.8 36.7 40.8 43.2 48.8 49.7 55.2 55.6 60.5 65.7 69.7 74.6 74.9 81.7 84.8 84.9 88.1 92.2 127.5 135.1 176.5 0 50 100 150 200 Malta Iceland Sweden Greece Norway Luxembourg Italy Switzerland Israel Germany Netherlands Finland Denmark France United Kingdom Ireland Czech Republic Austria Belgium Andorra Spain Slovenia Albania Slovakia Turkey Poland Hungary Croatia TFYR Macedonia Armenia Portugal Yugoslavia Bulgaria Estonia Belarus Tajikistan Azerbaijan Uzbekistan Lithuania Ukraine Turkmenistan Republic of Moldova Latvia Georgia Russian Federation Romania Kyrgyzstan Kazakhstan Per 100 000 population Bosnia and Herzegovina Some infectious diseases New cases of tuberculosis, 2001 Atlas of health in europa.p65 14-05-2003, 14:1362 Diseases 63 0 10 20 30 40 1980 1985 1990 1995 2000 Year Pe r 1 00 0 00 p op ul at io n CIS CSEC EU 40 25 15 10 5 Per 100 000 population – < – < – < – < – < Some infectious diseases New cases of viral hepatitis B Atlas of health in europa.p65 14-05-2003, 14:1363 Atlas of health in Europe64 0.8 0.9 1.3 1.5 1.6 1.6 1.7 1.7 2.0 2.0 2.1 2.1 2.1 2.4 2.5 2.6 2.8 3.0 3.0 3.2 3.5 3.6 4.4 4.5 4.5 4.5 5.2 6.2 7.6 8.3 8.7 8.9 9.7 10.2 11.0 11.0 11.9 12.0 14.3 15.9 16.0 18.6 19.1 19.4 21.7 23.7 32.9 35.6 35.7 0 10 20 30 40 Denmark (2001) Slovenia (2001)Malta (2001) Italy (2001)Hungary (2001) United Kingdom (2001)Israel (2001) Switzerland (2001)Spain (2001) Albania (2000)Greece (2001) Portugal (2001)Azerbaijan (2001) Sweden (2001)Finland (2001) Austria (2001)Slovakia (2001) Germany (2001)Andorra (2001) Armenia (2001)Bosnia and Herzegovina (1999) Tajikistan (2001)Czech Republic (2001) Norway (2001) Yugoslavia (2001)Croatia (2001) Belgium (2001)Poland (2001) TFYR Macedonia (2001)Turkey (2001) France (1998)Ireland (2001) Belarus (2001)Netherlands (2001) Lithuania (2001)Georgia (2001) Turkmenistan (2001)Romania (2001) Bulgaria (2001)Republic of Moldova (2001) Kazakhstan (2001)Luxembourg (2001) Kyrgyzstan (2001)Ukraine (2001) Iceland (2001)Uzbekistan (2001) Estonia (2001)Latvia (2001) Russian Federation (2001) Per 100 000 population Some infectious diseases New cases of viral hepatitis B Atlas of health in europa.p65 14-05-2003, 14:1364 Diseases 65 0 50 100 150 200 1980 1985 1990 1995 2000 Year Pe r 1 00 0 00 p op ul at io n CIS CSEC EU Some infectious diseases New cases of syphilis 170 90 30 10 4 No data Per 100 000 population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1365 Atlas of health in Europe66 0.0 0.0 0.0 0.1 0.2 0.3 0.4 0.5 0.8 0.9 0.9 0.9 0.9 1.0 1.2 1.2 1.3 1.4 1.7 1.9 2.4 2.7 3.0 3.9 3.9 4.2 5.0 5.7 5.8 5.8 7.2 9.4 11.4 11.7 18.4 25.2 25.2 25.3 27.6 29.9 47.7 56.0 60.6 80.5 86.5 91.6 144.1 161.4 0 50 100 150 200 Andorra (2000) Malta (2000) Greece (2001)TFYR Macedonia (2001) Italy (2000) Albania (1999)Bosnia and Herzegovina (1999) Croatia (2001)Netherlands (1998) Sweden (2001) Belgium (2000)Norway (2000) Luxembourg (2000) Denmark (2001)Slovenia (2001) Ireland (2000) Portugal (2001)Germany (1999) Spain (2000) Yugoslavia (2001)Switzerland (1998) Poland (2001) United Kingdom (2000)Austria (2001) Finland (2000)Hungary (2001) Turkey (2001) Slovakia (2000)Israel (2001) Armenia (2001) Azerbaijan (1999)Czech Republic (2000) Iceland (2001) Tajikistan (2001)Bulgaria (2001) Georgia (2001) Latvia (2001)Lithuania (2001) Uzbekistan (2001) Estonia (2001)Turkmenistan (1999) Romania (2001)Kyrgyzstan (2001) Belarus (2001) Republic of Moldova (2001)Ukraine (2000) Russian Federation (2001) Kazakhstan (2000) Per 100 000 population Some infectious diseases New cases of syphilis Atlas of health in europa.p65 14-05-2003, 14:1366 Diseases 67 0.01 0.02 0.02 0.02 0.05 0.06 0.06 0.09 0.11 0.15 0.15 0.16 0.16 0.18 0.21 0.21 0.24 0.25 0.28 0.29 0.33 0.34 0.36 0.37 0.54 0.65 0.66 0.84 0.91 0.92 0.94 0.95 1.19 1.46 1.53 1.72 1.74 2.37 2.77 3.07 5.95 10.25 0 1 2 3 4 5 6 7 8 9 10 11 12 Malta (2001) Kyrgyzstan (2001) Kazakhstan (1999) Uzbekistan (2001) Tajikistan (2001) Russian Federation (2000) Belarus (2001) Turkey (2001) Czech Republic (2001) Slovakia (2001) Albania (2000) Armenia (2001) TFYR Macedonia (2001) Estonia (2001) Croatia (2001) Bulgaria (2001) Hungary (2001) Republic of Moldova (2001) Azerbaijan (2001) Georgia (2001) Slovenia (2001) Netherlands (2001) Lithuania (2001) Finland (2001) Ireland (2001) Iceland (2001) Poland (2001) Sweden (2001) Norway (2001) Yugoslavia (2001) Austria (2001) Greece (2001) Luxembourg (2001) Israel (2001) Germany (2001) Romania (2001) United Kingdom (2001) Denmark (2001) Belgium (2001) Ukraine (2001) Latvia (2001) Switzerland (2001) France (2001) Italy (2001) Spain (2001) Portugal (2001) Per 100 000 population Bosnia and Herzegovina (2001) 0.60 0.20 0.10 0.00 0.00 Some infectious diseases New cases of clinically diagnosed AIDS Atlas of health in europa.p65 14-05-2003, 14:1367 Atlas of health in Europe68 0 1 2 3 4 5 6 7 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Some infectious diseases New cases of clinically diagnosed AIDS 0 10 20 30 40 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU New cases of HIV infection Atlas of health in europa.p65 14-05-2003, 14:1368 Diseases 69 0.2 0.2 0.3 0.3 0.5 0.5 0.5 0.6 0.7 0.7 0.8 0.8 0.8 1.5 1.6 1.6 2.0 2.1 2.1 2.2 2.5 2.8 3.1 3.1 3.6 3.9 4.1 5.5 5.6 5.6 5.8 7.3 7.8 7.9 8.8 9.1 9.4 11.5 14.3 25.1 34.3 60.6 108.1 0 25 50 75 100 Slovakia TFYR Macedonia Turkey Czech Republic Bulgaria Tajikistan Yugoslavia Croatia Albania Armenia Slovenia Hungary Poland Azerbaijan Germany Romania Georgia Lithuania Uzbekistan Finland Malta Kyrgyzstan Sweden Norway Iceland Greece Israel Denmark Belarus United Kingdom Ireland Kazakhstan Switzerland Luxembourg Belgium San Marino Ukraine Portugal Latvia Estonia Per 100 000 population Russian Federation Republic of Moldova Bosnia and Herzegovina Some infectious diseases New cases of HIV infection, 2001 Atlas of health in europa.p65 14-05-2003, 14:1369 Atlas of health in Europe70 France August Q fever: 79 cases Russian Federation January Haemorrhagic fever with renal syndrome: 55 cases Sweden May Salmonellosis (imported): 342 cases Belarus May Shigellosis: 606 cases Italy June Measles: 368 cases, 3 deaths Greece April Acute respiratory infection: 53 cases, 3 deaths Yugoslavia (Kosovo) February Tularemia: 1462 cases Tajikistan November–December Measles: 715 cases, 7 deaths Czech Republic February Cholera (imported): 2 cases Lithuania February Measles: 102 cases United Kingdom February Legionnaires' disease: 116 cases, 3 deaths September–December Salmonellosis: 19 outbreaks, almost 1000 cases, 10 deaths Spain February Trichinellosis: 26 cases Albania December Hepatitis A: over 200 cases Some infectious diseases Selected outbreaks of infectious diseases, 2002 Atlas of health in europa.p65 14-05-2003, 14:1370 Diseases 71 0.2 0.2 0.2 0.4 0.4 0.4 0.6 0.6 0.7 0.9 1.0 1.1 1.3 1.4 1.5 1.5 1.5 1.6 1.7 1.9 2.0 2.0 2.0 2.0 2.4 2.7 2.9 3.0 3.2 3.2 3.5 3.7 4.8 4.9 4.9 6.4 6.6 0 1 2 3 4 5 6 7 Iceland (1995) Greece (1998) Tajikistan (2001) Turkmenistan (1997) Uzbekistan (2001) Kyrgyzstan (2001) Azerbaijan (2001) Kazakhstan (2001) Republic of Moldova (2001) Armenia (2001) Georgia (2001) Bosnia and Herzegovina (2001) Yugoslavia (1999) Belarus (2001) Russian Federation (2001) Lithuania (2001) Latvia (2001) Romania (2001) Bulgaria (2000) Ukraine (2001) TFYR Macedonia (1998) Turkey (1998) Norway (1995) Netherlands (1995) Denmark (1999) Finland (2001) Sweden (1995) France (2000) Israel (2000) Belgium (2000) Slovenia (1993) Italy (1995) Portugal (1996) Slovakia (2001) Hungary (2001) Czech Republic (2001) Malta (2001) Percent of population Some noncommunicable diseases Prevalence of diabetes mellitus Atlas of health in europa.p65 14-05-2003, 14:1371 Atlas of health in Europe72 2.3 5.3 3.9 9.8 8.1 19.0 18.1 26.1 22.4 19.7 22.2 24.4 35.7 33.9 35.4 31.4 41.2 46.0 40.2 41.4 38.2 39.7 37.1 42.8 38.3 40.1 36.9 41.6 47.6 29.3 64.2 45.4 49.0 48.9 50.2 55.0 54.7 61.6 53.9 59.1 56.6 77.6 2.2 3.8 7.4 12.1 13.3 16.0 16.5 17.1 22.0 23.5 27.0 32.0 32.7 33.8 37.3 37.6 39.3 40.5 41.4 43.0 43.2 43.8 43.9 44.1 44.5 44.7 45.1 46.5 47.4 49.4 51.8 52.5 53.6 54.0 55.9 58.0 63.5 63.9 65.9 74.1 95.4 4.9 150 100 50 0 50 100 150 Tajikistan (1999) Turkmenistan (1997) Uzbekistan (2001) Azerbaijan (2001) Kyrgyzstan (2001) Albania (2000) Georgia (2001) Portugal (1993) Republic of Moldova (2001) Israel (1998) Armenia (2000) Kazakhstan (2001) Finland (2000) Sweden (1999) Romania (1999) Malta (2000) France (1995) Luxembourg (1999) Slovakia (1999) Ireland (2000) Ukraine (2000) Russian Federation (2001) Belarus (2001) Iceland (1997) Norway (1999) Austria (1999) Bulgaria (2001) Lithuania (2001) Latvia (2001) TFYR Macedonia (1998) Belgium (1996) Germany (1997) Slovenia (1999) Poland (1996) Estonia (2000) Netherlands (1998) Czech Republic (1999) Denmark (1998) Italy (1995) United Kingdom (1997) Croatia (2000) Hungary (2001) Crude death rate per 100 000 population New cases per 100 000 population Some noncommunicable diseases Lung cancer incidence and deaths Atlas of health in europa.p65 14-05-2003, 14:1372 Diseases 73 2.6 4.5 5.4 7.7 9.1 8.3 22.1 16.7 22.7 22.5 25.3 23.9 24.0 30.3 28.2 20.8 28.7 28.8 29.5 32.2 37.5 26.3 38.4 35.9 37.0 38.7 48.0 31.3 37.5 29.9 42.1 32.6 52.4 35.0 43.1 36.2 44.6 44.6 31.0 31.0 50.7 33.1 8.2 9.4 11.9 16.8 19.1 22.9 33.3 34.4 35.1 39.2 41.3 48.8 53.9 56.1 59.1 59.4 62.2 66.3 66.3 70.2 72.9 82.1 94.9 94.9 96.1 98.0 104.5 105.0 105.5 106.1 110.1 110.3 112.0 112.7 112.7 113.5 125.6 129.9 133.2 133.5 136.6 140.9 80 40 0 40 80 120 160 200 Tajikistan (1999) Turkmenistan (1997) Uzbekistan (2001) Kyrgyzstan (2001) Azerbaijan (2001) Albania (2000) Republic of Moldova (2001) Kazakhstan (2001) Armenia (2000) Georgia (2001) Romania (1999) Poland (1996) Belarus (2001) Ukraine (2000) Russian Federation (2001) TFYR Macedonia (1998) Portugal (1993) Slovakia (1999) Lithuania (2001) Latvia (2001) Estonia (2000) Bulgaria (2001) Italy (1995) Czech Republic (1999) Croatia (2000) Slovenia (1999) Belgium (1996) Norway (1999) Austria (1999) Israel (1998) Germany (1998) Iceland (1997) Malta (2000) Ireland (2000) Hungary (2001) France (1995) United Kingdom (1997) Netherlands (1998) Finland (2000) Luxembourg (1999) Denmark (1998) Sweden (1999) Crude death rate per 100 000 population New cases per 100 000 population Some noncommunicable diseases Female breast cancer incidence and deaths Atlas of health in europa.p65 14-05-2003, 14:1373 Atlas of health in Europe74 Crude death rate per 100 000 population New cases per 100 000 population 2.6 1.2 2.9 1.6 1.5 3.4 1.8 2.6 3.4 3.5 3.7 3.6 5.8 4.6 3.4 2.6 4.1 4.1 4.9 4.4 5.2 9.7 7.0 8.7 6.6 6.6 8.2 4.7 3.8 9.3 4.0 8.0 10.2 5.1 7.4 4.2 8.3 10.1 12.4 8.9 3.1 3.9 4.6 4.7 4.8 5.7 6.1 8.7 9.1 9.2 9.6 10.0 10.5 10.8 10.9 11.0 11.4 11.6 11.8 12.2 12.6 12.7 13.7 14.3 14.9 15.8 15.9 16.7 17.8 17.9 19.2 19.3 19.6 19.9 21.4 21.4 22.0 23.2 26.1 26.7 30 25 20 15 10 5 0 5 10 15 20 25 30 35 Malta (2000) Albania (2000) Finland (2000) Azerbaijan (2001) Tajikistan (1999) Turkmenistan (1997) Israel (1998) Uzbekistan (2001) Belgium (1996) Netherlands (1998) Iceland (1997) Sweden (1999) Georgia (2001) United Kingdom (1997) Ireland (2000) France (1995) Luxembourg (1999) Austria (1999) Kyrgyzstan (2001) Armenia (2000) Norway (1999) Kazakhstan (2001) Latvia (2001) Belarus (2001) Denmark (1998) Russian Federation (2001) Germany (1998) Portugal (1993) Ukraine (2000) Croatia (2000) Slovakia (1999) Poland (1996) Slovenia (1999) Czech Republic (1999) TFYR Macedonia (1998) Estonia (2000) Hungary (2001) Lithuania (2001) Bulgaria (2001) Republic of Moldova (2001) Some noncommunicable diseases Cervical cancer incidence and deaths Atlas of health in europa.p65 14-05-2003, 14:1374 Diseases 75 Hospitalization Hospital discharges for cancer 88.3 103.4 190.4 199.2 222.8 248.0 280.9 291.3 325.2 363.2 373.0 430.0 549.9 623.8 652.5 772.6 795.6 828.0 882.3 973.7 994.5 1039 1076 1147 1171 1269 1306 1377 1411 1442 1503 1585 1608 1614 1665 1743 1775 1883 1908 1919 1963 1981 2315 2415 3636 0 500 1000 1500 2000 2500 3000 3500 4000 Tajikistan (2001) Azerbaijan (2001) Georgia (2001) Turkmenistan (1997) Uzbekistan (2001) Kyrgyzstan (2001) Armenia (2001) Albania (2000) Malta (2001) Andorra (2001) Turkey (2000) Republic of Moldova (2001) Kazakhstan (2001) Ukraine (2001) TFYR Macedonia (2000) Netherlands (2001) Portugal (2001) Ireland (2001) Spain (1999) Israel (1999) Bulgaria (2001) Russian Federation (2001) United Kingdom (1994) Poland (1996) Croatia (2001) Latvia (2001) Iceland (1994) Italy (2000) Romania (2001) Greece (1998) Belarus (2001) Estonia (2001) Slovakia (2001) Lithuania (2001) Sweden (2001) Slovenia (2001) Norway (2001) Belgium (1998) Czech Republic (2001) Hungary (2000) France (2000) Denmark (2000) Germany (1999) Finland (2001) Austria (2000) Per 100 000 population Atlas of health in europa.p65 14-05-2003, 14:1375 Atlas of health in Europe76 500 750 1000 1250 1500 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Hospitalization Hospital discharges for cancer 1500 1750 2000 2250 2500 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Hospital discharges for diseases of the circulatory system Atlas of health in europa.p65 14-05-2003, 14:1376 Diseases 77 411.6 483.7 508.4 539.9 560.6 609.8 664.6 875.1 983.6 1036 1059 1193 1267 1300 1310 1363 1374 1389 1522 1607 1691 1738 2013 2122 2181 2181 2214 2244 2371 2544 2569 2609 2658 2741 2774 2812 3020 3136 3237 3367 3410 3653 4074 4163 4239 4749 0 1000 2000 3000 4000 5000 6000 Georgia (2001) Azerbaijan (2001) Armenia (2001) Albania (2000) Tajikistan (2001) Andorra (2001) Malta (2001) Turkmenistan (1997) Turkey (2000) Kyrgyzstan (2001) Uzbekistan (2001) Portugal (2001) TFYR Macedonia (2000) Yugoslavia (1996) Republic of Moldova (2001) Spain (1999) Netherlands (2001) Kazakhstan (2001) Ireland (2001) United Kingdom (1994) Croatia (2001) Slovenia (2001) Bulgaria (2001) Poland (1996) Israel (1999) Iceland (1994) Greece (1998) France (2000) Norway (2001) Italy (2000) Slovakia (2001) Belgium (1998) Denmark (2000) Romania (2001) Ukraine (2001) Sweden (2001) Russian Federation (2001) Latvia (2001) Estonia (2001) Germany (1999) Czech Republic (2001) Finland (2001) Austria (2000) Lithuania (2001) Hungary (2000) Belarus (2001) Per 100 000 population Hospitalization Hospital discharges for diseases of the circulatory system Atlas of health in europa.p65 14-05-2003, 14:1377 Atlas of health in Europe78 483.6 565.9 620.7 694.7 740.2 838.1 864.3 865.2 879.1 1025 1078 1100 1148 1187 1198 1203 1211 1227 1264 1305 1309 1357 1370 1418 1468 1470 1485 1522 1596 1609 1750 1941 1950 2016 2027 2045 2104 2159 2231 2239 2257 2892 2942 2973 3087 4310 0 1000 2000 3000 4000 5000 Armenia (2001) Malta (2001) Netherlands (2001) Georgia (2001) Portugal (2001) Azerbaijan (2001) Yugoslavia (1996) Turkey (2000) Andorra (2001) Sweden (2001) Croatia (2001) Spain (1999) TFYR Macedonia (2000) Albania (2000) United Kingdom (1994) Italy (2000) Tajikistan (2001) Slovenia (2001) Germany (1999) Greece (1998) Poland (1996) Norway (2001) France (2000) Slovakia (2001) Czech Republic (2001) Ireland (2001) Republic of Moldova (2001) Iceland (1994) Israel (1999) Denmark (2000) Belgium (1998) Kyrgyzstan (2001) Turkmenistan (1997) Kazakhstan (2001) Bulgaria (2001) Austria (2000) Estonia (2001) Hungary (2000) Uzbekistan (2001) Latvia (2001) Finland (2001) Lithuania (2001) Russian Federation (2001) Ukraine (2001) Romania (2001) Belarus (2001) Per 100 000 population Hospitalization Hospital discharges for diseases of the respiratory system Atlas of health in europa.p65 14-05-2003, 14:1378 Diseases 79 1000 1500 2000 2500 3000 3500 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Hospitalization Hospital discharges for diseases of the respiratory system 1300 1500 1700 1900 2100 2300 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Hospital discharges for diseases of the digestive system Atlas of health in europa.p65 14-05-2003, 14:1379 Atlas of health in Europe80 Hospitalization Hospital discharges for diseases of the digestive system 466.0 503.9 573.9 729.9 758.5 817.9 923.3 926.3 928.3 1042 1061 1157 1201 1253 1257 1264 1289 1291 1298 1315 1319 1337 1361 1362 1384 1422 1524 1561 1661 1702 1724 1778 1834 1835 1911 1917 2056 2084 2105 2191 2200 2323 2418 2647 2936 3204 0 1000 2000 3000 4000 Georgia (2001) Armenia (2001) Azerbaijan (2001) Turkey (2000) Malta (2001) Netherlands (2001) Tajikistan (2001) TFYR Macedonia (2000) Yugoslavia (1996) Andorra (2001) Portugal (2001) Norway (2001) Turkmenistan (1997) United Kingdom (1994) Bulgaria (2001) Albania (2000) Spain (1999) Sweden (2001) Croatia (2001) Kyrgyzstan (2001) Uzbekistan (2001) Israel (1999) Iceland (1994) Poland (1996) Ireland (2001) Kazakhstan (2001) Slovenia (2001) Republic of Moldova (2001) Denmark (2000) Greece (1998) Italy (2000) Finland (2001) Estonia (2001) Hungary (2000) Germany (1999) Slovakia (2001) Latvia (2001) Czech Republic (2001) Ukraine (2001) Russian Federation (2001) Lithuania (2001) Austria (2000) Romania (2001) Belgium (1998) France (2000) Belarus (2001) Per 100 000 population Atlas of health in europa.p65 14-05-2003, 14:1380 Diseases 81 62.2 89.8 118.1 124.0 167.2 234.4 281.7 301.0 307.1 323.9 402.2 407.5 459.7 476.9 566.1 572.0 600.3 601.2 601.9 643.8 646.8 661.9 687.0 738.4 761.7 830.0 879.3 908.0 928.3 987.4 1016 1082 1103 1108 1136 1238 1250 1315 1437 1449 1550 1730 2001 2054 2127 2834 0 500 1000 1500 2000 2500 3000 3500 Georgia (2001) Azerbaijan (2001) Albania (2000) Armenia (2001) Malta (2001) Yugoslavia (1996) Turkey (2000) Tajikistan (2001) Turkmenistan (1997) Portugal (2001) TFYR Macedonia (2000) Kazakhstan (2001) Uzbekistan (2001) Israel (1999) Ireland (2001) Republic of Moldova (2001) Croatia (2001) Kyrgyzstan (2001) Poland (1996) Netherlands (2001) Spain (1999) Greece (1998) Andorra (2001) Bulgaria (2001) United Kingdom (1994) Sweden (2001) Slovenia (2001) Slovakia (2001) Italy (2000) Ukraine (2001) Denmark (2000) Romania (2001) Russian Federation (2001) Norway (2001) Lithuania (2001) Iceland (1994) Latvia (2001) Estonia (2001) Czech Republic (2001) Germany (1999) France (2000) Hungary (2000) Belgium (1998) Belarus (2001) Finland (2001) Austria (2000) Per 100 000 population Hospitalization Hospital discharges for diseases of the musculoskeletal system Atlas of health in europa.p65 14-05-2003, 14:1381 Atlas of health in Europe82 500 700 900 1100 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu lat io n CIS CSEC EU 1000 1250 1500 1750 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Hospitalization Hospital discharges for diseases of the musculoskeletal system Hospital discharges for injury and poisoning Atlas of health in europa.p65 14-05-2003, 14:1382 Diseases 83 208.7 318.3 335.9 396.8 400.0 432.4 441.6 455.6 588.6 719.4 730.6 744.5 752.2 878.1 946.3 1056 1112 1210 1219 1268 1321 1324 1325 1345 1346 1460 1467 1472 1487 1489 1560 1591 1608 1656 1697 1708 1909 1916 1993 2054 2087 2093 2126 2210 2211 3159 0 1000 2000 3000 4000 Azerbaijan (2001) Armenia (2001) Georgia (2001) Turkey (2000) Malta (2001) Yugoslavia (1996) Albania (2000) Tajikistan (2001) TFYR Macedonia (2000) Portugal (2001) Turkmenistan (1997) Netherlands (2001) Uzbekistan (2001) Spain (1999) Croatia (2001) Bulgaria (2001) Poland (1996) Kyrgyzstan (2001) Republic of Moldova (2001) Estonia (2001) Slovakia (2001) Israel (1999) United Kingdom (1994) Romania (2001) Andorra (2001) Greece (1998) Iceland (1994) Italy (2000) Hungary (2000) Kazakhstan (2001) Sweden (2001) Slovenia (2001) Ukraine (2001) Ireland (2001) Czech Republic (2001) Norway (2001) Denmark (2000) Russian Federation (2001) Germany (1999) France (2000) Belgium (1998) Belarus (2001) Finland (2001) Lithuania (2001) Latvia (2001) Austria (2000) Per 100 000 population Hospitalization Hospital discharges for injury and poisoning Atlas of health in europa.p65 14-05-2003, 14:1383 Atlas of health in Europe84 0.6 0.7 0.8 0.9 0.9 0.9 0.9 1.1 1.1 1.1 1.2 1.2 1.3 1.4 1.5 1.5 1.6 1.6 1.7 1.8 1.9 2.1 2.1 2.3 2.4 2.4 2.5 2.6 2.7 2.7 2.9 3.1 3.3 3.4 3.5 3.7 3.7 3.8 4.1 4.2 4.2 4.3 4.4 4.9 6.1 7.3 0 1 2 3 4 5 6 7 8 9 Netherlands (1998) Luxembourg (1999) Switzerland (1996) Uzbekistan (2001) United Kingdom (2001) Sweden (2001) Denmark (2001) Kyrgyzstan (1993) Ireland (1997) Finland (1997) Tajikistan (1990) Germany (2000) Republic of Moldova (1995) Israel (1994) Norway (1999) Iceland (1996) Malta (1991) Belgium (1998) Austria (1997) Slovenia (1998) France (1998) Kazakhstan (1990) Italy (1996) Spain (1994) Georgia (1990) Armenia (1990) Turkey (1996) Turkmenistan (1990) Greece (1998) Estonia (1998) Albania (1996) TFYR Macedonia (1999) Portugal (1999) Belarus (1999) Czech Republic (1998) Croatia (1999) San Marino (1990) Russian Federation (1995) Hungary (1996) Poland (1999) Latvia (1998) Bulgaria (1998) Slovakia (1999) Ukraine (1992) Lithuania (1994) Bosnia and Herzegovina (2001) Romania (1998) Average number per child 3.0 Teeth Decayed, missing or filled teeth in 12-year-olds Atlas of health in europa.p65 14-05-2003, 14:1384 Lifestyles and environment 85 4. Lifestyles and environment Notes Smoking (pp. 87–88 ) Countries estimate the percentage of regular daily smokers aged 15 years and over on the basis of health interview surveys. The tobacco-free Europe programme, at the WHO Regional Office for Europe, collates the data. Most of the estimates are based on multiple sources, however, and population samples are not always representative of a whole country. Intercountry comparisons should therefore be made with caution. Smoking prevalence among young people (15-year-olds) is estimated in a more uniform way across the European Region, through the WHO Health Behaviour in School-aged Children Study. The Study does not collect data for all countries, however. Average cigarette consumption is estimated on the basis of data published by the Tobacco journal international. Alcohol (pp. 89–91) The data show the estimated amount of pure ethanol consumed in the form of spirits, wine, beer and other alcoholic drinks, per person per year. This estimate is calculated from official statistics on local production, sales, imports and exports, taking into account stocks and home production whenever possible. The alcohol and drugs programme, at the WHO Regional Office for Europe, collects data and makes calculations mainly from three sources: World drink trends (published regularly by Productschap voor Gedistilleerde Dranken, Schiedam, Netherlands), the FAO and data reported directly by countries. In the Republic of Moldova, and probably in some other countries too, the total consumption of alcohol, particularly spirits, is likely to be somewhat overestimated, owing to the low reported export Atlas of health in europa.p65 14-05-2003, 14:1385 Atlas of health in Europe86 figures. As no data were available on stocks, it was assumed that all spirits produced and not otherwise accounted for were “consumed”. Foodborne disease (p. 92) Infections or intoxications due to microbiologically contaminated food include such diseases as trichinellosis, salmonellosis, and Campylobacter enteritis. National definitions and registration practices vary significantly, therefore intercountry comparability is limited. Work-related deaths (pp. 93–94) The data source is the ILO. Motor vehicle traffic accidents (p. 95) The main data source for accidents is Statistics of road traffic accidents in Europe and North America regularly published by the UNECE, in Geneva. Data on deaths from traffic accidents come from the WHO mortality database. Traffic accident registration practices vary significantly among countries, thus limiting international comparisons. The available data show that the number of registered accidents per 100 000 population is lowest in the eastern and some central European countries, but the number of people killed per 1000 accidents in these countries is the highest. This correlation is most likely partially the result of incomplete registration of all accidents in these countries, but also of the really low traffic safety precautions in the eastern part of the Region. Atlas of health in europa.p65 14-05-2003, 14:1386 Lifestyles and environment 87 9 14 18 19 21 21 24 24 24 24 25 26 27 27 27 27 28 29 29 29 29 29 30 30 30 30 30 30 31 32 33 33 34 34 35 35 35 36 36 36 36 38 39 39 42 47 48 8.5 9.8 16.5 22.9 22.7 21.6 16.1 17.7 9.7 19.8 22.1 17.6 17.3 17.8 14.8 18.5 16.9 15.8 19.1 17.1 24.4 20.1 19.2 27.5 9.8 15.8 9.9 16.3 19.1 40 30 20 10 0 10 20 30 40 50 Malta (1995) Turkmenistan (1990) Republic of Moldova (2001) Sweden (2001) Portugal (1999) Romania (2000) Iceland (2001) Slovenia (2001) Finland (2001) Czech Republic (2002) Italy (2000) Belarus (2001) Azerbaijan (1997) United Kingdom (2000) Israel (2000) France (2000)Kazakhstan (2000) Slovakia (1998) Austria (2000) Armenia (1998) Latvia (1999) Estonia (2000) Norway (2001) Luxembourg (2000) Kyrgyzstan (1999) Denmark (2000) Belgium (2000) Croatia (2000) Ireland (1998) Lithuania (2000) Georgia (1998)Switzerland (1997) Ukraine (2000)Spain (2001) Netherlands (2001)Germany (2000) Turkey (1993) Bulgaria (1996) Andorra (1997) TFYR Macedonia (1999) Russian Federation (1998) Greece (2000) Poland (1993) Albania (2000) Hungary (2000) Yugoslavia (2000) Bosnia and Herzegovina (1995) aData refer to 2001 / 2002 Percent of 15-year-oldsa Percent of adults (age 15+) Smoking Smokers among adults and 15-year-olds Atlas of health in europa.p65 14-05-2003, 14:1387 Atlas of health in Europe88 65 55 50 40 30 No data % of adult male population – < – < – < – < – < Smoking Smokers among adult males 1000 1250 1500 1750 2000 2250 1980 1985 1990 1995 2000 Year N um be r p er pe rs on pe r ye ar CIS CSEC EU Cigarette consumption Atlas of health in europa.p65 14-05-2003, 14:1388 Lifestyles and environment 89 4 5 6 7 8 9 10 11 12 1980 1985 1990 1995 2000 Year CIS CSEC EU Li tre s (pu re alc oh ol eq uiv ale nt) pe r p ers on pe r y ea r Alcohol Total alcohol consumption 16 11 9 7 5 Litres (pure alcohol equivalent) per person per year – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1389 Atlas of health in Europe90 0.7 0.8 0.9 1.1 1.3 1.4 1.4 1.7 2.5 3.1 3.2 3.7 4.2 4.2 4.8 5.1 5.2 5.4 6.1 6.5 6.6 6.7 6.8 7.2 7.5 7.7 7.8 7.9 7.9 8.0 8.1 8.1 9.1 9.4 9.4 9.6 9.9 10.0 10.1 10.4 10.4 10.6 10.8 12.6 13.3 13.8 14.0 15.9 0 5 10 15 Tajikistan Turkmenistan Uzbekistan Turkey Armenia Albania Israel Kazakhstan Kyrgyzstan Ukraine TFYR Macedonia Malta Norway Iceland Georgia Azerbaijan Sweden Bulgaria Romania Poland Belarus Yugoslavia Estonia Latvia Netherlands Greece Italy United Kingdom Belgium Finland Russian Federation Hungary Denmark Switzerland Spain Slovakia Lithuaniaa Austria Germany Croatia Slovenia France Czech Republic Ireland Luxembourg Portugal Republic of Moldova a 2001 Bosnia and Herzegovina Litres (pure alcohol equivalent) per person Alcohol Total alcohol consumption, 2000 Atlas of health in europa.p65 14-05-2003, 14:1390 Lifestyles and environment 91 0.4 0.5 0.5 0.5 0.6 0.6 0.7 0.9 1.0 1.0 1.1 1.1 1.2 1.2 1.2 1.3 1.4 1.5 1.6 1.6 1.7 1.9 1.9 2.1 2.2 2.2 2.3 2.4 2.4 2.4 2.6 2.8 2.8 3.2 3.4 4.0 4.0 4.2 4.5 4.6 5.3 5.5 5.6 0 1 2 3 4 5 6 7 8 9 10 11 12 Albania Tajikistan Italy Georgia Turkey Israel Norway Malta Sweden Armenia Iceland Romania Denmark Kazakhstan Belgium Croatia Austria Switzerland United Kingdom Luxembourg Netherlands Germany Greece Yugoslavia Finland Ukraine Bulgaria Ireland Spain France Estonia Slovenia Hungary Poland Czech Republic Lithuaniaa Azerbaijan Portugal Slovakia Belarus Latvia a 2001 Republic of Moldova Russian Federation Bosnia and Herzegovina 11.4 Litres (pure alcohol equivalent) per person Alcohol Consumption of spirits, 2000 Atlas of health in europa.p65 14-05-2003, 14:1391 Atlas of health in Europe92 0.1 0.1 0.1 0.5 1.3 2.1 2.1 2.2 5.5 6.3 6.9 12.1 12.5 14.7 17.3 19.1 25.5 27.4 28.1 28.3 35.0 35.7 36.7 45.4 48.7 50.9 61.3 67.0 73.6 76.6 82.8 100.2 125.8 131.0 140.4 146.0 164.1 238.5 259.6 374.9 595.0 0 100 200 300 400 500 600 700 Uzbekistan (2001) Kyrgyzstan (2001) Azerbaijan (2001) Kazakhstan (2001) Armenia (2001) Greece (2001) Ukraine (2000) Belarus (2001) Russian Federation (1999) Estonia (2001) Republic of Moldova (2001) Andorra (2001) Romania (2001) Turkey (2000) Israel (2001) France (1992) Croatia (2001) TFYR Macedonia (2001) Belgium (1999) Spain (1996) Albania (1998) Slovenia (2001) Bosnia and Herzegovina (2001) Hungary (2001) Finland (2001) Iceland (2001) Malta (2001) Turkmenistan (1992) Tajikistan (1992) Lithuania (1998) Luxembourg (2001) Ireland (2001) Norway (2001) Switzerland (2001) Austria (1992) Denmark (2001) United Kingdom (2000) Germany (2000) Georgia (2001) Slovakia (2001) Czech Republic (2001) Per 100 000 population Foodborne disease Cases of microbiological foodborne disease Atlas of health in europa.p65 14-05-2003, 14:1392 Lifestyles and environment 93 0 1 2 3 4 5 6 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Work and traffic accidents Deaths from work-related accidents 4 2 1.5 1 0.5 No data Per 100 000 population – < – < – < – < – < Atlas of health in europa.p65 14-05-2003, 14:1393 Atlas of health in Europe94 Work and traffic accidents Deaths from work-related accidents 0.2 0.3 0.3 0.4 0.4 0.4 0.6 0.6 0.7 0.7 0.8 0.8 0.8 0.8 0.9 0.9 1.2 1.2 1.2 1.3 1.4 1.4 1.5 1.5 1.5 1.6 1.7 1.7 1.7 1.8 1.9 1.9 1.9 2.0 2.2 2.3 2.4 2.5 2.5 2.6 2.7 2.8 2.9 2.9 0 1 2 3 TFYR Macedonia (2001) Tajikistan (2001) Azerbaijan (2001) Iceland (2001) United Kingdom (2000) Armenia (2001) Croatia (2001) Netherlands (2000) Sweden (2000) Greece (1998) Yugoslavia (1999) Kyrgyzstan (2001) Finland (1999) Norway (2001) Republic of Moldova (2001) Denmark (2001) Switzerland (1999) France (1999) Belgium (2001) Hungary (2001) Germany (2000) Poland (2001) Turkey (2001) Malta (2001) Andorra (1997) Israel (2001) Ireland (2001) Bulgaria (2000) Slovenia (2001) Austria (2000) Kazakhstan (1999) Slovakia (2001) Romania (2001) Czech Republic (2001) Estonia (2001) Lithuania (2001) Belarus (2001) Italy (2000) Luxembourg (2001) Spain (2001) Ukraine (2001) Portugal (2000) Latvia (2001) Russian Federation (1999) Per 100 000 population Atlas of health in europa.p65 14-05-2003, 14:1394 Lifestyles and environment 95 122 100 217 196 387 205 101 155 152 168 238 167 123 87 63 125 146 184 58 65 91 109 118 23 75 32 41 141 51 92 63 92 63 54 27 50 21 35 13 15 21 36 31 30 19 20 14 24 25 34 34 38 49 55 60 64 68 76 80 84 110 110 128 143 146 166 171 171 179 187 189 205 206 212 230 247 248 263 327 384 428 480 519 432 424 391 380 25 285 482 148 84 500 400 300 200 100 0 100 200 300 400 500 600 Albania (2000) Tajikistan (1999) Armenia (2000) Azerbaijan (2000) Romania (2000) Turkmenistan (1998) Georgia (2000) Uzbekistan (1999) Kyrgyzstan (2000) Republic of Moldova (2000) Belarus (2000) Ukraine (2000) Kazakhstan (2000) Yugoslavia (2000) TFYR Macedonia (2000) Bulgaria (2000) Estonia (2000) Russian Federation (1998) Finland (2000) Denmark (1999) Slovakia (2000) Poland (2000) Lithuania (2000) Malta (1998) Hungary (2000) Sweden (1999) Norway (1999) Latvia (2000) Ireland (2000) Luxembourg (2000) France (1999) Greece (1999) Spain (1999) Czech Republic (2000) Netherlands (1997) Croatia (1999) Switzerland (1999) Italy (1999) Iceland (1997) United Kingdom (2000) Israel (1998) Slovenia (2000) Portugal (2000) Belgium (1996) Germany (1999) Austria (2000) Deaths per 1000 accidents Accidents per 100 000 population Work and traffic accidents Motor vehicle traffic accidents and deaths Atlas of health in europa.p65 14-05-2003, 14:1395 Atlas of health in Europe96 Atlas of health in europa.p65 14-05-2003, 14:1396 Health care 97 5. Health care Notes Physicians (pp. 99–100) The data show the number of practising physicians working in public or private health services. Not all countries report the data strictly according to the recommended definitions. Countries also differ in the way they compile national statistics on employment in the health sector. The number of physicians per head of population is steadily increasing in western and, to a lesser extent, in central parts of the Region. Previously high and increasing ratios in the eastern part began to decline in the early 1990s. Dentists (pp. 100–101) The data include dentists who have completed university level studies in dentistry and are actually working in dental care. Nurses (p. 102) The data show nurses who have completed a programme of nursing education (either basic or at university level), and are qualified and authorized in their country to practice nursing in all settings for the promotion of health, the prevention of illness, the care of the sick and rehabilitation. The international comparability of statistics on nurses is particularly limited, owing to the variations in national definitions and practices. Hospital beds (pp.103–105) The number of available beds includes beds in all hospitals, regardless of specialty. The main limitation on intercountry comparability is that some countries count nursing homes and similar institutions as hospitals while others do not. Atlas of health in europa.p65 14-05-2003, 14:1397 Atlas of health in Europe98 The number of hospital beds per 100 000 population and the average length of stay are clearly declining throughout the Region, with the highest levels still in the eastern part. A number of countries have seen a remarkable reduction in psychiatric beds. Inpatient hospital admissions (pp. 106–107) The inpatient hospital admissions rate is steadily increasing in western and central parts of the Region. Previously high rates in the eastern part dropped during the 1990s and averages for all three parts of the Region are currently very close. Nevertheless, the hospital admissions rates vary significantly from country to country. Caesarean sections (pp. 107–108) The number of Caesarean sections performed is increasing throughout the Region. The highest rates are currently in the western part of the Region, and the lowest in the eastern part. Childhood vaccination (p. 109) The data show the percentage of infants reaching their first birthday in the given year who have been fully vaccinated (with three doses) against diphtheria, and the percentage of children reaching their second birthday who have been vaccinated against measles. Health expenditure (pp. 110–112) The data source for OECD countries is the OECD health database. The remaining countries reported the data directly. Health expenditure in some of these countries, particularly in the eastern part of the Region, is likely to be underestimated, owing to the exclusion of the private sector and out-of-pocket payments. The health expenditure, both as a percentage of gross domestic product (GDP) and in international dollars (purchasing power parities expressed in US $ (US $PPP)) per person, varies significantly between countries. In the western part of the Region, expenditure is steadily increasing while in the eastern part it is stable or increasing much more slowly, thus further increasing the east–west gap. Atlas of health in europa.p65 14-05-2003, 14:1398 Health care 99 123 139 145 164 189 212 213 219 219 220 238 239 252 254 265 271 272 284 287 287 291 291 293 298 300 311 313 318 323 326 328 329 330 342 344 345 350 352 355 359 363 367 375 403 419 420 430 438 450 567 0 100 200 300 400 500 600 700 Turkey (2001) Albania (2000) Bosnia and Herzegovina (2001) United Kingdom (1993) Romania (2001) Tajikistan (2001) Yugoslavia (1999) Slovenia (2001) TFYR Macedonia (2001) Poland (2000) Croatia (2001) Ireland (2001) San Marino (1990) Luxembourg (2001) Andorra (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Denmark (1999) Sweden (1999) Armenia (2001) Latvia (2001) Malta (2001) Uzbekistan (2001) Ukraine (2001) Turkmenistan (1997) Finland (2001) Estonia (2001) Portugal (2000) Austria (2001) Slovakia (2001) Netherlands (2001) Spain (2000) France (2001) Czech Republic (2001) Bulgaria (2001) Kazakhstan (2001) Switzerland (2000) Iceland (2001) Hungary (1999) Azerbaijan (2001) Germany (2001) Norway (2002) Israel (2001) Lithuania (2001) Belgium (2001) Russian Federation (2001) Georgia (2001) Greece (1999) Belarus (2001) Italy (1999) Per 100 000 population Health personnel Number of physicians Atlas of health in europa.p65 14-05-2003, 14:1399 Atlas of health in Europe100 200 250 300 350 400 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Health personnel Number of physicians 20 30 40 50 60 70 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Number of dentists Atlas of health in europa.p65 14-05-2003, 14:13100 Health care 101 16.7 18.1 18.7 21.2 21.6 21.9 22.6 24.3 26.1 29.2 30.4 31.2 32.1 32.6 36.4 38.5 39.3 39.8 40.2 41.4 42.8 44.1 44.2 44.3 44.5 46.8 47.2 52.3 52.9 55.2 56.9 57.4 59.1 63.6 64.1 65.1 68.0 68.1 69.7 71.5 77.9 80.2 81.9 85.6 91.2 100.7 114.7 115.3 121.4 125.4 152.1 0 30 60 90 120 150 180 Tajikistan (2001) Bosnia and Herzegovina (2001)Armenia (2001) Uzbekistan (2001) Turkmenistan (1997)Kyrgyzstan (2001) Romania (2001)Turkey (2000) Azerbaijan (2001)Kazakhstan (2001) Poland (2000) Republic of Moldova (2001) Russian Federation (2001) Georgia (2001)San Marino (1984) Yugoslavia (1999)Ukraine (2001) United Kingdom (1992) Malta (2001)Albania (1998) Portugal (2000)Belarus (2001) Slovakia (2001)Spain (2000) Switzerland (2001) Netherlands (2001)Austria (2001) Ireland (2001)Latvia (2001) TFYR Macedonia (2001)Hungary (1999) Italy (2000)Slovenia (2001) Andorra (2001) Luxembourg (2001)Czech Republic (2001) France (2001)Croatia (2001) Belgium (1998)Lithuania (2001) Germany (2001) Estonia (2001)Bulgaria (2001) Denmark (1999)Finland (2001) Iceland (2000)Israel (2001) Greece (1999) Monaco (1995)Norway (2001) Sweden (1997) Per 100 000 population Health personnel Number of dentists Atlas of health in europa.p65 14-05-2003, 14:13101 Atlas of health in Europe102 244 257 281 309 367 372 375 386 391 403 423 426 445 449 450 500 508 508 518 527 583 587 591 593 623 629 669 684 715 738 748 768 768 779 793 798 843 869 937 944 955 1011 1075 1236 1328 1621 1676 2068 2171 0 500 1000 1500 2000 2500 Turkey (2000)Greece (1992) Hungary (2000)Andorra (2001) Portugal (2000) Spain (2000)Malta (2001) Armenia (2001) Albania (2001)Romania (2001) Georgia (2001) Tajikistan (2001)Bosnia and Herzegovina (2001) Yugoslavia (1999)Bulgaria (2001) Croatia (2001)Latvia (2001) San Marino (1990) TFYR Macedonia (2001)Poland (1990) Austria (2000) Turkmenistan (1997)Israel (2001) Kazakhstan (2001) Estonia (2001)Republic of Moldova (2001) France (2001)Kyrgyzstan (2001) Slovenia (2001)Azerbaijan (2001) Slovakia (2000) Luxembourg (2001)Ukraine (2001) Switzerland (1990) Russian Federation (2001)Lithuania (2001) Sweden (1999)Iceland (1999) Denmark (1999)Czech Republic (2001) Germany (2001) Uzbekistan (2001)Belgium (1996) Belarus (2001) Netherlands (2001)Monaco (1995) Ireland (2000) Norway (2001)Finland (2001) Per 100 000 population Health personnel Number of nurses Atlas of health in europa.p65 14-05-2003, 14:13102 Health care 103 9 12 15 1980 1985 1990 1995 2000 Year CIS CSEC EU Av er ag e nu m be r o f d ay s 500 600 700 800 900 1000 1100 1200 1300 1980 1985 1990 1995 2000 Year Pe r 10 0 00 0 po pu la tio n CIS CSEC EU Hospitals Hospital beds Length of stay in hospital Atlas of health in europa.p65 14-05-2003, 14:13103 Atlas of health in Europe104 236 322 326 357 392 401 417 427 430 434 440 450 466 488 493 516 522 534 541 556 589 600 615 616 618 640 672 697 699 711 720 737 749 779 820 820 825 851 852 861 874 903 912 922 1083 1100 1258 6.9 9.0 9.8 11.7 6.6 7.7 12.5 8.3 8.3 6.3 8.9 12.5 11.8 13.3 11.1 13.0 14.0 8.7 14.1 11.5 13.4 10.7 10.3 8.6 10.0 10.8 11.3 8.7 11.5 7.6 14.6 13.7 11.9 10.9 15.2 15.3 13.3 5.8 11.8 11.0 11.6 17.5 7.6 9.7 9.7 7.5 10.5 25 0 250 500 750 1000 1250 1500 Average number of days Beds per 100 000 population Turkey (2001) Albania (2000) Ireland (2001) Portugal (1999) Spain (2001) United Kingdom (1997) Armenia (2001) Georgia (2001) Denmark (2000) Norway (2001) Italy (2000) Netherlands (2001) Greece (1998) TFYR Macedonia (2001) Slovenia (2001) Sweden (2001) Uzbekistan (2001) Yugoslavia (1999) Poland (2000) Republic of Moldova (2001) Croatia (2001) Kyrgyzstan (2001) Israel (2001) Switzerland (2000) Tajikistan (2001) Estonia (2001) Kazakhstan (2001) Belgium (2001) Turkmenistan (1997) Bulgaria (2001) Finland (2001) Romania (2001) Slovakia (2001) France (2000) Latvia (2001) Hungary (2001) Azerbaijan (2001) Czech Republic (2001) Austria (2000) Ukraine (2001) Iceland (1996) Germany (2000) Lithuania (2001) Russian Federation (2001) Luxembourg (1996) Belarus (2001) Bosnia and Herzegovina (2001) 50 Hospitals Number of beds and length of stay in hospital Atlas of health in europa.p65 14-05-2003, 14:13104 Health care 105 12.3 14.2 18.2 26.2 26.8 29.4 31.3 40.3 43.4 44.5 44.7 49.8 56.7 58.4 59.2 61.3 62.5 64.3 65.3 67.2 67.4 68.1 68.4 69.8 75.1 76.0 78.0 80.0 81.9 85.0 87.0 92.1 96.3 97.1 99.3 100.4 102.7 107.1 110.2 113.7 115.6 116.1 117.3 117.9 122.4 127.6 143.3 150.1 153.9 0 50 100 150 200 250 300 350 400 Turkey (2001) Italy (2000) Andorra (2001) Georgia (2001) Tajikistan (2001) Albania (2000) Uzbekistan (2001) Armenia (2001) Hungary (2000) Bosnia and Herzegovina (2001) Turkmenistan (1997) Azerbaijan (2001) Spain (1997) Republic of Moldova (2001) Kyrgyzstan (2001) Austria (2000) Sweden (2000) Bulgaria (2001) Kazakhstan (2001) Norway (2001) Poland (2000) TFYR Macedonia (2001) Estonia (2001) Portugal (1998) Slovenia (2001) Romania (2001) Denmark (1999) Yugoslavia (1999) United Kingdom (1997) Israel (2001) Slovakia (2001) Greece (1999) Ukraine (2001) Luxembourg (1998) Belarus (2001) Finland (2001) Croatia (2001) France (2000) Ireland (2001) Czech Republic (2001) Switzerland (2000) Belgium (2001) Russian Federation (2001) Iceland (1995) Lithuania (2001) Germany (2000) Malta (2001) Latvia (2001) Netherlands (2001) Per 100 000 population Latest value 1980 Hospitals Psychiatric hospital beds Atlas of health in europa.p65 14-05-2003, 14:13105 Atlas of health in Europe106 4.5 4.9 4.9 7.8 7.8 8.8 9.0 9.0 9.3 10.6 11.5 12.0 12.5 13.0 13.8 14.5 14.8 15.1 15.3 15.4 15.5 15.5 15.8 16.5 16.6 16.6 16.9 17.6 18.7 18.9 19.4 19.7 19.7 19.7 19.7 20.2 20.7 21.6 22.5 23.0 23.5 24.0 24.4 26.0 26.1 29.2 30.0 0 10 20 30 Georgia (2001) Azerbaijan (2001) Armenia (2001) Turkey (2001) Albania (2001) TFYR Macedonia (2001) Tajikistan (2001) Netherlands (2001) Yugoslavia (1999) Spain (1997) Portugal (1998) Republic of Moldova (2001) Turkmenistan (1997) Uzbekistan (2001) Kyrgyzstan (2001) Ireland (2001) United Kingdom (1998) Bulgaria (2001) Greece (1998) Kazakhstan (2001) Poland (2000) Croatia (2001) Italy (2000) Sweden (2001) Slovenia (2001) Switzerland (1998) Norway (2001) Israel (2001) Denmark (2001) Luxembourg (1994) Estonia (2001) Ukraine (2001) Belgium (1998) Slovakia (2001) Czech Republic (2001) Latvia (2001) Iceland (1995) Russian Federation (2001) France (1999) Germany (2000) Lithuania (2001) Romania (2001) Finland (2001) Hungary (2001) Austria (2000) Belarus (2001) Per 100 population Bosnia and Herzegovina (2001) Hospitals Inpatient hospital admissions Atlas of health in europa.p65 14-05-2003, 14:13106 Health care 107 15 18 21 24 1980 1985 1990 1995 2000 Year Pe r 10 0 po pu la tio n CIS CSEC EU Hospitals Inpatient hospital admissions 50 100 150 200 1980 1985 1990 1995 2000 Year Pe r 10 00 li v e bi rth s CIS CSEC EU Caesarean sections Some procedures Atlas of health in europa.p65 14-05-2003, 14:13107 Atlas of health in Europe108 13.9 18.1 28.8 31.0 33.2 40.9 53.3 67.4 74.2 78.6 102.2 103.6 114.1 119.1 125.2 129.5 130.3 135.1 136.0 136.4 136.6 141.5 144.0 147.0 147.6 150.1 152.7 155.1 156.3 159.2 161.1 161.2 163.5 163.6 164.0 166.5 167.7 177.0 185.5 188.6 198.0 208.9 211.8 237.3 240.0 243.2 275.3 319.3 0 50 100 150 200 250 300 350 Tajikistan (2001) Luxembourg (1998) Turkmenistan (1997) Azerbaijan (2001) Uzbekistan (2001) Kyrgyzstan (2001) Yugoslavia (1998) Republic of Moldova (2001) Kazakhstan (2001) Armenia (2001) TFYR Macedonia (2001) Georgia (2001) Ukraine (2001) Croatia (2001) Slovenia (2001) Czech Republic (2001) Albania (2001) Lithuania (2001) Turkey (1998) Netherlands (2001) Norway (2000) United Kingdom (1995) Sweden (1999) Bulgaria (2001) Russian Federation (2001) Israel (2000) Denmark (2000) Estonia (2001) Romania (2001) Belgium (1999) France (1999) Poland (1997) Latvia (2001) Finland (2001) Belarus (2001) Slovakia (2001) Iceland (2001) Switzerland (1991) Ireland (2000) Austria (2001) Spain (1997) Germany (2000) Hungary (2001) Andorra (1999) Greece (1991) Malta (2001) Portugal (1998) Italy (1999) Per 1000 live births Some procedures Caesarean sections Atlas of health in europa.p65 14-05-2003, 14:13108 Health care 109 Some procedures Children vaccinated against measles and diphtheria 87.0 84.0 78.5 73.2 73.9 75.0 55.0 90.0 90.0 92.2 90.0 94.0 84.7 94.7 90.0 95.5 93.6 97.4 94.0 83.0 70.0 95.2 97.6 99.0 98.4 74.2 96.8 98.9 96.0 94.0 94.1 82.4 98.2 98.9 95.1 95.0 98.0 91.0 83.0 86.8 97.2 97.1 98.9 98.3 98.0 96.0 98.8 99.4 99.9 99.9 81.0 83.0 83.6 84.3 84.9 85.0 85.7 89.0 90.0 90.5 91.0 92.3 93.3 93.5 93.6 93.7 94.4 94.6 95.0 95.0 95.0 95.2 95.4 95.8 95.8 95.8 96.7 96.9 97.0 97.0 97.1 97.1 97.3 97.5 97.8 97.8 98.0 98.0 98.0 98.1 98.3 98.4 98.7 99.0 99.0 99.0 99.1 99.3 99.4 99.8 99.9 100 150 125 100 75 50 25 0 25 50 75 100 125 150 Malta (1999) Turkey (2001)Austria (2001) Ireland (2001) Bosnia and Herzegovina (2000)Germany (1997) Georgia (2001)Andorra (1998) Greece (1997) TFYR Macedonia (2001)Norway (2001) Slovenia (2001)United Kingdom (2001) Estonia (2001) Bulgaria (2001)Armenia (2001) Croatia (2001)Lithuania (2001) Israel (2001)Switzerland (1991) Italy (1999) Spain (2000)Turkmenistan (2001) Kazakhstan (2001)Russian Federation (2001) San Marino (2000) Tajikistan (2001)Uzbekistan (2001) Netherlands (1998)Denmark (2001) Republic of Moldova (2001) Belgium (1999)Romania (1999) Azerbaijan (2001)Yugoslavia (2001) Albania (2001)Monaco (1991) Luxembourg (1997) France (1998)Portugal (2001) Poland (2001)Czech Republic (2000) Kyrgyzstan (2001) Latvia (2001)Finland (1999) Sweden (1997)Ukraine (2001) Belarus (2001) Slovakia (2001)Hungary (2001) Iceland (1999) Percent of children (measles) Percent of infants (diphtheria) Atlas of health in europa.p65 14-05-2003, 14:13109 Atlas of health in Europe110 Health expenditure Total health expenditure as a percent of GDP 0.8 1.2 1.6 1.9 2.3 2.6 2.9 2.9 3.4 3.5 4.2 4.3 4.5 4.5 4.6 4.7 4.8 5.1 5.5 5.7 5.7 6.0 6.2 6.5 6.6 6.7 7.3 7.4 7.5 7.6 7.7 7.9 8.0 8.0 8.1 8.2 8.2 8.4 8.7 8.8 8.9 8.9 9.0 9.2 9.5 10.6 10.7 0 2 4 6 8 10 12 Azerbaijan (2001) Tajikistan (1998) Kazakhstan (2001) Albania (2000) Kyrgyzstan (2001) Uzbekistan (2001) Republic of Moldova (2001) Russian Federation (2000) Ukraine (2001) Turkmenistan (1996) Armenia (1993) Turkey (2000) Romania (1999) TFYR Macedonia (2000) Belarus (2001) Bulgaria (1994) Latvia (2001) Georgia (2000) Estonia (2001) Hungary (2001) Lithuania (2001) Luxembourg (1999) Poland (1999) Slovakia (2000) Finland (2000) Ireland (2000) United Kingdom (2000) Czech Republic (2001) Norway (2000) Yugoslavia (2000) Spain (2000) Sweden (1998) Austria (2000) Italy (2001) Netherlands (2000) Portugal (2000) Slovenia (2001) Denmark (2001) Belgium (2000) Israel (2001) Iceland (2000) Malta (2001) Croatia (1994) Greece (2001) France (2000) Germany (2000) Switzerland (2000) Percent of GDP Latest value 1991a a 1992 in Germany Atlas of health in europa.p65 14-05-2003, 14:13110 Health care 111 0 1 2 3 4 5 6 7 8 9 1980 1985 1990 1995 2000 Year Pe rc en t o f G DP CIS CSEC EU 0 500 1000 1500 2000 1980 1985 1990 1995 2000 Year US $P PP pe r p er so n CIS CSEC EU Health expenditure Total health expenditure as a percent of GDP Total health expenditure per person Atlas of health in europa.p65 14-05-2003, 14:13111 Atlas of health in Europe112 12 26 49 52 63 67 73 86 112 136 160 214 229 243 272 297 332 338 358 426 557 594 690 841 1031 1389 1399 1441 1522 1556 1664 1671 1748 1763 1953 2032 2162 2246 2268 2269 2349 2420 2608 2613 2748 3222 0 1000 2000 3000 4000 Tajikistan (1998) Azerbaijan (2000) Turkmenistan (1994) Kyrgyzstan (2000) Republic of Moldova (2000) Albania (2000) Uzbekistan (2000) Armenia (1993) Kazakhstan (2000) Georgia (2000) Ukraine (2000) Bulgaria (1994) TFYR Macedonia (2000) Russian Federation (2000) Romania (1999) Turkey (2000) Belarus (2000) Latvia (2000) Croatia (1994) Lithuania (2000) Poland (1999) Estonia (2000) Slovakia (2000) Hungary (2000) Czech Republic (2000) Slovenia (2000) Greece (2000) Portugal (2000) Malta (2000) Spain (2000) Finland (2000) Israel (2000) Sweden (1998) United Kingdom (2000) Ireland (2000) Italy (2000) Austria (2000) Netherlands (2000) Norway (2000) Belgium (2000) France (2000) Denmark (2000) Iceland (2000) Luxembourg (1999) Germany (2000) Switzerland (2000) Latest value 1991a a 1992 in Germany US $PPP per person Health expenditure Total health expenditure per person Atlas of health in europa.p65 14-05-2003, 14:13112 The WHO Regional Offi ce for Europe The World Health Organization (WHO) is a specialized agencyof the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Offi ce for Europe is one of six regional offi ces throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan 92 890 1370 2 Sw.fr. 20.- ATLAS OF HEALTH IN EUROPE This statistical atlas presents key health fi gures for the WHO European Region. They cover basic data on populations, births, deaths, life expectancy and diseases, lifestyle and environmental indicators such as drinking, smoking and traffi c accidents, and types and levels of health care. All indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. Using the WHO Regional Offi ce for Europe’s unique health for all database, combined with the best alternative sources of data around the Region, this atlas offers the most comprehensive overview of health in Europe. In a handy size, this atlas is designed to be an easily accessible resource at all times, in the offi ce or on the road. World Health Organization Regional Offi ce for Europe Scherfi gsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-Mail: postmaster@euro.who.int Web site: www.euro.who.int

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Publications

Date d'adoption 1 janvier 2003

Source Organisation mondiale de la santé