The need for rehabilitation services in the WHO European Region

in the WHO European Region The need for REHABILITATION SERVICES

The need for rehabilitation services in the WHO European Region Abstract Rehabilitation aims to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. It is a cost-effective service that anyone may need at some point in their lives. Universal health coverage and the attainment of the Sustainable Development Goals cannot be achieved without access to quality rehabilitation without financial hardship. The Global Burden of Diseases, Injuries and Risk Factors Study 2019 assessed the prevalence and incidence as well as years lived with disability resulting from over 300 diseases and injuries. From this dataset this report describes the need for rehabilitation services in the WHO European Region. A total of 25 disease causes, impairments and sequelae that are amenable to rehabilitation at some point in their course were identified. For each Member State of the WHO European Region, the need for rehabilitation was described by presenting the prevalence and years lived with disability of the conditions amenable to rehabilitation. Data are disaggregated by age group (0–14 years, 15–64 years, ≥ 65 years) and sex as well as according to seven groups of health conditions: musculoskeletal disorders, neurological disorders, sensory impairments, mental disorders, chronic respiratory diseases, cardiovascular diseases and neoplasms. In the WHO European Region in 2019, 394 million people had a health condition amenable to rehabilitation during its course. This represents two in five people. Musculoskeletal disorders, sensory impairments and neurological disorders were the most prevalent groups of health conditions. The significant rehabilitation needs in the overall population require strong rehabilitation services. Keywords REHABILITATION, HEALTH SERVICES ACCESSIBILITY, PRIMARY HEALTH CARE, UNIVERSAL HEALTH CARE, WORLD HEALTH ORGANIZATION ISBN: 978-92-890-5850-6 © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; http://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Contents Foreword ......................................................................................................................................................................vi Acknowledgements ............................................................................................................................................... vii Glossary ..................................................................................................................................................................... viii Introduction ............................................................................................................................................. 1 Rehabilitation .......................................................................................................................................... 2 Rehabilitation benefits ........................................................................................................................... 3 Universal health coverage and the Sustainable Development Goals ................................................. 4 The importance of rehabilitation in primary health care..................................................................... 5 Drivers for the need for rehabilitation................................................................................................... 6 Ageing ...........................................................................................................................................................................6 Noncommunicable diseases ..................................................................................................................................6 Disability .......................................................................................................................................................................6 Violence and injuries ................................................................................................................................................7 Migrants and refugees .............................................................................................................................................7 Emergencies ................................................................................................................................................................7 Conflict ...........................................................................................................................................................7 Disease outbreaks .......................................................................................................................................8 Rehabilitation in the WHO European Region ........................................................................................ 9 Rehabilitation leadership and governance ......................................................................................................9 Financing of rehabilitation .....................................................................................................................................9 Rehabilitation information ..................................................................................................................................10 Rehabilitation workforce ......................................................................................................................................10 Health products, technologies and medicines for rehabilitation .........................................................10 Rehabilitation service delivery and its quality .............................................................................................11 Estimating the need for rehabilitation using Global Burden of Disease data ..................................12 Country estimates ..................................................................................................................................................12 Methods .....................................................................................................................................................................12 WHO European Region estimates ....................................................................................................................13 Data visualization tools ........................................................................................................................................13 Call for action .........................................................................................................................................14 WHO resources.......................................................................................................................................15 Conclusion ..............................................................................................................................................16 Regional fact sheet ................................................................................................................................17 iiiTHE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Country fact sheets................................................................................................................................19 Albania ........................................................................................................................................................................20 Andorra ......................................................................................................................................................................21 Armenia ......................................................................................................................................................................22 Austria .........................................................................................................................................................................23 Azerbaijan..................................................................................................................................................................24 Belarus ........................................................................................................................................................................25 Belgium ......................................................................................................................................................................26 Bosnia and Herzegovina ......................................................................................................................................27 Bulgaria ......................................................................................................................................................................28 Croatia .........................................................................................................................................................................29 Cyprus .........................................................................................................................................................................30 Czechia .......................................................................................................................................................................31 Denmark ....................................................................................................................................................................32 Estonia ........................................................................................................................................................................33 Finland ........................................................................................................................................................................34 France .........................................................................................................................................................................35 Georgia .......................................................................................................................................................................36 Germany .....................................................................................................................................................................37 Greece .........................................................................................................................................................................38 Hungary .....................................................................................................................................................................39 Iceland ........................................................................................................................................................................40 Ireland .........................................................................................................................................................................41 Israel .........................................................................................................................................................................42 Italy .........................................................................................................................................................................43 Kazakhstan ................................................................................................................................................................44 Kyrgyzstan .................................................................................................................................................................45 Latvia .........................................................................................................................................................................46 Lithuania ....................................................................................................................................................................47 Luxembourg .............................................................................................................................................................48 Malta .........................................................................................................................................................................49 Monaco .......................................................................................................................................................................50 Montenegro ..............................................................................................................................................................51 Netherlands ..............................................................................................................................................................52 North Macedonia ....................................................................................................................................................53 Norway .......................................................................................................................................................................54 Poland .........................................................................................................................................................................55 Portugal ......................................................................................................................................................................56 Republic of Moldova ..............................................................................................................................................57 Romania .....................................................................................................................................................................58 Russian Federation .................................................................................................................................................59 San Marino ................................................................................................................................................................60 Serbia .........................................................................................................................................................................61 Slovakia ......................................................................................................................................................................62 Slovenia ......................................................................................................................................................................63 Spain .........................................................................................................................................................................64 Sweden .......................................................................................................................................................................65 Switzerland ...............................................................................................................................................................66 Tajikistan ....................................................................................................................................................................67 THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGIONiv Türkiye ........................................................................................................................................................................68 Turkmenistan ...........................................................................................................................................................69 Ukraine .......................................................................................................................................................................70 United Kingdom of Great Britain and Northern Ireland ...........................................................................71 Uzbekistan .................................................................................................................................................................72 References ..............................................................................................................................................74 vTHE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Foreword I welcome the publication of this report on the need for rehabilitation services in the WHO European Region. Using the Global Burden of Diseases, Injuries and Risk Factors Study 2019 dataset to estimate the extent and the nature of the need for rehabilitation services, the report enriches the evidence base for rehabilitation policy and system design. As the report highlights, the need for rehabilitation is very significant in all Member States of the WHO European Region and is expected to increase. The sheer size of the need for rehabilitation presented in this report dispels the common view that rehabilitation is a service required by only a select few. Anyone may require rehabilitation during the course of their lives. Rehabilitation services are cost-effective, should be integrated into all levels of care and should be accessible to all without financial hardship. The WHO Regional Office for Europe set three priorities as part of its 2020–2025 European Programme of Work entitled “United action for better health in Europe”. The programme is the driving force of the work of WHO in the Region and rehabilitation contributes to all three priorities. The first priority is to support countries towards universal health coverage, in line with the Sustainable Development Goals. This coverage includes rehabilitation services. The second priority is to protect populations from health emergencies. Health emergencies not only compromise rehabilitation service provision, but they also increase the need for rehabilitation. Thus, rehabilitation is considered an essential service in health emergencies. Finally, the third priority is to ensure healthy lives and well-being for all, where again, rehabilitation is a central element. The WHO Regional Office for Europe is committed to supporting Member States in integrating rehabilitation into their health systems and strengthening their rehabilitation workforce. I hope that this report, presenting data and identifying resources, will act as catalyst for action – for strengthening rehabilitation systems throughout the Region, and thereby, for promoting health and well-being across the life course. Dr Natasha Azzopardi Muscat Director of the Division of Country Health Policies and Systems WHO Regional Office for Europe THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGIONvi Acknowledgements WHO Regional Office for Europe would like to thank the following people: The report was conceptualised, reviewed and edited by Satish Mishra, WHO Regional Office for Europe. Contributing authors Justine Gosling, WHO Regional Office for Europe; Ariane Laplante-Lévesque, WHO Regional Office for Europe; Satish Mishra, WHO Regional Office for Europe. Peer contributors Susan Eitel, WHO Regional Office for Europe; Kaloyan Kamenov, World Health Organization; Pauline Kleinitz, World Health Organization; Govin Permanand, WHO Regional Office for Europe; Theo Vos, Institute for Health Metrics and Evaluation. Peer reviewers Keyrellous Adib, WHO Regional Office for Europe; Stefania Davia, WHO Regional Office for Europe; Kirsten (Kiki) Lentz, United States Agency for International Development; Tomas Zapata, WHO Regional Office for Europe. This report was produced with the financial support of the United States Agency for International Development (USAID) and Norway’s Ministry of Foreign Affairs. viiTHE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Glossary Assistive products An assistive product is any external product (including devices, equipment, instruments or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence and thereby promote their well-being. Assistive products are also used to prevent impairments and secondary health conditions (1). Assistive technology Assistive technology is the application of organized knowledge and skills related to assistive products, including systems and services, and is a subset of health technology (1). Disability Disability results from the interaction between individuals with a health condition, such as cerebral palsy or depression, and personal and environmental factors, such as negative attitudes, inaccessible transportation and public buildings or limited social support (2). Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (3). Health condition A health condition is an umbrella term covering acute and chronic disease, disorders, injury or trauma. Health conditions may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition (4). Impairment Impairments are problems in body function or structure, such as a significant deviation or loss (2). Rehabilitation Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment (5). Rehabilitation outcomes Rehabilitation outcomes represent changes in the functioning of an individual over time that are attributable to rehabilitation interventions. They may include fewer hospital admissions; greater independence; reduced burden of care; a return to roles and occupations that are relevant to their age, gender and context, such as school or work; and better quality of life (5). Rehabilitation stakeholder Rehabilitation stakeholders include individuals with disability, caretakers for individuals with disability, health professionals, administrators and policy-makers. Stakeholders could represent governmental bodies, private for-profit organizations, non-governmental organizations, community-based organizations, or disabled people’s organizations. These bodies could be at the regional, national or international level (6). Rehabilitation worker A rehabilitation worker is a person delivering or supporting the delivery of rehabilitation, whether interacting directly or indirectly with a person, their family or user groups (7). Rehabilitation workforce This represents the wide range of professions who deliver care across the different levels of the health system and in settings, such as hospitals, schools, workplaces and people’s homes (7). Universal health coverage Universal health coverage is the possibility for all individuals and communities to receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation and palliative care across the life course (8). THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGIONviii References 1. Priority assistive products list: improving access to assistive technology for everyone, everywhere. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/handle/10665/207694, accessed 10 June 2022). 2. International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001 (http://apps.who.int/iris/handle/10665/42407, accessed 10 June 2022). 3. Constitution. Geneva: World Health Organization; 1989 (http://apps.who.int/iris/handle/10665/36851, accessed 10 June 2022). 4. World Report on Disability. Geneva: World Health Organization & World Bank; 2011 (http://apps.who.int/ iris/handle/10665/44575, accessed 10 June 2022). 5. Rehabilitation [website]. In: WHO/Fact sheet. Geneva: World Health Organization; 2021 (http://www.who. int/news-room/fact-sheets/detail/rehabilitation, accessed 10 June 2022). 6. Darzi AJ, Officer A, Abualghaib O, Akl EA. Stakeholders' perceptions of rehabilitation services for individuals living with disability: a survey study. Health Qual Life Outcomes. 2016 Jan 8;14:2. doi: 10.1186/s12955- 016-0406-x. 7. Rehabilitation Competency Framework. Geneva: World Health Organization; 2021 (http://apps.who.int/ iris/handle/10665/338782, accessed 10 June 2022). 8. Universal Health Coverage [website]. In: WHO/Health topic. Geneva: World Health Organization; 2022 (http://www.who.int/health-topics/universal-health-coverage, accessed 10 June 2022). ixTHE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION

Introduction Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care (1). Rehabilitation is essential to the attainment of the 2030 Agenda for Sustainable Development adopted by all United Nations Member States in 2015 (2). This report focuses on the rehabilitation needs in the WHO European Region. The WHO 2020–2025 European Programme of Work has three main pillars (3). Rehabilitation contributes to all three pillars by: • supporting countries towards universal health coverage, the definition of which includes rehabilitation as an essential quality health service; • protecting populations from health emergencies, such as conflict and disease outbreaks, and rehabilitation is considered an essential service in health emergencies; and • ensuring healthy lives and well-being for all, where rehabilitation plays a key role. Many countries in the Region offer limited rehabilitation services and many people do not receive the rehabilitation they need. This report summarizes the estimated need for rehabilitation in each of the Region’s 53 Member States. Data on the need for rehabilitation are derived from the Global Burden of Diseases, Injuries and Risk Factors Study 2019 (4). This report has three aims, including: • raising awareness of rehabilitation and the wide range and high prevalence of conditions that are amenable to rehabilitation; • providing country-specific information on the estimated need for rehabilitation; and • serving as a resource that can support the development or expansion of rehabilitation services and of the rehabilitation workforce. 1THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Rehabilitation Rehabilitation addresses the impact of a health condition on a person’s life with a primary focus on improving and maintaining their functioning. Difficulties in functioning occur because of impairments in body functions, such as pain or muscle weakness; limitations in activities, such as self-care or walking; and restrictions in participation, such as in community life or at work (5). WHO defines rehabilitation as a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment (6). Rehabilitation addresses a person’s limitations in everyday physical, mental and social functioning due to ageing or a health condition, including chronic diseases or disorders, injuries, or trauma (6). Fundamentally, rehabilitation focuses on the functioning of an individual and not on the disease. It does this through a strong emphasis on optimizing functioning and educating and empowering people to manage their health conditions, adjust to their situation, and remain active. Rehabilitation might be needed by anyone, regardless of age, gender, or socioeconomic status. Rehabilitation is an essential health service that expands the focus of health beyond preventive and curative care to address how people function (7). Rehabilitation should be available at all levels of health care, from primary through to tertiary health-care settings. It may be delivered through specialized rehabilitation facilities and programmes, especially for people with complex and intensive rehabilitation needs. It is also a highly integrated form of health care and is incorporated in a wide range of other health specialties and services, such as in the care of people who have neurological, mental health, musculoskeletal, cardiovascular, pediatric, geriatric, vision, hearing, women’s health, or pulmonary issues, as well as cancer or a communicable disease. Importantly, rehabilitation should be available in primary care settings, where most cases of chronic diseases are managed, and in community settings, such as homes and schools, where individuals participate in activities meaningful to them. Rehabilitation workers typically include people belonging to the professions of occupational therapists, orthotists, physiotherapists, prosthetists, psychologists, rehabilitation doctors, rehabilitation nurses, social workers and speech and language therapists. The rehabilitation workforce also includes rehabilitation assistants, technicians and community-based rehabilitation workers, or any other health cadres delivering rehabilitation. Depending on a person’s needs, rehabilitation may be provided by one professional, although it often requires multi-professional collaboration. The provision of and training in the use of assistive products is a component of rehabilitation. People with difficulties in their functioning benefit from a wide range of assistive products, such as those for mobility, vision, hearing, self-care, communication and cognition (8). The provision of most assistive products occurs in the context of wider health care – for example, hearing care requires assessment, fitting, training, follow-up and maintenance support. An important component of the provision process is ensuring the assistive product is well-fitted and is suited to the individual and appropriate for the environment within which they operate. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION2 Rehabilitation benefits Evidence shows that rehabilitation interventions are cost-effective and help to achieve and maintain the best outcomes of other health interventions (for example, 9–10). Rehabilitation has the potential to avoid costly hospitalization and reduce the time spent in a hospital, decrease re-admissions and reduce the risks of complications due to health problems (11). By improving function and the ability to participate in everyday life, rehabilitation cuts the costs of ongoing care and supports individuals to participate in education and employment (6). Evidence has shown that functional capability can be improved, even with low-cost interventions in low resource settings (for example, 12). Importantly, access to rehabilitation supports the realization of the right of all people to health, and this is particularly important for realizing the rights of people with disabilities as well as other population groups, such as older persons. Access to rehabilitation is enshrined in the Convention on the Rights of Persons with Disabilities (13). 3THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Universal health coverage and the Sustainable Development Goals Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. This includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care (14). Universal health coverage thus requires that everyone has access to quality rehabilitation services and assistive products at all health-care levels, without financial hardship. Countries that progress towards universal health coverage often concurrently make progress towards other health and non-health related targets, such as access to school and work. At the individual level, good health and functioning promotes community inclusion and supports participation, allowing children to learn and adults to earn an income. It also helps lift people out of poverty and contributes to long-term, sustainable economic development. At the population level, rehabilitation is an important investment in human capital and contributes to health and economic and social development, and progress towards the attainment of the 2030 Agenda for Sustainable Development and several of its Sustainable Development Goals (2). This includes Sustainable Development Goal 3 regarding good health and well-being, Sustainable Development Goal 4 regarding quality education, Sustainable Development Goal 8 regarding decent work and economic growth and Sustainable Development Goal 10 regarding reduced inequalities (2). Rehabilitation is included in the indicators of overall progress towards sustainable development (15). The positive health, social and economic effects of rehabilitation can have a profound impact on population health and therefore cements the position of rehabilitation as an essential health service. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION4 The importance of rehabilitation in primary health care Crucial to achieving universal health coverage is the integration of rehabilitation in primary health care. Primary health care is an integral part of every country’s health system (16). It brings health care to people where they live and work and is often the first point of contact to a health-care pathway and where most chronic diseases are managed (16). Primary health care is usually a person’s most accessible and frequented health-care contact, and therefore a vital service for overall health management, the detection of health problems, referrals to other health services and early diagnosis (16). The Alma-Ata Declaration on primary health care states that rehabilitation is an essential component of primary health care (17). The integration of rehabilitation service provision into primary health care is important, because many people who could benefit from rehabilitation services may never enter the hospital system and may require long-term rehabilitation that is close to their home and local community. Rehabilitation in primary health care facilitates a life course approach to health interventions that promotes and optimizes well-being and functioning as well as socioeconomic benefits (18). However, in many countries rehabilitation services are provided in secondary and tertiary level facilities that are situated in urban areas, leaving rural and remote areas underserved. In most health systems, rehabilitation has not been fully or effectively integrated into primary health care (18). 5THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Drivers for the need for rehabilitation This section summarises factors that drive the need for rehabilitation in the WHO European Region. Ageing The WHO European Region has the oldest population of the six WHO regions. Of the world’s 25 countries and areas with the oldest populations in 2015, 22 were in Europe (19). The Region has the highest median age in the world and the proportion of people aged 60 and older is forecast to increase from 23.9% in 2015 to 34.2% in 2050 (19). Increasing age correlates with multimorbidity and functioning impairments resulting from frailty, impaired cognition as well as continence, gait and balance problems (20). Collectively, these functioning deficits lead to a higher risk of disability and difficulties in completing essential daily activities, and consequently, this group requires rehabilitation services (20). Noncommunicable diseases Globally, in 2013, noncommunicable diseases accounted for two out of every three years lived with disability (21, 22). Of the six WHO regions, the European Region is the most affected by noncommunicable diseases and they are the leading cause of death, disease and disability in the Region (23). Alone, five noncommunicable diseases – namely, diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders – account for an estimated 86% of the deaths and 77% of the disease burden in the Region (23). Noncommunicable diseases can lead to functioning difficulties related to mobility, self-care, communication, pain and cognition (23). Such functioning difficulties can challenge participation in employment and social activities, leading to isolation, poverty and increased demands on social and health systems (24). Thus, many people living with noncommunicable diseases and consequential functional difficulties require rehabilitation services. Disability Disability refers to the interaction between individuals with a health condition, such as cerebral palsy, depression, diabetic amputation or blindness, and personal and environmental factors, such as negative attitudes, inaccessible transportation and public buildings or limited social support (5). In the WHO European Region, six to 10 out of every 100 people live with a disability (25), a number which is growing, in part due to ageing populations and an increase in chronic health conditions. Compared to people without disabilities, persons with disabilities experience poorer health and more health-care needs, are more vulnerable to complications, secondary conditions, comorbidities and age-related health conditions, face widespread barriers in accessing services, and have higher rates of premature death (26). Rehabilitation services, including the provision of assistive technology, are among the health services that people with disabilities most commonly require to optimise functioning, independence and participation. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION6 Violence and injuries Violence and unintentional injuries cause deaths, human suffering and disability. In the WHO European Region, they accounted for almost 525,000 deaths, or 5.5% of all deaths, and 10.1% of all disability-adjusted life years in 2019 (27). This burden contributes significantly to the need for rehabilitation services. Hospital and community- based rehabilitation for serious injuries, such as those sustained in assaults or road traffic crashes, is required to improve the outcomes of emergency and surgical care and to limit the physical and psychological impact of injuries (28). Migrants and refugees In 2018, approximately 10% of the WHO European Region’s population were international migrants – an increase from 3.9% in 1990 (29). This diverse and heterogenous group faces various health challenges and therefore have different health-care needs. A person’s health outcomes are often a result of an entire lifetime of risks and exposures – both harmful and protective – which may occur before, during or after migration, and health differences may appear differently across the life course (30). Migrants and refugees may be particularly vulnerable to infectious diseases, and injuries resulting from violence and trauma, due to exposures in living and working conditions, as well as a lack of access to, or interrupted, care  (30). Care for chronic conditions and rehabilitation for disabilities are often the most pressing needs of migrant and refugee children (31). This large population, of unknown size and for which the extent of health-care need is unclear, faces particular and often multiple disadvantages in accessing health-care services. Emergencies Emergencies come in many forms, from disease outbreaks to conflicts, humanitarian crises and disasters. They can have devastating and long-lasting effects, not only on people’s health but also on societies and their economies. Emergencies, particularly sudden-onset disasters, such as earthquakes or mud slides, can result in a sudden surge of traumatic injuries that overwhelm health systems and leave a legacy of permanent disability in their wake (32, 33, 34). WHO has recognized rehabilitation as an essential component of the response in health emergencies and disease outbreaks (35). Conflict Conflict causes direct physical harm that necessitates the immediate provision of health services, and impacts health systems with damage or disruption to infrastructure, the workforce and health facilities, thereby affecting the provision of, and access to, health services, including rehabilitation care (36). Traumatic injury resulting from violence, land mines and other explosive weapons of war can cause devastating and long-lasting physical and psychological disability, requiring early and tailored rehabilitation interventions from a multidisciplinary team and long-term follow-up to optimize function and quality of life (37). Consequently, conflict increases both the demand for rehabilitation and difficulties in accessing such interventions. Conflict exacerbates existing unmet rehabilitation needs, particularly in low- and middle-income settings where rehabilitation service provision is already lacking (37). 7THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Disease outbreaks A sudden increase in occurrences of a communicable disease, such as poliomyelitis (polio) or COVID-19, can cause a surge in rehabilitation needs that require early and multi-disciplinary rehabilitation interventions. The response must trigger a quick and tailored response for the prevention of further infections and for its treatment, while minimizing disruption to health systems and routine health care provision. When this is not the case, rehabilitation services may suffer. For example, the COVID-19 pandemic severely disrupted rehabilitation service delivery in the WHO European Region. A rapid assessment of noncommunicable disease service provision found 79% of responding countries reporting disruptions (38). Services were closed for various reasons, such as being thought to be nonessential, due to lack of staff from illness or redeployment to other clinical services or with the aim to reduce costs. These service disruptions have posed significant challenges to those who rely on rehabilitation services for the long- term management of chronic conditions (38), and for those with new rehabilitation needs due to the disease or a new condition or injury. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION8 Rehabilitation in the WHO European Region Within the 53 Member States of the WHO European Region, there is large variation in the provision, access to and quality of rehabilitation services. What is common, however, is the substantial need for rehabilitation and aspirations to achieve universal health coverage and the attainment of the 2030 Agenda for Sustainable Development. In some countries, rehabilitation has been a core component of health care for many decades and is generally available to those who need it. In other countries across the Region, rehabilitation services have developed more recently and remain limited with many people unable to access the rehabilitation they need (39). In the Region, there are many complex and interrelated reasons for having limited rehabilitation services and these reasons often vary across contexts. For example, countries with underdeveloped rehabilitation services often have limited awareness about what they are, what they do and their many benefits. Low levels of awareness about rehabilitation may occur within health administration structures or among health providers and people in the community. Additionally, misconceptions are common and rehabilitation can be erroneously perceived as a disability-specific service needed by only a few, or a luxury service that only the select few can afford (40, 41). Widespread limited awareness and misconceptions about rehabilitation contribute to a low demand for services, underdeveloped services and numerous system level challenges. One way to represent the challenges faced by rehabilitation as an essential health service is to describe them across the six building blocks of the WHO health systems framework: leadership and governance; financing; information; workforce; health products, technologies and medicines, and; service delivery (42). Rehabilitation leadership and governance Rehabilitation leadership and governance typically includes identifying priorities and setting the strategic direction for rehabilitation through legislation, policy and planning, and then identifying methods for overseeing the implementation of actions, establishing accountability and tracking progress. Usually, these functions within countries are limited or do not occur, along with inadequate rehabilitation leadership and coordination mechanisms. Ways forward to address this include evidence-informed advocacy to support the prioritization of rehabilitation in health leadership, creating sector coordination mechanisms, strengthened rehabilitation planning and integration into other health and social sector plans and establishing monitoring frameworks that track the status and outcomes of rehabilitation. Financing of rehabilitation Health financing focuses on the core functions of: • revenue raising through sources of funds, including government budgets, compulsory or voluntary prepaid insurance schemes; direct out-of-pocket payments by users; and external aid; • pooling funds, namely the accumulation of prepaid funds on behalf of some or all of the population; and • purchasing services, namely the payment or allocation of resources to health service providers. 9THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION These functions are achieved through health and social sector financing schemes that exist in countries. In many countries, rehabilitation is not well integrated and there is limited coordination between financing schemes, leading to insufficient financing for rehabilitation, inadequate coverage and reduced service quality. Ways forward to address this include the further integration of rehabilitation into financing mechanisms, better definition of services packages, improved coordination between financing mechanisms, and improved data collection to track service delivery and outcomes. Rehabilitation information Health information systems serve multiple users and a wide array of purposes that can be summarized as the generation of information to enable decision-makers at all levels of the health system to identify problems and needs, make evidence-informed decisions on health policy, and allocate scarce resources optimally. There is currently a lack of robust information on rehabilitation needs and service delivery and limited integration into existing health information systems. Ways forward to address this include the integration of rehabilitation into data collection from different sources, from health facilities, population-based surveys, and civil registration and vital statistics systems. Rehabilitation workforce The rehabilitation workforce is composed of a wide range of occupational groups who deliver care across the different levels of the health system, and in settings such as hospitals, schools, workplaces and people’s homes. Many countries experience shortages or an inequitable distribution of rehabilitation workers, and regulatory issues that impact on the quality of rehabilitation services. In the WHO European Region, there are 12 times fewer physiotherapists, 141 times fewer occupational therapists, six times fewer prosthetics and orthotics professionals and three times fewer physical and rehabilitation medicine practitioners in middle-income countries than in high-income countries (43). Solutions include strengthening rehabilitation workforce planning, education and training and regulation through competency-based approaches. Health products, technologies and medicines for rehabilitation Assistive technology is the application of organized knowledge and skills related to assistive products, including systems and services. Assistive products maintain and improve individual functioning and include external devices, equipment, instruments or software that are used to support mobility, vision, hearing, cognition and communication. The provision of assistive products aims to improve people’s functioning, prevent complications and promote health. However, this provision is often limited, and people cannot access or afford the products they need. In addition, the systems that supports provision, including its leadership, regulation, financing, procurement and distribution, are often weak. Ways forward to address this include: the development of national priority assistive product lists; adoption of standards and regulatory mechanisms; integration into health planning, financing and information systems; and ensuring the provision of assistive products is a core component of rehabilitation, hearing, vision and other health services. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION10 Rehabilitation service delivery and its quality Rehabilitation services can be provided over different levels of care, settings and models, in both inpatient and outpatient care. This occurs at hospital and institutional settings at district, regional and national levels, such as general hospitals and specialized rehabilitation wards, centres and hospitals. Rehabilitation services are crucial in primary care and may include outpatient, outreach and home care in community settings, including single or multi-professional practices, homes, schools and workplaces. Furthermore, rehabilitation services should be person-centred, evidence-based and outcomes-focused. However, rehabilitation services may be limited at all levels of care and not be available in home and community settings where required; usually, they are focused in major urban areas and have limited availability in rural and remote areas. In addition, the quality of rehabilitation can vary both within and across countries. Ways forward to address this include better integration of rehabilitation into service planning and financing with a focus on inclusion within health-care benefit packages, establishing service standards, and ensuring the provision of person-centred, evidence-based and cost-effective care. 11THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Estimating the need for rehabilitation using Global Burden of Disease data Country estimates The needs for rehabilitation in each of the Region’s 53 Member States are summarized in a series of country fact sheets. Each fact sheet presents, as of 2019, the: • total population of the country and its income classification; • number of people who need rehabilitation as well as number of years lived with disability, with the prevalence of the need for rehabilitation disaggregated by age group (0–14 years, 15–64 years, ≥65 years) as well as by sex; and • seven main groups of health conditions that contribute to the need for rehabilitation services: musculoskeletal disorders, neurological disorders, sensory impairments, mental disorders, chronic respiratory diseases, cardiovascular diseases and neoplasms. Methods The 2019 Global Burden of Diseases data from the Institute for Health Metrics and Evaluation based in Seattle, Washington, United States of America, was used to estimate the need for rehabilitation by presenting the prevalence, and associated years lived with disability, of 25 health conditions – disease causes, impairments and sequelae – that are amenable to rehabilitation at some point in the course of disease (4). The methods are the same as used in a paper published in 2020 (44). The 25 health conditions were selected using a three-step approach (44). First, 20 conditions with the highest number of associated years lived with disability were identified. Second, from the 20 conditions, some were excluded, as rehabilitation is considered not essential and is indicated as a secondary intervention. Third, WHO convened a group of rehabilitation experts to discuss the list of conditions and add any other condition for which rehabilitation is a key intervention. The resulting 25 disease causes, impairments and sequelae are categorized within seven groups of health conditions (see Table 1). Table 1. Health conditions amenable to rehabilitation at some point in their course Groups of health conditions (n=7) Disease causes, impairments and sequelae (n=25) musculoskeletal disorders low back pain; neck pain; fractures; other injuries; osteoarthritis; amputation; rheumatoid arthritis neurological disorders cerebral palsy; stroke; traumatic brain injury; Alzheimer’s disease and dementia; spinal cord injury; Parkinson’s disease; multiple sclerosis; motor neuron disease; Guillain-Barré syndrome sensory impairments hearing loss; vision loss mental disorders developmental intellectual disability; schizophrenia; autism spectrum disorders chronic respiratory diseases chronic obstructive pulmonary disease cardiovascular diseases heart failure; acute myocardial infarction neoplasms neoplasms Source: adapted with permission of the authors (44). THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION12 Exclusions included mild health states, motor impairment, borderline intellectual disability, mild hearing loss, mild vision loss and minor injuries, assuming people with these conditions would be less likely to require rehabilitation. For malignant neoplams, the diagnosis and primary therapy phase of all cancers, as well as colon and rectum cancer with stoma, larynx cancer with laryngectomy and breast cancer with mastectomy, were included (44). Years lived with disability is a measure of the burden of non-fatal disease and injury; it was calculated by multiplying the prevalence of each condition by the estimated level of health loss in the form of a disability weight. Disability weights range from 0 (that is, perfect health) to 1 (that is, death) and represent the severity of the disease. These weights were derived from population surveys using pairwise comparison methods between random pairs of health states. The disability weights were defined, measured and given numerical value to quantify the time lived in non-fatal health states. All Global Burden of Diseases 2019 years lived with disability estimates were corrected for comorbidity using simulation methods and assumed a multiplicative model for coexisting health states, to account for the cumulative effect of comorbidities (44). For each Member State of the WHO European Region, population size was described according to the 2019 Global Burden of Disease data. The income classification arises from the World Bank, based on the 2019 calendar year (45). Source data from the Institute for Health Metrics and Evaluation, which is responsible for the Global Burden of Disease data, were accessed to estimate the need for rehabilitation. Stata 15.1 (College Station TX), a statistical software, was used to extract the WHO European Region data from the source data. WHO European Region estimates The country estimates were added together to arrive at the WHO European Region estimates, summarized in the regional fact sheet. In 2019, 394 million people, or two of every five inhabitants, had a disease or injury deemed amenable to rehabilitation during the course of the condition. Musculoskeletal diseases, including low back pain, neck pain, fractures, other injuries, osteoarthritis, amputation and rheumatoid arthritis, were the main type of cases needing rehabilitation services, accounting for over 60% of cases. Sensory impairments, including hearing and vision loss, were the second main type, accounting for approximately 17% of cases. Neurological disorders accounted for approximately 9% of cases. The remaining, accounting for approximately 10% of cases in total, comprised chronic respiratory diseases, mental disorders, cardiovascular diseases and neoplasms. Data visualization tools Readers interested in further exploring the data are invited to visit two data visualization tools. Both tools allow users to download the supporting data. Firstly, the data has been integrated into the European Health Information Gateway, which allows users to view and interact with country results (46). Whilst the present report focuses on 2019 data, the European Health Information Gateway presents data for all consecutive years from 1990 to 2019. Secondly, the Institute for Health Metrics and Evaluation data visualization allows users to view the results in maps, bar charts and line charts for a country or world region of interest, and also by prevalence, years of life lived with disability, age, sex and year (47). Just like in (44), the Institute for Health Metrics and Evaluation data visualization (47) aggregated countries in seven regions: World Bank high-income countries and all six of the WHO regions, excluding the high-income countries from each region. For this reason the regional estimates presented here are different from those of (44) and (47), but the country estimates are the same. 13THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Call for action In 2017, WHO Member States and rehabilitation stakeholders from around the world endorsed Rehabilitation 2030: A Call for Action (48), which acknowledges the profound unmet need for rehabilitation, emphasizes the value of equity in access to quality rehabilitation services and identifies priority actions to strengthen rehabilitation in health systems. In particular, considering national circumstances and priorities, the call for action urges countries to: • raise awareness and build political commitment for rehabilitation and to foster the integration of rehabilitation within their national health policies, while promoting inter-ministerial and intersectoral work; • improve the integration of rehabilitation into health financing mechanisms and incorporate rehabilitation into packages of essential health care as part of universal health coverage; • expand rehabilitation to all levels of health care, including primary health care, with rehabilitation ensured at the community level; develop specialized rehabilitation centres and services to meet the requirements of people with complex needs; and ensure rehabilitation reaches people in urban, rural and remote areas; • ensure the integrated and coordinated provision of quality, evidence-based interventions for rehabilitation along the continuum of care, including the provision of assistive products; • develop a strong multidisciplinary rehabilitation workforce that is suitable for a country’s context, and promote rehabilitation competencies among all health workers; • integrate rehabilitation information into health information systems, including utilizing the International Classification of Functioning, Disability and Health for information on functioning, so that rehabilitation outcomes can be monitored effectively; and promote high quality rehabilitation research, including health policy and systems research; and • ensure the timely integration of rehabilitation in emergency preparedness and response. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION14 WHO resources In response to Rehabilitation 2030: A Call for Action (48), WHO is developing a series of resources to assist Member States in evaluating their existing rehabilitation services, and to expand them to provide accessible and quality rehabilitation programs. The key resources include: • Rehabilitation in Health Systems: Guide for Action (49) to identify priorities, develop strategic plans and establish monitoring mechanisms; • Package of Interventions for Rehabilitation (50) to inform budget and service planning in countries to ensure that rehabilitation, including assistive technology, is integrated into universal health coverage mechanisms, such as essential health-care packages; • Rehabilitation Competency Framework (51) to improve workforce planning in low-resource settings and to address workforce challenges; • Guide for Rehabilitation Workforce Evaluation (52) to assist countries to evaluate rehabilitation workforce levels, and to inform workforce strengthening efforts; • District Health Information System 2 Rehabilitation Module (53) to support routine rehabilitation data collection in countries, including for assistive technology; and • Minimum Technical Standards and Recommendations for Rehabilitation (54) to ensure that emergency medical teams, both national and international, prevent patient complications and ensuing impairment and ensure a continuum of care. Additionally, WHO resources have been developed that support strengthening assistive technology, which can be used in the context of strengthening the provision of assistive products, including: • Priority Assistive Products List (55) • Assistive Technology Capacity Assessment (56) • Rapid Assistive Technology Assessment tool (57) • Assistive Product Specifications (58) • Manual for public procurement of assistive products, accessories, spare parts and related services (59) • Personnel training in priority assistive products (60). The Global Report on Assistive Technology presents a comprehensive dataset and analysis of the current access to assistive technology and makes recommendations for concrete actions that will improve access (8). 15THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION Conclusion This report describes the large number of people that could benefit from rehabilitation services in the WHO European Region. Policy-makers may use the information presented in this report to better understand the magnitude of the need for rehabilitation in their country and compare the size of the need with the current capacity of their rehabilitation services. They may be encouraged and prompted by the call to action and use WHO resources described above to take steps to strengthen rehabilitation governance and services, including rehabilitation workforce planning. Furthermore, the data presented in this report may be used to advocate among service providers, policy-makers and governments the setting of priorities to act and address rehabilitation needs. Building understanding and increasing awareness regarding the need for rehabilitation in countries remains an important key to strengthening rehabilitation services. The 53 country fact sheets have been developed to support evidence- informed advocacy and awareness raising activities that can also inform health planning through better insights into the rehabilitation needs of national populations. Country stakeholders may familiarize themselves with this information and make linkages between rehabilitation needs, services available and any gaps that may exist. The results demonstrate the large reduction in morbidity that would result from rehabilitation services became widely available. This powerful figure should be a catalyst for governments to strengthen rehabilitation services as part of their drive to achieve universal health coverage, ensuring access to all. The WHO Regional Office for Europe is committed to support countries in strengthening their rehabilitation services. The need for rehabilitation is expected to rapidly grow with an ageing population, an increasing number of people living with noncommunicable diseases and the consequences of injuries affecting function. The demand for rehabilitation has also been compounded with the disruption to services caused by health emergencies. These trends should urge health policy planners to prioritize rehabilitation services. Rehabilitation has the power to unleash significant human potential and contribute to societal growth and must no longer be viewed as an optional service for the few; rehabilitation is crucial to ensure the health outcomes of the many. THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION16 Regional fact sheet REGIONAL NEED FOR REHABILITATION SERVICES W H O E U RO PE A N R EG IO N Population: 931 680 438 inhabitants Member states: 53 394 292 822 people have at least one condition that would benefit from rehabilitation services, contributing to 49 221 779 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 7 015 969 7 732 784 124 338 991 130 083 119 73 762 199 51 359 760 14 748 753 254 422 110 125 121 959 394 292 822 What? Health conditions contributing to the prevalence of the need for rehabilitation services Musculoskeletal disorders Neurological disorders Sensory impairments 64.3% 1.3%3.7% 4.3% 1.2% 8.7% 16.4% Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION18 Country fact sheets A LB A N IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 2 720 353 inhabitants World Bank classification: Upper middle income 1 223 439 people have at least one condition that would benefit from rehabilitation services, contributing to 141 396 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 20 915 26 951 374 691 473 713 164 850 162 319 47 866 848 404 327 169 1 223 439 What? Health conditions contributing to the prevalence of the need for rehabilitation services 69.0% 1.1%1.8%3.1% 0.4% 8.6% 15.9% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION20 A N D O R R ACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 83 064 inhabitants World Bank classification: High income 36 116 people have at least one condition that would benefit from rehabilitation services, contributing to 4 470 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 470 526 13 321 11 817 5 159 4 823 996 25 138 9 982 36 116 What? Health conditions contributing to the prevalence of the need for rehabilitation services 70.3% 1.5%3.2% 4.5% 1.0% 7.5% 12.0% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 21THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION A R M EN IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 3 019 674 inhabitants World Bank classification: Upper middle income 1 141 279 people have at least one condition that would benefit from rehabilitation services, contributing to 132 614 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 23 350 28 254 403 352 399 430 170 322 116 571 51 604 802 782 286 893 1 141 279 What? Health conditions contributing to the prevalence of the need for rehabilitation services 62.6% 1.1%2.5% 4.6% 0.7% 8.1% 20.3% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION22 A U ST R IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 8 916 185 inhabitants World Bank classification: High income 3 820 274 people have at least one condition that would benefit from rehabilitation services, contributing to 473 208 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 54 484 60 120 1 216 357 1 131 286 772 898 585 129 114 604 2 347 643 1 358 027 3 820 274 What? Health conditions contributing to the prevalence of the need for rehabilitation services 67.1% 2.1%3.2% 3.8% 1.4% 8.6% 13.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 23THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION A ZE R B A IJ A N COUNTRY NEED FOR REHABILITATION SERVICES Total population: 10 278 674 inhabitants World Bank classification: Upper middle income 3 266 603 people have at least one condition that would benefit from rehabilitation services, contributing to 364 253 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 81 765 107 288 1 256 696 1 371 808 259 721 189 325 189 053 2 628 504 449 046 3 266 603 What? Health conditions contributing to the prevalence of the need for rehabilitation services 65.9% 0.8%2.2%5.0% 0.4% 7.4% 18.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION24 B EL A R U SCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 9 500 785 inhabitants World Bank classification: Upper middle income 4 299 733 people have at least one condition that would benefit from rehabilitation services, contributing to 513 889 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 69 426 75 110 1 439 214 1 508 033 795 804 412 146 144 536 2 947 247 1 207 950 4 299 733 What? Health conditions contributing to the prevalence of the need for rehabilitation services 65.9% 0.7%1.7%3.4% 1.0% 9.4% 18.0% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 25THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION B EL G IU M COUNTRY NEED FOR REHABILITATION SERVICES Total population: 11 419 166 inhabitants World Bank classification: High income 5 046 655 people have at least one condition that would benefit from rehabilitation services, contributing to 649 572 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 86 932 96 652 1 490 374 1 562 794 1 032 635 777 268 183 584 3 053 168 1 809 903 5 046 655 What? Health conditions contributing to the prevalence of the need for rehabilitation services 66.0% 1.6%3.1% 5.9% 1.6% 8.2% 13.6% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION26 B O SN IA A N D H ER ZE G O V IN ACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 3 299 982 inhabitants World Bank classification: Upper middle income 1 628 124 people have at least one condition that would benefit from rehabilitation services, contributing to 196 017 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 23 674 27 425 505 713 610 325 256 686 204 301 51 099 1 116 038 460 987 1 628 124 What? Health conditions contributing to the prevalence of the need for rehabilitation services 67.2% 1.1%2.5%3.1% 0.6% 9.9% 15.4% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 27THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION B U LG A R IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 6 934 625 inhabitants World Bank classification: Upper middle income 3 540 328 people have at least one condition that would benefit from rehabilitation services, contributing to 438 910 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 46 880 56 629 966 330 1 243 328 706 511 520 650 103 509 2 209 658 1 227 161 3 540 328 What? Health conditions contributing to the prevalence of the need for rehabilitation services 65.7% 1.3%2.5%3.1% 0.9% 10.0% 16.5% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION28 C R O AT IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 4 247 903 inhabitants World Bank classification: High income 2 081 622 people have at least one condition that would benefit from rehabilitation services, contributing to 265 747 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 28 956 33 510 586 107 708 075 420 589 304 385 62 466 1 294 182 724 974 2 081 622 What? Health conditions contributing to the prevalence of the need for rehabilitation services 65.3% 1.0%2.9% 3.4% 1.0% 10.0% 16.5% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 29THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION C YP R U S COUNTRY NEED FOR REHABILITATION SERVICES Total population: 1 313 477 inhabitants World Bank classification: High income 520 378 people have at least one condition that would benefit from rehabilitation services, contributing to 61 903 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 8 841 10 353 176 347 180 370 76 330 68 137 19 194 356 717 144 467 520 378 What? Health conditions contributing to the prevalence of the need for rehabilitation services 70.9% 1.5%3.7% 4.0% 0.9% 6.8% 12.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION30 C ZE C H IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 10 643 487 inhabitants World Bank classification: High income 5 341 208 people have at least one condition that would benefit from rehabilitation services, contributing to 649 596 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 85 083 95 647 1 502 105 1 856 678 1 015 358 786 337 180 730 3 358 783 1 801 695 5 341 208 What? Health conditions contributing to the prevalence of the need for rehabilitation services 67.1% 1.6%2.6%3.0% 0.8% 9.4% 15.5% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 31THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION D EN M A R K COUNTRY NEED FOR REHABILITATION SERVICES Total population: 5 858 922 inhabitants World Bank classification: High income 2 565 531 people have at least one condition that would benefit from rehabilitation services, contributing to 330 503 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 41 616 46 247 767 973 788 821 510 062 410 812 87 863 1 556 794 920 874 2 565 531 What? Health conditions contributing to the prevalence of the need for rehabilitation services 69.0% 1.6%2.2% 6.7% 0.7% 7.4% 12.5% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION32 ES TO N IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 1 312 361 inhabitants World Bank classification: High income 589 153 people have at least one condition that would benefit from rehabilitation services, contributing to 70 396 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 9 451 8 760 171 007 186 526 138 206 75 203 18 211 357 533 213 409 589 153 What? Health conditions contributing to the prevalence of the need for rehabilitation services 66.0% 1.4%1.5%2.8% 1.0% 9.1% 18.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 33THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION FI N LA N D COUNTRY NEED FOR REHABILITATION SERVICES Total population: 5 534 095 inhabitants World Bank classification: High income 2 593 316 people have at least one condition that would benefit from rehabilitation services, contributing to 323 319 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 44 326 50 015 718 561 761 027 580 135 439 252 94 341 1 479 588 1 019 387 2 593 316 What? Health conditions contributing to the prevalence of the need for rehabilitation services 67.4% 1.5%2.9% 3.4% 1.5% 8.8% 14.3% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION34 FR A N C ECOUNTRY NEED FOR REHABILITATION SERVICES Total population: 66 204 316 inhabitants World Bank classification: High income 28 287 093 people have at least one condition that would benefit from rehabilitation services, contributing to 3 510 473 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 529 523 566 887 8 346 196 8 131 732 6 224 535 4 488 220 1 096 410 16 477 928 10 712 755 28 287 093 What? Health conditions contributing to the prevalence of the need for rehabilitation services 68.1% 1.7%2.5% 3.1% 1.3% 8.5% 14.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 35THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION G EO R G IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 3 664 752 inhabitants World Bank classification: Upper middle income 1 520 042 people have at least one condition that would benefit from rehabilitation services, contributing to 181 635 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 27 435 35 859 446 865 549 845 283 385 176 653 63 294 996 710 460 038 1 520 042 What? Health conditions contributing to the prevalence of the need for rehabilitation services 61.3% 1.5%2.6% 3.8% 0.7% 8.9% 21.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION36 G ER M A N YCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 84 914 056 inhabitants World Bank classification: High income 38 483 874 people have at least one condition that would benefit from rehabilitation services, contributing to 5 033 693 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 539 288 580 192 11 237 207 11 501 366 8 391 257 6 234 564 1 119 480 22 738 573 14 625 821 38 483 874 What? Health conditions contributing to the prevalence of the need for rehabilitation services 65.1% 1.7%2.8% 6.0% 1.6% 8.6% 14.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 37THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION G R EE C E COUNTRY NEED FOR REHABILITATION SERVICES Total population: 10 337 172 inhabitants World Bank classification: High income 4 537 827 people have at least one condition that would benefit from rehabilitation services, contributing to 588 231 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 64 770 69 886 1 323 248 1 295 527 996 521 787 875 134 656 2 618 775 1 784 396 4 537 827 What? Health conditions contributing to the prevalence of the need for rehabilitation services 64.0% 1.6%3.3% 5.2% 1.5% 8.6% 15.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION38 H U N G A RY COUNTRY NEED FOR REHABILITATION SERVICES Total population: 9 674 413 inhabitants World Bank classification: High income 4 771 113 people have at least one condition that would benefit from rehabilitation services, contributing to 599 067 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 66 922 78 354 1 391 791 1 613 420 981 766 638 860 145 276 3 005 211 1 620 626 4 771 113 What? Health conditions contributing to the prevalence of the need for rehabilitation services 65.4% 1.3%2.6% 4.2% 0.9% 9.4% 16.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 39THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION IC EL A N D COUNTRY NEED FOR REHABILITATION SERVICES Total population: 344 876 inhabitants World Bank classification: High income 137 098 people have at least one condition that would benefit from rehabilitation services, contributing to 16 992 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 2 880 3 155 43 418 45 671 22 608 19 366 6 035 89 089 41 974 137 098 What? Health conditions contributing to the prevalence of the need for rehabilitation services 69.4% 1.3%3.6% 4.8% 1.2% 7.4% 12.4% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION40 IR EL A N DCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 4 910 358 inhabitants World Bank classification: High income 1 929 011 people have at least one condition that would benefit from rehabilitation services, contributing to 237 866 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 47 101 50 579 640 425 632 245 303 359 255 302 97 680 1 272 670 558 661 1 929 011 What? Health conditions contributing to the prevalence of the need for rehabilitation services 69.2% 1.6% 5.1% 3.9% 0.9% 6.9% 12.3% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms All data are from 2019 Data sources: (4, 44) 41THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION IS R A EL COUNTRY NEED FOR REHABILITATION SERVICES Total population: 9 309 583 inhabitants World Bank classification: High income 3 163 277 people have at least one condition that would benefit from rehabilitation services, contributing to 369 387 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 112 226 120 342 1 027 019 1 044 796 481 711 377 183 232 568 2 071 815 858 894 3 163 277 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 70.0% 1.2%3.0% 4.6% 0.7% 7.2% 13.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION42 IT A LYCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 60 313 168 inhabitants World Bank classification: High income 27 117 057 people have at least one condition that would benefit from rehabilitation services, contributing to 3 660 525 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 326 724 386 150 7 431 739 7 906 424 6 322 574 4 743 446 712 874 15 338 163 11 066 020 27 117 057 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 61.2% 2.6% 3.0% 3.9% 1.9% 8.6% 18.9% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 43THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION K A ZA K H ST A N COUNTRY NEED FOR REHABILITATION SERVICES Total population: 18 392 068 inhabitants World Bank classification: Upper middle income 5 845 234 people have at least one condition that would benefit from rehabilitation services, contributing to 670 508 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 175 948 213 193 2 101 616 2 314 574 657 633 382 270 389 141 4 416 190 1 039 903 5 845 234 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.9% 0.7%2.9% 4.6% 0.4% 8.2% 18.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION44 K YR G YZ ST A NCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 6 535 459 inhabitants World Bank classification: Lower middle income 1 734 718 people have at least one condition that would benefit from rehabilitation services, contributing to 196 495 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 77 899 92 219 645 052 681 580 143 334 94 634 170 118 1 326 632 237 968 1 734 718 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 63.5% 0.7%2.7% 7.5% 0.2% 7.6% 17.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 45THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION LA TV IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 1 915 292 inhabitants World Bank classification: High income 897 949 people have at least one condition that would benefit from rehabilitation services, contributing to 111 206 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 12 655 13 756 265 160 278 663 216 548 111 167 26 411 543 823 327 715 897 949 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64% 1.3%1.4%2.7% 0.8% 9.7% 20.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION46 LI TH U A N IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 2 794 223 inhabitants World Bank classification: High income 1 315 772 people have at least one condition that would benefit from rehabilitation services, contributing to 163 842 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 17 101 18 441 398 149 413 758 306 082 162 241 35 542 811 907 468 323 1 315 772 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.3% 1.2%1.6%2.6% 0.7% 9.8% 19.7% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 47THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION LU X EM B O U R G COUNTRY NEED FOR REHABILITATION SERVICES Total population: 618 550 inhabitants World Bank classification: High income 254 111 people have at least one condition that would benefit from rehabilitation services, contributing to 31 239 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 4 294 4 692 84 374 87 959 41 127 31 665 8 986 172 333 72 792 254 111 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 69.4% 1.7%3.3% 4.8% 1.4% 7.3% 12.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION48 M A LT ACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 439 221 inhabitants World Bank classification: High income 200 148 people have at least one condition that would benefit from rehabilitation services, contributing to 24 898 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 2 853 3 346 57 479 61 786 41 504 33 180 6 199 119 265 74 684 200 148 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 68.3% 1.9%3.3% 3.6% 1.4% 7.7% 13.9% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 49THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION M O N A C O COUNTRY NEED FOR REHABILITATION SERVICES Total population: 37 572 inhabitants World Bank classification: High income 17 483 people have at least one condition that would benefit from rehabilitation services, contributing to 2 273 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 193 213 4 812 4 881 4 125 3 259 406 9 693 7 384 17 483 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.8% 2.4%2.6% 5.6% 1.4% 8.4% 14.9% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION50 M O N TE N EG R OCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 620 340 inhabitants World Bank classification: Upper middle income 280 009 people have at least one condition that would benefit from rehabilitation services, contributing to 32 360 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 5 044 6 209 86 846 106 644 41 451 33 815 11 253 193 490 75 266 280 009 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 69.0% 1.1%1.3%3.3% 0.9% 9.3% 15.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 51THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION N ET H ER LA N D S COUNTRY NEED FOR REHABILITATION SERVICES Total population: 17 156 788 inhabitants World Bank classification: High income 6 902 825 people have at least one condition that would benefit from rehabilitation services, contributing to 906 437 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 106 832 114 621 2 073 717 2 031 854 1 440 431 1 135 370 221 453 4 105 571 2 575 801 6 902 825 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 65.6% 2.1%3.6% 5.9% 1.1% 8.4% 13.4% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION52 N O RT H M A C ED O N IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 2 152 731 inhabitants World Bank classification: Upper middle income 946 171 people have at least one condition that would benefit from rehabilitation services, contributing to 108 912 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 15 626 18 618 294 896 383 326 122 177 111 528 34 244 678 222 233 705 946 171 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 68.2% 0.9%2.1%3.8% 0.8% 9.5% 14.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 53THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION N O R W AY COUNTRY NEED FOR REHABILITATION SERVICES Total population: 5 348 847 inhabitants World Bank classification: High income 2 173 468 people have at least one condition that would benefit from rehabilitation services, contributing to 277 501 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 37 180 42 035 641 419 693 622 414 522 344 690 79 215 1 335 041 759 212 2 173 468 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.2% 1.6%2.9% 4.8% 1.4% 8.5% 16.5% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION54 P O LA N DCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 38 434 444 inhabitants World Bank classification: High income 18 538 769 people have at least one condition that would benefit from rehabilitation services, contributing to 2 265 737 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 266 047 298 630 5 624 993 6 625 297 3 353 030 2 370 772 564 677 12 250 290 5 723 802 18 538 769 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 67.0% 1.8%2.5%2.5% 0.7% 8.9% 16.6% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 55THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION P O RT U G A L COUNTRY NEED FOR REHABILITATION SERVICES Total population: 10 651 263 inhabitants World Bank classification: High income 4 622 579 people have at least one condition that would benefit from rehabilitation services, contributing to 592 996 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 57 949 62 303 1 417 487 1 247 726 1 088 335 748 779 120 252 2 665 213 1 837 114 4 622 579 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.9% 1.5%3.2% 5.5% 1.0% 8.0% 15.9% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION56 R EP U B LI C O F M O LD O VA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 3 688 191 inhabitants World Bank classification: Lower middle income 1 593 353 people have at least one condition that would benefit from rehabilitation services, contributing to 194 412 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 29 554 32 292 544 120 555 033 266 188 166 166 61 846 1 099 153 432 354 1 593 353 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 61.8% 1.0%1.8% 4.5% 0.5% 9.6% 20.7% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 57THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION R O M A N IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 19 237 066 inhabitants World Bank classification: High income 9 294 541 people have at least one condition that would benefit from rehabilitation services, contributing to 1 135 792 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 142 845 162 291 2 656 663 3 292 052 1 748 291 1 292 399 305 136 5 948 715 3 040 690 9 294 541 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 66.5% 1.5%2.6%2.7% 0.6% 9.4% 16.6% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION58 R U SS IA N F ED ER AT IO NCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 146 717 424 inhabitants World Bank classification: Upper middle income 67 796 627 people have at least one condition that would benefit from rehabilitation services, contributing to 8 373 650 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 1 155 056 1 166 051 23 468 076 23 097 342 12 456 278 6 453 824 2 321 107 46 565 418 18 910 102 67 796 627 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 65.7% 1.0%1.7%3.0% 0.7% 9.2% 18.7% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 59THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION SA N M A R IN O COUNTRY NEED FOR REHABILITATION SERVICES Total population: 33 100 inhabitants World Bank classification: High income 13 926 people have at least one condition that would benefit from rehabilitation services, contributing to 1 754 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 220 245 4 387 4 234 2 609 2 231 465 8 621 4 840 13 926 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 66.9% 1.6%3.2% 5.1% 1.3% 7.8% 14.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION60 SE R B IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 8 746 785 inhabitants World Bank classification: Upper middle income 4 093 212 people have at least one condition that would benefit from rehabilitation services, contributing to 494 610 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 66 920 83 057 1 194 920 1 429 791 713 597 604 927 149 977 2 624 711 1 318 524 4 093 212 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 66.3% 0.9%3.0%3.4% 0.9% 9.5% 16.0% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 61THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION SL O VA K IA COUNTRY NEED FOR REHABILITATION SERVICES Total population: 5 437 223 inhabitants World Bank classification: High income 2 592 879 people have at least one condition that would benefit from rehabilitation services, contributing to 306 474 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 37 904 44 407 768 973 1 004 556 426 010 311 029 82 311 1 773 529 737 039 2 592 879 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 69.2% 0.8%2.0%2.6% 1.4% 9.1% 14.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION62 SL O V EN IACOUNTRY NEED FOR REHABILITATION SERVICES Total population: 2 074 271 inhabitants World Bank classification: High income 1 067 632 people have at least one condition that would benefit from rehabilitation services, contributing to 129 942 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 14 991 18 008 290 670 386 210 201 249 156 504 32 999 676 880 357 753 1 067 632 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 67.9% 0.9%2.4% 2.5% 1.5% 9.5% 15.3% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 63THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION SP A IN COUNTRY NEED FOR REHABILITATION SERVICES Total population: 46 021 216 inhabitants World Bank classification: High income 19 742 156 people have at least one condition that would benefit from rehabilitation services, contributing to 2 439 222 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 336 008 366 313 5 988 080 5 862 416 4 183 501 3 005 838 702 321 11 850 496 7 189 339 19 742 156 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 61.6% 1.2%4.3% 4.4% 1.5% 7.8% 19.2% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION64 SW ED EN COUNTRY NEED FOR REHABILITATION SERVICES Total population: 10 222 546 inhabitants World Bank classification: High income 4 240 877 people have at least one condition that would benefit from rehabilitation services, contributing to 549 408 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 7 566 84 700 1 182 114 1 255 710 897 263 745 426 160 364 2 437 824 1 642 689 4 240 877 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 66.1% 1.6% 3.9% 5.8% 2.7% 8.5% 11.4% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 65THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION SW IT ZE R LA N D COUNTRY NEED FOR REHABILITATION SERVICES Total population: 8 775 204 inhabitants World Bank classification: High income 3 947 377 people have at least one condition that would benefit from rehabilitation services, contributing to 498 127 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 59 884 66 324 1 210 591 1 280 595 751 697 578 286 126 208 2 491 186 1 329 983 3 947 377 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 69.8% 1.0%3.0% 3.9% 1.5% 8.2% 12.6% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION66 TA JI K IS TA NCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 9 492 414 inhabitants World Bank classification: Low income 2 394 312 people have at least one condition that would benefit from rehabilitation services, contributing to 263 348 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 121 936 144 110 890 808 1 028 771 109 760 98 927 266 046 1 919 579 208 687 2 394 312 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.9% 0.2%1.7%6.5% 0.5% 8.4% 17.8% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 67THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION TÜ R K IY E COUNTRY NEED FOR REHABILITATION SERVICES Total population: 81 359 696 inhabitants World Bank classification: Upper middle income 25 872 100 people have at least one condition that would benefit from rehabilitation services, contributing to 3 279 257 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 569 606 612 553 9 138 006 9 775 243 3 157 185 2 619 507 1 182 159 18 913 249 5 776 692 25 872 100 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 59.4% 0.4%5.6% 6.0% 1.2% 8.5% 18.9% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION68 TU R K M EN IS TA NCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 5 083 081 inhabitants World Bank classification: Upper middle income 1 442 820 people have at least one condition that would benefit from rehabilitation services, contributing to 157 881 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 54 929 65 095 511 769 609 966 118 579 82 482 120 024 1 121 735 201 061 1 442 820 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.4% 0.3%1.3%5.3% 0.8% 7.9% 20.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 69THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION U K R A IN E COUNTRY NEED FOR REHABILITATION SERVICES Total population: 44 042 432 inhabitants World Bank classification: Lower middle income 20 844 829 people have at least one condition that would benefit from rehabilitation services, contributing to 2 524 968 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 299 166 331 374 6 793 912 7 384 164 3 907 313 2 128 900 630 540 14 178 076 6 036 213 20 844 829 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 65.5% 0.6%1.9%3.3% 1.1% 9.0% 18.6% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION70 U N IT ED K IN G D O M O F G R EA T B R IT A IN A N D N O RT H ER N IR EL A N DCOUNTRY NEED FOR REHABILITATION SERVICES Total population: 67 220 448 inhabitants World Bank classification: High income 29 018 919 people have at least one condition that would benefit from rehabilitation services, contributing to 3 695 178 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 552 814 597 879 9 102 076 8 821 960 5 538 425 4 405 765 1 150 693 17 924 036 9 944 190 29 018 919 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 64.0% 1.0%3.6% 5.9% 1.6% 6.9% 17.1% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms 71THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION COUNTRY NEED FOR REHABILITATION SERVICES Total population: 33 677 096 inhabitants World Bank classification: Lower middle income 8 967 875 people have at least one condition that would benefit from rehabilitation services, contributing to 979 690 years lived with disability. Who? Prevalence of people with at least one condition that would benefit from rehabilitation services, according to age and sex 0–14 years 15–64 years ≥65 years Female Male Female Male Female Male 375 813 454 918 3 421 770 3 848 349 500 973 366 052 830 731 7 270 119 867 025 8 967 875 What? Health conditions contributing to the prevalence of the need for rehabilitation services All data are from 2019 Data sources: (4, 44) 66.1% 0.4%1.4% 6.7% 0.6% 7.5% 17.4% Musculoskeletal disorders Neurological disorders Sensory impairments Cardiovascular diseases Chronic respiratory diseases Mental disorders Neoplasms U ZB EK IS TA N THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION72 73THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION THE NEED FOR REHABILITATION SERVICES IN THE WHO EUROPEAN REGION74 References 1. Universal Health Coverage for Sustainable Development – Issue Brief. 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