Core Health Indicators in the WHO European Region 2013: special focus: noncommunicable diseases

Core Health Indicators in the WHO European Region Special focus: Noncommunicable diseases Demographic and socioeconomic context * The former Yugoslav Republic of Macedonia GDP = gross domestic product PPP = purchasing power parity Note: a=2012 b=2011 c=2010 d=2009 e=2008 1 2 3 4 5 6 7 8 9 10 Mid-year population (thousands) Population aged ≥ 65 years (% of total) Total fertility rate Natural population growth per 1000 Urban population (%) Crude death rate per 1000 population Unemploy- ment rate (%) Real GDP, PPP$ per capita Annual growth rate of GDP (%) Life expectancy at birth (years) Country 2012 2011 2011 2011 2010 2011 2011 2011 2012 2011 Albania 3227 1.6 52 8866 0.8 Andorra 68 1.2 88 3.6e Armenia 3107 10.3 d 1.5 4.7 64 8.6 6.2 5789 7.1 73.9 d Austria 8418 17.7 1.4 0.2 68 9.1 4.2 42 173 0.8 81.3 Azerbaijan 9418 2.4 a 52 0.9 c 10 062 4.5 Belarus 9537 13.9 c 1.5 -2.5 d 75 14.0 d 0.6 14 938 1.5 70.6 d Belgium 10 770 17.1 d 1.8 d 2.2 d 97 9.6 d 7.1 38 723 -0.3 80.3 d Bosnia and Herzegovina 3747 15.1 1.2 -0.8 49 9.1 27.6 9076 -0.7 76.7 Bulgaria 7401 18.7 1.5 -5.1 71 14.7 11.2 15 083 0.8 74.3 Croatia 4389 17.2 1.4 -2.2 58 11.6 13.4 19 487 -2.0 77.3 Cyprus 862 12.8 1.4 4.9 70 6.3 7.7 32 254 -2.4 81.7 Czech Republic 10 548 15.9 1.4 0.2 74 10.2 6.7 26 332 -1.3 78.1 Denmark 5589 17.1 1.8 1.8 87 9.4 7.6 40 933 -0.5 80.1 Estonia 1340 17.1 1.5 -0.4 69 11.4 12.5 21 997 3.2 76.6 Finland 5397 17.8 1.8 1.8 85 9.4 7.8 37 455 -0.2 80.8 France 63 418 16.7 d 2.0 c 4.1 d 85 8.6 d 9.3 35 247 0.0 81.8 d Georgia 4306 13.8 c 1.7 2.2 c 53 10.7 c 5465 6.0 74.7 c Germany 81 964 20.6 1.4 -2.1 74 10.4 5.9 39 456 0.7 80.6 c Greece 11 419 19.5 1.5 d -0.4 61 9.8 17.7 25 858 -6.4 80.9 Hungary 9947 16.8 1.2 -4.1 68 12.9 10.9 21 661 -1.7 75.2 Iceland 328 11.8 d 2.0 7.8 d 93 6.3 d 7.1 36 483 1.6 81.9 d Ireland 4580 11.1 c 2.0 10.2 c 62 6.1 c 14.4 40 868 0.9 80.8 c Israel 7673 10.1 3.0 16.2 c 92 5.2 c 5.6 28 809 4.7 b 82.2 c Italy 60 820 20.3 c 1.4e -0.5 c 68 9.7 c 8.4 32 672 -2.4 82.5 c Kazakhstan 16 407 6.7 c 2.6 13.6 c 59 8.9 c 5.4 13 099 5.0 68.6 c Kyrgyzstan 5464 4.5 c 3.1 20.5 c 35 6.6 c 2.5 2402 -0.9 69.5 c Latvia 2234 17.4 c 1.3 -4.5 c 68 13.4 c 16.2 18 951 5.6 73.7 c Lithuania 3296 16.3 c 1.6 -2.1 c 67 12.8 c 15.4 21 480 3.7 73.6 c Luxembourg 531 14.0 a 1.6 c 3.7 85 7.2 4.9 88 797 0.3 81.7 Malta 419 16.1 1.5 2.4 95 7.9 6.5 27 504 1.0 81.0 Monaco 38 100 10.0e Montenegro 633 12.9 d 1.7 2.3 d 61 9.3 d 19.7 13 432 0.5 75.6 d Netherlands 16 695 15.9 1.8 3.0 83 8.1 4.4 42 779 -1.0 81.2 c Norway 4951 15.3 1.9 3.8 79 8.3 3.2 60 392 3.1 81.5 Poland 38 315 13.6 1.3 0.3 61 9.8 12.5 21 085 1.9 77.0 Portugal 10 686 19.2 a 1.4 c -0.6 61 9.8 12.7 25 564 -3.2 80.9 Republic of Moldova 3560 9.9 c 1.3 -0.0 a 47 11.1 a 3.6 3369 -0.8 71.1 a Romania 21 397 14.9 c 1.3 c -2.2 c 57 12.1 c 7.4 15 983 3.7 73.8 c Russian Federation 142 668 12.8 -1.9 c 73 14.2 c 6.6 21 921 3.4 69.0 c San Marino 29 1.5 94 4.8 1.9e Serbia 7259 16.8 1.4 -5.1 56 14.2 23.6 11 887 -1.7 74.6 Slovakia 5478 12.4 c 1.5 1.3 c 55 9.8 c 13.5 24 095 2.0 75.7 c Slovenia 2040 16.6 c 1.6 1.5 c 50 9.1 c 8.2 26 943 -2.3 80.0 c Spain 46 657 17.2 1.4 1.8 77 8.4 21.6 32 087 -1.4 82.5 Sweden 9478 18.3 c 1.9 2.2 c 85 9.7 c 7.6 41 484 0.7 81.8 c Switzerland 7724 16.9 c 1.5 2.3 c 74 8.0 c 4.1 51 227 1.0 82.8 c Tajikistan 7086 26 2324 8.0 MKD* 2066 11.7 c 1.5 2.5 c 59 9.3 c 31.4 11 561 -0.3 75.1 c Turkey 74 547 7.3 2.0 11.5 70 5.1 9.8 17 110 2.2 74.5 Turkmenistan 5164 50 9420 11.1 Ukraine 44 992 15.3 1.5 -3.6 69 14.6 8.1 c 7208 0.2 71.1 United Kingdom 62 807 16.6 c 4.0 c 80 9.0 c 8.0 35 598 0.3 80.8 c Uzbekistan 28 125 2.2 36 3287 8.2 WHO European Region 899 020 15.3 1.6 1.5 70 10.5 8.8 25 800 76.7 Preface I am pleased to present the second edition of one of our key publications, presenting the core health indicators for the WHO European Region. Health in the Region continues to improve in several areas: life expectancy is steadily increasing; child and maternal health are continuously improving, and the burden of some noncommunicable and communicable diseases is declining in many countries. New health technologies, more integrated health care, stronger public health practice and programmes, improved reporting and surveillance of health events and new, more inclusive policies have all contributed to these changes. Nevertheless, this is no time for complacency; important challenges remain: more adequately addressing health inequities, the social determinants of health and common risk factors such as tobacco, poor nutrition and physical inactivity. Other problems – the continuing financial and economic crises in many countries in the Region, social unrest, natural disasters and disease outbreaks or re-emergence – necessitate the continuous monitoring of health trends. To protect past achievements and foster further progress, WHO’s European Member States approved Health 2020, a policy framework to support action for health and well-being in Europe, including a set of targets, in 2012. Within the Health 2020 framework, Member States confirmed that timely and high- quality health information is essential to monitor trends and evaluate policy. Core health indicators in the WHO European Region 2013 contributes to these efforts by providing basic country and Region-wide information that is collected annually from WHO Member States. The WHO Regional Office for Europe is committed to continuing this work. Following the example of previous editions, Core health indicators in the WHO European Region 2013 presents comparable key health statistics on demographic and socioeconomic factors, health status, risk factors and health systems. Its special theme is noncommunicable diseases (NCDs), to which additional subsets of indicators have been dedicated. NCDs remain the leading cause of premature death, disease and disability in the WHO European Region. The publication also includes figures and tables illustrating country trends in cardiovascular disease mortality, child overweight and obesity as one of its risk factors and Member States’ work to limit the effects of risk factors. Monitoring NCDs is an important task in reaching key Health 2020 targets, and thus for implementing and evaluating the new European health policy. This process is further supported by the global monitoring framework on NCDs adopted by the World Health Assembly in May 2013. The global framework is expected to drive progress in prevention and control of NCDs and provide the foundation for advocacy, raising awareness, reinforcing political commitment and promoting global action. The indicators on NCDs and their risk factors that are included in this succinct indicator list show the diversity and magnitude of the challenges for public health in Europe, as well as some positive trends in mortality. We at the WHO Regional Office for Europe are pleased to present this leaflet to you, and look forward to continued work with countries to support the generation of high-quality health information for monitoring progress in implementing Health 2020 and reaching its NCDs targets. Zsuzsanna Jakab WHO Regional Director for Europe 19 20 21 22 23 24 25 26 27 (SDR) PER 100 000 POPULATION MDG 6 CANCER INCIDENCE PER 100 000 External causes of injury and poisoning Infectious and parasitic diseases Mental and behavioural disorders Ill defined** causes of death (%) Newly diagnosed HIV cases per 100 000 TB incidence per 100 000 All forms Female breast Cervix uteri 2011 2011 2011 2011 2011 2011 2011 2011 2011 2.2 13.1 107.8 20.8 c 5.9 c 2.5 3.7 39.4 d 9.2 d 5.2 d 3.5 d 5.5 38.6 240.4 67.8 17.1 36.7 5.2 24.5 2.2 3.5 4.8 437.9 c 117.6 c 8.8 c 6.0 70.8 93.0 a 31.0 a 7.2 a 133.6 d 11.5 d 19.6 d 11.0 d 12.6 49.6 446.7 73.3 18.6 48.7 d 13.3 d 42.7 d 2.1 d 11.0 6.6 578.6 c 181.3 c 10.8 c 28.1 6.7 13.0 7.1 0.7 35.4 215.5 43.5 20.6 32.7 5.6 9.8 2.3 2.7 29.6 448.7 98.2 27.3 48.3 4.4 28.9 0.6 1.7 14.1 472.8 c 109.0 c 14.1 c 28.5 8.0 23.1 1.3 6.3 3.6 356.7 e 109.1 e 5.9 e 47.2 9.0 20.5 1.2 1.5 5.4 769.3 d 111.9 d 19.19 d 30.5 8.6 52.9 6.6 4.8 6.5 645.5 c 182.0 c 13.0 c 77.2 8.6 22.5 1.5 27.3 22.1 531.2 e 87.1 e 27.0 e 57.3 4.4 73.5 0.7 3.3 5.8 544.4 c 171.3 c 5.1 c 44.1 d 10.0 d 41.2 d 6.3 d 6.3 4.1 560.6 157.8 8.1 21.9 c 4.2 c 7.8 c 53.6 c 9.5 101.4 94.8 31.1 9.2 27.7 10.5 31.5 2.9 3.5 4.4 572.1 e 171.1 e 11.65 e 26.3 4.7 8.9 9.0 7.4 4.0 54.1 4.5 29.2 0.1 1.6 12.8 949.7 140.1 22.1 34.7 d 2.8 d 51.7 d 0.7 d 7.2 2.5 441.0 d 129.4 d 10.8 d 35.2 c 5.4 c 32.2 c 0.3 c 7.0 6.1 733.8 116.3 13.6 26.0 c 19.4 c 27.4 c 5.1 c 5.9 5.3 361.8 c 115.3 c 6.2 c 25.3 c 8.6 c 27.2 c 1.0 c 5.7 3.3 421.6 c 123.0 c 11.6 c 116.4 c 16.7 c 15.5 c 13.6 c 12.1 115.6 183.0 41.1 16.9 86.8 c 20.1 c 11.9 c 1.0 c 10.7 100.3 90.4 21.7 15.3 84.9 c 10.0 c 17.8 c 1.5 c 14.5 42.0 557.9 111.4 23.4 113.1 c 12.5 c 16.3 c 1.5 c 5.2 54.2 554.3 89.3 26.2 40.4 12.4 33.1 2.5 8.5 2.1 421.3 d 135.2 d 7.2 d 19.5 4.5 37.6 0.2 5.1 5.3 480.0 183.5 7.7 2.9 c 35.2 d 0.9 d 8.0 d 13.6 d 1.5 17.7 26.3 8.0 44.6 2.9 6.1 5.8 647.0 c 181.8 c 8.6 c 40.3 11.0 43.2 4.5 5.4 6.3 578.2 c 116.1 c 13.2 c 54.9 6.6 14.9 4.2 2.5 20.6 364.9 c 79.4 c 15.5 c 29.0 14.0 17.1 8.2 8.5 22.8 85.1 a 14.8 a 12.7 a 0.7 a 20.3 118.2 227.0 47.8 17.3 53.3 c 10.4 c 10.8 c 0.9 c 1.8 79.2 266.3 53.1 c 28.9 c 140.8 c 22.0 c 16.2 c 5.1 c 43.8 c 79.1 364.4 74.5 c 19.2 c 25.0 549.5 0 0 37.6 4.4 24.0 4.3 1.8 29.9 358.7 c 83.8 c 26.5 c 50.1 c 6.0 c 12.0 c 1.2 c 0.9 6.4 56.3 c 2.8 c 16.1 c 1.5 c 2.7 8.8 597.2 e 111.6 e 12.7 e 22.6 8.7 37.6 2.6 6.0 13.1 35.4 c 10.4 c 44.1 c 3.7 c 3.9 4.8 590.1 c 168.1 c 9.1 c 32.4 c 5.5 c 49.1 c 3.1 c 7.3 4.9 478.4 d 139.6 d 6.7 d 13.5 90.1 36.6 d 28.3 c 3.1 c 8.4 c 6.6 c 0.0 16.2 0.9 20.2 147.2 e 31.7 e 4.2 e 0.0 64.1 c 70.4 15.9 c 10.4 c 85.1 29.2 14.7 2.5 38.1 75.2 349.3 66.3 20.4 26.3 c 6.1 c 39.7 c 0.5 c 10.0 12.6 522.5 c 156.8 c 9.0 c 13.1 c 49.4 65.9 18.1 8.4 60.4 13.1 25.9 4.2 15.8 33.3 397.9 c Note: a=2012 b=2011 c=2010 d=2009 e=2008 11 12 13 14 15 16 17 18 LIFE EXPECTANCY MDG 4 MDG 5 AGE-STANDARDIZED DEATH RATES Life expectancy at birth (years) Infant mortality rate per 1000 live births Child mortality before age 5 years per 1000 live births Maternal mortality ratio per 100 000 live births All cause mortality Circulatory system Malignant neoplasms Diseases of the respiratory system Males Females Country 2011 2011 2011 2011 2011 2011 2011 2011 2011 Albania 5.8 Andorra 0.0 Armenia 70.6 d 76.9 d 11.7 12.1 13.8 1045.1 d 532.2 d 189.9 d 73.4 d Austria 78.4 84.0 3.6 4.3 2.6 530.9 196.4 154.6 26.4 Azerbaijan 15.7 c Belarus 64.8 d 76.6 d 4.7 d 6.3 d 0.9 1160.8 d 601.1 d 162.9 d 36.0 d Belgium 77.5 d 83.0 d 3.5 d 4.4 d 4.7 d 577.3 d 164.7 d 166.9 d 56.4 d Bosnia and Herzegovina 74.2 79.0 5.8 6.6 6.3 803.6 426.8 156.9 27.8 Bulgaria 70.8 77.9 8.5 10.2 2.8 932.9 592.0 155.9 36.1 Croatia 74.0 80.4 4.7 5.2 9.7 761.3 351.0 212.2 28.7 Cyprus 79.8 83.5 2.8 3.6 10.2 c 518.3 198.7 115.6 33.8 Czech Republic 74.9 81.2 2.7 3.4 1.8 708.4 331.5 186.7 37.1 Denmark 78.0 82.1 3.4 3.9 3.2 597.3 139.2 185.7 61.0 Estonia 71.3 81.4 2.4 3.1 13.6 759.7 369.2 186.5 21.7 Finland 77.5 84.0 2.4 3.0 4.9 c 554.4 203.7 135.2 21.5 France 78.2 d 85.2 d 3.5 d 4.2 d 9.4 d 508.5 d 118.9 d 165.5 d 27.5 d Georgia 70.2 c 79.0 c 11.2 c 13.0 c 27.6 858.7 c 247.7 c 56.0 c 9.7 c Germany 78.1 c 83.1 c 3.4 c 4.1 c 5.5 c 549.4 196.6 157.9 36.2 Greece 78.6 83.2 3.4 4.1 3.8 547.9 220.1 147.3 46.6 Hungary 71.3 78.8 4.9 5.8 10.2 875.4 402.1 238.7 44.5 Iceland 79.9 d 83.9 d 1.8 d 2.2 d 0.0 c 507.4 d 172.8 d 155.9 d 42.4 d Ireland 78.5 c 83.0 c 3.8 c 4.5 c 2.7 554.0 c 181.5 c 172.4 c 61.5 c Israel 80.2 c 84.1 c 3.7 c 4.5 c 2.4 489.8 c 119.1 c 142.5 c 34.3 c Italy 79.8 c 85.0 c 3.4 c 3.9 c 2.9 c 478.1 c 159.8 c 156.8 c 27.6 c Kazakhstan 63.7 c 73.5 c 16.5 c 19.9 c 17.7 1270.1 c 621.1 c 157.0 c 59.6 c Kyrgyzstan 65.5 c 73.7 c 22.3 c 26.1 c 47.5 1195.6 c 701.9 c 113.9 c 92.6 c Latvia 68.6 c 78.4 c 5.7 c 7.2 c 5.4 939.2 c 477.6 c 193.8 c 22.3 c Lithuania 68.0 c 79.0 c 4.3 c 5.4 c 5.8 950.6 c 494.5 c 187.3 c 28.2 c Luxembourg 79.2 83.9 2.8 3.3 0.0 520.0 163.8 157.4 40.6 Malta 78.8 83.1 6.3 7.1 0.0 538.6 231.4 149.1 35.5 Monaco Montenegro 73.3 d 78.0 d 5.8 d 6.2 d 846.2 d 461.6 d 128.7 d 38.7 d Netherlands 79.1 c 83.1 c 3.8 c 4.5 c 2.2 c 528.2 139.2 180.6 48.3 Norway 79.3 83.7 2.3 2.9 5.0 521.2 147.0 154.9 47.0 Poland 72.7 81.2 4.7 5.5 2.3 747.7 317.8 190.9 38.5 Portugal 77.6 84.1 3.1 3.9 5.2 546.6 148.6 152.5 54.5 Republic of Moldova 67.2 a 75.1 a 9.8 a 12.1 a 30.4 a 1135.0 a 659.0 a 163.2 a 49.7 a Romania 70.2 c 77.6 c 9.8 c 11.7 c 25.5 948.0 c 539.8 c 180.1 c 49.0 c Russian Federation 63.1 c 75.0 c 7.6 c 9.8 c 16.9 c 1223.1 c 673.8 c 177.9 c 45.8 c San Marino 0.0 Serbia 72.0 77.3 6.3 7.1 10.7 930.4 473.5 204.2 44.5 Slovakia 71.8 c 79.4 c 5.7 c 6.8 c 9.9 849.7 c 440.2 c 196.7 c 52.0 c Slovenia 76.6 c 83.2 c 2.5 c 3.4 c 4.6 d 599.7 c 218.4 c 196.0 c 32.3 c Spain 79.4 85.5 3.2 3.9 3.0 481.5 132.5 152.1 46.0 Sweden 79.7 c 83.7 c 2.5 c 3.1 c 0.9 514.1 c 182.2 c 141.2 c 27.3 c Switzerland 80.4 c 85.0 c 3.8 c 4.3 c 3.7 c 464.1 c 144.9 c 137.9 c 25.4 c Tajikistan 46.5 d MKD* 73.0 c 77.3 c 7.6 c 8.4 c 4.4 939.5 c 553.0 c 171.5 c 34.4 c Turkey 72.0 77.1 7.7 11.3 15.9 Turkmenistan 5.9 Ukraine 66.0 76.0 9.0 10.7 16.9 1102.0 682.8 157.5 30.5 United Kingdom 78.8 c 82.7 c 4.3 c 5.1 c 5.0 c 553.1 c 164.2 c 170.4 c 67.6 c Uzbekistan 10.5 14.2 23.1 WHO European Region 73.1 80.3 7.0 8.8 11.5 789.1 369.5 162.0 43.5 * The former Yugoslav Republic of Macedonia ** See technical notes for more information TB = tuberculosis Health status: mortality and morbidity indicators 38 39 40 41 42 43 44 45 46 47 48 MDG 4 MDG 6 ENVIRONMENT Outpatient contacts per person per year Inpatient care discharges per 100 population Abortions per 1000 live births Children immunized (%) against Treatment success rate (%) for new laboratory- confirmed TB cases Air quality Water Sanitation Impact PM2.5 in capital (µg/m3) PM10 in capital (µg/m3) Population with improved drinking water sources (%) Population with improved sanitation (%) Leukaemia incidence ages 0–14 years per 100 000 population DTP measles 2011 2011 2011 2011 2011 2010 2011 2011 2011 2011 2008 2.2 7.5 205.3 99 99 91.0 38.5 d 82 94 3.2 99 99 100 100 3.5 10.6 279.9 95 97 71.7 96 90 6.9 27.4 83 76 64.6 19.0 27.3 100 100 3.8 4.5 a 6.4 a 164.9 a 95 98 76.6 51 82 13.1 31.0 293.5 99 99 66.3 26.0 e 91 93 4.0 7.4 17.0 c 147.8 c 98 95 75.3 17.7 26.5 100 100 4.2 5.3 10.9 88 89 98.4 48.5 c 82 96 2.5 26.7 447.7 95 94 86.3 41.2 65.2 97 100 4.2 6.0 17.0 105.5 96 96 75.1 87 d 98 5.3 2.3 9.0 99 87 25.5 23.2 100 100 5.1 11.1 20.5 221.4 99 98 69.0 21.2 26.2 95 d 100 3.2 4.6 c 13.6 c 256.5 c 91 87 64.7 16.2 12.5 c 100 100 4.1 6.3 18.0 455.7 93 94 67.2 6.9 12.5 90 d 98 3.5 4.2 17.6 175.0 99 97 74.6 7.4 13.1 99 100 6.4 6.8 19.0 d 263.8 d 98 89 18.1 23.6 100 100 4.0 2.1 7.5 537.5 95 94 76.3 78 93 9.7 24.3 162.9 c 99 96 76.6 17.2 24.5 100 100 3.4 19.8 e 138.2 e 99 99 99 99 3.8 11.8 20.4 d 436.6 99 99 68.9 26.5 33.2 94 d 100 3.5 6.1 13.5 215.7 95 94 87.5 10.8 c 100 100 6.1 3.8 c 13.1 95 92 72.6 8.9 17.9 100 99 3.4 6.2 d 19.1 115.9 94 98 75.8 100 100 11.8 a 203.3 d 96 90 25.2 32.1 100 7.3 7.1 15.8 255.8 99 99 60.9 55 97 3.5 15.7 104.4 96 97 54 93 6.3 19.0 384.3 94 99 75.7 15.8 d 23.0 82 d 79 d 4.8 7.2 23.1 180.5 92 94 68.4 23.5 90 87 d 3.9 6.6 15.2 99 96 0.0 13.7 18.3 100 100 0.0 14.6 0.0 96 84 80.0 100 100 4.6 99 99 100 100 4.4 c 12.9 c 114.1 95 91 87.2 91 90 2.5 6.6 11.7 c 150.7 c 97 96 77.7 16.7 24.7 100 100 4.7 5.2 d 18.7 d 254.8 94 93 91.4 8.3 22.9 100 100 4.6 6.8 16.2 1.6 c 99 98 65.8 26.9 34.7 98 89 e 1.8 4.2 10.8 209.5 97 97 11.9 27.9 100 100 3.8 6.4 18.5 401.0 93 91 57.1 53 86 1.6 4.5 21.6 526.8 89 93 83.8 19.6 39.5 62 72 e 2.5 9.4 22.0 598.8 c 97 98 53.1 26.0 d 82 70 3.7 12.5 86 83 8.1 c 15.8 c 322.5 94 93 85.8 50.9 86 97 2.6 11.0 18.5 277.4 99 98 84.2 26.3 30.8 94 d 100 4.1 6.5 17.5 196.1 96 96 86.0 24.1 29.4 d 100 100 3.9 7.4 11.3 232.3 c 97 97 70.4 12.4 21.8 99 100 5.6 3.1 16.5 337.8 98 96 85.1 14.7 100 100 3.4 17.5 137.1 95 92 14.9 d 20.3 100 100 4.2 4.2 d 11.3 d 51.2 d 96 98 80.1 48 95 6.1 11.4 233.8 c 96 97 89.5 90 91 3.5 8.2 15.1 56.1 97 98 91.3 58.1 99 91 3.6 16.8 106.5 97 99 45 99 10.7 22.6 223.8 50 67 59.8 66 94 4.1 5.0 d 13.6 250.6 95 90 80.9 14.4 21.8 100 100 4.2 9.1 15.7 59.8 99 99 81.1 47 100 7.7 17.9 274.3 94 94 89 92 4.0 Note: a=2012 b=2011 c=2010 d=2009 e=2008 Health system coverage and utilization and the environment * The former Yugoslav Republic of Macedonia DTP = diphtheria, tetanus, poliomyelitis PM = particulate matter, measured as particles with aerodynamic diameter < 2.5 µm (PM2.5) or < 10 µm (PM10) 28 29 30 31 32 33 34 35 36 37 AS % OF TOTAL HEALTH EXPENDITURE PER 100 000 POPULATION Total health expenditure as % of GDP Government expenditure on health as % of total government expenditure Public sector health expenditure Private households’ out of pocket expenditure Total inpatient expenditure Total pharma- ceutical expenditure Hospitals Physicians General practitioners Nurses Country 2011 2011 2011 2011 2011 2011 2011 2011 2011 2011 Albania 6.3 9.9 44.9 55.0 48.0 1.4 a 115 a 50 a Andorra 7.2 21.3 73.5 19.6 2.4 d 316 d 49 d 369 d Armenia 4.3 5.8 35.8 57.4 4.1 a 269 a 50 a 491 a Austria 10.6 15.9 75.6 16.4 40.2 11.7 3.2 483 78 791 Azerbaijan 5.2 3.7 21.5 70.1 74.0 d 26.2 c 5.8 a 350 a 29 a 682 a Belarus 5.3 13.0 70.7 26.7 43.0 18.0 6.9 379 45 1062 Belgium 10.6 15.1 76.0 19.1 42.3 15.5 1.8 a 300 114 1585 c Bosnia and Herzegovina 10.2 16.2 68.0 31.3 30.5 d 1.0 173 c 28 c 529 c Bulgaria 7.3 11.3 55.3 43.3 4.7 386 64 475 Croatia 7.8 17.7 84.7 14.6 1.3 284 51 579 Cyprus 7.4 6.9 43.3 49.4 10.2 296 443 Czech Republic 7.4 14.2 83.5 15.1 32.6 20.0 2.4 364 70 846 Denmark 11.2 16.4 85.2 13.2 37.9 6.8 348 d 1573 d Estonia 6.0 12.3 78.9 18.6 32.2 21.5 4.1 326 74 647 Finland 8.9 12.1 74.8 19.2 35.1 13.2 5.1 272 e 1072 c France 11.6 15.9 76.7 7.5 37.1 15.6 4.1 318 a 161 a 971 a Georgia 9.4 5.4 18.1 64.9 17.1 44.1 c 5.1 a 424 a 97 a 328 a Germany 11.1 18.5 75.9 12.4 34.8 14.1 4.0 382 66 1154 Greece 9.0 11.5 65.7 29.8 36.4 28.5 2.8 d 614 30 354 d Hungary 7.8 10.2 64.8 26.2 26.9 33.4 1.7 296 638 Iceland 9.1 15.4 80.4 18.2 43.7 15.4 2.4 a 348 a 56 a 1562 a Ireland 9.4 13.5 70.4 14.5 17.5 2.1 a 272 a 72 a 1215 Israel 7.7 10.7 61.5 21.4 33.1 d 1.2 a 326 26 a 502 Italy 9.5 14.7 77.3 19.9 46.6 15.7 a 2.0 410 76 659 Kazakhstan 3.9 10.5 57.9 41.5 5.7 a 358 a 32 a 823 a Kyrgyzstan 6.5 11.6 59.7 34.4 2.6 a 196 a 32 a 611 a Latvia 6.2 9.3 58.5 39.6 28.7 d 22.2 d 3.4 314 516 Lithuania 6.6 12.6 71.3 27.9 25.0 c 26.4 c 3.3 385 67 736 Luxembourg 7.7 15.5 84.3 11.5 38.1 e 9.1 e 2.3 a 278 a 83 a 1229 a Malta 8.7 13.3 64.0 33.9 28.5 1.9 a 349 a 80 a 709 a Monaco 4.3 18.8 88.6 7.0 7.9 a 665 a 37 a 1614 Montenegro 9.3 13.6 67.0 30.0 1.8 202 30 535 Netherlands 12.0 20.6 85.7 5.1 46.4 9.4 1.6 296 c 73 c 855 e Norway 9.1 17.7 85.6 13.6 44.9 a 6.6 a 1.3 372 90 1332 Poland 6.7 11.0 71.2 22.9 32.0 22.5 2.5 219 20 580 Portugal 10.4 13.4 64.1 27.3 19.8 17.9 2.1 398 51 633 Republic of Moldova 11.4 13.3 45.6 45.0 29.2 34.6 2.4 a 283 a 52 a 642 a Romania 5.8 11.9 80.2 19.4 2.3 239 68 551 Russian Federation 6.2 10.1 59.7 35.4 San Marino 7.2 13.6 84.7 14.7 3.4 a 556 a 963 a Serbia 10.4 14.1 62.2 36.2 31.1 c 30.9 c 307 a 71 a 627 a Slovakia 8.7 14.5 63.8 26.2 21.0 27.4 2.6 619 Slovenia 9.1 13.0 72.8 13.0 35.7 19.5 1.4 a 250 45 839 Spain 9.4 15.4 73.6 20.1 30.2 17.4 1.7 370 a 75 548 Sweden 9.4 14.8 80.9 16.9 28.4 12.1 63 c Switzerland 10.9 21.0 65.4 25.0 45.2 9.4 3.9 394 1738 Tajikistan 5.8 6.2 29.6 60.1 6.4 190 26 447 MKD* 6.6 11.7 61.4 38.3 3.2 274 421 Turkey 6.7 12.8 74.9 16.1 1.9 169 56 237 Turkmenistan 2.7 9.8 60.8 39.2 2.3 a 228 a 58 a 459 a Ukraine 7.3 12.8 55.7 41.5 32.6 d 4.2 d 5.3 a 353 a 37 a 759 a United Kingdom 9.3 15.9 82.7 9.2 11.4 e 279 a 81 a 883 a Uzbekistan 5.4 8.5 51.4 43.9 2.6 c 238 a 28 a 1195 a WHO European Region 8.3 13.4 69.0 24.1 3.3 334 61 766 TURKMENISTANTURKEY UKRAINE UZBEKISTAN EUROPEAN REGION AVERAGE NATIONAL TREND UNITED KINGDOM 0 1000 500 1990 2000 20101990 2000 2010 1990 2000 2010 1990 2000 2010 1990 2000 2010 SPAINSLOVENIA SWEDEN TAJIKISTANSWITZERLAND MKD* 0 1000 500 ROMANIAREPUBLIC OF MOLDOVA SERBIASAN MARINO SLOVAKIA 0 1000 500 RUSSIAN FEDERATION MONTENEGROMONACO POLANDNORWAY PORTUGAL 0 1000 500 NETHERLANDS KYRGYZSTANKAZAKHSTAN LUXEMBOURGLITHUANIA MALTA 0 1000 500 LATVIA HUNGARYGREECE ICELAND ISRAELIRELAND ITALY 0 1000 500 BOSNIA AND HERZEGOVINA BELGIUM BULGARIA CYPRUSCROATIA CZECH REPUBLIC 0 1000 500 ANDORRAALBANIA ARMENIA AZERBAIJANAUSTRIA BELARUS 0 1000 500 ESTONIADENMARK FINLAND GEORGIAFRANCE GERMANY 0 1000 500 Trends in mortality from circulatory diseases SDR, CIRCULATORY DISEASES, ALL AGES, PER 100,000, 1980–2015 * The former Yugoslav Republic of Macedonia Noncommunicable diseases and risk factors 49 50 51 52 53 54 55 56 57 58 RISK FACTORS NATIONAL SYSTEMS RESPONSE Tobacco Alcohol Overweight and obesity Tobacco Alcohol Age-standardized prevalence (%) of current tobacco smoking** among adults ≥ 15 years Males Females Prevalence (%) of current*** tobacco smoking among adolescents Males Females Yearly consumption per adult ≥15 years (litres of pure alcohol equivalent) Age-standardized prevalence (%) among adults ≥ 20 years Overweight Obesity BMI≥25 BMI≥30 Price of most sold brand of cigarette in Intl. dollars (pack of 20) Taxes**** as % of price Excise tax as % of total retail price for 1 litre of pure alcohol Country 2011 2011 2011 2011 2009 2008 2008 2012 2012 2008 Albania 48 5 17.6 d 6.3 d 5.2 f 54.2 21.1 3.2 60.7 Andorra 11.8 f Armenia 47 2 11.0 c 1.4 c 3.5 55.1 23.4 2.7 25.0 17.7 Austria 46 47 25.2 c 29.3 c 12.2 49.6 18.3 5.2 74.2 Azerbaijan 34 <1 11.4 2.1 1.5 f 57.4 24.7 2.0 18.6 Belarus 50 11 31.2 f 21.7 f 13.8 f 2.4 42.5 2.6 Belgium 31 23 10.8 e 51.5 19.1 5.8 76.1 26.4 Bosnia and Herzegovina 44 27 14.3 e 9.4 e 13.5 e 57.6 24.2 3.5 74.8 Bulgaria 48 31 24.4 e 31.6 e 10 54.3 21.4 6.1 83.6 Croatia 36 30 26.7 27.0 10.1 53.2 21.3 4.6 71.0 7.0 Cyprus 41 18 20.7 7.5 8.4 55.9 23.4 4.9 75.9 Czech Republic 40 32 28.0 33.1 15 61.7 28.7 5.0 77.6 24.0 Denmark 30 27 14.1 c 13.0 c 10.7 48.4 16.2 4.6 79.3 22.5 Estonia 43 21 22.0 c 16.3 c 12.5 c 51 18.9 5.2 76.9 15.6 Finland 27 20 4.0 6.0 10 53 19.9 5.0 79.9 37.9 France 39 32 20.4 c 20.3 c 12.3 45.9 15.6 6.8 79.9 5.7 Georgia 55 3 15.2 e 2.8 e 6 1.4 58.1 Germany 35 25 11.1 12.4 11.7 54.8 21.3 6.3 73.0 Greece 46 34 17.5 c 13.2 c 8.2 49.1 17.5 5.1 82.2 Hungary 35 27 30.8 a 23.7 a 11.5 57.7 24.8 5.2 83.7 10.9 Iceland 19 18 8.8 c 6.8 c 7.5 f 56.4 21.9 7.4 57.0 38.5 Ireland 11.8 c 13.7 c 11.9 c 60.9 24.5 10.6 79.0 24.7 Israel 35 17 12.0 f 7.0 f 6.9 60.1 25.5 6.2 83.5 Italy 31 18 19.4 c 21.6 c 7 49.2 17.2 5.8 75.2 Kazakhstan 40 9 9.7 d 6.0 d 7 f 56.7 24.4 1.0 30.0 Kyrgyzstan 45 2 6.8 e 2.2 e 5.5 f 46.6 17.2 1.1 65.8 0.3 Latvia 46 20 29.2 33.8 13.2 e 53.6 22.0 4.4 79.1 30.6 Lithuania 43 25 34.4 c 21.4 c 12.6 56.9 24.7 4.9 75.3 Luxembourg 22 25 8.0 c 10.0 c 15.3 56.7 23.4 4.5 70.6 Malta 31 20 23.0 20.0 7.7 61.6 26.6 7.0 76.9 1.0 Monaco Montenegro 5.7 e 4.4 e 8.3 2.2 80.5 Netherlands 29 23 15.0 c 16.8 c 9.2 47.8 16.2 6.6 72.2 29.5 Norway 28 26 8.8 c 8.2 c 6.7 55 19.8 8.3 72.8 44.9 Poland 38 27 15.7 c 12.1 c 10.1 55.7 23.2 5.9 79.6 18.2 Portugal 30 15 11.4 c 10.1 c 11.4 f 55.3 21.6 6.1 76.0 6.2 Republic of Moldova 43 5 18.5 e 5.6 e 20.6 e 49.2 20.4 1.8 43.7 Romania 38 18 25.2 c 15.4 c 12.7 48.6 17.7 6.1 73.3 1.4 Russian Federation 59 25 19.2 c 15.3 c 11.5 e 57.8 24.9 1.9 40.5 San Marino 10.9 c 11.6 c Serbia 38 27 9.3 e 8.9 e 7.3 55.9 23.0 3.0 75.9 8.1 Slovakia 39 19 23.2 23.0 11.4 4.8 83.9 Slovenia 28 21 13.3 20.3 11.9 4.6 80.1 12.5 Spain 33 27 14.8 c 22.6 c 11.4 58.2 24.1 5.6 79.3 Sweden 25 24 12.6 c 15.3 c 7.4 50 16.6 5.6 73.8 25.4 Switzerland 31 22 18.7 c 15.0 c 10.2 44.3 14.9 4.8 62.2 10.2 Tajikistan 1.1 f 0.6 f 0.3 e 33.8 9.9 1.5 30.8 MKD* 14.0 c 9.3 c 3.7 52.8 20.3 2.6 71.2 30.4 Turkey 42 13 10.2 d 5.3 d 1.3 63.6 29.3 4.9 80.3 17.5 Turkmenistan 2.3 f 43.6 14.3 5.0 30.0 Ukraine 49 14 30.8 c 12.9 c 9.8 f 51.8 20.1 1.8 67.0 United Kingdom 22 22 10.0 c 15.0 c 10.7 61.5 24.9 9.8 80.1 19.5 Uzbekistan 22 3 2.4 e 1.2 e 1.8 f 48.1 17.3 1.8 29.3 * The former Yugoslav Republic of Macedonia ** Smoking of any form of tobacco, including cigarettes, cigars and pipes and excluding smokeless tobacco, at the time of the survey including daily and non-daily smoking. *** At least once in the past week. Data for Finland apply to daily cigarette use. **** Excise taxes, import duties if applicable, value-added tax and other taxes not elsewhere specified. Note: a=2012 b=2011 c=2010 d=2009 e=2008 f=2007 or earlier BMI = body mass index 59 60 61 62 63 64 65 66 TOBACCO POLICY NUTRITION (Member States action networks) Ratified WHO Framework Convention on Tobacco Control (FCTC)** Signed Protocol to Eliminate Illicit Trade in Tobacco Products*** Childhood obesity surveillance Reducing marketing pressure on children Reducing salt intake in the population School nutrition Hospital nutrition Obesity and health inequalities Country Albania • • • Andorra Armenia • Austria • Azerbaijan • Belarus • Belgium • • • • • Bosnia and Herzegovina • • • Bulgaria • • • • • • Croatia • • • • Cyprus • • • • Czech Republic • • • Denmark • • • • Estonia • • • Finland • • • • • France • • • • Georgia • • • Germany • Greece • • • • • • Hungary • • • Iceland • Ireland • • • • • Israel • • • • Italy • • • • • Kazakhstan • Kyrgyzstan • Latvia • • • • Lithuania • • • Luxembourg • Malta • • • Monaco Montenegro • • • Netherlands • • • • • Norway • • • • Poland • • • Portugal • • • • • • Republic of Moldova • • • • Romania • • Russian Federation • • San Marino • Serbia • • • • Slovakia • Slovenia • • • • • • Spain • • • Sweden • • • • Switzerland • • • Tajikistan • MKD* • • • • Turkey • • • • • Turkmenistan • Ukraine • United Kingdom • • • • Uzbekistan • • • • = Policies and action networks to which Member States are signed up * The former Yugoslav Republic of Macedonia ** Adopted by the World Health Assembly on 21 May 2003 and entering into force on 27 February 2005. *** Adopted on 12 November 2012 at the fifth session of the Conference of the Parties in Seoul, Republic of Korea, and currently open for signature by the Parties to the WHO FCTC. Policies and action networks BELGIUM BULGARIA CZECH REPUBLIC IRELAND LATVIA LITHUANIA MALTA** PORTUGAL SLOVENIA SWEDENNORWAY* ITALY* BOYS GIRLS 50% 40% 30% 20% 10% 0% PREVALENCE OF OVERwEIGHT (INCLUDING OBESITY) AMONG 7-YEAR-OLDS, 2008 PREVALENCE OF OBESITY AMONG 7-YEAR-OLDS, 2008 Overweight and obesity among children 25% 20% 15% 10% 5% 0% BELGIUM BULGARIA CZECH REPUBLIC IRELAND LATVIA LITHUANIA MALTA** PORTUGAL SLOVENIA SWEDEN NORWAY* ITALY* BOYS GIRLS * 8-year-olds ** 6-year-olds Source: Wijnhoven TM et al. WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6–9-year-old children. Pediatric Obesity, 2013, 8(2):79–97. Indicator Data Source 1, 2, 3, 4 The national data reported by countries directly to WHO or, when unavailable, World population prospects: the 2010 revision, from the United Nations Department of Economic and Social Affairs, Population Division 3 Reports of the World Bank, the United Nations Development Programme and country statistical yearbooks 5 World urbanization prospects: the 2009 revision from the United Nations Department of Economic and Social Affairs, Population Division 7 Yearbook of labour statistics from the International Labour Organization, Department of Statistics 9 The World Development Indicators database of the World Bank 29 The WHO Global Health Observatory 28, 30 WHO estimates based on nationally reported data and data or estimates from the International Monetary Fund, the World Bank, the United Nations and OECD 32, 33 OECD Health Data 46, 47 Progress on sanitation and drinking-water. 2013 update from the WHO/ UNICEF Joint Monitoring Programme for Water Supply and Sanitation 49–52, 56, 57 WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship (Appendix IX, X, XI) 51, 52 Depending on the country, various studies with differing adolescent age groups: Global Youth Tobacco Survey (13–15 years), Health Behaviour in School-aged Children survey (15 years), national surveys and The European School Survey Project on Alcohol and Other Drugs (between 12 and 18 years) 54, 55, 58 The WHO Global Health Observatory 61–66 The WHO Regional Office for Europe website (http://www.euro.who.int), though information not necessarily available for certain participants © world Health Organization 2013 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part if the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. world Health Organization, Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Email: contact@euro.who.int; Website: www.euro.who.int Technical notes and sources Data were retrieved from the WHO European Health for All Database (HFA-DB), unless specified in the tables. The range of data presented was limited to the years 2008–2012 for the sake of actuality and comparability. Additional indicators and more detailed data can be found in the databases on the websites of the WHO Regional Office for Europe (http://www.euro.who.int/ en/what-we-do/data-and-evidence/databases) and WHO headquarters (www.who.int). The data for the core health indicators were compiled, validated and processed in a standard way by WHO, the Organisation for Economic Co-operation and Development (OECD), EUROSTAT, other United Nations agencies and international networks, in order to improve the international comparability of the statistics. Nevertheless, many factors may influence the accuracy and comparability of national statistics, such as variation in definitions, incomplete registration, and other national specificities in data recording and processing. The international comparison of indicators should therefore always be interpreted with caution. Four mortality-based indicators (life expectancy and rates for infant, child (under 5 years) and maternal mortality) are presented, based on official mortality data from countries. Cause-specific mortality rates (indicators 15–21) are age-standardized death rates, calculated using the European standard population structure (see the European Mortality Database (http://data.euro. who.int/hfamdb/help/mTechnical.htm)). Age- standardization improves international comparability by removing the effects in mortality rates of intercountry differences in population age structures. The proportion of ill-defined causes of death is used as an indication of the quality of the certification and coding of causes of death. The bottom row in the data tables, the WHO European Region, gives the population-weighted average for all countries in the Region for which data are available. The exception is indicator 1, mid- year population, where the value is the sum of the countries’ populations. Indicators related to the Millennium Development Goals (MDGs) are indicated as such. Document number: WHO/EURO:2013-1955-41706-57073