Chapter 2: Health situation in the European Region

The European Region has passed the half-way point of the Health 2020 implementation period. In this chapter we assess the extent to which progress has been made towards the targets as defined in the Health 2020 monitoring framework.

It provides an overview of progress made by the Member States towards reaching the Health 2020 targets at the regional level in relation to the agreed 2010 baseline. The Health 2020 monitoring framework (Annex 1) is the backbone of this report.

It has three main components:

• burden of disease and risk factors;
• healthy people, well-being and determinants; and
• processes, governance and health systems.

Each area is linked to one or more targets (six in total). There are 19 core indicators and 18 additional indicators by which to measure progress on the six targets.

Target 1. Reduce premature mortality in Europe by 2020

Since the beginning of the millennium, Europe has maintained a consistent reduction in the risk of premature death from the four major NCDs (cardiovascular diseases, cancer, diabetes mellitus and chronic respiratory diseases) among people aged 30 to 70 years. Similar progress has also been made in relation to all-cause mortality rates. In fact, a 2017 review of progress has established that the WHO European Region is likely to achieve SDG Target 3.4 earlier than 2030, and will most probably exceed it significantly. The most recent data, reported for 2014, reveal that Europe has been making clear progress over recent decades in reducing premature mortality from NCDs. Yet, there is a need to sustain this progress in order to reach the target. Similar progress was made in all-cause (all ages) mortality rates but there are large inequalities in mortality rates in Europe between the sexes, and between countries.

Tobacco smoking rates present a challenge for Europe as rates for the adult population are the highest of the six WHO regions though the figures varied between countries and age groups. Similarly, despite the decreasing trend of alcohol consumption in the Region, levels of consumption among the adult population are still the highest in the world which poses a threat to population health. Differences in the levels of alcohol consumption between countries remain large. The prevalence of overweight and obesity among adults in the European Region is high and on the
rise. In most countries in the Region, the prevalence of overweight was higher among men, while the prevalence of obesity was higher among women.

On the other hand, the reported prevalence of overweight and obesity among adolescents varied between genders, countries and age groups. Child immunization coverage has increased since the year 2000. Nevertheless, vigilance is needed as differences between countries persist. In 2015, several countries still had vaccination rates below 90%. There is a steady decline in the average regional mortality rates from all external causes and injuries. However, there were very wide inequalities in the death rates between the sexes and between countries.

Target 2. Increase life expectancy in Europe

The regional average life expectancy has steadily increased over recent years and the gaps in average life expectancy between the sexes and between countries are getting narrower. However, there are still considerable differences which require continued monitoring to ascertain consistent improvement. In 2015, the difference between countries with the highest life expectancy and the lowest was more than a decade. Women still live longer than men at all ages.

Target 3. Reduce inequalities in health in Europe (social determinants target)

The inequalities in infant mortality between countries and gender have been declining over recent decades. The Region has experienced a noticeable reduction in infant mortality rates since 2000 but differences still exist between countries. Since 2000, the Region has made progress in the proportion of children of official primary school age that are enrolled in school but there was also a large variation between countries regarding the proportion of children not enrolled in primary school.

Differences between countries in the Region in unemployment rates have been decreasing. Nevertheless, there is a wide variation between countries. Out of the 53 countries in the WHO European Region, the number of countries that have implemented a policy or strategy to address inequality or social determinants has increased since 2010 and the regional average of income inequality as expressed by the Gini coefficient has decreased. At the same time, there were large differences in levels of income inequality between the countries in the Region.

Such inequalities have significant humanitarian, health and economic implications. To narrow these gaps, current collaborative efforts across all relevant sectors and stakeholders need to be strengthened.

Target 4. Enhance the well-being of the European population

The assessment of well-being as a multidimensional concept is a core target area in Health 2020 policy for the Region. Reporting on well-being indicators within the Health 2020 framework informs stakeholders about the distribution of well-being across different population groups as well as the drivers and barriers to well-being.

The WHO European Region’s overall life satisfaction index is 6. However, some countries have a relatively low life satisfaction score of 5 or below, while other countries have the highest scores in the world.

Target 5. Ensure universal coverage and the “right to health”

Target 5 is focused on achieving universal health coverage by 2020 and envisages the “right to health” as a core policy construct and vision that fosters the idea that provision of equitable fair access to effective and needed services without financial burden is a fundamental right of all citizens.

The WHO Director-General, Dr Tedros, identified universal health coverage as one of the five key priorities for the World Health Organization. Ensuring universal health coverage without impoverishment is the foundation for achieving the health objectives of the SDGs. The World Health Assembly made universal health coverage one of WHO’s three strategic priorities in the WHO’s thirteenth general programme of work 2019–2023, by setting the strategic priority (and goal) of “reducing persistent barriers to accessing health services and 1 billion more people benefitting from universal health coverage”.

Target 6. Set national goals and targets related to health

An important element of Health 2020 is its accountability mechanisms through Target 6 which requests Member States to set national goals and targets related to health.

In 2016, the majority of Member States provided feedback and evidence documenting their actions in relation to Target 6. Using data obtained from a survey conducted by the WHO Regional Office for Europe on the qualitative indicators for Target 6, this midpoint assessment of the Health 2020 policy deployment in the Region showed that an increased number of Member States are effectively aligning national policies with Health 2020 policy, adopting the required implementation plans, and establishing accountability mechanisms for monitoring and assessing their progress.