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Health at a Glance: Europe 2014 presents key indicators of health and health systems in 35 European countries, including the 28 European Union member states, four candidate countriesAlbania has become a EU candidate country on 27 June 2014, but is not included in this publication due to limited data availability when this report was prepared. and three European Free Trade Association countries. This third edition builds on the two previous in 2010 and 2012 and presents a greater number of indicators included in the list of European Core Health Indicators (ECHI, www.echim.org), reflecting progress in data availability and comparability. Complemeting the chapter on quality of care which was added in 2012, this 2014 edition includes a new chapter on access to care, based mainly on ECHI indicators, complemented with some additional indicators related to financial access and geographic access.

As we emerge from the economic crisis, the squeeze on health budgets continues in many EU countries, and policy makers face the challenge of maintaining universal access to essential and high-quality care with reduced resources.

Alcohol related harm is a major public health concern in the European Union, both in terms of morbidity and mortality (Rehm et al., 2009; WHO Europe, 2012). Alcohol was the third leading risk factor for disease and mortality after tobacco and high blood pressure in Europe in 2012 and accounted for an estimated 7.6% of all men’s deaths and 4.0% of all women’s deaths, though there is evidence that women may be more vulnerable to some alcohol-related health conditions compared to men (WHO, 2014). High alcohol intake is associated with increased risk of heart, stroke and vascular diseases, as well as liver cirrhosis and certain cancers, but even moderate alcohol consumption increases the long term risk of developing such diseases. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairments. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide, particularly among young people.

Diabetes is a chronic disease characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (type-1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (type-2 diabetes). People with diabetes are at greater risk of developing cardiovascular diseases such as heart attack and stroke if the disease is left undiagnosed or poorly controlled. They also have elevated risks for sight loss, foot and leg amputation due to damage to the nerves and blood vessels, and renal failure requiring dialysis or transplantation.

Low birth weight – defined as a newborn weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004). Babies with a birth weight under 1500 grams are termed very low birth weight babies and are at the highest risk.

The onset of AIDS is caused by HIV (human immunodeficiency virus) infection and can manifest itself through many different diseases, such as pneumonia and tuberculosis, as the immune system is no longer able to defend the body, leaving it susceptible to different infections and tumors. There is a time lag between HIV infection, AIDS diagnosis and death, which can be any number of years depending on the treatment administered. Despite worldwide research, there is no cure or vaccine currently available. HIV remains a major public health issue in Europe, with approximately 800 000 people living with HIV infection in the European Union in 2012 and continued transmission increasing this number.

Dementia describes a variety of brain disorders which progressively lead to brain damage, and cause a gradual deterioration of the individual’s functional capacity and social relations. It is one of the most important causes of disability among the elderly, placing a large burden not only on sufferers, but also on carers. Alzheimer’s disease is the most common form of dementia, representing about 60% to 80% of cases. Successive strokes that lead to multi-infarct dementia are another common cause. Currently, there is no treatment that can halt dementia, but pharmaceutical drugs and other interventions can slow the progression of the disease.

Spending on pharmaceuticals accounted for almost a fifth of all health expenditure on average across EU member states in 2012, making it the third largest spending component after inpatient and outpatient care.

The number of hospital beds provides an indication of the resources available for delivering services to inpatients in hospitals. This section presents data on the total number of hospital beds, including those allocated for curative care, psychiatric care, long-term care and other types of care. It does not capture the capacity of hospitals to provide same-day emergency or elective interventions.

Spending on inpatient care and outpatient care covers the major part of health expenditure across EU member states – almost two-thirds of current health expenditure on average in 2012 (). A further quarter of overall health spending was allocated to medical goods (mainly pharmaceuticals), while 10% went towards long-term care and the remaining 6% to collective services, including public health and prevention services and administration.

Life expectancy at birth continues to increase in European countries, reflecting reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors, including improved lifestyle and better education, as well as greater access to quality health services.

Vaccination programmes are among the safest and most effective public health interventions to provide protection against diseases such as diphtheria, tetanus and pertussis, measles and hepatitis B. All EU member countries have established vaccination schedules, recommending the vaccines to be given at various ages during childhood. Although there is strong evidence that childhood vaccines are highly cost-effective health care intervention, too many children in Europe go unvaccinated and remain vulnerable to these potentially life-threatening diseases. Notably, children from disadvantaged socio-economic groups such as Roma migrants have a lower likelihood of receiving vaccination, which calls for actions to design more effective vaccination strategies.

Consultations with doctors can take place in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes. In many European countries (e.g., Denmark, Italy, the Netherlands, Portugal, the Slovak Republic, Spain and the United Kingdom), patients are required or given incentives to consult a general practitioner (GP) about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries (e.g., Austria, the Czech Republic, Iceland and Luxembourg), patients may approach specialists directly.

All European countries endorse equity of access to health care for all people as an important policy objective. One method of gauging to what extent this objective is achieved is through assessing reports of unmet needs for health care. The problems that people report in obtaining care when they are ill or injured often reflect significant barriers to care.

Patient safety remains one of the most prominent issues in health policy and public debate. The European Commission estimates that without any policy changes, there are likely to be 10 million adverse events related to hospitalisations (including infection-related ones) in the European Union per year, of which almost 4.4 million would be preventable (European Commission, 2008). The European Union Network for Patient Safety and Quality of Care, PaSQ Joint Action, was launched in 2012 to create a permanent platform for future co-operation between member states in the area of patient safety and quality of care.

There are large variations in the levels and rates of growth of health spending across Europe. How much a country spends on health and the rate at which this expenditure grows reflect a wide array of economic and social factors, as well the financing and organisational structures of its health system.

Cancer is the second leading cause of mortality in EU member states after diseases of the circulatory system, accounting for 24% of all deaths in 2011. In 2011, cancer mortality rates were lowest in Cyprus, Finland, Bulgaria, Sweden and Switzerland, with rates at least 15% lower than the EU average. They were highest in some central and eastern European countries, including Hungary, Croatia, the Slovak Republic, Slovenia and Denmark, with rates at least 15% higher than the EU average ().

The use of illicit drugs is an important public health issue in Europe. Almost a quarter of adults in the European Union, or over 73 million people, have used illicit drugs at some points in their lives. In most cases, they have used cannabis, but some have also used cocaine, amphetamines, ecstasy and other drugs (EMCDDA, 2014). The use of illicit drugs, particularly among people who use them regularly, is associated with higher risks of cardiovascular diseases, mental health problems, accidents, as well as infectious diseases such as HIV when the drug is injected. Illicit drug use is a major cause of mortality among young people in Europe, both directly through overdose and indirectly through drug-related diseases, accidents, violence and suicide. More than 6 000 overdose deaths and 1 700 HIV/AIDS deaths were attributed to drug use in Europe in 2010 (EMCDDA, 2014).

Nutrition is an important determinant of health. Inadequate consumption of fruit and vegetables is one factor that can play a role in increased morbidity. Proper nutrition assists in preventing a number of chronic conditions, including hypertension, cardiovascular disease, stroke, diabetes, certain cancers and musculoskeletal disorders. The 2007 EU Strategy on Nutrition, Overweight and Obesity-related Health Issues promotes a balanced diet and active lifestyle among all the population. The European Commission is monitoring progress in the consumption of fruit and vegetables as one of a number of ways to offset a worsening trend of poor diets and low physical activity (European Commission, 2013a).