European Region – long reputed to have some of the world’s strongest health systems – is largely stagnating or even backsliding on a range of indicators from child and adolescent health to chronic diseases. That’s the thrust of WHO’s latest European Health Report, drawing upon the most recently available data across all 53 Member States across Europe and Central Asia.
Published every three years and using country-level evidence, the flagship European Health Report paints the most comprehensive picture of health regionwide. It provides governments and policymakers clear markers as to the way forward at a time when megatrends including dangerous disinformation, a health workforce crisis, rapid population ageing, and climate change are impacting health as never before.
Closing the infant mortality gap and protecting child health
While the European Region as a whole has some of the lowest rates of preventable child deaths globally, the difference between the best and worst-performing countries is vast, ranging from 1.5 deaths per 1,000 live births to 40.4 deaths per 1,000 live births. Closing this gap remains a challenge.
Looking at the most recently available data on under-five mortality across all 53 Member States reveals that 75,647 children died before their fifth birthday in 2022. The top five causes of under-five mortality are: preterm birth complications, birth asphyxia, congenital heart anomalies, lower respiratory infections, and neonatal sepsis and other infections.
Additional concerns for child and adolescent health:
- 1 in 5 adolescents in the European Region grapples with a mental health condition.
- Suicide is the leading cause of death among 15-29-year-olds.
- Girls consistently report lower levels of mental well-being compared with boys.
- 15% of adolescents report they have recently experienced cyberbullying.
- 1 in 10 adolescents aged 13-15 years use some form of tobacco product, including e-cigarettes.
- Nearly 1 in 3 school-aged children is overweight and 1 in 8 is living with obesity.
The marketing of products high in salt, fat and sugar has a negative influence on children’s and adolescents’ consumption patterns, along with long-term ill health. Yet most countries still allow such harmful marketing practices to continue.
“In our online and interconnected world, our young people are ironically feeling lonelier than ever before, with many struggling with their weight and self-confidence, setting them up for poor health as adults,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “That’s why later this year, WHO Europe and UNICEF, will present all 53 Member States of the WHO European Region with a landmark new child and adolescent health strategy for adoption.”
Preventable deaths from noncommunicable diseases
The European Region has made great strides in tackling noncommunicable diseases (NCDs) – by far the biggest killer in our Region. At least 10 Member States have met the WHO target of a 25% reduction in premature mortality from the four major NCDs. Yet overall in the WHO European Region one in six people still die before they reach their 70th birthday from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases.
Cardiovascular diseases account for 33.5% – one third – of premature deaths from noncommunicable diseases in the Region, with the risk nearly five times higher in Eastern Europe and Central Asia than in Western Europe. Cancer causes another third – 32.8% – of premature deaths in the European Region as a whole.
The report identifies the following additional concerns related to NCDs:
- The WHO European Region has the world’s highest alcohol intake, averaging 8.8 litres of pure alcohol per adult per year. Intake is currently highest in the European Union and lowest in the Central Asian countries.
- Tobacco use among adults remains high at 25.3% overall.
- The Region is not on track to meet the target of a 30% reduction in smoking by 2025.
“Noncommunicable diseases still don’t get the attention they deserve, despite accounting for 90% of all deaths in our Region,” noted Dr Kluge. “Interestingly, cancer incidence is higher in Western and Northern Europe compared to Eastern Europe and Central Asia, where cardiovascular diseases are more common, in part due to different living conditions, population health behaviours, and health system effectiveness. The entire region must confront the root causes of chronic disease, from tobacco and alcohol use to poor access to healthy and nutritious food, to air pollution, to a lack of physical activity. The climate crisis is only making matters worse by driving disease burdens across the spectrum, especially chronic disease.”
The WHO European Region is the fastest warming of the six WHO regions, with temperatures rising at around twice the global average rate. Across the Region, there are an estimated 175,000 heat-related deaths every year. Additionally, it is important to recognize the impact of the health sector itself on the environment. In 2020 the global health-care sector was responsible for approximately 5% of global greenhouse gas emissions.
Routine vaccination rates are stagnating with resurgence of infectious disease
Suboptimal vaccination rates in recent years, in an environment of increased anti-vaccine sentiment fuelled by disinformation, have led to a resurgence of preventable diseases. In 2023 there were 58,000 measles cases across 41 WHO/Europe Member States, a staggering 30-fold rise on the previous year.
Meanwhile, success in addressing tuberculosis (TB) in the European Region must be celebrated, with a 25% reduction in TB incidence and a 32% decrease in TB deaths between 2015 and 2022. Despite this, drug- resistant TB remains a growing problem. These hard-to-treat drug-resistant TB cases account for a quarter of new cases and their treatment success rate is well below the target of 80%. However, new evidence from 13 countries shows how a reduced 9-month treatment plan for multidrug-resistant TB has a treatment success rate of 83%, well above the current average success rate for the European Region of 57%. In the past, treatment for drug-resistant TB could take as long as 3 years.
Furthermore, around 3 million people are living with HIV in the European Region. Although the rate of diagnosed HIV infection decreased from 16.4 to 12.4 per 100,000 from 2013 to 2022 across the Region, only 72% of those infected are aware of their status and only 63% receive lifesaving antiretroviral therapy. Only five of the 53 Member States in the Region meet the target of having 90% of HIV-positive cases on treatment.
A lifetime of good health
“The European Health Report’s great value is demonstrating health linkages across the entire life cycle. Protecting and improving child health provides dividends throughout a person’s life while reducing the cost to society,” noted Dr Kluge. “A healthy child is more likely to grow into a healthy adolescent, a healthy adult and a healthy older person. This couldn’t be more crucial because for the first time ever, there are more people aged over 65 years than under 15 years in the European Region.”
Dementia is one of the leading causes of dependency and disability among older people. Over the past few decades there has been a stark increase in the proportion of deaths caused by Alzheimer’s disease and other dementias. In 2019 dementia affected more than 14 million people in the Region, and the prevalence is expected to double by 2030.
As financial and human resources are increasingly strained, accessing healthcare becomes more difficult,” explained Dr Natasha Azzopardi-Muscat, WHO/Europe Director of Country Health Policies and Systems. “This particularly impacts low-income households. Across our 53 Member States, the proportion of households experiencing catastrophic health spending ranges from under 1% to over 21%. In 25 Member States an estimated 5% of households experience catastrophic health spending, meaning healthcare costs prevents them from meeting other basic needs like food and energy. Ensuring a lifetime of good health means investing strategically in health systems to ensure that coverage is genuinely universal.”
A roadmap and call to action
WHO/Europe has embarked on a comprehensive consultative process with all 53 Member States to chart priorities and actions over the next five years, using the European Health Report as a key evidence-base to guide the discussions.
The second European Programme of Work will be adopted by Member States at WHO/Europe’s Regional Committee in late October. There is widespread consensus on a number of pressing health challenges including mental health, noncommunicable diseases, health security, violence against women and girls and the health impacts of climate change.
“This report – published every three years – is what WHO does best: transforming raw numbers from massive datasets into actionable insights, identifying trends, uncovering risks and guiding smart policy decisions,” concluded Dr Kluge. “At a time of increasing social and political polarization including on health, the European Health Report equips governments with the evidence and knowledge they need to act fast to bring about sound health policies, build resilient health systems, safeguard lives and in the process strengthen the very fabric of society We can, and must, do better in working quickly towards health for all.”
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