Core Health Indicators in the WHO European Region 2013

Core Health Indicators in the WHO European Region

Special focus: Noncommunicable diseases

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 highquality 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 context

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

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 WHO European Region

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2

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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

Unemployment rate (%)

Real GDP, PPP$ per capita

Annual growth rate of GDP (%)

Life expectancy at birth (years)

2011

2011 1.6 1.2 1.5 1.4 2.4 a 1.5 1.8 d 1.2 1.5 1.4 1.4 1.4 1.8 1.5 1.8 2.0 c 1.7 1.4 1.5 d 1.2 2.0 2.0 3.0 1.4e 2.6 3.1 1.3 1.6 1.6 c 1.5

2011

2011

2011

2011 8866

8.6 9.1

6.2 4.2 0.9 c 0.6 7.1 27.6 11.2 13.4 7.7 6.7 7.6 12.5 7.8 9.3

5789 42 173 10 062 14 938 38 723 9076 15 083 19 487 32 254 26 332 40 933 21 997 37 455 35 247 5465 39 456 25 858 21 661 36 483 40 868 28 809 32 672 13 099 2402 18 951 21 480 88 797 27 504

2.3 d 3.0 3.8 0.3 -0.6 -0.0 a -2.2 c -1.9 c

2012 0.8 3.6e 7.1 0.8 4.5 1.5 -0.3 -0.7 0.8 -2.0 -2.4 -1.3 -0.5 3.2 -0.2 0.0 6.0 0.7 -6.4 -1.7 1.6 0.9 4.7 b -2.4 5.0 -0.9 5.6 3.7 0.3 1.0 10.0e 0.5 -1.0 3.1 1.9 -3.2 -0.8 3.7 3.4 1.9e -1.7 2.0 -2.3 -1.4 0.7 1.0 8.0 -0.3 2.2 11.1 0.2 0.3 8.2

2011

1.7 1.8 1.9 1.3 1.4 c 1.3 1.3 c

2010 52 88 64 68 52 75 97 49 71 58 70 74 87 69 85 85 53 74 61 68 93 62 92 68 59 35 68 67 85 95 100 61 83 79 61 61 47 57 73 94 56 55 50 77 85 74 26 59 70 50 69 80 36 70

2012 3227 68 3107 8418 9418 9537 10 770 3747 7401 4389 862 10 548 5589 1340 5397 63 418 4306 81 964 11 419 9947 328 4580 7673 60 820 16 407 5464 2234 3296 531 419 38 633 16 695 4951 38 315 10 686 3560 21 397 142 668 29 7259 5478 2040 46 657 9478 7724 7086 2066 74 547 5164 44 992 62 807 28 125 899 020

* The former Yugoslav Republic of Macedonia GDP = gross domestic product PPP = purchasing power parity

10.3 d 17.7 13.9 c 17.1 d 15.1 18.7 17.2 12.8 15.9 17.1 17.1 17.8 16.7 d 13.8 c 20.6 19.5 16.8 11.8 d 11.1 c 10.1 20.3 c 6.7 c 4.5 c 17.4 c 16.3 c 14.0 a 16.1 12.9 d 15.9 15.3 13.6 19.2 a 9.9 c 14.9 c 12.8

4.7 0.2 -2.5 d 2.2 d -0.8 -5.1 -2.2 4.9 0.2 1.8 -0.4 1.8 4.1 d 2.2 c -2.1 -0.4 -4.1 7.8 d 10.2 c 16.2 c -0.5 c 13.6 c 20.5 c -4.5 c -2.1 c 3.7 2.4

16.8 12.4 c 16.6 c 17.2 18.3 c 16.9 c

1.5 1.4 1.5 1.6 1.4 1.9 1.5

-5.1 1.3 c 1.5 c 1.8 2.2 c 2.3 c

11.7 c 7.3

1.5 2.0

2.5 c 11.5

15.3 16.6 c

1.5

-3.6 4.0 c

15.3

2.2 1.6

1.5

14.0 d 9.6 d 9.1 14.7 11.6 6.3 10.2 9.4 11.4 9.4 8.6 d 10.7 c 10.4 9.8 12.9 6.3 d 6.1 c 5.2 c 9.7 c 8.9 c 6.6 c 13.4 c 12.8 c 7.2 7.9 9.3 d 8.1 8.3 9.8 9.8 11.1 a 12.1 c 14.2 c

5.9 17.7 10.9 7.1 14.4 5.6 8.4 5.4 2.5 16.2 15.4 4.9 6.5

14.2 9.8 c 9.1 c 8.4 9.7 c 8.0 c

19.7 4.4 3.2 12.5 12.7 3.6 7.4 6.6 4.8 23.6 13.5 8.2 21.6 7.6 4.1

9.3 c 5.1

31.4 9.8

14.6 9.0 c

8.1 c 8.0

10.5

8.8

13 432 42 779 60 392 21 085 25 564 3369 15 983 21 921 11 887 24 095 26 943 32 087 41 484 51 227 2324 11 561 17 110 9420 7208 35 598 3287 25 800

73.9 d 81.3 70.6 d 80.3 d 76.7 74.3 77.3 81.7 78.1 80.1 76.6 80.8 81.8 d 74.7 c 80.6 c 80.9 75.2 81.9 d 80.8 c 82.2 c 82.5 c 68.6 c 69.5 c 73.7 c 73.6 c 81.7 81.0 75.6 d 81.2 c 81.5 77.0 80.9 71.1 a 73.8 c 69.0 c 74.6 75.7 c 80.0 c 82.5 81.8 c 82.8 c 75.1 c 74.5 71.1 80.8 c 76.7

Note: a=2012 b=2011 c=2010 d=2009 e=2008

Health status: mortality and morbidity indicators 11

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 WHO European Region

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15

16

17

18

19

21

22

23

25

27

MDG 4

MDG 5

Infant Child mortality mortality rate before age per 1000 5 years live births per 1000 live births

Maternal mortality ratio per 100 000 live births

All cause mortality

Circulatory system

Malignant neoplasms

Diseases of the respiratory system

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 5.8 0.0 13.8 2.6 15.7 c 0.9 4.7 d 6.3 2.8 9.7 10.2 c 1.8 3.2 13.6 4.9 c 9.4 d 27.6 5.5 c 3.8 10.2 0.0 c 2.7 2.4 2.9 c 17.7 47.5 5.4 5.8 0.0 0.0

2011

2011

2011

2011

2011

2011

2011

2011

2011 20.8 c

2011 5.9 c

532.2 d 196.4

189.9 d 154.6

73.4 d 26.4

39.4 d 36.7

9.2 d 5.2

5.2 d 24.5

3.5 d 2.2

1160.8 d 577.3 d 803.6 932.9 761.3 518.3 708.4 597.3 759.7 554.4 508.5 d 858.7 c 549.4 547.9 875.4 507.4 d 554.0 c 489.8 c 478.1 c 1270.1 c 1195.6 c 939.2 c 950.6 c 520.0 538.6

601.1 d 164.7 d 426.8 592.0 351.0 198.7 331.5 139.2 369.2 203.7 118.9 d 247.7 c 196.6 220.1 402.1 172.8 d 181.5 c 119.1 c 159.8 c 621.1 c 701.9 c 477.6 c 494.5 c 163.8 231.4

162.9 d 166.9 d 156.9 155.9 212.2 115.6 186.7 185.7 186.5 135.2 165.5 d 56.0 c 157.9 147.3 238.7 155.9 d 172.4 c 142.5 c 156.8 c 157.0 c 113.9 c 193.8 c 187.3 c 157.4 149.1

36.0 d 56.4 d 27.8 36.1 28.7 33.8 37.1 61.0 21.7 21.5 27.5 d 9.7 c 36.2 46.6 44.5 42.4 d 61.5 c 34.3 c 27.6 c 59.6 c 92.6 c 22.3 c 28.2 c 40.6 35.5

133.6 d 48.7 d 28.1 32.7 48.3 28.5 47.2 30.5 77.2 57.3 44.1 d 21.9 c 27.7 26.3 54.1 34.7 d 35.2 c 26.0 c 25.3 c 116.4 c 86.8 c 84.9 c 113.1 c 40.4 19.5

11.5 d 13.3 d 6.7 5.6 4.4 8.0 9.0 8.6 8.6 4.4 10.0 d 4.2 c 10.5 4.7 4.5 2.8 d 5.4 c 19.4 c 8.6 c 16.7 c 20.1 c 10.0 c 12.5 c 12.4 4.5

19.6 d 42.7 d 13.0 9.8 28.9 23.1 20.5 52.9 22.5 73.5 41.2 d 7.8 c 31.5 8.9 29.2 51.7 d 32.2 c 27.4 c 27.2 c 15.5 c 11.9 c 17.8 c 16.3 c 33.1 37.6

11.0 d 2.1 d 7.1 2.3 0.6 1.3 1.2 6.6 1.5 0.7 6.3 d 53.6 c 2.9 9.0 0.1 0.7 d 0.3 c 5.1 c 1.0 c 13.6 c 1.0 c 1.5 c 1.5 c 2.5 0.2

240.4 437.9 c 93.0 a 446.7 578.6 c 215.5 448.7 472.8 c 356.7 e 769.3 d 645.5 c 531.2 e 544.4 c 560.6 94.8 572.1 e

67.8 117.6 c 31.0 a 73.3 181.3 c 43.5 98.2 109.0 c 109.1 e 111.9 d 182.0 c 87.1 e 171.3 c 157.8 31.1 171.1 e

17.1 8.8 c 7.2 a 18.6 10.8 c 20.6 27.3 14.1 c 5.9 e 19.19 d 13.0 c 27.0 e 5.1 c 8.1 9.2 11.65 e

949.7 441.0 d 733.8 361.8 c 421.6 c 183.0 90.4 557.9 554.3 421.3 d 480.0

140.1 129.4 d 116.3 115.3 c 123.0 c 41.1 21.7 111.4 89.3 135.2 d 183.5

22.1 10.8 d 13.6 6.2 c 11.6 c 16.9 15.3 23.4 26.2 7.2 d 7.7

846.2 d 528.2 521.2 747.7 546.6 1135.0 a 948.0 c 1223.1 c

461.6 d 139.2 147.0 317.8 148.6 659.0 a 539.8 c 673.8 c

128.7 d 180.6 154.9 190.9 152.5 163.2 a 180.1 c 177.9 c

38.7 d 48.3 47.0 38.5 54.5 49.7 a 49.0 c 45.8 c

35.2 d 26.3 40.3 54.9 29.0 85.1 a 53.3 c 140.8 c

0.9 d 8.0 11.0 6.6 14.0 14.8 a 10.4 c 22.0 c

8.0 d 44.6 43.2 14.9 17.1 12.7 a 10.8 c 16.2 c

13.6 d 2.9 4.5 4.2 8.2 0.7 a 0.9 c 5.1 c

2011 13.1 3.7 38.6 4.8 70.8 49.6 6.6 35.4 29.6 14.1 3.6 5.4 6.5 22.1 5.8 4.1 101.4 4.4 4.0 12.8 2.5 6.1 5.3 3.3 115.6 100.3 42.0 54.2 2.1 5.3 2.9 c 17.7 5.8 6.3 20.6 22.8 118.2 79.2 79.1

2011 107.8

1045.1 d 530.9

2011 2.2 2.5 5.5 3.5 6.0 12.6 11.0 0.7 2.7 1.7 6.3 1.5 4.8 27.3 3.3 6.3 9.5 3.5 7.4 1.6 7.2 7.0 5.9 5.7 12.1 10.7 14.5 5.2 8.5 5.1

647.0 c 578.2 c 364.9 c

181.8 c 116.1 c 79.4 c

8.6 c 13.2 c 15.5 c

930.4 849.7 c 599.7 c 481.5 514.1 c 464.1 c

473.5 440.2 c 218.4 c 132.5 182.2 c 144.9 c

204.2 196.7 c 196.0 c 152.1 141.2 c 137.9 c

44.5 52.0 c 32.3 c 46.0 27.3 c 25.4 c

37.6 50.1 c 56.3 c 22.6 35.4 c 32.4 c

4.4 6.0 c 2.8 c 8.7 10.4 c 5.5 c

24.0 12.0 c 16.1 c 37.6 44.1 c 49.1 c

4.3 1.2 c 1.5 c 2.6 3.7 c 3.1 c

227.0 266.3 364.4 549.5 358.7 c

47.8 53.1 c 74.5 c 0 83.8 c

17.3 28.9 c 19.2 c 0 26.5 c

597.2 e

111.6 e

12.7 e

590.1 c 478.4 d 36.6 d

168.1 c 139.6 d

9.1 c 6.7 d

939.5 c

553.0 c

171.5 c

34.4 c

28.3 c

3.1 c

8.4 c

6.6 c

147.2 e 70.4 349.3 522.5 c 65.9 397.9 c

31.7 e 15.9 c 66.3 156.8 c 18.1

4.2 e 10.4 c 20.4 9.0 c 8.4

Females 2011

2011

2011

70.6 d 78.4

76.9 d 84.0

11.7 3.6

12.1 4.3

64.8 d 77.5 d 74.2 70.8 74.0 79.8 74.9 78.0 71.3 77.5 78.2 d 70.2 c 78.1 c 78.6 71.3 79.9 d 78.5 c 80.2 c 79.8 c 63.7 c 65.5 c 68.6 c 68.0 c 79.2 78.8

76.6 d 83.0 d 79.0 77.9 80.4 83.5 81.2 82.1 81.4 84.0 85.2 d 79.0 c 83.1 c 83.2 78.8 83.9 d 83.0 c 84.1 c 85.0 c 73.5 c 73.7 c 78.4 c 79.0 c 83.9 83.1

4.7 d 3.5 d 5.8 8.5 4.7 2.8 2.7 3.4 2.4 2.4 3.5 d 11.2 c 3.4 c 3.4 4.9 1.8 d 3.8 c 3.7 c 3.4 c 16.5 c 22.3 c 5.7 c 4.3 c 2.8 6.3

6.3 d 4.4 d 6.6 10.2 5.2 3.6 3.4 3.9 3.1 3.0 4.2 d 13.0 c 4.1 c 4.1 5.8 2.2 d 4.5 c 4.5 c 3.9 c 19.9 c 26.1 c 7.2 c 5.4 c 3.3 7.1

73.3 d 79.1 c 79.3 72.7 77.6 67.2 a 70.2 c 63.1 c

78.0 d 83.1 c 83.7 81.2 84.1 75.1 a 77.6 c 75.0 c

5.8 d 3.8 c 2.3 4.7 3.1 9.8 a 9.8 c 7.6 c

6.2 d 4.5 c 2.9 5.5 3.9 12.1 a 11.7 c 9.8 c

72.0 71.8 c 76.6 c 79.4 79.7 c 80.4 c

77.3 79.4 c 83.2 c 85.5 83.7 c 85.0 c

6.3 5.7 c 2.5 c 3.2 2.5 c 3.8 c

7.1 6.8 c 3.4 c 3.9 3.1 c 4.3 c

73.0 c 72.0

77.3 c 77.1

7.6 c 7.7

8.4 c 11.3

66.0 78.8 c

76.0 82.7 c

73.1

80.3

9.0 4.3 c 10.5 7.0

10.7 5.1 c 14.2 8.8

* The former Yugoslav Republic of Macedonia ** See technical notes for more information TB = tuberculosis

2.2 c 5.0 2.3 5.2 30.4 a 25.5 16.9 c 0.0 10.7 9.9 4.6 d 3.0 0.9 3.7 c 46.5 d 4.4 15.9 5.9 16.9 5.0 c 23.1 11.5

1102.0 553.1 c 789.1

MDG 6

26

Life expectancy at birth (years)

2011

(SDR) PER 100 000 POPULATION

24

LIFE EXPECTANCY

Males

AGE-STANDARDIZED DEATH RATES

20

682.8 164.2 c

157.5 170.4 c

30.5 67.6 c

85.1 26.3 c

29.2 6.1 c

14.7 39.7 c

2.5 0.5 c

369.5

162.0

43.5

60.4

13.1

25.9

4.2

1.5 6.1 5.4 2.5 8.5 20.3 1.8 43.8 c 25.0 1.8 0.9 2.7 6.0 3.9 7.3 13.5 0.0 0.9 0.0 38.1 10.0 13.1 c 15.8

CANCER INCIDENCE PER 100 000

29.9 6.4 8.8 13.1 4.8 4.9 90.1 16.2 20.2 64.1 c 75.2 12.6 49.4 33.3

Note: a=2012 b=2011 c=2010 d=2009 e=2008

Health system coverage and utilization and the environment 28

29

30

31

32

33

34

AS % OF TOTAL HEALTH EXPENDITURE Total health Government Public sector Private Total inpatient Total expenditure expenditure health households’ expenditure pharmaas % on health as % of expenditure out of pocket ceutical of GDP total government expenditure expenditure expenditure

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 WHO European Region

2011 6.3 7.2 4.3 10.6 5.2 5.3 10.6 10.2 7.3 7.8 7.4 7.4 11.2 6.0 8.9 11.6 9.4 11.1 9.0 7.8 9.1 9.4 7.7 9.5 3.9 6.5 6.2 6.6 7.7 8.7 4.3 9.3 12.0 9.1 6.7 10.4 11.4 5.8 6.2 7.2 10.4 8.7 9.1 9.4 9.4 10.9 5.8 6.6 6.7 2.7 7.3 9.3 5.4 8.3

2011 9.9 21.3 5.8 15.9 3.7 13.0 15.1 16.2 11.3 17.7 6.9 14.2 16.4 12.3 12.1 15.9 5.4 18.5 11.5 10.2 15.4 13.5 10.7 14.7 10.5 11.6 9.3 12.6 15.5 13.3 18.8 13.6 20.6 17.7 11.0 13.4 13.3 11.9 10.1 13.6 14.1 14.5 13.0 15.4 14.8 21.0 6.2 11.7 12.8 9.8 12.8 15.9 8.5 13.4

2011 44.9 73.5 35.8 75.6 21.5 70.7 76.0 68.0 55.3 84.7 43.3 83.5 85.2 78.9 74.8 76.7 18.1 75.9 65.7 64.8 80.4 70.4 61.5 77.3 57.9 59.7 58.5 71.3 84.3 64.0 88.6 67.0 85.7 85.6 71.2 64.1 45.6 80.2 59.7 84.7 62.2 63.8 72.8 73.6 80.9 65.4 29.6 61.4 74.9 60.8 55.7 82.7 51.4 69.0

2011 55.0 19.6 57.4 16.4 70.1 26.7 19.1 31.3 43.3 14.6 49.4 15.1 13.2 18.6 19.2 7.5 64.9 12.4 29.8 26.2 18.2 14.5 21.4 19.9 41.5 34.4 39.6 27.9 11.5 33.9 7.0 30.0 5.1 13.6 22.9 27.3 45.0 19.4 35.4 14.7 36.2 26.2 13.0 20.1 16.9 25.0 60.1 38.3 16.1 39.2 41.5 9.2 43.9 24.1

2011 48.0

40.2 74.0 d 43.0 42.3

32.6 37.9 32.2 35.1 37.1 17.1 34.8 36.4 26.9 43.7 33.1 d 46.6

28.7 d 25.0 c 38.1 e

46.4 44.9 a 32.0 19.8 29.2

2011

11.7 26.2 c 18.0 15.5 30.5 d

20.0 6.8 21.5 13.2 15.6 44.1 c 14.1 28.5 33.4 15.4 17.5 15.7 a

22.2 d 26.4 c 9.1 e 28.5

9.4 6.6 a 22.5 17.9 34.6

Hospitals

2011 1.4 a 2.4 d 4.1 a 3.2 5.8 a 6.9 1.8 a 1.0 4.7 1.3 10.2 2.4 4.1 5.1 4.1 5.1 a 4.0 2.8 d 1.7 2.4 a 2.1 a 1.2 a 2.0 5.7 a 2.6 a 3.4 3.3 2.3 a 1.9 a 7.9 a 1.8 1.6 1.3 2.5 2.1 2.4 a 2.3 3.4 a

31.1 c 21.0 35.7 30.2 28.4 45.2

32.6 d

30.9 c 27.4 19.5 17.4 12.1 9.4

4.2 d 11.4 e

* 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)

35

36

37

38

39

40

41

PER 100 000 POPULATION

2.6 1.4 a 1.7 3.9 6.4 3.2 1.9 2.3 a 5.3 a 2.6 c 3.3

Physicians

2011 115 a 316 d 269 a 483 350 a 379 300 173 c 386 284 296 364 348 d 326 272 e 318 a 424 a 382 614 296 348 a 272 a 326 410 358 a 196 a 314 385 278 a 349 a 665 a 202 296 c 372 219 398 283 a 239 556 a 307 a 250 370 a 394 190 274 169 228 a 353 a 279 a 238 a 334

General practitioners

2011 50 a 49 d 50 a 78 29 a 45 114 28 c 64 51 70 74 161 a 97 a 66 30 56 a 72 a 26 a 76 32 a 32 a 67 83 a 80 a 37 a 30 73 c 90 20 51 52 a 68

71 a 45 75 63 c 26 56 58 a 37 a 81 a 28 a 61

Nurses

2011 369 d 491 a 791 682 a 1062 1585 c 529 c 475 579 443 846 1573 d 647 1072 c 971 a 328 a 1154 354 d 638 1562 a 1215 502 659 823 a 611 a 516 736 1229 a 709 a 1614 535 855 e 1332 580 633 642 a 551 963 a 627 a 619 839 548 1738 447 421 237 459 a 759 a 883 a 1195 a 766

Outpatient contacts per person per year

Inpatient care discharges per 100 population

Abortions per 1000 live births

2011 2.2

2011 7.5

2011 205.3

3.5 6.9 4.5 a 13.1 7.4 5.3

10.6 27.4 6.4 a 31.0 17.0 c 10.9 26.7 17.0 9.0 20.5 13.6 c 18.0 17.6 19.0 d 7.5 24.3 19.8 e 20.4 d 13.5 13.1 19.1 11.8 a 15.8 15.7 19.0 23.1 15.2 14.6

279.9

6.0 2.3 11.1 4.6 c 6.3 4.2 6.8 2.1 9.7 11.8 6.1 3.8 c 6.2 d 7.1 3.5 6.3 7.2 6.6

4.4 c 6.6 5.2 d 6.8 4.2 6.4 4.5 9.4 8.1 c 11.0 6.5 7.4 3.1 4.2 d 6.1 8.2 3.6 10.7 5.0 d 9.1 7.7

12.9 c 11.7 c 18.7 d 16.2 10.8 18.5 21.6 22.0 12.5 15.8 c 18.5 17.5 11.3 16.5 17.5 11.3 d 11.4 15.1 16.8 22.6 13.6 15.7 17.9

164.9 a 293.5 147.8 c 447.7 105.5 221.4 256.5 c 455.7 175.0 263.8 d 537.5 162.9 c 138.2 e 436.6 215.7 115.9 203.3 d 255.8 104.4 384.3 180.5 0.0 114.1 150.7 c 254.8 1.6 c 209.5 401.0 526.8 598.8 c 322.5 277.4 196.1 232.3 c 337.8 137.1 51.2 d 233.8 c 56.1 106.5 223.8 250.6 59.8 274.3

42

43

MDG 4

MDG 6

Children immunized (%) against

Treatment success rate (%) for new laboratoryconfirmed TB cases

DTP

measles

2011 99 99 95 83 95 99 98 88 95 96 99 99 91 93 99 98 95 99 99 99 95 95 94 96 99 96 94 92 99 96 99 95 97 94 99 97 93 89 97 86 94 99 96 97 98 95 96 96 97 97 50 95 99 94

2011 99 99 97 76 98 99 95 89 94 96 87 98 87 94 97 89 94 96 99 99 94 92 98 90 99 97 99 94 96 84 99 91 96 93 98 97 91 93 98 83 93 98 96 97 96 92 98 97 98 99 67 90 99 94

2010 91.0 71.7 64.6 76.6 66.3 75.3 98.4 86.3 75.1 25.5 69.0 64.7 67.2 74.6 76.3 76.6 68.9 87.5 72.6 75.8

44

45

Air quality PM10 in PM2.5 in capital capital (µg/m3) (µg/m3)

2011

19.0

2011 38.5 d

27.3

41.2

26.0 e 26.5 48.5 c 65.2

23.2 21.2 16.2 6.9 7.4 18.1

26.2 12.5 c 12.5 13.1 23.6

17.2

24.5

26.5

33.2 10.8 c 17.9

17.7

8.9 25.2

32.1

13.7

23.0 23.5 18.3

16.7 8.3 26.9 11.9

24.7 22.9 34.7 27.9

57.1 83.8 53.1

19.6

39.5 26.0 d

85.8 84.2 86.0 70.4 85.1

26.3 24.1 12.4

87.2 77.7 91.4 65.8

15.8 d

14.9 d 80.1 89.5 91.3 59.8 80.9 81.1

47

48

ENVIRONMENT

60.9 75.7 68.4 0.0 80.0

46

50.9 30.8 29.4 d 21.8 14.7 20.3

58.1

14.4

21.8

Water Sanitation Population Population with with improved improved drinking water sanitation (%) sources (%)

2011 82 100 96 100 51 91 100 82 97 87 d 100 95 d 100 90 d 99 100 78 100 99 94 d 100 100 100 100 55 54 82 d 90 100 100 100 91 100 100 98 100 53 62 82

2011 94 100 90 100 82 93 100 96 100 98 100 100 100 98 100 100 93 100 99 100 100 99 100 97 93 79 d 87 d 100 100 100 90 100 100 89 e 100 86 72 e 70

86 94 d 100 99 100 100 48 90 99 45 66 100 47 89

97 100 100 100 100 100 95 91 91 99 94 100 100 92

Impact Leukaemia incidence ages 0–14 years per 100 000 population

2008 3.2

3.8 4.0 4.2 2.5 4.2 5.3 5.1 3.2 4.1 3.5 6.4 4.0 3.4 3.8 3.5 6.1 3.4 7.3

4.8 3.9 0.0 4.6 2.5 4.7 4.6 1.8 3.8 1.6 2.5 3.7 2.6 4.1 3.9 5.6 3.4 4.2 3.5

4.1 4.2 4.0

Note: a=2012 b=2011 c=2010 d=2009 e=2008

Noncommunicable diseases and risk factors 49

50

51

52

53

54

55

RISK FACTORS Tobacco Alcohol Age-standardized Prevalence (%) Yearly prevalence (%) of current of current*** consumption per tobacco smoking** among tobacco smoking among adult ≥15 years adults ≥ 15 years adolescents (litres of pure alcohol equivalent) Males Females Males Females 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

2011 48

2011 5

2011 17.6 d

2011 6.3 d

47 46 34 50 31 44 48 36 41 40 30 43 27 39 55 35 46 35 19

2 47 <1 11 23 27 31 30 18 32 27 21 20 32 3 25 34 27 18

11.0 c 25.2 c 11.4 31.2 f

1.4 c 29.3 c 2.1 21.7 f

35 31 40 45 46 43 22 31

17 18 9 2 20 25 25 20

29 28 38 30 43 38 59

23 26 27 15 5 18 25

38 39 28 33 25 31

27 19 21 27 24 22

42 49 22 22

14.3 e 24.4 e 26.7 20.7 28.0 14.1 c 22.0 c 4.0 20.4 c 15.2 e 11.1 17.5 c 30.8 a 8.8 c 11.8 c 12.0 f 19.4 c 9.7 d 6.8 e 29.2 34.4 c 8.0 c 23.0

9.4 e 31.6 e 27.0 7.5 33.1 13.0 c 16.3 c 6.0 20.3 c 2.8 e 12.4 13.2 c 23.7 a 6.8 c 13.7 c 7.0 f 21.6 c 6.0 d 2.2 e 33.8 21.4 c 10.0 c 20.0

13

5.7 e 15.0 c 8.8 c 15.7 c 11.4 c 18.5 e 25.2 c 19.2 c 10.9 c 9.3 e 23.2 13.3 14.8 c 12.6 c 18.7 c 1.1 f 14.0 c 10.2 d

4.4 e 16.8 c 8.2 c 12.1 c 10.1 c 5.6 e 15.4 c 15.3 c 11.6 c 8.9 e 23.0 20.3 22.6 c 15.3 c 15.0 c 0.6 f 9.3 c 5.3 d

14 22 3

30.8 c 10.0 c 2.4 e

12.9 c 15.0 c 1.2 e

2009 5.2 f 11.8 f 3.5 12.2 1.5 f 13.8 f 10.8 e 13.5 e 10 10.1 8.4 15 10.7 12.5 c 10 12.3 6 11.7 8.2 11.5 7.5 f 11.9 c 6.9 7 7f 5.5 f 13.2 e 12.6 15.3 7.7 8.3 9.2 6.7 10.1 11.4 f 20.6 e 12.7 11.5 e 7.3 11.4 11.9 11.4 7.4 10.2 0.3 e 3.7 1.3 2.3 f 9.8 f 10.7 1.8 f

Overweight and obesity Age-standardized prevalence (%) among adults ≥ 20 years Overweight Obesity BMI≥25 BMI≥30

56

Trends in mortality from circulatory diseases 57

58

NATIONAL SYSTEMS RESPONSE Tobacco Alcohol Price of most Taxes**** Excise sold brand of as % tax as % of cigarette of price total retail in Intl. dollars price for 1 (pack of 20) litre of pure alcohol

SDR, circulatory diseases, all ages, per 100,000, 1980–2015 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

1000 500 0

2008 54.2

2008 21.1

2012 3.2

2012 60.7

2008

55.1 49.6 57.4

23.4 18.3 24.7 19.1 24.2 21.4 21.3 23.4 28.7 16.2 18.9 19.9 15.6

54.8 49.1 57.7 56.4 60.9 60.1 49.2 56.7 46.6 53.6 56.9 56.7 61.6

21.3 17.5 24.8 21.9 24.5 25.5 17.2 24.4 17.2 22.0 24.7 23.4 26.6

25.0 74.2 18.6 42.5 76.1 74.8 83.6 71.0 75.9 77.6 79.3 76.9 79.9 79.9 58.1 73.0 82.2 83.7 57.0 79.0 83.5 75.2 30.0 65.8 79.1 75.3 70.6 76.9

17.7

51.5 57.6 54.3 53.2 55.9 61.7 48.4 51 53 45.9

2.7 5.2 2.0 2.4 5.8 3.5 6.1 4.6 4.9 5.0 4.6 5.2 5.0 6.8 1.4 6.3 5.1 5.2 7.4 10.6 6.2 5.8 1.0 1.1 4.4 4.9 4.5 7.0

47.8 55 55.7 55.3 49.2 48.6 57.8

16.2 19.8 23.2 21.6 20.4 17.7 24.9

2.2 6.6 8.3 5.9 6.1 1.8 6.1 1.9

80.5 72.2 72.8 79.6 76.0 43.7 73.3 40.5

55.9

23.0

58.2 50 44.3 33.8 52.8 63.6 43.6 51.8 61.5 48.1

24.1 16.6 14.9 9.9 20.3 29.3 14.3 20.1 24.9 17.3

3.0 4.8 4.6 5.6 5.6 4.8 1.5 2.6 4.9 5.0 1.8 9.8 1.8

75.9 83.9 80.1 79.3 73.8 62.2 30.8 71.2 80.3 30.0 67.0 80.1 29.3

1000

2.6 26.4

500 0 1000

7.0

500 24.0 22.5 15.6 37.9 5.7

0 1000 500

10.9 38.5 24.7

0 1000

0.3 30.6

500 0

1.0

1000

29.5 44.9 18.2 6.2

500

1.4

1000

8.1

0

500

12.5

0

25.4 10.2

1000

30.4 17.5

500 0

19.5

* 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

1000

NATIONAL TREND

500

EUROPEAN REGION AVERAGE

0

1990 2000 2010

1990 2000 2010

1990 2000 2010

1990 2000 2010

1990 2000 2010

* The former Yugoslav Republic of Macedonia

Policies and action networks

Overweight and obesity among children

59

Prevalence of overweight (including obesity) among 7-year-olds, 2008

60

61

62

TOBACCO POLICY

BOYS

GIRLS

ITALY*

50%

PORTUGAL 40% MALTA**

SLOVENIA

IRELAND BULGARIA

30% BELGIUM

LATVIA

20%

NORWAY*

LITHUANIA

CZECH REPUBLIC

SWEDEN

10%

0%

Prevalence of obesity among 7-year-olds, 2008

ITALY*

BOYS

GIRLS

25%

20% PORTUGAL MALTA** 15%

BULGARIA

IRELAND LATVIA

10%

NORWAY*

SLOVENIA

BELGIUM 5%

Ratified WHO Signed Protocol Framework to Eliminate Convention on Illicit Trade Tobacco Control in Tobacco (FCTC)** Products***

LITHUANIA CZECH REPUBLIC

0% * 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.

SWEDEN

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

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

•

Childhood obesity surveillance

Reducing marketing pressure on children

•

•

•

•

•

•

• • •

• • •

• •

• • • •

•

•

63

64

65

66

Hospital nutrition

Obesity and health inequalities

• •

• •

NUTRITION (Member States action networks) Reducing salt intake in the population

• • • •

• •

•

• •

•

• •

• • •

•

• •

•

• • • • • •

School nutrition

• • •

•

•

•

• •

• • •

•

• • •

• • • • • •

• • • • •

•

•

•

•

•

• • •

•

• •

•

•

• • •

• • • •

• •

• •

• •

• •

• •

•

•

• = 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.

•

Technical notes and sources

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.

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).

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

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, midyear population, where the value is the sum of the countries’ populations.

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

Indicators related to the Millennium Development Goals (MDGs) are indicated as such.

61–66

The WHO Regional Office for Europe website (http://www.euro.who.int), though information not necessarily available for certain participants

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)). Agestandardization 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.

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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.

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