Atlas of Health in Europe

The WHO Regional Office for Europe ATLAS OF HEALTH IN EUROPE The World Health Organization (WHO) is a specialized agen...

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The WHO Regional Office for Europe

ATLAS OF HEALTH IN EUROPE

The World Health Organization (WHO) is a specialized agencyof the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan

92 890 1370 2 Sw.fr. 20.-

This statistical atlas presents key health figures for the WHO European Region. They cover basic data on populations, births, deaths, life expectancy and diseases, lifestyle and environmental indicators such as drinking, smoking and traffic accidents, and types and levels of health care. All indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. Using the WHO Regional Office for Europe’s unique health for all database, combined with the best alternative sources of data around the Region, this atlas offers the most comprehensive overview of health in Europe. In a handy size, this atlas is designed to be an easily accessible resource at all times, in the office or on the road.

World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-Mail: [email protected] Web site: www.euro.who.int

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The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organization seeks to support national health strategies and address the most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health.

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Atlas of health in Europe

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WHO Library Cataloguing in Publication Data Atlas of health in Europe. 1. Health surveys – statistics – atlases 2. Health status 3. Morbidity – statistics 4. Mortality – statistics 5. Europe ISBN 92 890 1370 2


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Atlas of health in Europe ISBN 92 890 1370 2 Address requests for copies of publications of the WHO Regional Office to [email protected]; for permission to reproduce them to [email protected]; and for permission to translate them to [email protected]; or contact Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark (tel.: +45 3917 1717; fax: +45 3917 1818; web site: http://www.euro.who.int). © W orld Health Or ganization 2003 World Organization 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 of 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. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization.

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Contents

Contents Foreword ........................................................................... Technical notes .................................................................

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1. Demography .......................................................... Notes ................................................................................. Population Mid-year population, 2002 ............................................ Natural population growth ............................................. Age pyramid, 2000 ....................................................... Young population, 0–14 years ...................................... Old population, 65 years and over ................................ Births Birth rate ....................................................................... Low-weight births, under 2500 g .................................. Births to young mothers, under 20 years ..................... Births to older mothers, 35 years and over .................. Abortions Abortions .......................................................................

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2. Life and death ........................................................ Notes ................................................................................. Life expectancy Conventional and estimated life expectancy ................ Life expectancy at birth and at 65 years ....................... Estimated disability-adjusted life expectancy, 2001 ..... Life expectancy at birth ................................................. Deaths Deaths from all causes .................................................. Infant deaths ................................................................. Perinatal deaths ............................................................ Maternal deaths ............................................................ Causes of death Main causes of death by age group ............................. Deaths from: diseases of the circulatory system ............................ ischaemic heart diseases ..........................................


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9 10–11 11 12 13–14 15–16 16–17 18 18 19 21 21 26 27 28 29 29–31 32–33 34 35–36 36 37–38 39–40

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Atlas of health in Europe cerebrovascular diseases ......................................... cancer ....................................................................... lung cancer ............................................................... female breast cancer ................................................ cervical cancer .......................................................... external causes of injury and poisoning .................... motor vehicle traffic accidents .................................. suicide ....................................................................... diseases of the respiratory system ........................... diseases of the digestive system ..............................

40–41 42–44 44–46 47–48 48–49 50–51 52–53 53–54 55–56 57–58

3. Diseases ................................................................ Notes ................................................................................. Some infectious diseases New cases of: tuberculosis ............................................................... viral hepatitis B .......................................................... syphilis ...................................................................... clinically diagnosed AIDS .......................................... HIV infection .............................................................. Selected outbreaks of infectious diseases, 2002 ......... Some noncommunicable diseases Prevalence of diabetes mellitus ..................................... Lung cancer incidence and deaths ............................... Female breast cancer incidence and deaths ................ Cervical cancer incidence and deaths .......................... Hospitalization Hospital discharges for: cancer ....................................................................... diseases of the circulatory system ............................ diseases of the respiratory system ........................... diseases of the digestive system .............................. diseases of the musculoskeletal system ................... injury and poisoning .................................................. Teeth Decayed, missing or filled teeth in 12-year-olds ...........

59 59


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61–62 63–64 65–66 67–68 68–69 70 71 72 73 74

75–76 76–77 78–79 79–80 81–82 82–83

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Contents 4. Lifestyles and envir onment ..................................... environment Notes ................................................................................. Smoking Smokers among adults and 15-year-olds ..................... Smokers among adult males ........................................ Cigarette consumption .................................................. Alcohol Total alcohol consumption ............................................ Consumption of spirits, 2000 ........................................ Foodborne disease Cases of microbiological foodborne disease ................ Work and traffic accidents Deaths from work-related accidents ............................. Motor vehicle traffic accidents and deaths ...................

85 85 87 88 88 89–90 91 92 93–94 95

5. Health car e ............................................................ care 97 Notes ................................................................................. 97 Health personnel Number of: physicians ................................................................. 99–100 dentists ..................................................................... 100–101 nurses ....................................................................... 102 Hospitals Hospital beds ................................................................ 103 Length of stay in hospital .............................................. 103 Number of beds and length of stay in hospital ............. 104 Psychiatric hospital beds .............................................. 105 Inpatient hospital admissions ........................................ 106–107 Some procedures Caesarean sections ....................................................... 107–108 Children vaccinated against measles and diphtheria .... 109 Health expenditure Total health expenditure as a percent of GDP .............. 110–111 Total health expenditure per person .............................. 111–112


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Foreword

Foreword Decisions in the area of public health are based on a profound understanding of a wide range of factors, health statistics among them. Policy-makers consider all the available data on the health status in their countries, and shape their policies and design their actions accordingly. The comparison of national with international health data is a major part of the complex picture of public health: statistics backed up by in-depth analyses can be a powerful resource to help health authorities identify failures and successes, constraints and good practices. The WHO Regional Office for Europe offers this atlas to a wide range of public health and medical professionals, as well as to a broader audience. Rich and elaborate data from various sources have been gathered, systematized, grouped and formatted to present readers with the most complete picture of the health of Europe that can be expressed through figures. We hope this statistical atlas will be useful for those committed to the improvement of public health Europe-wide.

Mar c Danzon Marc Regional Director WHO Regional Office for Europe

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Technical notes

Technical notes This publication contains basic health-related statistics for the 51 Member States of the WHO European Region. The data cover the main aspects of health and its determinants, i.e. basic demographic data, health status in terms of mortality and morbidity, and some indicators on lifestyles and the environment, health care resources and their utilization. The period covered runs from 1980 at the earliest to 2001 at the latest, depending on the data available in the various countries. The only exception is the mid-year population graph, which shows data for 2002. Most of the data used in this publication come from the Member States themselves, usually from statistical units of ministries of health or public health institutions, and national statistical institutions. These data are systematically collected by the technical units of WHO (at the Regional Office for Europe or in headquarters) or by WHO collaborating centres. All these data, and more, are available in databases accessible on the WHO/Europe web site (http://www.euro.who.int) Information sources > Data > European health for all database; and on the WHO headquarters web site (http://www.who.int) Research tools > WHOSIS. For the sake of completeness, some publicly available data collected and published by other international organizations (such as the International Labour Office (ILO), the United Nations Economic Commission for Europe (UNECE), the Organisation for Economic Co-operation and Development (OECD), and the Food and Agriculture Organization of the United Nations (FAO)) have also been included when appropriate, with the information source acknowledged. Data were compiled, validated and processed in a uniform way in order to improve the international comparability of statistics. Nevertheless, many factors, such as variations in national definitions, incomplete registration in some countries or other national specificities in data recording and processing, may influence the accuracy and comparability of the national statistics.


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Atlas of health in Europe Therefore, statistics, particularly in international comparisons, should always be interpreted with caution. The same applies to statistics for countries with very small populations (figures tend to “jump” up and down purely because of the small numbers registered). On the other hand, the “statistical noise” from possible data inaccuracies or random fluctuations due to small figures is usually not so high as to mask completely what the statistics show. Most of the data in this publication are presented in three standard graphic forms. The ranked bar -char bar-char -chartt shows the relative position of each country in relation to other countries. The data used are from 2001, or the latest available year. But as the timing of data reporting to WHO varies a lot, data from different years often have to be used. As more recent data are provided, rankings may change. Serbia and Montenegro is still referred to as Yugoslavia, because that was the name that pertained at the time the data apply. The map aims to reveal specific geographical patterns in the data, such as the east–west mortality gradient. Again, data from different years may have to be used, although 2001 is the most common year. The line char chartt shows health trends over the last 20 years, in different parts of the Region. Technically, it is difficult to present trends separately for each of the 51 countries on one line chart. On the other hand, had only the average trends for the whole Region been given, some important sub-regional differences in health trends would not have been visible. Therefore, sub-regional population-weighted averages for each indicator are calculated for three groups of countries, representing the trends in the eastern, central and western parts of the Region. The first (eastern) group consists of the 12 countries of the former USSR that now constitute the Commonwealth of Independent States (CIS). The second (central) group is the 15 central and south-eastern European countries (CSEC) in rapid transition, including the three Baltic states. The third (western) group represents the western part of the Region, consisting of the 15 member states of the European Union (EU).


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Technical notes

Unless otherwise stated, death rates are age-standardized death rates (SDR), i.e. the number of deaths per 100 000 people in a “standard” population. This facilitates international comparability by removing differences in rates caused by different population age structures between countries. The European standard population (see the table below) was used to calculate the SDR. The mortality rates used cover all age groups: those aged under 65 (so called premature mortality) or aged 25–64 (representing the working age). Readers interested in other or more detailed age groups may consult the European health for all database.

The European standard population structure Age (years)

Percent of population

Age (years)


0 1–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44

1.6 6.4 7 7 7 7 7 7 7 7

45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+ All ages

7 7 6 5 4 3 2 1 1 100


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Demography

1. Demography Notes Population (p. 9) In mid-2002, the population of the 51 countries of the WHO European Region totalled 874.6 million. The six largest countries (the Russian Federation, Germany, Turkey, France, United Kingdom, and Italy) make up more than half of the Region’s population. The data are estimates published by United Nations Statistical Division. Natural population growth (pp.10–11) In the 1990s, the decline in the number of births and the increase in the number of deaths reached a cross-over point for several countries, mostly in the central and eastern part of the Region. Deaths now exceed births in the European Region as a whole. Age structure (pp.11–14) European countries generally have an ageing population. Every seventh person is aged 65 years or more and this proportion is growing while the proportion of children is declining. The ageing process is more advanced in the western part of the Region. The graphs are based on population data by age, as most recently reported by countries to WHO. Births (pp.15–18) Live birth rates are declining in European countries and this decline is particularly sharp in eastern, central and south-eastern parts of the Region. This is most likely due to the profound socioeconomic changes and economic crises in this group of European countries. The proportion of infants with low birth weight (below 2500 g) is growing throughout the entire Region. The worst situation seems to be in the central and south-eastern parts of the Region, although


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Atlas of health in Europe low-weight births may also be high but underreported in some countries of the eastern part of the Region. While births to young mothers are most common in the eastern part of the Region, births to mothers over 35 years of age are most frequent in western countries. Abortions (p. 19) The legal requirements for abortion vary between countries. The dramatic increase in the average rate of abortions in the central and south-eastern part of the Region in 1990 was caused by a six-fold increase in the number of abortions in Romania after a change in the law.


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Demography Population

Mid-year population, 2002 Russian Federation Germany Turkey France United Kingdom Italy Ukraine Spain Poland Uzbekistan Romania Kazakhstan Netherlands Greece Yugoslavia Belgium Czech Republic Belarus Portugal Hungary Sweden Azerbaijan Austria Bulgaria Switzerland Israel Tajikistan Slovakia Denmark Georgia Finland Kyrgyzstan Turkmenistan Croatia Norway Republic of Moldova Bosnia and Herzegovina Ireland Armenia Lithuania Albania Latvia TFYR Macedoniaa Slovenia Estonia Luxembourg Malta Iceland Andorra Monaco San Marino

143752 81990 68569 59670 59657 57450 48652 39924 38543 25618 22332 16026 15990 10631 10523 10275 10250 10106 10048 9867 8823 8147 8070 7790 7168 6303 6177 5408 5342 5213 5183 5047 4930 4657 4506 4273 4127 3878 3790 3681 3164 2392 2051 1984 1360 447 394 283 64 30 27 0

50 000

100 000

150 000

Population (thousands) a


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Atlas of health in Europe Population

Natural population growth Tajikistan (1999) Israel (1998) Turkey (1998) Uzbekistan (2001) Turkmenistan (1998) Kyrgyzstan (2001) Albania (2000) Iceland (1997) Azerbaijan (2001) Bosnia and Herzegovina (1991) Ireland (2000) TFYR Macedonia (2000) Kazakhstan (2001) Netherlands (2000) Luxembourg (2001) San Marino (2000) France (1999) Norway (1999) Armenia (2000) Malta (2001) Switzerland (1999) Finland (2001) Denmark (1999) Portugal (2000) Georgia (2001) Belgium (1996) United Kingdom (2000) Yugoslavia (2000) Slovakia (2000) Poland (2000) Spain (1999) Austria (2001) Greece (1999) Slovenia (2001) Italy (1999) Sweden (1999) Germany (1999) Republic of Moldova (2001) Czech Republic (2001) Romania (2001) Croatia (2001) Lithuania (2001) Hungary (2001) Estonia (2001) Belarus (2001) Bulgaria (2001) Latvia (2001) Russian Federation (2001) Ukraine (2000)

25.7

15.6 15.5 15.2 14.8 13.3 10.8 8.5 8.0 7.6 6.2 6.0 4.9 4.2 4.0 3.8 3.5 3.2 2.7 2.5 2.2 1.5 1.4 1.4 1.2 1.2 1.2 0.7 0.5 0.3 0.2 0.1 -0.3 -0.6 -0.8 -0.8 -0.9 -1.0 -1.7 -1.8 -1.9 -2.5 -3.5 -4.3 -4.9 -5.6 -5.7 -6.6 -7.6 -15

-5

5

15

25

Rate per 1000 population


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Natural population growth 15 CIS

CSEC

EU

Rate per 1000 population

10

5

0

-5 1980

1985

1990

1995

2000

Year

Age pyramid, 2000 CIS

85+

CSEC

EU

Males

Females

80–84 75–79 70–74 65–69 60–64

Age group (years)

55–59 50–54 45–49 40–44 35–39 30–34 25–29 20–24 15–19 10–14 5–9 0–4 15 000


11

10 000

5000 0 5000 Population (thousands)

10 000

15 000

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Young population, 0–14 years 30


CIS

CSEC

EU

25

20

15 1980

1985

1990

1995

2000

Year

–< 42 –< 30

–< 25 –< 18 –< 17 % of population


12

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Old population, 65 years and over 20


CIS

CSEC

EU

15

10

5 1980

1985

1990

1995

2000

Year

–< 18 –< 16 –< 14 –< 10 –< 5 % of population


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Old population, 65 years and over Italy (1999) Sweden (1999) Greece (1999) Bulgaria (2001) Spain (1999) Belgium (1997) San Marino (2000) Germany (1999) France (1999) Croatia (2001) United Kingdom (2000) Austria (2001) Portugal (2000) Latvia (2001) Norway (1999) Estonia (2001) Switzerland (2000) Hungary (2001) Finland (2001) Denmark (1999) Slovenia (2001) Georgia (2001) Lithuania (2001) Luxembourg (2001) Ukraine (2000) Czech Republic (2001) Yugoslavia (2000) Romania (2001) Belarus (2001) Netherlands (2000) Russian Federation (2001) Malta (2001) Poland (2000) Iceland (1998) Slovakia (2000) Ireland (2000) TFYR Macedonia (2000) Israel (1998) Republic of Moldova (2001) Armenia (2000) Kazakhstan (2001) Bosnia and Herzegovina (1991) Azerbaijan (2001) Albania (2000) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1998) Tajikistan (2001)

17.8 17.3 17.1 16.8 16.7 16.4 16.2 16.1 16.0 15.6 15.6 15.5 15.5 15.4 15.4 15.3 15.3 15.2 15.1 14.9 14.3 14.2 14.1 14.0 13.9 13.8 13.7 13.6 13.6 13.6 12.8 12.5 12.2 11.6 11.4 11.2 10.1 9.9 9.5 9.4 6.8 6.3 6.1 6.1 5.5 4.3 3.8 3.8 0


14

5

10 15 Percent of population

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15

Demography Births

Birth rate 27.2

Tajikistan (2001) Israel (2000) Turkey (2000) Turkmenistan (1998) Uzbekistan (2001) Kyrgyzstan (2001) Albania (2000) Iceland (2000) Kazakhstan (2001) Ireland (2000) TFYR Macedonia (2000) Azerbaijan (2001) Norway (2000) Netherlands (2000) France (1999) Denmark (2000) Luxembourg (2001) Yugoslavia (2000) Portugal (2000) Andorra (2000) Belgium (2000) United Kingdom (2000) Switzerland (2000) Finland (2001) San Marino (2000) Bosnia and Herzegovina (2000) Slovakia (2000) Sweden (2000) Georgia (2001) Republic of Moldova (2001) Malta (2001) Spain (2000) Romania (2001) Poland (2000) Greece (1999) Hungary (2001) Italy (2000) Germany (2000) Austria (2001) Estonia (2001) Croatia (2001) Belarus (2001) Russian Federation (2001) Lithuania (2001) Armenia (2000) Czech Republic (2001) Slovenia (2001) Bulgaria (2001) Latvia (2001) Ukraine (2000)

16.1 15.4 14.9 14.5 14.5 13.6 13.3 13.0 12.7 12.7 12.4 11.8 11.8 11.5 11.4 11.4 10.9 10.8 10.8 10.4 10.2 10.2 10.1 10.0 10.0 10.0 9.8 9.8 9.6 9.5 9.4 9.3 9.3 9.3 9.2 9.2 9.1 9.1 9.0 8.8 8.7 8.6 8.4 7.8 0


15

5

21.7 21.5 21.1 20.6 19.9

10 15 20 25 Live births per 1000 population

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Atlas of health in Europe Births

Birth rate 25 CIS

CSEC

EU

Per 1000 population

20

15

10

5 1980

1985

1990

1995

2000

Year

Low-weight births, under 2500 g 8

Percent of live births

7

6

5

CIS

CSEC

EU

4 1980

1985

1990

1995

2000

Year


16

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Demography Births

Low-weight births, under 2500 g Bulgaria (2001) Romania (2001) Hungary (2001) Israel (2001) Greece (1999) Portugal (2001) Armenia (2001) Luxembourg (2000) Belgium (1997) Andorra (2001) United Kingdom (1997) Slovakia (2001) Georgia (2001) Albania (1990) Tajikistan (2001) France (1998) Austria (2001) Azerbaijan (2001) Germany (1999) Switzerland (1999) Croatia (2001) Malta (2001) Russian Federation (2001) Poland (2000) Czech Republic (2001) Spain (1997) Italy (1998) Ireland (1999) Slovenia (2001) Denmark (2000) Kyrgyzstan (2001) Ukraine (2001) Kazakhstan (2001) Republic of Moldova (2001) Belarus (2001) Latvia (2001) Yugoslavia (1999) Turkmenistan (1997) Norway (2000) Uzbekistan (2001) Lithuania (2001) Sweden (1999) Finland (2001) Estonia (2001) Iceland (2001)

9.1 8.8 8.5 8.2 8.1 7.9 7.9 7.5 7.5 7.3 7.3 7.0 6.9 6.9 6.7 6.7 6.7 6.6 6.5 6.3 6.2 6.1 6.1 6.1 6.0 6.0 5.9 5.7 5.7 5.5 5.5 5.4 5.3 5.2 5.2 5.1 5.0 4.9 4.9 4.7 4.5 4.4 4.3 4.3 3.8 0


17

1

2

3 4 5 6 7 Percent of live births

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9

10

18

Atlas of health in Europe Births

Births to young mothers, under 20 years

–< 18 –< 12 –< 9 –< 5 –< 2 No data % of all births

Births to older mothers, 35 years and over

–< 22 –< 17 –< 14 –< 10 –< 6

No data % of all births


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Demography Abortions

Abortions CIS CSEC EU

1500

Per 1000 live births

1000

500

0 1980

1985

1990 Year

1995

2000

–< 1500 –< 1000 –< 700 –< 400 –< 200 No data Per 1000 live births


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Life and death

2. Life and death Notes Life expectancy (pp. 26–29) Life expectancy, or the average number of years that a newborn baby can expect to live if mortality patterns remain unchanged, is one of the most common measurements of the health status of a population. As it is calculated using mortality statistics, its accuracy depends on the accuracy and completeness of official national mortality data. The table on p.26 shows two different estimates of life expectancy. One is the conventional life expectancy based on reported official mortality statistics. The other estimate is calculated using special demographic techniques to counteract possible underreporting of deaths (see The world health report 20001 for details on methodology). Countries with the largest differences between these two estimates most probably have life expectancies well below the level calculated from official statistics. This problem occurs mainly in central Asia, the Caucasus and the Balkans, which were affected by armed conflicts and severe socioeconomic difficulties during the 1990s. Many countries’ national vital statistics systems (registration of marriages, births and deaths) were damaged. This should be kept in mind when comparing the life expectancy in these areas with other countries. The trends in life expectancy show a dramatic increase in the gap between the western and eastern parts of the Region. The average trend for the CIS is particularly complex, as it reflects the effects of both the anti-alcohol campaign introduced in the USSR in 1985 and the deep socioeconomic crisis of the 1990s. The same pattern can be seen in the cause-specific mortality trends: a relatively sharp improvement in 1985–1986, a sharp deterioration in the first half of the 1990s, a gradual improvement in 1995–1998 and a 1

The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000.


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Atlas of health in Europe deterioration again in 1999–2000. The latest deterioration may have some association with the financial crisis that hit the Russian Federation and other CIS countries in the autumn of 1998. Disability-adjusted life expectancy (often also called healthy life expectancy) shows the estimated number of years of life expected to be lived in full health. These estimates were calculated by WHO using special techniques (see The world health report 20002 for details on methodology). Deaths from all causes (pp. 29–31) Mortality is gradually increasing from the western to the eastern part of the Region. The level of premature mortality (i.e. below 65 years of age) varies particularly dramatically. East–west differences in the mortality of the elderly population (i.e. those aged 65 years or over) are relatively less pronounced. Excess male mortality is presented as the ratio of male death rates to female death rates on the left side of the bar charts on pp. 30–31. Particularly high premature male mortality in eastern countries makes the largest contribution proportionally to the east–west gap in total mortality. Infant deaths (pp. 32–33) Infant mortality shows the number of deaths of children under 1 year of age per 1000 live births. Unfortunately, some countries cannot ensure the complete registration of infant deaths and live births, in accordance with the WHO definition of live births. The infant mortality rates they report are therefore lower than they actually are and intercountry comparisons should be treated with caution. As mentioned above, particularly high levels of under-registration occur in central Asia and the Caucasus, and possibly in countries of the former Yugoslavia and Albania. Special household surveys carried out in the 1990s by the United States Agency for International Development (USAID) and the United Nations Children’s Fund (UNICEF) in some of these countries produced much higher estimates of infant mortality rates 2

The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000.


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Life and death than the official figures based on national vital statistics systems. For example, differences between reported infant mortality and survey-based estimates were: for Azerbaijan 19.9 vs. 79.0, Kazakhstan 25.2 vs. 61.9, Tajikistan 47.0 vs. 89.0, Uzbekistan 30.7 vs. 43.5, Kyrgyzstan 29.1 vs. 66.2.3 Although, for methodological reasons, survey-based estimates are not directly comparable with registration-based data, these differences indicate the possible size of under-registration. Infant mortality is higher in the eastern part of the Region, with the highest levels in some south-eastern countries. Given the likely under-registration, the real infant mortality in these countries is probably even higher. Perinatal deaths (p. 34) The rate shows the number of deaths of fetuses weighing 1000 g or more and of newborn babies aged 0–6 full days per 1000 births (live and stillborn). Where weight-specific data were not available, calculations were based on the data provided by countries whatever the national criteria. Maternal deaths (pp. 35–36) A maternal death is the death of a woman while pregnant or within 42 days of the end of a pregnancy, from any cause related to or aggravated by the pregnancy or its management. Maternal mortality (deaths per 100 000 live births) was calculated using mortality data from routine vital statistics reported to WHO and hospital data reported by ministries of health, taking the larger figure where they differed. Even in countries with good vital statistics systems, however, maternal mortality is believed to be higher than reported. WHO, UNICEF and the United Nations Population Fund (UNFPA) have estimated that maternal mortality in these countries may actually be some 50% higher.4 The drop in the average rate in the central and south-eastern part of the Region in 1990 is attributable to the sharp reduction in 3 4

A decade of transition. New York, UNICEF, 2002 (Regional Monitoring Report, No.8). WHO, UNICEF, UNFPA. Maternal mortality in 1995: estimates developed by WHO, UNICEF, UNFPA. Geneva, World Health Organization, 2001 (WHO/RHR/01.9).


23

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24

Atlas of health in Europe maternal mortality in Romania after the change in the anti-abortion law. Deaths by cause and age (p. 36) The importance of specific causes of death differs significantly in the different phases of the life span. Respiratory and some other diseases are leading causes of death in childhood, replaced by accidents and other external causes of death among adolescents and young adults. Cancer and diseases of the circulatory system become leading causes of death in older age groups. Deaths from diseases of the circulatory system (pp. 37–41) The average trends in mortality from these diseases show a decline in the western and central parts of the Region. The average for the CIS shows the specific trend pattern noted under life expectancy during the 1990s. A clear east–west gradient contributes a large part of the east–west difference in total mortality and life expectancy. The patterns of trends and differences in death rates from ischaemic heart diseases and cerebrovascular diseases are similar to those for all diseases of the circulatory system. Deaths from cancer (pp. 42–49) Trends in cancer death rates show some general improvement in the EU and the CIS, while in the central part of the Region the overall situation is deteriorating. The average cancer mortality in western countries is relatively low in younger age groups and relatively high among the older population. The opposite is true in the CIS while, in the central part of the Region, mortality is high in both younger and older age groups. Female mortality from lung cancer is steadily increasing in the western and central parts of the Region. Deaths from external causes of injury and poisoning (pp.50–54) External causes of death from injury and poisoning include accidents, homicide, suicide and other causes that are not diseases. A remarkable increase in mortality in the eastern part of the Region, in the first half of the 1990s, is attributable to the


24

14-05-2003, 14:12

25

Life and death combined effect of the end of the anti-alcohol campaign that started in the USSR in 1985 and the socioeconomic crisis of the 1990s. Deaths from diseases of the respiratory system (pp. 55–56) Generally, there is a downward trend in all parts of the Region. The average for the CIS follows the specific trend pattern described above for diseases of the circulatory system and for life expectancy. Deaths from diseases of the digestive system (pp. 57–58) Deaths from chronic liver disease and cirrhosis are responsible for about half of all deaths from this group of diseases. Mortality is steadily declining in the western part of the Region and is stable or slightly increasing in the central part. The average for the CIS follows the specific trend pattern as described above for diseases of the respiratory and circulatory systems, and for life expectancy.


25

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26

Atlas of health in Europe Life expectancy

Conventional and estimated life expectancy Males

Females

Conventional Estimated life life expectancy expectancy, 2001 (years) (years) Albania (2000) Andorra Armenia (2000) Austria (2001) Azerbaijan (2001) Belarus (2001) Belgium (1996) Bosnia and Herzegovina (1991) Bulgaria (2001) Croatia (2001) Czech Republic (2001) Denmark (1999) Estonia (2001) Finland (2001) France (1999) Georgia (2001) Germany (1999) Greece (1999) Hungary (2001) Iceland (1997) Ireland (2000) Israel (1998) Italy (1999) Kazakhstan (2001) Kyrgyzstan (2001) Latvia (2001) Lithuania (2001) Luxembourg (2001) Malta (2001) Monaco Netherlands (2000) Norway (1999) Poland (2000) Portugal (2000) Republic of Moldova (2001) Romania (2001) Russian Federation (2001) San Marino (2000) Slovakia (2000) Slovenia (2001) Spain (1999) Sweden (1999) Switzerland (1999) Tajikistan (1999) TFYR Macedonia (2000) Turkey Turkmenistan (1998) Ukraine (2000) United Kingdom (2000) Uzbekistan (2001) Yugoslavia (2000)


26

72.03 73.46 76.10 69.66 62.79 73.97 69.49 68.55 71.03 72.18 74.13 64.91 74.72 75.17 72.44 74.89 75.82 68.32 76.41 74.01 76.21 76.28 60.57 64.53 64.48 65.89 75.48 76.37 75.65 75.71 69.80 72.63 64.54 67.69 59.08 77.93 69.26 72.32 75.24 77.13 76.97 69.99 71.18 62.48 62.30 75.69 67.57 70.36

66.3 76.2 66.2 75.9 60.7 62.9 74.8 69.3 68.4 68.9 71.9 74.8 65.7 74.5 75.6 65.4 75.1 75.5 67.3 78.2 73.8 76.1 76.2 58.8 60.1 65.2 67.7 74.9 75.8 76.5 75.8 76.1 69.9 72.7 64.2 67.8 58.9 77.6 69.3 72.1 75.3 77.7 77.3 59.9 68.9 67.0 58.9 62.2 75.1 62.7 69.7

Conventional Estimated life life expectancy expectancy, 2001 (years) (years) 78.04 78.11 81.95 75.01 74.55 80.76 75.98 75.44 78.17 78.71 78.87 76.44 81.81 82.83 78.48 81.02 81.03 76.76 81.61 79.31 80.59 82.62 71.40 72.97 75.68 77.49 81.13 81.19 80.76 81.32 78.09 79.67 71.94 75.01 72.28 86.58 77.64 80.52 82.35 82.08 82.80 73.98 75.74 69.84 73.62 80.51 72.64 75.18

73.2 82.9 73.0 81.8 66.6 74.2 81.2 76.4 74.8 77.1 78.8 79.5 76.5 81.2 82.9 72.4 81.1 80.8 76.1 81.3 79.2 80.9 82.2 67.2 68.2 76.0 77.9 81.8 80.3 84.0 80.7 81.4 78.1 80.1 71.7 74.5 72.3 83.9 77.4 79.5 82.6 82.3 82.8 66.9 74.9 71.2 66.5 73.3 79.9 68.5 74.8

14-05-2003, 14:12

27

Life and death Life expectancy

Life expectancy at birth and at 65 years San Marino (2000) Switzerland (1999) Sweden (1999) Italy (1999) Austria (2001) France (1999) Iceland (1997) Malta (2001) Spain (1999) Norway (1999) Israel (1998) Greece (1999) Luxembourg (2001) Finland (2001) Netherlands (2000) United Kingdom (2000) Germany (1999) Belgium (1996) Ireland (2000) Denmark (1999) Slovenia (2001) Portugal (2000) Armenia (2000) Czech Republic (2001) Georgia (2001) Albania (2000) Croatia (2001) Poland (2000) Slovakia (2000) TFYR Macedonia (2000) Bosnia and Herzegovina (1991) Yugoslavia (2000) Hungary (2001) Azerbaijan (2001) Tajikistan (1999) Bulgaria (2001) Lithuania (2001) Romania (2001) Estonia (2001) Latvia (2001) Uzbekistan (2001) Kyrgyzstan (2001) Belarus (2001) Republic of Moldova (2001) Ukraine (2000) Turkmenistan (1998) Kazakhstan (2001) Russian Federation (2001)

21.3 19.1 18.4 18.7 18.8 19.2 18.3 17.4 18.4 17.8 17.9 18.0 18.3 18.2 17.6 17.7 17.9 17.5 16.5 16.8 17.2 16.7 17.3 16.0 17.4 15.3 15.6 15.9 15.2 14.5 15.0 14.7 15.5 15.5 15.3 14.5 16.0 14.9 15.5 15.2 14.4 14.6 13.9 13.1 13.8 13.8 13.2 13.6

82.3 80.0 79.6 79.5 79.2 79.0 79.0 78.9 78.8 78.5 78.5 78.4 78.4 78.4 78.3 78.2 78.1 77.4 76.6 76.5 76.5 76.2 75.7 75.5 75.4 74.9 74.7 74.0 73.5 73.4 72.7 72.7 72.6 72.4 72.0 71.9 71.7 71.3 70.7 70.1 70.1 68.7 68.5 68.3 67.9 66.1 65.9 65.3

40 30 20 10 0 10 20 30 40 50 60 70 80 90 Years at 65


27

Years at birth

14-05-2003, 14:12

28

Atlas of health in Europe Life expectancy

Estimated disability-adjusted life expectancy, 2001 Switzerland San Marino Sweden Monaco France Iceland Italy Austria Spain Andorra Norway Luxembourg Greece Germany Finland Denmark Netherlands Belgium United Kingdom Israel Malta Ireland Slovenia Portugal Czech Republic Poland Slovakia Croatia Bulgaria Bosnia and Herzegovina TFYR Macedonia Yugoslavia Estonia Hungary Lithuania Romania Latvia Turkey Georgia Albania Belarus Armenia Republic of Moldova Ukraine Russian Federation Uzbekistan Azerbaijan Kazakhstan Kyrgyzstan Turkmenistan Tajikistan

72.8 72.2 71.8 71.3 71.3 71.2 71.0 71.0 70.9 70.9 70.8 70.6 70.4 70.2 70.1 70.1 69.9 69.7 69.6 69.4 69.2 69.0 67.7 66.8 66.6 64.3 64.1 63.3 63.0 62.5 62.2 62.1 62.0 61.8 61.1 60.9 60.0 59.8 59.8 58.7 58.4 58.3 57.5 57.4 56.7 53.5 52.8 52.4 51.5 50.3 50.1 50

55

60

65

70

Years


28

14-05-2003, 14:12

75

29

Life and death Life expectancy

Life expectancy at birth 80 CIS

CSEC

EU

Years

75

70

65 1980

1985

1990

1995

2000

Year

Deaths

Deaths from all causes

–< 1500 –< 1300 –< 1100 –< 800 –< 650 No data Per 100 000 population


29

14-05-2003, 14:12

30

Atlas of health in Europe Deaths

Deaths from all causes, 0–64 years Russian Federation (2001) Kazakhstan (2001) Turkmenistan (1998) Ukraine (2000) Belarus (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Latvia (2001) Estonia (2001) Lithuania (2001) Uzbekistan (2001) Romania (2001) Hungary (2001) Tajikistan (1999) Bulgaria (2001) Azerbaijan (2001) Bosnia and Herzegovina (1991) Yugoslavia (2000) Slovakia (2000) Poland (2000) TFYR Macedonia (2000) Georgia (2001) Croatia (2001) Armenia (2000) Czech Republic (2001) Slovenia (2001) Denmark (1999) Portugal (2000) Belgium (1996) Albania (2000) Ireland (2000) France (1999) Germany (1999) Finland (2001) Luxembourg (2001) United Kingdom (2000) Austria (2001) Spain (1999) Greece (1999) Netherlands (2000) Israel (1998) Norway (1999) Iceland (1997) Italy (1999) Switzerland (1999) Sweden (1999) Malta (2001) San Marino (2000) 600

400

200

Ratio males / females (%)


30

771.2 703.9 629.7 621.5 604.2 571.6 570.9 539.4 523.0 476.6 474.9 443.9 433.6 406.5 400.5 391.8 376.4 371.4 361.7 360.2 320.7 319.4 305.2 299.4 285.2 283.1 262.2 254.3 236.7 234.7 230.8 229.1 223.3 222.5 218.7 210.7 205.4 204.7 203.5 201.4 200.3 196.2 195.5 182.4 178.4 173.2 163.3 152.5

303 250 183 292 308 199 216 288 297 309 165 222 243 146 230 181 230 188 271 255 175 245 247 203 225 246 154 229 196 186 172 231 201 232 186 160 200 248 222 155 179 173 162 204 188 164 176 302 0

200

400

600

800

Per 100 000 population

14-05-2003, 14:12

1000

31

Life and death Deaths

Deaths from all causes, 65 years and over Republic of Moldova (2001) Kazakhstan (2001) Russian Federation (2001) Albania (2000) Ukraine (2000) Belarus (2001) Turkmenistan (1998) Bulgaria (2001) TFYR Macedonia (2000) Uzbekistan (2001) Kyrgyzstan (2001) Romania (2001) Yugoslavia (2000) Bosnia and Herzegovina (1991) Slovakia (2000) Latvia (2001) Tajikistan (1999) Estonia (2001) Hungary (2001) Croatia (2001) Azerbaijan (2001) Czech Republic (2001) Poland (2000) Lithuania (2001) Portugal (2000) Ireland (2000) Denmark (1999) Slovenia (2001) Armenia (2000) Malta (2001) Georgia (2001) Belgium (1996) Netherlands (2000) United Kingdom (2000) Norway (1999) Israel (1998) Germany (1999) Greece (1999) Finland (2001) Iceland (1997) Luxembourg (2001) Spain (1999) Sweden (1999) Italy (1999) Austria (2001) Switzerland (1999) France (1999) San Marino (2000)

139 156 157 169 147 161 134 134 128 120 136 132 112 119 151 159 122 171 152 147 125 147 151 163 156 147 140 169 114 140 114 168 159 145 159 129 154 129 161 152 152 162 152 163 148 159 170 174 400

200

8014 7695 7267 7242 7239 7117 7005 6810 6628 6562 6468 6383 6355 6122 6070 6067 6009 5914 5906 5903 5821 5677 5640 5589 5469 5297 5042 4850 4819 4762 4749 4696 4666 4580 4547 4502 4495 4428 4360 4304 4294 4276 4243 4100 4089 3910 3872 3085 0

Ratio males / females (%)


31

2000 4000

6000 8000 10 000


14-05-2003, 14:12

32


Infant deaths 30


25

20

15

10

5 CIS 0 1980

CSEC

1985

EU

1990

1995

2000

Year

–< 40 –< 20 –< 15 –< 10 –< 5 Per 1000 live births


32

14-05-2003, 14:12

33


Infant deaths Turkey (1999) Turkmenistan (1998) Tajikistan (2001) Kyrgyzstan (2001) Kazakhstan (2001) Romania (2001) Uzbekistan (2001) Republic of Moldova (2001) Armenia (2000) Bosnia and Herzegovina (1999) Russian Federation (2001) Bulgaria (2001) Yugoslavia (2000) Azerbaijan (2001) Ukraine (2000) TFYR Macedonia (2000) Albania (2000) Latvia (2001) Georgia (2001) Belarus (2001) Estonia (2001) Slovakia (2000) Hungary (2001) Poland (2000) Lithuania (2001) Croatia (2001) Ireland (2000) Greece (1999) Andorra (1999) Israel (1998) United Kingdom (2000) Portugal (2000) Iceland (1997) Belgium (1996) Italy (1999) Netherlands (2000) Monaco (1999) Luxembourg (2001) Austria (2001) Switzerland (1999) Germany (1999) Spain (1999) Malta (2001) France (1999) Slovenia (2001) Denmark (1999) Norway (1999) Czech Republic (2001) Sweden (1999) Finland (2001)

32.8 21.6 19.2 18.4 18.4 16.4 15.8 15.0 14.6 14.4 13.3 12.5 12.0 11.8 11.6 11.0 10.4 9.2 8.8 8.6 8.1 8.1 7.9 7.7 6.2 6.2 6.0 6.0 5.6 5.5 5.5 5.3 5.2 5.1 5.0 5.0 4.8 4.6 4.5 4.5 4.3 4.3 4.3 4.2 4.0 4.0 3.4 3.2 0

10

20

30



33

40.0

27.9

14-05-2003, 14:12

40

34


Perinatal deaths Tajikistan (2001) Georgia (2001) Turkmenistan (1997) Armenia (2001) TFYR Macedonia (2001) Kazakhstan (2001) Republic of Moldova (2001) Yugoslavia (1998) Kyrgyzstan (2001) Bulgaria (2001) Romania (2001) Russian Federation (2001) Albania (1992) Azerbaijan (2001) Uzbekistan (2001) Poland (2000) Hungary (2001) Latvia (2001) Greece (1999) Ukraine (2001) United Kingdom (2000) Netherlands (2001) Belarus (2001) Croatia (2001) France (1998) Belgium (1995) Slovakia (2001) Switzerland (1999) Italy (1998) Luxembourg (2001) Germany (2000) Ireland (1999) Estonia (2001) Lithuania (2001) Sweden (2000) Spain (1999) Denmark (1999) Portugal (2000) Israel (1998) Malta (2001) Slovenia (2001) Norway (2000) Czech Republic (2001) Iceland (2001) Austria (2001) Finland (2001) Andorra (2001)

21.2 20.7 17.1 16.4 16.4 15.5 14.7 13.6 13.2 12.3 11.8 11.7 11.5 11.3 10.0 9.7 9.5 9.0 8.8 8.8 8.2 7.9 7.4 7.3 7.0 7.0 6.5 6.5 6.4 6.2 6.1 5.9 5.8 5.7 5.6 5.6 5.4 5.2 5.2 5.1 4.5 4.5 3.8 3.7 3.6 3.4 1.3 0


34

5

10 15 Per 1000 births

20

14-05-2003, 14:12

25

35


Maternal deaths, three-year average Turkey (1998) Tajikistan (1999) Georgia (2000) Kyrgyzstan (2000) Turkmenistan (1995) Kazakhstan (2000) Armenia (2000) Russian Federation (2000) Romania (2000) Azerbaijan (2000) Uzbekistan (2000) Republic of Moldova (2000) Latvia (2000) Malta (2000) Ukraine (2000) Iceland (2000) Estonia (2000) Belarus (2000) Albania (2000) Bosnia and Herzegovina (1990) Bulgaria (2000) Slovenia (2000) Lithuania (2000) TFYR Macedonia (2000) Netherlands (1999) Slovakia (2000) France (1998) Poland (1995) Czech Republic (2000) Belgium (1996) Yugoslavia (1999) Croatia (2000) Hungary (2000) United Kingdom (1999) Luxembourg (1997) Norway (1998) Israel (2000) Denmark (1998) Germany (1999) Portugal (1999) Switzerland (1998) Finland (2000) Greece (1998) Italy (1998) Austria (2000) Sweden (1999) Spain (1998) Ireland (2000) Andorra (2000)

130.0

55.0 53.0 47.5 45.5 43.1 42.6 40.2 35.9 35.5 33.3 33.2 30.5 24.7 24.6 24.4 20.8 19.7 19.6 19.2 19.1 15.2 13.6 11.9 9.9 9.4 9.1 8.6 7.8 7.8 6.9 6.8 6.5 6.3 6.2 5.7 5.5 5.5 5.3 5.2 5.1 4.7 4.3 3.5 3.5 3.4 2.9 1.2 0.0 0

50

100

Per 100 000 live births


35

14-05-2003, 14:12

150

36


Maternal deaths 60 CIS

CSEC

EU

Per 100 000 live births

50

40

30

20

10

0 1980

1985

1990

1995

2000

Year

Causes of death

Main causes of death by age group Infectious and parasitic diseases

Cancer

Diseases of the circulatory system

Diseases of the respiratory system

Other diseases

External causes of injury and poisoning

100

Percent of all deaths in each group

80

60

40

20

0 0

1–14

15–24

25–34

35–44

45–54

55–64

65–74

75–84

Age group (years)


36

14-05-2003, 14:12

85+

37

Life and death Causes of death

Deaths from diseases of the circulatory system 800

CIS

CSEC

EU


700

600

500

400

300

200 1980

1985

1990

1995

2000

Year



37

14-05-2003, 14:12

38

Atlas of health in Europe Causes of death

Deaths from diseases of the circulatory system, 25–64 years Russian Federation (2001) Turkmenistan (1998) Kazakhstan (2001) Belarus (2001) Ukraine (2000) Kyrgyzstan (2001) Uzbekistan (2001) Republic of Moldova (2001) Latvia (2001) Bulgaria (2001) Azerbaijan (2001) Tajikistan (1999) Estonia (2001) Romania (2001) Georgia (2001) Yugoslavia (2000) Lithuania (2001) Bosnia and Herzegovina (1991) Hungary (2001) TFYR Macedonia (2000) Slovakia (2000) Poland (2000) Armenia (2000) Croatia (2001) Czech Republic (2001) Albania (2000) Ireland (2000) Slovenia (2001) Greece (1999) United Kingdom (2000) Finland (2001) Germany (1999) Luxembourg (2001) Austria (2001) Denmark (1999) Belgium (1996) Netherlands (2000) Malta (2001) Portugal (2000) San Marino (2000) Israel (1998) Sweden (1999) Norway (1999) Iceland (1997) Italy (1999) Spain (1999) Switzerland (1999) France (1999)

442.7 441.9 419.8 378.1 361.4 344.0 320.4 293.9 290.5 288.8 272.6 254.9 254.1 250.2 233.3 220.1 217.5 215.3 209.7 189.9 188.1 175.5 172.8 153.1 135.9 115.9 102.9 98.0 97.5 91.2 91.0 87.7 85.6 84.1 83.7 79.3 76.6 76.0 74.7 72.0 71.3 70.1 69.9 67.6 65.0 63.6 56.8 55.2 0

100

200

300

400



38

14-05-2003, 14:12

500

39


Deaths from ischaemic heart diseases, 25–64 years Russian Federation (2001) Belarus (2001) Ukraine (2000) Kazakhstan (2001) Turkmenistan (1998) Azerbaijan (2001) Latvia (2001) Republic of Moldova (2001) Uzbekistan (2001) Kyrgyzstan (2001) Georgia (2001) Estonia (2001) Lithuania (2001) Armenia (2000) Tajikistan (1999) Romania (2001) Hungary (2001) Slovakia (2000) Bulgaria (2001) Bosnia and Herzegovina (1991) TFYR Macedonia (2000) Poland (2000) Yugoslavia (2000) Czech Republic (2001) Croatia (2001) Ireland (2000) United Kingdom (2000) Greece (1999) Finland (2001) Malta (2001) Albania (2000) Iceland (1997) Germany (1999) Austria (2001) Norway (1999) Slovenia (2001) Sweden (1999) Belgium (1996) Denmark (1999) Netherlands (2000) Israel (1998) Luxembourg (2001) Spain (1999) Switzerland (1999) Italy (1999) Portugal (2000) France (1999) San Marino (2000)

225.6 221.9 214.4 204.7 199.3 175.6 156.8 147.0 141.8 139.4 133.6 127.1 119.4 113.5 110.2 106.2 103.0 95.7 85.7 79.5 76.9 76.3 74.7 69.6 66.5 61.1 57.0 54.2 52.2 50.7 46.5 44.8 44.0 43.8 42.5 41.1 40.4 37.8 36.9 36.1 35.4 34.3 30.3 29.1 27.5 27.2 20.7 13.1 0


39

50 100 150 200 Per 100 000 population

14-05-2003, 14:12

250

40


Deaths from ischaemic heart diseases, 25–64 years 250 CIS

CSEC

EU


200

150

100

50

0 1980

1985

1990

1995

2000

Year

Deaths from cerebrovascular diseases, 25–64 years 125 CIS

CSEC

EU


100

75

50

25

0 1980

1985

1990

1995

2000

Year


40

14-05-2003, 14:12

41


Deaths from cerebrovascular diseases, 25–64 years Kyrgyzstan (2001) Russian Federation (2001) Republic of Moldova (2001) Kazakhstan (2001) Belarus (2001) Ukraine (2000) Romania (2001) Uzbekistan (2001) Georgia (2001) Latvia (2001) Bulgaria (2001) Yugoslavia (2000) TFYR Macedonia (2000) Bosnia and Herzegovina (1991) Estonia (2001) Hungary (2001) Azerbaijan (2001) Lithuania (2001) Turkmenistan (1998) Croatia (2001) Armenia (2000) Poland (2000) Albania (2000) Tajikistan (1999) Portugal (2000) Slovakia (2000) Czech Republic (2001) Slovenia (2001) Luxembourg (2001) Greece (1999) Denmark (1999) San Marino (2000) Finland (2001) Ireland (2000) United Kingdom (2000) Belgium (1996) Austria (2001) Iceland (1997) Malta (2001) Netherlands (2000) Spain (1999) Germany (1999) Sweden (1999) Italy (1999) Norway (1999) France (1999) Israel (1998) Switzerland (1999)

149.5 120.5 116.4 106.4 99.0 91.0 82.7 80.9 72.8 71.4 71.2 65.1 60.3 57.1 56.3 53.6 51.7 42.1 41.6 41.2 40.1 39.6 32.9 31.8 30.4 25.5 25.5 24.0 21.1 20.5 20.2 18.3 18.1 16.6 15.2 15.0 14.6 14.4 13.8 13.5 13.5 13.3 13.2 12.5 11.9 11.8 11.8 7.9 0

30

60

90

120



41

14-05-2003, 14:12

150

180

42


Deaths from cancer, 25–64 years 230.1

Hungary (2001) Slovakia (2000) Ukraine (2000) Russian Federation (2001) Poland (2000) Latvia (2001) Belarus (2001) Czech Republic (2001) Romania (2001) Lithuania (2001) Croatia (2001) Kazakhstan (2001) Estonia (2001) Republic of Moldova (2001) Yugoslavia (2000) Denmark (1999) Slovenia (2001) Bosnia and Herzegovina (1991) France (1999) TFYR Macedonia (2000) Belgium (1996) Bulgaria (2001) Iceland (1997) Ireland (2000) Netherlands (2000) Spain (1999) Germany (1999) Armenia (2000) United Kingdom (2000) Portugal (2000) Italy (1999) Austria (2001) Norway (1999) Kyrgyzstan (2001) Greece (1999) San Marino (2000) Israel (1998) Azerbaijan (2001) Luxembourg (2001) Switzerland (1999) Sweden (1999) Turkmenistan (1998) Malta (2001) Finland (2001) Albania (2000) Georgia (2001) Uzbekistan (2001) Tajikistan (1999)

180.3 178.6 178.3 174.6 172.0 169.9 169.8 167.3 166.8 166.1 165.3 162.9 159.4 157.7 152.4 149.4 145.6 145.0 144.1 142.0 141.9 138.8 133.4 128.8 127.7 127.2 124.3 123.6 120.4 118.6 115.9 114.0 112.1 111.8 111.6 109.8 107.5 107.1 102.9 98.8 96.7 95.8 93.5 85.7 84.5 81.9 65.3 0

50

100

150

200

250



42

14-05-2003, 14:12

43


Deaths from cancer, 0–64 years


Deaths from cancer, 65 years and over



43

14-05-2003, 14:12

44


Deaths from cancer 210


200

190

180

170 CIS

CSEC

EU

160 1980

1985

1990

1995

2000

Year

Deaths from lung cancer, males, 25–64 years 90


80

70

60

50 CIS

CSEC

EU

40 1980

1985

1990

1995

2000

Year


44

14-05-2003, 14:12

45


Deaths from lung cancer, females, 25–64 years 16 CIS

CSEC

EU


14

12

10

8

6 1980

1985

1990 Year

1995

2000

Deaths from lung cancer, 65 years and over 225


200

175

150

125 CIS

CSEC

EU

100 1980

1985

1990

1995

Year


45

14-05-2003, 14:12

2000

46


Deaths from lung cancer, 25–64 years Hungary (2001) Poland (2000) Croatia (2001) Bosnia and Herzegovina (1991) Czech Republic (2001) Yugoslavia (2000) Romania (2001) Slovakia (2000) Belgium (1996) Latvia (2001) Russian Federation (2001) Denmark (1999) Ukraine (2000) Slovenia (2001) Kazakhstan (2001) Belarus (2001) Estonia (2001) Iceland (1997) France (1999) TFYR Macedonia (2000) Lithuania (2001) Bulgaria (2001) Netherlands (2000) Greece (1999) Spain (1999) Republic of Moldova (2001) Armenia (2000) Germany (1999) Luxembourg (2001) Italy (1999) Austria (2001) Ireland (2000) United Kingdom (2000) Norway (1999) Switzerland (1999) Albania (2000) San Marino (2000) Portugal (2000) Malta (2001) Israel (1998) Sweden (1999) Azerbaijan (2001) Finland (2001) Georgia (2001) Kyrgyzstan (2001) Turkmenistan (1998) Uzbekistan (2001) Tajikistan (1999)

67.0 46.9 42.3 41.9 40.9 40.8 40.0 37.8 37.5 37.4 37.1 35.5 35.3 34.7 34.6 34.2 34.2 34.1 33.8 32.9 32.8 32.2 31.5 31.1 30.6 30.0 28.2 27.8 27.5 26.9 26.5 26.0 25.7 24.3 23.3 20.5 20.3 19.9 18.7 18.5 18.1 17.7 16.8 16.6 15.5 11.7 9.8 6.3 0

10

20

30

40

50

60

70



46

14-05-2003, 14:12

80

47


Deaths from female breast cancer, 25–64 years Belgium (1996) Ireland (2000) Iceland (1997) Denmark (1999) Armenia (2000) Netherlands (2000) Yugoslavia (2000) Hungary (2001) Ukraine (2000) Estonia (2001) United Kingdom (2000) Israel (1998) Latvia (2001) France (1999) TFYR Macedonia (2000) Germany (1999) Russian Federation (2001) Slovenia (2001) Republic of Moldova (2001) Lithuania (2001) Croatia (2001) Romania (2001) Italy (1999) Slovakia (2000) Austria (2001) Kazakhstan (2001) Portugal (2000) Luxembourg (2001) Malta (2001) Czech Republic (2001) Georgia (2001) Bulgaria (2001) Switzerland (1999) Belarus (2001) Finland (2001) Norway (1999) Poland (2000) Spain (1999) Sweden (1999) Greece (1999) Azerbaijan (2001) Bosnia and Herzegovina (1991) Kyrgyzstan (2001) Uzbekistan (2001) Albania (2000) Turkmenistan (1998) Tajikistan (1999)

38.4 38.4 38.2 35.3 34.5 33.2 32.8 32.4 32.3 32.1 31.7 30.4 30.2 30.0 29.9 29.1 28.9 28.9 28.8 28.7 28.2 25.8 25.6 25.2 25.2 25.2 24.7 24.7 24.6 24.4 24.4 23.9 23.8 23.7 23.6 23.5 23.5 22.9 22.5 21.4 19.9 19.0 17.2 14.5 14.2 11.3 8.8 0

10

20

30

Per 100 000 females


47

14-05-2003, 14:12

40

48


Deaths from female breast cancer

Per 100 000 females

30

25

20

15 CIS

CSEC

EU

10 1980

1985

1990

1995

2000

Year

Deaths from cervical cancer 10 9

Per 100 000 females

8 7 6 5 4 3 CIS

CSEC

EU

2 1980

1985

1990

1995

2000

Year


48

14-05-2003, 14:12

49


Deaths from cervical cancer, 25–64 years Romania (2001) Republic of Moldova (2001) Lithuania (2001) Poland (2000) Yugoslavia (2000) Kyrgyzstan (2001) Hungary (2001) Bulgaria (2001) Ukraine (2000) Kazakhstan (2001) Slovakia (2000) Latvia (2001) Russian Federation (2001) Czech Republic (2001) Estonia (2001) TFYR Macedonia (2000) Georgia (2001) Belarus (2001) Denmark (1999) Uzbekistan (2001) Armenia (2000) Tajikistan (1999) Ireland (2000) Norway (1999) Portugal (2000) Luxembourg (2001) Germany (1999) Turkmenistan (1998) Slovenia (2001) United Kingdom (2000) Bosnia and Herzegovina (1991) Iceland (1997) Croatia (2001) Azerbaijan (2001) Sweden (1999) Israel (1998) Belgium (1996) Netherlands (2000) Spain (1999) France (1999) Greece (1999) Austria (2001) Albania (2000) Switzerland (1999) Finland (2001) Italy (1999) Malta (2001)

20.0 15.1 14.6 11.9 10.9 10.7 10.6 10.2 9.9 9.6 9.4 8.7 8.5 8.5 8.0 7.5 7.1 6.8 6.8 6.6 6.0 5.7 5.2 5.1 4.8 4.6 4.3 4.2 4.1 4.0 3.9 3.8 3.5 3.5 3.3 3.2 3.1 2.9 2.7 2.6 2.5 2.5 2.3 1.9 1.7 1.2 1.0 0

5

10

15

20

Per 100 000 females


49

14-05-2003, 14:12

25

50


Deaths from external causes of injury and poisoning 200


150

100

50

CIS

CSEC

EU

0 1980

1985

1990

1995

2000

Year



50

14-05-2003, 14:12

51


Deaths from external causes of injury and poisoning, 0–64 years Russian Federation (2001) Belarus (2001) Estonia (2001) Lithuania (2001) Kazakhstan (2001) Ukraine (2000) Latvia (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Hungary (2001) Romania (2001) Poland (2000) Turkmenistan (1998) Finland (2001) Slovenia (2001) Slovakia (2000) Uzbekistan (2001) Czech Republic (2001) Bulgaria (2001) Luxembourg (2001) Albania (2000) Croatia (2001) Belgium (1996) France (1999) Tajikistan (1999) Austria (2001) Greece (1999) Portugal (2000) Ireland (2000) Iceland (1997) Denmark (1999) Yugoslavia (2000) Spain (1999) TFYR Macedonia (2000) Switzerland (1999) Armenia (2000) Georgia (2001) Norway (1999) Germany (1999) Azerbaijan (2001) Sweden (1999) Israel (1998) Italy (1999) United Kingdom (2000) Malta (2001) Netherlands (2000) 200

82.0 56.0 57.3 52.1 61.0 49.4 52.6 41.7 32.7 22.1 23.7 18.5 29.4 24.9 17.8 17.1 23.7 17.9 16.8 25.1 17.5 16.4 23.6 21.4 13.6 16.8 15.4 13.2 13.7 13.6 19.2 14.8 12.5 11.7 15.2 9.1 7.9 14.6 13.8 11.3 15.3 10.1 9.9 11.7 10.9 11.7 100

278.5 270.3 264.7 263.8 246.8 246.3 162.2 134.2 94.2 94.0 92.5 92.3 91.7 87.1 86.6 78.2 70.3 70.2 69.9 69.5 68.8 63.0 62.9 57.1 55.2 54.4 53.1 52.9 52.4 52.0 51.6 48.0 45.4 44.6 44.2 43.9 43.6 41.5 40.3 40.1 39.9 37.5 35.9 30.0 28.8 0

Per 100 000 population, females


51

369.6

100

200

300

400

Per 100 000 population, males

14-05-2003, 14:12

500

52


Deaths from motor vehicle traffic accidents Latvia (2001) Lithuania (2001) Russian Federation (1998) Greece (1999) Luxembourg (2001) Poland (2000) Belarus (2001) Republic of Moldova (2001) Spain (1999) Belgium (1996) Slovenia (2001) Croatia (2001) Estonia (2001) Romania (2001) France (1999) Slovakia (2000) Portugal (2000) Hungary (2001) Kyrgyzstan (2001) Italy (1999) Czech Republic (2001) Kazakhstan (2001) Ukraine (2000) Bulgaria (2001) Austria (2001) Ireland (2000) Israel (1998) Denmark (1999) Uzbekistan (2001) Germany (1999) Turkmenistan (1998) San Marino (2000) Finland (2001) Norway (1999) Yugoslavia (2000) Switzerland (1999) Netherlands (2000) Azerbaijan (2000) Armenia (2000) United Kingdom (2000) TFYR Macedonia (2000) Sweden (1999) Iceland (1997) Malta (2001) Georgia (2001) Tajikistan (1999) Albania (2000)

23.48 21.52 19.71 19.30 17.62 15.67 14.75 14.20 14.18 13.92 13.75 13.51 13.49 13.31 12.99 12.96 12.47 12.39 12.30 12.14 11.64 11.48 10.96 10.67 9.72 9.70 9.34 9.22 9.19 8.93 8.47 8.45 7.77 7.31 6.75 6.64 6.47 5.67 5.57 5.50 5.37 5.37 4.63 4.33 3.99 3.82 2.14 0

5

10

15

20

25



52

14-05-2003, 14:12

30

53


Deaths from motor vehicle traffic accidents 25 CIS CSEC


EU 20

15

10 1980

1985

1990

1995

2000

1995

2000

Year

Deaths from suicide 35 CIS

CSEC

EU


30

25

20

15

10 1980

1985

1990 Year


53

14-05-2003, 14:12

54


Deaths from suicide Lithuania (2001) Russian Federation (2001) Kazakhstan (2001) Belarus (2001) Latvia (2001) Ukraine (2000) Estonia (2001) Hungary (2001) Slovenia (2001) Finland (2001) Republic of Moldova (2001) Belgium (1996) Croatia (2001) Switzerland (1999) Austria (2001) France (1999) Luxembourg (2001) Yugoslavia (2000) Poland (2000) Czech Republic (2001) Bulgaria (2001) Kyrgyzstan (2001) Slovakia (2000) Denmark (1999) Iceland (1997) Norway (1999) Sweden (1999) Ireland (2000) Romania (2001) Germany (1999) Turkmenistan (1998) Bosnia and Herzegovina (1991) Uzbekistan (2001) Netherlands (2000) TFYR Macedonia (2000) Malta (2001) United Kingdom (2000) Spain (1999) Italy (1999) Israel (1998) Tajikistan (1999) Portugal (2000) Azerbaijan (2001) San Marino (2000) Greece (1999) Albania (2000) Georgia (2001) Armenia (2000)

43.7 37.9 32.6 32.4 28.6 28.2 28.1 26.6 26.5 22.0 18.3 18.3 17.8 16.3 16.3 16.1 16.0 15.1 14.8 14.4 14.3 14.2 13.4 13.3 13.2 13.0 12.7 12.1 11.9 11.9 10.9 9.9 9.2 8.9 7.6 7.4 7.0 7.0 6.0 5.9 4.5 4.4 4.4 3.6 3.3 2.3 2.1 1.8 0

10

20

30

40



54

14-05-2003, 14:12

50

55


Deaths from diseases of the respiratory system CIS

CSEC

EU


100

80

60

40 1980

1985

1990

1995

2000

Year



55

14-05-2003, 14:12

56


Deaths from diseases of the respiratory system Kyrgyzstan (2001) Ireland (2000) Turkmenistan (1998) United Kingdom (2000) Tajikistan (1999) Kazakhstan (2001) Malta (2001) Republic of Moldova (2001) Uzbekistan (2001) Portugal (2000) Spain (1999) Denmark (1999) Belgium (1996) Ukraine (2000) Netherlands (2000) Azerbaijan (2001) Albania (2000) Russian Federation (2001) Romania (2001) Belarus (2001) Iceland (1997) Norway (1999) Slovenia (2001) Slovakia (2000) Finland (2001) Luxembourg (2001) Armenia (2000) Poland (2000) Yugoslavia (2000) France (1999) Greece (1999) Sweden (1999) Switzerland (1999) Germany (1999) Bulgaria (2001) Israel (1998) Italy (1999) Czech Republic (2001) Bosnia and Herzegovina (1991) Lithuania (2001) TFYR Macedonia (2000) Estonia (2001) Croatia (2001) Hungary (2001) Austria (2001) Latvia (2001) San Marino (2000) Georgia (2001)

128.0 115.3 111.8 104.6 104.6 94.4 81.2 79.8 79.8 77.5 73.0 71.8 70.1 67.4 67.3 65.6 65.5 63.4 63.1 60.2 59.9 58.4 54.9 54.5 50.3 49.3 47.4 46.2 45.4 44.8 44.3 40.9 40.5 39.7 39.1 38.7 38.2 37.7 37.6 37.2 36.8 36.7 35.2 33.6 30.9 28.5 27.7 21.0 0

25

50

75

100

125



56

14-05-2003, 14:12

150

57


Deaths from diseases of the digestive system 50


45

40

35

CIS

CSEC

EU

30 1980

1985

1990 Year

1995

2000



57

14-05-2003, 14:12

58


Deaths from diseases of the digestive system Republic of Moldova (2001) Hungary (2001) Kyrgyzstan (2001) Romania (2001) Turkmenistan (1998) Uzbekistan (2001) Azerbaijan (2001) Kazakhstan (2001) Slovenia (2001) Slovakia (2000) Russian Federation (2001) Tajikistan (1999) Croatia (2001) Estonia (2001) Ukraine (2000) Denmark (1999) Lithuania (2001) Latvia (2001) Luxembourg (2001) Poland (2000) Czech Republic (2001) Bosnia and Herzegovina (1991) Germany (1999) Spain (1999) Portugal (2000) France (1999) Austria (2001) United Kingdom (2000) Belgium (1996) Belarus (2001) Finland (2001) Bulgaria (2001) Italy (1999) Yugoslavia (2000) Ireland (2000) Georgia (2001) Netherlands (2000) Armenia (2000) Switzerland (1999) Malta (2001) Norway (1999) Israel (1998) Albania (2000) Sweden (1999) TFYR Macedonia (2000) Greece (1999) Iceland (1997) San Marino (2000)

128.2 81.6 67.8 67.4 64.8 62.7 56.6 56.5 55.9 50.9 46.1 45.2 44.8 42.8 42.1 41.3 38.9 38.5 38.0 37.4 37.3 36.9 35.6 34.3 33.9 32.0 31.9 31.9 30.9 30.4 29.9 29.7 28.8 28.1 26.6 25.9 25.8 25.0 22.8 21.5 20.7 20.0 20.0 19.6 18.8 16.1 15.2 9.2 0

50

100



58

14-05-2003, 14:12

150

59

Diseases

3. Diseases Notes Tuberculosis (pp. 61–62) The figures present rates of newly diagnosed tuberculosis cases, including relapses, of all forms and in all organs. Syphilis (pp. 65–66) Syphilis is considered a good indicator of the trends in all sexually transmitted diseases. In the 1990s, the eastern part of the Region suffered an epidemic-like increase in the incidence of syphilis. HIV/AIDS (pp. 67–69) The data for HIV/AIDS are collected by the European Centre for the Epidemiological Monitoring of AIDS in Paris (a UNAIDS/WHO collaborating centre on AIDS). While the AIDS data for the most recent years are adjusted for reporting delays, the data for HIV infections are as reported by countries. Reported new HIV infections have increased dramatically in some countries in the eastern and central parts of the Region, particularly in the Russian Federation and the Baltic states. Cancer (pp. 72–74) The right side of each bar chart shows the number of people newly diagnosed with cancer during the given year per 100 000 population. Data sources are usually national cancer registers. The incidence of lung cancer is clearly correlated with the death rate. This correlation is less clear in the case of female breast and cervical cancer. Hospital discharges (pp. 75–83) The rates represent the total number of patients per 100 000 population discharged from all hospitals (including through death) during the year, categorized by the principal diagnosis. The intercountry comparability of hospital discharge data is limited,


59

14-05-2003, 14:12

60

Atlas of health in Europe owing to the differences in how hospital data collection systems are organized in different countries, and the differences in health care systems in general. Particular caution should therefore be applied when discharge data are used as an estimate of morbidity. Teeth (p. 84) The average number of decayed, missing or filled teeth among 12year-old children is the commonly used index to assess the oral health situation. The data are collected by the WHO oral health programme and the WHO Collaborating Centre for Education, Training and Research in Oral Health, at Malmö University, Sweden.


60

14-05-2003, 14:13

61

Diseases Some infectious diseases

New cases of tuberculosis


80

CIS

CSEC

EU

60

40

20

0 1980

1985

1990

1995

2000

Year

–< 180 –< 100 –< 70 –< 40 –< 20 Per 100 000 population


61

14-05-2003, 14:13

62

Atlas of health in Europe Some infectious diseases

New cases of tuberculosis, 2001 Kazakhstan Kyrgyzstan Romania Russian Federation Georgia Latvia Republic of Moldova Turkmenistan Ukraine Lithuania Uzbekistan Bosnia and Herzegovina Azerbaijan Tajikistan Belarus Estonia Bulgaria Yugoslavia Portugal Armenia TFYR Macedonia Croatia Hungary Poland Turkey Slovakia Albania Slovenia Spain Andorra Belgium Austria Czech Republic Ireland United Kingdom France Denmark Finland Netherlands Germany Israel Switzerland Italy Luxembourg Norway Greece Sweden Iceland Malta

176.5 135.1 127.5 92.2 88.1 84.9 84.8 81.7 74.9 74.6 69.7 65.7 60.5 55.6 55.2 49.7 48.8 43.2 40.8 36.7 31.8 31.0 28.7 26.3 25.5 18.3 18.1 18.0 17.2 15.1 12.9 12.7 12.6 10.2 10.1 9.8 9.2 8.9 8.8 8.5 8.5 7.5 7.5 7.0 6.2 4.7 4.5 4.3 4.1 0

50

100

150



62

14-05-2003, 14:13

200

63


New cases of viral hepatitis B 40


30

20

CIS

CSEC

EU

10

0 1980

1985

1990

1995

2000

Year

–< 40 –< 25 –< 15 –< 10 –< 5



63

14-05-2003, 14:13

64


New cases of viral hepatitis B Russian Federation (2001) Latvia (2001) Estonia (2001) Uzbekistan (2001) Iceland (2001) Ukraine (2001) Kyrgyzstan (2001) Luxembourg (2001) Kazakhstan (2001) Republic of Moldova (2001) Bulgaria (2001) Romania (2001) Turkmenistan (2001) Georgia (2001) Lithuania (2001) Netherlands (2001) Belarus (2001) Ireland (2001) France (1998) Turkey (2001) TFYR Macedonia (2001) Poland (2001) Belgium (2001) Croatia (2001) Yugoslavia (2001) Norway (2001) Czech Republic (2001) Tajikistan (2001) Bosnia and Herzegovina (1999) Armenia (2001) Andorra (2001) Germany (2001) Slovakia (2001) Austria (2001) Finland (2001) Sweden (2001) Azerbaijan (2001) Portugal (2001) Greece (2001) Albania (2000) Spain (2001) Switzerland (2001) Israel (2001) United Kingdom (2001) Hungary (2001) Italy (2001) Malta (2001) Slovenia (2001) Denmark (2001)

35.7 35.6 32.9

23.7 21.7 19.4 19.1 18.6 16.0 15.9 14.3 12.0 11.9 11.0 11.0 10.2 9.7 8.9 8.7 8.3 7.6 6.2 5.2 4.5 4.5 4.5 4.4 3.6 3.5 3.2 3.0 3.0 2.8 2.6 2.5 2.4 2.1 2.1 2.1 2.0 2.0 1.7 1.7 1.6 1.6 1.5 1.3 0.9 0.8 0

10

20

30



64

14-05-2003, 14:13

40

65


New cases of syphilis 200

CIS

CSEC

EU


150

100

50

0 1980

1985

1990

1995

2000

Year



65

14-05-2003, 14:13

66


New cases of syphilis Kazakhstan (2000) Russian Federation (2001) Ukraine (2000) Republic of Moldova (2001) Belarus (2001) Kyrgyzstan (2001) Romania (2001) Turkmenistan (1999) Estonia (2001) Uzbekistan (2001) Lithuania (2001) Latvia (2001) Georgia (2001) Bulgaria (2001) Tajikistan (2001) Iceland (2001) Czech Republic (2000) Azerbaijan (1999) Armenia (2001) Israel (2001) Slovakia (2000) Turkey (2001) Hungary (2001) Finland (2000) Austria (2001) United Kingdom (2000) Poland (2001) Switzerland (1998) Yugoslavia (2001) Spain (2000) Germany (1999) Portugal (2001) Ireland (2000) Slovenia (2001) Denmark (2001) Luxembourg (2000) Norway (2000) Belgium (2000) Sweden (2001) Netherlands (1998) Croatia (2001) Bosnia and Herzegovina (1999) Albania (1999) Italy (2000) TFYR Macedonia (2001) Greece (2001) Malta (2000) Andorra (2000)

161.4 144.1 91.6 86.5 80.5 60.6 56.0 47.7 29.9 27.6 25.3 25.2 25.2 18.4 11.7 11.4 9.4 7.2 5.8 5.8 5.7 5.0 4.2 3.9 3.9 3.0 2.7 2.4 1.9 1.7 1.4 1.3 1.2 1.2 1.0 0.9 0.9 0.9 0.9 0.8 0.5 0.4 0.3 0.2 0.1 0.0 0.0 0.0 0

50

100

150



66

14-05-2003, 14:13

200

67


New cases of clinically diagnosed AIDS Portugal (2001) Spain (2001) Italy (2001) France (2001) Switzerland (2001) Latvia (2001) Ukraine (2001) Belgium (2001) Denmark (2001) United Kingdom (2001) Romania (2001) Germany (2001) Israel (2001) Luxembourg (2001) Greece (2001) Austria (2001) Yugoslavia (2001) Norway (2001) Sweden (2001) Poland (2001) Iceland (2001) Ireland (2001) Finland (2001) Lithuania (2001) Netherlands (2001) Slovenia (2001) Georgia (2001) Azerbaijan (2001) Republic of Moldova (2001) Hungary (2001) Bulgaria (2001) Bosnia and Herzegovina (2001) Croatia (2001) Estonia (2001) TFYR Macedonia (2001) Armenia (2001) Albania (2000) Slovakia (2001) Czech Republic (2001) Turkey (2001) Belarus (2001) Russian Federation (2000) Tajikistan (2001) Uzbekistan (2001) Kazakhstan (1999) Kyrgyzstan (2001) Malta (2001)

10.25 5.95 3.07 2.77 2.37 1.74 1.72 1.53 1.46 1.19 0.95 0.94 0.92 0.91 0.84 0.66 0.65 0.60 0.54 0.37 0.36 0.34 0.33 0.29 0.28 0.25 0.24 0.21 0.21 0.20 0.18 0.16 0.16 0.15 0.15 0.11 0.10 0.09 0.06 0.06 0.05 0.02 0.02 0.02 0.01 0.00 0.00 0

1

2

3

4

5

6

7

8

9



67

14-05-2003, 14:13

10

11 12

68


New cases of clinically diagnosed AIDS 7 CIS 6 CSEC EU


5

4

3

2

1

0 1980

1985

1990

1995

2000

Year

New cases of HIV infection 40 CIS

CSEC

EU


30

20

10

0 1980

1985

1990

1995

2000

Year


68

14-05-2003, 14:13

69


New cases of HIV infection, 2001 Estonia Russian Federation Latvia Portugal Ukraine San Marino Belgium Luxembourg Switzerland Kazakhstan Ireland United Kingdom Belarus Denmark Israel Republic of Moldova Greece Iceland Norway Sweden Kyrgyzstan Malta Finland Uzbekistan Lithuania Georgia Romania Germany Azerbaijan Poland Hungary Slovenia Armenia Albania Croatia Yugoslavia Tajikistan Bulgaria Czech Republic Turkey TFYR Macedonia Bosnia and Herzegovina Slovakia

108.1 60.6 34.3 25.1 14.3 11.5 9.4 9.1 8.8 7.9 7.8 7.3 5.8 5.6 5.6 5.5 4.1 3.9 3.6 3.1 3.1 2.8 2.5 2.2 2.1 2.1 2.0 1.6 1.6 1.5 0.8 0.8 0.8 0.7 0.7 0.6 0.5 0.5 0.5 0.3 0.3 0.2 0.2 0

25

50

75

100



69

14-05-2003, 14:13

70


Selected outbreaks of infectious diseases, 2002 United Kingdom February Legionnaires' disease: 116 cases, 3 deaths

Sweden May Salmonellosis (imported): 342 cases

September–December Salmonellosis: 19 outbreaks, almost 1000 cases, 10 deaths

Czech Republic February Cholera (imported): 2 cases

Russian Federation January Haemorrhagic fever with renal syndrome: 55 cases

Lithuania February Measles: 102 cases

Belarus May Shigellosis: 606 cases

Tajikistan November–December Measles: 715 cases, 7 deaths

Spain February Trichinellosis: 26 cases


Italy June Measles: 368 cases, 3 deaths

France August Q fever: 79 cases

70

Albania December Hepatitis A: over 200 cases

Greece April Acute respiratory infection: 53 cases, 3 deaths

Yugoslavia (Kosovo) February Tularemia: 1462 cases

14-05-2003, 14:13

71

Diseases Some noncommunicable diseases

Prevalence of diabetes mellitus Malta (2001) Czech Republic (2001) Hungary (2001) Slovakia (2001) Portugal (1996) Italy (1995) Slovenia (1993) Belgium (2000) Israel (2000) France (2000) Sweden (1995) Finland (2001) Denmark (1999) Netherlands (1995) Norway (1995) Turkey (1998) TFYR Macedonia (1998) Ukraine (2001) Bulgaria (2000) Romania (2001) Latvia (2001) Lithuania (2001) Russian Federation (2001) Belarus (2001) Yugoslavia (1999) Bosnia and Herzegovina (2001) Georgia (2001) Armenia (2001) Republic of Moldova (2001) Kazakhstan (2001) Azerbaijan (2001) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1997) Tajikistan (2001) Greece (1998) Iceland (1995)

6.6 6.4 4.9 4.9 4.8 3.7 3.5 3.2 3.2 3.0 2.9 2.7 2.4 2.0 2.0 2.0 2.0 1.9 1.7 1.6 1.5 1.5 1.5 1.4 1.3 1.1 1.0 0.9 0.7 0.6 0.6 0.4 0.4 0.4 0.2 0.2 0.2 0

1

2

3

4

5



71

14-05-2003, 14:13

6

7

72

Atlas of health in Europe Some noncommunicable diseases

Lung cancer incidence and deaths Hungary (2001) Croatia (2000) United Kingdom (1997) Italy (1995) Denmark (1998) Czech Republic (1999) Netherlands (1998) Estonia (2000) Poland (1996) Slovenia (1999) Germany (1997) Belgium (1996) TFYR Macedonia (1998) Latvia (2001) Lithuania (2001) Bulgaria (2001) Austria (1999) Norway (1999) Iceland (1997) Belarus (2001) Russian Federation (2001) Ukraine (2000) Ireland (2000) Slovakia (1999) Luxembourg (1999) France (1995) Malta (2000) Romania (1999) Sweden (1999) Finland (2000) Kazakhstan (2001) Armenia (2000) Israel (1998) Republic of Moldova (2001) Portugal (1993) Georgia (2001) Albania (2000) Kyrgyzstan (2001) Azerbaijan (2001) Uzbekistan (2001) Turkmenistan (1997) Tajikistan (1999)

77.6 56.6 59.1 53.9 61.6 54.7 55.0 50.2 48.9 49.0 45.4 64.2 29.3 47.6 41.6 36.9 40.1 38.3 42.8 37.1 39.7 38.2 41.4 40.2 46.0 41.2 31.4 35.4 33.9 35.7 24.4 22.2 19.7 22.4 26.1 18.1 19.0 8.1 9.8 3.9 5.3 2.3

150

100

50

Crude death rate per 100 000 population


72

95.4 74.1 65.9 63.9 63.5 58.0 55.9 54.0 53.6 52.5 51.8 49.4 47.4 46.5 45.1 44.7 44.5 44.1 43.9 43.8 43.2 43.0 41.4 40.5 39.3 37.6 37.3 33.8 32.7 32.0 27.0 23.5 22.0 17.1 16.5 16.0 13.3 12.1 7.4 4.9 3.8 2.2 0

50 100 150 New cases per 100 000 population

14-05-2003, 14:13

73

Diseases Some noncommunicable diseases

Female breast cancer incidence and deaths Sweden (1999) 33.1 Denmark (1998) 50.7 Luxembourg (1999) 31.0 Finland (2000) 31.0 44.6 Netherlands (1998) United Kingdom (1997) 44.6 36.2 France (1995) Hungary (2001) 43.1 Ireland (2000) 35.0 Malta (2000) 52.4 Iceland (1997) 32.6 42.1 Germany (1998) Israel (1998) 29.9 37.5 Austria (1999) Norway (1999) 31.3 Belgium (1996) 48.0 Slovenia (1999) 38.7 Croatia (2000) 37.0 35.9 Czech Republic (1999) Italy (1995) 38.4 26.3 Bulgaria (2001) Estonia (2000) 37.5 Latvia (2001) 32.2 Lithuania (2001) 29.5 Slovakia (1999) 28.8 28.7 Portugal (1993) TFYR Macedonia (1998) 20.8 28.2 Russian Federation (2001) Ukraine (2000) 30.3 Belarus (2001) 24.0 Poland (1996) 23.9 Romania (1999) 25.3 22.5 Georgia (2001) Armenia (2000) 22.7 16.7 Kazakhstan (2001) Republic of Moldova (2001) 22.1 Albania (2000) 8.3 Azerbaijan (2001) 9.1 Kyrgyzstan (2001) 7.7 5.4 Uzbekistan (2001) Turkmenistan (1997) 4.5 2.6 Tajikistan (1999) 80 40 0 Crude death rate per 100 000 population


73

140.9 136.6 133.5 133.2 129.9 125.6 113.5 112.7 112.7 112.0 110.3 110.1 106.1 105.5 105.0 104.5 98.0 96.1 94.9 94.9 82.1 72.9 70.2 66.3 66.3 62.2 59.4 59.1 56.1 53.9 48.8 41.3 39.2 35.1 34.4 33.3 22.9 19.1 16.8 11.9 9.4 8.2 40

80 120 160 New cases per 100 000 population

14-05-2003, 14:13

200

74

Atlas of health in Europe Some noncommunicable diseases

Cervical cancer incidence and deaths Bulgaria (2001) Lithuania (2001) Hungary (2001) Estonia (2000) TFYR Macedonia (1998) Czech Republic (1999) Slovenia (1999) Poland (1996) Slovakia (1999) Croatia (2000) Ukraine (2000) Portugal (1993) Germany (1998) Russian Federation (2001) Denmark (1998) Belarus (2001) Latvia (2001) Kazakhstan (2001) Republic of Moldova (2001) Norway (1999) Armenia (2000) Kyrgyzstan (2001) Austria (1999) Luxembourg (1999) France (1995) Ireland (2000) United Kingdom (1997) Georgia (2001) Sweden (1999) Iceland (1997) Netherlands (1998) Belgium (1996) Uzbekistan (2001) Israel (1998) Turkmenistan (1997) Tajikistan (1999) Azerbaijan (2001) Finland (2000) Albania (2000) Malta (2000)

8.9 12.4 10.1 8.3 4.2 7.4 5.1 10.2 8.0 4.0 9.3 3.8 4.7 8.2 6.6 6.6 8.7 7.0 9.7 5.2 4.4 4.9 4.1 4.1 2.6 3.4 4.6 5.8 3.6 3.7 3.5 3.4 2.6 1.8 3.4 1.5 1.6 2.9 1.2 2.6 30 25 20 15 10

5

Crude death rate per 100 000 population


74

26.7 26.1 23.2 22.0 21.4 21.4 19.9 19.6 19.3 19.2 17.9 17.8 16.7 15.9 15.8 14.9 14.3 13.7 12.7 12.6 12.2 11.8 11.6 11.4 11.0 10.9 10.8 10.5 10.0 9.6 9.2 9.1 8.7 6.1 5.7 4.8 4.7 4.6 3.9 3.1 0

5

10 15 20 25 30 35 New cases per 100 000 population

14-05-2003, 14:13

75

Diseases Hospitalization

Hospital discharges for cancer 3636

Austria (2000) Finland (2001) Germany (1999) Denmark (2000) France (2000) Hungary (2000) Czech Republic (2001) Belgium (1998) Norway (2001) Slovenia (2001) Sweden (2001) Lithuania (2001) Slovakia (2001) Estonia (2001) Belarus (2001) Greece (1998) Romania (2001) Italy (2000) Iceland (1994) Latvia (2001) Croatia (2001) Poland (1996) United Kingdom (1994) Russian Federation (2001) Bulgaria (2001) Israel (1999) Spain (1999) Ireland (2001) Portugal (2001) Netherlands (2001) TFYR Macedonia (2000) Ukraine (2001) Kazakhstan (2001) Republic of Moldova (2001) Turkey (2000) Andorra (2001) Malta (2001) Albania (2000) Armenia (2001) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1997) Georgia (2001) Azerbaijan (2001) Tajikistan (2001)

2415 2315 1981 1963 1919 1908 1883 1775 1743 1665 1614 1608 1585 1503 1442 1411 1377 1306 1269 1171 1147 1076 1039 994.5 973.7 882.3 828.0 795.6 772.6 652.5 623.8 549.9 430.0 373.0 363.2 325.2 291.3 280.9 248.0 222.8 199.2 190.4 103.4 88.3 0

500

1000

1500

2000

2500

3000

3500



75

14-05-2003, 14:13

4000

76

Atlas of health in Europe Hospitalization

Hospital discharges for cancer CIS 1500

CSEC


EU 1250

1000

750

500 1980

1985

1990

1995

2000

Year

Hospital discharges for diseases of the circulatory system 2500

CIS

CSEC

EU


2250

2000

1750

1500 1980

1985

1990

1995

2000

Year


76

14-05-2003, 14:13

77


Hospital discharges for diseases of the circulatory system Belarus (2001) Hungary (2000) Lithuania (2001) Austria (2000) Finland (2001) Czech Republic (2001) Germany (1999) Estonia (2001) Latvia (2001) Russian Federation (2001) Sweden (2001) Ukraine (2001) Romania (2001) Denmark (2000) Belgium (1998) Slovakia (2001) Italy (2000) Norway (2001) France (2000) Greece (1998) Iceland (1994) Israel (1999) Poland (1996) Bulgaria (2001) Slovenia (2001) Croatia (2001) United Kingdom (1994) Ireland (2001) Kazakhstan (2001) Netherlands (2001) Spain (1999) Republic of Moldova (2001) Yugoslavia (1996) TFYR Macedonia (2000) Portugal (2001) Uzbekistan (2001) Kyrgyzstan (2001) Turkey (2000) Turkmenistan (1997) Malta (2001) Andorra (2001) Tajikistan (2001) Albania (2000) Armenia (2001) Azerbaijan (2001) Georgia (2001)

4749 4239 4163 4074 3653 3410 3367 3237 3136 3020 2812 2774 2741 2658 2609 2569 2544 2371 2244 2214 2181 2181 2122 2013 1738 1691 1607 1522 1389 1374 1363 1310 1300 1267 1193 1059 1036 983.6 875.1 664.6 609.8 560.6 539.9 508.4 483.7 411.6 0

1000

2000

3000

4000

5000



77

14-05-2003, 14:13

6000

78


Hospital discharges for diseases of the respiratory system Belarus (2001) Romania (2001) Ukraine (2001) Russian Federation (2001) Lithuania (2001) Finland (2001) Latvia (2001) Uzbekistan (2001) Hungary (2000) Estonia (2001) Austria (2000) Bulgaria (2001) Kazakhstan (2001) Turkmenistan (1997) Kyrgyzstan (2001) Belgium (1998) Denmark (2000) Israel (1999) Iceland (1994) Republic of Moldova (2001) Ireland (2001) Czech Republic (2001) Slovakia (2001) France (2000) Norway (2001) Poland (1996) Greece (1998) Germany (1999) Slovenia (2001) Tajikistan (2001) Italy (2000) United Kingdom (1994) Albania (2000) TFYR Macedonia (2000) Spain (1999) Croatia (2001) Sweden (2001) Andorra (2001) Turkey (2000) Yugoslavia (1996) Azerbaijan (2001) Portugal (2001) Georgia (2001) Netherlands (2001) Malta (2001) Armenia (2001)

4310 3087 2973 2942 2892 2257 2239 2231 2159 2104 2045 2027 2016 1950 1941 1750 1609 1596 1522 1485 1470 1468 1418 1370 1357 1309 1305 1264 1227 1211 1203 1198 1187 1148 1100 1078 1025 879.1 865.2 864.3 838.1 740.2 694.7 620.7 565.9 483.6 0

1000

2000

3000

4000



78

14-05-2003, 14:13

5000

79


Hospital discharges for diseases of the respiratory system CIS 3500

CSEC EU


3000

2500

2000

1500

1000 1980

1985

1990

1995

2000

Year

Hospital discharges for diseases of the digestive system 2300 CIS CSEC 2100


EU

1900

1700

1500

1300 1980

1985

1990

1995

Year


79

14-05-2003, 14:13

2000

80


Hospital discharges for diseases of the digestive system 3204 2936 2647 2418 2323 2200 2191 2105 2084 2056 1917 1911 1835 1834 1778 1724 1702 1661 1561 1524 1422 1384 1362 1361 1337 1319 1315 1298 1291 1289 1264 1257 1253 1201 1157 1061 1042 928.3 926.3 923.3 817.9 758.5 729.9 573.9 503.9 466.0

Belarus (2001) France (2000) Belgium (1998) Romania (2001) Austria (2000) Lithuania (2001) Russian Federation (2001) Ukraine (2001) Czech Republic (2001) Latvia (2001) Slovakia (2001) Germany (1999) Hungary (2000) Estonia (2001) Finland (2001) Italy (2000) Greece (1998) Denmark (2000) Republic of Moldova (2001) Slovenia (2001) Kazakhstan (2001) Ireland (2001) Poland (1996) Iceland (1994) Israel (1999) Uzbekistan (2001) Kyrgyzstan (2001) Croatia (2001) Sweden (2001) Spain (1999) Albania (2000) Bulgaria (2001) United Kingdom (1994) Turkmenistan (1997) Norway (2001) Portugal (2001) Andorra (2001) Yugoslavia (1996) TFYR Macedonia (2000) Tajikistan (2001) Netherlands (2001) Malta (2001) Turkey (2000) Azerbaijan (2001) Armenia (2001) Georgia (2001) 0

1000

2000

3000



80

14-05-2003, 14:13

4000

81


Hospital discharges for diseases of the musculoskeletal system Austria (2000) Finland (2001) Belarus (2001) Belgium (1998) Hungary (2000) France (2000) Germany (1999) Czech Republic (2001) Estonia (2001) Latvia (2001) Iceland (1994) Lithuania (2001) Norway (2001) Russian Federation (2001) Romania (2001) Denmark (2000) Ukraine (2001) Italy (2000) Slovakia (2001) Slovenia (2001) Sweden (2001) United Kingdom (1994) Bulgaria (2001) Andorra (2001) Greece (1998) Spain (1999) Netherlands (2001) Poland (1996) Kyrgyzstan (2001) Croatia (2001) Republic of Moldova (2001) Ireland (2001) Israel (1999) Uzbekistan (2001) Kazakhstan (2001) TFYR Macedonia (2000) Portugal (2001) Turkmenistan (1997) Tajikistan (2001) Turkey (2000) Yugoslavia (1996) Malta (2001) Armenia (2001) Albania (2000) Azerbaijan (2001) Georgia (2001)

2834 2127 2054 2001 1730 1550 1449 1437 1315 1250 1238 1136 1108 1103 1082 1016 987.4 928.3 908.0 879.3 830.0 761.7 738.4 687.0 661.9 646.8 643.8 601.9 601.2 600.3 572.0 566.1 476.9 459.7 407.5 402.2 323.9 307.1 301.0 281.7 234.4 167.2 124.0 118.1 89.8 62.2 0

500

1000

1500

2000

2500



81

14-05-2003, 14:13

3000

3500

82


Hospital discharges for diseases of the musculoskeletal system CIS 1100 CSEC


EU

900

700

500 1980

1985

1990 Year

1995

2000

Hospital discharges for injury and poisoning 1750

CIS CSEC


EU

1500

1250

1000 1980


1985

82

1990 Year

1995

2000

14-05-2003, 14:13

83


Hospital discharges for injury and poisoning Austria (2000) Latvia (2001) Lithuania (2001) Finland (2001) Belarus (2001) Belgium (1998) France (2000) Germany (1999) Russian Federation (2001) Denmark (2000) Norway (2001) Czech Republic (2001) Ireland (2001) Ukraine (2001) Slovenia (2001) Sweden (2001) Kazakhstan (2001) Hungary (2000) Italy (2000) Iceland (1994) Greece (1998) Andorra (2001) Romania (2001) United Kingdom (1994) Israel (1999) Slovakia (2001) Estonia (2001) Republic of Moldova (2001) Kyrgyzstan (2001) Poland (1996) Bulgaria (2001) Croatia (2001) Spain (1999) Uzbekistan (2001) Netherlands (2001) Turkmenistan (1997) Portugal (2001) TFYR Macedonia (2000) Tajikistan (2001) Albania (2000) Yugoslavia (1996) Malta (2001) Turkey (2000) Georgia (2001) Armenia (2001) Azerbaijan (2001)

3159 2211 2210 2126 2093 2087 2054 1993 1916 1909 1708 1697 1656 1608 1591 1560 1489 1487 1472 1467 1460 1346 1345 1325 1324 1321 1268 1219 1210 1112 1056 946.3 878.1 752.2 744.5 730.6 719.4 588.6 455.6 441.6 432.4 400.0 396.8 335.9 318.3 208.7 0

1000

2000

3000



83

14-05-2003, 14:13

4000

84

Atlas of health in Europe Teeth

Decayed, missing or filled teeth in 12-year-olds Romania (1998) Bosnia and Herzegovina (2001) Lithuania (1994) Ukraine (1992) Slovakia (1999) Bulgaria (1998) Latvia (1998) Poland (1999) Hungary (1996) Russian Federation (1995) San Marino (1990) Croatia (1999) Czech Republic (1998) Belarus (1999) Portugal (1999) TFYR Macedonia (1999) Albania (1996) Estonia (1998) Greece (1998) Turkmenistan (1990) Turkey (1996) Armenia (1990) Georgia (1990) Spain (1994) Italy (1996) Kazakhstan (1990) France (1998) Slovenia (1998) Austria (1997) Belgium (1998) Malta (1991) Iceland (1996) Norway (1999) Israel (1994) Republic of Moldova (1995) Germany (2000) Tajikistan (1990) Finland (1997) Ireland (1997) Kyrgyzstan (1993) Denmark (2001) Sweden (2001) United Kingdom (2001) Uzbekistan (2001) Switzerland (1996) Luxembourg (1999) Netherlands (1998)

7.3 6.1 4.9 4.4 4.3 4.2 4.2 4.1 3.8 3.7 3.7 3.5 3.4 3.3 3.1 3.0 2.9 2.7 2.7 2.6 2.5 2.4 2.4 2.3 2.1 2.1 1.9 1.8 1.7 1.6 1.6 1.5 1.5 1.4 1.3 1.2 1.2 1.1 1.1 1.1 0.9 0.9 0.9 0.9 0.8 0.7 0.6 0

1

2

3

4

5

6

7

8

Average number per child


84

14-05-2003, 14:13

9

85

Lifestyles and environment

4. Lifestyles and environment Notes Smoking (pp. 87–88 ) Countries estimate the percentage of regular daily smokers aged 15 years and over on the basis of health interview surveys. The tobacco-free Europe programme, at the WHO Regional Office for Europe, collates the data. Most of the estimates are based on multiple sources, however, and population samples are not always representative of a whole country. Intercountry comparisons should therefore be made with caution. Smoking prevalence among young people (15-year-olds) is estimated in a more uniform way across the European Region, through the WHO Health Behaviour in School-aged Children Study. The Study does not collect data for all countries, however. Average cigarette consumption is estimated on the basis of data published by the Tobacco journal international. Alcohol (pp. 89–91) The data show the estimated amount of pure ethanol consumed in the form of spirits, wine, beer and other alcoholic drinks, per person per year. This estimate is calculated from official statistics on local production, sales, imports and exports, taking into account stocks and home production whenever possible. The alcohol and drugs programme, at the WHO Regional Office for Europe, collects data and makes calculations mainly from three sources: World drink trends (published regularly by Productschap voor Gedistilleerde Dranken, Schiedam, Netherlands), the FAO and data reported directly by countries. In the Republic of Moldova, and probably in some other countries too, the total consumption of alcohol, particularly spirits, is likely to be somewhat overestimated, owing to the low reported export


85

14-05-2003, 14:13

86

Atlas of health in Europe figures. As no data were available on stocks, it was assumed that all spirits produced and not otherwise accounted for were “consumed”. Foodborne disease (p. 92) Infections or intoxications due to microbiologically contaminated food include such diseases as trichinellosis, salmonellosis, and Campylobacter enteritis. National definitions and registration practices vary significantly, therefore intercountry comparability is limited. Work-related deaths (pp. 93–94) The data source is the ILO. Motor vehicle traffic accidents (p. 95) The main data source for accidents is Statistics of road traffic accidents in Europe and North America regularly published by the UNECE, in Geneva. Data on deaths from traffic accidents come from the WHO mortality database. Traffic accident registration practices vary significantly among countries, thus limiting international comparisons. The available data show that the number of registered accidents per 100 000 population is lowest in the eastern and some central European countries, but the number of people killed per 1000 accidents in these countries is the highest. This correlation is most likely partially the result of incomplete registration of all accidents in these countries, but also of the really low traffic safety precautions in the eastern part of the Region.


86

14-05-2003, 14:13

87

Lifestyles and environment Smoking

Smokers among adults and 15-year-olds 48 47

Bosnia and Herzegovina (1995) Yugoslavia (2000) Hungary (2000) Albania (2000) Poland (1993) Greece (2000) Russian Federation (1998) TFYR Macedonia (1999) Andorra (1997) Bulgaria (1996) Turkey (1993) Germany (2000) Netherlands (2001) Spain (2001) Ukraine (2000) Switzerland (1997) Georgia (1998) Lithuania (2000) Ireland (1998) Croatia (2000) Belgium (2000) Denmark (2000) Kyrgyzstan (1999) Luxembourg (2000) Norway (2001) Estonia (2000) Latvia (1999) Armenia (1998) Austria (2000) Slovakia (1998) Kazakhstan (2000) France (2000) Israel (2000) United Kingdom (2000) Azerbaijan (1997) Belarus (2001) Italy (2000) Czech Republic (2002) Finland (2001) Slovenia (2001) Iceland (2001) Romania (2000) Portugal (1999) Sweden (2001) Republic of Moldova (2001) Turkmenistan (1990) Malta (1995)

19.1 16.3 9.9 15.8 9.8

27.5 19.2 20.1 24.4 17.1 19.1 15.8 16.9 18.5 14.8 17.8 17.3 17.6 22.1 19.8 9.7 17.7 16.1 21.6 22.7 22.9 16.5 9.8 14 8.5 40

a


42 39 39 38 36 36 36 36 35 35 35 34 34 33 33 32 31 30 30 30 30 30 30 29 29 29 29 29 28 27 27 27 27 26 25 24 24 24 24 21 21 19 18

30

20

10

Percent of 15-year-oldsa

9 0

10

20

30

Data refer to 2001 / 2002

87

40

Percent of adults (age 15+)

14-05-2003, 14:13

50

88

Atlas of health in Europe Smoking

Smokers among adult males

–< 65 –< 55 –< 50 –< 40 –< 30 No data % of adult male population

Cigarette consumption 2250

Number per person per year

2000

1750

1500

1250 CIS

CSEC

EU

1000 1980

1985

1990

1995

Year


88

14-05-2003, 14:13

2000

89

Lifestyles and environment Alcohol

Total alcohol consumption Litres (pure alcohol equivalent) per person per year

12 CIS

11

CSEC

EU

10 9 8 7 6 5 4 1980

1985

1990 Year

1995

2000

–< 16 –< 11 –< 9 –< 7 –< 5 Litres (pure alcohol equivalent) per person per year


89

14-05-2003, 14:13

90

Atlas of health in Europe Alcohol

Total alcohol consumption, 2000 15.9

Republic of Moldova Portugal Luxembourg Ireland Czech Republic France Slovenia Croatia Germany Austria Lithuaniaa Slovakia Spain Switzerland Denmark Hungary Russian Federation Finland Belgium United Kingdom Italy Greece Netherlands Latvia Estonia Yugoslavia Belarus Poland Romania Bulgaria Sweden Azerbaijan Bosnia and Herzegovina Georgia Iceland Norway Malta TFYR Macedonia Ukraine Kyrgyzstan Kazakhstan Israel Albania Armenia Turkey Uzbekistan Turkmenistan Tajikistan

14.0 13.8 13.3 12.6 10.8 10.6 10.4 10.4 10.1 10.0 9.9 9.6 9.4 9.4 9.1 8.1 8.1 8.0 7.9 7.9 7.8 7.7 7.5 7.2 6.8 6.7 6.6 6.5 6.1 5.4 5.2 5.1 4.8 4.2 4.2 3.7 3.2 3.1 2.5 1.7 1.4 1.4 1.3 1.1 0.9 0.8 0.7 0

a


2001

90

5

10

15

Litres (pure alcohol equivalent) per person

14-05-2003, 14:13

91

Lifestyles and environment Alcohol

Consumption of spirits, 2000 Republic of Moldova Latvia Russian Federation Belarus Slovakia Portugal Azerbaijan Lithuaniaa Bosnia and Herzegovina Czech Republic Poland Hungary Slovenia Estonia France Spain Ireland Bulgaria Ukraine Finland Yugoslavia Greece Germany Netherlands Luxembourg United Kingdom Switzerland Austria Croatia Belgium Kazakhstan Denmark Romania Iceland Armenia Sweden Malta Norway Israel Turkey Georgia Italy Tajikistan Albania

11.4 5.6 5.5 5.3 4.6 4.5 4.2 4.0 4.0 3.4 3.2 2.8 2.8 2.6 2.4 2.4 2.4 2.3 2.2 2.2 2.1 1.9 1.9 1.7 1.6 1.6 1.5 1.4 1.3 1.2 1.2 1.2 1.1 1.1 1.0 1.0 0.9 0.7 0.6 0.6 0.5 0.5 0.5 0.4 0

a


2001

91

1

2

3

4

5

6

7

8

9

10

Litres (pure alcohol equivalent) per person

14-05-2003, 14:13

11

12

92

Atlas of health in Europe Foodborne disease

Cases of microbiological foodborne disease Czech Republic (2001) Slovakia (2001) Georgia (2001) Germany (2000) United Kingdom (2000) Denmark (2001) Austria (1992) Switzerland (2001) Norway (2001) Ireland (2001) Luxembourg (2001) Lithuania (1998) Tajikistan (1992) Turkmenistan (1992) Malta (2001) Iceland (2001) Finland (2001) Hungary (2001) Bosnia and Herzegovina (2001) Slovenia (2001) Albania (1998) Spain (1996) Belgium (1999) TFYR Macedonia (2001) Croatia (2001) France (1992) Israel (2001) Turkey (2000) Romania (2001) Andorra (2001) Republic of Moldova (2001) Estonia (2001) Russian Federation (1999) Belarus (2001) Ukraine (2000) Greece (2001) Armenia (2001) Kazakhstan (2001) Azerbaijan (2001) Kyrgyzstan (2001) Uzbekistan (2001)

595.0 374.9 259.6 238.5 164.1 146.0 140.4 131.0 125.8 100.2 82.8 76.6 73.6 67.0 61.3 50.9 48.7 45.4 36.7 35.7 35.0 28.3 28.1 27.4 25.5 19.1 17.3 14.7 12.5 12.1 6.9 6.3 5.5 2.2 2.1 2.1 1.3 0.5 0.1 0.1 0.1 0

100

200

300

400

500

600



92

14-05-2003, 14:13

700

93

Lifestyles and environment Work and traffic accidents

Deaths from work-related accidents 6


5

4

3

2

1 CIS

CSEC

EU

0 1980

1985

1990 Year

1995

2000

–< 4 –< 2 –< 1.5 –< 1 –< 0.5 No data Per 100 000 population


93

14-05-2003, 14:13

94

Atlas of health in Europe Work and traffic accidents

Deaths from work-related accidents Russian Federation (1999) Latvia (2001) Portugal (2000) Ukraine (2001) Spain (2001) Luxembourg (2001) Italy (2000) Belarus (2001) Lithuania (2001) Estonia (2001) Czech Republic (2001) Romania (2001) Slovakia (2001) Kazakhstan (1999) Austria (2000) Slovenia (2001) Bulgaria (2000) Ireland (2001) Israel (2001) Andorra (1997) Malta (2001) Turkey (2001) Poland (2001) Germany (2000) Hungary (2001) Belgium (2001) France (1999) Switzerland (1999) Denmark (2001) Republic of Moldova (2001) Norway (2001) Finland (1999) Kyrgyzstan (2001) Yugoslavia (1999) Greece (1998) Sweden (2000) Netherlands (2000) Croatia (2001) Armenia (2001) United Kingdom (2000) Iceland (2001) Azerbaijan (2001) Tajikistan (2001) TFYR Macedonia (2001)

2.9 2.9 2.8 2.7 2.6 2.5 2.5 2.4 2.3 2.2 2.0 1.9 1.9 1.9 1.8 1.7 1.7 1.7 1.6 1.5 1.5 1.5 1.4 1.4 1.3 1.2 1.2 1.2 0.9 0.9 0.8 0.8 0.8 0.8 0.7 0.7 0.6 0.6 0.4 0.4 0.4 0.3 0.3 0.2 0

1

2

3



94

14-05-2003, 14:13

95

Lifestyles and environment Work and traffic accidents

Motor vehicle traffic accidents and deaths Austria (2000) Germany (1999) Belgium (1996) Portugal (2000) Slovenia (2000) Israel (1998) United Kingdom (2000) Iceland (1997) Italy (1999) Switzerland (1999) Croatia (1999) Netherlands (1997) Czech Republic (2000) Spain (1999) Greece (1999) France (1999) Luxembourg (2000) Ireland (2000) Latvia (2000) Norway (1999) Sweden (1999) Hungary (2000) Malta (1998) Lithuania (2000) Poland (2000) Slovakia (2000) Denmark (1999) Finland (2000) Russian Federation (1998) Estonia (2000) Bulgaria (2000) TFYR Macedonia (2000) Yugoslavia (2000) Kazakhstan (2000) Ukraine (2000) Belarus (2000) Republic of Moldova (2000) Kyrgyzstan (2000) Uzbekistan (1999) Georgia (2000) Turkmenistan (1998) Romania (2000) Azerbaijan (2000) Armenia (2000) Tajikistan (1999) Albania (2000)

20 19 30 31 36 21 15 13 35 21 50 27 54 63 92 63 92 51 141 41 32 75 23 118 109 91 65 58 184 146 125 63 87 123 167 238 168 152 155 101 205 387 196 217 100 122

519 482 480 432 428 424 391 384 380 327 285 263 248 247 230 212 206 205 189 187 179 171 171 166 148 146 143 128 110 110 84 84 80 76 68 64 60 55 49 38 34 34 25 25 24 14

500 400 300 200 100 0 100 200 300 400 500 600 Deaths per 1000 accidents


95

Accidents per 100 000 population

14-05-2003, 14:13

96



96

14-05-2003, 14:13

97

Health care

5. Health care Notes Physicians (pp. 99–100) The data show the number of practising physicians working in public or private health services. Not all countries report the data strictly according to the recommended definitions. Countries also differ in the way they compile national statistics on employment in the health sector. The number of physicians per head of population is steadily increasing in western and, to a lesser extent, in central parts of the Region. Previously high and increasing ratios in the eastern part began to decline in the early 1990s. Dentists (pp. 100–101) The data include dentists who have completed university level studies in dentistry and are actually working in dental care. Nurses (p. 102) The data show nurses who have completed a programme of nursing education (either basic or at university level), and are qualified and authorized in their country to practice nursing in all settings for the promotion of health, the prevention of illness, the care of the sick and rehabilitation. The international comparability of statistics on nurses is particularly limited, owing to the variations in national definitions and practices. Hospital beds (pp.103–105) The number of available beds includes beds in all hospitals, regardless of specialty. The main limitation on intercountry comparability is that some countries count nursing homes and similar institutions as hospitals while others do not.


97

14-05-2003, 14:13

98

Atlas of health in Europe The number of hospital beds per 100 000 population and the average length of stay are clearly declining throughout the Region, with the highest levels still in the eastern part. A number of countries have seen a remarkable reduction in psychiatric beds. Inpatient hospital admissions (pp. 106–107) The inpatient hospital admissions rate is steadily increasing in western and central parts of the Region. Previously high rates in the eastern part dropped during the 1990s and averages for all three parts of the Region are currently very close. Nevertheless, the hospital admissions rates vary significantly from country to country. Caesarean sections (pp. 107–108) The number of Caesarean sections performed is increasing throughout the Region. The highest rates are currently in the western part of the Region, and the lowest in the eastern part. Childhood vaccination (p. 109) The data show the percentage of infants reaching their first birthday in the given year who have been fully vaccinated (with three doses) against diphtheria, and the percentage of children reaching their second birthday who have been vaccinated against measles. Health expenditure (pp. 110–112) The data source for OECD countries is the OECD health database. The remaining countries reported the data directly. Health expenditure in some of these countries, particularly in the eastern part of the Region, is likely to be underestimated, owing to the exclusion of the private sector and out-of-pocket payments. The health expenditure, both as a percentage of gross domestic product (GDP) and in international dollars (purchasing power parities expressed in US $ (US $PPP)) per person, varies significantly between countries. In the western part of the Region, expenditure is steadily increasing while in the eastern part it is stable or increasing much more slowly, thus further increasing the east–west gap.


98

14-05-2003, 14:13

99

Health care Health personnel

Number of physicians 567

Italy (1999) Belarus (2001) Greece (1999) Georgia (2001) Russian Federation (2001) Belgium (2001) Lithuania (2001) Israel (2001) Norway (2002) Germany (2001) Azerbaijan (2001) Hungary (1999) Iceland (2001) Switzerland (2000) Kazakhstan (2001) Bulgaria (2001) Czech Republic (2001) France (2001) Spain (2000) Netherlands (2001) Slovakia (2001) Austria (2001) Portugal (2000) Estonia (2001) Finland (2001) Turkmenistan (1997) Ukraine (2001) Uzbekistan (2001) Malta (2001) Latvia (2001) Armenia (2001) Sweden (1999) Denmark (1999) Kyrgyzstan (2001) Republic of Moldova (2001) Andorra (2001) Luxembourg (2001) San Marino (1990) Ireland (2001) Croatia (2001) Poland (2000) TFYR Macedonia (2001) Slovenia (2001) Yugoslavia (1999) Tajikistan (2001) Romania (2001) United Kingdom (1993) Bosnia and Herzegovina (2001) Albania (2000) Turkey (2001)

450 438 430 420 419 403 375 367 363 359 355 352 350 345 344 342 330 329 328 326 323 318 313 311 300 298 293 291 291 287 287 284 272 271 265 254 252 239 238 220 219 219 213 212 189 164 145 139 123 0

100

200

300

400

500



99

14-05-2003, 14:13

600

700

100

Atlas of health in Europe Health personnel

Number of physicians 400


350

300

250

CIS

CSEC

EU

1990

1995

2000

1995

2000

200 1980

1985

Year

Number of dentists 70 CIS

CSEC

EU


60

50

40

30

20 1980

1985

1990 Year


100

14-05-2003, 14:13

101

Health care Health personnel

Number of dentists Sweden (1997) Norway (2001) Monaco (1995) Greece (1999) Israel (2001) Iceland (2000) Finland (2001) Denmark (1999) Bulgaria (2001) Estonia (2001) Germany (2001) Lithuania (2001) Belgium (1998) Croatia (2001) France (2001) Czech Republic (2001) Luxembourg (2001) Andorra (2001) Slovenia (2001) Italy (2000) Hungary (1999) TFYR Macedonia (2001) Latvia (2001) Ireland (2001) Austria (2001) Netherlands (2001) Switzerland (2001) Spain (2000) Slovakia (2001) Belarus (2001) Portugal (2000) Albania (1998) Malta (2001) United Kingdom (1992) Ukraine (2001) Yugoslavia (1999) San Marino (1984) Georgia (2001) Russian Federation (2001) Republic of Moldova (2001) Poland (2000) Kazakhstan (2001) Azerbaijan (2001) Turkey (2000) Romania (2001) Kyrgyzstan (2001) Turkmenistan (1997) Uzbekistan (2001) Armenia (2001) Bosnia and Herzegovina (2001) Tajikistan (2001)

125.4 121.4 115.3 114.7 100.7 91.2 85.6 81.9 80.2 77.9 71.5 69.7 68.1 68.0 65.1 64.1 63.6 59.1 57.4 56.9 55.2 52.9 52.3 47.2 46.8 44.5 44.3 44.2 44.1 42.8 41.4 40.2 39.8 39.3 38.5 36.4 32.6 32.1 31.2 30.4 29.2 26.1 24.3 22.6 21.9 21.6 21.2 18.7 18.1 16.7 0

30

60

90

120



101

14-05-2003, 14:13

152.1

150

180

102

Atlas of health in Europe Health personnel

Number of nurses Finland (2001) Norway (2001) Ireland (2000) Monaco (1995) Netherlands (2001) Belarus (2001) Belgium (1996) Uzbekistan (2001) Germany (2001) Czech Republic (2001) Denmark (1999) Iceland (1999) Sweden (1999) Lithuania (2001) Russian Federation (2001) Switzerland (1990) Ukraine (2001) Luxembourg (2001) Slovakia (2000) Azerbaijan (2001) Slovenia (2001) Kyrgyzstan (2001) France (2001) Republic of Moldova (2001) Estonia (2001) Kazakhstan (2001) Israel (2001) Turkmenistan (1997) Austria (2000) Poland (1990) TFYR Macedonia (2001) San Marino (1990) Latvia (2001) Croatia (2001) Bulgaria (2001) Yugoslavia (1999) Bosnia and Herzegovina (2001) Tajikistan (2001) Georgia (2001) Romania (2001) Albania (2001) Armenia (2001) Malta (2001) Spain (2000) Portugal (2000) Andorra (2001) Hungary (2000) Greece (1992) Turkey (2000)

1676 1621

2171 2068

1328 1236 1075 1011 955 944 937 869 843 798 793 779 768 768 748 738 715 684 669 629 623 593 591 587 583 527 518 508 508 500 450 449 445 426 423 403 391 386 375 372 367 309 281 257 244 0

500

1000

1500

2000



102

14-05-2003, 14:13

2500

103

Health care Hospitals

Hospital beds 1300 1200


1100 1000 900 800 700 600

CIS

CSEC

EU

500 1980

1985

1990

1995

2000

Year

Length of stay in hospital

Average number of days

15

12

CIS

CSEC

EU

9 1980

1985

1990

1995

Year


103

14-05-2003, 14:13

2000

104

Atlas of health in Europe Hospitals

Number of beds and length of stay in hospital Belarus (2001) Luxembourg (1996) Russian Federation (2001) Lithuania (2001) Germany (2000) Iceland (1996) Ukraine (2001) Austria (2000) Czech Republic (2001) Azerbaijan (2001) Hungary (2001) Latvia (2001) France (2000) Slovakia (2001) Romania (2001) Finland (2001) Bulgaria (2001) Turkmenistan (1997) Belgium (2001) Kazakhstan (2001) Estonia (2001) Tajikistan (2001) Switzerland (2000) Israel (2001) Kyrgyzstan (2001) Croatia (2001) Republic of Moldova (2001) Poland (2000) Yugoslavia (1999) Uzbekistan (2001) Sweden (2001) Slovenia (2001) TFYR Macedonia (2001) Greece (1998) Netherlands (2001) Italy (2000) Norway (2001) Denmark (2000) Georgia (2001) Armenia (2001) United Kingdom (1997) Spain (2001) Portugal (1999) Ireland (2001) Albania (2000) Bosnia and Herzegovina (2001) Turkey (2001)

13.3 15.3 15.2 10.9 11.9 13.7 14.6 7.6 11.5 17.5 8.7 11.3 10.8 10.0 8.6 10.3 10.7 13.4 11.5 14.1 8.7 14.0 13.0 11.1 13.3 11.8 12.5 8.9 11.0 11.6 6.3 8.3 11.8 8.3 12.5 7.6 7.7 6.6 9.7 11.7 9.8 9.7 9.0 7.5 6.9 10.5 5.8 50

25

Average number of days


104

1258 1100 1083 922 912 903 874 861 852 851 825 820 820 779 749 737 720 711 699 697 672 640 618 616 615 600 589 556 541 534 522 516 493 488 466 450 440 434 430 427 417 401 392 357 326 322 236 0

250

500

750

1000 1250 1500

Beds per 100 000 population

14-05-2003, 14:13

105


Psychiatric hospital beds 153.9 150.1

Netherlands (2001) Latvia (2001) Malta (2001) Germany (2000) Lithuania (2001) Iceland (1995) Russian Federation (2001) Belgium (2001) Switzerland (2000) Czech Republic (2001) Ireland (2001) France (2000) Croatia (2001) Finland (2001) Belarus (2001) Luxembourg (1998) Ukraine (2001) Greece (1999) Slovakia (2001) Israel (2001) United Kingdom (1997) Yugoslavia (1999) Denmark (1999) Romania (2001) Slovenia (2001) Portugal (1998) Estonia (2001) TFYR Macedonia (2001) Poland (2000) Norway (2001) Kazakhstan (2001) Bulgaria (2001) Sweden (2000) Austria (2000) Kyrgyzstan (2001) Republic of Moldova (2001) Spain (1997) Azerbaijan (2001) Turkmenistan (1997) Bosnia and Herzegovina (2001) Hungary (2000) Armenia (2001) Uzbekistan (2001) Albania (2000) Tajikistan (2001) Georgia (2001) Andorra (2001) Italy (2000) Turkey (2001)

143.3 127.6 122.4 117.9 117.3 116.1 115.6 113.7 110.2 107.1 102.7 100.4 99.3 97.1 96.3 92.1 87.0 85.0 81.9 80.0 78.0 76.0 75.1 69.8 68.4 68.1 67.4 67.2 65.3 64.3 62.5 61.3 59.2 58.4 56.7 49.8 44.7 44.5 43.4 40.3 31.3 29.4 26.8 26.2 18.2 14.2 12.3 0


105

50

Latest value 1980

100 150 200 250 300 Per 100 000 population

14-05-2003, 14:13

350

400

106

Atlas of health in Europe Hospitals

Inpatient hospital admissions Belarus (2001) Austria (2000) Hungary (2001) Finland (2001) Romania (2001) Lithuania (2001) Germany (2000) France (1999) Russian Federation (2001) Iceland (1995) Latvia (2001) Czech Republic (2001) Slovakia (2001) Belgium (1998) Ukraine (2001) Estonia (2001) Luxembourg (1994) Denmark (2001) Israel (2001) Norway (2001) Switzerland (1998) Slovenia (2001) Sweden (2001) Italy (2000) Croatia (2001) Poland (2000) Kazakhstan (2001) Greece (1998) Bulgaria (2001) United Kingdom (1998) Ireland (2001) Kyrgyzstan (2001) Uzbekistan (2001) Turkmenistan (1997) Republic of Moldova (2001) Portugal (1998) Spain (1997) Yugoslavia (1999) Netherlands (2001) Tajikistan (2001) TFYR Macedonia (2001) Albania (2001) Turkey (2001) Bosnia and Herzegovina (2001) Armenia (2001) Azerbaijan (2001) Georgia (2001)

30.0 29.2 26.1 26.0 24.4 24.0 23.5 23.0 22.5 21.6 20.7 20.2 19.7 19.7 19.7 19.7 19.4 18.9 18.7 17.6 16.9 16.6 16.6 16.5 15.8 15.5 15.5 15.4 15.3 15.1 14.8 14.5 13.8 13.0 12.5 12.0 11.5 10.6 9.3 9.0 9.0 8.8 7.8 7.8 4.9 4.9 4.5 0

10

20

30

Per 100 population


106

14-05-2003, 14:13

107


Inpatient hospital admissions CIS

CSEC

EU

Per 100 population

24

21

18

15 1980

1985

1990

1995

2000

Year

Some procedures

Caesarean sections 200 CIS

CSEC

EU


150

100

50 1980

1985

1990

1995

Year


107

14-05-2003, 14:13

2000

108

Atlas of health in Europe Some procedures

Caesarean sections Italy (1999) Portugal (1998) Malta (2001) Greece (1991) Andorra (1999) Hungary (2001) Germany (2000) Spain (1997) Austria (2001) Ireland (2000) Switzerland (1991) Iceland (2001) Slovakia (2001) Belarus (2001) Finland (2001) Latvia (2001) Poland (1997) France (1999) Belgium (1999) Romania (2001) Estonia (2001) Denmark (2000) Israel (2000) Russian Federation (2001) Bulgaria (2001) Sweden (1999) United Kingdom (1995) Norway (2000) Netherlands (2001) Turkey (1998) Lithuania (2001) Albania (2001) Czech Republic (2001) Slovenia (2001) Croatia (2001) Ukraine (2001) Georgia (2001) TFYR Macedonia (2001) Armenia (2001) Kazakhstan (2001) Republic of Moldova (2001) Yugoslavia (1998) Kyrgyzstan (2001) Uzbekistan (2001) Azerbaijan (2001) Turkmenistan (1997) Luxembourg (1998) Tajikistan (2001)

319.3 275.3 243.2 240.0 237.3 211.8 208.9 198.0 188.6 185.5 177.0 167.7 166.5 164.0 163.6 163.5 161.2 161.1 159.2 156.3 155.1 152.7 150.1 147.6 147.0 144.0 141.5 136.6 136.4 136.0 135.1 130.3 129.5 125.2 119.1 114.1 103.6 102.2 78.6 74.2 67.4 53.3 40.9 33.2 31.0 28.8 18.1 13.9 0

50

100

150

200

250

300



108

14-05-2003, 14:13

350

109

Health care Some procedures

Children vaccinated against measles and diphtheria Iceland (1999) Hungary (2001) Slovakia (2001) Belarus (2001) Ukraine (2001) Sweden (1997) Finland (1999) Latvia (2001) Kyrgyzstan (2001) Czech Republic (2000) Poland (2001) Portugal (2001) France (1998) Luxembourg (1997) Monaco (1991) Albania (2001) Yugoslavia (2001) Azerbaijan (2001) Romania (1999) Belgium (1999) Republic of Moldova (2001) Denmark (2001) Netherlands (1998) Uzbekistan (2001) Tajikistan (2001) San Marino (2000) Russian Federation (2001) Kazakhstan (2001) Turkmenistan (2001) Spain (2000) Italy (1999) Switzerland (1991) Israel (2001) Lithuania (2001) Croatia (2001) Armenia (2001) Bulgaria (2001) Estonia (2001) United Kingdom (2001) Slovenia (2001) Norway (2001) TFYR Macedonia (2001) Greece (1997) Andorra (1998) Georgia (2001) Germany (1997) Bosnia and Herzegovina (2000) Ireland (2001) Austria (2001) Turkey (2001) Malta (1999)

150 125 100 75 50 25 Percent of children (measles)


109

99.9 99.8 99.4 99.3 99.1 99.0 99.0 99.0 98.7 98.4 98.3 98.1 98.0 98.0 98.0 97.8 97.8 97.5 97.3 97.1 97.1 97.0 97.0 96.9 96.7 95.8 95.8 95.8 95.4 95.2 95.0 95.0 95.0 94.6 94.4 93.7 93.6 93.5 93.3 92.3 91.0 90.5 90.0 89.0 85.7 85.0 84.9 84.3 83.6 83.0 81.0

99.9 99.9 99.4 100 98.8 96.0 98.0 98.3 98.9 97.1 97.2 86.8 83.0 91.0 98.0 95.0 95.1 98.9 98.2 82.4 94.1 94.0 96.0 98.9 96.8 74.2 98.4 99.0 97.6 95.2 70.0 83.0 94.0 97.4 93.6 95.5 90.0 94.7 84.7 94.0 90.0 92.2 90.0 90.0 55.0 75.0 73.9 73.2 78.5 84.0 87.0 0

25 50 75 100 125 150 Percent of infants (diphtheria)

14-05-2003, 14:13

110

Atlas of health in Europe Health expenditure

Total health expenditure as a percent of GDP 10.7 10.6

Switzerland (2000) Germany (2000) France (2000) Greece (2001) Croatia (1994) Malta (2001) Iceland (2000) Israel (2001) Belgium (2000) Denmark (2001) Slovenia (2001) Portugal (2000) Netherlands (2000) Italy (2001) Austria (2000) Sweden (1998) Spain (2000) Yugoslavia (2000) Norway (2000) Czech Republic (2001) United Kingdom (2000) Ireland (2000) Finland (2000) Slovakia (2000) Poland (1999) Luxembourg (1999) Lithuania (2001) Hungary (2001) Estonia (2001) Georgia (2000) Latvia (2001) Bulgaria (1994) Belarus (2001) TFYR Macedonia (2000) Romania (1999) Turkey (2000) Armenia (1993) Turkmenistan (1996) Ukraine (2001) Russian Federation (2000) Republic of Moldova (2001) Uzbekistan (2001) Kyrgyzstan (2001) Albania (2000) Kazakhstan (2001) Tajikistan (1998) Azerbaijan (2001)

9.5 9.2 9.0 8.9 8.9 8.8 8.7 8.4 8.2 8.2 8.1 8.0 8.0 7.9 7.7 7.6 7.5 7.4 7.3 6.7 6.6 6.5 6.2 6.0 5.7 5.7 5.5 5.1 4.8 4.7 4.6 4.5 4.5 4.3 4.2 3.5 3.4 2.9 2.9 2.6 2.3 1.9 1.6 1.2 0.8 0

a


1992 in Germany

110

2

4

Latest value 1991a

6

8

10

Percent of GDP

14-05-2003, 14:13

12

111

Health care Health expenditure

Total health expenditure as a percent of GDP 9 8 7

Percent of GDP

6 5 4 3 2 1

CIS

CSEC

EU

0 1980

1985

1990

1995

2000

Year

Total health expenditure per person 2000

US $PPP per person

CIS

CSEC

EU

1500

1000

500

0 1980

1985

1990

1995

Year


111

14-05-2003, 14:13

2000

112

Atlas of health in Europe Health expenditure

Total health expenditure per person 3222

Switzerland (2000) Germany (2000) Luxembourg (1999) Iceland (2000) Denmark (2000) France (2000) Belgium (2000) Norway (2000) Netherlands (2000) Austria (2000) Italy (2000) Ireland (2000) United Kingdom (2000) Sweden (1998) Israel (2000) Finland (2000) Spain (2000) Malta (2000) Portugal (2000) Greece (2000) Slovenia (2000) Czech Republic (2000) Hungary (2000) Slovakia (2000) Estonia (2000) Poland (1999) Lithuania (2000) Croatia (1994) Latvia (2000) Belarus (2000) Turkey (2000) Romania (1999) Russian Federation (2000) TFYR Macedonia (2000) Bulgaria (1994) Ukraine (2000) Georgia (2000) Kazakhstan (2000) Armenia (1993) Uzbekistan (2000) Albania (2000) Republic of Moldova (2000) Kyrgyzstan (2000) Turkmenistan (1994) Azerbaijan (2000) Tajikistan (1998)

2748 2613 2608 2420 2349 2269 2268 2246 2162 2032 1953 1763 1748 1671 1664 1556 1522 1441 1399 1389 1031 841 690 594 557 426 358 338 332 297 272 243 229 214 160 136 112 86 73 67 63 52 49 26 12 0

a 1992


in Germany

112

1000

Latest value 1991a

2000

3000

US $PPP per person

14-05-2003, 14:13

4000

The WHO Regional Office for Europe

ATLAS OF HEALTH IN EUROPE

The World Health Organization (WHO) is a specialized agencyof the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan

92 890 1370 2 Sw.fr. 20.-

This statistical atlas presents key health figures for the WHO European Region. They cover basic data on populations, births, deaths, life expectancy and diseases, lifestyle and environmental indicators such as drinking, smoking and traffic accidents, and types and levels of health care. All indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. Using the WHO Regional Office for Europe’s unique health for all database, combined with the best alternative sources of data around the Region, this atlas offers the most comprehensive overview of health in Europe. In a handy size, this atlas is designed to be an easily accessible resource at all times, in the office or on the road.

World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-Mail: [email protected] Web site: www.euro.who.int

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