London School of Hygiene & Tropical Medicine

Political failures, squandered opportunities and professional indifference have led to the health of European citizens facing crisis, according to new research. Shortfalls caused by withdrawn services due to the financial crisis, failure to adapt to new health challenges, and a lack of will to implement public health policies are outlined in the Lancet Series on Europe.

Led by Professor Martin McKee, researchers identified a range of disparities in access to health and preventive care services, and in health outcomes across Europe, including:

• Disparity in male life expectancy between eastern and western Europe is now greater than it was 40 years ago
• Public health efforts are at risk of disruption and deregulation from EU law
• Countries of the former Soviet Union face health crisis due to alcohol and tobacco-related disease
• 6,000 children’s lives could be saved annually with “achievable” improvements in child health services, with the UK worst performing on child health in Europe
• Migrant health is being threatened as progressive health policies disappear
• “Alarmist” concerns about ageing European society must not be used to justify welfare cuts
• Public health voices must break their silence to combat ill effects of financial crisis on health

Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine, said: “Europe has changed greatly in the past 40 years, and the immense differences in healthcare and life expectancy highlight this.

“While some countries have excelled, others have withdrawn services due to the financial crisis, failed to adapt to new health challenges, and lacked the will to implement public health policies around tobacco and alcohol. Policy makers must act now before children, migrants and older people face a public health crisis, both in the UK and across Europe."

Disparity between male life expectancy in eastern and western Europe now greater than 40 years ago

While life expectancy in Western Europe has almost continuously improved during the past 40 years, researchers found that progress in Eastern Europe has been erratic. In the former Soviet Union, poor economic progress, combined with failure to stem rising levels of infectious disease – particularly HIV / AIDS and TB – as well as dangerous alcohol and tobacco use in these countries, has contributed to life expectancies in this region lagging far behind western Europe, with the gap at 12 years for men, and 8 years for women. 

Public health efforts at risk of disruption and deregulation from EU law

Tensions between the EU’s legal commitment to a free market and individual countries’ efforts to effectively manage public health are of particular concern to the authors, who say that legislation governing the movement and trade of substances such as food, tobacco, and alcohol are subject to strong influence from industry and a marked “pro-business” stance from EU lawmakers. 

Countries of the former Soviet Union face health crisis

Hazardous drinking in Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Uzbekistan and Ukraine is thought to cause between 4 and 6 out of every 10 deaths in working age men, and a third of deaths in women of the same age, yet governments have largely failed to tackle the production and distribution of cheap alcohol. Where public health policies have been implemented – for example, in Russia – the authors say they have been marked by little ambition, poor engagement and excessive industry influence.  Likewise, the accumulated burden of tobacco-related disease in men under 75 in the Commonwealth of Independent States of the former Soviet Union is the highest in the world.

6,000 children’s lives could be saved annually with “achievable” improvements in child health services

Children’s health services in Europe are not keeping pace with changing patterns in child health, say the authors.  While child survival has improved greatly in the last 30 years across the first 15 members of the European Union (EU15)*, 6,000 children’s lives could be saved annually if all of the EU15 countries could match the performance of Sweden, which has the lowest child mortality rates. This is an entirely achievable goal, say the authors, but will depend on child health services adapting to new challenges in child health, where non-communicable diseases such as asthma, musculoskeletal disorders, and neuropsychiatric disorders such as depression are increasingly common causes of disability and death in children. 2,000 children’s lives could be saved every year in the UK alone.

Migrant health threatened as progressive health policies disappear

While research suggests that migrants generally arrive in a country in an above-average standard of health, they face a number of challenges in accessing health care, including language barriers, lack of awareness of services, and poverty, according to the authors. The problems faced by asylum seekers and undocumented migrants are particularly acute; in 2010, only five EU states offered this group access to any health care beyond emergency services, and nine EU countries effectively barred this group from access to any health care, including emergency services.  Some countries, such as Spain, which formerly adopted progressive and inclusive policies for providing health care to migrants, have recently withdrawn these services, citing financial pressure engendered by the ongoing economic crisis. 

“Alarmist” concerns about ageing European society must not be used to justify welfare cuts

While Europe is undoubtedly an ageing population, with twice as many people over 65 than those under 15 expected by 2060, an ageing society does not present a fundamental threat to the European state, and must not be used as part of a political agenda to cut back on the welfare state, say the authors. Projected increases in health expenditure due to ageing have been exaggerated, whereas other factors, such as technological developments, have a much larger effect on aggregate health care costs. The authors also state that an ageing European population is likely to result in changing pension policies, and given established effects of the social determinants of health, radical new pension policies – such as differentiation of retirement age by socioeconomic group – might be “appropriate and even inevitable”.

Public health voices must break their silence to combat ill effects of financial crisis on health

The authors warn that strong social protection mechanisms are needed to mitigate the adverse effects of the current financial crisis on public health, yet austerity measures are already leading to a weakening of social protection in some countries, through reduced state funding and the threat of prescriptive EU-mandated health spending policies in countries which have undergone the most severe financial shocks.

• Martin McKee discussing key findings on the state of health in Europe in a Lancet podcast

Publications

Full list of papers in the Lancet Series on Europe:

• J P Mackenbach, M Karanikolos, M McKee The unequal health of Europeans: successes and failures of policies Lancet doi:10.1016/S0140-6736(12)62082-0
• S L Greer, T K Hervey, J P Mackenbach, M McKee Health law and policy in the European Union Lancet doi:10.1016/S0140-6736(12)62083-2
• B Rechel, B Roberts, E Richardson, S Shishkin, V M Shkolnikov, D A Leon, M Bobak, M Karanikolos, M McKee Health and health systems in the Commonwealth of Independent States Lancet doi:10.1016/S0140-6736(12)62084-4
• I Wolfe, M Thompson, P Gill, G Tamburlini, M Blair, A Bruel, J Ehrich, M Pettoello-Mantovani, S Janson, M Karanikolos, M McKee Health services for children in western Europe Lancet doi:10.1016/S0140-6736(12)62085-6
• B Rechel, P Mladovsky, D Ingleby, J P Mackenbach, M McKee Migration and health in an increasingly diverse Europe Lancet doi:10.1016/S0140-6736(12)62086-8
• B Rechel, E Grundy, J Robine, J Cylus, J P Mackenbach, C Knai, M McKee Ageing in the European Union Lancet doi:10.1016/S0140-6736(12)62087-X
• M Karanikolos, P Mladovsky, J Cylus, S Thomson, S Basu, D Stuckler, J P Mackenbach, M McKee Financial crisis, austerity, and health in Europe Lancet doi:10.1016/S0140-6736(13)60102-6

^*EU15 countries are Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and United Kingdom.