Introductory note
Most definitions are those used by the European Health for All database (HFA-DB), which is the main source of the statistical data in the tables. Other sources of definitions are indicated as appropriate.
Terms are listed in the order in which they are presented in each table.
Table 1
Total mid-year population
Estimate of resident (de jure) population on 1 July of given calendar year, usually calculated as an average of end-year estimates. The central statistical office is the source in most countries.
This data item is used as the denominator to calculate most other indicators. Although de facto population would be preferable, the de jure population is used because it is more commonly available, particularly in age-disaggregated form. In some countries, however, particularly in those affected by armed conflict in the 1990s, the difference between official population estimates and the population actually residing in the country (de facto population) may be too large. In such cases special efforts should be made to provide estimates for de facto population to be used as a denominator.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Average population density per km2
Simple ratio of the mid-year population to the country area.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Total fertility rate
Average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given set of age-specific fertility rates. It is computed by summing the age-specific fertility rates for all ages and multiplying by the interval into which the ages are grouped. Data are usually provided by country statistical offices. Reports of the World Bank, the United Nations Development Programme (UNDP) and country statistical yearbooks are used as data sources for the HFA-DB.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population aged < 15 (% of total)
Estimate of the resident (de jure) population aged 0–14 years on 1 July of given calendar year. Usually it is calculated as an average of end-year estimates. The central statistical office is the source in most countries.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population aged ≥ 65 (% of total)
Estimate of resident (de jure) population aged 65 years and above on 1 July of given calendar year, usually calculated as an average of end-year estimates. The central statistical office is the source in most countries.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Table 2
Human Development Index
Composite index measuring average achievement in three basic dimensions of human development: a long and healthy life, knowledge and a decent standard of living. UNDP reports are used as a data source for the HFA-DB. For details on how the Index is calculated, see the latest UNDP human development report.
Sources: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009) and UNDP.
GDP [gross domestic product] in US$ per capita
Total output of goods and services for final use produced by an economy, by both residents and non-residents, regardless of the allocation to domestic and foreign claims. The WHO Regional Office for Europe uses World Bank reports as a common data source, and the Organisation for Economic Co-operation and Development (OECD) health database as the primary data source for OECD member states.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Real GDP in international dollars (PPP) per capita
GDP expressed in purchasing power parity (PPP) is adjusted to the relative domestic purchasing power of the national currency as compared to the US dollar, rather than using the official exchange rate. Multipliers (PPPs) are estimated periodically, using the cost of the standard basket of goods. The WHO Regional Office for Europe uses OECD and UNDP as common data sources.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Total government expenditure as % of GDP
Total government expenditure corresponds to the consolidated outlays of all levels of government (central/federal, provincial/regional/state/district and municipal/local governments) social security institutions and extrabudgetary funds, including capital outlays.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population with primary education (% of total)
Proportion of the population aged 25 years or more with the highest level of education attained corresponding to primary, incomplete primary or no formal schooling. The main data source is the Institute for Statistics of the United Nations Educational, Scientific and Cultural Organization (UNESCO). Some countries provided data directly to the WHO Regional Office for Europe.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population with secondary education (% of total)
Proportion of the population aged 25 years or more with the highest level of education attained corresponding to secondary education (lower or higher level). The main data source is the UNESCO Institute for Statistics. Some countries provided data directly to the WHO Regional Office for Europe.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population with postsecondary education (% of total)
Proportion of the population aged 25 years or more with the highest level of education attained corresponding to postsecondary education. The main data source is the UNESCO Institute for Statistics. Some countries provided data directly to the WHO Regional Office for Europe.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population in the labour force (% of total)
Economically active population as a percentage of the total population. The data source for HFA-DB is the International Labour Organization (ILO) yearbook of labour statistics.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Unemployment rate (%)
Ratio of the unemployed people to the total labour force. The ILO definition is applied, in which the unemployed comprise all people above a specified age who were without work, currently available for work or seeking work during the reference period. The WHO Regional Office for Europe uses the ILO yearbook of labour statistics as a common source of data.
Sources: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009) and Yearbook of labour statistics 2008 (Geneva, International Labour Organization, 2008).
Table 3
Life expectancy at birth (years)
Average number of years that a newborn baby is expected to live if current mortality rates continue to apply, calculated by the WHO Regional Office for Europe for all countries that report detailed mortality data to WHO, using Wiesler’s method. Mortality data are disaggregated by age: 0, 1–4, 5–9, 10–14, etc., 80–84, ≥ 85 years. Unfortunately, some countries cannot ensure complete registration of all deaths and births. As a result, life expectancy calculated using incomplete mortality data is higher than it actually is, and intercountry comparisons should be made with caution. In some cases, underregistration of deaths may reach 20%. Particularly high levels of mortality underregistration are observed in countries that were affected by armed conflict during the 1990s. In one such country (Georgia), the lack of sufficiently accurate population estimates used as denominator aggravates this problem.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Healthy life expectancy at birth (years)
Equivalent number of years in full health that a newborn child can expect to live based on the current mortality rates and prevalence distribution of health states in the population. Healthy life expectancy at birth is based on life expectancy but includes an adjustment for time spent in poor health. The source of the data is the January 2009 draft of World health statistics 2009.
Source: World health statistics 2009. Geneva, World Health Organization, 2009 (http://
www.who.int/whosis/whostat/2009/en/index.html, accessed 4 June 2009).
Probability of dying before age 5 years (per 1000 live births), national data reports
Number of deaths per 1000 live births until 5 years of age. The figures are taken from the appropriate cells of the relevant life tables and as such are by-products of the life expectancy calculations, i.e. (1 – L5 probability to survive by 5) x 1000. Unfortunately, some countries cannot ensure complete registration of all deaths and births. Thus, under-5 mortality rates calculated using incomplete mortality data are lower than they actually are and intercountry comparisons should be made with caution. Particularly high levels of mortality underregistration are observed in the countries of central Asia and the Caucasus, some countries of the former Yugoslavia and Albania.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Probability of dying before age 5 years (per 1000 live births), WHO estimates WHO headquarters makes these estimates, using special techniques, and publishes them in the annual world health reports. Data from various sources, including surveys, have been used when routine vital statistics were unavailable or incomplete. The estimates were also partially harmonized with survey-based estimates used by the United Nations Children’s Fund (UNICEF) and other organizations. These estimates may differ significantly from the official national figures for some countries, where the registration of deaths and births is incomplete.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Maternal mortality ratio (per 100 000 live births), national data reports
A maternal death is death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) code: O00-O99). Two sources of information on maternal mortality are used to calculate this indicator:
• routine mortality data by cause regularly reported to WHO (in most cases from central statistical offices); and
• hospital data reported to health ministries.
Normally, the numbers of maternal deaths from both sources should be identical. This is the case in most western countries, but differences arise in some countries, mainly in the eastern part of the WHO European Region, owing to national practices of death certification and
coding. In such cases, hospital data are likely to be accurate. Since the January 2001 version of HFA-DB, the maternal mortality rate has been calculated using both data sources (when both figures are reported) and HFA-DB uses the larger figure. Nevertheless, experts argue that, even in countries with good vital registration systems, maternal mortality is actually about 50% higher than the official figures. WHO, UNICEF and the United Nations Population Fund (UNFPA) have therefore developed adjusted estimates for selected years.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Maternal mortality ratio (per 100 000 live births), WHO/UNICEF/UNFPA/World Bank estimates
WHO and UNICEF, with the participation of UNFPA and the World Bank, have developed an approach to estimating maternal mortality that seeks to generate estimates for countries with no data and to correct available data for underreporting and misclassification. These estimates may differ significantly from the national statistics reported by the countries to WHO. The source of the estimates is the WHO, UNICEF, UNFPA and World Bank publication on maternal mortality.
Source: Maternal mortality in 2005. Estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/making_
pregnancy_safer/documents/9789241596213/en, access 27 May 2009).
Perinatal deaths (per 1000 births)
Number of weight-specific (≥ 1000 g) fetal deaths and early neonatal deaths per 1000 births (live births and stillbirths). If weight-specific data are not available, any available data provided according to national criteria are used as a proxy.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Table 4
Population with homes connected to a water supply system (% of total)
Percentage based on data from various sources. Definitions and estimation methods used may differ significantly between countries and time periods. For more detail, see HFA-DB.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Population with access to hygienic means of sewage disposal (% of total)
Percentage with access to a sewage system, septic tank or other hygienic means of sewage disposal based on data from various sources. Definitions and estimation methods used may differ significantly between countries and time periods. For more detail, see HFA-DB.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Deaths due to work-related accidents (per 100 000)
Number of deaths per 100 000 population due to work-related accidents: those occurring at or in the course of work which may result in death, personal injury or disease. The data source is the ILO yearbook of labour statistics. All industries are included, but commuting accidents (on the way to or from work) are excluded. National definitions and registration practices are understood to vary significantly.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Regular daily smokers in the population aged ≥ 15 (% of total)
Percentage of the population aged 15 years and above that regularly smokes each day, measured using a standard questionnaire during a health interview of a representative sample of this population. Many countries regularly carry out health interview surveys. The WHO Regional Office for Europe collects most of the data in HFA-DB from multiple sources. When only male and female values are available, the total is calculated as the average of the male and the female rates. More details on the sources may be available from the WHO Regional Office for Europe (http://data.euro.who.int/tobacco).
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Pure alcohol consumption (litres per capita)
Estimated amount of pure ethanol in spirits, wine, beer and other alcoholic drinks consumed per head in a country during a calendar year. It is calculated from official statistics on local production, sales, imports and exports, taking account of stocks and home production whenever possible. Pure alcohol is estimated at 4.5% in beer and 14% in wine. The WHO Regional Office for Europe calculates estimates on the basis of data collected mainly from three sources:
• publications on world drink trends formerly issued by Produktschap woor Gedistilleerde Dranken (Schiedam, Netherlands);
• the Food and Agriculture Organization of the United Nations (FAO); and
• WHO national counterparts.
Additional data are available in the specialized alcohol database maintained by the Regional Office (http://data.euro.who.int/alcohol/) and in the Global Information System on Alcohol and Health (http://apps.who.int/globalatlas/default.asp) maintained by WHO headquarters.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Road traffic accidents involving alcohol (per 100 000)
Number of road traffic accidents involving one or more people under the influence of alcohol per 100 000 population. This includes accidents involving personal injury, but not those with only material damage. A road traffic accident is defined according to the Inland Transport Committee of the United Nations Economic Commission for Europe (UNECE).
From 2002 onward, the data source is UNECE statistics on road traffic accidents in Europe.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
People killed or injured in road traffic accidents (per 100 000)
Number of people killed or injured in road traffic accidents per 100 000 population. See also the definition above. From 2002 onwards the data source is UNECE statistics on road traffic accidents in Europe.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
First admissions to drug treatment centres (per 100 000)
Number of people per 100 000 population who were admitted for the first time for treatment of conditions related to drug abuse during the calendar year.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Table 5
Total health expenditure as % of GDP, WHO estimates
Sum of general government and of private expenditure on health. WHO produced the estimates for this indicator, basing them as much as possible on the national health accounts classification (see 2006 world health report (http://www.who.int/whr/2006/
en) for details). The sources include both nationally reported data and estimates from international organizations – such as the International Monetary Fund (IMF), the World Bank, the United Nations and OECD – so they may differ from official national statistics reported by countries.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Total health expenditure per capita (in international dollars (PPP)), WHO estimates
Sum of general government and of private expenditure on health, as expressed in international dollars (US$ PPP – see definition in discussion of GDP above). WHO produced the estimates for this indicator, basing them as much as possible on the national health accounts classification (see 2006 world health report (http://www.who.int/whr/2006/
en) for details). The sources include both nationally reported data and estimates from international organizations – such as IMF, the World Bank, the United Nations and OECD – so they may differ from official national statistics reported by countries.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
General government health expenditure as % of total health expenditure
General government expenditure on health is the sum of outlays for health maintenance, restoration or enhancement paid for in cash or supplied in kind by government entities, such as the health ministry, other ministries, parastatal organizations or social security agencies (without double counting government transfers to social security and extrabudgetary funds).
It includes transfer payments to households to offset medical care costs and extrabudgetary funds to finance health services and goods. The revenue base of these entities may comprise multiple sources, including external funds. Total expenditure on health includes funds mobilized by the system; it is the sum of general government expenditure on health and private expenditure on health.
WHO produced the estimates for this indicator, basing them as much as possible on the national health accounts classification (see 2006 world health report (http://www.who.int/
whr/2006/en) for details). The sources include both nationally reported data and estimates from international organizations – such as IMF, the World Bank, the United Nations and OECD – so they may differ from official national statistics reported by countries.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
General government health expenditure as % of total government expenditure General government expenditure is the consolidated outlays of all levels of government (central/federal, provincial/regional/state/district, municipal/local governments), social security institutions and extrabudgetary funds, including capital outlays. It is provided by the central bank/finance ministry to IMF or by the United Nations Statistics Department.
General government expenditure on health is the sum of outlays for health maintenance, restoration or enhancement paid for in cash or supplied in kind by government entities, such as the health ministry, other ministries, parastatal organizations or social security agencies (without double counting government transfers to social security and extrabudgetary funds). It includes transfer payments to households to offset medical care costs and extrabudgetary funds to finance health services and goods. The revenue base of these entities may comprise multiple sources, including external funds.
WHO produced the estimates for this indicator, basing them as much as possible on the national health accounts classification (see 2006 world health report (http://www.who.int/
whr/2006/en) for details). The sources include both nationally reported data and estimates from international organizations – such as IMF, the World Bank, the United Nations and OECD – so they may differ from official national statistics reported by countries.
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).
Source: European Health for All database (HFA-DB) [online database]. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/hfadb, accessed 27 May 2009).