Life expectancy has risen across the Region since 1990, with women in general living longer than men, but increased differences between countries and worrying increases in early death in men in eastern countries, particularly middle-aged men in Eur-C, need to be addressed.
Life expectancy
Average life expectancy is the standard summary measure of the length of the lifespan. The average for the Region has reached 74 years, an increase of 1 year since 1990. The life-expectancy estimates in this section are based exclusively on official statistics of Member States and may differ from those in Annex Table 2, which were computed by WHO to assure comparability.
Life expectancy has recouped the losses of the mid-1990s, although several countries in the Commonwealth of Independent States (CIS) still struggle to regain the positions they held in 1990. Differences between individual countries, and between Eur-A, -B and -C, however, have widened (Table 1).
Countries such as the Czech Republic, Hungary and Poland have made big strides, but others were in turmoil in the early 1990s, with significant declines in life expectancy. The difference between the countries with the highest and lowest estimated average life expectancy rose from about 12 years in 1990 (Iceland and Sweden versus Turkey and Turkmenistan) to about 15 years in 2003 (Iceland and Switzerland versus Kazakhstan and the Russian Federation).
In many countries, the average life expectancy for women is now over 80 years, particularly in Eur-A (Fig. 2). Eur-C males have the lowest figures. The average gap in life expectancy between
Country
Life expectancy (years)
1990 1995 Latest
available (year)
Bosnia and Herzegovina Bulgaria
Croatia Cyprus Czech Republic Denmark
Republic of Moldova Romania
Russian Federation San Marino
Serbia and Montenegro Slovakia TFYR Macedoniab Turkey
Turkmenistan Ukraine United Kingdom Uzbekistan European Region Eur-A
75.8 (2003) NA 73.1 (2003) 78.9 (2003) 72.4 (2002) 68.5 (2003) 77.6 (1997) 72.7 (1991) 72.4 (2003) 74.7 (2003) 79.4 (2003) 75.4 (2003) 77.2 (2000) 71.2 (2002) 78.7 (2003) 79.4 (2000) 76.1 (2001) 78.8 (2001) 79.0 (2001) 72.6 (2003) 80.9 (2001) 77.2 (2001) 79.7 (2003) 80.3 (2001) 65.9 (2003) 67.9 (2003) 71.0 (2003) 72.2 (2003) 78.9 (2003) 78.6 (2003) NA 78.8 (2003) 79.1 (2002) 74.7 (2002) 77.3 (2002) 68.1 (2003) 71.0 (2002) 64.9 (2003) 82.3 (2000) 72.7 (2002) 73.9 (2002) 76.5 (2003) 79.8 (2001) 80.0 (2001) 80.5 (2001) 72.0 (2001) 73.5 (2003) 70.0 (2003) 66.1 (1998) 67.8 (2003) 78.5 (2002) 70.0 (2002) 74.0 79.0 (2003) 71.6 (2002) 66.3 (2003)
a NA= not available.
b The former Yugoslav Republic of Macedonia Source: European health for all database (3).
Table 1. Life expectancy at birth in the WHO European Region
women and men in the Region is about 8 years: about 4 years in Tajikistan and Iceland, but 13 years in the Russian Federation. In general, the female–male differences in life expectancy between countries decreased in the 1990s. These differences are smallest in Eur-A, where the difference decreased considerably, while life expectancy in Eur-B increased more for men than women. The
difference grew in Eur-C, however, where male mortality increased in several CIS countries.
Mortality and socioeconomic factors
The mortality crises in several CIS countries have been accompanied by increasing inequality in socioeconomic indicators, at least temporarily
(Annex Table 3). In the early 1990s, the Russian Federation and Ukraine were among those with the largest increases in income inequality (4) and in mortality among middle-aged men, although the most recent surveys show improvements. Among the countries in the eastern half of the Region, relatively small increases in income inequalities were found in the Czech Republic, Hungary and Poland, where male life expectancy at birth rose.
Gradients in mortality between socioeconomic groups have increased in many western European countries, too, such as France, the Nordic
countries and the United Kingdom (5).
Underlying societal changes have shaped the health trajectories of populations in the European Region, across countries and socioeconomic subgroups. In many cases, unfavourable mortality trends in particular
socioeconomic subgroups are
probably behind the increasing health inequalities in countries. In general,
Fig. 2. Life expectancy at birth by sex and country grouping, 1980–2003
disadvantaged groups benefit later from improvements in health determinants. They are also the most vulnerable when unexpected societal changes occur. Evidence is accumulating, however, that such vulnerability is related to negative changes in people’s relative position in society, which create long periods of unhealthy psychosocial stress. This can result in unhealthy behaviour, particularly in the absence of supportive social environments and personal coping skills (6–9).
Amenable mortality
Analysis of amenable mortality – the deaths that would be preventable if all the relevant medical knowledge, services and resources of the health system and society were optimally applied – can address the question of how much health systems specifically contribute to health. The results could indicate the levels of utilization of the available knowledge in practice. The question has two parts: what are the contributions of health care and of public health programmes to population health outcomes?
This report addresses the latter, as amenable mortality can show the impact of primary and secondary prevention. Primary prevention – interventions to reduce people’s exposure to lifestyle and occupational risk factors for diseases and injuries – should reduce the incidence and deadliness of amenable conditions. Secondary prevention comprises screening, early case detection, diagnosis and adequate treatment.
85
80
75
70
65
60
55
Source: European health for all database (3).
1980 1985 1990 1995 2000 2005 Year
Life expectancy (years)
Eur-A, females
Eur-A, males
Eur-B, females Eur-C, females
Eur-B, males
Eur-C, males
Table 2 shows a time cross-section of such conditions (10) and the mortality rates in the countries in the Region. Countries show little difference in some conditions, such as melanoma of the skin and breast cancer, but large differences, which mean potential for improvement, in others, such as stroke, liver diseases, cancer of the uterus and traffic accidents.
Over time, amenable mortality is one of the factors underlying the differentials in mortality between countries. A recent study showed that, in 1980–1997, amenable mortality declined in all the countries that comprised the EU before May 2004 (11). The largestvariations in trends between countries, however, appeared in conditions mainly subject to prevention strategies.
Several countries showed trends that deviated significantly from the average, and some large avoidable causes had relatively unfavourable trends.
Similarly, amenable mortality can explain a large part of the east–west gap in life expectancy.
Andreev et al. (12) compared trends in life expectancy in the Russian Federation and the United Kingdom and their components attributable to amenable mortality. In the period 1965–1999, mortality from such causes remained practically unchanged in the Russian Federation (apart from fluctuations), while the rates in the United Kingdom steadily declined. In 1999, amenable causes were responsible for differentials in life expectancy between the two countries: three years in men and two years in women.
Differences across countries and population groups indicate how much impact policies to prevent and control major risk factors – such as high blood pressure, high cholesterol, smoking, etc. – could have. They also show that no country consistently has the best results on all indicators.
Rather, every country can learn from comparisons with its peers and benefit from their knowledge, if appropriately transferred and adapted for use according to local needs and resources.
HALE
The methodology of HALE estimations has improved considerably in recent years. This has created momentum in countries: HALE is increasingly calculated at country and subnational level and, no less important, public health experts and authorities have started to demand HALE estimates to assist their policy-making. They appreciate that HALE can usefully complement traditional health indicators. For example, an analysis of HALE in the Russian Federation (13) provided insights into patterns of population health in different age groups and by sex; these differ from the mortality patterns. Public health experts in the United Kingdom (14) recognize that HALE provides valuable information on morbidity and health care use and can therefore complement the analyses of population health needs and health inequalities that form the basis for the allocation of resources at the subnational level (15). HALE is a practical summary measure of population health, because the indicator is easy to communicate and suitable data are available in many countries of the Region through registers and population surveys.