Transcript Witold Zatonski - ENQ Conference 2007

Health Inequalities in EU
Witold Zatonski
European Network of Quitlines Conference
10-11 December 2007, Rome, Italy
The project is jointly funded by the European Commission (60%) and by the Polish Government (40%).
W.Z. 2007
0
History of premature mortality in
Eastern Europe
1
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Life expectancy at birth in selected countries, both sexes
80
Sweden
75
South
Korea
70
Hungary
years
65
60
55
50
45
40
1950
1960
1970
1980
1990
2000
2
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 In the second part of twentieth century
there has been an amazing phenomenon
in eastern part of Europe – reversal of
adult health transformation
 Today we know that the reason for this
was serious negligence in public health;
lack of modern public health policy
3
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Overall Mortality Trend in Children Aged 0-14 and
Males aged 15-64, 1950-1990
1600
850
800
Increase of
Premature Mortality
1200
750
700
1000
650
800
600
600
550
400
500
200
0
1950
overall mortality, age 15-64
overall mortality, age 0-14
1400
450
400
1967
Mortality, age 0-14
1977
1987
Mortality, age 15-64
4
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Overall mortality trend in boys aged 0-14 and men aged 15-64 and
life expectancy at the age of 15 in Poland in men
mortality in age group 0-14
1400
Increase in premature mortality
800
750
1200
700
1000
650
800
600
600
550
400
450
400
1967
1977
1987
Mortality in age group 0-14
Mortality in age group 15-64
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56
55
54
53
52
500
200
0
1950
57
850
mortality in age group 15-64
1600
51
Decrease in life expectancy
50
1950 1955 1960 1965 1970 1975 1980 1985 1990
Life expectancy at the age of 15, men
5
Increase of adult
premature mortality
(1960-1990)
6
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Mortality from all causes
Poland and UK
600
500
600
Males 0-14
Males 15-59
550
400
deaths / 100,000
deaths / 100,000
500
300
200
450
400
350
300
100
250
0
200
1962 1967 1972 1977 1982 1987 1992 1997 2002
year
Poland
UK
1964
1968
1972
1976
1980
year
Poland
1984
1988
1992
UK
7
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 Dramatic increase of adult premature
mortality connected with lifestyle:
 Non-communicable diseases (manmade diseases)
 Fatal injuries (sudden deaths from
non medical causes)
8
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Trends in mortality in selected countries,
age group 20-64, 1963-1990 (1986-1994)
CVD
450
Lung cancer
deaths / 100 000
90
400
80
350
70
Poland
300
60
250
50
200
40
Liver cirrhosis
deaths / 100 000
100
Poland
Injuries
deaths / 100 000
600
150
500
80
70
0
1963
UK
1981
1990
0
1963
40
200
Poland
France 100
20
10
1972
300
30
20
50
Latvia
400
60
30
100
Russia
Hungary
90
50
Finland
deaths / 100 000
UK
10
1972
1981
1990
0
1963
1972
1981
1990
0
1986
1988
1990
1992
1994
9
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Adult premature over mortality in EE vs. WE,
(especially in men)
 Groups of diseases, in which primary
prevention (rather than treatment) is
effective, with known causes
 Appreciable successes were achieved in
their control in Western Europe
10
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 The highest premature
mortality of adult men in the
world (after sub-Saharan Africa)
11
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PROBABILITY OF DYING BY REGION, 1990
(data adapted from Murray and Lopez, 1994)
40
30
Males, age 15-59
Males, age 0-14
20
percentage
percentage
30
20
10
10
0
0
EME CHN MEC LAC
OAI
IND FSE SSA
OAI MEC IND
COMMUNICABLE DISEASES
COMMUNICABLE DISEASES
NON-COMMUNICABLE DISEASES
NON-COMMUNICABLE DISEASES
INJURIES
INJURIES
EME - Established Market Economies
FSE – Former Socialistic Economies
CHN - China
LAC - Latin America and the Caribbean
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EME FSE CHN LAC
OAI - Other Asia and Islands
MEC - Middle Eastern Crescent
IND - India
SSA - Sub-Saharan Africa
SSA
12
In the year 2002

The life expectancy in men in the Baltic countries of Latvia, Estonia and
Lithuania is about 12 years shorter than in the nearby Sweden.

Cardiovascular mortality is 5 times higher in Bulgarian women
(351/100,000) than in French women (69/100,000).

Lung cancer amongst Hungarian men (77/100,000) is nearly 4 times more
frequent than amongst Swedish males (20/100,000).

The death rates from liver cirrhosis in Hungarian (65/100,000) or Romanian
(52/100,000) men are more than 10 times higher than in men from the
Netherlands (4.4/100,000) or from Greece (5.3/100,000).

Fatal injuries amongst men in the Baltic States (Lithuania 219/100,000,
Latvia 210/100,000, Estonia 206/100,000) are about seven fold higher than
in the Netherlands (31/100,000) and the UK (33/100,000).
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Inequalities in Access to Health between East and
West of Europe
Gap between east and west part of Europe


One of the most important challenges for
European Union is the existing inequality in
access to health between east and west of
European Union.
The level of premature mortality among young
adults is a basic condition for diminishing the
economical and social discrepancies between
the countries in enlarging European Union.
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The gap in mortality between East and West of
European Union





It is mostly in young and middle age adults (20-64),
there is no difference in infant and children mortality
It is mostly pronounced in men, however as well in
women, but less
Cardiovascular mortality is the main contributor to the
gap in both sexes, however in men in the Baltic States
injuries exceed the share of CVD
Tobacco is still the biggest contributor to the health
gap, averaging 46% in men and 20 in women
Alcohol is a cause of that difference especially in men
(particularly from Baltic States), in women it doesn’t
have such impact
15
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Adult premature mortality from all causes, 20-64
men
2000
1500
1594
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1000
500
248
278
281
314
314
331
333
334
339
345
347
366
381
382
385
429
487
500
628
639
665
682
756
790
939
1008
1040
women
0
0
Sweden
Italy
Netherlands
Greece
United Kingdom
Ireland
EU15
Spain
Austria
Germany
Denmark
Luxembourg
Belgium
Finland
France
Portugal
Slovenia
Czech Republic
Poland
Slovakia
Bulgaria
EU10
Romania
Hungary
Lithuania
Estonia
Latvia
Russia
Spain
Greece
Italy
Sweden
Austria
EU15
France
Finland
Germany
Ireland
Luxembourg
Portugal
United Kingdom
Netherlands
Slovenia
Belgium
Czech Republic
Denmark
Slovakia
Poland
EU10
Bulgaria
Lithuania
Estonia
Hungary
Romania
Latvia
Russia
500
129
130
136
150
158
162
162
163
169
174
177
177
187
188
189
193
207
223
226
227
261
273
287
308
309
316
327
495
1000
1500
2000
16
Adult premature mortality from all causes in 2002,
men aged 20-64
EU15
333.0
EU5: Czech Rep., Hungary,
Poland, Slovakia, Slovenia
628.5
730.9
EU2: Bulgaria, Romania
EU3: Latvia, Lituania, Estonia
986.6
Russia
1593.6
0
200
400
600
800
1000
1200
1400
1600
1800
rates / 100,000
17
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Cardiovascular mortality
18
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Cardiovascular disease mortality
men aged 20-64, EU10 vs EU15
350
300
EU10
rate / 100,000
250
200
150
100
EU15
50
0
1970
1978
1986
1994
19
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Cardiovascular disease mortality
men aged 20-64 , EU5 vs EU15
350
300
EU5
rate / 100,000
250
200
150
100
EU15
50
0
1970
1978
1986
1994
2002
20
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Consumption of vegetable oils and butter
in Poland in 1970-2000 (kg/capita/year)
20
18
16
14
kg
12
10
8
6
4
2
0
1970
1980
year
vegetable oils
Source: National Food and Nutrition Institute, Poland
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1990
2000
butter
21
Polyunsaturated / saturated fatty acids ratio
in Poland and UK, 1950-1999
0,6
0,5
ratio
0,4
Poland
UK
0,3
0,2
0,1
0
1950
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1960
1970
year
1980
1990
2000
22
Tobacco
23
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Difference of life expectancy between EU10 and EU15, 2002
Tobacco attributable mortality, age 35-64
Tobacco-attributable fraction (PETO)
Men
age
Life expectancy difference
(years)
Life expectancy difference
due to tobacco
(years)
%
35-64
3.80
1.75
46%
Women
age
Life expectancy difference
(years)
Life expectancy difference
due to tobacco
(years)
%
35-64
1.42
0.28
20%
24
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Trends in smoking prevalence in men aged 20-64, 2002
EU10
60%
56%
EU15
54%
51%
47%
Percentage (%)
50%
43%
40%
36%
35%
30%
30%
26%
20%
17%
10%
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Sweden
Ireland
Portugal
Greece
Slovenia
Czech Rep.
Bulgaria
Latvia
EU15
EU10
0%
25
Trends in smoking prevalence in women aged 20-64, 2002
EU10
35%
33%
Percentage (%)
30%
25%
EU15
32%
31%
32%
27%
25%
21%
20%
15%
13%
19%
13%
10%
5%
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Sweden
Finland
Greece
Portugal
Romania
Lithuania
Hungary
Bulgaria
EU15
EU10
0%
26
Lung cancer mortality at age 20-64
EU10 vs. EU15
80
14
EU10
70
EU10
12
60
10
deaths/100,000
deaths/100,000
50
40
EU15
EU15
8
6
30
4
20
2
10
0
1967
1974
1981
1988
1995
2002
0
1967
1974
1981
1988
1995
2002
27
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Men
Women
Conclusions
 Tobacco is a leading cause of premature death in all
parts of the EU but tobacco-attributed mortality among
men is now higher in the East.
 In women the picture is more heterogeneous; in the East
there are countries with the lowest tobacco-attributable
mortality in the EU (Lithuania and Romania) and
countries with the highest (Hungary).
 Tobacco control in Eastern parts of the European Union
has a similar dimension as in the EU15, however a time
delay is observed. There has been much progress in
tobacco control in the EU10 in the last decade. This was
due in part to the policy changes necessary for
accession to the European Union.
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Is the gap closing?
29
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Changes in risk of dying, 1990 vs. 2002*
men aged 20-64 years
EU5: Czech Rep., Hungary,
Poland, Slovakia, Slovenia
-7.1
-4.6
EU15
EU2: Bulgaria, Romania
1.5
EU3: Latvia, Lituania, Estonia
2.1
15.4
20
Russia
15
* Belgium 1997, Denmark 2001
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10
5
percentage points
0
-5
-10
30
Closing the Gap
(assessment of the situation in years 1990-2002)
 the increase of adult premature mortality was stopped
 in the EU5 countries - in 1990
 in the Baltic States – in the mid 1990s (in 1994)
 Bulgaria and Romania – at the end of 1990s (1997)
 divergence of health situation in eastern part of
European Union
 systematic appreciable improvement of health indicators in EU5
countries, but in pace slightly higher than in the EU15
 despite the fact that the premature mortality stopped increasing
in the remaining 5 countries, there is only a slight improvement
of the health state observed, when compared to the end on
1980s; the gap between these countries and the EU15 was
increasing, especially in men
31
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What can be done to
close that gap?
32
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 There is a need for a special program of
health improvement (decline of adult
premature mortality) and evidence based
policy intervention
 Growth of the economy do not illustrate
changes in health (for example: Hungary,
Baltic States and Albania)
33
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34
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Tobacco-attributable premature deaths in 2002
in men aged 35-64, by major cause
(standardised mortality rates pre 100,000)
0
200
400
600
800
EU10
Lung cancer
Other cancers
Cardiovascular
Respiratory
Other causes
EU15
35
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Tobacco-attributable premature deaths in 2002
in women aged 35-64, by major cause
(standardised mortality rates pre 100,000)
0
5
10
15
20
25
EU10
Lung cancer
Other cancers
Cardiovascular
Respiratory
Other causes
EU15
36
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Changes in risk of dying (in percentage points),
1990 vs. 2002, age group 20-64, men
Changes in risk of dying (in percentage points),
1990 vs. 2002, age group 20-64, w omen
Russia; 15.36
Russia; 6.27
Latvia; 2.31
Netherlands; -0.29
Lithuania; 2.12
Romania; -0.48
Estonia; 1.91
Latvia; -0.49
Romania; 1.81
Bulgaria; -0.55
Bulgaria; 0.61
Estonia; -0.68
Greece; -1.57
Belgium; -0.85
Belgium; -1.88
Lithuania; -0.90
Netherlands; -3.57
France; -0.96
Luxembourg; -3.67
Greece; -1.59
EU10; -3.77
Sweden; -1.65
Spain; -3.83
Finland; -1.84
France; -3.88
Italy; -1.90
Portugal; -4.06
Spain; -1.95
Sweden; -4.39
EU15; -1.96
UK; -4.43
Slovenia; -2.15
EU15; -4.58
Portugal; -2.34
Ireland; -5.08
EU10; -2.41
Denmark; -5.27
Austria; -2.51
Italy; -5.37
UK; -2.66
Hungary; -5.46
Germany; -2.68
Slovenia; -5.55
Luxembourg; -2.82
Austria; -5.60
Denmark; -3.19
Germany; -5.68
Hungary; -3.38
Poland; -6.81
Poland; -3.47
Finland; -7.28
Ireland; -3.51
Slovakia; -7.52
Slovakia; -3.58
Czech Rep.; -9.31
-15
-10
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Czech Rep.; -3.88
-5
0
5
10
15
20
-6
-4
37
-2
0
2
4
6
8