Intended for healthcare professionals


Life expectancy falls in Europe

BMJ 1998; 317 doi: (Published 19 September 1998) Cite this as: BMJ 1998;317:767
  1. Adrea Mach
  1. Geneva

    Laying the blame squarely on “poverty, unemployment, homelessness, excessive drinking, and smoking” and on health reforms that are too reliant on “market forces,” the World Health Organisation's latest report reveals that Europe's overall health is deteriorating for the first time in 50 years.

    The report, which contains data on key indicators of health, was released at this week's meeting of the 50 active member states of the WHO's regional committee for Europe in Copenhagen. It shows that average life expectancy across Europe (although still higher than in the other WHO regions) has fallen for the first time since the second world war--from 73.1 years in 1991 to 72.3 in 1995.

    The reason for the fall is the social and economic upheaval in the newly independent states of the former Soviet Union and the countries of central and eastern Europe. On average, a child born in the newly independent states can expect to live 11 years less than a child in the European Union.

    Re-emerging infectious diseases (such as malaria, diphtheria, tuberculosis), sexually transmitted diseases (such as syphilis and HIV/AIDS), and lifestyle mediated diseases (such as cancer, cardiovascular disease, and illnesses related to alcohol and tobacco) take a heavy toll. And, as the social safety net of the welfare state dissolves, extreme poverty (affecting 120 million of Europe's 870 million people), homelessness, and other social and environmental factors also undermine health.

    However, the report states that even among the 15 countries of the European Union there is little room for complacency as rising unemployment and the expanding divide between rich and poor have resulted in health problems. Also although infectious diseases such as tuberculosis and diptheria have so far been confined mainly to countries in the east of the region there is a risk that they will spread to western Europe.

    To tackle these problems, the WHO's regional committee for Europe is adopting a new strategy, Health21, which sets 21 targets for the 21st century. Arun Nanda, WHO's regional adviser for Europe, denied that this means that the organisation has abandoned its Health For All goals (see figure). He said that the Health21 document is the result of an unprecedented two year consultation process to update and consolidate the 38 regional health targets set in 1984. “It adapts the universal Health For All principles to our rapidly changing times and region,” he said.

    “The European region has changed dramatically over the last decade,” emphasised the WHO's director general, Gro Harlem Brundtland, in her address to the regional meeting. With 20 new members since the early 1990s, many new needs, and a disturbing trend in which “the vast majority of rich countries decrease their development cooperation,” the World Health Assembly in May had responded with “an historic decision … to increase allocations to two regions--Africa and Europe.” These resources are sorely needed in Europe, where “cardiovascular disease, cancer, and diabetes are the top three health problems … and share common risk factors--smoking, unhealthy nutrition, lack of physical exercise, and heavy drinking,” said Dr Brundtland.

    In reversing these trends, universal access to high quality healthcare services must remain “a bedrock principle,” Dr Brundtland emphasised. Market forces may have increased productivity; business may have enhanced cost effective resource allocation, but “the private sector will never become the key provider of primary health care or the guarantor of securing health services to the poor … that is a key responsibility for governments.”

    Health in Europe 1997 can be found on the World Health Organisation's website (

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    Selected Health For All targets: how Europe fared