Intended for healthcare professionals

Analysis Health Systems Perspectives

Health policy in Europe: factors critical for success

BMJ 2013; 346 doi: (Published 20 March 2013) Cite this as: BMJ 2013;346:f533
  1. Johan P Mackenbach, professor of public health1,
  2. Marina Karanikolos, research associate2,
  3. Martin McKee, professor of European public health 2
  1. 1Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
  2. 2European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  1. Correspondence to: J P Mackenbach j.mackenbach{at}
  • Accepted 7 January 2013

Large health gains could be made if all countries in Europe adopted the health policies of the best performing country. Johan P Mackenbach, Marina Karanikolos, and Martin McKee examine the differences between countries and the reasons behind them

Over recent decades, policies in areas such as tobacco and alcohol control, early detection of hypertension and cancer, and child and road safety have made important contributions to improvements in population health in Europe. This progress has, however, been uneven, and some countries lag considerably behind the front runners.1 2 While some of these variations reflect differences in available resources, others reflect differences in willingness to take action, as illustrated by the fact that neighbouring countries in similar economic conditions sometimes have very different outcomes.

Major successes mirrored by large failures

Over the past 40 years, European countries have followed very different health trajectories. This can most easily be seen in the area of life expectancy, which has increased almost continuously in the Nordic countries, the United Kingdom and Ireland, and continental and Mediterranean Europe. Yet in central and eastern Europe3 and the former Soviet Union,4 it was already stagnating by 1970 and began to improve only in the 1990s or later (fig 1). The differences are due to diverging trends in rates of death from a wide range of causes, many of which have become amenable to interventions within and outside the healthcare sector, such as lung, cervical, and breast cancer; ischaemic heart and cerebrovascular disease; liver cirrhosis; maternal and infant mortality; and road traffic and other injuries.

Fig 1 Trends in life expectancy at birth (both sexes combined) in exemplar countries from western Europe (Sweden), central and eastern Europe (Hungary), and the former Soviet Union (Russian Federation)

Changes in mortality from a particular cause almost always reflect the interplay of …

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