1. FOREWORD

The main objectives of this Report, consisting of the executive summary, the extended summary and the full report, are:

·          Assessment of the status of health through selected indicators and their trends mainly over the last 10 years and, when possible, over a longer period;

·          Analysis of the health determinants underlying the evolution of health indicators, and related Community and National policies;

·          Provision of data and information to facilitate the identification of priority issues for future investigations or actions and, when possible, of valuable relevant practicable approaches and policies.

This Report, therefore, does not intend to identify priorities in public health on behalf of the European Commission and/or Member States nor to recommend them the adoption of specific policies and control tools to address emerging needs, but only to provide a reliable and scientifically-sound picture of what is the status of health in the European Union, the nature of health determinants and relevant information gaps, what are the main policies and control tools adopted so far and, whenever possible, the extent of their success or failure.

So far, two related Reports have been published:

a) in 2003, “The Health Status of the European Union - Narrowing the Health gap”;

b) in 1996, “The State of Health in the European Community”.

However, this comprehensive Report considers a very different Institution than those addressed in the two above-mentioned Reports. Not only the number of Member States and the size of the overall population of the European Union has remarkably increased following the enlargement to 25 countries in 2004 and to 27 countries in 2007, but also previously-identified health-related trends have developed fast, while new trends have brought new challenges. In the meantime, civil society involvement and mobilization have been considerably strengthened and many new institutional and policy developments have taken place both at EU and Member States levels.

This very comprehensive Report has been: (i) financially supported by the D.G. "Health and Consumers" of the European Commission (Grant Agreement n. 2005115) (ii) produced through a 3-year process (from 15 November 2005 to November 2008), begun by the Steering Committee (Peter Achterberg, Yves Charpak, Pietro Folino Gallo, Paola Di Martino, Donato Greco, Nata Menabde, Antoni Montserrat, Zsuzsanna Jakab, Arun Nanda, Walter Ricciardi, Stefania Salmaso, Emanuele Scafato, Benedetto Terracini, Lorenzo Tomatis) who met in one occasion to set the overall guidance for the Report development; ii) with the participation of more than 60 experts from most European Member States and of several international Organizations (Appendix 1); (iii) reviewed by the experts listed in Appendix 2; (iv) supervised by officers designated by the Ministries of Health (or by the Scientific Institutions appointed by them) of all the EU Member States, Croatia, Turkey, Iceland and Norway1 as well as of several Intergovernmental and International Organizations and EU Agencies (Appendix 3); and (v) considered by the Drafting Committee (Appendix 4).

The Report covers most relevant diseases and disorders as well as health determinants and main policies developed at Community and Member State level. The adopted approach takes into account the four-dimensional character of the interactions between human beings with their highly-specific intrinsic characteristics (e.g. genome and age) and biological, chemical, physical and socio-economic factors through a number of exposure routes and many different kinds of environment. This kind of approach is fundamental to understand well how the health status of each individual at a given time in his/her life is the result of the many interactions occurred until that time. However, due to the complexity of these interactions and of their development throughout life, there is an obvious need for developing much more complex interpretative models than those currently available to fully understand and predict the impact of the different stressors on public and individual health.

It is important to highlight at the outset that while this Report adopts a European comparative perspective, there are considerable difficulties and limitations associated with making such comparisons. For instance, definitions and measurement of key indicators and data coverage inevitably vary across countries, due to cultural, technical, political and social factors. Cross-country comparisons should, therefore, always be interpreted with caution. A European public health goal should therefore seek convergence or mapping between local variations of measurement, if comparisons are to be strengthened.

The process used to collect all the available data (see Appendix 5) for preparing the Report clearly highlights a practicable approach on how to make optimal use of the available data previously collected by European, Intergovernmental and International Organizations within their mandates and on how to obtain additional data and information from Member States or other sources, including relevant EU-funded projects. This kind of approach could be adopted also for producing future reports on the status of health in the European Union as it provides for a wide participation and allows considerable resource savings.

Apart from a few exceptions, each Chapter of this Report, constituting its 5 Parts, has been structured into 8 sections: (i) Introduction; (ii) Data sources; (iii) Data description and analysis; (iv) Risk factors; (v) Control tools and policies; (vi) Future developments; (vii) References; and (viii) Acronyms.

We hope that this Report and the approaches it has used can be useful for EU D.G. “Health and Consumers” and Health Authorities of European Countries for fulfilling their task of collecting, analyzing and disseminating data and information related to health status, health determinants, health systems and health policies as well as to facilitate the cooperation among the EU Member States and with the European Commission. Furthermore, the Report may be an information tool for the Member States to establish in an efficient manner public health priorities as well as adopt and implement adequate policies and control tools to further improve the health conditions of their citizens. The Summaries and the Report are available at the EUGLOREH project website (www.eugloreh.it) and will be linked to the homepage of the European Commission D. G. Health and Consumers (http://ec.europa.eu/dgs/health_consumer/index_en.htm).

The value of this Report largely depends on the contributions of many experts who have kindly accepted to collaborate by providing manuscripts with high-quality scientific analyses and comments on specific subjects. On the other hand, integrations and amendments have been often made to the original contributions in order to take into account comments and suggestions received by other partners for improving the comprehensiveness and coherence of the Report as a whole. Therefore, in some cases, the Report may not completely reflect the views of the original contributions.

We wish to express our sincere appreciation and thanks to all those who have contributed and made possible this undertaking. While it is not possible to mention all of them, we wish to acknowledge the kind help of the colleagues at the Ministry of Health and at the National Health Institute: Nicola Begini, Francesca Belli, Antonella Calabrò, Marina D’Avanzo and Paola Marini for financial matters, Gaetano Guglielmi for taking care of website matters, as well as Susanna Conti, Carlo Donati and Colomba Iacontino for different scientific and administrative aspects. Finally, we wish to acknowledge the invaluable assistance of Beniamino Cislaghi, seconded from the World Health Organization - European Regional Office, in the management of the project.

 Vittorio Silano                                                          Luciano Vittozzi

Project Coordinator                                                  Project Manager

October 2008