13.3. Demographic and socio-economic changes

The ageing of European populations is the inevitable consequence of developments that are fundamentally positive: increased life expectancy - often in good health - and easier choice over whether and when to have children, in particular by increasingly educated women who enjoy easier access to the labour market. Active inclusion and active labour market policies are needed to target the most disadvantaged population groups. Having a job represents the best chance of avoiding exclusion, although this is not always guaranteed. Looking at the population overall, some 16% of EU citizens, i.e. 78 million people, are at risk of income poverty, with women more likely to be exposed. In most Member States, children and young people are among the vulnerable groups facing an even higher risk.

A number of indicators highlighted in this Report clearly show that the status of health in the EU is improving fast and that it is possible to move further toward a healthier European Union. Such a conclusion stems from many different analysis and particularly from the large differences emerging for all the above-mentioned indicators when health data concerning the EU Member States are compared. This is also the case when the positive time-trends of most different diseases prevalence and incidence are compared. In 2006, the European Commission, Directorate-General for Economic and Financial Affairs, released a Communication with recommendations for addressing “The demographic future of Europe – from challenge to opportunity” (European Commission 2006) and another for addressing The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long-term care, education and unemployment transfers (2004-2050). Very relevant in this context is also the Joint Report on Social Protection and Social Inclusion (2008).

However, the complexity of the health systems and the many involved variables represent important limitations when developing public health policies. The lack at European level, of a consensus methodological approach to define priorities, support decisions and evaluate cost-effectiveness of programmes represents the main limitation facing public health decision makers. More research is needed to evaluate the effectiveness and cost-effectiveness of public health intervention. The current thinking of economic evaluations and the mechanism of economic appraisal can and should be more applied in the area of public health in order to better inform policy makers. Within this context, the European cooperation is fundamental and may provide new and more sophisticated tools to cope with current needs.

The far-reaching demographic and socioeconomic changes, highlighted in this Report, call for the adoption of new policies, for reasons of both economic efficiency and social equity. After reforms under the Lisbon strategy, growth has picked up and jobs are being created while unemployment is being reduced across Europe, although the economic scene is currently complicated by the on-going economic crisis. Moreover, healthy growth and job creation do not automatically enhance social cohesion or improve the situation of those most marginalised within our societies. Active inclusion and active labour market policies are needed to target the most disadvantaged. Having a job represents the best chance of avoiding exclusion, although this is not always guaranteed. Some 8% of EU citizens live at a risk of poverty despite being employed. Even in buoyant labour markets, the share of jobless households can remain unaffected and some find themselves stuck in a cycle of low pay/no pay. Looking at the population overall, some 16% of EU citizens, i.e. 78 million people, are at risk of income poverty, with women more likely to be exposed. In most Member States, children and young people are among the vulnerable groups facing an even higher risk.