THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE
PART IV - PROTECTING AND PROMOTING PUBLIC HEALTH AND TREATING DISEASES: HEALTH SYSTEMS, SERVICES AND POLICIES
13. THE WAY FORWARD
13.2. Assessing priorities through estimation of the burden of disease
13.2.2. Burden of diseases
13.2.2. Burden of
burden of disease estimates (EBD) are important communication tools, performed
at global, European and local scale. EBD indicators show big differences
between people living in industrialised and developing countries, and between
the east and west of Europe. The environment-related share of the burden of a
disease also depends strongly on socio-economic aspects such as income, the
share generally being higher in lower-income countries, i.e: estimated to be
2-6% of the total burden of disease in the OECD and 13% in non-OECD countries.
countries, acute infectious diseases still cause most of the disease burden;
while in the high-income countries chronic diseases at older ages
(cardiopulmonary diseases and cancer) dominate the picture (Figure 13.1).
Figure 13.1. Patterns of total and environmental Burden of Disease
in the developing and the developed world (non-OECD versus OECD)
health loss due to exposures from the physical environment is much higher in low-income
countries compared to developed countries. This is reflected in a different
disease pattern. In low-income, more traditional countries, the environmental
problems mainly concern the lack of access to clean water and inappropriate
housing and are primarily related to infectious diseases, indoor air pollution
and malnutrition. In post-industrial society, life-style is responsible for the
largest avoidable health loss.
A summary table
of the results of the global burden of disease study, published in 2005,
reports data on worldwide population, EU25, EU15 (Table 13.4).
Table 13.2. Global burden of disease study results (DALYs)
additional estimations of the burden of specific diseases are shown in Table 13.5.
Table 13.3. Additional estimations of burden of diseases and
selected health determinants
2005, neuropsychiatric conditions were the second most frequent cause of
disability adjusted life years (DALYs) in the WHO European Region according
to the Global Burden of Disease estimates, amounting to one fifth of DALYs
due to health conditions. In the WHO European Region, the age group 15 – 29
has the highest values of schizophrenia-associated DALYs – 616 544 for males,
and 579 006 for females, respectively. Mild mental retardation, resulting
from lead exposure, accounted for 4% of DALYs. The total DALY for Multiple
Sclerosis in Europe is 307 000 years and varies according to mortality
strata, being 157 000 in the very-low-child/very-low-adult stratum, 63 000 in the low-child/low-adult and 87 000 in the low-child/high-adult mortality strata
respectively (WHO, 2004). Few studies measuring DALYs have been carried out
so far for MS as compared to other neurological disorders. Furthermore,
comorbidity in MS and associated symptoms (eg., depression, urinary tract
infections) are often overlooked when measuring DALYs in MS.
terms of years lived with disability (YLD), the portion of neuropsychiatric
conditions is even higher – more than two fifths. With regard to single
neuropsychiatric conditions, four of the top 15 contributors to DALYs in Europe are neuropsychiatric disorders (depression in third place, alcohol use disorders
sixth rank, self inflicted injuries eleventh, and dementia fourteenth). In
terms of YLDs, schizophrenia is ranking 11th and accounts for 2.3%
of the years lived with disability (unipolar depressive disorder ranks 1st
and accounts for 13.7% of YLDs, followed by alcohol use disorder accounting
for 6.2% YLDs).
children aged 0-4 years, living in the WHO European region (51 countries),
2-6% of deaths from all causes were attributed to outdoor air pollution in
2004. Acute lower respiratory tract infections attributable to indoor air
pollution accounted for 5% of all deaths and 3% of DALYs.
conditions are a major cause of loss disability adjusted life years (DALYs)
and years lived with disability (YLDs). They are seldom fatal and the level
of disability for many is low to moderate; generally the major impact is
later in life. Musculoskeletal conditions rank in the top 10 causes of DALY
in Europe and osteoarthritis is the 5th greatest cause of YLDs in high-income
analysis carried out by the Swedish Institute of Public Health concluded
that in the EU, poor nutrition accounted for 4.5% of all DALYs
(disability-adjusted life years) lost. A similar figure was found for the
World Health Organization (WHO) European Region (at
present comprising 53 Member States) where excess body
weight is responsible for more than 1 million deaths and 12 million
life-years of ill health every year. In 2002, poor nutrition accounted
for 4.6% of all DALYs lost, obesity accounted for an additional 3.7% of DALYs
lost, while more than two thirds of the population is not engaged in
sufficient physical activity, contributing a further 1.4%
of DALYs lost.
all ages combined, UV radiation-induced melanoma leads to the loss of up to
250 000 DALYs annually in the WHO European Region.
smoking is the single most preventable cause of disease burden in the EU
accounting for about 12% of disability adjusted life years (DALYs)
World Health Report 2002 also estimated that over 3% of all disease burden,
over 20% of CHD, and 10% of stroke in developed countries is caused by