EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

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

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13.2.2. Burden of diseases

 

Environmental 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.

 

In low-income 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)

 

Furthermore, the 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)

 

Moreover, 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

·          In 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 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.

·          In  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).

·           Among 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.

·          Musculoskeletal 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 countries.

·          An 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.

·          For all ages combined, UV radiation-induced melanoma leads to the loss of up to 250 000 DALYs annually in the WHO European Region.

·          Tobacco smoking is the single most preventable cause of disease burden in the EU accounting for about 12% of disability adjusted life years (DALYs)

·          The 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 physical inactivity.