Remarks by Angel Gurría,
Secretary-General, OECD
Brussels, Belgium
23 November 2016
(As prepared for delivery)
Dear Commissioner Andriukaitis, Ladies and Gentlemen:
I am delighted to present the 2016 edition of Health at a Glance: Europe. This report is a joint flagship publication of the OECD and the European Commission and reflects our renewed and strengthened co-operation. I would like to thank Commissioner Andriukaitis for his personal commitment and support.
Health at a Glance: Europe is a diagnostic tool: it presents key indicators of health and health systems in 36 European countries ─ including the 28 EU member states, five candidate countries and three European Free Trade Association countries ─ and is intended to help these countries assess the relative strengths and weaknesses of their health systems. It is a good example of the OECD’s efforts to inform evidence-based policy, rather than document policy-based evidence!
Given the scale of the health challenges our countries face, including Sustainable Development Goal 3 to “ensure healthy lives and promote well-being for all at all ages”, this report offers a timely contribution to support more effective, accessible and resilient health systems in Europe.
The EU has made progress: people are living longer and receiving better treatment
Health at a Glance: Europe shows that the quality of care has improved in EU countries over the past decade, contributing to steady gains in life expectancy. Since 1990, life expectancy has risen by more than six years on average across EU countries, reaching 80.9 years in 2014.
Survival rates for life-threatening conditions such as heart attacks and strokes have gone up across Europe, thanks to earlier diagnosis and better treatments. Over the past decade, survival rates for people admitted to hospital for heart attacks have increased by almost 40% on average in the EU. Death rates from all types of cancer among men and women have declined ─ at least slightly ─ in most EU member states since 2000.
At the same time, the number of physicians per capita has increased in nearly all EU countries, on average by 20% since 2000 ─ from 2.9 doctors per 1,000 population at the turn of the millennium to 3.5 in 2014.
Health spending in EU countries fell to zero growth in the years following the crisis and then recovered only gradually: in the past two years, growth of health spending averaged between 1% and 2% in real terms, about the same rate as GDP growth. For the EU as a whole, health spending accounts for around 10% of GDP. Germany, Sweden and France allocate 11% or more of their GDP to health, while countries in the Eastern part of the EU tend to spend much less, ranging from 5% to 6%.
While the EU has made good progress overall, the report emphasises the need to face up to a number of key challenges that threaten the health and well-being of EU citizens.
Let me take a moment to highlight a few of these.
Firstly, pressure on health budgets is increasing. This is in part because the EU is ageing: the share of the population aged over 65 in EU countries is projected to rise to 30% by 2060, compared to less than 10% in 1960 (and nearly 20% in 2015). Most of the 50 million EU citizens currently suffering from two or more chronic conditions are aged over 65.
Naturally, public demand for cutting-edge ─ and expensive ─ technologies that offer better and earlier diagnoses and treatment options is growing. Achieving further efficiency gains in hospital, pharmaceutical spending, administration and other health spending items will be critical to managing these pressures with limited resources.
Secondly, further efforts are needed to prevent, treat and manage different cancers and chronic diseases. In the EU, non-communicable diseases such as heart attacks, strokes, diabetes, cancer and respiratory diseases result in the premature death of more than 550,000 people of working age each year. This represents a loss of about 3.4 million potential productive life years, and a loss of EUR 115 billion annually (0.8% of EU GDP). These costs are unaffordable. Yet they are avoidable!
Many EU countries are actively targeting the risk factors for chronic diseases through a mix of public awareness campaigns, regulations and taxation. Yet, more than one in five adults in the EU continue to smoke every day. More than one in five adults in the EU report heavy alcohol consumption on a regular basis. And one in six adults is obese. We must do more ─ not only for the health of our populations, but for the health of our economies!
This means further investment in prevention ─ member states currently allocate only around 3% on average of their health budget to public health and prevention. It also means more integrated health and labour market policies, for example encouraging firms to remove physical barriers to work; providing equal training opportunities for people with some forms of disabilities; reinforcing employment protection regulations; and offering work flexibility for early return-to-work.
Further progress in the fight against cancer could be achieved through national cancer control plans that focus political and public attention on performance in cancer prevention, early diagnosis and treatment. This will require greater efforts to reduce important risk factors like smoking, to increase cancer screening rates, and to ensure timely access to the best treatments available.
Thirdly, health inequalities persist across the EU. The increase in life expectancy is to be celebrated, but differences remain, both across and within countries. People in Western European countries live, on average, five years longer than those in Central and Eastern Europe. Within countries, the most educated live around seven years longer than those with the lowest levels of education. This is a shocking statistic. The better prevention policies that I called for earlier will help. In addition:
- We need to continue to work towards universal access to high quality health care: four EU countries (Cyprus, Greece, Bulgaria and Romania) still had more than 10% of their population not regularly covered for health care costs in 2014. This includes ensuring a sufficient number and mix of health care providers in rural, regional and remote areas in line with the recommendations of the UN High-Level Commission on Health Employment and Economic Growth (which the OECD co-vice chaired with the World Health Organisation and International Labour Organisation), and the recommendations of the OECD report, Health Workforce Policies in OECD Countries. We need the right health care jobs, and the right skills, in the right places!
- We must also keep a close watch on out-of-pocket medical expenses, to ensure the poor are not priced out of quality healthcare. In 2014, poor people were, on average, ten times more likely to report unmet medical needs for financial reasons than rich people across EU countries.
Ladies and Gentlemen: Good health is the foundation of well-being. It is the key to long, happy and productive lives. As the Roman poet Virgil once said “the greatest wealth is health”. Health policy is not something we can afford to get wrong.
This study is a timely reflection on how to get it right in the EU, on how to improve health spending efficiency, strengthen the prevention and management of different cancers and chronic diseases, and address persistent health inequalities.
It is also the building block of the OECD’s new strategic co-operation with the European Commission that will also involve country-specific assessments and the development of a new generation of health statistics ─ patient-reported indicators to put people at the centre of health care systems.
Together, we can improve the “State of Health in the EU” and empower all European citizens with good health for better, longer, and more active lives.
Thank you.
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