The World Health Organisation has urged Europe to put health at the heart of its socioeconomic recovery from the coronavirus pandemic.
Its European Health Report 2021, published on Thursday, describes the challenge as daunting but suggests there is a "critical window" in which meaningful action can be taken.
The report identifies several successes and failures in Europe's health outlook, with a reduction in cardiovascular disease countered by a general worsening of mental health.
“We have a stark choice at this juncture almost two years into the pandemic,” said Dr Hans Henri P Kluge, WHO regional director for Europe.
“We can prioritise the health sector as never before, with an urgent focus on long-neglected issues including mental health, recognising health systems and health workers as essential pillars of socioeconomic recovery and key to preparing for future shocks."
The Russia-Ukraine war is less a future shock, and a two-million strong diaspora of largely Covid unvaccinated migrants from a country in the midst of a polio outbreak is very much in the WHO's purview, with a press briefing on the potential impact of the crisis this week.
A WHO representative told The National the body was monitoring the crisis but does not think it will distract European countries from addressing existing health inequalities.
As well as setting out a framework for action, the triannual report monitors health indicators such as universal health coverage, non-communicable diseases and environmental health.
In concert with report co-author Dr Ausra Zelviene, WHO consultant and head of psychoactive substance use, prevention and co-ordination division at the drug, tobacco, and alcohol control department with the government of Lithuania, The National highlights some of Europe's health successes and failures.
Europe's health successes
Cardiovascular deaths decrease by almost 20%
Between 2010 and 2018, premature mortality because of cardiovascular diseases fell by almost 20 per cent.
The trend is not a new one, with deaths related to the heart decreasing now for 25 years.
Dr Zelviene identifies two factors in this reduction: better health behaviour and improved healthcare which now acts as an early warning system for problems.
"Primary healthcare [now] sees the intermediate risk factors like race blood compression, race blood glucose, race blood lipids, and obesity … and reacts to these conditions," she said.
Going deeper into the data, four out of five incidences of cardiovascular disease are either heart attacks or strokes, and one third is experienced by those under 70.
The risk of cardiovascular disease is also much higher in women than in men.
"There is a greater prevalence of behavioural risk factors in men like unhealthy diets, physical inactivity, tobacco smoking," Dr Zelviene said.
Cancer deaths decrease by 10 per cent
The picture with cancers is less clear cut than cardiovascular as cancer still accounts for more than 20 per cent of all deaths, a situation exacerbated by the pandemic’s impact on screening and treatment.
Yet decreasing deaths have to be categorised as a success, and further lifestyle interventions and narrowing in health disparities could ease the trajectory.
"Around one third of deaths from cancer are due to tobacco use and other unhealthy behaviours like high alcohol and low fruit and vegetable consumption," Dr Zelviene said.
"One of the main messages would be that many cancers can be cured if detected early and treated effectively."
This is where health inequities need urgent redress.
"Many health systems in low and middle income countries are not very well prepared to manage this burden and large numbers of cancer patients do not have access to timely and quality diagnosis and treatment," Dr Zelviene said.
"Comprehensive treatment is available in more than 90 per cent of high income countries and less than 15 per cent of low income countries.
Lower maternal, newborn and child mortality
All countries in the WHO European region have met the WHO target for maternal mortality of fewer than 70 per 100,000 live births by 2030. The region’s average rate is at 13 per 100,000 live births, as of 2017.
Almost all countries in the WHO European region have met the target for newborn and child mortality rate of fewer than 12 and 25 deaths per 1,000 live births, respectively.
Dr Zelviene said the main factor in this propitious trend is improved access to, and provision of, care to poor people.
"Women who are in trouble, that is both before pregnancy and during pregnancy, they will get appropriate care and if something bad happens those events will be investigated, and the knowledge is transmitted further in order to avoid them in future," she said.
"One more [very important factor] is the continuous education both of healthcare providers and patients to see the earliest signs of medical complications of pregnancy."
Europe's health failures
More smokers than global average
Twenty-six per cent of the adult population still smoke tobacco compared to the global average of 23.6 per cent.
This is not the full picture, however, as Europe started from a very high level - 35 per cent at the millennium.
Interestingly, while the prevalence of male smokers has dropped during this period, the prevalence of female smokers has plateaued at about 18 per cent.
A reason for the slowness of the decline is regulatory.
"Only 14 out of all 53 countries in the region prohibit smoking in all out of places and public places," Dr Zelviene said.
She also highlighted the fierce opposition of the tobacco industry as an impediment to robust regulatory change, and many countries in Europe fail to tax big tobacco proportionately.
The common denominator in countries such as Finland, Iceland and Denmark, where prevalence of smoking is very low, is "clear and restrictive rules on smoking in outdoor public spaces, as well as indoors and in workplaces", she said.
"The situation is very uneven across the region and needs to be improved."
Worsening mental health
The coronavirus pandemic has had a rapid and profound impact on mental health and well-being in the region.
Both the direct threat of the outbreak of infections and containment measures have resulted in feelings of loneliness, fear and pessimistic perspectives, as well an increase in symptoms of depression and anxiety among parts of the population.
One of the highest global suicide rates
Globally every year, 700,000 people take their own life with many more suicide attempts.
Despite a declining trend, the region still has one of the highest standardised suicide mortality rates in the world.
In 2019, before the pandemic, 119,000 people in the region died because of suicide.
WHO has prioritised the reduction of suicide mortality and aims to reduce the suicide rate by a third by 2030.
Rising HIV infections
Europe is one of two WHO regions where the number of HIV infections is increasing.
New HIV infections increased by 6 per cent for every 1,000 people between 2015 and 2019.
One in three children obese
Almost 1 in 3 children in the region are overweight or obese
Obesity is one of the greatest public health challenges of the 21st century, and a complex and multifactorial disease.
The prevalence of obesity also varies between boys and girls and across member states: 13 per cent in boys and 9 per cent in girls.
Higher rates are observed in Mediterranean countries, whereas central Asian countries have the lowest prevalence.