East/West Differences in Health in Europe: Rates, Expectancies and DALYs

  • J. Powles
  • H. Gouda
Reference work entry


There is a very large health gap between Eastern and Western Europe. We show how different health metrics can be used to characterize this gap. We compare the 15 countries that joined the European Union prior to May 2004 (EU15), the ten who joined since May 2004 – excluding Malta and Cyprus – (EU10) and the three Slavic states of Russia, Ukraine and Belarus (Slavic 3).  Rates and  risks show that mortality differences are most pronounced amongst adult males, with those in the Slavic 3 being worst off. They also identify the diseases of the circulatory system and injuries as leading contributors to this gap.  Life table methods can show how different life stages and different causes of death each contribute to the overall mortality gap. Summary measures –  health expectancies and health gaps – combine information on health losses from premature death with information on losses from disease and injury among the living. A particular advantage of health gap metrics (such as the Disability adjusted life years (DALY)) is their capacity to “decompose” health differences into the conditions that produce them. These can, in turn, be attributed to the risk factors that cause them. We illustrate this process with an assessment of the contribution of alcohol to the health gap. Health losses attributable to alcohol are several times higher in males than in females and much higher for males in EU10 and especially Slavic 3 than in EU15.

Metrics for public health assessments should be chosen carefully with the purpose for conducting the assessment clearly in mind.


Perfect Health Mortality Level Mortality Difference Disability Adjust Life Life Table Method 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


disability adjusted life year


European Union


European Union Members before May 2004 (see Table 30‐1 )


European Members since May 2004 (Excluding Malta and Cyprus, see Table 30‐1 )


 Health Adjusted Life Expectancy

Slavic 3

Three Slavic States, Russia, Belarus and Ukraine (see Table 30‐1 )


World Health Organisation


  1. Bennett K, Kabir Z, Unal B, Shelley E, Critchley J, Perry I, Feely J, Capewell S. (2006). J Epidemiol Commun Health. 60: 322–327.CrossRefGoogle Scholar
  2. Britton A, McKee M. (2000). J Epidemiol Commun Health. 54: 328–332.CrossRefGoogle Scholar
  3. Capewell S, Beaglehole R, Seddon M, McMurray J. (2000). Circulation. 102: 1511–1516.PubMedGoogle Scholar
  4. Critchley J, Liu J, Zhao D, Wei W, Capewell S. (2004). Circulation. 110: 1236–1244.PubMedCrossRefGoogle Scholar
  5. Didkowska J, Manczuk M, McNeill A, Powles J, Zatonski W. (2005). Br Med J. 331: 189–191.CrossRefGoogle Scholar
  6. Ezzati M, Lopez AD, Rodgers A, Murray CJL. (2004). Comparative Quantification of Health Risks: Global and Regional Burden of Diseases Attributable to Selected Major Risk Factors. World Health Organization, Geneva.Google Scholar
  7. Ford E, Ajani UAA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. (2007). N Engl J Med. 356: 2388–2398.PubMedCrossRefGoogle Scholar
  8. Kelly S, Baker A, and Gupta S. Health Statistics Quarterly 2000(7): 32–37.Google Scholar
  9. Mathers C, Murray CJL, Salomon JA, Murray CJL, Evans DB (eds.) (2003a). Methods for Measuring Healthy Life Expectancy. Health Systems Performance Assessment: Debates, Methods and Empiricism. World Health Organization, Geneva, pp. 437–470.Google Scholar
  10. Mathers CD, Bernard C, Moesgaard Iburg K, Inoue M, Ma Fat D, Shibuya K, Stein C, Tomijima N, Xu H. (2003b). Global Burden of Disease in 2002: Data Sources, Methods and Results. World Health Organization, Geneva.Google Scholar
  11. Powles JW, Day NE. (1997). Lancet. 350: 956–956.PubMedCrossRefGoogle Scholar
  12. Powles JW, Zatonski W, Vander HS, Ezzati M. (2005). BMC Public Health. 5: 116.PubMedCrossRefGoogle Scholar
  13. Rehm J, Sulkowska U, Manczuk M, Boffetta P, Powles J, Popova S, Zatonski W. (2007). Int J Epidemiol. 36: 458–467.PubMedCrossRefGoogle Scholar
  14. Unal B, Critchley JA, Capewell S. (2004). Circulation. 109: 1101–1107.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • J. Powles
  • H. Gouda

There are no affiliations available

Personalised recommendations