East/West Differences in Health in Europe: Rates, Expectancies and DALYs
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.
KeywordsPerfect Health Mortality Level Mortality Difference Disability Adjust Life Life Table Method
List of Abbreviations:
disability adjusted life year
European Union Members before May 2004 (see Table 30‐1 )
European Members since May 2004 (Excluding Malta and Cyprus, see Table 30‐1 )
- Slavic 3
Three Slavic States, Russia, Belarus and Ukraine (see Table 30‐1 )
World Health Organisation
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