In 2016, 1.5 million people aged less than 75 years died in the European Union (EU), out of which two-thirds (1.0 million) could be considered as premature according to the Eurostat-OECD list of avoidable mortality. These deaths could have been avoided through effective public health and primary prevention interventions (preventable deaths) or through timely and effective health care interventions (treatable deaths).
In the EU, lung cancer (37.1 per 100,000 inhabitants under 75 years), ischaemic heart diseases (18.9), alcohol-specific disorders and poisonings (11.7), cerebrovascular diseases and chronic obstructive pulmonary disease (both 10.0) were the five most common causes of preventable death among people aged less than 75 years, accounting for 55% of all such deaths in 2016.
In fact, the toll of avoidable death from the top five causes of preventable mortality is massive. In 2016, by far the most common causes of avoidable death in the EU-27 for people aged less than 75 years were
- ischaemic heart diseases (151,000),
- lung cancer (149,000 deaths),
- cerebrovascular diseases (79,000),
- colorectal cancer (60,000) and
- alcohol-specific disorders and poisonings (48,000).
In 2017, among these five leading causes of preventable deaths, lung cancer had the highest standardised death rate for people aged less than 75 years in 20 of the 27 EU Member States. Latvia, Lithuania, Romania and Slovakia recorded the highest rate of preventable deaths for ischaemic heart disease, while Estonia and Finland registered the highest rate for alcohol-specific disorders and poisonings. Bulgaria had the highest rate of preventable deaths for cerebrovascular diseases.
What are preventable deaths?
The concept of treatable and preventable mortality is based on the idea that certain deaths (for specific diseases/ conditions defined by the ICD classification) could be ‘avoided’ among people aged less than 75 years. In other words, these avoidable deaths would not have occurred at this stage (before the age of 75 years) if there had been more effective public health and/ or medical interventions in place.
A mortality is considered as treatable if the death could have been avoided through optimal quality health care.
The concept of preventable deaths covers deaths which could have been avoided by public health interventions focusing on wider determinants of public health, such as behaviour and lifestyle factors, socioeconomic status and environmental factors.
Some diseases/ conditions are considered to be treatable and preventable. These diseases/ conditions that can be both largely prevented and treated once they have occurred are classified as preventable.
Alcohol policy best, good buys to avoid preventable deaths
The total number of avoidable deaths among persons aged less than 75 years was 1.0 million in 2016. Among the avoidable deaths of people aged less than 75 years, 371,000 could have been avoided with health care systems offering timely and effective medical treatments (deaths from treatable diseases/ conditions) and 645,000 deaths could have been prevented through better public health interventions (preventable deaths).
The five alcohol policy best and good buys of the WHO SAFER technical package comprise measures for both timely and effective treatment of alcohol use disorder as well as proven public health interventions to prevent alcohol-related deaths.
For instance, the Task Force on Fiscal Policy for Health found in their 2019 report that raising alcohol taxes would avert 9 to 22 million premature deaths worldwide over the range of tax increases of 20 to 50%.
Alcohol taxes can bring in the most additional revenue in large part because alcohol taxes are currently low and consumption is widespread. Over 50 years, a tax that increases alcohol prices by 20% over current levels could generate almost US$9 trillion in additional revenues in present discounted value; for a 50% increase, the gain could be almost US$17 trillion in additional revenues – 3 times more than the BRICS country governments collected in revenues in 2017 (US$5.4 trillion).”Task Force on Fiscal Policy for Health, 2019 report (p. 14)
This SAFER technical package is aimed at government officials with responsibility for developing policy and action plans to reduce the harm done by alcohol. Given that alcohol-related harm extends beyond public health, and that preventing and reducing such harm requires multicomponent action that involves many stakeholders, this guidance should also be of use to those working in sectors other than health.
In addition to alcohol taxation, the SAFER technical package of the World Health Organization contains four more cost-effective, high-impact measures that are proven to prevent avoidable deaths.
- Strengthen restrictions on alcohol availability.
- Advance and enforce drink driving countermeasures.
- Facilitate access to screening, brief interventions, and treatment.
- Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion.
- Raise prices on alcohol through excise taxes and pricing policies.
These alcohol policy solutions, comprising the dimensions of timely and effective medical treatments and better public health interventions, are catalysts for healthier, longer lives in the European Union.