The European Health Report is produced every three years as a flagship publication by the WHO Regional Office for Europe. The aims of the 2021 edition are to provide insight into Regional progress towards the health-related Sustainable Development Goals and the effects of the COVID-19 pandemic on population health, thereby focusing on health inequalities and how the pandemic is affecting these.
In addition, the report describes how the Regional Office, through implementation of the European Programme of Work 2020–2025, aims to support Member States in tackling the major challenges in the Region and building back better after the pandemic. As strong health information systems will be an important prerequisite for these endeavours, the report describes how WHO will support all Member States in tackling the main gaps in data and information that are currently hampering the evidence-informed implementation of the European Programme of Work, WHO’s global Thirteenth General Programme of Work 2019–2023 and the Sustainable Development Goals.
The report reveals encouraging progress in the European Region
- All countries in the WHO European Region have met the SDG target for maternal mortality of less 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 Region have met the SDG target for a newborn and child mortality rate of less than 12 and 25 deaths per 1000 live births, respectively.
- The Region’s average rate is at 4 and 8 deaths per 1000 live births, respectively.
- The Region has also seen mixed progress in premature mortality because of noncommunicable diseases.
- Between 2010 and 2018, premature mortality because of cardiovascular diseases decreased by almost 20%, and nearly 10% because of cancers, even though cancer still accounts for more than 20% of all deaths, a situation further exacerbated by the pandemic’s impact on cancer screening and treatment.
The report also reveals concerning trends
- The pandemic has had an unprecedented impact on people’s mental health in the Region.
- Preliminary evidence suggests that even though the biggest decline in mental well-being occurred among men aged 18–24 years, the lowest mental well-being was registered among women aged 18–24 years and 35–44 years.
- Suicide continues to be an important contributor to premature mortality.
- Despite a declining trend, the Region still has one of the highest age-standardized suicide mortality rates globally.
- In 2019, even before the pandemic, 119,000 people in the Region died because of suicide.
- The European Region is one of two WHO regions where the number of HIV infections is increasing.
- New HIV infections increased by 6% for every 1000 uninfected people between 2015 and 2019.
- Financial protection continues to be a challenge in the Region.
- Catastrophic health spending – a household’s inability to pay for health care because of high costs – is experienced by between 1% and 19% of all households across countries.
- COVID-19 has strained health systems beyond measure, leading to major disruptions in health services.
- In 2020, during the first months of the pandemic, 40% of essential health services were at least partially disrupted in the Region.
- This pattern persisted in 2021, with about 29% of health services still at least partially disrupted during the first three months of the year.
- On noncommunicable diseases, despite recent progress in the Region tackling risk factors such as alcohol and tobacco use, 26% of the adult population still smokes tobacco (compared to the global average of 23.6%) and adults consume on average 9.5 litres of pure alcohol per year (compared to the global average of 5.8 litres).
- Almost 1 in 3 children in the Region are overweight or obese.
What the report says about alcohol harm in Europe specifically
Even though all countries in the WHO European Region have met the SDG target for maternal mortality and almost all countries the target for child mortality, there are still large differences between countries for these indicators. Other areas with substantial and persistent inequalities between countries include HIV, tuberculosis (TB), hepatitis B and C infections, antimicrobial resistance (AMR), alcohol consumption and road traffic mortality.
The COVID-19 pandemic has exacerbated pre-existing inequalities in society. Vulnerable groups and those on the lower end of the socioeconomic gradient have been hit hardest, including children, adolescents, women, older people, refugees and migrants, marginalized groups, people with long-term health conditions or disabilities, people working in vulnerable or insecure jobs, people who are unemployed, and people living in poverty.
Around 85% of the NCD burden is caused by preventable and amenable risk factors, and the Region is the worst performing WHO region for two risk factors, alcohol and tobacco use.
Three main findings on alcohol harm in Europe
- Total alcohol consumption per capita decreased by 1.3 litres (21%) between 2000 and 2019 in the WHO European Region;
- But levels of alcohol consumption in the Region remain the highest globally.
- Annually, every adult (15 years and older) in the Region drinks, on average, 9.5 litres of pure alcohol.
- There are large differences in estimated alcohol consumption across Member States, ranging from 0.9 to 14.3 litres of pure alcohol per capita per year in 2019.
- Of the 10 countries that consume the most alcohol in the world, nine are located in the WHO European Region.
- Alcohol also makes the largest contribution to all-cause mortality in the European region.
- Since the SDGs were adopted in 2015, alcohol consumption levels have stagnated in the WHO European Region, with only a small decrease of 0.3 litres (3.1%) per capita reported between 2015 and 2019.
- The most substantial decline at country level was 3.7 litres per capita, and the most substantial increase was 2.1 litres per capita, while overall changes have been modest and for some Member States statistically non-significant.
- Out of 51 Member States with available data, only six have reduced their alcohol consumption by more than 1 litre per capita.
The declines in overall alcohol use in Europe were less apparent for those with low or average incomes and those experiencing distress, as well as among people who lost their jobs or had other financial worries.
The report warns that the economic fallout from the COVID-19 pandemic could reverse the reductions in alcohol use in Europe.
Based on past experiences, the economic downturn due to the COVID-19 pandemic will likely increase alcohol consumption levels in the coming years, especially for men and those in a low socioeconomic stratum,” states the report as per Reuters.European Health Report (2021), World Health Organization
Movendi International has previously reported that crises can increase alcohol use.
A study by Ramboll on behalf of Systembolaget has found that alcohol is a risk factor during crises, such as COVID-19, for both the individual and society as a whole.
- Men, socio-economically disadvantaged groups, and young people are at higher risk of developing heavy alcohol use consumption due to anxiety, isolation, and stress caused by crises such as the current pandemic.
- During previous crises increased heavy use of alcohol has been noted among the unemployed and specifically among unemployed men.
Considering the previous evidence, there is a high risk that the economic consequences of the pandemic lead to increased alcohol harm in Europe. The effects of the pandemic are already being felt in many countries. For example in the UK, Switzerland, and Italy – countries that Movendi International reported about recently.
- In England and Northern Ireland, the number of people with alcohol problems has continued to climb during the pandemic.
- According to the all-party parliamentary group (APPG) on children of alcoholics (CoA), UK households who had been buying the most alcohol before lockdown increased their alcohol purchases significantly while confined to their homes.
- Alcohol deaths in the UK increased by 19% between 2019 and 2020 reaching an all-time high.
- While alcohol use declined in Switzerland as per an Addiction Switzerland Foundation study, the researchers note that there was a polarization.
- While alcohol use declined in some population sub-groups, there are other groups where alcohol use increased.
- The most vulnerable people cited using alcohol as a coping mechanism during the pandemic such as relaxing from depression and also forgetting problems.
- Using alcohol as a coping mechanism increases the risk of developing alcohol use disorder and additction.
- In Italy, the Instituto Superiore di Sanità ISS (Italian Health Institute) reported preliminary data on alcohol trends in 2020 showing that home delivery of alcohol increased between 181% to 250% during the COVID-19 lockdown in the country.
- Increased consumption means increased alcohol use problems for the country.
The way forward
The EPW will be the leading policy framework in the WHO European Region for the coming years to take on the challenges identified by steering and coordinating action towards building back better after the COVID-19 crisis.
For the next biennium (2022–2023), priority areas for action have been defined, particularly focusing upon major flagship initiatives planned to move the agenda forward. These include, but are not limited to:
- Launching the Mental Health Coalition and a cancer movement;
- Ensuring equitable access to immunization through a transformative immunization agenda;
- Forging new alliances to address access to affordable medicines;
- Improving health care for refugees and migrants;
- Improving emergency prevention and preparedness;
- Promoting and generating behavioural science/insights to maximize health outcomes;
- Tackling childhood obesity and alcohol consumption; and
- Operationalizing One Health.