Category Archives: Health Determinants: Environment

The European Union has an active policy against external factors which could affect the health of European citizens. It thus intends to offer access to healthcare for all, better quality care and more efficient national healthcare systems. It also aims to tackle the effects of environmental factors on human health, specifically air and noise pollution. Moreover, the Union plans to limit the exposure of European citizens to electromagnetic fields in order to protect them from the harmful effects of such exposure. Finally, every effort is made to detect cancers.

Environment and Health Action Plan 2004-2010

Environment and Health Action Plan 2004-2010

Outline of the Community (European Union) legislation about Environment and Health Action Plan 2004-2010


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

Environment and Health Action Plan 2004-2010

Document or Iniciative

Communication of 9 June 2004 from the Commission: “The European Environment & Health Action Plan 2004-2010” [COM(2004) 416 – Official Journal C 49, 28.02.2006].


Covering the first cycle of the European Environment and Health Strategy, i.e. the period from 2004 to 2010, this Action Plan aims, on the one hand, to provide the EU with the scientifically grounded information needed to help Member States reduce the adverse health impacts of certain environmental factors and, on the other hand, to step up cooperation between stakeholders in the environment, health and research fields, whether these are public authorities in Member States, European bodies or institutions, or civil society.

In line with the European Environment and Health Strategy, the Action Plan focuses particularly on the links between environmental factors and respiratory diseases, neuro-developmental disorders, cancer and endocrine disrupting effects.

The Action Plan is based on three main themes, each covering a number of actions:

  • improving the information chain by developing integrated environment and health information to understand the links between sources of pollutants and health effects:
    Action 1: Develop environmental health indicators;
    Action 2: Develop integrated monitoring of the environment, including food, to allow the determination of relevant human exposure;
    Action 3: Develop a coherent approach to biomonitoring in Europe;
    Action 4: Enhance coordination and joint activities on environment and health;
  • filling the knowledge gap by strengthening research on environment and health and identifying emerging issues:
    Action 5: Integrate and strengthen European environment and health research;
    Action 6: Target research on diseases, disorders and exposures;
    Action 7: Develop methodological systems to analyse interactions between environment and health;
    Action 8: Ensure that potential hazards on environment and health are identified and addressed;
  • reviewing policies and improving communication by developing awareness raising, risk communication, training and education to give citizens the information they need to make better health choices, and to make sure that professionals in each field are alert to environment and health interactions:
    Action 9: Develop public health activities and networking on environmental health determinants through the public health programme;
    Action 10: Promote training of professionals and improve organisational capacity in environment and health by reviewing and adjusting risk reduction policy;
    Action 11: Coordinate ongoing risk reduction measures and focus on the priority diseases;
    Action 12: Improve indoor air quality;
    Action 13: Follow developments regarding electromagnetic fields.

Member States, the Commission, international organisations and stakeholder groups (industries and civil society, for example) will share responsibility for implementing the Action Plan.

The Commission will play a major role and will continue to engage with all the main stakeholders and promote cooperation at EU level, within its areas of competence, and liaise with the European Environment Agency, the European Food Safety Agency and other relevant bodies. It will implement the actions through existing initiatives and programmes which already have allocated resources, notably the Public Health Programme and the Sixth Framework Programme for Research, and through the operational budgets of the services concerned.

Stakeholders will be fully involved in the implementation process through the Consultative Group, comprising Member States, stakeholders and international organisations. Relevant scientific committees and working groups will also be consulted.

In 2007 the Commission will conduct a mid-term review of the implementation of the Action Plan.


The Action Plan serves as the Commission’s contribution to the Fourth Ministerial Conference on Environment and Health, organised by the World Health Organisation (WHO) in Budapest in June 2004.

Related Acts

Communication of 11 June 2007 from the Commission: “Mid Term Review of the European Environment and Health Action Plan 2004-2010” [COM(2007) 314 final – Official Journal C 191, 17.08.2007].
In this communication the Commission notes the growing links between environment policy and health policy, and especially the development of information systems, the priority given to research into environment and health interactions, the closer cooperation between environment, research and health, and the concentration on emerging issues such as nanotechnology. In addition, several initiatives have been launched since the Action Plan got under way, such as the Water Information System for Europe (WISE), and measures on air quality and chemicals.

Cancer screening

Cancer screening

Outline of the Community (European Union) legislation about Cancer screening


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

Cancer screening

Document or Iniciative

Council Recommendation of 2 December 2003 on cancer screening [Official Journal L 327 of 16.12.2003].


This Recommendation sets out guidelines for best practice in the early detection of breast, colorectal and cervical cancers. It recommends implementing effective and high-quality screening programmes involving the following screening tests:

  • mammography screening for breast cancer in women aged 50 to 69;
  • faecal occult blood screening for colorectal cancer in men and women aged 50 to 74;
  • pap smear screening for cervical abnormalities from the ages of 20 to 30.

Implementation of cancer screening programmes

With regard to the implementation of screening programmes, the Council recommends that Member States:

  • offer evidence-based cancer screening through a systematic population-based approach with quality assurance at all appropriate levels;
  • implement screening programmes in accordance with European guidelines on best practice and facilitate the further development of best practice for high-quality cancer screening programmes at national and, where appropriate, regional levels;
  • ensure that the people participating in a screening programme are fully informed about the benefits and risks;
  • ensure that appropriate complementary diagnostic procedures, treatment, psychological support and after-care are provided for those with a positive screening test;
  • make available human and financial resources in order to assure appropriate organisation and quality control;
  • take decisions on the implementation of a cancer screening programme nationally or regionally depending on the burden the disease represents, the resources available, the side effects and cost-effectiveness of screening, and experience from scientific trials and pilot projects;
  • set up a systematic call/recall system, together with an effective and appropriate diagnosis, treatment and after-care service;
  • ensure that due regard is paid to data protection legislation, particularly as it applies to personal health data.

Registration and management of screening data

With regard to the registration and management of screening data, Member States are called upon to:

  • make available the data systems needed to run the screening programmes;
  • ensure that all persons targeted by the screening programme are invited, by means of a call/recall system, to take part in the programme;
  • collect, manage and evaluate data on all screening tests, assessments and diagnoses in accordance with relevant legislation on data protection;
  • collect, manage and evaluate data in full compliance with the relevant legislation on the protection of personal data.

Monitoring and training

Member States are requested to monitor regularly the process and outcome of organised screening and report these results quickly to the public and the personnel providing the screening. Appropriate training of personnel is also recommended to ensure that they are able to deliver high-quality screening.


The Council recommends that Member States seek a high level of compliance, based on fully informed consent, when screening is offered. The Council also advocates action to ensure equal access to screening, taking account of the possible need to target particular socioeconomic groups.

Introduction of novel screening tests taking into account international research results

Member States are encouraged to:

  • implement new cancer screening tests in routine healthcare only after they have been evaluated in randomised controlled trials;
  • run trials on subsequent treatment procedures, clinical outcome, side effects, morbidity and quality of life;
  • assess level of evidence concerning effects of new methods by pooling trial results from representative settings;
  • consider the introduction into routine healthcare of screening tests which are currently being evaluated, provided the evidence is conclusive;

consider the introduction into routine healthcare of potentially promising new modifications of established screening tests, once the effectiveness of the modification has been successfully evaluated, possibly using other epidemiologically validated surrogate endpoints.

Background: cancer in Europe

Cancer is an enormous burden on European society, given that one person in three develops the disease during their lifetime, which is approximately equivalent to 3.2 million European citizens every year. After circulatory disease, cancer was the second cause of death in 2006, accounting for two out of ten deaths in women (approximately 554 000 women) and three out of ten deaths in men (approximately 698 000 men). The health strategy (2008 – 2013) highlights the importance of Community action in sectors such as cancer which provides considerable added value to counter the main health challenges more effectively, thanks to the sharing of information and the exchange of expertise and good practice as demonstrated by the various ‘Europe against cancer’ programmes (from 1987 to 1989, 1990 to 1994 and 1996 to 2002). In order to continue those efforts, the Commission intends to create a European action partnership against cancer during the second half of 2009 in order to unite the stakeholders involved throughout the Union in a collective effort against cancer. This partnership will support Member States in combating cancer more effectively. The target areas for future activities on cancer will include: health information, collection and analysis of comparative data; primary prevention, identification and promotion of good cancer care practices and the priorities for cancer research.

Related Acts

Report from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions – Implementation of the Council Recommendation of 2 December 2003 on cancer screening (2003/878/EC) [– Not published in the Official Journal].

This Report is the first assessment of the implementation of Recommendation 2003/878/EC. It is based on:

  • the results of a survey of Member States in the second half of 2007;
  • information from the European Cancer Network and the European Network for Information on Cancer;
  • population statistics obtained from the European Statistical System or national sources.

The Council Recommendation of 2 December 2003 set out six priorities to be implemented by Member States. This Report gives a positive assessment of the implementation of those six priorities. Most of the measures have been implemented satisfactorily. Efforts remain to be made in the field of cancer screening. In this perspective, the European Commission intends to set up a partnership for action against cancer in 2009.

The first point relating to the establishment of screening programmes is reported to be followed by at least 2/3 of the Member States;

The second point relating to the quality of screening programmes is reported to be followed by a large proportion of the Member States;

The third point establishing the necessary basis for quality assurance of screening programmes is followed by only 55% of the Member States;

The fourth point highlighting the importance of training of healthcare staff is a success, in that 20 out of Member States report that screening programme personnel is adequately trained;

The fifth point intended to promote equal access to screening is also largely followed;

The sixth and final point recommending the implementation of novel forms of screening still shows a number of shortcomings, in that only 50% of Member States report adherence. The Report underlines the importance of prevention and the exchange of good practice with a view to controlling and preventing cancer at European level (particularly colorectal, breast and cervical cancer).

Women's health

Women’s health

Outline of the Community (European Union) legislation about Women’s health


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

Women’s health

Document or Iniciative

Commission Report of 22 May 1997 on the state of women’s health in the European Community [COM(97) 224 final – Not published in the Official Journal]


The report examines the main causes of mortality and morbidity as well as a number of individual and social determinants which influence women’s health within the context of evolving demographic and social trends.

The main sources of data are:

  • the World Health Organisation’s “Health for All” database;
  • various reports and data from EUROSTAT;
  • an EC-wide Eurobarometer survey carried out in early 1996.

The data obtained are somewhat limited in their comprehensiveness and comparability. These constraints narrow the range of subjects dealt with in the report.

The report focuses on women aged 15 years and older, because most gender-specific health data at EC level concentrate on this age-group.

Social and demographic trends

Women account for 51.2% of the population of the European Community. This percentage is very stable across the Member States, varying from a 50.4% in Ireland to 51.8% in Portugal.

There is considerable variation in the percentage of women across age-groups: in the group of women under 20 years of age, there are 95 women for every 100 men, while among 80-year-olds there are about 221 women for every 100 men. This degree of variation can be partly explained by the difference in life expectancy, with that of women having significantly increased to reach 80 years old, six years more than the average expectancy for men.

There have been considerable changes in family life. The rate of marriage has declined significantly, from 8 to 5.1 marriages for every 1 000 persons in the period from 1960 to 1995. At the same time, the rate of divorce has more than tripled, from 0.54 to 1.8 for every 1 000 persons (except in Ireland). The average age of first marriage and the age at first birth have risen to 26.1 and 28.6 years respectively.

Women’s labour force participation has increased tremendously, although there are very considerable variations across the Member States, ranging from 70% in the Nordic countries (where there exists the greater equality between sexes) to 40% in southern Europe. Concomitant with this trend has been an increase in part-time work (between 70% and 90% of part-time jobs are done by women) and temporary employment. Women are affected more than men by unemployment.

Selected health indicators

Infant mortality has fallen sharply in the Community; only 6.9 baby girls out of 1 000 live births die before the age of 1 year, which represents a decline of 68% since 1970. Maternal mortality rates have also declined significantly (by 79% since 1970) to 7 deaths per 100 000 women in 1992.

62% of women in the Community consider themselves to be in good or very good health, although this figure obscures very considerable variations between Member States, ranging from 75.8% in Ireland to 34.7% in Portugal.

The average height of women has increased over the last few decades, and is now 163.5 cm. Dutch women average a height of 167.9 cm, while Portuguese women average 159.6 cm.


Since there are no disease-specific morbidity measures at Community level, indirect measures such as short- and long-term disability and health care utilisation have been used.

On average, almost one out of every four women report limitations in their daily activities to some extent (17.3%) or severely (6.3%) because of long-standing illness. This average varies from a high of 30% in Finland and Portugal to a low of 15% in Luxembourg, and increases with age.

The rate of temporary activity limitation is fairly low in absolute terms, although 14% of women report having had to cut down on their activities in the past two weeks because of illness or injury. The lowest rate is in Italy (5.6%) and the highest in the Netherlands (20%).

On average, one out of three women has consulted with a physician in person or by telephone in the past two weeks (ranging from 25% in Ireland and the Netherlands to 38% in Spain). An average of 10% of women in the Community report having had one or more (non-birth) hospitalisations in the past year, staying a total of about 10 days in the hospital. There is a considerable variation in this figure between Denmark (3.8%) and France and Finland (13%). Older women are twice as likely as younger women to have been hospitalised, and they tend to stay longer as well.

Causes of death and trends in female mortality

Across all ages, the most frequent causes of death among women are diseases of the circulatory system (accounting for 43% of all deaths), cancer (26%), diseases of the respiratory system (6%) and suicide and accidents (5%).

The major causes of death vary with age:

  • for women under 30, motor vehicle accidents are the main cause of death;
  • in the 30-34 age-group, the main cause is suicide;
  • for women aged 35-64, the main cause of death is cancer, particularly breast and cervical cancer;
  • for women aged 65 and over, diseases of the circulatory system account for almost half of all deaths.

Health determinants and health promotion

To a very large extent, the two major causes of mortality (heart disease and cancer) are preventable through primary (healthier lifestyles) or secondary prevention (early detection through, for example, screening). The main risk factors associated with much premature mortality (death before the age of 65) include smoking, excessive alcohol consumption, unhealthy diet and lack of exercise.

In most Member States, about 25% of women smoke, and this figure is increasing continually. Denmark and Portugal stand out because of their respectively very high (42%) and very low rates (12%) of smoking among women. Smoking is the main risk factor in about 30% of cancers and is a major factor in cardiovascular diseases.

There are no data available on average alcohol consumption among women. However, it is known that women drink less than men, although this gap between the sexes is gradually getting smaller. Immoderate consumption increases the risk of liver complaints, diseases of the circulatory system and certain types of cancer.

Even though data on diet are scarce, analyses can draw on data on the outcome of eating patterns, i.e. weight. In the Community, one out of every five women is overweight as measured by the body mass index (BMI), while 15% are underweight. The highest incidences of excess weight are in Greece (33.2%) and Portugal (28.5%), and the lowest in France (15.5%) and Denmark (16.6%). Being overweight is a significant risk factor for heart disease, diabetes and cancer.

The frequency and types of health check-ups for women vary considerably by age-group and by country. For example, 44% of women aged 65 or over have had a heart check-up in the past year, compared with only 10% among women aged under 35. In Germany, 35.3% of women have had a heart check-up, whilst the figure for the Netherlands is 9.7%.

As regards diabetes, around 22% of women have had a diabetes test in the past year, although the figure is 44% among overweight women aged 40 and over. There is considerable variation between Member States: Germany reports the highest rate of testing (35.3%), with the lowest rates being reported in the Netherlands and Sweden (9.7% and 12.8% respectively).

Around 16% of women in the Community report having had an osteoporosis test in the past year. The rate of testing ranges from 4% in Finland to 28% in Austria.

Thanks to the various programmes at national and Community level, the rate of cancer screening is very high. Almost 40% of women report having had a cervical smear in the previous year, although the figure varies considerably between Member States, from 15.8% in Ireland to 63.5% in Denmark.

Similarly, almost 40% of women report having performed a breast self-examination in the previous year, and 18% report having had a mammography during the same period. Some Member States have introduced systematic screening programmes which have had a significant impact on the cancer mortality rate. Moreover, 90% of women endorsed free mammography screening.

Special issues in women’s health

Several health issues have emerged over the past few years because of their particular importance for women:

– There is a lack of data on the incidence and prevalence of eating disorders (bulimia and anorexia nervosa), although the perception is that it has been increasing throughout the Community over the last 20 years. One study puts the mortality rate among anorexia suffers at 6% (suicide, heart attack) and at 3% for those with bulimia.

– At the end of 1996, women accounted for 17% of AIDS sufferers, and this percentage was on the increase. Most of these women were intravenous drug users. The main transmission routes of HIV among women vary between Member States: intravenous drug use in Spain, Italy, Portugal, Ireland and heterosexual transmission in Belgium. Men are more likely to transmit HIV to women than vice versa. Preventive interventions aimed at women have in general been limited.

Availability of contraceptives and abortion are important issues for women of reproductive age. Most Member States report contraceptive use rates between 71% and 81%, except for Spain (59%) and Portugal (66%). The most widely used method of contraception is the birth control pill, followed by the condom. The choice of contraceptive method is influenced by a variety of factors, particularly health risks and the side-effects associated with a particular method, as well as the age of the woman (younger women favour the use of birth control pills or condoms, while older women may prefer IUDs or surgical sterilisation). Abortion is permitted, under varying criteria/conditions, in all Member States except Ireland and Northern Ireland. Abortion rates per 1 000 women vary from one Member State to another, ranging from 18.3 in Sweden to 5.4 in Spain.

– the average age at menopause is 50-52 years. Its effects on women’s health vary: 75% of menopausal women experience some problems or discomfort, but only 10-20% seek medical help. The increasing longevity of women has intensified the debate about the possible long-term consequences of menopause. Although there is currently no proof of a causal link between post-menopausal hormone levels and health, morbidity statistics reveal increased incidence of cardiovascular disease and osteoporosis in post-menopausal women. Hormone replacement therapy (HRT) is still surrounded by controversy; rates of HRT use are estimated at 2% in Italy and 56% in Finland. It should be noted that a large majority of women feel that they are not being properly informed about the advantages and cost of this treatment.

Violence against women is gradually being recognised as a public health issue because of both the physical and psychological harm it causes. Although data are scarce, it is now recognised that violence against women by a male partner is the most endemic form of violence. It is estimated that between one woman in three (Portugal and Germany) and one woman in five (Ireland) are victims of domestic violence.

In overall terms, the conclusion may be drawn that women in Europe are in good health and feel quite healthy. However, the report emphasises the improvements needed as regards preventive measures and the provision of information, and also the need to recognise that some health problems are specific to women.

Health determinants: environment

Health determinants: environment

Outline of the Community (European Union) legislation about Health determinants: environment


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

Health determinants: environment

The European Union has an active policy against external factors which could affect the health of European citizens. It thus intends to offer access to healthcare for all, better quality care and more efficient national healthcare systems. It also aims to tackle the effects of environmental factors on human health, specifically air and noise pollution. Moreover, the Union plans to limit the exposure of European citizens to electromagnetic fields in order to protect them from the harmful effects of such exposure. Finally, every effort is made to detect cancers.

Socio-economic health determinants

  • Women’s health
  • The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability


  • Environment and Health Action Plan 2004-2010
  • Environment and health strategy

Electromagntic fields

  • Exposure to electromagnetic fields
  • Exposure to electromagnetic fields

Genetics and screening

  • Cancer screening

Environment and health strategy

Environment and health strategy

Outline of the Community (European Union) legislation about Environment and health strategy


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

Environment and health strategy

Document or Iniciative

European environment and health strategy of 11 June 2003 [COM(2003) 338 final – Not published in the Official Journal].


Key elements and implementation of the strategy

The objective of this strategy is to integrate the information on the state of the environment, the ecosystem and human health. The ultimate objective is to establish a framework to help produce a better understanding of the cause-and-effect relationships between the environment and health and to make available the information needed to develop an integrated Community policy. Other objectives of the strategy are to identify and reduce any new health threats caused by environmental factors and to strengthen the Union’s capacity for policymaking in this area. As the acronym indicates, the strategy is based on science, focuses on children, aims at raising awareness, uses legal instruments and includes continuous evaluation.

The plan is to implement the strategy incrementally in successive cycles. The first cycle, from 2004 to 2010, will focus on the link between environmental factors and:

  • childhood respiratory diseases, asthma and allergies;
  • neurodevelopmental disorders;
  • childhood cancer;
  • disruption of the endocrine system (glands which secrete hormones).

The strategy will pave the way for a Community information system for assessing the overall impact of the environment on human health and the cause-and-effect links and for developing an integrated policy on the environment and health. In the first cycle three pilot projects will be launched to develop a method for putting in place a European system for integrated environment and health monitoring. These projects will focus on three priority pollutants for which data collection and monitoring are already well underway: dioxins, heavy metals and endocrine disrupters. The possibility of developing a harmonised European bio-monitoring system for children will also be considered during the first cycle.

Other research activities will be undertaken in order to gain a better understanding of environment and health issues.

Additional efforts will be made to reduce exposure to environmental hazards. These will concentrate on air quality, heavy metals, electromagnetic fields and a healthy urban environment in particular.

Implementation of this strategy will demand full stakeholder involvement. The Commission will set up technical working groups plus a consultative group on environment and health. Three regional conferences were planned up to 2004. In spring 2004 a major stakeholder conference was held to define the action plan for 2004-2010, which set out the goals and action for the first cycle as the Commission’s contribution to the Fourth Ministerial Conference on Environment and Health in Budapest held in June 2004.

Previous activities on environment and health

Hitherto the political responses on environment and health have taken no account of the interaction between the two. Nevertheless, the Union has already put in place legislation on health hazards, such as chemicals, endocrine disrupters, pesticides, air and water pollution, noise, waste, industrial accidents and ionising radiation.

A Community action programme on public health, covering the period 2003-2008, has been under way since 1 January 2003. Other activities are in progress on tobacco control, food safety, electromagnetic fields, radiation protection and health impact assessment.

Research on the environment and health has been included in the European Framework Programmes for research and development activities since 1995.

The Community also has a strategy on health and safety at work.

The Union is participating in international activities such as the European Charter on Environment and Health and the “Healthy Environment for Children” project, both in collaboration with the World Health Organisation. It is also helping with the preparations for the next pan-European Ministerial Conference on Environment and Health, which will be held in Budapest.


Communication of 9June 2004 from the Commission to the Council, the European Parliament and the European Economic and Social Committee – “The European Environment & Health Action Plan 2004-2010” [

COM(2004) 416

final – Not published in the Official Journal].

The European Environment & Health Action Plan 2004-2010 is designed to reduce the burden of disease caused by environmental pollution. The added value of the action plan is that it will improve information and understanding and step up coordination between the health, environment and research sectors.

The plan provides for 13 actions geared towards the following objectives:

  • better information on the environment-health link;
  • stepping up research activity in Europe, particularly on the four priority health effects: asthma/allergies, neurodevelopmental disorders, cancer and endocrine disruption;
  • setting up mechanisms to improve risk assessment, as well as a system for early detection of emerging issues such as the effects of climate change on health;
  • drawing conclusions from the improved information and action, via awareness-raising campaigns, better risk communication, and training and educational activities.

The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability

The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability

Outline of the Community (European Union) legislation about The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability

Document or Iniciative

Communication from the Commission of 5 December 2001 – The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability [COM(2001) 723 final – Not published in the Official Journal].


The EU’s overall health situation and health care systems are among the best in the world, thanks to the widespread extension of cover against sickness and invalidity, the rise in the standard of living, improved living conditions and better health education.
Total health care spending rose from around 5 % of GDP in 1970 to over 8 % in 1998. Public health care spending followed the same trend of growing faster than GDP in most countries.


The impact of demographic ageing on health care systems and expenditure

The ageing of the population in Europe involves two aspects:

  • since 1970, life expectancy at birth has risen by 5.5 years for women and almost 5 years for men. This trend also means higher life expectancy in “good health” and in the absence of disability;
  • there are more elderly people. The proportion of the total European population older than 65 is set to increase from 16.1 % in 2000 to 27.5 % by 2050, while the proportion of the population aged over 80 years (3.6 % in 2000) is expected to reach 10 % by 2050.

If Eurostat’s basic scenarios are confirmed, public expenditure on health care could increase by between 0.7 and 2.3 GDP points in the period 2000-2050.
The increase in the numbers of elderly people will thus increase the pressure on the public sector for long-term care.
In light of these needs, health care structures, methods of financing and the organisation of services will have to evolve. It will be particularly important to deal with the increased need for skilled manpower, as smaller and more unstable family structures make it increasingly difficult to rely on the support of family networks.

The growth of new technologies and treatments

Developments in medical technology (gene therapies, growing replacement organs, new medicinal substances, etc.) provide benefits for patients, for example by reducing the risks of serious illness by means of preventive treatment. However, these innovations come at a cost, and financing is an issue that must be considered. In the context of prudent budget management, clear, transparent and effective evaluation mechanisms must be developed, as this is the only way to guarantee greater accessibility to these new products and treatments.

The increase in patients’ demands

It has been observed for half a century that the demand for health care tends to increase more than proportionally to the per capita income. Demand is determined by standard of living and level of education. This has three main consequences:

  • patients are better educated and are able to adopt healthier lifestyles and a prevention-based attitude which in the long run makes it possible to avoid the need for costly care. This is why health care systems are focusing increasingly on education and prevention;
  • patients expect ever better quality and efficiency from health care systems. The spread of information technologies gives patients access to more information on services available at European level and allows them to make an increasingly well-informed choice;
  • health care consumers feel that they need to be considered as partners and players in health care systems, not only by health professionals but also by the public authorities. They also expect greater transparency on the performance and quality of care services.


While the organisation of health care systems, their funding (ratio of public/private funding) and planning as a function of the needs of the population are a matter for the Member States, this responsibility is exercised increasingly within a general framework on which many Community policies have a bearing (research, public health policy, free movement of persons and services, viability of public funds). This is an argument for strengthening European cooperation.

The Communication identifies three long-term objectives for national systems, which should be pursued in parallel.


Access to health care is a right enshrined in the Charter of Fundamental Rights of the European Union. However, it is often affected by an individual’s social status. It is therefore particularly important to ensure that access to health care for disadvantaged groups and for the poorest members of society is guaranteed.
The joint report to evaluate the national action plans for social inclusion proposes three categories of measures:

  • measures to develop disease prevention and promote health education (mother and child care, medical care at school and medical care at work);
  • providing less expensive and even free care for those in low-income brackets;
  • measures aimed at disadvantaged groups, e.g. the mentally ill, migrants, the homeless, alcoholics and drug addicts.


In order to provide quality health care, national governments are required to achieve an optimum balance between the health benefits and the cost of medication and treatment. Ascertaining quality in this way is made complex by:

  • the diversity of the structures and levels of health care, which often influence demand for health care and consequently the level of expenditure;
  • the different approaches to medical treatment.

Comparative analysis of health care systems and medical treatment should make it possible to identify “best practice” and thus to help improve the quality of health care systems.

Financial viability

A certain level of financing is required to ensure the availability of high-quality health care that is accessible to the population. There is upward pressure on these health care costs, irrespective of the way in which Member States’ health care systems are organised. Member States have been undertaking reforms since the early 1990s, based mainly on two methods:

  • regulation of demand, by increasing contributions or by ensuring that the final consumer bears an increasingly large share of the costs;
  • regulation of supply, by determining budgets or resource envelopes for health care providers, creating a contractual relationship between “buyers” and “providers” of health care.

It is often difficult, however, to distinguish the short-term effects from the more structural effects of these reforms, which allow spending to develop at a sustainable pace. This Communication recommends more exchanges of experience, which would help to keep track of the policies introduced and would be a useful way of comparing health care systems and encouraging progress.

In order to achieve these objectives it is essential that all parties concerned (local authorities, health care professionals, social protection bodies, supplementary insurance companies, consumers) work together to build strong partnerships.


This Communication is a response to the conclusions of the Lisbon European Council of March 2000, which stressed that social protection systems needed to be reformed in order to be able to provide high-quality health care services. It also takes up the request made by the Gothenburg summit (June 2001) to prepare a progress report for the Spring 2002 European Council suggesting guidelines in the field of health and care for the elderly.

Key figures
  • life expectancy in 2000: 74.7 for men and 81.1 for women
  • life expectancy in 2050 (Eurostat forecast): 79.7 for men and 85.1 for women
  • percentage of people aged over 65 in Europe in 2000: 16.1 %
  • percentage of people aged over 65 in Europe in 2050: 27.5 %
  • percentage of people aged over 80 in Europe in 2000: 3.6 %
  • percentage of people aged over 80 in Europe in 2050: 10 %

Related Acts

Communication from the Commission of 20 April 2004 – Modernising social protection for the development of high-quality, accessible and sustainable health care and long-term care: support for the national strategies using the “open method of coordination” [COM(2004) 304 final – Not published in the Official Journal].
This Communication proposes that the “open method of coordination” be extended to the health and long-term care sector. This will allow a framework to be established to promote exchanges of experience and best practices and support the Member States in the reform of health care and long-term care.

Joint report from the Commission and the Council on health care and care for the elderly: Supporting national strategies for ensuring a high level of social protection .
The Barcelona European Council (2002) invited the Commission and the Council to examine more thoroughly the questions of access, quality and financial sustainability. A questionnaire was sent to the Member States in 2002 in order to collect information on their approaches to these three objectives. The joint report is based on the responses received.
This joint report was adopted by the “Employment, Social Affairs, Health and Consumer Affairs” Council on 6 March and by the “Economic and Financial Affairs” Council on 7 March as a contribution to the March 2003 European Council.