This 2018 edition of Health at a Glance: Europe marks the start of a new State of Health in the EU cycle by the European Commission designed to assist EU Member States in improving the health of their citizens and the performance of their health systems.

Health at a Glance: Europe 2018 presents comparative analyses of the health status of EU citizens and the performance of the health systems of the 28 EU Member States, 5 candidate countries and 3 EFTA countries. It is the first step in the State of Health in the EU cycle of knowledge brokering. This publication has two parts. Part I comprises two thematic chapters, the first focusing on the need for concerted efforts to promote better mental health, the second outlining possible strategies for reducing wasteful spending in health. In Part II, the most recent trends in key indicators of health status, risk factors and health spending are presented, together with a discussion of progress in improving the effectiveness, accessibility and resilience of European health systems.

Health at a Glance: Europe 2018 presents key data and analysis of health and health systems in the 28 EU member states, 5 candidate countries and 3 European Free Trade Association countries.

Good mental health is a critical part of individual well-being, and the foundation for happy, fulfilled, productive lives. However, this chapter finds that more than one in six people across EU countries had a mental health problem in 2016. Living with mental ill-health means that individuals are less able to succeed at school and work, are more likely to be unemployed, and may suffer worse physical health. For some, mental illnesses lead to premature mortality: over 84 000 people died of mental health problems and suicides across EU countries in 2015.The economic costs of mental illness are also significant. This chapter estimates total costs related to mental ill-health at more than 4% of GDP – or over EUR 600 billion – across the 28 EU countries in 2015. EUR 190 billion (or 1.3% of GDP) is direct spending on health care, another EUR 170 billion (1.2% of GDP) is spending on social security programmes, while a further EUR 240 billion (1.6% of GDP) is caused by indirect costs in the labour market, driven by lower employment rates and reduced productivity due to mental illness.The heavy economic, social and individual burden of mental illness is not inevitable, and more must be done to prevent and treat mental disorders, and to foster good mental health. The latter part of this chapter explores some effective ways by which European countries are promoting mental well-being and preventing mental illness, and identifies critical gaps where more action is needed.

Evidence suggests that as much as one-fifth of health spending is wasteful, and could be reduced or eliminated without undermining health system performance. With as much as 9.6% of European GDP directed to health care, reducing such spending is thus important not only for improving access to needed care, but also for ensuring health system resilience.This chapter points the lens at two particular areas of waste: hospitals and pharmaceuticals. Hospitals represent an integral and essential component of any functioning health system, but are often the most expensive part. In many instances, the resources consumed in hospitals can be put to more efficient use. Improved community care for chronic diseases could reduce millions of avoidable admissions and bed days across EU countries. Reducing unnecessary investigations and procedures would not compromise quality. Greater use of day surgery and reducing delays in discharging patients no longer requiring inpatient care could also free-up resources for patients with greater needs.Minimising waste and optimising the value derived from expenditure on pharmaceuticals are also critical to efficient and sustainable health systems. This chapter discusses a mix of supply and demand side policy levers that include ensuring value for money in selection and coverage, procurement and pricing of medicines; exploiting the potential of savings from generics and biosimilars; encouraging rational prescribing and use; and improving adherence to treatment.Ultimately, progress in reducing wasteful spending may be seen not only as a barometer of quality improvement, but also an ethical and financial imperative in the pursuit of more resilient and equitable health care systems.