Life expectancy at birth continues to increase remarkably in EU countries, reflecting reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors, including rising living standards, improved lifestyle and better education, as well as greater access to quality health services. Other factors, such as better nutrition, sanitation and housing also play a role, particularly in countries with developing economies (OECD, 2004).

Life expectancy at age 65 has increased significantly among both women and men over the past several decades in all EU countries. Some of the factors explaining the gains in life expectancy at age 65 include advances in medical care combined with greater access to health care, healthier lifestyles and improved living conditions before and after people reach age 65.

Mortality rates are one of the most common measures of population health. Statistics on deaths remain one of the most widely available and comparable sources of information on health. Registering deaths is compulsory in all European Union countries, and the data collected through the process of registration can be used by statistical and health authorities to monitor diseases and health status, and to plan health services. In order to compare levels of mortality across countries and over time, the data need to be aggregated in suitable ways and standardised for differences in age-structure.

Cardiovascular diseases are the main cause of mortality in almost all European Union countries, accounting for 40% of all deaths in the region in 2008. They cover a range of diseases related to the circulatory system, including ischemic heart disease (known as IHD, or heart attack) and cerebro-vascular disease (or stroke). Together, IHD and stroke comprise 60% of all cardiovascular deaths, and caused one-quarter of all deaths in EU countries in 2008.

Cancer is the second leading cause of mortality in EU countries (after diseases of the circulatory system), accounting for 26% of all deaths in 2008. Cancer mortality rates for the total population were the lowest in Cyprus, Finland, Switzerland and Sweden, at under 150 deaths per 100 000 population. They were the highest in central and eastern European countries (Hungary, Poland, the Czech and Slovak Republics, Slovenia) and Denmark, above 200 deaths per 100 000 population.

Worldwide, an estimated 1.2 million people are killed in transport accidents each year, mostly due to road traffic accidents, and as many as 50 million people are injured or disabled (WHO, 2009b). In EU countries alone, they were responsible for approximately 48 000 deaths in 2008. In 2008, Italy, Poland, France and Germany each experienced around 5 000- 6 000 transport accident deaths.

The intentional killing of oneself is evidence not only of personal breakdown, but also of a deterioration of the social context in which an individual lives. Suicide may be the end-point of a number of different contributing factors. It is more likely to occur during crisis periods associated with divorce, alcohol and drug abuse, unemployment, clinical depression and other forms of mental illness. Because of this, suicide is often used as a proxy indicator of the mental health status of a population. However, the number of suicides in certain countries may be under-estimated because of the stigma that is associated with the act, or because of data issues associated with reporting criteria (see “Definitions and deviations”).

Infant mortality, the rate at which babies of less than one year of age die, reflects the effect of economic and social conditions on the health of mothers and newborns, as well as the quality of medical care and preventive services.

Low birth weight – defined here as newborns weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004).

Most European countries conduct regular health surveys which allow respondents to report on different aspects of their health. A commonly-asked question relates to self-perceived health status, of the type: “How is your health in general?”. Despite the subjective nature of this question, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (for instance, see Miilunpalo et al., 1997). For the purpose of international comparisons however, cross-country differences in perceived health status are difficult to interpret because responses may be affected by social and cultural factors.

Communicable diseases such as measles, pertussis and hepatitis B still pose a major threat to the health of European citizens. Measles, a highly infectious disease of the respiratory system, is caused by a virus. Symptoms include fever, cough, runny nose, red eyes and a characteristic rash. It can lead to severe health complications, including pneumonia, encephalitis, diarrhoea and blindness. Pertussis (or whooping cough) is also highly infectious, and is caused by the bacterium Bordetella pertussis. The disease derives its name from the sound made from the intake of air after a cough. Hepatitis B is an infection of the liver caused by the hepatitis B virus. The virus is transmitted by contact with blood or body fluids of an infected person. A small proportion of infections become chronic, and these people are at high risk of death from cancer or cirrhosis of the liver. Protection against each of these diseases is available through vaccination (see Indicator 3.3).

The first cases of Acquired Immunodeficiency Syndrome (AIDS) were diagnosed almost 30 years ago. The onset of AIDS is normally caused as a result of HIV (human immunodeficiency virus) infection and can manifest itself as any number of different diseases, such as pneumonia and tuberculosis, as the immune system is no longer able to defend the body. There is a time lag between HIV infection, AIDS diagnosis and death due to HIV infection, which can be any number of years depending on the treatment administered. Despite worldwide research, there is no cure currently available.

Around 2.4 million new cases of cancer (excluding non-melanoma skin cancers) were diagnosed in EU countries in 2008 (Ferlay et al., 2010), with 55% occurring among males and 45% among females. The most common forms of the disease were prostate, colorectal, breast and lung cancer. The risk of getting cancer before the age of 75 years is 26.5%, or around one in four. However, because the population of Europe is ageing, the rate of new cases of cancer is also expected to increase (European Commission, 2008b).

Diabetes is a chronic metabolic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (type 1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (type 2 diabetes). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke if the disease is left undiagnosed or poorly controlled. They also have elevated risks for sight loss, foot and leg amputation due to damage to the nerves and blood vessels, and renal failure requiring dialysis or transplantation.

Dementia describes a variety of brain disorders which progressively damage and destroy brain cells. Affecting mainly people over the age of 60 years, dementia results in the deterioration of mental ability characterised by impairments in memory and cognition. It is one of the most important causes of disability in the elderly. The most common cause of dementia in the European Union is Alzheimer’s disease (around 50-70%), followed by successive strokes that lead to multi-infarct dementia (around 30%). There is no cure for dementia, but drugs exist to alleviate and temporarily delay the symptoms.