Improving public health and the performance of health care systems is a key priority across EU countries. One approach to assess the general effectiveness of public health programmes and health care policies, in achieving their objective of improving health outcomes, is through measuring potentially avoidable mortality. This term refers to deaths that might either be avoided through effective preventive strategies or through the provision of high-quality care. Better prevention and health care policies should be reflected in lower numbers of both preventable deaths and deaths amenable to health care.

Most health systems have developed a primary level of care whose functions include health promotion, disease prevention, managing new health issues, managing chronic conditions, and referring patients to hospital-based services when appropriate (see ). This primary level serves as a consistent point of care for patients and provides continuity in health management including chronic disease management. As rates of chronic conditions rise across EU countries, managing these conditions at the primary level becomes increasingly important to improve health outcomes and control costs.

Beyond consumption and expenditure information (see ), prescribing can be used as an indicator of health care quality. Antibiotics, for example, should be prescribed only where there is an evidence-based need, to reduce the risk of resistant bacteria. Quinolones and cephalosporins are considered second-line antibiotics in most prescribing guidelines and their use should be restricted in order to ensure their availability, should first‑line antibiotics fail. The total volume of antibiotics prescribed and the proportion of second-line antibiotics prescribed have been validated as markers of quality in the primary care setting. In the context of rising antibiotic resistance, the European Commission has requested that the ECDC develop draft EU guidelines on the prudent use of antimicrobials in human medicine.

Mortality due to coronary heart disease has declined substantially since the 1970s (see indicator Mortality from heart disease and stroke in ). Smoking reduction (see indicator Smoking among adults in ) and improvements in treatment of cardiovascular diseases have played a large role in this decline (OECD, 2015) along with changes in diet and exercise. Clinical practice guidelines such as those developed by the European Society of Cardiology have also helped optimise treatment. Despite these advances, AMI (or heart attack) remains the leading cause of cardiovascular deaths across EU countries, making further improvements a priority.

Annually, 15 million people worldwide suffer a stroke leading to 5 million deaths and 5 million people permanently disabled (WHO, 2016). Ischemic stroke represents around 85% of all cerebrovascular disease cases. Ischemic stroke occurs when the blood supply to a part of the brain is interrupted, leading to a necrosis (i.e. cell death) of the affected region. Treatment for ischemic stroke has advanced dramatically over the last decade. Clinical trials have demonstrated clear benefits of thrombolytic treatment for ischemic stroke as well as receiving care in dedicated stroke units to facilitate timely and aggressive diagnosis and therapy for stroke victims (Seenan et al., 2007).

Cervical cancer is highly preventable if precancerous changes are detected and treated before progression occurs. The main cause of cervical cancer is the human papilloma virus (HPV) which accounts for approximately 95% of all cases (IARC, 2005).

Breast cancer is the most prevalent form of cancer in women across EU countries. One in nine women will develop breast cancer at some point in their life and one in thirty will die from the disease. Risk factors that increase a person’s chance of getting this disease include age, family history of breast cancer, genetic predisposition, reproductive factors, oestrogen replacement therapy, and lifestyles-related factors including obesity, physical inactivity, diet, and alcohol consumption.

Colorectal cancer is the third most commonly diagnosed form of cancer among men after prostate and lung cancers and the second most common form among women (after breast cancer) across EU countries. Incidence varies greatly across the EU region from over 40 cases per 100 000 population in the Slovak Republic, Hungary, Denmark and the Netherlands to less than half this rate in Greece. Several risk factors exist including age, ulcerative colitis, a personal or family history of colorectal cancer or polyps, along with lifestyle factors such as a high‑fat, low‑fibre diet, lack of physical activity, obesity, tobacco use and alcohol consumption.

Each year in the European Union, over 4 million patients acquire a healthcare-associated infection (HAI). These infections are estimated to contribute to roughly 110 000 deaths across Europe, along with substantial morbidity and cost for health systems (ECDC, 2016a).

All EU countries have established vaccination programmes based on the appraisal of the epidemiology of diseases and the availability of vaccines which have been proven to be safe and effective for prophylactic use. Measles, diphtheria and pertussis are highly infectious diseases spread through human contact while tetanus is often acquired through a wound or skin puncture. Effective vaccination is available for all of these diseases and usually managed by the primary health care system (see ). These vaccines are part of larger childhood vaccinations efforts across the European Union.

Influenza is a common infectious disease affecting 5‑10% of adults and 20-30% of children. Seasonal influenza causes 4-50 million symptomatic cases in the UE/EEA each year, and 15 000-70 000 European citizens die every year of causes associated with influenza (ECDC, 2016). Epidemics of influenza can result in high rates of worker absenteeism and place high demands on health systems from increases in medical visits, hospitalisations, and medication usage including antibiotics. Vaccination has proven to be an effective tool in reducing the burden of seasonal influenza and is usually managed at the primary level of health care (see ). Older people are at high risk for serious illness from influenza and WHO recommends vaccination in this group. A review of vaccination drivers and barriers found that among elderly populations, personalised postcards or phone calls were effective in increasing vaccination coverage while barriers included social disadvantage, smoking, and lack of social support (ECDC, 2013). In addition to older people, the European Council recommends influenza vaccination for persons with chronic medical conditions and health care workers. Along with these groups, WHO recommends influenza vaccination also for pregnant women and children.

Along with a growing prevalence of chronic diseases, management of infectious diseases such as Human Immunodeficiency Virus (HIV) and Tuberculosis remains a priority in many EU countries.