Health At A Glance 2017. OECD Indicators
This new edition of Health at a Glance presents the most recent comparable data on the health status of populations and health system performance in OECD countries. Where possible, it also reports data for partner countries (Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, Russian Federation and South Africa). The data presented in this publication come from official national statistics, unless otherwise stated.
This edition contains a range of new indicators, particularly on risk factors for health. It also places greater emphasis on time trend analysis. Alongside indicator-by-indicator analysis, this edition offers snapshots and dashboard indicators that summarise the comparative performance of countries, and a special chapter on the main factors driving life expectancy gains.
At a glance – findings about alcohol harm
The report confirms that alcohol use remains a leading cause of death and disability worldwide, specifically for people of working age. Across the 32 OECD countries, alcohol use ranks among the top 10 leading risk factors in terms of years of healthy life lost. Moreover, alcohol consumption in OECD countries is well above the global average. Ranging from cancers to heart diseases, liver diseases and others, alcohol use led to 2.3 million deaths in 2015.
Regarding total alcohol consumption by country, the report charts a reduction from 9.5 litres per capita in 2000, to 9 litres per capita today. This aggregate reduction of alcohol consumption was not uniform across the 32 OECD countries, with consumption rising in 13 of them – as well as in applicant country Lithuania.
European countries in which alcohol consumption increased include
- Norway,
- Slovenia and
- Sweden (all by 0.1 litres up to 1 litre per capita) as well as
- Belgium,
- Iceland,
- Latvia,
- Poland and
- Lithuania (all by between 1.1 litres till up to 5.3 litres per capita).
The most significant reductions in alcohol consumption (by more than 2 litres per capita) were found in
- Denmark,
- Ireland,
- Italy and
- the Netherlands.
The report noted the gendered nature of alcohol use and associated harm, with men exhibiting higher rates in nearly all countries. Across the OECD, the report found that that 12% of women and 30% of men binge-use alcohol on a regular basis. The gender gaps were smallest in Greece and Spain, and largest in Estonia, Finland and Latvia.
The report detailed the variety of existing policy options to tackle alcohol consumption and related harm, and highlighted that taxes, fiscal policies, regulations and enforcement all vary from country to country.
The report concludes by recommending comprehensive policy packages which integrate fiscal measures and regulation, as well as some less stringent policies (eg. workplace interventions) as those most effective at reducing alcohol harm.
Executive summary
Health at a Glance 2017 presents up-to-date cross-country comparisons of the health status of populations and health system performance in OECD and partner countries. Alongside indicator-by-indicator analysis, this edition offers snapshots and dashboard indicators that summarise the comparative performance of countries, and a special chapter on the main factors driving life expectancy gains.
Most OECD countries have universal health coverage systems which promote equitable access for needed health services. Quality of care has also generally improved, but this has come at a cost: health spending now accounts for about 9% of GDP on average.
Investing in cost-effective health promotion interventions is one important way to improve value for money and reduce health inequities.
People in OECD countries are living longer, but the burden of mental illness and chronic disease is rising
- Life expectancy at birth is 80.6 years, on average, across OECD countries. Japan and Spain lead a group of 25 OECD countries with life expectancies over 80 years.
- Turkey, Korea and Chile have experienced the largest gains in life expectancy since 1970.
- Health spending contributes to longevity, but only explains part of the cross-country differences and gains in life expectancy over time. New regression estimates suggest healthier habits and wider social determinants of health are also key.
- Women can expect to live just over ve years longer than men, while people with tertiary level education live around six years longer than those with the lowest level of education.
- Across the OECD, more than one in three deaths are caused by ischaemic heart disease, stroke or other circulatory diseases; one in four deaths are due to cancer.
- Mortality rates for circulatory diseases have fallen rapidly, with 50% fewer deaths due to ischaemic heart disease, on average, since 1990. Cancer mortality rates have also fallen, though less markedly, by 18% since 1990.
While smoking rates continue to decline, there has been little success in tackling obesity and alcohol harm, and air pollution is often neglected
- Smoking rates have decreased in most OECD countries, but 18% of adults still smoke daily. Rates are highest in Greece, Hungary and Turkey, and lowest in Mexico.
- Alcohol consumption in the OECD averaged 9 litres of pure alcohol per person per year, equivalent to almost 100 bottles of wine. This gure is driven by the sizeable share of heavy alcohol users: 30% of men and 12% of women binge-use at least once per month.
- In 13 OECD countries alcohol consumption has increased since 2000, most notably in Belgium, Iceland, Latvia and Poland.
- Since the late 1990s, obesity has risen quickly in many OECD countries, and more than doubled in Korea and Norway, albeit from low levels.
- 54% of adults in OECD countries today are overweight, including 19% who are obese. Obesity rates are higher than 30% in Hungary, Mexico, New Zealand and the United States.
- Among 15 year olds, 25% are overweight and only 15% do enough physical activity. Further, 12% smoke weekly and 22% have been drunk at least twice in their lives.
- In 21 countries, over 90% of people are exposed to unsafe levels of air pollution.
Most OECD countries have achieved universal or near-universal health coverage, but access to care needs to be improved
- Population coverage for a core set of services is 95% or higher in all but seven OECD countries and lowest in Greece, the United States and Poland.
- Out-of-pocket payments by households make up 20% of all health spending on average in the OECD, and over 40% in Latvia and Mexico.
- Cost concerns lead about 10% of people to skip consultations, while 7% do not purchase prescribed medicines. Poorer households are most affected.
- The number of physicians per 1000 people is much higher in capitals and other cities, with variation between areas most marked in the United States and the Netherlands.
- Waiting times for elective surgery are long in a number of countries, particularly Estonia, Poland and Chile.
Patient experiences and outcomes of care are improving, with lower mortality rates after a heart attack or stroke and higher survival rates for people with cancer
- Over 80% of patients report positive experiences in terms of their time spent with a doctor, easy-to-understand explanations and involvement in treatment decisions.
- Avoidable hospital admissions for chronic conditions have fallen in most OECD countries, indicating an improving quality of primary care.
- In terms of acute care, fewer people are dying following heart attack or stroke. Improvements are particularly striking among heart attack patients in Finland, and stroke patients in Australia.
- Timeliness of hip fracture surgery (a measure of patient safety) has improved in most countries, with over 80% occurring within two days of admission.
- Rates of obstetric trauma have remained relatively unchanged, with tearing of the perineum in 5.7% of instrument-assisted vaginal deliveries.
- Across the OECD, five-year survival rates for breast cancer were 85% and just over 60% for colon and rectal cancers, with survival rates improving in most countries over time.
- Childhood vaccinations are near universal in most OECD countries, though measles coverage has fallen slightly in Australia and Italy in recent years.
Having sufficient financial and material resources is critical to the functioning of a health system. These resources need to be used wisely to avoid ineffective spending
- Spending on health in the OECD was about USD 4,000 per person on average (adjusted for purchasing powers). The United States spends almost USD 10,000 per person.
- Health spending was 9% of GDP on average in the OECD, ranging from 4.3% in Turkey to 17.2% in the United States.
- In all countries except the United States, government schemes and compulsory health insurance are the main health care nancing arrangements.
- Hospitals account for nearly 40% of health spending.
- Since 2000, the number of doctors and nurses has grown in nearly all OECD countries. There are about three nurses per doctor, with the nurse-to-doctor ratio highest in Japan, Finland and Denmark.
- Hospital beds per capita have fallen in all OECD countries except Korea and Turkey, linked to lower hospitalisation rates and increased day surgery.
- Increased use of generics in most OECD countries has generated cost-savings, though generics still represent less than 25% of the volume of pharmaceuticals sold in luxembourg, Italy, Switzerland and Greece.
- Population ageing has increased the demand for long-term care, with spending increasing more than for any other type of health care.
- On average, 13% of people aged 50 and older provide weekly care for a dependent relative or friend; 60% of informal carers are women.
Alcohol consumption among adults
Alcohol use and related harm is a leading cause of death and disability worldwide, particularly in those of working age (OECD, 2015). Alcohol use is among the top ten leading risk factors in terms of years of healthy life lost in 32 OECD countries (Forouzanfar et al., 2016), and consumption in OECD countries remains well above the world average. In 2015, alcohol use lead to 2.3 million deaths, caused by cancers, heart diseases and liver diseases, among others. Most alcohol is consumed by the heaviest-using 20% of the population. Heavy alcohol intake is associated with a lower probability of employment, more absence from work, and lower productivity and wages.
On average, recorded alcohol consumption has decreased in the OECD since 2000 (Figure 4.3), from 9.5 litres per capita per year to 9 litres of pure alcohol per capita each year, equivalent to 96 bottles of wine. The extent of the decrease varies greatly by country, and consumption has in fact increased in thirteen OECD countries, as well as in China, India, Lithuania and South Africa. Consumption increased by 0.1 to 1 litre in Canada, Chile, Israel, Korea, Mexico, Norway, Slovenia, Sweden and the United States, as well as in South Africa. The increase was stronger in Belgium, Iceland, latvia and Poland, as well as China, India and Lithuania (1.1 to 5.3 litres per capita). In all other countries, alcohol consumption decreased between 2000 and 2015. The largest drops occurred in Denmark, Ireland, Italy and the Netherlands (more than 2 litres per capita).
Although adult alcohol consumption per capita is a useful measure to assess long-term trends, it does not identify sub-populations at risk from harmful alcohol use patterns. Heavy alcohol intake and alcohol dependence account for an important share of the burden of diseases associated with alcohol. Across the OECD, an average of 12% of women and 30% of men take part in regular binge-alcohol use (at least once per month) (Figure 4.4). Rates range from 8% in Hungary to 37% in Denmark, and display large gender gaps, with men exhibiting higher rates in virtually all countries. These gaps are lowest in Spain and Greece (8- 10 points), and are highest in Estonia, Finland and Latvia (over 25 points).
Many policies addressing alcohol use and associated harm already exist: some target heavy alcohol users only, while others are more population based. While all OECD countries apply taxes to alcoholic beverages, the level of taxes may greatly vary across countries. New forms of fiscal policies have been implemented like minimum pricing of one unit of alcohol in Scotland. Regulations on advertising alcoholic products have been set up in many OECD countries, but the forms of media included in these regulations (e.g. printed newspapers, billboards, the internet) and the enforcement of the law vary a lot across countries. All OECD countries have legally set maximum levels of blood alcohol concentration for drivers, but the enforcement of these regulations may be haphazard and varies widely across and within countries. Less stringent policies include health promotion messages, school-based and worksite interventions and interventions in primary health care settings. Comprehensive policy packages including fiscal measures, regulations and less stringent policies are shown to be the most effective to reduce and prevent alcohol harm (OECD, 2015).