There is some good news in WHO’s European Health Report 2015: Europe appears to be on track in reducing premature mortality from the four main chronic diseases (cardiovascular diseases, cancer, diabetes, respiratory diseases). [1] Total alcohol consumption decreased by 10% in Europe in the period 2005 – 2010. Smoking decreased in nearly all countries between 2010 and 2012, although few countries are on track to achieve a 30% reduction in tobacco use by 2025.
The good news however comes with a few caveats: Progress is overwhelmingly due to reductions in cardiovascular disease mortality and is also almost entirely due to improvements in countries that started out with the highest mortality levels. Reduced mortality should not be confused with “healthy life years” gained, or “disability-free life expectancy”. The latter are measures of years lived in health, while mortality rates reflect on longevity without any indications of life quality.
The bad news is that, incidence of smoking and alcohol consumption are still too high, and the number of Europeans who are overweight or obese has actually increased between 2010 and 2014 in all European countries.
Nearly 60% of Europeans are now overweight or obese. [4] Obesity can shorten life expectancy by as much as 14 years. According to opinions inside the WHO the younger generation may, for the first time in modern history, face life expectancy lower than their parents.
Well-being, a new public health metric, apart from the latest trends in health, the report is important for emphasising that the concept of “well-being” should be used as a public health indicator. Most of us are well aware of the fundamental defects of GDP as a measure or even proxy for anything more than the amount of goods and services a country produces. Will another cigarette, bottle of vodka or box of sugar-pumped breakfast cereal contribute to improved welfare? Probably not.
Well-being encompasses many traditional notions of health, but also addresses other factors that are meaningful for people’s life experience. It is a comprehensive metric, combining subjective (qualitative) and objective (quantitative) indicators. It is holistic and can contribute to integrated thinking about health, including helping transition health systems away from a sickness orientation. Well-being can be a positive agenda-setter, preferable to morbid notions of mortality and disease.
Asking public institutions to make us ’happy’ falters on the acceptability scale, particularly in the Western civilisation, although promotion of ’well-being’, on the other hand, is a reasonable and legitimate demand.
Although work on operationalising the indicator is still in progress, public health organisations should support well-being as a key concept and strategic idea. To be relevant, public health should take centre stage in defining the meaning of human, societal and economic progress.
[1] Reduction in mortality has accelerated from 0.8% per year in 1998-2005 to 2.6% between 2006 and 2012, averaging 2% per year. The target is a 1.5% annual reduction between 2010 and 2020.
By Nikolai Pushkarev, Policy Coordinator Food, Drink & Agriculture, EPHA
