The unequal health of Europeans: reflection of the successes and
failures of policies
Johan P. Mackenbach [a]
Marina Karanikolos [b]
Martin McKee [b]
Affiliations
[a] Department of Public Health
Erasmus MC, University Medical Center Rotterdam
Rotterdam, Netherlands
[b] London School of Hygiene and Tropical Medicine
London, United Kingdom
Published as: Mackenbach JP, Karanikolos M, McKee M. The unequal health of Europeans:
successes and failures of policies. Lancet. 2013 Mar 30;381(9872):1125-34.
1
Abstract
Europe, with its 53 countries and divided history, is a remarkable but inadequately exploited
natural laboratory for studying the effects of health policy. In this paper, the first in a series
on Europe, we review recent developments in population health in Europe, focusing on
trends in mortality, and highlight the main successes and failures of health policy in the past
four decades. In western Europe life expectancy has improved almost continuously, but
progress has been erratic in eastern Europe, and as a result disparities in male life
expectancy now are greater than four decades ago. The mortality declines seen in western
Europe involve many different causes of death and reflect the combined impacts of
economic growth, better health care, and successful health policies (for example on tobacco
control and road traffic safety). The less favourable mortality trends in eastern Europe
reflect economic and health care problems, as well as a failure to implement effective health
policies in many areas. The political history of Europe has left deep divisions in the health of
its population. Important health challenges remain both in western and eastern Europe,
reflecting unresolved issues of health policy (for example on alcohol and food) as well as
rising health inequalities within countries.
Key messages
Europe offers a remarkable natural laboratory in which to study the effects of health policy
and health systems
The political divisions of Europe in the twentieth century remain apparent in patterns of
health, with a persisting East West divide
Despite overall progress, there have been some remarkable failures of health policy even in
western Europe, such as delays in acting on tobacco in Denmark, Germany and Austria, and
the rise of alcohol-related deaths in Finland and the United Kingdom
The East West health divide is partly due to failures of health policy in eastern Europe, e.g. in
the fields of tobacco and alcohol, infectious diseases, road and child safety, and health care.
Patterns of health also vary greatly within countries, by region, by socioeconomic group and
by ethnicity, providing further opportunities for health improvement in addition to those
related to experience elsewhere
2
Introduction
This is the first in a series of papers on health and health policy in Europe. We define Europe
pragmatically as the 53 countries of the World Health Organisation’s European Region while
remaining aware that any attempt to define Europe is far from straightforward (Box 1). The
Lancet has produced many series on different parts of the world but this is the first time it
has come home to Europe. We believe that this series should be of interest to Lancet
readers for a number of reasons.
First, Europe provides a rich natural laboratory for studying the determinants of population
health and the effects of health policy. For example, the diet and drinking patterns of
Europeans, both known determinants of health, vary widely due to climatic and thus
agricultural diversity. The countries of Europe have also pursued very different policies that
impact on the determinants of health, whether proximal, such as tobacco, traffic injury, and
illicit drugs, or distal, such as poverty. While united in a commitment to universal coverage
of health services, each organises their health systems in different ways. There is much that
can be learned from this diversity. 1
Second, Europe differs from many of the other parts of the world that have featured in
previous Lancet series on countries such as China, India, Brazil and Mexico. These countries
are expanding access to health care as their predominantly rural societies undergo rapid
industrialisation and urbanisation, accompanied by rising standards of living, even if the
benefits are unevenly shared. Europe, in contrast, is faced with the challenge of sustaining
comprehensive health systems while undergoing a process of deindustrialisation and, in
many places, relative or absolute economic decline as manufacturing shifts to parts of the
world where labour is cheaper. This challenge is being exacerbated by the current global
financial crisis and by demographic changes, with falling birth rates, increasing life
expectancy, and migration changing the pattern of disease and the ability of labour-intensive
health and social services to respond.
In this first paper we review patterns of health in the different parts of Europe, charting
successes and failures. The remaining papers will explore some of these issues in greater
depth. The second paper looks at the European project to build an ever closer union.2 Many
policies that impact on health are now decided collectively.3 This is inevitable, given the
common challenges that the countries of Europe face and which, in a single market, can only
be tackled through joint action. Yet, for many people, the workings of the European Union
are a mystery, a situation not helped by the scant attention paid to it in some countries by
the mass media, except, in some cases, to hold it responsible for all the evils in the world,
both real and imagined.
The third paper looks at the countries that emerged from the break-up of the Soviet Union.4
These countries were united for most of the 20th century. At the outset, the Soviet regime
made health a priority but, by the 1960s, it was suffering from a combination of scientific
isolation and diversion of resources to the military-industrial complex. Although the Soviet
Union had some of the trappings of a superpower, with nuclear weapons and a major space
programme, it neglected the health of its people. By the time it collapsed, life expectancy
was plummeting, a situation only otherwise seen in wartime or as a consequence of the AIDS
epidemic sweeping parts of Africa.5
Three further papers examine the changing needs of different population groups in Europe
today. The fourth considers children.6 The pattern of disease among children in Europe has
3
been transformed, especially as a consequence of progress against infectious disease. Health
professionals are now caring for children with complex chronic diseases, such as juvenile
onset diabetes, a condition whose incidence is rising substantially, genetic disorders,
childhood cancers, and behavioural disorders such as autism. Health systems have
responded in different ways, offering opportunities to learn from each others’ experiences.7
The fifth paper examines how European governments are responding to increasing numbers
of migrants.8 Europe needs migration to fill the gap left by declining birth rates. Yet migrants
often face many disadvantages and, in many cases, outright discrimination.9 This paper will
provide an opportunity to draw on experience of good practice from across Europe.
The sixth paper looks at older Europeans.10 Improvements in living conditions, healthier
lifestyles, and improved health care mean that Europeans are living longer than ever. This
brings many opportunities for people to contribute to society for much longer. Yet it also
brings challenges, as health services are confronted by more people surviving with complex
chronic diseases.11
The final paper in the series addresses an issue that has dominated media coverage of
Europe for the past four years, the impact of the global economic crisis.12 Some countries
have been affected much more than others, in particular the so-called PIGS, Portugal,
Ireland, Greece and Spain. Yet the crisis has implications for nearly all countries in Europe,
whether as recipients or donors of funds to support Europe’s ailing economies or as major
trading partners. Many of the policy responses have been characterised by austerity and this
paper will examine how they impact on health and health services.
Improvements and setbacks, convergences and divergences
The political divisions of Europe are immediately apparent in its patterns of mortality. The
countries of western Europe have experienced sustained improvements in life expectancy
throughout the last 50 years,5 (Figure 1a) despite occasional short-term stagnation or even
reversal of mortality decline in some age groups, such as among young Spanish men in the
1980s (due largely to injuries and HIV/AIDS)13 and among women in Denmark and the
Netherlands in the 1990s (due to a peak in smoking-related deaths).14-15 The overall pattern
within Western Europe is one of convergence of life expectancy, with slightly faster progress
in countries that were still lagging behind in 1960, such as Finland and Portugal. 16
In contrast, the former communist countries of central and eastern Europe and the Soviet
Union experienced stagnation or even decline of life expectancy during the 1960s, 1970s and
1980s, with the overall figure concealing increases in mortality among middle-aged men that
were compensated for, and to some extent obscured by, continued improvements in
mortality among children. 17 The situation changed after 1990 (Figure 1b). Life expectancy
improved almost at once in the former East Germany, Poland and what was then
Czechoslovakia, but the improvement was delayed until 1993 in Hungary and a few years
later in Romania and Bulgaria. Of the countries that emerged from Yugoslavia. Slovenia was
the only successor state whose secession was largely peaceful, and whose life expectancy
improved without interruption. Elsewhere, ethnic violence killed hundreds of thousands of
people and displaced many more. Because of interruptions in data collection it is difficult to
see these events in life expectancy trends, with the exception of Croatia that had a clear dip
in male life expectancy in the early 1990s (Figure 1b). The situation in the countries of the
former Soviet Union differed again, with a series of rapid fluctuations from the mid- 1980s
4
onwards that, although varying in magnitude, were similar in timing. 18-19 The overall pattern
within eastern Europe is one of divergence of life expectancy, especially for men.
Some of these trends and variations can be explained by economic developments. Western
Europe experienced economic growth in the 1980s when many countries in central and
eastern Europe and the Soviet Union were experiencing economic stagnation due to the
failure of the communist economic model, with severe economic decline in the 1990s
exacerbated by forced restructuring of the economy 20. The effect of economic growth on
life expectancy, however, is likely to be mediated by a range of different factors, including
less exposure to hazardous living conditions, lifestyle change, more effective public health
systems, better health care, etc. 21-22
By the beginning of the 21st century, most of Europe had achieved a degree of stability and
life expectancy was again on a sharp upward course almost everywhere. In the European
Union, life expectancy for men increased by 3.15 years between 1999 and 2010 while the
corresponding figure for women was 2.47 years. These gains can be decomposed to
determine how many years the major causes of death at different ages contributed to the
overall change in life expectancy (Figure 2). It can be seen that the greatest share was
brought about by reductions in deaths among men aged 60 and above and women aged 65
and above. These were largely due to declines in cardiovascular disease mortality, although
reduced deaths from external causes (injuries and violence) played a role in younger men.
The large declines in mortality among elderly people seem to open a new phase in the
epidemiologic transition, which may have important consequences for population aging 23-24.
Recent progress of life expectancy in the former Soviet Union has been more diverse.25-26
The 1990s were characterised by a series of dramatic fluctuations but the three Baltic states
began an upward, although at times erratic, trend after 1994 while sustained improvements
in the remaining 12 countries only began in the mid-2000s (Figure 1b). Life expectancy at
birth still lags far behind that in the EU, with the gap, for men, at 12 years, while the
corresponding figure for women is 8 years. Any gains since 1990 have been driven by lower
death rates in infancy; there has been almost no change at other ages among women and
death rates among men at many ages are higher than in 1990 (Figure 2). Very recent
improvements in some countries (not shown) are due, largely, to reductions in deaths from
circulatory diseases, in both males and females and at older ages, thought to reflect
improvements in access to health care,25 but rates remain two to three times higher than
the EU average. Countries in the South Caucasus (Armenia, Azerbaijan, and Georgia) have
long had lower death rates from cardiovascular disease, which is plausibly linked to their
somewhat healthier “Mediterranean” diets, but some caution is required when interpreting
mortality data from this area.27 More details on European mortality patterns can be found in
the Web Appendix, and in Box 2 we describe recent progress in the collection of morbidity
data.
Successes and failures of health policy in western Europe
Specific health policies that have contributed to favourable health trends in western Europe
in recent decades were identified through a process of consultation with experts in a range
of subject areas who then conducted targeted literature reviews and additional data
analyses.1 The areas identified can be found in health protection and health promotion (e.g.,
tobacco control, home and road traffic safety, reductions in air pollution) as well in improved
health care (e.g. perinatal and maternal health, immunisations, hypertension detection and
5
treatment, cancer screening, more effective treatment for many diseases). Other areas of
health policy, such as those on alcohol and food, have had more mixed results.1
Notwithstanding some overall successes, western European countries have differed
significantly in their implementation of effective health policies, leaving substantial room for
further health gains. We will illustrate this using four examples.
Tobacco control
Tobacco remains the leading cause of avoidable premature mortality in Europe, but many
western European countries have made substantial progress in tobacco control. Countries
that have implemented more tobacco control policies, such as price increases, restrictions
on smoking in public places, and advertising bans, tend to have a lower smoking prevalence,
particularly among men (Figure 3a). Male lung cancer mortality is on the decline in many
European countries, and declines in smoking have contributed substantially to declines in
ischemic heart disease mortality 28-30.
Unfortunately, countries have differed considerably in the nature and timing of their policies
31. This is illustrated by the slow spread of bans on smoking in public places 32. Ireland was
the first western European country to enact a comprehensive ban, soon followed by
Scotland, England, Wales, Italy, Spain and France, but now extending more widely to
countries such as Bulgaria. However, other countries, and especially those where links
between the tobacco industry and politicians and scientists have been closer, such as
Germany 33 and Austria, have been slower and what measures have been taken have been
partial and poorly enforced.
The contrast between Denmark and Sweden is especially marked.34 The former has been
reluctant to take action against smoking. The tobacco industry in Denmark has been
successful in promoting the view that smoking is an expression of individual freedom, while
in Sweden successive governments have taken wide-ranging action to reduce smoking (it
should be noted that some commentators have linked Sweden’s success, in part, to its
legalisation of chewing tobacco but this is not supported by the evidence).35 As a
consequence, the death rate from lung cancer in Denmark is now twice that in Sweden, with
than among Danish women by far the highest in Western Europe.
Alcohol control
By contrast, progress in alcohol control has been limited over the last four decades. While
alcohol control policies have become more strict in some countries, particularly in southern
Europe (starting from a very low level), they have remained more or less stable in many
other countries 36. Alcohol consumption has gone up in many western European countries,
although not in southern Europe. Differences in consumption partly reflect differences in
policy (Figure 3b) and have profound consequences for health.
Alcohol consumption is deeply rooted in European culture, although there has historically
been considerable variation in what was drunk, in large part as a consequence of variations
in agriculture. However, these historical patterns are breaking down in the face of a massive
marketing campaign by the global alcohol industry, coupled with the introduction of new
products such as ‘alcopops’ designed to appeal to adolescents.37
France, which in 1970 had one of the highest death rates from chronic liver disease and
cirrhosis, has imposed a wide range of policies designed to reduce hazardous consumption.
These include restrictions on access, price increases, controls on marketing, and measures to
6
reduce drunk driving. These measures have been accompanied by a steady decline in deaths
from cirrhosis, to a level that is now less than a third of what it was in 1970. 38 Elsewhere,
policy changes have been less favourable. The United Kingdom has pursued a deregulatory
approach that has facilitated much easier access to alcohol. Unlike in France, the death rate
from cirrhosis has increased almost four-fold since 1970.39
Finland provides another example of policy failure. On joining the EU in 1994, Finland
deregulated what had been a very strict alcohol control regime, including a state monopoly
on alcohol. In 2004, when neighbouring Estonia, with its much lower alcohol prices, joined
the EU, it reduced taxes substantially.40 Mortality from alcohol-related causes, including
cirrhosis, went up considerably although there are indications that mortality from
cardiovascular disease among the elderly went down 41. A relatively small increase in taxes
was introduced in 2008,42 following which death rates have begun to decline slightly.
Food policy
Food policy is still in its infancy. As with alcohol, food consumption in Europe has historically
been shaped by patterns of agriculture, giving rise to the Mediterranean diet rich in fresh
fruits, vegetables and olive oil, believed to be a factor in the lower rates of ischemic heart
disease in southern Europe.43 In recent decades, European diets have changed considerably,
with mixed consequences for health. On the one hand, there has been an increase in the
consumption of animal products in those southern European countries that traditionally had
healthy diets. On the other hand, people in northern Europe, whose diets were previously
characterised by high levels of fat and low micronutrients, are eating more fresh fruit and
vegetables 44. To a considerable extent these changes have been a consequence of
globalisation of food production and marketing, including the European common market,
and what government intervention took place was largely to support the agricultural
industry, for example by providing subsidies regardless of the health effects of consuming
what was being supported.
However, there are a few examples of where governments have stepped in to influence
nutrition on grounds of health. The most well-known is in Finland where the North Karelia
project, initiated in 1972, adopted a multisectoral approach to improve the traditional
unhealthy Finnish diet.45 Although there have been many similar projects elsewhere, albeit
on a more localised scale, until recently European governments have been reluctant to take
specific measures to influence what we eat on grounds of health. However, this may be
changing, with Denmark taking action on trans-fats 46, several countries, such as France and
Finland, imposing new taxes on sweetened soft drinks, and some countries considering
action on salt.
Road traffic safety
Road traffic safety is another success story in Western Europe. The death rate from motor
vehicle traffic injuries among the 15 pre-2004 EU Member States has fallen from 22.3 per
100,000 in 1970 to 5.8 in 2009, partly as a result of policies to make roads safer, to
implement and enforce legislation on seat belts (Figure 3c), speed limits, helmets and drunk
driving, and to educate the public with media campaigns 47-48.
Some of the greatest declines have been in those countries with the highest initial rates,
such as Portugal, which has progressively introduced a set of comprehensive measures. Yet
other countries, where death rates were already relatively low, have achieved even further
7
declines. In 1997 Sweden launched its Vision Zero campaign, which brought together the
transport, education, justice environment and health sectors to pursue a goal of preventing
all deaths and serious injuries on Swedish roads 49. Similarly, in the 1990s, the Netherlands
adopted the Sustainable Safety Strategy, which placed a particular emphasis on design to
protect cyclists and pedestrians 50. Sweden and the Netherlands have the lowest death rates
from motor vehicle accidents among the pre-2004 EU Member States. Unfortunately, not
everywhere has road safety been so successful and death rates in Greece have increased
over the past four decades.
Successes and failures of health policy in central and eastern Europe
and the former Soviet Union
Unfortunately there are rather fewer successes to report in central and eastern Europe and
the former Soviet Union, and the less favourable health trends in these parts of Europe are
partly attributable to a lack of implementation of effective health policies. Before the
collapse of the Soviet Union many areas of health policy were seriously underdeveloped.
There was almost no tobacco control, alcohol control was erratic, and awareness of the
health risks of a diet rich in saturated fats and low in fruits and vegetables was low, resulting
in high rates of chronic disease. In Romania, the policies adopted by Nicolae Ceausescu had
especially tragic health impacts, with extremely high levels of maternal mortality due to the
prohibition of contraception and induced abortion, and a cohort of children infected by HIV
as a consequence of the bizarre policy of giving blood transfusions with the idea that they
would boost the immune system of malnourished children. 51
Tobacco and alcohol control
Tobacco control still lags behind that in the west, although some countries are making
progress. The downside to the fall of the Iron Curtain has been the entry to formerly closed
markets by the transnational tobacco industries who have marketed their products
aggressively,52 especially to women who were traditionally less likely to smoke in this region.
As expected, smoking rates among young women have risen considerably.53 Alcohol control
is even weaker, despite the role played by heavy drinking, especially in the former Soviet
Union. This often involves cheap and easily available surrogate alcohols, ostensibly sold as
aftershaves and medicinal tinctures and therefore untaxed, but containing 70-90% ethanol.54
There is now considerable evidence implicating them in sudden cardiac death, thought to be
a result of the direct toxic effect of ethanol on the myocardium.55 However, some progress is
apparent in Russia, where a 2006 law introduced some controls on production and sale of
these surrogates.56
Infectious disease control
After the system change that occurred around 1990 new, more effective, health policies
were implemented only slowly, and some existing health policies actually broke down. One
of the few areas where the Soviet health system achieved some success was in the control of
infectious disease. Unfortunately, the systems that many of the newly independent states
inherited in 1991 rapidly collapsed, with the re-emergence of diseases such as diphtheria
that had once been controlled 57 and the emergence of new problems, most notably multidrug resistant tuberculosis (MDR-TB) and HIV/AIDS.58 Indeed, central and eastern Europe
and the former Soviet Union currently include 15 of the 27 countries identified as having a
high burden of MDR-TB.
8
There are, however, some promising signs and Estonia has been praised for developing a
comprehensive strategy to tackle MDR-TB that is beginning to bear fruit, involving bans on
sales of anti-TB drugs in pharmacies, enhanced training of health professionals, and greater
efforts to tackle TB among heavy drinkers.59
Home and road safety
Alcohol is heavily implicated in the high death rates from injuries and violence in this region.
However, other factors contribute as well, such as the condition of the road network,
although major improvements have been made in central and Eastern Europe as a result of
investment by EU structural funds. Another is the failure to enforce road safety laws,
exacerbated by pervasive police corruption in some countries.60 Children in this region are
especially vulnerable, often with limited access to safe play areas and exposed to many
hazards in the home environment.61 Rates of drowning are very high, reflecting the common
practice of swimming in rivers and lakes without adult supervision.61
Health care
Inadequate health care has been another contributor to lack of improvement of population
health in this region.62-63 Poor control of hypertension is an example. After the system
change, there have been substantial improvements in mortality from causes where medical
care can prevent or delay death in some countries. The failure of the Soviet system to
develop a modern pharmaceutical industry, coupled with an inefficient distribution system,64
meant that many chronic diseases were untreated, a situation that persists in many parts of
the region.65 It is commonly believed that the upward turn in life expectancy trends seen in
Central and Eastern Europe in the early to mid-1990s at least partly reflected improvements
in health care. 66 However, in many former Soviet countries the previous system that at least
provided basic care has broken down. Many people must pay out of pocket for care, either
as formal or informal payments. As a consequence, many fail to obtain care when needed.67
Box 3 describes the contrasting experiences of Austria and the Czech Republic, and of
Estonia and Finland, whose current health situation is still strongly determined by Europe’s
political history.
Sub-national variations
The countries of Europe vary enormously in size, from Monaco and San Marino, each with
under 40,000 inhabitants, to Russia and Germany, with 141 and 82 million respectively.
Unsurprisingly, within-country differences are often as large as between-country
differences.
Regional variations
A recent mortality atlas by Eurostat reveals striking patterns of regional variation. 68 Thus, in
France, Germany and the United Kingdom life expectancy is higher in the South, while in
Spain it is higher in the North. These sub-national variations in health are sometimes quite
large, with life expectancy at birth in Scotland 2.5 years (men) and 1.9 years (women) below
the United Kingdom average. Despite European integration, national boundaries can still
clearly be seen in maps of cause-specific mortality, suggesting the continuing influence of
national-level factors (Figure 4). Nevertheless, as many of the larger European countries
undergo processes of decentralisation, policies related to health are increasingly determined
at regional rather than national level. In the United Kingdom, for example, the four
9
constituent countries now have markedly different policies on the delivery of health care, 69
as do the 17 regions of Spain, although there the financial crisis is leading to a rebalancing of
power between the centre and regions, led by finance ministries.70
Socioeconomic inequalities
The most significant source of health variations within countries is the scale of inequalities
between socioeconomic groups defined on the basis of education, occupation or income.
Inequalities in life expectancy between socioeconomic groups typically are in the order of 5
to 8 years and they have been stable or even widening throughout the years since 1970 71.
This is most often because, although life expectancy has improved in all socioeconomic
groups, it has done so faster in the higher groups.72 This is mainly due to the widening gap in
cardiovascular disease mortality: declines in cardiovascular disease mortality have been
greater in the higher than in the lower socioeconomic groups reflecting differences in uptake
of behaviour changes and new health care interventions. Some of the successes of health
policy mentioned above thus do not appear to have been shared equally.
Yet variations in the magnitude of health inequalities between European regions show that
they are modifiable.73 In the Mediterranean countries, inequalities in mortally are smaller
than elsewhere, due to narrower inequalities in mortality from cardiovascular disease and
cancer (particularly among women), with smaller differences in smoking and excessive
alcohol consumption. In Central and Eastern Europe, on the other hand, inequalities in
mortality are larger than elsewhere, due to larger differences in mortality from
cardiovascular disease, cancer and injuries, due to larger inequalities in smoking, excessive
alcohol consumption and inadequate health care.73 Most of the increase in mortality seen in
Central and Eastern Europe and the former Soviet Union in the 1990s was limited to lower
socioeconomic groups, which appear to have been particularly vulnerable to the economic
transformation of this region.74
Added to these are ethnic variations, but patterns are far from consistent due to variations
in country of origin and to health-related selection processes, a topic addressed later in this
series. Crucially, ethnic disadvantage is not restricted to migrant population and, in many
countries in central and eastern Europe, the Roma population face widespread
discrimination and suffer from worse health than the majority populations.75
The European Regional Office of the WHO has recently conducted a major review of social
determinants of health in Europe and this forms a key part of its new Health 2020 strategy.76
Conclusions
The political history of Europe has left deep traces in current population health. The failure
of the communist system to foster economic growth and to implement effective health
policies in the 1970s and 1980s and its disruptive transition to a capitalist economy in the
1990s have been a disaster for population health. Fortunately, many countries, particularly
those oriented towards the European Union, have been catching up quickly in recent years,
but it will take many more years and considerable efforts in health policy to close the gap.
In Western Europe, developments have been more favourable, partly because of the
implementation of effective health policies. Even there, however, there have been
remarkable differences between countries, with some countries doing better and others
worse, leaving considerable room for further population health gain. The latter will also
10
require strengthening of policy in areas that currently are only weakly developed, such as
food. Important challenges remain, not only for the improvement of average population
health but also for the reduction of health inequalities within populations.
Contributors: JM and MM drafted the paper jointly. MK undertook the data analysis. All
authors revised the paper.
Acknowledgement: This paper was drafted during a residency at the Rockefeller Foundation
in Bellagio, Italy and draws extensively on the work undertaken during the residency, to be
published as a book in late 2012. This series was supported by the European Observatory on
Health Systems and Policies.
11
Box 1 Europe: more than a geographical expression?
Europe is part of the Eurasian land mass, with the border with Asia a question of culture and
history as much as of physical geography – a fact noted by Metternich who pejoratively
suggested that Asia began on the outskirts of Vienna. 77 Two partly European countries,
Turkey and Russia, have the largest parts of their land masses in Asia, and both draw on
cultural traditions from east and west. 78-79 The European region of the World Health
Organisation stretches from western Greenland to Vladivostok and includes a number of
countries that are unambiguously in Asia, such as Kazakhstan, Uzbekistan, Kyrgyzstan,
Tajikistan, Turkmenistan, and Israel. The European Union extends across the globe, with the
Spanish enclaves of Ceuta and Melilla on the north coast of Africa, French and Dutch
departments and provinces in the Caribbean and, in the case of French Guiana, on the South
American mainland, and other French departments in the Indian Ocean.
Geographical complications also exist within mainland Europe as a consequence of changing
borders. The collapse of the communist bloc in the 1990s reshaped the map of Europe. New
countries were formed, with the two parts of Germany reunited and the two parts of
Czechoslovakia dividing. Two of the most multi-ethnic states, the Soviet Union and
Yugoslavia, broke up into their constituent republics, a process that may not yet have
reached its conclusion given the still contested status of entities such as Kosovo, TransDniester and a number of other autonomous enclaves in the former Soviet Union. 80 But it is
not just the location of borders that is changing, it is also their nature. National borders have
all but disappeared within most of the European Union, with the creation of the Schengen
Zone within which people may travel without hindrance. This has, however, been achieved
by reinforcing the European Union’s external borders, creating what has been termed
“fortress Europe”,81 designed to keep out those who lack the skills or resources that Europe
needs. In some cases, as in the former Soviet Union and Yugoslavia, countries that were
once united have even had to erect frontier posts.
Defining national groupings within Europe often gives rise to confusion. For example, the
European Union comprises 27 member states, soon to be 28 with the accession of Croatia in
2013. However, it excludes several smaller states within its borders (Monaco, San Marino,
Andorra and Liechtenstein) and some larger nearby ones (Iceland, Switzerland and Norway),
all of which are, to greater or lesser degrees, closely linked to it functionally. The smaller
states within the borders of the EU all use the euro as their currency and Norway enacts
European Union laws as if it was a member, in some cases faster than the actual member
states. All are members of the open border Schengen agreement, in contrast to the United
Kingdom and Ireland. As all these countries share many common features, it makes sense to
group them together, but an adequate term for this cluster of countries does not exist (the
European Economic Area, while wider than the European Union, only includes three of these
non-member states). Also, the term central and eastern Europe usually includes all those
former communist countries that were not part of the USSR, but strictly speaking many
former Soviet republics are also part of eastern Europe. According to customary usage, prior
to German unification the German Democratic Republic was in central and eastern Europe,
but it is now part of western Europe.
A similar problem arises with the countries that have emerged from the USSR. Originally
referred to as by the WHO and others as the “Newly Independent States”, this term seems
inappropriate 21 years after they achieved independence. The term “former Soviet Union”
strictly includes the three Baltic States that are now part of the European Union. The
12
Commonwealth of Independent States was created to link the remaining twelve former
Soviet Republics, but one, Georgia, is not a member. Thus, when the term Commonwealth of
Independent States is used this is often done on the tacit understanding that it also includes
Georgia.
Box 2 Sources of morbidity data
Unlike the USA, which has undertaken regular nationwide health interview and examination
surveys for many years, the European Union is only beginning this process and, where data
exist, they provide incomplete coverage. Perhaps the best known example is the network of
European cancer registries, which in a series of specific research projects (EUROCARE) have
done much to harmonise data collection.82 However, not all countries are included (e.g.
Luxembourg and Hungary do not participate) and even in some participating countries (e.g.
France, Spain and Italy). Research using the EUROCARE data has exposed wide variations in
outcomes 83 and had a major impact on cancer policy in some countries.84 Other data are
available from a diverse range of health interview and examination surveys, now being coordinated to produce core modules that can be compared across Europe. However, there is
still considerable work to be done to achieve comprehensive and consistent coverage by the
European Health Interview Surveys (EHIS) and the European Health Examination Surveys.
EHIS, where progress is more advanced, covers background demographic variables, risk
factors, health status, and health care utilisation. Other sources of data include the Survey of
Income and Living Conditions in Europe (SILC), but the health content is very limited and
many of the questions on potential explanatory variables have changed in recent years and
in different countries. Finally, the Survey of Health, Ageing and Retirement in Europe
(SHARE) is following up 55,000 individuals aged 50 or over from 20 European countries.
Despite its limited age-range, this has become an important source of morbidity data
because it includes measures of self-reported health problems and disabilities as well as
measured functional limitations.85
Box 3. The contrasting experiences of the Czech Republic and Austria, and of Estonia and
Finland
Czechoslovakia and Austria became independent countries after the First World War, with
the dissolution of the Austro-Hungarian Empire. In the 1920s and 1930s both countries had
very similar economic and cultural conditions, and their life expectancies in that period were
nearly identical. After the Second World War, however, Czechoslovakia became part of the
Soviet bloc, following a communist coup d’état, while Austria remained in the western
sphere of influence. From about 1970 their life expectancies started to diverge, with
Austria’s life expectancy on an upward track and that of Czechoslovakia stagnating and
gradually becoming similar to the lower life expectancy in Poland. It is only since the breakup of the Soviet bloc that the gap in life expectancy between Austria and (now) the Czech
and Slovak Republics has started to diminish somewhat. Currently, the Czech Republic is
performing better than many other central and eastern European countries in several areas
of health policy, including teenage pregnancies and neonatal mortality, cancer screening and
road traffic safety, but it is lagging behind in tobacco and alcohol control 1.
13
Estonia became independent from Russia in 1918, but was re-occupied by the Soviet Union
in 1940, and became independent again only in 1989. Finland provides a possible
counterfactual of what could have happened to Estonian life expectancy if it would not have
been in the Russian sphere of influence for more than 40 years. Finland also started the 20th
century as part of the Russian empire, but became independent in 1917 and has been
independent ever since. In 1930, Finland and Estonia still had a similar level of life
expectancy, some 5 to 10 years lower than that of Sweden, but 15 to 20 years higher than
that of Russia. After 1950, their life expectancies began to diverge, and while Finland steadily
narrowed the gap with Sweden, Estonia followed in the steps of Russia with stagnating life
and even declining expectancy, particularly among men. It is only since independence that
Estonian life expectancy trends started to break away from those in Russia once moreagain
.25-26 Currently, Estonia still lags far behind Finland in many areas of health policy: weaker
tobacco control and higher smoking rates and lung cancer mortality rates, less alcohol
control and higher alcohol consumption and liver cirrhosis mortality rates, more teenage
pregnancies and higher neonatal mortality rates, worse road safety and higher motor vehicle
accident mortality rates. 1
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Illustrations
Figure 1
Trends in life expectancy at birth in Europe, men, 1960-2010
a. Selected countries in Western Europe
80
75
Finland
70
Germany (FRG)
65
Italy
Portugal
60
Sweden
United Kingdom
55
2008
2005
2002
1999
1996
1993
1990
1987
1984
1981
1978
1975
1972
1969
1966
1963
1960
50
b. Selected countries in Central and Eastern Europe
80
75
70
Germany (DDR)
Croatia
65
Hungary
Estonia
60
Russian Federation
55
Source: Human Lifetable Database
19
2008
2005
2002
1999
1996
1993
1990
1987
1984
1981
1978
1975
1972
1969
1966
1963
1960
50
Figure 2 Age- and cause-specific contributions to life expectancy changes by region, 1980-2010
Contribution to life expectancy by cause
between 1990 and 2010 in CIS countries (males);
total change -0.1 years
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
-0.1
-0.2
-0.3
years
yearss
under 1s
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
under 1s
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Contribution to life expectancy by cause
between 1990 and 2010 in CIS countries (females);
total change 0.7 years
age groups
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
-0.1
-0.2
-0.3
Contribution to life expectancy by cause
between 1990 and 2010 in the EU countries (males);
total change 5.0 years
Contribution to life expectancy by cause
between 1990 and 2010 in the EU countries (females);
total change 3.9 years
years
under 1s
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
under 1s
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
years
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
-0.1
-0.2
-0.3
age groups
age groups
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
-0.1
-0.2
-0.3
Source: WHO mortality database (updated October2012)
Notes:
20
other
infectious
Digestive
Respiratory
external
cancer
age groups
CVD
Life expectancy was calculated using Chiang’s method 86 and decomposition by cause used Arriaga’s method.87
Data for France, Greece,
Hungary, Italy, Luxembourg, Armenia, Belarus, Georgia, Kazakhstan and Kyrgyzstan for 2009, Azerbaijan for 2007, Belgium and Denmark for
2006, Uzbekistan and Tajikistan 2005, Turmkenistan 1998
In these graphs, the y-axes represent the number of years that changing death rates in each age band contribute to the overall change in life
expectancy while the x-axes represent the different age bands. Bars above the x-axis represent causes from which deaths have declined, thus
contributing to gains in life expectancy, while those below the axis have increased, contributing negatively to life expectancy.
21
Figure 3
Between-country comparisons of indicators of tobacco control, alcohol
control, and road traffic safety
a. Association between a country’s score on the Tobacco Control Scale and male smoking
prevalence, circa. 2009.
60
50
male smoking prevalence (%)
r=-0.402
40
30
20
10
0
0
10
20
30
40
50
60
70
80
90
Tobacco Control Scale
Tobacco Control Scale score: country score (on a scale of 0-100) indicating completeness of
implementation of a range of tobacco control policies, ca. 2010 31. Smoking prevalence:
percentage of population aged 15 and over who is a current daily smoker, ca. 2008 (source:
WHO Health for All Database).
22
b. Association between a country’s score on the Alcohol Policy Scale and alcohol
consumption, circa. 2004
1.60
1.40
r=-0.314
Litres alcohol per capita
1.20
1.00
0.80
0.60
0.40
0.20
0.00
0
10
20
30
40
50
60
70
80
90
100
Alcohol Policy Scale
Alcohol Policy Scale score: country score (on a scale of 0-100) indicating completeness of
implementation of a range of alcohol control policies, ca. 2002 88. Alcohol consumption:
litres of alcohol per capita, ca. 2006 (source: WHO Health for All Database).
23
c. Association between a country’s seat belt wearing rate and road traffic injury mortality
among car occupants
3
Deaths per 10000 vehicles per year
2.5
r=-0.854
2
1.5
1
0.5
0
0
20
40
60
80
100
Percentage of drivers in front seats wearing seat belts
Seat belt wearing: Observed seat belt wearing rate (%) among front seat occupants, ca. 2006
48. Road traffic injury mortality among car occupants: deaths per 10000 vehicles per year
(calculated from WHO data 48).
24
Figure 4
Mortality from transport accidents by NUTS2 region, EU27, Iceland,
Switzerland and Norway; 3-year average (2007-2010 or latest available)
© EuroGeographics for the administrative boundaries
25
Web appendixEuropean mortality data (all data from the WHO Health for All database)
Life expectancy at birth and age 65 in Europe, latest available year
country
Albania (2004)
Armenia (2009)
Austria (2010)
Azerbaijan (2007)
Belarus (2009)
Belgium (2006)
Bulgaria (2011)
Croatia (2010)
Cyprus (2010)
Czech Republic (2010)
Denmark (2006)
Estonia (2010)
Finland (2010)
France (2009)
Georgia (2009)
Germany (2010)
Greece (2009)
Hungary (2009)
Iceland (2009)
Ireland (2010)
Italy (2009)
Kazakhstan (2010)
Kyrgyzstan (2010)
Latvia (2010)
Lithuania (2010)
Luxembourg (2010)
Malta (2010)
Montenegro (2009)
Netherlands (2010)
Norway (2010)
Poland (2010)
Portugal (2010)
Republic of Moldova (2011)
Romania (2010)
Russian Federation (2010)
Serbia (2010)
Slovakia (2010)
Slovenia (2010)
Spain (2010)
Sweden (2010)
Switzerland (2010)
Tajikistan (2005)
TFYR Macedonia (2010)
Turkmenistan (1998)
Ukraine (2010)
United Kingdom (2010)
Uzbekistan (2005)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
Life expectancy at
birth
males
females
73.7
78.9
70.6
76.9
78.0
83.7
71.3
76.3
64.8
76.6
76.9
82.5
70.8
77.9
73.6
80.0
79.6
84.1
74.6
81.0
76.2
80.8
70.7
80.8
77.0
83.7
77.8
84.8
69.3
78.0
78.1
83.1
77.9
82.8
70.3
78.5
79.9
83.9
78.5
83.0
79.3
84.6
63.7
73.5
65.5
73.7
68.6
78.4
68.0
79.0
78.8
83.9
79.3
83.6
73.3
78.0
79.1
83.1
79.1
83.5
72.2
80.8
76.6
82.7
66.8
75.1
70.2
77.6
62.9
74.8
71.8
77.0
71.8
79.4
76.6
83.2
79.2
85.4
79.7
83.7
80.4
85.0
71.2
76.3
73.0
77.3
62.5
69.8
65.2
75.3
78.5
82.6
68.2
73.0
77.0
82.9
78.4
83.8
71.6
79.6
64.7
74.7
26
Life expectancy at age 65
males
females
14.9
17.8
13.4
16.2
18.0
21.6
14.5
16.3
11.8
16.9
17.2
20.9
14.0
17.4
14.7
18.2
18.6
21.3
15.5
19.1
16.4
19.2
14.2
19.5
17.6
21.6
18.5
22.9
13.7
18.1
18.0
21.1
18.2
20.3
14.0
18.3
18.7
21.1
17.8
21.0
18.4
22.2
11.9
15.6
12.8
15.7
13.4
18.3
13.6
18.5
17.7
22.0
18.6
21.2
15.2
17.3
17.9
21.2
18.2
21.3
15.2
19.6
17.0
20.5
12.7
15.7
14.1
17.3
12.2
16.5
14.0
16.2
14.1
18.1
16.9
21.1
18.7
22.9
18.4
21.3
19.2
22.7
14.5
17.8
14.0
16.1
12.4
14.9
12.2
16.1
18.2
20.9
13.0
15.0
17.4
21.0
18.2
21.7
14.7
18.7
12.4
16.2
Childhood mortality in Europe, latest available year
country
Albania (2004)
Armenia (2009)
Austria (2010)
Azerbaijan (2007)
Belarus (2009)
Belgium (2006)
Bulgaria (2011)
Croatia (2010)
Cyprus (2010)
Czech Republic (2010)
Denmark (2006)
Estonia (2010)
Finland (2010)
France (2009)
Georgia (2009)
Germany (2010)
Greece (2009)
Hungary (2009)
Iceland (2009)
Ireland (2010)
Italy (2009)
Kazakhstan (2010)
Kyrgyzstan (2010)
Latvia (2010)
Lithuania (2010)
Luxembourg (2010)
Malta (2010)
Montenegro (2009)
Netherlands (2010)
Norway (2010)
Poland (2010)
Portugal (2010)
Republic of Moldova (2011)
Romania (2010)
Russian Federation (2010)
Serbia (2010)
Slovakia (2010)
Slovenia (2010)
Spain (2010)
Sweden (2010)
Switzerland (2010)
Tajikistan (2005)
TFYR Macedonia (2010)
Turkmenistan (1998)
Ukraine (2010)
United Kingdom (2010)
Uzbekistan (2005)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
Infant
deaths per
1000 live
births
7.8
10.2
3.9
9.8
4.7
4.1
8.5
4.4
2.2
2.7
3.4
3.3
2.3
3.5
14.9
3.4
3.2
5.1
1.8
3.8
3.6
16.5
22.3
5.7
4.3
2.7
5.5
5.8
3.8
2.6
5.0
2.6
11.0
9.8
7.6
6.7
5.7
2.5
3.2
2.5
3.8
14.1
7.6
32.8
9.2
4.3
15.0
4.1
3.6
5.9
11.3
SDR per 100,000, 0-14 year olds, all causes
males
129.3
112.1
43.3
141.7
72.3
46.3
102.2
50.0
24.0
34.7
40.5
54.3
29.8
41.6
157.1
39.2
39.2
55.5
26.6
42.5
40.6
196.7
246.2
67.6
54.9
28.8
57.2
67.3
41.2
30.9
55.2
32.7
135.0
111.3
104.5
74.2
66.1
24.1
35.9
29.2
36.0
256.7
75.9
463.9
110.4
47.2
194.4
46.3
40.7
68.9
153.7
27
females
103.9
98.7
36.6
115.4
49.4
40.0
80.1
39.5
27.3
29.7
30.9
38.0
24.0
33.3
142.3
32.6
33.4
50.3
12.0
34.1
33.3
149.9
199.8
62.7
43.9
28.4
48.8
45.9
35.3
25.5
45.3
30.4
88.9
88.3
80.3
57.6
55.4
37.6
31.4
26.6
37.2
203.8
66.4
374.7
83.2
41.1
155.0
38.7
34.3
56.4
120.7
All- and selected- cause mortality in Europe, all ages, SDR per 100,000, latest year available
country
Albania (2004)
Armenia (2009)
Austria (2010)
Azerbaijan (2007)
Belarus (2009)
Belgium (2006)
Bulgaria (2011)
Croatia (2010)
Cyprus (2010)
Czech Republic (2010)
Denmark (2006)
Estonia (2010)
Finland (2010)
France (2009)
Georgia (2009)
Germany (2010)
Greece (2009)
Hungary (2009)
Iceland (2009)
Ireland (2010)
Italy (2009)
Kazakhstan (2010)
Kyrgyzstan (2010)
Latvia (2010)
Lithuania (2010)
Luxembourg (2010)
Malta (2010)
Montenegro (2009)
Netherlands (2010)
Norway (2010)
Poland (2010)
Portugal (2010)
Republic of Moldova (2011)
Romania (2010)
Russian Federation (2010)
Serbia (2010)
Slovakia (2010)
Slovenia (2010)
Spain (2010)
Sweden (2010)
Switzerland (2010)
Tajikistan (2005)
TFYR Macedonia (2010)
Turkmenistan (1998)
Ukraine (2010)
United Kingdom (2010)
Uzbekistan (2005)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
all causes
males
females
992.5
653.1
1318.2
847.9
699.4
428.6
1098.5
799.3
1728.3
790.1
764.5
473.7
1199.7
716.4
1023.3
612.5
615.4
406.3
940.8
557.1
826.8
566.8
1185.1
555.9
754.7
429.3
703.9
387.6
1207.4
674.2
697.1
453.4
693.2
473.3
1244.8
677.5
603.6
422.5
673.7
456.6
632.3
391.3
1714.7
952.0
1518.1
933.0
1351.5
671.5
1394.5
652.7
678.6
416.0
625.5
429.4
996.3
714.7
658.7
454.3
646.4
438.7
1064.5
556.9
799.6
470.7
1488.5
888.7
1222.7
724.8
1805.9
882.8
1135.8
787.0
1142.5
635.9
800.1
448.4
641.3
361.1
619.0
428.1
576.7
376.4
1131.8
799.4
1114.2
790.7
1651.2
1081.2
1619.0
864.8
670.1
473.7
1334.3
984.2
773.5
468.2
680.8
427.7
1127.6
623.1
1658.2
887.7
28
circulatory diseases
males
females
490.8
354.8
640.4
450.6
252.5
170.6
616.8
488.9
893.8
427.6
224.2
149.0
732.4
478.3
440.3
313.3
222.2
153.1
424.4
282.4
243.8
154.4
567.1
310.6
288.3
154.4
163.3
94.7
638.1
368.0
246.5
173.2
271.0
219.2
548.4
331.0
218.6
131.9
228.2
141.7
205.3
138.0
813.6
485.7
841.8
588.4
674.7
353.1
667.0
383.0
211.2
134.0
212.6
167.3
510.1
415.4
180.9
119.2
190.6
119.4
439.7
259.9
210.3
152.9
797.4
570.0
647.3
453.9
939.4
533.8
546.8
440.7
551.8
360.3
269.2
178.1
168.7
110.4
227.5
144.9
181.2
115.9
672.8
486.4
626.9
490.8
1017.4
716.7
956.7
590.7
210.5
130.9
858.2
662.3
275.4
178.9
208.7
137.7
532.3
337.6
899.1
548.0
lung cancer
males
females
42.7
11.7
84.5
13.9
46.2
19.6
17.0
3.8
67.6
5.0
76.3
19.2
58.6
11.3
79.9
18.8
34.7
7.4
66.2
19.5
63.2
44.2
75.1
11.2
43.6
14.5
61.8
16.3
31.8
4.6
49.9
19.8
68.6
12.2
106.3
37.5
38.4
36.6
47.0
28.2
57.2
14.5
57.5
7.7
30.0
6.7
73.2
9.3
70.5
7.0
52.7
17.2
49.3
12.6
67.0
18.6
63.4
31.9
42.5
27.4
84.5
23.6
44.9
8.6
50.3
8.6
68.6
13.1
72.1
8.4
85.0
24.4
63.9
14.7
66.5
19.4
61.4
10.8
28.6
22.3
41.2
18.8
8.1
4.0
66.1
12.1
17.5
4.4
55.1
6.5
49.0
31.7
14.2
4.3
59.8
19.7
55.3
19.7
77.3
19.7
57.0
7.2
external causes
males
females
63.5
21.2
63.6
18.9
56.9
20.1
45.0
13.7
233.8
50.8
68.8
30.3
53.0
13.8
77.6
30.0
46.0
16.7
74.8
23.4
54.0
24.9
133.7
28.7
92.4
30.6
66.1
26.3
62.0
13.1
40.8
17.0
48.3
11.5
94.1
29.3
48.8
20.1
50.7
20.1
39.3
15.3
198.1
48.9
144.9
34.3
148.8
32.2
197.9
42.9
60.5
25.4
41.1
10.3
53.7
18.7
35.4
18.0
54.0
26.6
94.6
20.8
50.7
17.6
146.1
32.7
87.1
22.2
248.8
57.9
60.9
17.6
84.3
19.5
87.0
28.7
34.7
12.1
50.7
21.1
45.6
20.4
49.7
16.7
41.9
15.5
97.3
33.1
154.4
33.2
37.3
16.2
77.0
22.1
55.4
19.2
45.9
18.3
92.3
22.9
191.4
45.0
Life expectancy at birth, in years, male
Life expectancy at birth, in years, female
country
Switzerland (2010)
Iceland (2009)
Sweden (2010)
Cyprus (2010)
Italy (2009)
Malta (2010)
Spain (2010)
Norway (2010)
Netherlands (2010)
Luxembourg (2010)
Ireland (2010)
United Kingdom (2010)
Germany (2010)
Austria (2010)
Greece (2009)
France (2009)
Finland (2010)
Belgium (2006)
Portugal (2010)
Slovenia (2010)
Denmark (2006)
Czech Republic (2010)
Albania (2004)
Croatia (2010)
Montenegro (2009)
TFYR Macedonia (2010)
Poland (2010)
Slovakia (2010)
Serbia (2010)
Azerbaijan (2007)
Tajikistan (2005)
Bulgaria (2011)
Estonia (2010)
Armenia (2009)
Hungary (2009)
Romania (2010)
Georgia (2009)
Latvia (2010)
Uzbekistan (2005)
Lithuania (2010)
Republic of Moldova (2011)
Kyrgyzstan (2010)
Ukraine (2010)
Belarus (2009)
Kazakhstan (2010)
Russian Federation (2010)
Turkmenistan (1998)
LE0
80.44
79.94
79.73
79.61
79.32
79.27
79.16
79.13
79.05
78.78
78.5
78.5
78.14
78
77.92
77.78
76.97
76.93
76.6
76.56
76.21
74.58
73.72
73.62
73.27
72.99
72.2
71.81
71.78
71.33
71.21
70.8
70.7
70.59
70.29
70.15
69.34
68.64
68.15
68
66.83
65.48
65.24
64.8
63.69
62.94
62.48
country
Spain (2010)
Switzerland (2010)
France (2009)
Italy (2009)
Cyprus (2010)
Luxembourg (2010)
Iceland (2009)
Sweden (2010)
Finland (2010)
Austria (2010)
Malta (2010)
Norway (2010)
Slovenia (2010)
Netherlands (2010)
Germany (2010)
Ireland (2010)
Greece (2009)
Portugal (2010)
United Kingdom (2010)
Belgium (2006)
Czech Republic (2010)
Estonia (2010)
Poland (2010)
Denmark (2006)
Croatia (2010)
Slovakia (2010)
Lithuania (2010)
Albania (2004)
Hungary (2009)
Latvia (2010)
Montenegro (2009)
Georgia (2009)
Bulgaria (2011)
Romania (2010)
TFYR Macedonia (2010)
Serbia (2010)
Armenia (2009)
Belarus (2009)
Azerbaijan (2007)
Tajikistan (2005)
Ukraine (2010)
Republic of Moldova (2011)
Russian Federation (2010)
Kyrgyzstan (2010)
Kazakhstan (2010)
Uzbekistan (2005)
Turkmenistan (1998)
LE0
85.43
85.02
84.75
84.62
84.14
83.94
83.85
83.74
83.66
83.65
83.62
83.46
83.21
83.1
83.09
83.03
82.79
82.69
82.58
82.54
80.98
80.84
80.79
80.76
80.01
79.4
78.97
78.93
78.47
78.4
77.96
77.95
77.86
77.62
77.28
77.03
76.92
76.57
76.25
76.25
75.26
75.09
74.77
73.69
73.53
73.03
69.84
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
76.99
78.39
71.62
64.65
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
82.88
83.75
79.59
74.71
29
Life expectancy at age 65, in years, male
Life expectancy at age 65, in years, female
country
Switzerland (2010)
Iceland (2009)
Spain (2010)
Cyprus (2010)
Malta (2010)
France (2009)
Sweden (2010)
Italy (2009)
Greece (2009)
United Kingdom (2010)
Norway (2010)
Austria (2010)
Germany (2010)
Netherlands (2010)
Ireland (2010)
Luxembourg (2010)
Finland (2010)
Belgium (2006)
Portugal (2010)
Slovenia (2010)
Denmark (2006)
Czech Republic (2010)
Poland (2010)
Montenegro (2009)
Albania (2004)
Croatia (2010)
Azerbaijan (2007)
Tajikistan (2005)
Estonia (2010)
Slovakia (2010)
Romania (2010)
Hungary (2009)
Bulgaria (2011)
Serbia (2010)
TFYR Macedonia (2010)
Georgia (2009)
Lithuania (2010)
Armenia (2009)
Latvia (2010)
Uzbekistan (2005)
Kyrgyzstan (2010)
Republic of Moldova (2011)
Turkmenistan (1998)
Russian Federation (2010)
Ukraine (2010)
Kazakhstan (2010)
Belarus (2009)
LE65
19.17
18.73
18.66
18.6
18.58
18.49
18.43
18.4
18.19
18.17
18.15
18.02
17.96
17.85
17.84
17.72
17.6
17.21
17
16.89
16.41
15.54
15.18
15.16
14.91
14.69
14.52
14.52
14.22
14.12
14.08
14.04
14.02
13.99
13.97
13.68
13.59
13.37
13.37
13.01
12.8
12.69
12.36
12.21
12.21
11.94
11.75
country
France (2009)
Spain (2010)
Switzerland (2010)
Italy (2009)
Luxembourg (2010)
Finland (2010)
Austria (2010)
Sweden (2010)
Norway (2010)
Cyprus (2010)
Malta (2010)
Netherlands (2010)
Iceland (2009)
Slovenia (2010)
Germany (2010)
Ireland (2010)
United Kingdom (2010)
Belgium (2006)
Portugal (2010)
Greece (2009)
Poland (2010)
Estonia (2010)
Denmark (2006)
Czech Republic (2010)
Lithuania (2010)
Latvia (2010)
Hungary (2009)
Croatia (2010)
Georgia (2009)
Slovakia (2010)
Albania (2004)
Tajikistan (2005)
Bulgaria (2011)
Romania (2010)
Montenegro (2009)
Belarus (2009)
Russian Federation (2010)
Azerbaijan (2007)
Serbia (2010)
Armenia (2009)
TFYR Macedonia (2010)
Ukraine (2010)
Kyrgyzstan (2010)
Republic of Moldova (2011)
Kazakhstan (2010)
Uzbekistan (2005)
Turkmenistan (1998)
LE65
22.91
22.87
22.65
22.18
21.97
21.6
21.55
21.3
21.29
21.27
21.21
21.15
21.1
21.08
21.05
20.95
20.88
20.87
20.5
20.27
19.62
19.49
19.24
19.13
18.52
18.3
18.28
18.22
18.11
18.08
17.8
17.75
17.41
17.3
17.25
16.86
16.53
16.25
16.21
16.16
16.09
16.07
15.66
15.66
15.62
14.96
14.93
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
17.44
18.17
14.69
12.43
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
21.04
21.66
18.67
16.24
30
Infant deaths per 1000 live births
country
Iceland (2009)
Cyprus (2010)
Finland (2010)
Slovenia (2010)
Sweden (2010)
Portugal (2010)
Norway (2010)
Czech Republic (2010)
Luxembourg (2010)
Greece (2009)
Spain (2010)
Estonia (2010)
Denmark (2006)
Germany (2010)
France (2009)
Italy (2009)
Netherlands (2010)
Ireland (2010)
Switzerland (2010)
Austria (2010)
Belgium (2006)
Lithuania (2010)
United Kingdom (2010)
Croatia (2010)
Belarus (2009)
Poland (2010)
Hungary (2009)
Malta (2010)
Slovakia (2010)
Latvia (2010)
Montenegro (2009)
Serbia (2010)
Russian Federation (2010)
TFYR Macedonia (2010)
Albania (2004)
Bulgaria (2011)
Ukraine (2010)
Romania (2010)
Azerbaijan (2007)
Armenia (2009)
Republic of Moldova (2011)
Tajikistan (2005)
Georgia (2009)
Uzbekistan (2005)
Kazakhstan (2010)
Kyrgyzstan (2010)
Turkmenistan (1998)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
rate per 1,000 live
births
1.79
2.24
2.26
2.52
2.54
2.55
2.56
2.67
2.72
3.15
3.19
3.29
3.4
3.43
3.49
3.62
3.76
3.78
3.82
3.9
4.07
4.29
4.34
4.43
4.68
4.98
5.13
5.48
5.69
5.72
5.79
6.73
7.61
7.61
7.79
8.48
9.17
9.79
9.82
10.22
11
14.1
14.91
14.96
16.48
22.3
32.78
4.06
3.59
5.93
11.26
31
SDR(0-14),males, All causes, per 100000
SDR(0-14),females All causes, per 100000
Cyprus (2010)
Slovenia (2010)
Iceland (2009)
Luxembourg (2010)
Sweden (2010)
Finland (2010)
Norway (2010)
Portugal (2010)
Czech Republic (2010)
Spain (2010)
Switzerland (2010)
Greece (2009)
Germany (2010)
Denmark (2006)
Italy (2009)
Netherlands (2010)
France (2009)
Ireland (2010)
Austria (2010)
Belgium (2006)
United Kingdom (2010)
Croatia (2010)
Estonia (2010)
Lithuania (2010)
Poland (2010)
Hungary (2009)
Malta (2010)
Slovakia (2010)
Montenegro (2009)
Latvia (2010)
Belarus (2009)
Serbia (2010)
TFYR Macedonia (2010)
Bulgaria (2011)
Russian Federation (2010)
Ukraine (2010)
Romania (2010)
Armenia (2009)
Albania (2004)
Republic of Moldova (2011)
Azerbaijan (2007)
Georgia (2009)
Uzbekistan (2005)
Kazakhstan (2010)
Kyrgyzstan (2010)
Tajikistan (2005)
Turkmenistan (1998)
SDR per
100,000
24.04
24.09
26.56
28.79
29.2
29.84
30.85
32.66
34.68
35.92
36.03
39.16
39.19
40.52
40.56
41.16
41.6
42.47
43.26
46.31
47.2
49.97
54.25
54.93
55.19
55.52
57.19
66.12
67.29
67.64
72.32
74.15
75.9
102.24
104.47
110.35
111.25
112.12
129.32
135
141.74
157.07
194.39
196.67
246.19
256.67
463.88
Iceland (2009)
Finland (2010)
Norway (2010)
Sweden (2010)
Cyprus (2010)
Luxembourg (2010)
Czech Republic (2010)
Portugal (2010)
Denmark (2006)
Spain (2010)
Germany (2010)
France (2009)
Italy (2009)
Greece (2009)
Ireland (2010)
Netherlands (2010)
Austria (2010)
Switzerland (2010)
Slovenia (2010)
Estonia (2010)
Croatia (2010)
Belgium (2006)
United Kingdom (2010)
Lithuania (2010)
Poland (2010)
Montenegro (2009)
Malta (2010)
Belarus (2009)
Hungary (2009)
Slovakia (2010)
Serbia (2010)
Latvia (2010)
TFYR Macedonia (2010)
Bulgaria (2011)
Russian Federation (2010)
Ukraine (2010)
Romania (2010)
Republic of Moldova (2011)
Armenia (2009)
Albania (2004)
Azerbaijan (2007)
Georgia (2009)
Kazakhstan (2010)
Uzbekistan (2005)
Kyrgyzstan (2010)
Tajikistan (2005)
Turkmenistan (1998)
SDR per
100,000
12.04
23.99
25.53
26.62
27.31
28.36
29.67
30.38
30.94
31.37
32.63
33.27
33.31
33.37
34.05
35.34
36.62
37.22
37.62
38.04
39.52
39.99
41.11
43.85
45.32
45.94
48.79
49.37
50.29
55.35
57.56
62.72
66.43
80.06
80.31
83.23
88.25
88.9
98.69
103.87
115.37
142.3
149.91
155.03
199.83
203.78
374.66
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
46.3
40.72
68.87
153.66
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
38.65
34.27
56.41
120.71
country
country
32
SDR all causes, all ages, per 100000,
female
SDR all causes, all ages, per 100000, male
country
Switzerland (2010)
Iceland (2009)
Cyprus (2010)
Sweden (2010)
Malta (2010)
Italy (2009)
Spain (2010)
Norway (2010)
Netherlands (2010)
United Kingdom (2010)
Ireland (2010)
Luxembourg (2010)
Greece (2009)
Germany (2010)
Austria (2010)
France (2009)
Finland (2010)
Belgium (2006)
Portugal (2010)
Slovenia (2010)
Denmark (2006)
Czech Republic (2010)
Albania (2004)
Montenegro (2009)
Croatia (2010)
Poland (2010)
Azerbaijan (2007)
TFYR Macedonia (2010)
Tajikistan (2005)
Serbia (2010)
Slovakia (2010)
Estonia (2010)
Bulgaria (2011)
Georgia (2009)
Romania (2010)
Hungary (2009)
Armenia (2009)
Uzbekistan (2005)
Latvia (2010)
Lithuania (2010)
Republic of Moldova (2011)
Kyrgyzstan (2010)
Ukraine (2010)
Turkmenistan (1998)
Kazakhstan (2010)
Belarus (2009)
Russian Federation (2010)
SDR per
100,000
576.74
603.57
615.39
619
625.52
632.26
641.25
646.42
658.71
670.06
673.72
678.63
693.18
697.07
699.38
703.9
754.68
764.51
799.6
800.1
826.76
940.8
992.46
996.3
1023.31
1064.53
1098.52
1114.24
1131.78
1135.76
1142.52
1185.14
1199.74
1207.37
1222.69
1244.83
1318.19
1334.34
1351.51
1394.47
1488.47
1518.13
1619.02
1651.22
1714.68
1728.3
1805.91
Spain (2010)
Switzerland (2010)
France (2009)
Italy (2009)
Cyprus (2010)
Luxembourg (2010)
Iceland (2009)
Sweden (2010)
Austria (2010)
Finland (2010)
Malta (2010)
Norway (2010)
Slovenia (2010)
Germany (2010)
Netherlands (2010)
Ireland (2010)
Portugal (2010)
Greece (2009)
United Kingdom (2010)
Belgium (2006)
Estonia (2010)
Poland (2010)
Czech Republic (2010)
Denmark (2006)
Croatia (2010)
Slovakia (2010)
Lithuania (2010)
Albania (2004)
Latvia (2010)
Georgia (2009)
Hungary (2009)
Montenegro (2009)
Bulgaria (2011)
Romania (2010)
Serbia (2010)
Belarus (2009)
TFYR Macedonia (2010)
Azerbaijan (2007)
Tajikistan (2005)
Armenia (2009)
Ukraine (2010)
Russian Federation (2010)
Republic of Moldova (2011)
Kyrgyzstan (2010)
Kazakhstan (2010)
Uzbekistan (2005)
Turkmenistan (1998)
SDR per
100,000
361.06
376.43
387.59
391.25
406.33
415.98
422.5
428.13
428.64
429.29
429.36
438.73
448.44
453.44
454.34
456.63
470.65
473.26
473.67
473.69
555.93
556.9
557.11
566.79
612.48
635.85
652.73
653.07
671.47
674.21
677.46
714.72
716.44
724.75
786.99
790.09
790.68
799.25
799.44
847.87
864.83
882.75
888.68
932.96
952
984.17
1081.23
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
773.51
680.82
1127.55
1658.24
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007 (2010)
CIS (2010)
468.21
427.67
623.07
887.65
country
33
SDR, diseases of circulatory system, all ages per 100000, male
France (2009)
Spain (2010)
Netherlands (2010)
Switzerland (2010)
Norway (2010)
Italy (2009)
Portugal (2010)
United Kingdom (2010)
Luxembourg (2010)
Malta (2010)
Iceland (2009)
Cyprus (2010)
Belgium (2006)
Sweden (2010)
Ireland (2010)
Denmark (2006)
Germany (2010)
Austria (2010)
Slovenia (2010)
Greece (2009)
Finland (2010)
Czech Republic (2010)
Poland (2010)
Croatia (2010)
Albania (2004)
Montenegro (2009)
Serbia (2010)
Hungary (2009)
Slovakia (2010)
Estonia (2010)
Azerbaijan (2007)
TFYR Macedonia (2010)
Georgia (2009)
Armenia (2009)
Romania (2010)
Lithuania (2010)
Tajikistan (2005)
Latvia (2010)
Bulgaria (2011)
Republic of Moldova (2011)
Kazakhstan (2010)
Kyrgyzstan (2010)
Uzbekistan (2005)
Belarus (2009)
Russian Federation (2010)
Ukraine (2010)
Turkmenistan (1998)
SDR per
100,000
163.34
168.71
180.85
181.21
190.58
205.27
210.27
210.46
211.19
212.56
218.59
222.24
224.2
227.53
228.23
243.82
246.49
252.46
269.18
271.03
288.33
424.41
439.69
440.34
490.75
510.08
546.76
548.41
551.8
567.06
616.83
626.9
638.07
640.44
647.3
666.96
672.81
674.66
732.42
797.38
813.59
841.8
858.17
893.83
939.35
956.68
1017.41
EU (2010)
EU members before May 2004 (2010)
275.41
208.71
EU members since 2004 or 2007 (2010)
CIS (2010)
532.27
899.12
country
SDR, diseases of circulatory system, all ages per
100000, female
country
France (2009)
Spain (2010)
Switzerland (2010)
Netherlands (2010)
Norway (2010)
United Kingdom (2010)
Iceland (2009)
Luxembourg (2010)
Italy (2009)
Ireland (2010)
Sweden (2010)
Belgium (2006)
Portugal (2010)
Cyprus (2010)
Finland (2010)
Denmark (2006)
Malta (2010)
Austria (2010)
Germany (2010)
Slovenia (2010)
Greece (2009)
Poland (2010)
Czech Republic (2010)
Estonia (2010)
Croatia (2010)
Hungary (2009)
Latvia (2010)
Albania (2004)
Slovakia (2010)
Georgia (2009)
Lithuania (2010)
Montenegro (2009)
Belarus (2009)
Serbia (2010)
Armenia (2009)
Romania (2010)
Bulgaria (2011)
Kazakhstan (2010)
Tajikistan (2005)
Azerbaijan (2007)
TFYR Macedonia (2010)
Russian Federation (2010)
Republic of Moldova (2011)
Kyrgyzstan (2010)
Ukraine (2010)
Uzbekistan (2005)
Turkmenistan (1998)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007
(2010)
CIS (2010)
34
SDR per
100,000
94.68
110.37
115.87
119.2
119.41
130.89
131.88
134.01
137.95
141.72
144.88
148.96
152.93
153.14
154.35
154.39
167.27
170.57
173.15
178.05
219.24
259.91
282.38
310.56
313.29
331.01
353.12
354.76
360.25
368.01
383.01
415.43
427.62
440.65
450.57
453.92
478.31
485.67
486.42
488.91
490.78
533.75
570.01
588.35
590.69
662.34
716.72
178.9
137.68
337.63
547.98
SDR, trachea/bronchus/lung cancer, all ages per 100000, male
country
Tajikistan (2005)
Uzbekistan (2005)
Azerbaijan (2007)
Turkmenistan (1998)
Sweden (2010)
Kyrgyzstan (2010)
Georgia (2009)
Cyprus (2010)
Iceland (2009)
Switzerland (2010)
Norway (2010)
Albania (2004)
Finland (2010)
Portugal (2010)
Austria (2010)
Ireland (2010)
United Kingdom (2010)
Malta (2010)
Germany (2010)
Republic of Moldova (2011)
Luxembourg (2010)
Ukraine (2010)
Italy (2009)
Kazakhstan (2010)
Bulgaria (2011)
Spain (2010)
France (2009)
Denmark (2006)
Netherlands (2010)
Slovakia (2010)
TFYR Macedonia (2010)
Czech Republic (2010)
Slovenia (2010)
Montenegro (2009)
Belarus (2009)
Greece (2009)
Romania (2010)
Lithuania (2010)
Russian Federation (2010)
Latvia (2010)
Estonia (2010)
Belgium (2006)
Croatia (2010)
Poland (2010)
Armenia (2009)
Serbia (2010)
Hungary (2009)
SDR per
100,000
8.14
14.24
16.95
17.51
28.63
30.01
31.8
34.66
38.43
41.23
42.49
42.71
43.6
44.94
46.24
47.01
49.02
49.26
49.86
50.31
52.65
55.05
57.23
57.5
58.55
61.44
61.8
63.24
63.44
63.93
66.05
66.16
66.46
66.99
67.55
68.58
68.64
70.5
72.09
73.23
75.09
76.27
79.88
84.48
84.54
84.97
106.32
EU (2010)
EU members before May 2004 (2010)
59.79
55.25
EU members since 2004 or 2007 (2010)
CIS (2010)
77.25
56.96
SDR, trachea/bronchus/lung cancer, all ages per
100000, female
country
Azerbaijan (2007)
Tajikistan (2005)
Uzbekistan (2005)
Turkmenistan (1998)
Georgia (2009)
Belarus (2009)
Ukraine (2010)
Kyrgyzstan (2010)
Lithuania (2010)
Cyprus (2010)
Kazakhstan (2010)
Russian Federation (2010)
Portugal (2010)
Republic of Moldova (2011)
Latvia (2010)
Spain (2010)
Estonia (2010)
Bulgaria (2011)
Albania (2004)
TFYR Macedonia (2010)
Greece (2009)
Malta (2010)
Romania (2010)
Armenia (2009)
Finland (2010)
Italy (2009)
Slovakia (2010)
France (2009)
Luxembourg (2010)
Montenegro (2009)
Switzerland (2010)
Croatia (2010)
Belgium (2006)
Slovenia (2010)
Czech Republic (2010)
Austria (2010)
Germany (2010)
Sweden (2010)
Poland (2010)
Serbia (2010)
Norway (2010)
Ireland (2010)
United Kingdom (2010)
Netherlands (2010)
Iceland (2009)
Hungary (2009)
Denmark (2006)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007
(2010)
CIS (2010)
35
SDR per
100,000
3.83
3.99
4.33
4.38
4.64
5
6.46
6.73
6.98
7.44
7.66
8.4
8.58
8.6
9.29
10.78
11.16
11.28
11.71
12.12
12.15
12.63
13.09
13.86
14.5
14.52
14.71
16.29
17.19
18.64
18.76
18.79
19.2
19.4
19.48
19.64
19.84
22.33
23.61
24.4
27.43
28.15
31.74
31.9
36.59
37.46
44.22
19.66
19.65
19.72
7.19
SDR, external cause injury and poison, all ages per 100000,
male
country
Spain (2010)
Netherlands (2010)
United Kingdom (2010)
Italy (2009)
Germany (2010)
Malta (2010)
TFYR Macedonia (2010)
Azerbaijan (2007)
Switzerland (2010)
Cyprus (2010)
Greece (2009)
Iceland (2009)
Tajikistan (2005)
Ireland (2010)
Portugal (2010)
Sweden (2010)
Bulgaria (2011)
Montenegro (2009)
Norway (2010)
Denmark (2006)
Austria (2010)
Luxembourg (2010)
Serbia (2010)
Georgia (2009)
Albania (2004)
Armenia (2009)
France (2009)
Belgium (2006)
Czech Republic (2010)
Uzbekistan (2005)
Croatia (2010)
Slovakia (2010)
Slovenia (2010)
Romania (2010)
Finland (2010)
Hungary (2009)
Poland (2010)
Turkmenistan (1998)
Estonia (2010)
Kyrgyzstan (2010)
Republic of Moldova (2011)
Latvia (2010)
Ukraine (2010)
Lithuania (2010)
Kazakhstan (2010)
Belarus (2009)
Russian Federation (2010)
SDR per
100,000
34.7
35.41
37.27
39.31
40.75
41.08
41.91
45.01
45.59
46
48.3
48.81
49.69
50.65
50.69
50.71
52.97
53.7
53.96
54.01
56.91
60.5
60.87
62.01
63.47
63.55
66.11
68.83
74.75
76.96
77.55
84.28
87.04
87.05
92.42
94.05
94.56
97.28
133.65
144.86
146.11
148.75
154.41
197.85
198.06
233.78
248.83
EU (2010)
EU members before May 2004 (2010)
55.44
45.88
EU members since 2004 or 2007 (2010)
CIS (2010)
92.25
191.39
SDR, external cause injury and poison, all ages per
100000, female
country
Malta (2010)
Greece (2009)
Spain (2010)
Georgia (2009)
Azerbaijan (2007)
Bulgaria (2011)
Italy (2009)
TFYR Macedonia (2010)
United Kingdom (2010)
Tajikistan (2005)
Cyprus (2010)
Germany (2010)
Serbia (2010)
Portugal (2010)
Netherlands (2010)
Montenegro (2009)
Armenia (2009)
Slovakia (2010)
Ireland (2010)
Iceland (2009)
Austria (2010)
Switzerland (2010)
Poland (2010)
Sweden (2010)
Albania (2004)
Uzbekistan (2005)
Romania (2010)
Czech Republic (2010)
Denmark (2006)
Luxembourg (2010)
France (2009)
Norway (2010)
Slovenia (2010)
Estonia (2010)
Hungary (2009)
Croatia (2010)
Belgium (2006)
Finland (2010)
Latvia (2010)
Republic of Moldova (2011)
Turkmenistan (1998)
Ukraine (2010)
Kyrgyzstan (2010)
Lithuania (2010)
Kazakhstan (2010)
Belarus (2009)
Russian Federation (2010)
EU (2010)
EU members before May 2004 (2010)
EU members since 2004 or 2007
(2010)
CIS (2010)
36
SDR per
100,000
10.31
11.47
12.09
13.12
13.69
13.77
15.34
15.48
16.24
16.67
16.7
16.98
17.61
17.62
17.96
18.7
18.87
19.5
20.08
20.13
20.14
20.39
20.84
21.08
21.2
22.07
22.23
23.41
24.89
25.42
26.31
26.56
28.67
28.69
29.31
29.97
30.27
30.55
32.15
32.65
33.11
33.2
34.33
42.86
48.91
50.84
57.9
19.22
18.27
22.88
45