Archive:Quality of life in Europe - facts and views - health

This article has been archived. The paper format and the PDF format latest edition, ISBN 978-92-79-43616-1, doi:10.2785/59737, Cat. No KS-05-14-073-EN-N are still available. For updated information on quality of life, see Quality of life indicators - health.

Figure 1: Life expectancy at birth, by sex, EU-28, 2005 versus 2012 (mean number of years)
Source: Eurostat (demo_mlexpec)

Figure 2: Life expectancy at birth, by country, 2005 versus 2013 (¹) (mean number of years)
Source: Eurostat (demo_mlexpec)

Figure 3: Self-perceived health, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (hlth_silc_02)

Figure 4: Self-perceived health, by country, 2013 (% of population aged 16 and over)
Source: Eurostat (hlth_silc_02)

Figure 5: Self-perceived health, by age, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (hlth_silc_02)

Figure 6: Self-perceived health, by sex, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (hlth_silc_02)

Figure 7: Self-perceived health, by income tercile, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (EU SILC)

Figure 8: Self-perceived health, by labour status, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (hlth_silc_01)

Figure 9: Self-perceived health, by educational attainment, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (hlth_silc_02)

Figure 10: Self-perceived health, by availability of supportive social relationships, EU-28, 2013 (% of population aged 16 and over)
Source: Eurostat (EU SILC)

Table 1: Self-perceived health problems versus life expectancy and access to health care, by country, 2013
Source: Eurostat (hlth_silc_02), (hlth_silc_03), (hlth_silc_05), (hlth_silc_07) and (demo_mlexpec)

Figure 11: Bad or very bad self-perceived health versus self-perceived severe long-standing limitations in usual activities due to health problems, by counry, 2013 (% of population)
Source: Eurostat (hlth_silc_02) and (hlth_silc_07)

Figure 12: Bad or very bad self-perceived health versus people having a long-standing illness or health problem, by country, 2013 (% of population)
Source: Eurostat (hlth_silc_02) and (hlth_silc_05)

Figure 13: Bad or very bad self-perceived health versus self-reported unmet needs for medical examination (too expensive or too far to travel or waiting list), by country, 2013 (% of population)
Source: Eurostat (hlth_silc_02) and (hlth_silc_08)

Figure 14: Good or very good self-perceived health versus life expectancy, by country, 2013 (self-perceived health: % of population; life expectancy: mean number of years)
Source: Eurostat (hlth_silc_02) and (demo_mlexpec)

Figure 15: Bad or very bad self-perceived health versus low overall life satisfaction, by country, 2013 (% of population reporting a low life satisfaction and bad or very bad health)
Source: Eurostat (hlth_silc_02) and (ilc_pw01)

This article is the fourth in a series of nine articles dedicated to the quality of life of people in the European Union (EU) and is part of a set of articles forming the publication Quality of life in Europe - facts and views. The article takes an innovative approach and uses data on subjective evaluations of different domains, collected for the first time in European official statistics . Objective indicators belonging to the same area are used to complement and analyse this type of information.

Main statistical findings

Health in a quality of life perspective

In 2012 the residents of the EU were expected to live on average up to the age of 80.3, which is 1.8 years more than in 2005. Although northern EU Member States with high GDP per capita seem to get a better handle on problems such as access to medical care, the high life expectancy in southern Europe could lead to the conclusion that economic output is not the only determinant of health outcomes.

Life expectancy is not equal between the two genders. On average women in the EU lived 5.6 years longer than men in 2012, but the gap has diminished since 2005. On average, women could also hope to live 0.6 years longer than men without limitations to their usual activities caused by health problems, but this advantage has also declined compared with 2005.

Against this background, men nonetheless tended to have a more positive assessment of their health status. In particular, a higher share of men (70.7 %) than women (65.0 %) assessed their health as good or very good and a lower share stated that their health was bad or very bad (8.4 % versus 10.5 %) in 2013. Younger residents had the best self-assessed health status, for natural reasons. However, even over the age of 65, only 5.0 % of EU residents described their personal health situation as very bad.

How people assess their health seems to be associated with their income and those in the 3rd tercile were more numerous to report having good or very good health. As income levels tend to be higher among the most educated and those most actively participating in the labour market, higher education graduates or full-time employees reported the most positively about their health condition. The same applied to those in education or training for motives linked to their age. Retired people on the other hand displayed less favourable patterns of self-perceived health.

Meeting one’s medical needs appeared problematic in a very small number of EU Member States, however this did not appear to impact the way in which EU residents assessed their health condition. The share of the population assessing their health as (very) bad was, in most EU Member States, connected to the prevalence of health problems leading to limitations in usual activities and chronic diseases. Life expectancy at country level however appeared to be linked to the proportion of people assessing their health as good or very good. Lastly, self-reported health was the strongest predictor of overall life satisfaction.

Almost 7 out of 10 EU residents reported that they were in a good health condition.

Europeans live longer…

Figure 1 shows that the life expectancy at birth of EU residents has increased by 1.8 years from 2005 to 2012, to slightly more than 80 years (80.3). Figures for men and women presented a gap amounting to 5.6 years in life expectancy at birth. On the other hand, life expectancy for men seemed to rise faster, increasing by 2.1 years between 2005 and 2012, compared with 1.6 years for women.

A country-level analysis (Figure 2) confirms a general upward trend in life expectancy at birth for both sexes, however many differences remained at national level.

On average, Spanish, Italian, Cypriot and French residents lived longer than all other EU residents, with life expectancy figures at birth exceeding 82 years in 2013. At the other end of the scale, the Lithuanians, Latvians and Bulgarians were likely to live on average less than 75 years. In general, life expectancy was lower (not exceeding the EU average) in the countries that joined the EU after 2004, with the exception of southern EU Member States such as Malta and Cyprus.

While a 1.8 year increase in life expectancy could be observed for the EU as a whole from 2005 to 2012, at country level improvements ranged from 1.5 years in Sweden to 4.8 years in Estonia (where the former EU Member State had one of the highest life expectancies in the EU in 2005 and the latter one of the lowest). Using the latest data available at country level, the life expectancy rose by 1.7 years in Sweden and by 5.6 years in Estonia in the period 2005-13.

The reasons for these country differentials did not exclusively reside in differences in wealth production (although life expectancy was lower in countries from the central and eastern EU with a relatively low GDP or income per capita). Luxembourg was a good example as it was not the country with the highest life expectancy despite having the highest median equivalised net income in the EU. In a less pronounced manner, some of the western and northern EU Member States such as Denmark and Belgium, with high GDP or income per capita, were not among the EU Member States with the longest life expectancy. Indeed, some of the highest life expectancies were recorded in the Mediterranean EU Members States, despite average GDP or income per capita values. Hence, different ways of living, together with the progress of science and the increasing (near-universal) access to healthcare services for the EU population seem to have helped close the gap in life expectancy between EU Member States (See, Statistics Explained, Quality of life indicators — health

How do people in the EU evaluate their health status?

Self-perceived health is, by its very nature, subjective. The notion is restricted to an assessment coming from the individual and not from an interviewer, healthcare worker or relative. Even though it may be influenced by impressions or opinions of others, it takes place after these impressions have been processed by the individual relative to their own beliefs and attitudes. The reference is to health in general rather than the present state of health, as the question is not intended to measure temporary health problems. The respondent is expected to include the different dimensions of health, i.e. physical, social and emotional function and biomedical signs and symptoms. The analysis below examines how people in the EU perceived their health in general.

Two out of three people in the EU reported having a good or very good health

As can be seen in Figure 3, almost seven out of ten (67.7 %) EU residents reported being in good or very good health. Of these, 22.2 % actually reported being in very good health which is comparable to the shares of those who reported being in fair health (22.8 %). A more in-depth analysis shows that amongst those who felt the worst (9.5 %), only a very small percentage reported very bad health (1.8 % of the total population).

The country analysis depicted in Figure 4 reveals that individual EU residents perceived their health by a factor of almost 7 for bad or very bad, and by a factor of about 2 for good or very good.

In 2013, Irish residents assessed their health status the least negatively (3.6 %), followed by the Maltese (3.9 %), Swedish (4.0 %), Dutch (5.4 %), Finnish (6.7 %) and Cypriot (6.9 %) residents. Additionally, Irish residents assessed their health most positively with 82.4 % of them declaring a good or very good health, followed by the Swedish (81.1 %), Cypriot (76.8 %), Dutch (75.4 %), and Greek (75.1 %) residents. By contrast, less than half of the Croatian (47.0 %), Lithuanian (46.3 %) and Latvian (45.4 %) residents stated to be in a good or very good health whilst between 16.5 % and 24.7 % of them perceived their health to be bad or very bad. These countries also registered some of the shortest life expectancies in the EU.

Despite rather low proportions of people reporting bad or very bad health in Finland (6.7 %) and Germany (8.1 %), comparatively their populations reported low shares of good or very good health (at a bit less than 65 % each). This might be related to the level of awareness regarding potential health problems that also has an impact on the indicator ‘healthy life years’ (which has relatively low values in these two EU Member States).

The populations living in the EU Member States with high income levels such as Sweden and Finland and to a lesser extent the Netherlands and Ireland seemed more likely to be able to afford quality healthcare. Cyprus is considered a medium income country while median income in Malta and particularly Greece was well below the EU average. However, this did not prevent the residents of these countries from having a positive assessment of their health.

Hence, when analysing the differences across EU Member States a whole set of factors have to be taken into account. These factors may be of a socio-economic nature, including the availability/accessibility and quality of medical care which vary from one EU Member State to another although access to healthcare is almost universal in the EU. Other determinant factors include environmental conditions, cultural attitudes (e.g. towards smoking or drinking), differences in reporting one’s health status (including awareness of health problems). This could potentially explain the absence of Luxembourg — which held the EU’s highest figures in terms of median income and healthcare expenditure per capita/inhabitant — from the list of countries reporting the highest shares of people feeling in good or very good health.

How is the socio-demographic background related to self-perceived health?

The analysis below examines how factors such as age categories, gender, income quintiles etc. relate to how EU residents assessed their overall health status. The differences between groups are likely to reflect objective differences but also different expectations, lifestyles and levels of awareness which may translate in a distinct manner into an individual’s self-perceived health.

Self-perceived health declining with age

With age, the percentages of people in bad health increased and those of people in good health decreased (Figure 5). Overall, more than a quarter of the people in the 75+ age group declared to be in (very) good health (28.2 %), while a bit more than nine in ten of the younger age group (16–24) reported the same (92.5 %). The share of people reporting bad or very bad health increased significantly with age, the youngest residents (16–24) reporting the lowest share of bad or very bad health (1.4 %) and the oldest residents (75+) reporting the highest share of bad or very bad health (29.7 %).

Men reported being in better health than women

As shown in Figure 6, men in the EU tended to assess their health status more positively than women. 70.7 % of men either perceived their health as good or very good and only 8.4 % as bad or very bad, while the respective shares for women were 65.0 % and 10.5 %. The main differences between male and female perceptions lied in the higher assessment of very good health by the men (5.7 percentage points) and their lower assessment of fair health (3.5 percentage points).

In most age groups, women tended to report less positively (and more negatively) than men on their health. On the one hand, good or very good health was reported by 91.4 % of women versus 93.7 % of men in the 16–24 age group and by 34.3 % of women and 41.3 % of men in the 65+ age group. On the other hand, bad or very bad health was reported by 1.5 % of women versus 1.3 % of men in the 16–24 age group and by 24.7 % of women and 19.5 % of men in the 65+ age group.

A probable explanation could be that women were more likely to live longer than men, thus facing more health problems — they tended to be more prone to long-standing illnesses than men — and assessing their health more negatively. Women, in particular from the age of 65 (many of which are living on their own), also tended to have more problems meeting their medical needs due to financial reasons. Finally the degree of awareness on the importance of health varied between genders. As other studies have pointed out, men ended to be less aware of their symptoms than women, and were therefore more reluctant to seek help. As such, they were less likely than women to say they were in poor health, but more likely to die over the next 5 years.

People in the highest income tercile had better self-perceived health

Figure 7 illustrates the relation between self-perceived health and income terciles. The proportion of people in the lowest income tercile reporting bad or very bad health was much higher than in the highest tercile (13.4 % versus 5.6 %) while the proportion of people in the lowest income tercile perceiving their health as good or very good was much lower than in the highest tercile (60.4 % versus 75.6 %). In fact, there were very few people reporting very bad health regardless of the tercile (varying from less than 1 % in the highest to 2.7 % in the lowest tercile).

It is worth underlining that these patterns reflected diverging levels of affordability of medical care, healthy nutrition and income-dependent lifestyles, which translated into higher levels of long-standing illnesses among low income earners (35.9 %) rather than among high income earners (25.9 %). On the other hand, health problems may also have led people to constrain their work intensity or to even lose their job thus making them enter the lowest tercile and as a consequence face higher problems meeting their medical needs.

Persons in education or training and full-time employees assessed their health most positively

Figure 8 highlights a clear link between labour status and how health is perceived by people in the EU.

Being in education, training or employment generated the most positive health condition assessments. This may be related to the fact that people belonging to these groups tended to be younger. Indeed, more than nine in 10 people in education or training and eight in 10 people in full-time employment felt in good or very good condition. The situation was a bit less positive for the self-employed and part-time employed with shares of people in good or very good health nonetheless exceeding 75.0 %. The share of self-assessed good or very good health declined to 69.5 % in the case of the unemployed. The retired had by far the lowest proportions of people with very good health (40.0 %). The ‘other’ category encompassed people with heterogeneous socio-demographic backgrounds (including permanently unfit for work) whose health patterns could not be compared with those in the other labour status categories and thus were difficult to interpret.

The least educated had the worst self-perceived health

There is a strong correlation between educational attainment and self-perceived health, as indicated in Figure 9. About half of the people whose highest educational attainment was lower secondary had a good or very good assessment of their health status (54.2 %) as compared with 80.4 % of those with tertiary education. The low-educated people also had the least positive assessment of their health status as 16.3 % of them reported being in bad or very bad health, which was 4 times higher than the share reported by the most educated group.

This finding is not unexpected as education is also linked to income levels, hence greater capacities to meet one’s medical needs and probably also greater awareness of the suitability of adopting healthy lifestyles (and financial ability to pay for healthy diet including sufficient consumption of fruit and vegetables). Age also plays a role as younger generations included the highest shares of tertiary graduates (31.8 %) which was almost double that of the 55–74 age group (18.9 %) (See article 3 Education.

Those who can benefit from support from others reported a better health

More than nine in 10 (93.3 %) EU residents declared to be able to count on help from others (See article 5 Leisure and social interactions. On average EU residents also reported to be satisfied with their personal relationships at 7.8 out of 10, which was the highest assessment across all variables questioned in the SILC 2013 ad-hoc module on well-being. While those who could ask for/count on support from their relationships reported a higher overall life satisfaction than those who could not (7.2 versus 5.6 out of 10), Figure 10 shows that those who were able to get help were more likely to state that they were in (very) good health (68.4 %) than those who were not (49.5 %). In this second group, more than double the proportion of people reported bad or very bad health (20.0 % compared with 8.9 %). This was in line with recent findings, that often show a robust correlation between social and emotional support from others and physical health. However, why this comes to be (and especially if there is a protective effect of social support on health and the specificity of such links) is still being studied. This research could be crucial to better tailor support interventions (for example by including a social support element into them) impacting on physical health outcomes, and ultimately quality of life as well.

Help from others

In the EU-SILC ad-hoc module on subjective well-being, the variable refers to the respondent’s possibility to ask for help (any kind of help: moral, material or financial) from any relatives, friends or neighbours.

Among the EU residents who declared being able to get help when needed, 68 % reported to be in good or very good health, while this share fell below 50 % among people who had no help available.

What is the connection between incidence of self-reported health problems and life expectancy?

While affected by social and cultural factors, ‘self-perceived health’ is related to the existence or absence of health problems and people’s capacity to afford medical examinations or treatments.

Table 1 looks at EU Member States and compares the situation of residents reporting health problems or their inability to meet their medical needs with their life expectancy at birth.

In 2013 about 8.3 % of EU residents declared to be suffering from severe long-standing limitations in usual activities due to health problems. About 17.4 % of EU residents complained about some limitations while 74.2 % reported not having any limitations at all. Around one third of EU residents (32.0 %) reported having a long-standing illness or health problem while 3.6 % could not meet their medical needs because their access to healthcare was constrained. Trends over time showed an increased prevalence of these two types of long-standing health problems amongst the EU population together with a decreased share of people who reported unmet medical needs and a higher life expectancy at birth (80.3 in 2012 versus 78.5 in 2005).

As can be seen in Table 1, the EU Member State whose residents tended to report the most negatively about their health was Croatia (24.7 %) in 2013. The shares of the other EU Member States ranged from 18.5 % in Lithuania to 3.6 % in Ireland. The residents of Slovenia were the most affected by severe long-standing limitations (9.2 %) while those from Malta were the least affected (3.1 %). People reporting long-standing illnesses mostly resided in Finland (47.5 %) and Estonia (44.3 %). The population of Bulgaria and Romania were the least affected (below 20 %). The EU Member States whose residents had the most difficulty in meeting their medical needs were Latvia (13.8 %) and Romania (10.4 %). Conversely, several EU Member States such as Malta, Luxembourg, Spain, the Netherlands and Austria reported shares below 1 % with Slovenia even reaching 0.0 %. Against this background, the life expectancy of EU residents varied in 2013 from less than 75 years in Lithuania, Latvia and Bulgaria, to more than 82 years in Spain (83.2 years), Italy (82.9 years), Cyprus (82.5 years) and France (82.4 years).

Factors that mattered for achieving good health outcomes were numerous and included the importance given by individual governments to health expenditure in their national budgets, vaccination campaigns (and their effectiveness), disease management/screening programmes (and their longevity) to accompany some major diseases like cancer or diabetes and the adherence to quality guidelines in medical practice where available. Finally, environmental conditions and the existence of cultural factors (including e.g. ‘lifestyles’ and attitudes towards smoking and drinking, nutrition and physical activity) were expected to play a role as well.

The analysis below will examine how health-related issues correlate with self-perceived health at country level.

Self-perceived health and severe limitations in usual activities were not always correlated

In 2013, 8.3 % of EU residents declared having severe long-standing limitations in usual activities due to health problems. This corresponded to an increase of about 1 percentage point compared with the respective percentage in 2005 (7.4 %). Interestingly, 10.4 % of German residents reported having severe long-standing limitations in usual activities due to health problems in 2013. Conversely, less than 5 % of residents from Malta, Bulgaria and Spain reported a similar situation. Against this background, Figure 11 indicates the existence of a connection between self-assessments of bad or very bad health and severe long-standing limitations in 2013. With the exception of most central and eastern EU Member States, the two variables were reported in similar proportions by respondents in the majority of EU Member States. Deviations from the overall picture were only observed in Bulgaria, the Czech Republic, Portugal, Poland, Hungary, Latvia, Lithuania, Estonia and Croatia. In these EU Member States, a relative small proportion of residents reported long-standing limitations although a large proportion of these countries’ residents reported bad or very bad health (well above the EU average of 9.5 %). This was especially true in Croatia, where merely 7.6 % of the population reported limitations and as many as 24.7 % a bad or very bad health condition. These EU Member States also recorded some of the shortest life expectancies in the EU.

Most northern and western EU Member States are gathered in the bottom left section of Figure 11 — sometimes well below the EU average — as they recorded both low shares in self-perceived bad or very bad health and little long-standing limitations. Germany and the United Kingdom displayed a somewhat diverging pattern by registering shares of people with self-perceived limitations above the EU average (around 10 %).

In Malta only 3.1 % of residents declared having severe long-standing limitations in usual activities due to health problems and 3.9 % reported being in bad or very bad health in 2013.

The prevalence of chronic diseases was loosely related to shares of bad self-perceived health

Around 32.0 % of EU residents declared having a chronic disease in 2013, which was 1.7 percentage points higher than in 2005 (30.3 %). This was about 3 times higher than the share of people declaring to be in bad or very bad health (9.5 %).

As a general trend, one can extrapolate from Figure 12 a rather loose link between the prevalence of chronic diseases and the share of people assessing their health negatively (as bad or very bad).

Few country clusters stand out from Figure 12. The residents of Bulgaria, Romania, Greece and Luxembourg, displayed quite similar patterns, i.e. they recorded shares of bad or very bad self-perceived health between 8.2 % in Luxembourg and 11.3 % in Bulgaria — which was close to the EU average (9.5 %) — and shares of long-standing illness or health problems varying from 18.9 % in Bulgaria to 23.3 % in Luxembourg, which were well below the EU average (32.0 %).

Another group of EU Member States, consisting of Estonia, Latvia, Hungary and Portugal, recorded high shares (over 36 %) of people with a long-standing illness or health problem, as well as some of the highest shares of people reporting bad health (around 14–17 %). Conversely, in Ireland, Malta, Sweden and the Netherlands, some of the lowest shares in the two items were registered. In these EU Member States, the share of self-perceived bad health was comprised between 3.6 % (Ireland) and 5.4 % (the Netherlands) while the share of people having a long-standing illness or health problem was comprised between 27.3 % and 36.5 % (in the same countries).

Croatia and Lithuania were the countries with the highest percentage of the population reporting negatively about their health status (24.7 % and 18.5 % respectively). Despite this, the percentage of people reporting a chronic disease was close to the EU average (32.0 %). This could be explained by the relatively low life expectancy (77.8 years in Croatia and 74.1 years in Lithuania — several years under the EU average) and a low mean equivalised net income (around 7 000 PPS) in the two countries.

Meeting one’s medical needs was problematic in a very small number of EU Member States, and therefore not generally related with the percentage of people in bad health

With a growing (and near-universal) access to healthcare only a small share of EU residents (3.6 %) declared themselves unable to afford their medical needs for financial reasons or due to other barriers such as distance and waiting time, which was 1.4 percentage points lower than in 2005 (5.0 %). In Slovenia, the Netherlands, Austria, Spain, Malta and Luxembourg, less than 1 % of the population reported an inability to meet medical needs for financial reasons or due to other barriers in 2013. However, in Latvia and Romania 13.8 % and 10.4 % of the population respectively reported such an inability.

Two major country groups stand out from Figure 13. The first, located on the right-hand section of the graph includes Romania, Greece, Bulgaria, Poland, Estonia and Italy. These EU Member States presented the highest shares of people facing incapacity to meet some of their medical needs (for the reasons cited above) as well as the highest shares of people reporting a negative health condition close to or above the EU average (comprised between 9.1 % in Romania and 15.6 % in Estonia).

The second group, on the left-hand section of the graph, incorporates most remaining EU Member States (except Portugal, Hungary, Lithuania and Croatia). The countries in this group reported shares of unmet needs and of bad or very bad health which tended to be below or at a reasonable distance from the EU average. Indeed, in this group, the percentage of people in bad or very bad health ranged from 3.6 % in Ireland to 12.7 % in the Czech Republic.

Portugal, Hungary, Lithuania and Croatia displayed some of the lowest shares of people reporting unmet medical needs (between 2.4 % and 3.3 %) together with some of the highest shares of people reporting bad or very bad health, reaching 24.7 % in Croatia.

Therefore, meeting one’s medical needs alone did not appear to impact the way EU residents assessed their health condition. Country differentials should thus be ascribed to other factors already mentioned. To some extent, the responses regarding unmet needs for healthcare and self-perceived health may also have been affected by cultural attitudes and policy debates.

Strong correlation between self-perceived health and life expectancy

Life expectancy in the EU increased by 1.8 years from 2005 to 2012, reaching 80.3 years (see Figure 2). While reflecting declining mortality rates at all ages, this can be attributed to almost universal access to healthcare, as well as other factors such as lifestyles, education and rising standards of living.

While more than two thirds of EU residents (67.7 %) perceived their health as being good or very good in 2013, Figure 14 highlights a positive relation between life expectancy and the assessment rates on health status. Hence, the EU Member States with the highest life expectancy figures — appearing in the top-right section of the graph — also reported high shares of residents with a good or very good self-perceived health. Conversely, the EU Member States in the bottom-left part of the graph (mostly eastern EU Member States), reported low life expectancy figures as well as low shares of good or very good self-perceived health. In Portugal the registered life expectancy was higher than the EU average (80.9 years) however only half of Portugal’s residents reported good or very good health, which is substantially lower than the EU average. Slovak, Bulgarian and Romanian respondents, for whom life expectancy did not exceed 77 years, by comparison reported more positively about their health: the shares of people feeling in good health ranged from 66.2 % in Slovakia to 70.8 % in Romania.

Self-perceived health and life satisfaction

The next section examines how self-perceived health and overall life satisfaction may be linked at country level. General life satisfaction is based on an overall cognitive assessment of an individual’s life in a broad sense, and refers to an evaluation of all subjectively relevant life domains, such as the financial situation, housing, health, education, environment, security, etc. It is therefore considered an overall measure of subjective well-being.

Self-perceived health was strongly associated with overall life satisfaction

In 2013, similar proportions of EU residents reported low (21.0 %) or high (21.7 %) overall satisfaction with their life, whereas the remainder (57.4 %) declared a medium satisfaction). On the other hand, around 9.5 % of EU residents reported bad health (Table 1).

When considering these two aspects at country level (Figure 15), there appears to be a connection between bad health and low life satisfaction, with an equal number of EU Member States over and under the EU average both in terms of assessment of health status and of overall life satisfaction. Only a few eastern and southern EU Member States deviated from this. Among them, Bulgaria showed an extreme proportion of people with low life satisfaction (64.2 %) which could not only be ascribed to the share of its population feeling in bad or very bad health (11.3 %). To a much lesser extent, people living in Cyprus, Greece and Spain displayed a similar pattern. There could therefore be a whole set of determining factors affecting life satisfaction beyond perceived health status alone). The northern EU Member States and Belgium exhibited some of the smallest shares of people with both negative life satisfaction and health assessments. The pattern in Croatia was the complete opposite, as illustrated by its stand-alone position at the right end of the scale.

Data sources and availability

An ad-hoc module on subjective well-being was implemented in the EU-SILC 2013. This module contains subjective questions (e.g. How satisfied are you with your life these days?) which complement the mostly objective indicators from existing data collections and social surveys.

The "GDP and beyond" communication, the SSF Commission recommendations, the Sponsorship on measuring progress, and the Sofia memorandum all underlined the importance of collecting high quality data about people's quality of life and well-being and the central role that statistics on income and living conditions (SILC) have to play in this improved measurement. The collection of micro data related to well-being therefore is a key objective. In May 2010 both the Living Conditions Working Group and the Indicators Sub-Group of the Social Protection Committee supported Eurostat's proposal to collect micro data related to well-being within the 2013 module of SILC in order to better respond to this request.

For more information please visit: Eurostat - GDP and beyond - Quality of life

Health assessment

The statistical assessment of health requires both mortality- and morbidity-related measures (i.e. health outcomes), as well as health drivers and access to healthcare.

• Health outcomes indicators include data on life expectancy (the number of remaining years a person is expected to live at birth or at a certain age), as well as data on morbidity and health status, including healthy life years, self-perceived health and self-reported limitation in activities because of health problems. A mental health indicator is also being developed. Data for the indicators referring to long-standing illnesses and self-perception of health are collected through the European Statistics of Income and Living Conditions (EU-SILC). Data on life expectancy are provided in population statistics, and are based on administrative records. Healthy life years are estimated using data referring to life expectancy and a question on limitation in activities collected in EU-SILC.
• Health drivers refer to healthy or unhealthy behaviours and include data on body mass index (BMI) and regular smokers calculated using data from European Health Interview Survey (EHIS). This survey aims to measure the health status, lifestyle (health determinants) and healthcare services use of EU residents on a harmonised basis and with a high degree of comparability among EU Member States. Indicators on alcohol consumption and the frequency of physical activity are being developed.
• Access to healthcare is gauged by measuring self-reported unmet medical needs (for reasons of cost, distance or existence of waiting lists), data which is also collected as part of the EU-SILC.

Context

Bad health not only potentially shortens people’s life spans, but it can also undermine their quality of life. At a collective level, it hinders economic and social development by reducing the available so-called ‘human capital’ of a society and generates costs for it. Thus long and healthy lives are not just an important personal aim, but also an indication of societal well-being and success.

Health expenditure constitutes a significant part of government and private expenditure in the European Union (EU). Its effectiveness can be measured by a combination of objective ‘health outcome’ indicators, such as life expectancy and healthy life years, and self-assessments about access to healthcare and self-perceived (physical and mental) health status.

This article first presents indicators that are generally assumed to measure the outcomes of healthcare systems: life expectancy and healthy life years. The next indicator to be examined is self-perceived health (the overall levels and differences between socio-demographic groups such as age, gender, income, labour status and educational attainment levels). This evaluation will be followed by two types of analyses of the health assessment indicator:

• the link between the percentage of people assessing their health as bad or very bad and the incidence in the population of other healthcare related problems (such as long-standing illness and lack of access) in EU Member States.
• the relation — at the individual level — between self-perceived health and overall life satisfaction, as expressed by EU residents.

Reported assessments of health status reveal a link between income and wealth production, and health outcomes. Nonetheless, while health expenditure by all EU Member States (except Luxembourg) tends to be lower than in the United States, life expectancy is higher in most European countries. This finding suggests that several other factors are also at play, including the quality of healthcare, its funding (by private or public agents) and its accessibility across a national territory. Cultural attitudes and lifestyle choices also matter.

EU policies related to health

Health is not only a fundamental determinant of both the length and the quality of people’s lives. It also inherently affects access to all the other functional capabilities that in turn determine overall quality of life (i.e. the other quality of life dimensions). It is not only a value in itself. It is also a European policy goal of the utmost importance. The Proposal for a Regulation of the European Parliament and of the Council on establishing a Health for Growth Programme COM final 0709/2011 (the third multi-annual programme of EU action in the field of health for the period 2014–20), underlined the importance of health policy, especially in light of the challenges related to demographic change that Europe is facing, as well as the need for action to reduce inequalities in health as a condition for inclusive growth. In the Sustainable Development Strategy, health is a key challenge whose objective is to promote good public health on equal conditions and improve protection against health threats. The promotion of good health is also of particular importance in the Europe 2020 strategy, especially in relation to the attainment of its smart and inclusive growth priorities.

See also

• All articles on health
• Quality of life indicators (online publication)

Further Eurostat information

Main tables

• Income and living conditions (t_ilc), see:

Income distribution and monetary poverty (t_ilc_ip)

Monetary poverty (t_ilc_li)

Monetary poverty for elderly people (t_ilc_pn)

In-work poverty (t_ilc_iw)

Distribution of income (t_ilc_di)

Material deprivation (ilc_md)

Material deprivation by dimension (t_ilc_mddd)

Housing deprivation (t_ilc_mdho)

Environment of the dwelling (t_ilc_mddw)

• Mortality (t_demo_mor)

• Health status (t_hlth_state)

Database

• Income and living conditions (ilc), see:

Income distribution and monetary poverty (ilc_ip)

Monetary poverty (ilc_li)

Monetary poverty for elderly people (ilc_pn)

In-work poverty (ilc_iw)

Distribution of income (ilc_di)

SILC Adhoc module 2013 (ilc_ahm)

• Mortality (demo_mor), see:

Life expectancy by age and sex (demo_mlexpec)

• Health status (hlth_state)

Dedicated section

• Quality of life

Methodology / Metadata

• Income and living conditions (ESMS metadata file — ilc_esms)

Source data for tables and figures and maps (MS Excel)

• Chapter 4: Quality of life in Europe - health