We’re living longer – but can we live better?
We’re living longer – but can we live better?
Most Europeans born today will live into their eighties but behind that impressive statistic lie inequalities and ill-health. It’s time we focused on adding life to years instead of years to life.
In 1990, life expectancy at birth was 74.1 years in Europe. Today, it’s 80.9. This is a remarkable achievement, by any measure. However, adding to our quantity of life is no guarantee of quality of life. Yes, the chances of surviving cancer, heart attack and stroke are higher than ever, thanks to improved healthcare. The prospects of surviving without disability are less rosy.
Here is one of the most shocking statistics I’ve read in a long time: men and women spend 79% and 74% of their lives, respectively, in good health. Or, to put it another way, men live more than a fifth of their lives in bad health while women live more than a quarter of their lives in an unhealthy state.
This explains why policymakers are shifting focus to healthy life years. The EU is trying to add two healthy life years – or ‘disability-free life expectancy’ – to our lives by 2020. After all, adding two more years to life is not worth much if they are two extra years of misery. Today in Europe, 50 million people over the age of 65 live with two or more chronic conditions, according to figures published by the EU/OECD. This comes at a profound human cost as well as an estimated economic loss of €115 billion.
Another challenge that lies behind the impressive life expectancy figures is inequality. Let’s take gender first: the typical European women lives to around 83 while her male counterpart is lucky if he celebrates his 78th birthday. Even bigger disparities emerge if we compare Europe’s best-performing health services with its worst.
The average person (combining both genders) in France, Spain and Italy lives until they are 83. In Romania, Bulgaria, Lithuania and Latvia it’s just 75. There are big differences within countries too. Those in northern Italy outlive their southern compatriots, just as the average Londoner outlives those in Glasgow by several years.
How can we bring outcomes for people in every corner of Europe up to the standard of the best performers while improving the number of years we all spend in good health? Central to answering this is looking closely at national health services and sharing what works.The EU and OECD’s Health at a Glance reports can help. This project produces detailed reviews of national health systems, highlighting successes and areas for improvement. They are a resource for any country keen to learn from its neighbours.
Similarly, the European Consumer Health Index published this week (30 January) provides a snapshot of 35 health systems. It is packed with data and anecdotes on how health systems can make giant leaps forward – or fall behind.The latest edition of the Index rates the Netherlands as the best system in Europe. It is, say the authors, the most accessible and consumer-friendly, while also giving top results for people with diabetes, cardiac conditions, HIV, headache and hepatitis.
As impressive as the Dutch example can be, many readers in lower-income countries will find it unsurprising and perhaps even irrelevant. Bulgaria cannot copy the Dutch system overnight in the hope that life expectancy will increase. Perhaps a more instructive case study comes from Macedonia. Without question one of the poorest countries rated by the Index, Macedonia has the 20th best system in Europe – meaning that it outstrips many EU countries with much higher GDP.
How did Macedonia do it?
The area where Macedonia topped the table was in accessibility. In 2013, they introduced a new e-health tool that allows GPs to make appointments for patients with hospital consultants or to book slots on diagnostic scanners such as MRI and X-ray machines. For a relatively modest investment, they dramatically improved the efficiency of their system, getting more value for previous investments in imaging hardware and health professionals.
As a result, they effectively abolished waiting lists. For many conditions, earlier diagnosis and treatment can deliver significantly better outcomes – keeping people healthy and productive for longer.Their neighbours in Serbia have already taken note. They have licensed the same e-health tool and hired some of the IT experts that rolled out the system in Macedonia.
That’s not to say that Macedonia does not have plenty of problems in its health system but it shows that:
(a) simple technological solutions can unlock enormous value and
(b) ‘stealing’ one another’s best ideas is a fast-track to better outcomes.