Core Health Indicators in the WHO European Region

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1 Core Health Indicators in the WHO European Region Special focus: 2030 Sustainable Development Agenda

2 Preface I am pleased to present the sixth edition of a key annual publication for the WHO Regional Office for Europe: Core health indicators in the WHO European Region Core health indicators provide a good barometer for monitoring progress towards the achievement of Health 2020 targets in the 53 Member States of the WHO European Region and at the Regional level. The publication includes information on key health domains such as health status, determinants of health, risk factors, health systems resources and service utilization. The information is derived from data regularly submitted to WHO by national health and statistical authorities and other international agencies, under the umbrella of the European Health Information Initiative, a multi-member initiative of 34 partners, mostly Member States. This publication shows the diversity and magnitude of public health issues and challenges in the Region. From its inception in 2012 to the 2017 release, Core health indicators demonstrates each year that the Health 2020 policy framework is shaping national health policies in the Region and improving the well-being of the European population. The Region can be proud of the significant achievements observed in various health areas, including the increase in life expectancy and the reduction of premature mortality from major noncommunicable diseases (NCDs). However, important challenges remain, especially the high levels of alcohol consumption and tobacco use as well as the rising levels of overweight and obesity in the population. This sixth edition of Core health indicators coincides with the adoption of the WHO European Roadmap to implement 2030 Agenda for Sustainable Development, which focuses on the Sustainable Development Goals (SDGs), making them the natural special theme for the year. I am also delighted to note that the Regional Office has consulted on and proposed an approach to reduce the burden of reporting on Member States to develop a joint monitoring framework which would ease reporting of indicators and themes that are aligned across the Health 2020, SDG and NCD frameworks. Even the most developed of countries can only report on half of SDG indicators and about a third of targets. But more than 75% of Health 2020 indicators could be mapped with one or more SDG indicators or themes. This is not only offering an opportunity for a joint monitoring framework, it is also showing that Health 2020 was truly ahead of its time. This alignment is also reflected in this publication using a colour coding system (described below). SDGs therefore offer a golden opportunity to promote intersectoral action, accelerate the implementation of the Health 2020 priorities and inform the policymaking processes in the Region. Finally, based mostly on 2014 and 2015 data, the publication presents selected graphs and maps on key SDG-related topics relevant for the European Region, such as inequalities, universal health coverage, risk factors and NCDs. I am delighted to present this publication and look forward to continuing collaboration with Member States and all partners to support the generation and use of highquality evidence for monitoring progress towards the implementation of the Health 2020 and SDG policies and targets. Zsuzsanna Jakab WHO Regional Director for Europe COLOUR CODING FOR INDICATORS (FOR TABLES) SDG only SDG and Health 2020 Health 2020 only

3 Demographic and socioeconomic context Mid-year population (thousands) Population aged 65 years (% of total) Total fertility rate Natural population growth per 1000 Urban population (% of total) Health 2020 SDG 4 SDG 6 SDG 8 % of % of Real GDP, population population PPP$ with with access per capita secondary to improved education sanitation only, aged facilities 25+ years Annual growth rate of GDP (%) Country ** Albania d 6.3 d d Andorra c c Armenia b 5.1 b Austria b 1.5 b 0.4 b Azerbaijan d d Belarus b 1.7 b -0.4 b d Belgium b 1.7 b 1.8 b Bosnia and Herzegovina b 1.2 c -1.5 b Bulgaria b 1.5 b -5.2 c Croatia b -2.7 b d Cyprus b 1.3 b 4.4 b Czechia b 0.4 b Denmark b b Estonia b 1.5 b -1.5 b Finland b b b France c 2.0 b 3.5 c Georgia b 2.2 b 1.9 b b Germany b 1.5 b -1.9 b Greece b 1.3 d -1.5 d Hungary b -3.6 b Iceland b 7.1 b Ireland c 2.0 b 8.6 c d Israel b 3.1 b 17.0 b Italy d 1.4 c -1.4 d Kazakhstan d Kyrgyzstan d Latvia b 1.6 b -3.2 b Lithuania b -3.3 b Luxembourg b b d Malta b 1.4 b 2.4 b Monaco d Montenegro d 1.8 b 4.4 d d Netherlands b 2.1 b Norway b b Poland b 1.3 b -0.2 b b Portugal c 1.2 b -2.3 c Republic of Moldova b -0.3 b Romania b -1.5 b Russian Federation d -0.9 d d San Marino d Serbia b -4.9 b Slovakia b 1.4 c 0.7 b Slovenia b 0.9 b Spain b 1.3 b 0.7 b Sweden b Switzerland c 1.5 b 2.2 c Tajikistan b MKD* c c Turkey c 2.1 c 12.2 c Turkmenistan d 24.8 d Ukraine b 1.5 c -4.4 b United Kingdom c 3.2 c b Uzbekistan b 2.5 b 19.5 b WHO European Region b 1.7 b 2.6 b * The International Organization for Standardization (ISO) abbreviation for the former Yugoslav Republic of Macedonia ** Latest available data GDP = gross domestic product = no data available PPP = purchasing power parity Note: a = 2016, b = 2014, c = 2013, d =

4 Health status: mortality indicators Health 2020 Health 2020 Health 2020 SDG 3 SDG 16 SDG 3 Life expectancy at birth (years) Healthy life Infant deaths Neonatal Mortality Mortality Both sexes Males Females years at birth per 1000 mortality rates from rates from live births rate homicides suicide and per 1000 live births and assaults per population intentional self-harm per population Country Albania 79.6 d 77.5 d 81.9 d d 2.4 d 0.0 d 0.0 d Andorra Armenia 75.2 b 71.9 b 78.3 b b 1.1 b 1.8 b Austria 81.8 b 79.3 b 84.2 b b 2.3 b 0.4 b 12.6 b Azerbaijan 73.8 d 71.3 d 76.3 d d 6.0 d 0.3 d 0.7 d Belarus 73.4 b 67.9 b 78.7 b b 3.5 b 16.6 b Belgium 81.5 b 78.9 b 84.0 b b 2.3 b 1.0 c 15.3 c Bosnia and Herzegovina 77.5 b 75.2 b 79.8 b b 4.7 b 1.1 b 7.2 b Bulgaria 75.0 c 71.4 c 78.7 c c 4.2 c 1.1 c 8.0 c Croatia b 3.8 b 0.8 b 14.0 b Cyprus 82.4 b 80.3 b 84.4 b b 1.5 b 1.3 c 4.9 c Czechia b 1.6 b 0.7 b 12.5 b Denmark 81.0 b 79.0 b 83.0 b b 2.4 d 0.3 d 10.5 d Estonia 77.5 b 72.4 b 82.1 b b 1.5 b 3.0 b 16.3 b Finland 81.4 b 78.4 b 84.2 b b 1.4 b 1.5 b 13.6 b France 82.6 c 79.3 c 85.8 c c 2.4 c 0.6 c 13.3 c Georgia 73.1 b 68.8 b 77.3 b b 6.5 b 2.1 b 4.6 b Germany 81.3 b 78.8 b 83.7 b b 2.3 b 0.4 b 9.9 b Greece 81.6 b 78.9 b 84.3 b d 1.9 d 1.4 d 4.0 d Hungary b 2.9 b 0.8 b 16.5 b Iceland b 1.6 b 0.3 d 11.5 d Ireland 81.1 c 79.0 c 83.2 c c 2.6 d 0.6 c 10.7 c Israel 82.8 b 80.8 b 84.6 b b 2.1 b 1.7 c 5.1 c Italy 82.4 d 79.8 d 84.8 d d 2.3 d 0.7 d 5.9 d Kazakhstan a Kyrgyzstan c 8.6 c Latvia 74.8 b 69.5 b 79.7 b b 2.8 b 6.4 b 17.2 b Lithuania b 2.5 b 3.7 b 28.3 b Luxembourg 83.0 b 80.3 b 85.7 b b 1.5 b 0.7 b 11.1 b Malta 82.2 b 80.0 b 84.4 b b 3.8 b 0.8 b 7.2 b Monaco Montenegro 75.6 d 73.3 d 78.0 d d 4.1 d 2.0 d 16.3 d Netherlands b 2.7 b 0.8 c 10.1 c Norway 82.3 b 80.3 b 84.3 b b 1.8 b 0.6 b 10.2 b Poland 77.9 b 73.8 b 81.9 b b 2.9 b 0.8 b 14.3 b Portugal 81.0 c 77.6 c 84.1 c b 2.1 b 0.9 c 7.8 c Republic of Moldova b 6.2 b 5.0 b 15.6 b Romania b 5.0 b 1.5 b 8.9 b Russian Federation 70.0 d 64.2 d 75.8 d d 10.7 d 19.8 d San Marino Serbia b 4.3 b 1.5 b 12.4 b Slovakia 77.1 b 73.4 b 80.6 b b 3.3 b 0.8 b 9.1 b Slovenia b 1.4 b 0.4 d 17.2 d Spain 83.4 b 80.4 b 86.3 b b 2.1 b 0.6 b 7.0 b Sweden b 10.8 b Switzerland 83.1 c 80.8 c 85.2 c c 3.2 c 0.5 c 11.3 c Tajikistan 62.1 MKD* 75.5 c 73.5 c 77.6 c c 7.7 c 2.1 d 5.7 d Turkey 78.9 c 76.1 c 81.7 c c 6.4 c 1.7 c 2.5 c Turkmenistan 71.2 d 68.3 d 74.1 d b 1.7 d 2.4 d Ukraine 71.4 b 66.3 b 76.5 b b 6.1 b 16.6 b United Kingdom 81.2 c 79.3 c 83.0 c c 2.7 c 0.3 d 6.8 d Uzbekistan 73.5 b 71.2 b 75.9 b b 1.5 b 6.8 b WHO European Region 77.7 b 74.4 b 81.0 b b 4.5 b 2.9 c 11.2 c * The ISO abbreviation for the former Yugoslav Republic of Macedonia = no data available

5 All-cause mortality Malignant neoplasms Health 2020 SDG 3 Age-standardized death rates per population Circulatory system Digestive system Diseases of the respiratory system External causes of injury and poisoning Motor vehicle accidents Ill defined** causes of death (%) Country d 91.0 d d 10.6 d 18.4 d 31.8 d 0.0 d 10.5 d Albania Andorra b Armenia b b b 20.9 b 23.3 b 34.7 b 4.1 b 2.6 b Austria d 87.4 d d 60.4 d 55.9 d 28.6 d 1.0 d 8.3 d Azerbaijan b b b 34.4 b 16.1 b 92.5 b 12.1 b Belarus b b b 23.5 b 45.6 b 42.9 b 5.4 b 5.5 c Belgium b b b 19.4 b 27.1 b 24.3 b 3.6 b 8.2 b Bosnia and Herzegovina с c c 34.3 c 30.9 c 31.7 c 5.5 c 3.2 c Bulgaria b Croatia b b b 18.3 b 36.5 b 28.9 b 5.6 b 2.8 c Cyprus b Czechia b b b 25.3 b 55.2 b 27.6 b 2.9 b 7.3 d Denmark b b b 32.5 b 25.9 b 66.2 b 6.0 b 2.0 b Estonia b b b 30.2 b 18.1 b 48.6 b 3.6 b 1.3 b Finland с с c 20.7 c 26.6 c 38.4 c 4.3 c 10.1 c France b b b 29.4 b 27.4 b 46.4 b 13.6 b 29.4 b Georgia b b b 26.3 b 34.1 b 27.6 b 3.3 b 3.0 b Germany b b b 15.7 b 49.4 b 25.6 b 8.2 b 11.3 d Greece b Hungary d Iceland с с c 20.1 c 60.3 c 31.3 c 3.5 c 0.4 c Ireland b b b 15.3 b 35.6 b 20.9 b 3.8 b 5.9 c Israel d d d 19.3 d 29.4 d 24.5 d 5.8 d 1.8 d Italy Kazakhstan c Kyrgyzstan b b b 35.2 b 22.9 b 81.8 b 10.1 b 1.4 b Latvia b Lithuania b b b 22.5 b 30.3 b 34.4 b 4.8 b 2.5 b Luxembourg b b b 16.5 b 43.1 b 20.0 b 2.3 b 0.6 b Malta Monaco d d d 20.6 d 38.7 d 35.2 d 7.2 d 14.2 d Montenegro c Netherlands b b b 14.8 b 42.2 b 37.4 b 2.7 b 5.6 b Norway b b b 30.9 b 35.9 b 48.5 b 6.8 b 7.4 b Poland c c c 25.6 c 55.4 c 28.3 c 5.9 c 6.2 b Portugal b Republic of Moldova b Romania d d d 54.8 d 44.7 d d 5.1 d Russian Federation San Marino b Serbia b b b 44.2 b 39.4 b 50.5 b 5.3 b 2.2 b Slovakia d Slovenia b b b 22.6 b 43.0 b 22.1 b 3.6 b 2.1 b Spain b Sweden c c c 17.9 c 26.8 c 32.1 c 2.7 c 3.9 c Switzerland Tajikistan c c c 17.5 c 31.1 c 25.6 c 6.5 c 6.5 d MKD* c c c 17.0 c 64.1 c 28.9 c 9.3 c 2.2 c Turkey d 92.3 d d 62.5 d 28.5 d 28.1 d 12.2 d Turkmenistan b b b 50.1 b 26.8 b 85.4 b 2.3 b Ukraine c c c 28.8 c 70.1 c 27.6 c 2.3 c 2.0 c United Kingdom b 72.0 b b 48.0 b 35.8 b 33.2 b 8.9 b 1.5 b Uzbekistan b b b 34.6 b 44.0 b 52.1 b 8.5 b 4.2 b WHO European Region ** See technical notes for more information Note: a = 2016, b = 2014, c = 2013, d =

6 Health status: morbidity Health 2020 SDG 3 SDG 3 Incidence per Cancer incidence per % of HIV TB All forms Female breast Prostate Health services utilization infants vaccinated against rubella Acute care hospital discharges per 100 population Inpatient care Country Albania d 30.8 c 13.0 d c Andorra c Armenia b 76.3 b 22.6 b b 7.5 b Austria b d 17.6 b b 8.2 b Azerbaijan d d Belarus b 80.3 b 19.3 b b Belgium c c 17.1 c c 7.8 c Bosnia and Herzegovina 0.7 c b 37.5 b 18.7 b b Bulgaria c 93.8 b 19.0 c b Croatia b c 26.4 b b 8.8 b Cyprus c d 19.6 c b 6.4 b Czechia b c 23.3 b b 9.4 b Denmark d b 29.4 d d 4.3 c Estonia b c 36.5 b b 7.6 b Finland b b 20.7 b b 10.6 b France c c c 10.1 c Georgia b 47.9 b 12.6 b d 5.2 b Germany b d 19.8 b b 9.0 b Greece d 15.2 d d 6.8 d Hungary b b 21.7 b b 9.5 b Iceland d c 29.8 d b 6.1 b Ireland c c 21.3 c b 6.0 b Israel c c 9.9 c b 6.8 b Italy d b 13.5 d b 8.0 b Kazakhstan Kyrgyzstan c c Latvia b b 36.3 b b 8.3 b Lithuania b 94.7 d 29.7 b b 8.0 b Luxembourg b c 13.8 b b 8.8 b Malta b b 14.4 b b 7.9 b Monaco Montenegro d c 15.2 d b Netherlands c c d Norway b b 30.7 b b 6.0 b Poland b 87.4 c 21.2 b b 6.9 b Portugal c d 20.3 c b 8.9 b Republic of Moldova b 50.8 b 15.2 b b 9.0 b Romania b 75.7 b 17.1 b c 7.4 c Russian Federation 43.8 d d 78.9 c 18.7 d c 12.1 c San Marino d Serbia b 97.8 c 19.0 b b 10.0 b Slovakia b d 29.0 b b 7.3 b Slovenia d d 31.0 d b 6.9 b Spain b 15.3 b b 7.4 b Sweden b b 29.0 b b 5.7 b Switzerland c d 22.4 c b 8.5 b Tajikistan MKD* d 65.8 d 17.3 d c 7.9 c Turkey c 32.8 d 16.0 c b 4.0 b Turkmenistan 0.0 d d d Ukraine b 68.1 c 17.8 b c 11.8 c United Kingdom d b 23.4 d b 7.1 b Uzbekistan 13.3 d b b WHO European Region c c 17.5 c b 8.7 b Average length of stay (days) * The ISO abbreviation for the former Yugoslav Republic of Macedonia TB = tuberculosis HIV = human immunodeficiency virus = no data available

7 Health expenditures SDG 16 Public sector expenditure on health as % of total government expenditure (WHO estimates) Private households out-of-pocket expenditure (WHO estimates) Risk factors Health 2020 Health 2020 Estimated age-standardized prevalence (in %) of Public sector Insufficient Obesity (defined as Raised fasting plasma health physical BMI 30 kg/m 2 ) in people glucose ( 7.0 mmol/l expenditure activity aged 18 years and over or on medication) (WHO estimates) among adults Males Females Males Females as % of total health expenditure ** Country Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan MKD* Turkey Turkmenistan Ukraine United Kingdom Uzbekistan WHO European Region Note: a = 2016, b = 2014, c = 2013, d =

8 Theme in focus: SDGs Health 2020 SDG 10 SDG 4 SDG 8 Gini index (income distribution) Proportion (%) of children of official primary school age not enrolled Unemployment rate (% of labour force) Youth unemployment rate (% of labour force) Males Females Males Females Males Females Country Albania 29.0 d 3.5 c 4.8 c Andorra Armenia 31.5 b Austria 27.2 a Azerbaijan 31.8 d Belarus 27.2 b Belgium 26.3 a Bosnia and Herzegovina 33.8 d Bulgaria 38.3 a Croatia Cyprus Czechia Denmark Estonia Finland 25.4 a France b 0.4 b Georgia 40.1 b 3.7 d 6.0 d Germany Greece 34.3 a 3.4 b 4.0 b Hungary 28.2 a Iceland c 1.4 c Ireland b 0.4 b Israel 42.8 d Italy Kazakhstan 26.3 c 0.4 a 0.1 a Kyrgyzstan Latvia 34.5 a Lithuania Luxembourg b 3.8 b Malta Monaco Montenegro 31.9 b Netherlands Norway Poland b 3.5 b Portugal Republic of Moldova Romania 34.7 a Russian Federation 41.6 d San Marino 6.8 d 7.1 d Serbia Slovakia Slovenia b 1.6 b Spain 34.5 a Sweden Switzerland Tajikistan 30.8 b 1.8 a 0.4 a MKD* Turkey 42.1 c Turkmenistan Ukraine 24.1 b 4.5 b 2.4 b United Kingdom 0.1 d 0.3 d Uzbekistan 1.8 a 4.0 a WHO European Region * The ISO abbreviation for the former Yugoslav Republic of Macedonia ** Latest available data = no data available

9 % of infants vaccinated against poliomyelitis Treatment success rate: new TB cases (%) Health 2020 SDG 3 SDG 3 Age-standardized death rate Total health Availability per from major noncommunicable expenditure population diseases per population as % of GDP (30 69 years) (WHO Physicians Nurses and estimates) midwives Both sexes Males Females Mortality attributable to household and ambient air pollution (per population) ** Country 98 a 88 b d d d c Albania 98 a 83 b d 369 d Andorra 96 a 78 b b 499 b Armenia 87 a 74 b b b b b 34.2 Austria 98 a 83 b d d d b 635 b 68.0 Azerbaijan 98 a 88 b b b b b b Belarus 98 a 81 b b b b b d 30.2 Belgium 79 a 77 b b b b c 559 b Bosnia and Herzegovina 92 a 86 b с с с b 487 b Bulgaria 93 a 71 b b 614 b 89.5 Croatia 97 a 59 b b b b b 529 b 19.8 Cyprus 96 a 69 c c 833 b 59.5 Czechia 94 a 52 b b b b c c 20.3 Denmark 93 a 84 b b b b b 597 b 54.2 Estonia 92 a 45 b b b b c d 6.0 Finland 99 b с с с France 92 a 83 b b b b b 382 b Georgia b b b b b b 32.5 Germany 99 a b b b b 344 b 45.1 Greece 99 a 73 b b 657 b Hungary 91 a 89 b Iceland b c c c d 17.3 Ireland 94 c 89 b b b b b 526 b 15.8 Israel d d d b 648 b 35.3 Italy 83 a 90 b b 802 c 93.3 Kazakhstan 97 a 84 b b 599 c 99.5 Kyrgyzstan 98 a 83 b b b b b 503 b Latvia 95 a 81 b b 795 b 73.4 Lithuania 99 a 0 c b b b Luxembourg 97 a 76 c b b b Malta 100 c b b Monaco b d d d Montenegro 95 a 85 b b 856 d 24.0 Netherlands 96 a 84 b b b b b b 12.7 Norway b b b b b 574 b 68.9 Poland b с с с b 638 b 16.8 Portugal 91 a 79 b b 608 b Republic of Moldova 89 a 85 b c 552 c Romania 97 a 69 b d d d b 457 b Russian Federation 66 a b 855 b San Marino 93 a 81 b b 629 b Serbia 96 a 88 b b b b d 608 b 66.3 Slovakia b b 861 b 41.9 Slovenia 97 a 58 b b b b b 536 b 14.7 Spain 98 a 88 b c c 0.4 Sweden c c c b b 18.5 Switzerland 97 a 89 b b 473 b 97.6 Tajikistan c c c c c 421 c MKD* b c c c b 252 b 51.0 Turkey 98 a 72 c d d d b 456 b 72.9 Turkmenistan 56 a 72 b b b b b 668 b Ukraine 94 a 81 b c c c United Kingdom 99 a 87 b b b b b b 83.2 Uzbekistan 94 b 76 b b b b b 741 b 64.9 WHO European Region TB = tuberculosis Note: a = 2016, b = 2014, c = 2013, d =

10 Theme in focus: SDGs Mapping of indicators from Health 2020 with SDGs Mortality trend from major noncommunicable diseases in people aged years in the WHO European Region 900 % of total health expenditure % of total health expenditure Health % of H2020 indicators align with SDGs indicators: Alcohol Educational attainment Health expenditure Household consumption Mortality Reducing income inequality Sanitation Smoking Social support Tuberculosis treatment Unemployment Vaccination Maximum WHO European Region Minimum SDGs Trends in private households out-of-pocket payments on health in the WHO European Region litres of pure alcohol Age-standardized death rate % of total health expenditure % of total health expenditure Netherlands San Marino France Monaco United Kingdom Luxembourg Croatia Slovenia Germany Denmark Norway Sweden Czechia Andorra Austria Iceland Ireland Turkey Belgium Finland Romania Estonia Italy Slovakia Poland Spain WHO European Region Hungary Switzerland Portugal Israel Bosnia and Herzegovina Malta Lithuania Belarus Turkmenistan Greece Latvia Serbia MKD* Republic of Moldova Kyrgyzstan Montenegro Uzbekistan Bulgaria Kazakhstan Russian Federation Ukraine Cyprus Albania Armenia Georgia Tajikistan Azerbaijan per Age-standardized population death rate per population Male Female Per capita alcohol consumption among people aged 15+ within a calendar year Maximum WHO European Region Minimum Private households out-of-pocket payments on health, 2014 * The ISO abbreviation for the former Yugoslav Republic of Macedonia

11 Unemployment rate, % of total labour force, Belarus Iceland Czechia Germany Switzerland Norway United Kingdom Republic of Moldova Azerbaijan Hungary Kazakhstan Malta Israel Russian Federation Luxembourg Denmark Austria Netherlands Poland Romania Estonia Sweden Kyrgyzstan Bulgaria Ireland Belgium WHO European Region Turkmenistan Slovenia Ukraine Uzbekistan Finland Lithuania Latvia France Slovakia Turkey Tajikistan Portugal Italy Georgia Cyprus Croatia Albania Serbia Armenia Montenegro Spain Greece Bosnia and Herzegovina MKD* Regular daily smokers as a percentage of the population older than 14 years, age-standardized estimates, 2013 Recorded consumption of pure alcohol per capita older than 14 years, latest available data Proportion of children of official primary school age not enrolled, both sexes, latest available data United Kingdom Germany Norway Kazakhstan Finland Sweden Switzerland Spain France Lithuania Georgia Belgium Serbia Ireland Iceland Italy Tajikistan Denmark Netherlands Malta Croatia Portugal Kyrgyzstan Cyprus Slovenia WHO European Region Israel Russian Federation Uzbekistan Latvia Poland Ukraine Armenia Greece Luxembourg Albania Hungary Belarus Estonia Bulgaria Azerbaijan Turkey Montenegro San Marino MKD* Romania Republic of Moldova

12 Technical notes and sources The data for the core health indicators were compiled, validated and processed in a standard way by EUROSTAT, OECD, WHO and other United Nations agencies and international networks, to improve the international comparability of the statistics. Nevertheless, many factors may influence the accuracy and comparability of national statistics, such as variations in definition, incomplete registration and other national specificities in data recording and processing. The international comparison of indicators should, therefore, always be interpreted with caution. Seventeen mortality-based indicators (life expectancy at birth, disaggregated by sex, and rates for infant, neonatal and mortality by cause) are presented, based on official mortality data from countries. Cause-specific mortality rates (indicators and 51 53) are age-standardized death rates, calculated using the European standard population structure. 1 Age-standardized indicators obtained through the Global Health Observatory (indicators and 57) are standardized to the world population. Age standardization improves international comparability by removing the effects of differences in population age structures between countries. The proportion of ill defined causes of death (indicator 25) is used as an indication of the quality of the certification and coding of causes of death. The bottom row in the data tables (the WHO European Region) gives the populationweighted average for all countries in the Region for which data are available. The exception is indicator 1, mid year population, where the value is the sum of the countries populations. Health 2020 indicators and indicators related to the SDGs are indicated as such. Data were retrieved from the WHO European Health for All database or the European mortality indicator database, unless specified otherwise in the table below. Metadata is available in the aforementioned databases. The data presented were limited to the years for the sake of actuality and comparability. Additional indicators and more detailed data can be found on the WHO European Health Information Gateway 2 and WHO headquarters websites. 3 Indicator Data source 9, 45 48, unemployment (charts) The World Development Indicators database of the World Bank 37 41, 50, 57 The WHO Global Health Observatory database 1 See the European Health for All family of databases, technical notes. Copenhagen: WHO Regional Office for Europe; 2017 ( data-and-evidence/databases/european-health-for-all-family-of-databases-hfa-db, accessed 25 July 2017). 2 European Health Information Gateway [website]. Copenhagen: WHO Regional Office for Europe; 2017 ( accessed 25 July 2017). 3 Global Health Observatory (GHO) data [website]. Geneva: World Health Organization; 2017 ( accessed 25 July 2017). World Health Organization Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Tel.: ; Fax: euwhocontact@who.int Website: World Health Organization 2017 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

211 STATISTICAL APPENDIX

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