Public Policy

Life expectancy at birth (p.49) The gender gap in life expectancy increased substantially in many OECD countries during the 1970s and early 1980s to reach a peak of almost seven years in the mid-1980s, but it has narrowed since, reflecting higher gains in life expectancy among men than women. In 2015, life expectancy in OECD countries for women for men less than 80  years: Hungary, Latvia, Mexico more than 85 years: Japan, Spain, France, Korea, Switzerland less than 75 years: Latvia, Mexico, Hungary, the Slovak, Republic, Estonia , Poland over 80 years: Iceland, Japan, Switzerland, Norway, Australia, Sweden, Italy, Israel, Spain On average among 25 OECD countries for which recent data are available, people with the highest level of education can expect to live around six years longer than people with the lowest level of education at age 30 (53.4 versus 47.8 years). A higher education level not only provides the means to improve the socio-economic conditions in which people live and work, but may also promote the adoption of healthier lifestyles and facilitate access to appropriate health care. This is largely explained by older people in these countries having lower levels of education, and the greater prevalence of risk factors among men, such as tobacco and alcohol use.	OECD Health at a Glance 2017
Main causes of mortality (p.52) Diseases of the circulatory system and cancer are the two leading causes of death. First, population ageing is important since the main causes of death change with age. Second is the epidemiological transition from communicable to non-communicable diseases, which has already taken place in high-income countries and is rapidly occurring in many middle-income countries. For example, dementia is a more important cause of death for women than for men. In contrast, the rates of lung cancer and accident-related deaths were higher for men than for women. Social disparities are generally larger for the most preventable diseases, as deaths are amenable to medical intervention, behaviour change and injury prevention.
Mortality from circulatory diseases (p.54) Despite substantial declines in recent decades, circulatory diseases remain the main cause of mortality in most OECD countries, accounting for more than one-third (36%) of all deaths in 2015. Declining tobacco consumption contributed significantly to reducing the incidence of IHD (see indicator on “Smoking among adults” in Chapter  4), and consequently to reducing mortality rates. The initial rise in IHD mortality rates in Korea has been attributed to changes in lifestyle and dietary patterns as well as environmental factors at the time of birth, with people born between 1940 and 1950 facing higher relative risks. In 2006, Korea introduced a Comprehensive Plan to tackle circulatory diseases that encompassed prevention and primary care as well as better acute care, contributing to the reduction in mortality in recent years (OECD, 2012). The high prevalence of risk factors common to both diseases (e.g. smoking and high blood pressure) may explain this link. Since 1990, cerebrovascular disease mortality has decreased in all OECD countries, although to a lesser extent in Poland and the Slovak Republic. As with IHD, the reduction in mortality from cerebrovascular disease can be attributed at least partly to a reduction in risk factors as well as improvements in medical treatments (OECD, 2015; see indicator “Mortality following ischaemic stroke” in Chapter 6) but rising obesity and diabetes threatens progress in tackling cerebrovascular disease (OECD, 2015).
Mortality from cancer (p.56) The rising share of deaths due to cancer reflects the fact that mortality rates from other causes, particularly circulatory diseases, has been declining more rapidly than for cancer. Prevention, early detection and treatment remain at the forefront in the battle to reduce the burden of cancer. Substantial declines in mortality for men: stomach, colorectal, lung, prostate cancer for women: breast, cervical and ovarian cancer these gains were partially offset by increases in the number of deaths due to cancer of the liver, skin, pancreas trends the high number of females started smoking earlier diagnosis and better treatment→declined mortality an increase in the incidence of breast cancer a major cause of Colorectal cancer among both Prostate cancer become the most common cancer aged 65 years and over
Infant health (p.58) Birth defects, prematurity and other conditions arising during pregnancy are the main factors contributing to neonatal mortality in developed countries. In 2015, the average in OECD countries was less than four deaths per 1 000 live births. Despite this progress in reduced infant mortality, increasing numbers of low birth weight infants is a concern in some OECD countries. On average, one in 15 babies born in the OECD (or 6.5% of all births) weighed less than 2 500 grams at birth in 2015 (Figure 3.14). Risk factors for low birth weight include maternal smoking, excessive alcohol consumption, poor nutrition, low body mass index, lower socio-economic status, having had in-vitro fertilisation treatment and multiple births, and a higher maternal age. The increased use of delivery management techniques such as induction of labour and caesarean delivery, which have increased the survival rates of low birth weight babies, may also explain the rise in low birth weight infants.
Mental health (p.60) Lower stigma around depression may contribute to higher rates of self-reported illness, and higher rates of diagnosis. The social context, poverty, substance abuse, and unemployment are all associated with higher rates of suicide. Studies suggest that the gender gap for attempted suicide is smaller, but men tend to use more lethal means when attempting suicide. A range of interventions can both prevent and treat depression, and prevent suicide, but in many countries people with mental ill-health have difficulties accessing appropriate mental health care in a timely way.
Perceived health status (p.62) A commonly asked question is of the type: “How is your health in general?”. Despite the subjective nature of this question, indicators of perceived general health are a good predictor of people’s future health care use and mortality (Palladino et al., 2016). In addition, since older people report poor health more often than younger people, countries with a larger proportion of aged persons will also have a lower proportion of people reporting to be in good health. In many of these cases, though, adults consider themselves to be in fair health. Across the OECD, on average 9% of adults consider themselves to be in bad health. As expected, people’s rating of their own health tends to decline with age. causal link is also possible, with poor health status leading to lower employment and lower income. Greater emphasis on public health and disease prevention among disadvantaged groups, and improving access to health services may contribute to further improvements in population health status in general and reducing health inequalities.
Cancer incidence (p.64) These variations reflect not only variations in the prevalence of risk factors for cancer, but also national policies regarding cancer screening and differences in quality of reporting. in women breast(28%), colorectal (12%), lung (10%), and cervical (3%) The causes: not fully understood the risk factors: age, family history, breast density, exposure to oestrogen, being overweight or obese, alcohol intake, radiation and hormone replacement therapy among women breast cancer leading causes of death from cancer declined mortality rates since the 1990s due to earlier detection and improvements in treatments among men Prostate cancer: almost all OECD countries lung cancer: Hungary, Poland, Turkey and Greece colorectal cancer: Japan and Korea prostate cancer attributed to differences in the use of PSA testing Differences between countries’ rates can be partly Mortality rates decreased as a consequence of early detection and improvements in treatments
Diabetes prevalence (p.66) People with diabetes are more likely to suffer from cardiovascular diseases such as heart attack and stroke, sight loss, foot and leg amputation and renal failure. The International Diabetes Federation estimates that a further 33 million adults have undiagnosed diabetes in OECD countries. These trends mirror partly trends in population ageing, as well as the rise of obesity and physical inactivity, and their interactions (NCD Risk Factor Collaboration, 2016). Diabetes also disproportionately affects those in lower socio-economic groups and people from certain ethnicities. almost 230 000 children suffered from Type 1 diabetes in OECD countries in 2015. These burdens highlight the need for effective management of diabetes and its complications (see indicator on “Diabetes care” in Chapter 6), as well as appropriate preventive actions (see Chapter 4).
Smoking among adults (p.70) The WHO has estimated that tobacco smoking kills 7 million people per year across the world, of which 890,000 are due to second-hand smoke. It is the leading cause of death, illness and impoverishment. Men smoke more than women in all countries except Denmark and Iceland, where the gender gap is about one percentage point. Daily smoking has decreased in most OECD countries since 2000 Raising taxes on tobacco is the most effective way to reduce tobacco use (WHO, 2015).
Alcohol consumption among adults (p.72) Heavy drinking is associated with a lower probability of employment, more absence from work, and lower productivity and wages. On average, recorded alcohol consumption has decreased in the OECD since 2000 (Figure 4.3), from 9.5 litres per capita per year to 9 litres of pure alcohol per capita each year, equivalent to 96 bottles of wine. Although adult alcohol consumption per capita is a useful measure to assess long-term trends, it does not identify sub-populations at risk from harmful drinking patterns. All OECD countries have legally set maximum levels of blood alcohol concentration for drivers, but the enforcement of these regulations may be haphazard and varies widely across and within countries.
Smoking and alcohol consumption among children Early and frequent drinking and drunkenness is associated with detrimental psychological, social and physical effects, such as dropping out of high school without graduating. Trends for repeated drunkenness and regular smoking in 15-year-olds display similar patterns. Regular smoking displays the strongest decrease, as rates in boys and girls more than halved between 1997-98 and 2013-14. The gender gap for drunkenness has also shrunk since the 1990s. Worldwide, one third of youth experimentation with tobacco occurs as a result of exposure to tobacco advertising, promotion and sponsorship. To reduce youth tobacco use, its use in the general population must be denormalised. Young smokers are responsive to policies aiming to reduce tobacco consumption, including excise taxes to increase prices, clean indoor-air laws, restrictions on youth access to tobacco, and greater education about the effects of tobacco (Forster et al., 2007).
Healthy lifestyles among adults (p.76) Worldwide, diets low in fruit were the cause of nearly 3 million deaths in 2015, while low vegetable consumption caused nearly 2 million deaths, and low physical activity caused 1.6 million deaths. Including fruit and vegetables in the daily diet reduces the risk of coronary heart disease, stroke, as well as certain types of cancer (WHO, 2014). Regular physical activity improves muscular and cardiorespiratory fitness, and reduces the risk of hypertension, coronary heart disease, stroke, diabetes, and various cancers (WHO, 2017) Women consume more fruit than men in all countries, On average, 60% of people in the OECD consume vegetables daily (65% of women, and 55% of men) Across the OECD, an average of 66.5% of people perform 150 minutes of moderate physical activity per week, with 70.5% of men and 63% of women. Men are more physically active than women in all countries but Denmark.
Overweight and obesity among adults (p.80) Overweight and obesity are major risk factors for many chronic diseases, including diabetes, cardiovascular diseases, and cancer. Obesity has greatly risen in the past two decades, even in countries where rates have been historically low (Figure 4.16). Social media and new technologies have become tools for public health promotion, through mass media campaigns aiming to increase public awareness about healthier choices (Goryakin et al., forthcoming). Taxation policies have also been increasingly implemented to raise the price of potentially unhealthy products such as foods high in salt, fat, or sugar. Taxes on sugar-sweetened beverages are amongst the most popular, and there is reasonable evidence that appropriately designed taxes would result in proportional reductions in consumption, especially if fixed at 20% of the retail price or more (WHO, 2016). Comprehensive policy packages that include health promotion, education, interventions in primary care settings, and broader regulatory and fiscal policies, provide affordable and cost-effective solutions to tackle obesity (OECD, 2010).
Overweight and obesity among children (p.82) Obesity can affect a child’s physical health, through cardiovascular, endocrine, or pulmonary diseases, and psycho-social health, through the development of poor self-esteem, eating disorders, and depression (Inchley et al., 2016). Obesity can also affect educational attainment (Cohen et al., 2013). Furthermore, childhood obesity is a strong predictor of adult obesity, which has health and economic consequences (WHO, 2016). Several OECD countries have implemented policies aimed at tightening regulation of advertisements of unhealthy foods and beverages, specifically targeted toward children and young adults to prevent obesity (OECD, 2017).
Air pollution (p.84) Air pollution is a major environment-related health threat, especially to children and the elderly, as it can cause respiratory diseases, lung cancer, and cardiovascular diseases. It has also been linked to low birth-weight, dementia, and damage to DNA and the immune system (WHO, 2017). Outdoor air pollution in both cities and rural areas was estimated to cause 3 million premature deaths worldwide in 2012 (WHO, 2016), and can also have substantial economic and social consequences, from health costs to building restoration needs and agricultural output (OECD, 2015). Of particular concern for outdoor air pollution are carbon monoxide, nitrogen oxide and ozone, but also fine particulates, or PM2.5, whose diameter is 2.5 μm or smaller. The WHO has claimed that air pollution is one of the most pernicious threats facing global public health today and on a bigger scale than HIV or Ebola (WHO, 2017). Policies to limit air pollution consist of regulatory approaches, such as air quality standards, fuel quality standards or emission ceilings, as well as economic instruments, which include fuel taxes, road pricing or taxes on emissions.
Out-of-pocket medical expenditure (p.92) Financial protection through compulsory or voluntary health coverage can substantially reduce the amount that people need to pay directly for medical care. The burden of out-of-pocket medical spending (that is, excluding long-term care services) can be measured either as a share of total household income or consumption. The burden of out-of-pocket medical spending (that is, excluding long-term care services) can be measured either as a share of total household income or consumption. In most countries, a higher proportion of the cost is paid directly for pharmaceuticals, dental care and eye care than for hospital care and doctor consultations (Paris et al., 2016). In most OECD countries, spending on pharmaceuticals and outpatient care (including dental care) are the two main spending items for out-of-pocket expenditure (Figure 5.8). This may be due not only to co-payments for prescribed pharmaceuticals, but also high levels of spending on over-the-counter medicines for self-medication. Coverage for dental treatment is typically limited and as such dental care plays a significant part in outpatient and overall household spending, accounting for 20% of all out-of-pocket expenditure across OECD countries.
Diabetes care (p.106) It is a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation. Globally it is estimated that over 400 million adults had diabetes in 2015 and by 2040 it is projected this will grow to over 640 million adults. Diabetes caused 5 million deaths in 2015 (IDF, 2015). Effective control of blood glucose levels through routine monitoring, dietary modification and regular exercise can reduce the onset of serious complications and the need for hospitalisation. Management of other key risk factors such as smoking, blood pressure and lipid levels are also important in reducing complications of diabetes. A positive relationship can be demonstrated between overall hospital admissions and admissions for diabetes, providing some indication that access to hospital care can also play a role in explaining international variation (OECD, 2015).
AvoidablMost health systems have developed a ‘primary level’ of care whose functions include health promotion and disease prevention, managing new health complaints, managing long-term conditions and referring patients to hospital-based services when appropriate. A key aim is to keep people well, by providing a consistent point of care over the longer-term, tailoring and co-ordinating care for those with multiple health care needs and supporting the patient in self-education and self-management.e hospital admissions (p.104) Asthma may affect up to 334 million people worldwide (Global Asthma Network, 2014). About 3 million people died of COPD in 2015, which is equal to 5% of all deaths globally that year (WHO, 2016). Heart failure is estimated to affect over 26 million people worldwide resulting in more than 1 million hospitalisations annually in both the United States and Europe (Ponikowskiet al., 2014). Asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are three widely prevalent long-term conditions.
Nurses (p.159) Nurses greatly outnumber physicians in most OECD countries, and they play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions but increasingly in primary care settings (especially to manage the care of the chronically ill) and in home care settings. There are growing concerns in many OECD countries about possible future shortages of nurses, given that the demand for nurses is expected to rise in a context of population ageing and the retirement of the current “baby-boom” generation of nurses. The retention rate of nurses has increased in recent years in many countries either due to the impact of the economic crisis that have prompted more nurses to stay or come back in the profession, or following deliberate efforts to improve their working conditions (OECD, 2016). On average across OECD countries, the number of nurses on per capita basis has gone up from 7.3 per 1 000 population in 2000 to nine nurses per 1 000 population in 2015 (Figure 8.12). The number of nurses per capita increased in almost all OECD countries since 2000. In 2015, there were about three nurses per doctor on average across OECD countries, with about half of the countries reporting between two to four nurses per doctor (Figure 8.13).