European perspectives on global health: a policy glossary

1. Europe must make global health a priority
Global patterns of health and
disease are shifting
The global pattern of health refers to the
distribution of health and the determinants of
health that affect the burden of diseases across
different countries and regions of the world.
During the past decade a great deal of effort has gone
into estimating with greater precision the extent of illhealth
and its causes in different countries and regions
of the world. Burden of disease estimates both describe
the current situation and provide a basis for comparison
and describing trends. The most commonly used
indicator is the disability-adjusted life year or DALY.
Globally there has been a sustained decline in mortality
in all parts of the world in the past century and
especially the past three decades. However, there are
important exceptions ; there have been reversals in life
expectancy in Sub-Saharan Africa in the past decade
mainly as a result of increased mortality amongst young
adults and children due to HIV / AIDS. Health conditions
in Central and Eastern Europe have also deteriorated.
In the past fifteen years inequalities in mortality
between rich and poor countries and between socioeconomic
groups within countries have rapidly
widened. Accompanying this there have been changes
in the pattern of disease in poor countries ( especially
lower middle income countries ) with the rapid
emergence of non-communicable or lifestyle diseases
in both poor and middle-income communities, with
resulting increases in adult mortality and morbidity.
In many lower middle-income countries a situation
is rapidly emerging where infectious diseases persist
together with high levels of non-communicable
diseases and high levels of violence and injury, often
in the same community.
The recent emergence of a ‘dual’ or ‘triple’ burden
of disease in less developed countries can be traced
to processes of globalisation. Continuing rural
environmental degradation and accompanying
pauperisation of rural communities are resulting in
increasingly squalid living conditions. Globalisation,
with accelerated movement of humans and animals
( and animal products ) and more porous borders, is
also leading to the rapid spread of both ‘old’ ( e. g.
cholera, TB etc ) and new ( e.g. HIV, SARS, avian flu )
infectious diseases. The increased penetration, as
a result of economic globalisation of ‘obesogenic’
( processed, high fat, high sugar, high salt ) diets and
increased sedentariness and the spread of global
‘bads’ ( e. g. tobacco, alcohol and habit-forming drugs )
largely explain the rise of non-communicable diseases,
including mental illness, and contribute to increases in
injuries, especially in poor communities.
Europe has a responsibility for contributing to this
burden not only as a legacy of colonialism, but as
the product of current policies. Trade and agriculture
policies prevent rural communities in the developing
world from earning their way out of poverty. Failure
to counter the migration of health workers has led to
the near collapse of health systems in many countries.
Failures to provide access to <strong>European</strong> developments
in pharmaceuticals and information technology or to
match the Millennium Development Goals with aid
and debt relief have made the problems worse.
Many of the CEE states are experiencing a triple burden
of poor health and early death, but there has been a
lack of awareness of their health problems. The rates
of non-communicable diseases are increasing, due to
poverty and lifestyle factors and result in much higher
death rates due to the failure of health care services.
These also contribute to high rates of maternal and
infant mortality. Weak health protection services result
in lower levels of immunisation, increasing rates of
infectious diseases such as HIV / AIDS, tuberculosis and
syphilis. Basic conditions for health, nutrition, access to
safe water, healthy housing and social order are lacking
for many people in CEE. Levels of deaths from conflict
and violence amongst young men are three times
higher in CEE countries than in the EU and alcohol
abuse is a major cause of the decline in life expectancy
in several of these countries.
The EU is now starting to address the health and
other social and economic problems of countries in
the wider region through its 2004 “Neighbourhood
Policy”.
In Europe as a whole :
• Non-communicable diseases ( particularly
cardiovascular diseases and mental illness such
as depression ) represent 77 % of the burden of
DALYs.
16 <strong>European</strong> Foundation Centre – <strong>European</strong> Partnership for Global Health