Lifestyle-related risks: are trends in Europe converging?
Introduction
It is often mentioned in the literature and the media that European Union (EU) countries are becoming more and more similar. For aspects such as welfare systems and population dynamics, this phenomenon has been studied.1., 2. However, to date, this has not been shown for health behaviour and associated risk factors. In the past, there was a so-called north–south divide with respect to the prevalence of specific risk factors. In the 1960s, smoking was more prevalent in northern than southern Europe.3 High-saturated-fat diets were more common in northern Europe in contrast to low-saturated-fat diets in the Mediterranean countries at that time.4 Alcohol consumption was much more customary in southern Europe than in northern Europe a couple of decades ago.5 What has become of these differences in a united Europe with open borders and an open market? International comparisons in the field of public health are considered to be an important factor for sound health policy and a basis for effective policy interventions. Under the previous Public Health Programme (1997–2002), the Health Monitoring Programme (HMP) was established. Its core business was the development of reliable and comparable public health indicators, making use of the expertise built up in the Member States. The new Public Health Action Programme was adopted in 2002 by the European Parliament and has three main areas of activity: improving health information, responding rapidly to health threats and tackling health determinants.6 These goals seem very reasonable yet little is said about ways to achieve them. The European Commission does, however, realize the importance of the development of health indicators, data collection and comparability issues.7
In this paper, we report EU trends in lifestyle-related risk factors that have a well-known negative impact on health. Thus, we try to answer the question whether the gap in lifestyle-related risk factors in the EU has narrowed and what health policy makers can conclude from this. Can we already speak of a ‘McEuroburgher’, a typical European citizen, rather than a Brit, a German or a Frenchman in the first place? Which European policies affect public health? Is the time ripe for a common EU policy that tackles the public health problems we are facing? What information do we need to answer these questions, and what investments could be made to facilitate international comparisons in the future?
The rationale for the selection of lifestyle-related risk factors in this paper is their strong relationship with conditions in the EU that form a major burden in terms of mortality and costs, such as cardiovascular disease and cancer. Smoking, alcohol consumption, physical activity, obesity and food consumption all have an undisputed relationship with these and other non-communicable diseases. In 2002, the World Health Organisation (WHO) ranked a selection of risk factors and estimated how much of the burden caused by each of these factors is avoidable.8 The risk factors studied in this paper are among the top 10 of this WHO ranking, and they all make up a large proportion of the burden of disease in Europe. Smoking is estimated to cause over 90% of lung cancer in men and about 70% of lung cancer among women. In addition, 56–80% of chronic respiratory disease and 22% of cardiovascular disease is caused by smoking. The proportion of disease burden attributable to alcohol ranges from 8 to 18% of the total burden for males and 2–4% for females. In addition to the direct effects of intoxication and addiction, alcohol is estimated to cause about 20–30% of oesophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy and motor vehicle accidents. Overweight and obesity increase the risk of coronary heart disease, ischaemic stroke, type 2 diabetes mellitus and various cancers. Low intake of fruit and vegetables is estimated to cause about 19% of gastrointestinal cancer, 31% of ischaemic heart disease and 11% of stroke. In Europe, 5–8% of deaths are attributable to physical inactivity.8
In order to answer our research question and to make general solid comparisons of health determinants in the EU, reliable and standardized data collections are a prerequisite. For our analyses, we explored international data on health determinants to find out whether existing data are accessible and comparable. The data sources are presented schematically along with their main characteristics. For all the factors we analysed, available trend data are discussed. Finally, we give some food for thought for improving international comparisons on health.
Section snippets
Methods
A search was performed for international comparable data on the lifestyle-related risk factors that were selected: smoking, alcohol consumption, physical activity, obesity and food consumption.
Results
An overview of all studies that were included in our analysis is presented in Table 1, grouped by the five lifestyle-related risk factors. Some characteristics are given and, wherever possible, literature references are provided, except when there are no scientific publications to date or when extensive quality information is available on the Internet. In both cases, full web addresses are given.
Discussion
The gap in European lifestyle has narrowed over the past 30–40 years for smoking (women), alcohol consumption and total fat intake. For fruit and vegetable consumption, a north–south divide is still in existence and convergence is not taking place. Trends in smoking are declining, especially among men. Total alcohol consumption is also falling. Total fat consumption is increasing in almost all EU countries, as well as the related prevalence of obesity. Fruit and vegetable intake is stable and
Acknowledgements
We would like to thank Hans van Oers, Ronald Gijsen, Peter Achterberg and Gert Westert for their valuable comments.
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