Health at a Glance Europe 2022: Addressing Legacies from the Pandemic

Introduction‏

The pandemic has had a dramatic impact on people’s‏ lives in Europe and around the world. It has led to a‏ reduction of more than one year in life expectancy in‏ the EU in 2021 compared with the pre pandemic level‏ – the largest drop observed in most EU countries since‏ World War II. By the end of October 2022, more than‏ 1.1 million COVID 19 deaths had been reported across‏ the 27 EU countries. Over 90% of these deaths have‏ occurred among people aged over 60.‏

The 2022 edition of Health at a Glance: Europe‏ examines key challenges European countries must‏ address to develop stronger and more resilient health‏ systems following the acute phase of the COVID-19‏ pandemic. It includes a special focus on how the‏ pandemic has affected young people’s mental and‏ physical health, and assesses the pandemic’s disruption‏ of a wide range of health services for non-COVID‏ patients and the policy responses to minimise the‏ adverse consequences of these disruptions. The‏ report also addresses a number of important risk‏ factors to health that have exacerbated the impact of‏ the pandemic, highlighting the need to put a greater‏ focus on the prevention of both communicable and‏ non-communicable diseases.

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A Major Impact on the Mental and Physical‏ Health of Young People‏

While few people’s lives have been unaffected by‏ the pandemic, there have been concerns about the‏ mental and physical health of the millions of young‏ Europeans whose formative years have been marked‏ by fear, uncertainty and disruption – particularly given‏ the critical importance of early experiences in shaping‏ health and well-being later in life. Prolonged periods of‏ social isolation and break in education and employment‏ opportunities seriously disrupted the lives and routines of young people at a critical time of their physical and‏ social development.‏

School closures, the closure of sports facilities and‏ other mobility restrictions were associated with a‏ reduction in physical activity amongst children and‏ adolescents in virtually all European countries with‏ available data. Alongside a decline in physical activity‏ during the pandemic, many children and young people‏ experienced a worsening of their nutrition habits and‏ developed increased sedentary behaviour such as‏ staying seated and screen time, with indications of a rise‏ in child overweight and obesity in some countries.‏

The pandemic and the measures implemented‏ to contain it fuelled an unprecedented worsening‏ of population mental health, with the prevalence of‏ symptoms of depression amongst young people‏ (aged 18-29) more than doubling in several European‏ countries such as Belgium, Estonia, France, Sweden‏ and Norway (Figure 1). Young people in precarious‏ financial circumstances and young people at risk‏ of exclusion were at particularly high risk of mental‏ distress.‏

_{Source: OECD/European Union (2022), Health at a Glance: Europe 2022, Chapter 1}

The pandemic also disrupted mental health services,‏ particularly during the first wave. The measures‏ implemented to contain the pandemic not only disrupted‏ the prevention and identification of mental health issues,‏ but also their treatment. Following the initial disruption,‏ the demand for mental health care has increased‏ in many European countries, challenging alreadystretched‏ mental health care systems. One in two young‏ Europeans with unmet healthcare needs reported that‏ these unmet needs were related to mental health care in‏ spring 2021 and in spring 2022 (Figure 2).

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_{Source: Eurofound (2022), Fifth round of the Living, working and COVID-19 e-survey: living in a new era of uncertainty, reproduced in OECD/European Union (2022), Health at a Glance: Europe 2022, Chapter 1.}

Care Disruptions During the Pandemic‏ Led to Backlog of Patients for Cancer and‏ Elective Care‏

The pandemic also disturbed the provision of care for‏ other non-COVID patients. Disruptions in primary care,‏ cancer screening and treatment, care continuity for‏ people with chronic conditions, and elective (non-urgent)‏ surgery were especially severe during peaks of the‏ epidemic and lockdown periods.‏

During the first months of the pandemic in‏ spring 2020, disruptions in cancer screening and early‏ detection programmes resulted in increased number of‏ cancer cases being diagnosed at a later stage, reducing‏ survival probabilities. Many countries were able to offset‏ some of the initial reductions in cancer screening by‏ scaling up activities in the second half of the year. However,‏ screening rates for breast and cervical cancer still‏ fell by 6% on average in EU countries in 2020. Delays‏ in cancer screening resulted in a substantial reduction‏ in the number of patients admitted to hospital for cancer‏ care in 2020 (Figure 3), raising concerns about timely‏ treatment.‏

Most EU countries suspended elective care at different‏ times during the pandemic to divert efforts towards‏ COVID-19 patients and avoid people being infected‏ while seeking care. This created a backlog of patients‏ awaiting elective interventions, generating longer waiting‏ lists and waiting times. In 2020, 2 million fewer elective‏ surgical procedures were performed than in 2019 across‏ EU countries – a decrease of one sixth compared to pre‏ pandemic volumes. Hip replacements fell on average by‏ 14% in 2020 compared with 2019, whilst reductions in‏ knee replacements and cataract operations were even‏ larger in most EU countries, falling by 24% and 23% on‏ average (Figure 4). These “missing volumes” of operations‏ have increased waiting times for patients. Many EU‏ countries have provided additional funding to address‏ these backlogs, but the main constraint to scaling up‏ volumes of surgical procedures has been shortages of‏ health workers. Incentives were provided to staff to work‏ longer hours, but these clearly had limits and ran the risk‏ of leading to burnout and resignation.

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The Development of Teleconsultations‏ Offset at Least Partly the Reduction in‏ In-Person Consultations‏

On a more positive side, the rapid development of‏ teleconsultations at the beginning of the pandemic‏ helped to maintain access to care, in particular for‏ patients with chronic conditions. In some countries,‏ the overall number of teleconsultations and in-person‏ consultations in 2020 exceeded the number in 2019‏ because the increase in teleconsultations more‏ than offset any reduction in in-person consultations‏ (Figure 5). Although it is encouraging that the vast‏ majority of people who used telemedicine expressed‏ high satisfaction, there are nevertheless concerns‏ that some teleconsultations provide little benefit and‏ that teleconsultations pose risks of widening health‏ inequalities through digital exclusion for older and poorer‏ people and those living in rural areas.

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^{Source: OECD/European Union (2022), Health at a Glance: Europe 2022,Chapter 2}

Reducing Risk Factors and Prioritising‏ the Prevention of Infectious and‏ Non-Communicable Diseases

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Health at a Glance: Europe 2022 also highlights that‏ despite much talk about the importance of prevention,‏ health spending remained overwhelmingly focused‏ on curative care before the pandemic, with only 3%‏ of total health spending going toward prevention on‏ average. In 2020, most EU countries substantially‏ increased their spending on prevention, at least‏ temporarily, to fund testing, tracing, surveillance and‏ public information campaigns related to the pandemic.‏ In 2021, large additional resources were allocated to the‏ roll-out of COVID 19 vaccination campaigns. The rapid‏ deployment of vaccines was an important contributor to‏ the management of the pandemic, although vaccination‏ rates among vulnerable groups remain quite low in some‏ countries.‏

During the pandemic, many European countries also‏ made substantial progress in vaccinating vulnerable‏ groups against seasonal flu, with the proportion of‏ people aged over 65 vaccinated increasing by over‏ 10 percentage points in several countries (Figure‏ 6). Despite some temporary challenges in 2021,‏ most European countries were also able to maintain‏ childhood vaccination programmes.‏

One of the lessons from the pandemic is that‏ maximising people’s health and minimising their‏ exposure to risk factors before a crisis is critical. Obesity‏ and chronic conditions, such as diabetes and respiratory‏ problems, were important risk factors for serious‏ complications and death upon COVID-19 infection. The‏ prevention of risk factors can go a long way to improving‏ people’s health and reducing the prevalence of chronic‏ diseases and deaths.‏

Despite progress in reducing smoking rates over the‏ last decade, nearly one in five adults on average across‏ EU countries still smoked daily in 2020 (Figure 7).‏ Tobacco consumption remains the largest behavioural‏ risk factor to health, accounting for about 780 000‏ deaths per year in the EU.‏

Alcohol consumption has also been declining over‏ the past decade, but harmful alcohol use remains‏ widespread and alcohol consumption is still responsible‏ for nearly 300 000 deaths per year in the EU.

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Conclusion‏

The COVID-19 pandemic is the largest shock many‏ health systems have faced. The response of health‏ systems to this crisis provides insights into their‏ resilience. On the positive side, Health at a Glance:‏ Europe 2022 highlights the rapid evolutions to new‏ ways of safely delivering health care at the beginning‏ of the pandemic with a doubling of the share of‏ teleconsultations, and the rapid and widespread delivery‏ of COVID-19 vaccinations. However, the report also‏ highlights the extent and impact of disruptions in usual‏ health services during the pandemic and the unmet‏ health care needs that resulted from these disruptions,‏ as well as the growing needs for certain types of care‏ such as mental health services. The pandemic and‏ the confinement measures to contain it resulted in‏ an unprecedented worsening of population mental‏ health, particularly among young people with evidence‏ of a substantial increase in depression and anxiety‏ symptoms that fluctuated during the various waves‏ of the pandemic but generally remained higher two‏ years into the pandemic than prior to the pandemic.‏ European countries have implemented some measures‏ to support young people’s mental health, but further‏ action is needed to ensure the pandemic does not leave‏ permanent scars on a generation of young people.‏ European countries can use the experience gained‏ since 2020, including the indicators shown in Health‏ at a Glance: Europe 2022, to strengthen the recovery‏ and resilience of their health systems. Lessons from the‏ pandemic can help countries prepare and respond to‏ other future shocks arising from climate change, armed‏ conflict and anti-microbial resistance, among other risks.

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Conflict of Interest‏

None. ‏