Avoidable mortality rates are significantly higher in Eastern Europe compared to Western and Northern Europe. Euronews Health takes a closer look at preventable and treatable death rates.
More than 1.1 million deaths in 2022 could have been avoided in the European Union with better healthcare systems and public health interventions.
These deaths, caused by diseases and conditions, could have been either prevented or treated. They account for more than one in five deaths among EU citizens.
Indicators of avoidable mortality reflect the effectiveness of public health and healthcare systems, including the quality of care and access to services, according to the OECD and the EU's Health at a Glance: Europe 2024 report.
Avoidable death rates vary widely across Europe. Experts point to several influencing factors, including levels of health expenditure and the prevalence of preventable risk factors such as smoking and alcohol consumption.
What is “avoidable death” or “avoidable mortality”?
Avoidable death or mortality is classified into two categories according to Eurostat:
Preventable deaths: These are causes of death that could be avoided by public health interventions in the broadest sense. This category includes lung cancer, ischaemic heart diseases, COVID-19, alcohol-related death, stroke, accidents, chronic obstructive pulmonary disease (COPD), suicide, and other reasons.
Treatable deaths: These refer to causes of death that could be avoided through optimal quality health care. They include ischaemic heart diseases, colorectal cancer, breast cancer, stroke, pneumonia, hypertension, diabetes and other reasons.
In 2022, avoidable deaths among individuals under the age of 75 totalled 1.11 million across the EU, according to Eurostat. The age-standardised rate of death per 100,000 population under 75 is used to compare countries.
The avoidable mortality rate in the EU ranged from 169 deaths in Sweden to 543 in Latvia per 100,000 inhabitants, with an EU average of 258 deaths in 2022.
When EU candidate countries, EFTA members, and the UK are included—where data is available—Switzerland recorded the lowest avoidable death rate at 153 per 100,000.
Significant gaps: Eastern vs Western and Northern Europe
Eastern and Baltic European countries recorded the highest avoidable mortality rates. Latvia, Romania, Hungary, Lithuania, and Bulgaria topped the list, each exceeding 470 deaths per 100,000 people. They were followed by Serbia, Slovakia, and Estonia with lower rates but still reaching over 390 deaths.
On the contrary, Western and Northern European countries had lower avoidable death rates. Countries such as Switzerland, Sweden, Norway, the Netherlands and France show significantly lower rates, under 200 deaths per 100,000.
Central and Southern European countries typically reported mid-range rates of avoidable mortality. Croatia, Poland, Turkey, Greece, Czechia, and Italy fell within this range, with most recording between 200 and 300 deaths per 100,000 people.
Although Germany ranked below the EU average, it recorded the highest avoidable mortality rate (249) among the EU’s leading economies.
Two-thirds of deaths preventable, one-third treatable
Of the 1.11 million avoidable deaths in the EU in 2022, 65 per cent (725,624) were considered preventable, while 35 per cent (386,709) were treatable. This corresponds to 168 preventable deaths and 98 treatable deaths per 100,000 people in the EU.
There is a very strong positive correlation between the two types of avoidable mortality: Countries with higher rates of preventable deaths also tend to have higher rates of treatable deaths. Naturally, this is reflected in the overall avoidable mortality rate.
For example, Latvia and Romania were among the highest in both preventable and treatable mortality rates, whereas Switzerland and Sweden reported very low rates in both categories.
Main causes of avoidable mortality: Leading diseases and conditions
Heart disease was the leading treatable cause of mortality in the EU, accounting for 21 per cent of deaths, according to the Health at a Glance: Europe 2024 report. The percentages for other major causes were: colorectal cancer (14), breast cancer and stroke (10 each), pneumonia (8), hypertension (5), and diabetes (4).
In 2021, COVID-19 was the leading preventable cause of mortality, accounting for 24 per cent of deaths. However, its share dropped to 10 per cent in 2022 according to Eurostat. In that year, lung cancer represented the largest share at 19 per cent, followed by heart disease at 11 per cent. Alcohol-related deaths accounted for 8 per cent of preventable mortality.
Factors behind country-level differences
The prevalence of these causes varies across Europe, contributing to the differences in overall avoidable mortality between countries.
“Several determinants may influence the rates of preventable mortality, such as social and health expenditures, education, and gas emissions,” Aida Isabel Tavares, an associate professor at the Lisbon School of Economics and Management, told Euronews Health.
Lung cancer, heart disease and alcohol-specific disorders and poisonings are substantially higher in Central and Eastern European countries according to the report.
“Much of this can be attributed to differences in the prevalence of preventable risk factors, such as smoking and alcohol consumption,” it said.
Tavares also pointed out that countries with higher levels of public health expenditure tend to have lower rates of treatable mortality.
“In general terms, high treatable mortality is found in Eastern European countries and low mortality in Northern European countries,” she said. As an example, she cited Sweden, which spends a significant share of its GDP on health, compared to Bulgaria, which allocates a much smaller share.
Rok Hrzic, assistant professor from the department for international health at Maastricht University, noted that the majority of the differences in avoidable mortality between Western and Eastern European countries can be traced to deaths due to cardiovascular disease in middle and older ages.
“The persistently higher cardiovascular mortality in some Eastern European countries is widely seen as a remnant of the delayed cardiovascular revolution, i.e., the late adoption of medical technologies and policies that enable the prevention and treatment of heart disease,” he told Euronews Health.
Differences in registering the cause of death
Dr Susanne Stolpe, research associate at Ruhr University Bochum in Germany, pointed out that the differences in registering the cause of death can impact avoidable mortality rates.
“A certifier can choose among more than one disease to select as the cause of death. Depending on the subjective choice of a certifier, a death might then be due to a non-avoidable, preventable or amenable cause”, she told Euronews Health.
She further noted that the share of deaths with unknown causes also affects avoidable mortality rates, with lower proportions observed in the Baltic states, the United Kingdom, and Finland compared to most Western European countries.
Experts emphasised that healthcare expenditures significantly differ across Europe. This reflects the varying levels of healthcare access and the strength of healthcare systems.
Measured in euros per inhabitant, purchasing power standard (PPS) per inhabitant, and as a percentage of GDP, Western and Northern European countries reported the highest current health expenditures, while Eastern European and Balkan countries recorded the lowest.
Southern European countries generally had moderate expenditure levels. As Ireland and Luxembourg have very high GDPs, their health expenditure as a share of GDP remains comparatively lower.
Cancer screening rates widely vary
The wide gap in cancer screening rates is another indicator of healthcare inequalities among European countries. Not surprisingly, we observe a very similar pattern to that seen in health expenditures.
In colorectal cancer, cervical cancer, and mammography screening rates, Northern and Western European countries demonstrate strong and consistent preventive efforts, while Southern Europe performs moderately well.
In contrast, Eastern and Balkan countries lag significantly behind, particularly in colorectal and breast cancer screenings.
