Trends in public health
Life expectancy keeps rising but less rapidly than in the past 10 years
The life expectancy of Dutch men is 79 years wich is one of the highest in the European Union. Women reach an average age of 83 years. Their score is average compared to other European women, because they were relatively heavy smokers in the past. Life expectancy has risen rapidly in the Netherlands for the last 10 years, adding more than three years. This increase could for the most part be attributed to prevention and health care. Death by coronary heart disease and strokes in particular saw a strong decline.
According to the trend scenario, life expectancy will keep rising, although less rapidly so than for the last 10 years: between 2012 and 2030 Dutch men gain an extra 3 years and women just over 2 years. Compared to other EU countries, this means that the Netherlands remain around the sixth place.
Socio-economic differences are big, and may get bigger
The life expectancy for people with a limited educational background is 6 years lower on average than for those who are highly educated. The expectancy of good health differs with 19 years between these two groups. These differences have not changed significantly over the last 10 years. In the close future we expect the differences to become larger.
Many effects of the recent economic recession, such as unemployment, only now become noticeable and those with a limited education and other vulnerable groups are hardest hit. Whether this trent continues in the long term is uncertain.
Psychic conditions, cardiovasculair diseases and cancer have the greatest disease burden
Psychic conditions, cardiovasculair diseases and cancer are responsible for the greatest disease burden.
Within these main groups, coronary heart disease causes the greatest disease burden, followed by diabetes mellitus, strokes, anxiety disorders, COPD (chronic bronchitis and lung emphysema), lung cancer, mood disorders and neck- and back problems. The disease burden is high when the disease occurs frequently, last long, is relatively serious and/or causes frequent deaths. According to our projections in the trend scenario, coronary heart disease and diabetes will still cause the highest disease burden in 2030.
The disease burden from infectious diseases is currently low. The future is uncertain. New infectious diseases can occur. Furthermore, an increasing number of bacteria will be resistant to antibiotics in future.
Smoking is the main cause of disease and death
Smoking is by far the main cause of death and disease (with 13% of the disease burden), followed by obesity, lack of exercise and an unhealthy diet. The percentage of adult smokers is falling and according to the trend scenario will continue to do so, from 23% in 2012 to 19% in 2030. For the time being, the continuous rise in obesity for many years seems to come to an end. The percentage of people with obesity remains unchanged and high (48%). One in three Dutch people exercise little and this will remain so in 2030.
Besides life style, the social and physical environment are important for diseases to develop. Adverse working conditions and environmental factors each contribute approximately 5% to 6% to the disease burden. It is however also possible for the environment to stimulate more health, for instance by making public spaces more attractive to use for cycling, playing sport and outdoor games.
The number of senior citizens rises to a quarter of the population in 2030
Demographic developments are one of the most important factors influencing the trends within public health. The age distribution of the Dutch population in particular is changing rapidly. The 65+ age group has risen from 14% in 2000 tot 16% in 2012 and continues to rise to 24% in 2030. There are also changes within the group of seniors. There is an increasing number aged 70+, while the 80-year age group will probably be healthier in 2030 than today’s 80-year olds.
The number of people with chronic diseases rises, disabilities remain stable
Partly because of the ageing population, the prevalence of most diseases has risen in the last decade and that is expected to continue. Early detection of disease combined with better treatments, mean that people live longer with disease. In total we expect the number of people with a chronic disease to rise from 5,3 million in 2011 (23% of the population) to 7 million in 2013 (40%), wherein the number of people with two or more conditions (multimorbidity) will also increase. The aging and the rise of the number of chronic diseases in the population have not led to more people with disabilities during the past years; this number also remains quite steady in the future.
Most chronic patients participate, disabilities in particular are hindering
Approximately 80% of the age group between 20 – 65 without diseases have a paid job of 12 hours or more. People with a chronic condition work less. This is particularly the case for those who also have a limitation (40% work) or perceive themselves as being less healthy (49% work). Two thirds of the age group between 20 – 65 with a chronic disease have no limitations and perceive their own health to be good. This group has a paid job nearly as frequently as those who are not chronically ill (77%). It is not so much the diagnosis that determines the level of labour participation, therefore, but rather the limitations experienced and the perception of one’s health. This is also the case for volunteer work.
New older employees have a higher level of education and less limitations
The number of 20 – 65-year olds will be reduced between now and 2030. The potential workforce however, remains the same size, approximately 10 million people. This is due to the gradual rise of the pension entitled age to 68 years in 2030. In 2030 approximately 0,7 million of the potential work force will be between 65 and 68 years old. This new workforce is different to the current 65 – 68-year group. They are more educated (28% of this age group has had higher or university-level education, have less limitations but do have one or more chronic conditions.
More emphasis on independence, but not everyone is equally self-sufficient
Trends show an increasing number of chronically ill people who live longer, more frequently feel healthy, far from always have limitations and often participate in society. This means that there is an enormous variety in the large group of chronically ill. Health and participation seem to be less and less based on a medical diagnosis. The ability to adapt and be self-sufficient is increasingly important. The majority of people with chronic disease prefer to stay in charge of their condition and its care. A part of the chronically ill, particularly senior citizens, singles and people with an complex problem or physical impairments, however, cannot mange without help. They require a level of support suited to their abilities and wishes.
Health care utilization has costs and benefits
In 2012 we spent 83 billion euros on health care according to the definition used by the Dutch Central Bureau of Statistics (Centraal Plan Bureau), in their analyses of health care spending. This is almost 5.000 euro per citizen and 14% of gross domestic product.
Health care not only leads to costs but also to significant benefits. The rise in life expectancy can largely be attributed to curative and preventive care. The quality of Dutch health care is also high in terms of patient satisfaction and accessibility.
Most money spent on health care for cardiovascular disease and mental conditions
Most of the money is spent on the treatment of patients with cardiovasculair disease, other mental conditions (such as schizophrenia, depression and alcohol dependence) and mental handicaps. The health care spending for cancer, nervous and sensory diseases and metabolic diseases has risen relatively quickly. Since these are diseases predominantly occurring in elderly people, the effect of the aging population is relatively strong. Furthermore, many new, relatively expensive medicines have become available for diseases in these groups over the last few years.
Health care costs keep rising, how fast is uncertain
Between 2000 and 2012 health care costs rose on average 4 to 5% per year (with unchanged prices), the rate of growth being lower during the last years. As a percentage of gross domestic product (GDP), health care spending rose from approximately 10% to almost 14% during this period. If this trent were to continue, the expenditure on health care will rise to approximately 150 to 170 billion euro, equal to 19 to 21% of the GDP. One of the reasons behind recent measures in curative health care and the proposed changes in the organization and financing of long-term health care is to bend this trent rate. If these measures reach the desired effect, this will lead to a substantially lower growth than shown in the trend-based projection. The exact scale of this will become clearer in the coming years.
(Source: Dutch National Institute of Public Health and Environment, Dutch Ministry of Health, Well-being an d Sport)
Prevention is better than to Cure