How well are the French? What are the most important health-related issues for children of under 15 years of age, for young and older adults, for the elderly? What geographically and socially based inequalities affect health status? How can patients and users of the health care system -- members of the public -- be brought into the making of decisions that affect them in this literally vital field? Is our health care system well organised? And is it working in an efficient and democratic way? How are questions of resource allocation settled? This is the third in a series of official reports (the previous ones were published in 1994 and 1998) compiled by the High Committee on Public Health to analyse health status in the country, with an in-depth review of the strengths and weaknesses of the system as a whole. This report combines a critical analysis of the current health care system with a review of key current and projected health-related issues, focusing on public health targets identified from as broad and all-inclusive a perspective as possible.

What are public health services? Countries across Europe understand what they are or what they should include differently. This study describes the experiences of nine countries detailing the ways they have opted to organize and finance public health services and train and employ their public health workforce. It covers England France Germany Italy the Netherlands Slovenia Sweden Poland and the Republic of Moldova and aims to give insights into current practice that will support decision-makers in their efforts to strengthen public health capacities and services. Each country chapter captures the historical background of public health services and the context in which they operate; sets out the main organizational structures; assesses the sources of public health financing and how it is allocated; explains the training and employment of the public health workforce; and analyses existing frameworks for quality and performance assessment. The study reveals a wide range of experience and variation across Europe and clearly illustrates two fundamentally different approaches to public health services: integration with curative health services (as in Slovenia or Sweden) or organization and provision through a separate parallel structure (Republic of Moldova). The case studies explore the context that explain this divergence and its implications. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe Division of Health Systems and Public Health. It accompanies two other Observatory publications Organization and financing of public health services in Europe and The role of public health organizations in addressing public health problems in Europe: the case of obesity alcohol and antimicrobial resistance (both forthcoming).

No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved. This volume contains short structured profiles of markets for VHI in 34 countries in Europe. These are drawn from European Union member states plus Armenia Iceland Georgia Norway the Russian Federation Switzerland and Ukraine. The book is aimed at policy-makers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts. Each profile written by one or more local experts identifies gaps in publicly-financed health coverage describes the role VHI plays outlines the way in which the market for VHI operates summarises public policy towards VHI including major developments over time and highlights national debates and challenges. The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume provides an analytical overview of VHI markets across the 34 countries.

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.

The world is living dangerously - either because it has little choice or because it is making the wrong choices -- Dr Gro Harlem Brundtland WHO Director-General

Avoiding overweight and obesity is the best-established diet-related risk factor for cancer. The proportion of people who are overweight/obese is increasing, and the amount of physical activity is decreasing in most populations, including urban populations in many developing countries. The increasing prevalence of overweight/obesity is presumably due to the increasing availability of highly palatable, high-energy foods, and an increasing sedentary lifestyle due to mechanisation of both workplace and leisure activities. Overweight/obesity and reduced physical activity increases the risk of cancers in various organs. Maintaining a healthy body weight and regular physical activity is the second most important way to prevent cancer, after tobacco control. The suggestions of possible public health actions to tackle these risk factors include the promotion of balanced diets, which are not excessive in energy, and broad education and planning to enable and encourage physical activity during work and leisure. Recommendations and a full discussion of these topics are included in the sixth volume in this series of Handbooks.