This report provides member states with essential public health information. It provides a picture of the health status and health determinants in the European Region and identifies areas for public health action for the member states and the European public health community.

With the half-way point in the implementation period of Health 2020 having been crossed this report reflects on the effect that the policy has had on the Region. Like its predecessors in 2012 and 2015 the 2018 report is an essential resource for the 53 Member States of the WHO European Region to report on progress towards the Health 2020 targets outlining areas that may be unfinished by 2020 and beyond. Lessons learned from across the Region on action taken by the WHO Regional Office for Europe and Member States to improve the health and well-being of their populations are presented. The report also addresses the new public health challenges that have emerged in recent years. To respond effectively to these challenges new forms of evidence are essential to measure health and well-being in different cultural and subjective contexts. This is particularly important in the context of the 2030 Agenda for Sustainable Development and the Sustainable Development Goals whose health indicators overlap significantly with those for Health 2020. The report will be a useful source of information for policy-makers throughout the Region helping them identify areas that need further assessment and policy action at the national level. It should inspire Member States and other stakeholders to contribute to the work under the umbrella of the WHO European Health Information Initiative: a collaboration between the Regional Office European institutions and Member States aimed at improving the information that underpins policy. Only through broad international cooperation and bold strides in the way evidence is used in the 21st century will evidence fully inform health policy-making for the benefit of all.

This publication explores some of the key issues, ranging from interpreting the evidence base to assessing the policy context for, and approaches to, chronic disease management across Europe. Drawing on 12 detailed country reports (available in a second, online volume), the study provides insights into the range of care models and the people involved in delivering these; payment mechanisms and service user access; and challenges faced by countries in the implementation and evaluation of these novel approaches.

The publication of the European Health Report every three years gives readers (including policy-makers, politicians, public health specialists and journalists) a vital snapshot of health in the WHO European Region and progress towards health and well-being for all. The report also shows trends in and progress towards the goals of Health 2020, the European health policy, and reveals some gaps in progress, inequalities and areas of concern and uncertainty, where action must be taken.

The European health report responds to the statutory requirements to provide the member states with essential public health information. The report analyses a decade of evidence on health in the Region, which embraces 51 WHO Member States with some 870 million people. While overall levels of health in the Region are among the highest in the world, the report describes widening gaps between and within countries. It confirms the strong links between socioeconomic development, health and equity in the WHO European Region. The report builds on the view that health policies cannot be isolated from other policy sectors: One central task in improving health is to reduce socioeconomic inequalities, thus placing health in the context of human development. The link between health and employment, income maintenance, social welfare, housing and education is crucial in all European Member States. The report focuses on concrete evidence useful for decision-makers in public health. Its role is to summarize and feed back to Member States the information created, deposited and accredited during the Regional Office's work with Member States on key topics and issues in public health in Europe, in the context of the values and principles of WHO as one Organization.

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.

Health at a Glance: Europe 2018 presents comparative analyses of the health status of EU citizens and the performance of the health systems of the 28 EU Member States, 5 candidate countries and 3 EFTA countries.