ISSN 1681-1658 The social situation in the European Union — 2003 The social situation in the European The social situation in the European Union European Commission The social situation in the European Union 2003 European Commission Directorate-General for Employment and Social Affairs ACKNOWLEDGEMENTS The Employment and Social Affairs DG and Eurostat would like to thank all those who have contributed to this report, in particular the Health and Consumer Protection DG, the European Foundation for the Improvement of Living and Working Conditions, the Institute for Prospective Technological Studies and the European Centre for the Development of Vocational Training (Cedefop). In addition, the Employment and Social Affairs DG and Eurostat are grateful to the following experts for their valuable contributions to this report: Professor Elias Mossialos of LSE; Professor Géry Coomans of ISMEA; Professor Dr M. Harvey Brenner of the Berlin University of Technology and Johns Hopkins University; Professor Yannis Yfantopoulos of the University of Athens; Professor Christian Haerpfer and Dr Claire Wallace of the Institute for Advanced Studies, Vienna; and Dr Sjoerd Kooiker and Dr Jean Marie Wildeboer Schut of the Social and Cultural Planning Office of the Netherlands. Europe Direct is a service to help you find answers to your questions about the European Union New freephone number: 00 800 6 7 8 9 10 11 A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int). Cataloguing data can be found at the end of this publication. Luxembourg: Office for Official Publications of the European Communities, 2003 ISBN 92-894-5263-3 ISSN 1681-1658 © European Communities, 2003 Reproduction is authorised provided the source is acknowledged. Printed in Belgium PRINTED ON WHITE CHLORINE-FREE PAPER Table of contents Foreword 5 Section 1 The social situation in brief Introduction 9 1.1. Key social developments 11 1.2. Health and health care in the European Union 16 1.3. The resilience of the European Social Model 26 Section 2 The social dimension of health 2.1. Health trends of the European population 29 2.2. Socio-economic determinants of health 51 2.3. Healthcare systems in Europe 69 2.4. Society and health 89 Section 3 Areas of social policy concern – statistical portraits 107 1. Economic situation 110 2. Demography, household and families 114 3. Ageing of the population 117 4. Migration and asylum 120 5. Education and its outcomes 122 6. Lifelong learning 125 7. Employment 128 8. Employment of older workers 131 9. Unemployment 134 10. Youth unemployment 136 11. Long-term unemployment 138 12. Social protection expenditure and receipts 140 13. Social benefits 143 14. Labour market policy expenditure 146 15. Income distribution 148 16. Low-income households 151 17. Jobless households and low wages 154 18. Women and men in decision making 156 19. Employment of women and men 159 20. Earnings of women and men 162 21. Life and health expectancies 165 22. Accidents and work-related health problems 168 Annexes 173 Annex I Key social indicators per Member State 175 Annex II Statistical data – European Union Member States 177 Annex III Key social indicators per acceding State and candidate country 195 Annex IV Statistical data – European Union acceding States and candidate countries 197 Annex V Symbols, countries and country groupings, other abbreviations and acronyms 207 Annex VI Eurostat Data Shops 209 3 Foreword The Social Situation Report – published annually since 2000 – provides the most comprehensive overview of the social dimension in the European Union. It provides a holistic view of the population and its social conditions as a back- ground to social policy development and contributes to the monitoring of developments in the social field across Member States. Furthermore, it establishes links to other Commission publications such as Employment in Europe, Industrial Relations in Europe and the Gender Equality Report. One special characteristic of this report is that it combines harmonised quantitative information with survey data on public opinion. In this way it acts as a reference document, with the perceptions and attitudes of people living in Europe added to the overall portrait of the social situation. This year the report focuses on analysis and research on the health of people living in the European Union. In addi- tion, the report contains extensive statistical information at EU level, which provides a powerful tool for monitoring social developments over time. Anna Diamantopoulou Pedro Solbes Mira Member of the Commission Member of the Commission Employment and Social Affairs Economic and Financial Affairs, Eurostat 5 The social situation in brief Section 1 Section I The social situation in brief 7 The social situation in brief Section 1 Introduction The fourth annual report on the social situation in the European Union contains three sections. Section One presents an executive summary of the key social and economic developments in Europe, with facts and figures at European level. It also gives a synthesis of this year's special theme, which relates to the questions of how and why the health of European citizens has improved, along with some potential future challenges. Section One then concludes with a brief consideration of the European Social Model. Section Two provides a more detailed examination of developments in social trends related to health. Analysis and research, both quantitative and qualitative, are presented under four headings: health trends of the European popu- lation; socio-economic determinants of health; healthcare systems in Europe; and society and health. As in previous years, Section Three presents a set of harmonised social indicators for each Member State, which pro- vide an initial overview of the social situation. In addition, they provide a powerful tool for monitoring social deve- lopments over time. 9 The social situation in brief Section 1 1.1 Key social developments 1.1.1. The social situation: opportunities and advantage of the opportunities created for continuing challenges on a path of sustainable growth and steady improve- ments in the social situation1. The social situation is largely formed in the cross-field between longer-term developments in population struc- tures and short to medium term changes in the economy. 1.1.2. Population dynamics After five years of strong economic growth, which crea- Developments in the demography of Europe will impact ted 12 million jobs and raised the employment rate by significantly on the social situation and present major four percentage points to 64.0% of the working age challenges for the European economy. population, the outlook has now become less optimistic. In 2001 the rate of economic growth dropped to 1.5%, or The EU population is ageing…. less than half the level it achieved in 2000 and in 2002 recovery has been rather slow. Yet employment conti- The EU population is ageing and old age dependency nued to grow, albeit slowly. rates will increase. Although fertility increased slightly from 1.45 children per woman in 1999 to 1.47 in 2001, it Meanwhile, the medium term economic and social chal- is still well below the replacement level of 2.1. Life expec- lenges to society from the ongoing ageing of the tancy is growing and mortality is increasingly concentra- European population are becoming clearer. Soon the ted in old age. As the baby-boomers reach retirement century long growth in the size of Europe's working age age there will be growing numbers of people in the population will come to a halt. And in less than a decade elderly age groups. Today, people aged 65 and over the impact of the retirement of the baby boomers will represent 16% of the total population while those below begin to be fully felt. 15 represent 17%. By 2010 these ratios will become 18% and 16%. The most dramatic increase will occur in the The structural improvements achieved since 1996 and the number of 'very old' people (aged over 80), which will successful launch of the single currency have resulted in a rise by almost 50% over the next 15 years. better economic performance in monetary and financial terms and increased flexibility in the labour market. …and despite the younger age structure of acce- Beyond the obvious contributions to improvements in ding States, enlargement will not change this living conditions, policy opportunities were enhanced in trend. a number of areas. New possibilities emerged for tackling structural problems in employment, such as youth unem- As a consequence of high fertility levels in the 1970s and ployment and the low activity rates of women and older 1980s the acceding States presently have a younger age workers. Higher employment has also eased the pressure structure than EU-15 (population aged 65+ amounts to on social protection systems and created increased scope 13% while children below 15 years constitute 19%). for manoeuvre in pension reform. Inequality did not rise Consequently enlargement will have a rejuvenating during prosperity and rising employment rates and eco- effect. However, this effect will be both small and tem- nomic growth have produced new possibilities for porary. In the medium to long-term acceding States will addressing persistent problems of poverty and social tend to reinforce the population decline of the EU. Given exclusion. the onset and persistence of extremely low fertility levels the proportion of children in the population is rapidly The same period has witnessed significant improvements declining and by 2020 the share of older people will in the ability of Member States to draw support for their approach EU-15 levels. policy efforts from the EU. Collaboration on combating social exclusion and modernising social protection have At the same time families are becoming less stable been added to the processes of macro-economic coordi- and households smaller… nation and employment, creating the potential for a vir- tuous triangle of mutually reinforcing economic, employ- The rising old age dependency rates will impact on our ment and social policies.