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Europe can learn more from the developing world. Developing countries with their under-funded health systems are a lot closer and pose more of an impact on Europe than we think. And as poor as those countries may be, they may have some answers for our own health service challenges, including those facing ophthalmology. For instance, statistics from the World Health Organisation show that 34 of the world's poorest countries spend less than $8 per person on health each year. Some Eastern European countries spend only a little more per capita on health. For instance, Moldova spends $11 per capita on health each year; Albania spends $41 per capita; and the Ukraine spends $26 per capita. That's a huge difference from France , which spends about $2,500 per capita on health each year; and an even bigger difference from Germany and Switzerland . There the governments and health insurance funds spend an average of $3,000 per capita on health each year. If poor countries were able to spend more on health, they would not only increase the health of their citizens but also improve their overall economic performance, thereby sustaining any improvements in health, according to a leading health economist. Erio Ziglio, head of the World Health Organization's European Office for Investment for Health and Development, points to a recent report by the WHO report that underlines the connection between health and economic performance. The report, from the WHO's Commission on Macroeconomics and Health, found that each 10 percent of improvement in life expectancy is associated with an annual increase in economic growth of about 0.3% to 0.4%. "Good investment in health makes economic sense," says Dr. Ziglio, who made his remarks at a recent meeting of the European Medical Technology Industry Association in Nice. To be a good investment, the investment must be well placed, Dr. Ziglio insists. He points to the United States , which spends more per capita on health than any other country. "Its outcomes and morbidity are not that much better off despite such a high level of investment in health care," he says. According to at least two health indicators, the United States is actually worse off than European Union countries. For instance, the U.S. infant mortality rate of 6.8 deaths per 1,000 births is higher than any of the current 15 nations of the European Union and higher than many of the 10 new countries that will join the EU in May. Also, the average life expectancy rates for the United States of 74.4 years for men and 79.8 years for women are also below those of most EU countries. Whether trying to improve the life expectancies, reduce infant mortality or deliver more cataract surgery, health systems must continually strive for efficiency. In the United States as in large European countries like France and Germany inefficiency is almost inevitable. By contrast, many small European countries just like those in the developing world cannot afford to waste any personnel or money. And those small countries are a lot closer than we realise.Dr. Ziglio notes that with the expansion of the European Union to 25 countries in May, one-fifth of EU countries will have populations of fewer than three million: Latvia , Estonia , Malta , Luxembourg , and Slovenia . And two of those nations Malta and Luxembourg have populations of fewer than 500,000. Two other countries Ireland and Lithuania have populations of about 3.5 million. "The health services in these countries cannot afford to waste even a single human resource," Dr. Ziglio says. To overcome such challenges, doctors, nurses, administrators, and technicians in large and small European nations like their counterparts in developing countries must work together with colleagues inside and outside of their countries to develop strategies to share and stretch their limited resources to fight not only infectious disease but also degenerative conditions like cataract. "Slowly, it is happening," he says, noting that existing cross-border health projects among European nations illustrate that health services don't have to be confined to national boundaries. And just as developing counties must make every cent count, so too must even wealthier European nations realise that they should spend their money more wisely. "We have to ask ourselves, Can we make our existing health systems more efficient,'" Dr. Ziglio says. Against such a background, the World Health Organization is ready to help. "We want to work with them and see exactly how their systems work and what changes might improve the systems." The disparities within Europe are readily apparent when you look at the percentage of gross domestic product spent on health. Germany spends almost 12% of its gross domestic product on health. By contrast, the UK spends only about 5% of its GDP on health. The health indicators between the countries aren't that different. For instance, the average life expectancy of a man in the UK is 75.7 years, compared to an average of life expectancy of 75 .5 years for men in Germany. The average life expectancy of a woman in the UK is 80.7 years; in Germany the average life expectancy for a woman is 81.6 years. Infant mortality rates, too, are similar 5.3 deaths per 1,000 births in the UK and 4.2 deaths per 1,000 births in Germany . Dr. Ziglio notes that European health systems also need to look at ways in which their health systems can help reduce the stark health differences that can co-exist even within the same city. Dr. Ziglio, who conducted much research work in the Scottish city of Glasgow , noted that there is a difference of 10 years in life expectancy between areas of that city. And Glasgow is not alone, he adds, noting that significant differences in health exist in many cities throughout Europe . To reduce such differences in life expectancy and other health indicators, European nations need to spend their health money on programmes that don't neglect the poor, Dr. Ziglio says. "We need to ensure that health investment reduces inequalities." As ophthalmologists well know, similar inequalities face cataract patients in many regions of European countries. For instance, while patients in many large cities can often obtain cataract surgery within days or weeks of diagnosis, patients in more remote regions must wait months for their surgery. And between the 25 European Union countries, cataract surgery rates differ by a more than a three-fold margin. In Portugal , for instance, the rate of cataract surgery was 195.8 operations per 100,000 of population in 2001; in Denmark , the rate that year was 441.1 operations were 100,000 of population; in the UK , the rate was 469.3 operations per 100,000 of population. In Ireland the rate was 480.2 per 100,000; in Finland , the rate was 582.9 per 100,000; in the Netherlands , the rate was 591.7; in Hungary , the rate was 723.6 per 100,000; in Luxembourg , the rate was 730.4 per 100,000; and in Italy , the rate was 735.2 per 100,000. More details about those statistics, from the Organization for Economic Cooperation and Development, appear in the September 2003 issue of Eurotimes. Such massive variations are echoed in other health indicators of the 25 European Union countries. For instance, the average life expectancy of a woman in France is 83.1 years; in the Netherlands , a woman's average life expectancy is 81.8 years. By contrast, the average life expectancy of a woman in Latvia is 75.5 years; in Lithuania , it's 75.7 years. For men, the differences are even more pronounced. The highest average life expectancy for men in the European Union is in Sweden : 77.3 years. By contrast, the average life expectancy of a man in Latvia is 63.5 years; in Lithuania , it's 63.8 years. Meanwhile, the infant mortality rates of Latvia and Lithuania of about 14 deaths per 1,000 births are more than twice the current European Union average. Such poor health, says Dr. Ziglio, can only undermine a country's economic performance, he says. A comparison of the economic performance of Latvia and Lithuania bolsters the theory about the link between economic performance and health. For example, the gross domestic product per capita in such countries as France Sweden, and the Netherlands is more than $25,000. In Lithuania and Latvia , the per capita gross domestic product is just above $8,000. "Good investment in health is necessary not only to reduce poverty but also to promote economic development," he says. Perhaps politicians should remember those words the next time the think about curtailing cataract surgery services.
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