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Trends in Public Health

Life expectancy increases, with wide differences between socioeconomic classes

Life expectancy still rising, but less swiftly than in the past decade

The life expectancy of Dutch men now stands at 79 years and it rates among the highest in the European Union. The average life expectancy of women is 83 years, which is in the middle range in the EU due to relatively high rates of smoking by Dutch women in the past. Dutch life expectancy increased sharply by more than 3 years in the past decade. According to our trend scenario, it will continue to rise, but less strongly than in recent times; from 2012 to 2030, Dutch men will gain about 3 years of additional life expectancy, and women slightly more than 2 years. In relation other EU countries, the Netherlands will remain in about 6th place.

 

Life expectancy men and women at birth, 1950-2030

 

Large socioeconomic variations in health status, which could continue to widen

For people with low levels of education, life expectancy averages 6 years shorter than for people with high levels. In terms of life expectancy in self-perceived good health, the difference is 19 years. The gaps may widen in the near future. Many effects of the recent economic recession, such as unemployment, are only just emerging, and the lesser educated and other vulnerable groups have been hardest hit. Whether and how that trend will continue in the longer term is uncertain.

 

Relation between level of education and (healthy) life expectancy
 

 

Greatest burden of disease is from mental disorders, cardiovascular diseases and cancer

Greatest burden of disease is from mental disorders, cardiovascular diseases and cancer

Greatest burdens of disease are from mental disorders, cardiovascular diseases and cancer

Chronic diseases such as mental disorders, cardiovascular conditions and cancer were to blame for the heaviest burdens of disease in the Netherlands in 2011. More specifically, coronary heart disease caused the greatest burden, followed by diabetes mellitus, stroke, anxiety disorders, COPD (chronic obstructive pulmonary disease), lung cancer, mood disorders, and neck and back problems. The diseases shown in the figure are responsible for approximately 70% of the total burden of disease. A disease burden is considered high if a disease is widely prevalent, long in duration, relatively severe or frequently fatal. Our projections show that coronary heart disease and diabetes will still be the conditions with the highest disease burdens in 2030. The burden of infectious diseases is currently small; future outbreaks could change this picture, as antibiotic resistance keeps growing.

Contributions of various determinants to the total Dutch disease burden

 
Halt to unfavourable lifestyle trends

Smoking remains the major cause of death and illness by far (causing 13% of the disease burden). It is followed by overweight and lack of exercise (see figure). For many years now, the percentage of smokers has been declining. Extrapolating from past trends, we project that the Dutch rate of smoking will continue to decline in the future, from 23% in 2012 to 19% in 2030. People with low education have a 1.5 times higher rate of smoking than those with high education, a disparity that slightly widened from 1990 to 2012. For overweight and obesity, the persistently negative trend seems to have come to an end. Although the percentage of overweight people is not projected to further increase in our trend scenario, it will remain stubbornly high at 48%. One in three Dutch people get little exercise and that will still be the case in 2030. The percentage of heavy drinkers will remain at 10%, as in 2012.

More elderly, more people with chronic diseases, steady numbers with activity limitations

Anticipated trends in the Older Dutch population, 2013-2040

Older people to make up one quarter of the population by 2030

Demographic developments are among the most powerful forces driving public health trends. The population age structure, in particular, is set to alter substantially. The percentage of people aged 65 or older grew from 14% in 2000 to 16% in 2012, and it will further increase to 24% in 2030, after which it should more or less stabilise at around 26%. Shifts are also expected within this older age group. There will be more and more people 75 or older, and the 80-year-olds of 2030 should be healthier than those of today.
 

More people with chronic diseases, steady numbers with activity limitations

Partly because of health care improvements and the ageing population, the prevalence rates of most types of chronic illnesses increased in the past decade. That growth is expected to continue. Early detection and improved treatment of diseases imply that people live longer with their illnesses. We anticipate that the total number of people with chronic illnesses will grow from 5.3 million in 2011 (32% of the population) to 7 million (40%) by 2030, including increasing numbers with two or more long-term conditions (multimorbidity). The growth in the numbers of people with long-term illnesses in the Dutch population has not increased the numbers with activity limitations (see figure). The number of people with activity limitations will remain stable in the future. Most adults with chronic disease participate in the community.

 

Continued increase in numbers with chronic diseases up to 2030

Most adults with chronic disease are in paid employment

Percentages of people aged 20 to 65 in paid employment, 12 hours or more per week

Most adults with chronic disease are in paid employment

Over two thirds of people aged 20 to 65 with self-reported long-term illnesses work 12 or more hours per week. That is a lower rate of employment than among people without chronic illnesses, 80% of whom hold paid jobs. However, the underemployment applies predominantly to those who report activity limitations in addition to their illness (of whom 40% are working) or who feel less healthy (of whom 49% are working). Two thirds of those aged 20 to 65 who have long-term illnesses report no activity limitations and rate their own health as good. In this group, the percentage in paid employment (77%) almost matches that in the group without chronic illness. It is therefore not so much the disease diagnosis that governs the rate of work participation, but the activity limitations and the perceived state of health. A similar conclusion applies to people who participate in voluntary work.

Older employees in future will be more highly educated and have fewer activity limitations

The number of 20- to 65-year-olds will decrease between now and 2030, but the potential labour force will remain steady at about 10 million people. That is due to gradual increases in the retirement age to 68 in 2030. In 2030, about 0.7 million of the potential labour force will be aged between 65 and 68. This new workforce will differ from the current 65- to 68-year-olds. It will be more highly educated (28% having higher education degrees) and will have fewer activity limitations but a greater probability of having one or more chronic diseases.

 

New labour force of 65-68 years old

Increased emphasis on self-direction, but not all people are equally self-reliant

Increased emphasis on self-direction, but not all people are equally self-reliant

The observed trends show that more and more people have chronic diseases, but that many of them are living longer, are feeling healthy, do not experience activity limitations, and are taking part in the community. Hence, the category of people with chronic diseases is highly diverse. The ability to adapt and to manage one’s own life may be more important to health than a medical diagnosis. Individuals with health problems are also increasingly being engaged in managing their own care. Self-direction and freedom of choice presuppose self-reliance on the part of individual people. Not all individuals, though, have equal amounts of self-reliance. There are social groups, such as the lesser educated and the vulnerable elderly, that lack the potentials and capabilities to exercise self-direction. Vulnerable people therefore require support that is tailored to their capabilities and preferences.

 

Cure and care bring along costs and benefits

Cure and care bring along costs and benefits

In 2012, Dutch health care expenditures came to 83 billion euros. That amounts to nearly 5,000 euros per capita. Expressed as a percentage of gross domestic product, health care expenditures grew from 9.5% to nearly 14% in the 2000–2012 period. In terms of cure and prevention, the Dutch health system now has a high level of quality, which leads in large part to high life expectancy. Health care accessibility and patient satisfaction have also been rated highly.

Health care expenditures by disease category

Highest expenditures for cardiovascular disease and mental illness

In the Netherlands, the largest sums are spent on the treatment and care of patients with cardiovascular disease, mental illnesses in the category Other Mental Disorders (which includes conditions such as schizophrenia, mood disorders and alcohol dependence) and intellectual disabilities. Relatively rapid increases in expenditure have occurred for cancer, diseases of the nervous system and sensory organs, and metabolic diseases. These are conditions that occur predominantly in older people, indicating a relatively strong effect of population ageing on future health expenditures. These are also categories for which new, relatively expensive medicines have become available in recent years.

Health expenditures

Expenditures continue to rise, but at an uncertain rate

From 2000 to 2012, expenditures increased by 4% to 5% per year on average (at constant prices), although the increment over the most recent years was more moderate. Were this trend to continue, the per capita health care expenditures in the Netherlands would reach around 8,500 euros per capita by 2030. That would come to 150-170 billion euros, or 19% to 21% of GDP. Recent policy measures in the curative care sector, and the planned modifications to the organisation and funding of long-term care, are intended in part to alter this upward spending trend. If the measures achieve the anticipated effects, then a substantial easing of the trend should be evident by 2018. The exact scale of the savings will become clearer in the years to come, and the effects the measures have on other public health outcomes should also become more apparent.

 

From now to 2030

From now to 2030

Over the past decade, life expectancy increased by more than 3 years, due partly to higher levels of prevention and care. The difference in life expectancy between people with lower and higher levels of education remained about 6 years. More than 5 million people have chronic illnesses or psychiatric disorders, with cardiovascular diseases causing the highest disease burden, and smoking and obesity being important determinants. Many people who have an illness still feel healthy, have no activity limitations and participate in society. Emphasis is now shifting towards self-direction capabilities and freedom of choice in one’s personal health situation. Vulnerable groups will need support, tailored to their abilities and preferences. Health care expenditures increased between 2000 and 2012 from 10% to almost 14% of GDP.

A number of future trends can be foreseen with a reasonable amount of certainty. Until 2030, life expectancy will increase by 2 to 3 years, and the number of people with chronic diseases will increase to 7 million. In addition, we can anticipate shifts in certain trends. Unfavourable lifestyle trends have been halted, though it is still uncertain what the future will bring. The future evolution of health care expenditure is a trend that seems particularly uncertain. The longer-term effects of many health policies recently planned and implemented are not yet known. Which trends should be assigned the greatest importance will depend on societal norms and values. Such discussions and determinations are addressed in the section entitled Perspectives on the Future on this website.

 

More information

This summary describes the current state of health and the most important future trends in the Netherlands. Our trend scenario is a 'business-as-usual' scenario, extrapolating the current public health trends to 2030 under an assumption of no new policies. This overview is the result of integration of existing knowledge. The trend scenario is based on the analysis of historical trends, supplemented by expert judgments and by findings based on literature research and simulation models.

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Perspectives on the future

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