Filenews 31 December 2023 - by Marilena Panayi
We smoke more, drink less, live on average longer than many Europeans but Cypriot women live several years of their lives with disabilities and diseases.
Childhood obesity remains a major problem, mental health needs immediate management, but the General Health System has eliminated unmet health needs and inequalities in terms of financial ability to access health services. As a state, we spend less on health than the rest of Europe since the percentage of health expenditure in GDP, despite the increase in public spending, remains well below the EU average. The "Health Profile 2023", which is published annually by the European Commission and aims to record data in all health systems of EU member states, describes what applies in Cyprus in detail.
The key points of this year's report broadly show that:
-78% of the population of Cyprus reported in 2022 that their health condition is good. The EU average was 68%
As in other EU countries, people on higher incomes are more likely to report good health than people on lower incomes: 87% in the top income quintile reported being in good health compared to 61% in the bottom quintile.
Life expectancy in Cyprus is quite high. It stands at 81.7 years old, despite the fact that it decreased significantly during the pandemic years (also due to the large number of deaths of elderly people, mainly due to coronavirus).
The percentage of adults who smoke daily remains higher in Cyprus than in most EU countries, especially among men.
Alcohol consumption is below the EU average and only 4% of the population reported increased alcohol consumption.
The percentage of deaths attributable to dietary factors is much lower in Cyprus compared to the EU as a whole.
One in seven adult Cypriots (around 15%) was obese in 2019, similar to the EU average.
– In 2018-2020, 62% of children aged 6-9 were overweight, the highest among EU countries.
– Cyprus has low rates of preventable and treatable mortality despite the fact that deaths due to coronavirus are categorized as preventable mortality.
Most unmet needs are recorded in dental care, which continues to be funded mainly by direct private expenditure.
– Remote medical counselling is on the increase and Eurofound's survey data shows that the percentage of adults in Cyprus who reported having received remote medical advice since the beginning of the pandemic, either online or by phone, increased from 33% in June/July 2020 to 48% in February-March 2021.
– The GHS reduced the percentage of unmet needs below 1%
In hospital care, the main challenge for effectiveness is the overuse of expensive medical imaging for diagnoses.
– Guidelines and protocols for medical diagnosis are inadequate and there is a lack of adequate control of GHS-contracted private hospitals and pricing for services
Regarding health spending in Cyprus, the European report notes: "Health spending in Cyprus was lower than the EU average in 2021, but the share of public spending increased rapidly and is now the main source of funding for health. The ratio of expenditure to GDP stands at 9.4% compared to 11% in the EU as a whole." "Private direct payments fell by more than half in 2021 and now account for 10% of total health spending, well below the EU average of 15%."
As far as the General Health System is concerned, reference is made, inter alia, to the shortcomings that it still presents and mainly concern access to specific health services.
«Although the bundle of benefits is considered almost complete, for some services, the lack of availability of providers or infrastructure leads to limited access, thus impairing the right to full coverage. This applies in particular to long-term care, palliative care and rehabilitation services, which are partially covered by the GHS, as well as physiotherapy, speech therapy and home care, especially for patients with chronic conditions."
The establishment of the GHS gave the HIO the opportunity to conclude contracts with private providers, thus eliminating some of the limitations on the system's capacity in inpatient care as well as the accumulation of patients on waiting lists. In addition, although many planned surgeries were cancelled during the pandemic, access to regular emergency care was able to continue with contracted private providers, while the emergency response capacity of public hospitals was used to care for coronavirus patients."
The European report identifies a problem in the distribution of health professionals in health facilities: "The current main limitation of the system is labour shortages in the health sector, especially for nurses in public hospitals."
In addition, "the limited availability of some medical specialties leads to waiting lists for both medical advice and scheduled surgeries."
Significant reduction in referrals
The incorrect use of the services offered by the Personal Doctors of the GHS is also highlighted in this European report, which stresses, among other things, that the number of referrals issued is much higher than in the rest of the EU.
"In 2019 the proportion of primary care visits that led to referrals to specialist doctors stood at 70%, and although this has now fallen to 40%, it is still very high. The aim is to reduce it to 25% through a combination of incentives and professional training for personal doctors."
Smoking problem
Smoking remains a major public health problem, especially for men. Smoking continues to be a major public health concern in Cyprus. The proportion of adults reporting smoking on a daily basis in 2019 was 23%, which is among the highest in the EU.
This is mainly due to men's high smoking rates, with 32% reporting that they smoke on a daily basis, compared to only 13% of women. Data based on a 2019 general population survey place smoking rates even higher, with 38% of the general population smoking in the last 30 days, 35% smoking daily and 9% smoking more than 20 cigarettes a day in the last 30 days. Although many tobacco control policies are in place, these policies are relatively weak and poorly implemented.
Theriaklides Cypriots -19% of deaths caused by smoking
Life expectancy in Cyprus is high (81.7 years in 2022) and 78% of Cypriots report that their health is good, women live a large part of their lives with disabilities and diseases. Almost a fifth (19%) of all deaths in Cyprus in 2019 can be attributed to tobacco consumption (active and passive smoking), which is above the EU average (17%). However, deaths attributable to other behavioural risk factors are below EU averages, including alcohol consumption (4% in Cyprus, 6% across the EU) and dietary risk factors (14% in Cyprus, 17% across the EU).
–Mortality rates from preventable and treatable causes were low in Cyprus before the pandemic. The leading cause of preventable mortality was lung cancer, which is consistent with high rates. The main causes of treatable mortality in Cyprus are ischaemic heart disease, breast cancer and colorectal cancer, although cancer mortality in Cyprus is among the lowest in the EU.
– The increase in public health expenditure in Cyprus started from a low base before the COVID-19 pandemic, and culminated in health financing reforms within the General Health System, aimed at improving financial protection and reducing direct private payments. Private direct payments as a share of total health expenditure decreased significantly from 34% in 2019 to 18% in 2020 and 10% in 2021.
Prior to reforms with the introduction of the General Health System in Cyprus, patients often made direct private payments to gain faster access to private sector health services. Now, most of the private health sector has contracted with the Health Insurance Organization. Therefore, it is difficult to separate the impact of increased demand for health services due to COVID-19 infections and the universal coverage of the new health system, resulting in more patients who previously did not have access to health services.
– During the first waves of the pandemic, hospital capacity expanded to meet increased demand. However, despite the expansion of additional capacity, there was a decrease in the volume of planned surgeries performed in 2020. The additional capacity was used in 2021 and the volume of planned interventions made increased significantly. The main limiting factor at present is labour shortages in the health sector, and nurses in particular.
– Mental health is an important issue in Cyprus and creates a particularly high burden through indirect costs mainly due to the high level of unemployment among people with chronic mental health conditions. Broader health system reforms have consolidated public provision of mental health services as part of the universal package of benefits.
Risk of childhood obesity
Obesity in children is a public health concern. One in seven adult Cypriots (around 15%) was obese in 2019, similar to the EU average. However, in 2018-2020 62% of children aged 6-9 were overweight, this was the highest among EU countries (WHO Regional Office for Europe, 2022).
Poor nutrition is a determinant of overweight and obesity. Only 8% of adult Cypriots reported consuming five servings of fruit and vegetables per day in 2019, well below the EU average of 12%.
Physical activity also contributes significantly to the health of the population. In 2019, only around 22% of adults in Cyprus reported meeting the WHO recommendation of at least 150 minutes of moderate physical activity per week. This is well below the EU average of 33%. This share decreased slightly between 2014 and 2019 among both men and women in Cyprus, while EU averages increased slightly.
Children are vaccinated but adults are not vaccinated
Although coverage rates of regular childhood immunisation are high, the use of vaccinations in older age groups is lower. In 2019, just before the COVID-19 pandemic, the influenza vaccination rate among adults over the age of 65 was only 26%, well below the European Union average of 42% and even below the WHO's target of 75%.
By 2021, coverage in Cyprus had increased to 43%, while the European Union average had increased to 46%. This is reflected in the relatively low coverage of booster vaccinations against the coronavirus.
However, regular childhood immunisation rates are generally higher than the European Union averages, with the exception of measles. In 2021, vaccination rates of children for diphtheria, tetanus, pertussis (96%) and Haemophilus influenzae type B (96%) are comparable to European Union levels, however vaccination coverage for measles, mumps and rubella in 2021 was 86% for the first dose (down from 90% in 2018), while it remained stable at 88% for the second dose (WHO, 2023). Cyprus introduced the human papillomavirus (HPV) vaccine into its national vaccination programme in 2016. By 2019, 64% of girls aged 15 had been vaccinated against HPV, higher than the European Union average of 60% for that year.
