Health – Cause of Death, and How I/You Will Die

That across the European Union (EU), a commonly cited benchmark for a comfortably manageable patient list per general practitioner (GP) is around 1,800 patients per GP. Given that the annual mortality rate on average across EU populations is about 1%, that means ~18 deaths per GP’s patient list per year. The ~18 deaths per year happen mainly among elderly or already seriously ill patients. In older populations (e.g. rural areas, retirement hubs), the GP may see 25–40 deaths per year. But the GP may not be involved in end-of-life care for all patients who die (e.g. hospital deaths, nursing homes).

The average general practitioner (GP) in the EU sees approximately 4,000 to 7,000 patient contacts per year, depending on country, system structure, and workload. This includes face-to-face consultations, home visits, telephone/video calls, and administrative reviews. The typical GP in the EU works around 35 to 50 hours per week, but clinical contact hours (time actually spent seeing patients) are usually 25 to 35 hours per week, depending on country, practice structure, and administrative workload. So the time spent with a patient (on average) will be 10–20 minutes. A contact is any clinical encounter where a diagnosis, treatment, follow-up, or advice is given. And this includes remote consultations, repeat prescriptions, lab reviews, and mental health check-ins.

Between 35 and 70 patients on a GP’s list of 1,800 are likely to be seriously ill at any given moment. This means having a life-threatening, life-limiting, or disabling chronic condition, which require ongoing specialist care, hospitalisation, or palliative attention, and where there is a high risk of deterioration or death within 6–12 months. Around ~75% will require close specialist/shared care that can not be provided by primarily care alone.

A further 15–25% of patients may have moderate chronic conditions (e.g. diabetes, stable heart disease, depression), so not “serious” but still requiring regular attention.

With a patient list of ~1,800, each patient could be seen 2–4 times per year on average. However 50–60% of a GP’s workload is spent on the “moderately ill”. Typical conditions for the “moderately ill” are hypertension, type-2 diabetes (non-insulin), stable angina, chronic mild/moderate asthma, early COPD, mild/moderate depression or anxiety, early-stage arthritis, and thyroid disease.

It is these patients with common, manageable but ongoing conditions that require regular GP review (e.g. every 3–6 months), monitoring tests, medication adjustments, and occasional referrals. These patients form the core business of modern general practice.

The remaining patients will visit the GP for both minor/acute but short-lived issues such as colds, flu, sore throat, minor injuries, skin rashes or infections, urinary tract infections, back pain, and gastroenteritis. In addition there are those on low-complexity medication (e.g. mild hypertension or thyroid replacement), who may only need an annual review and repeat prescriptions. Finally there are healthy individuals, who require preventive care (e.g. vaccinations, health checks), travel advice, and screening (e.g. cervical smear, mammography referral).

On a typical GP list in the EU, about 10% to 20% of patients do not visit their GP at all in a given year. It possible that 30–50% of those who did not visit a GP had at least one medically justifiable reason to do so but didn’t. It is these people who develop preventable complications, receive late-stage diagnoses (e.g. cancer, diabetes), or end up in emergency care.

According to Eurostat and OECD data about 33–40% of all deaths in the EU are considered premature or preventable. But that varies from 25% (e.g. Sweden, Netherlands) to 50%+ (e.g. Romania, Bulgaria). Our average European GP will see ~6 to 7 people per year who will “die before their time”.

Probably the single most important thing a person can do is to recognise and act on symptoms (e.g. for unexplained weight loss, chest pain, persistent cough, depression). Delayed help-seeking is a leading cause of missed diagnoses.

Next is just managing known chronic conditions. This means control of diabetes, hypertension, asthma, etc. which prevents stroke, heart attack, kidney failure, etc. Everyday adherence matters more than occasional screening.

Thirdly, screening for cancer, blood pressure, cholesterol, diabetes catches problems early, i.e, when they’re treatable. Especially vital for asymptomatic diseases (e.g. bowel cancer, hypertension).

Then comes vaccination and prevention (e.g. flu, pneumococcal, COVID, shingles, HPV).

And finally, health literacy and self-care should not be forgotten. Understanding when to seek help, how to interpret symptoms, and how and why to follow medical advice helps everyone, everyday.

In 2023, the five major non-communicable disease (cardiovascular disease, cancer, diabetes, chronic respiratory disease, mental health) cost the EU economy an estimated €530 billion. That ~3.13% of EU GDP. Of that, ~60% were direct healthcare costs, the rest indirect (productivity loss, informal care). Up to 86% of deaths in Europe are attributed to chronic diseases largely caused by modifiable risk factors, namely smoking, poor diet, inactivity, and harmful alcohol use. It’s true that the majority of these deaths occur after age 70, but many are preventable or could be delayed. Up to 40–50% of these deaths (especially in people under 75) are classified as “premature” and linked to modifiable risk factors.

It’s not rocket science

If people want to dramatically improve their health they simply have to increase their daily physical activity.

Physical inactivity is a leading underlying cause of heart disease, stroke, diabetes, some cancers, and mental health issues. It’s a common problem across all ages and income levels, and is often the root cause or enabler of other risk factors (like obesity, hypertension, insulin resistance).

One in three adults and four in five adolescents in the EU do not meet minimum WHO activity recommendations (150 min/week of moderate activity).

It’s simple, sitting is the “the new smoking”

Brisk walking (30–45 minutes/day, most days) is the single best exercise for the general population across all age groups.

“Brisk walking” means at least 5–6 km/h pace (noticeable breathing, but still can talk). Ideally 30+ minutes per day, but even 2×15 mins helps. Including hills, stairs, uneven ground increases impact.

But even modest daily walking, without equipment, special clothing, or tracking, provides clear, measurable benefits.

A daily walk is the foundation of preventive medicine.