COVID-19: a regional health crisis 


The new coronavirus swept through the European Union during the first half of 2020. Every  country felt the impact on its health system. But a look at the numbers shows that the COVID-19 was very much a regional crisis. 

Dou​bling deaths

The situation in the hospitals of the Italian region of Lombardia at the beginning of March, overcrowded, with a shortage of medical supplies, and hundreds of deaths per day, showed what devastating effect the new coronavirus can have on communities and their health systems.

Lomb​ardia was clearly affected very heavily, but other regions soon followed. Assessing the COVID-19 situation accross the European Union for taking adequate measures to tackle the virus, proved to be difficult. Differences in testing strategies and in reporting on cases and hospitalisations made comparing numbers between countries difficult.

The measure that is probably best suited to show the impact of COVID-19 is excess mortality: the number of people that died in excess of what could be expected based on numbers from the same period in previous years. Here is what the map of the EU looks like for the excess mortality for the countries of the EU during March and April 2020.

Eastern countries have a much lower excess mortality than other countries. Hardest hit were Spain (47% more deaths than in previous years) and Italy (32%).

But as the region of Lombardia already showed, outbreaks tend to be very local, especially in the beginning of an outbreak. This map shows the regional excess mortality.

Lombardia had double the amount of deaths during March and April than in previous years, as had Madrid and Castilla La Mancha in Spain. Many regions registered an excess mortality above 50%, including Catalunya, Brussels, Stockholm and Ile de France and Alsace in France. Most eastern regions registered only very limited excess mortality, or even none at all.

So regions across the EU were impacted very unevenly by the virus.


​Diverse hea​​lth care landscape

The organisation of health care services differs widely between countries in the EU. In Greece, Ireland, Luxembourg and France, health care is organised centrally: it's the national government that is responsible for health care expenditure. But in other countries, like Italy, Sweden and Spain, health care expenditure is managed by subnational authorities. So in these countries, which were amongst the most affected by the virus, local and regional authorities can expect serious strains on their health care expenditures.


​Health care expenditure, health care policy and health care infrastructure vary widely ​​over EU regions. The number of hospital beds per 100 000 inhabitants, for example, varies by a factor 10 between the region with the lowest and highest number of hospital beds.

​ ​​

​The same variability can be seen in the share of health workers in total employment. This varies from less than 3% in regions in Romania and Poland, to more than 15% in some regions in Sweden and Norway. ​


In short: Asy​​​mmetric impact, loc​al response

It is clear that the COVID-19 crisis in the EU is a crisis at the regional level. Health care in many EU countries is governed at the regional and local level, especially in some of the harder hit countries like Spain and Italy. The pandemic hit some EU regions very hard, with excess mortality of more than 100 % in some of them, and others hardly experiencing any impact, with big differences even within countries. On top of that comes the health infrastructure and available health care workers, which also show high variability between regions.

Looking ahead, the asymmetric impact of the COVID-19 crisis on regions' healthcare systems shows the need for place-sensitive responses in the EU. 


Follow this​ year's EU Annual Regional and Local Barometer speech: On 12 October, President Apostolos Tzitzikostas will give his annual address on the state of the regions and cities of the European Union.
Download the report: full version (EN) or teaser (multiple languages)
​→ Engage via social media: #EURegionalBarometer