Important changes to the health system have occurred as a result of the country's Economic Adjustment Programme but, despite plans to transfer more powers to regional health authorities the health system remains highly centralised. There is a persistent gender gap in life expectancy of five years between women and men, as well as social inequality, with a four-year difference according to educational attainment. Ischaemic heart disease, stroke and lung cancer continue to have a Years o to 20 major impact on mortality, but transport accident deaths have fallen sharply. In contrast, alcohol consumption per adult has declined and is considerably below the EU average, as is binge drinking. While obesity rates among adults (17%) are only slightly higher than the EU average, almost a quarter of 15-year-olds are overweight or obese, the second highest rate among EU countries. This is 8.4% of GDP but, in the context of a shrinking economy, health spending has declined significantly since 2009.