The 2013 European Commission’ Report on Health Inequalities in the European Union points to some positive developments in implementing the EU strategy on health inequalities, ‘Solidarity in Health’ (2009), while concluding that more action is needed at local, national and EU levels. Overall life expectancy and infant mortality improved but health inequalities between social groups remain high and persistent with an additional current and future challenge due to the economic crisis.
Since the 2009 European Commission’s communication ‘Solidarity in health: reducing health inequalities in the EU’, the September 2013 report presents an overview of the size and trends in health inequalities in the EU. It also describes the main actions identified in the mentioned communication and carried out by the Commission.
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MAIN FINDINGS
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Health inequalities in the EU: facts and figures
- sizeable gaps in health exist within and between Member States of the EU;
- a social gradient in health status exist where people with lower educational status, a lower occupational class or lower income group tend to live shorter lives and have a higher incidence of major health problems;
- male life expectancy gap has narrowed by 17% (from 14.2yrs in 2007 to 11.8yrs in 2011) and female life expectancy gap decreased by 4% (from 8.2yrs in 2006 to 7.9yrs in 2011);
- over the period 2000 to 2010, the GINI coefficient (size of inequalities) showed a decline by 3.5% for men and 10.4% for women;
- this improvement in inequality in life expectancy has been due to decline in inequality in infant mortality by 32% between 2001 and 2011; despite the progress, there is still more than fourfold difference between the highest and the lowest ranking MS;
- divide in healthy life years expectancy is larger than life expectancy, and accounting to 19.0yrs for males and 18.4yrs for females in 2011 across the EU;
- an established social gradient is responsible for vast amount of health inequalities in the region, with less affluent and less well-educated people in the EU having worse average levels of health (typically more than twice as high) than their better-off counterparts, and this trend has not changed much over the last 5 years;
- social gradient seems to cause a significant health divide due to differential health behaviours related to tobacco and alcohol consumption, and obesity. It also relates to equity in access to and quality of healthcare due to such factors as cost, distance and waiting times;
Progress in implementing the Communication ‘Solidarity in health’
The European Commission communication addresses five challenges to be dealt with to strengthen action on health inequalities. These are:
- an equitable distribution of health as part of overall social and economic development – as part of its contribution to the achievement of the Europe2020 targets by means of the EIP on Healthy and Active Ageing and the EU Platform against Poverty and Social Exclusion. Additionally, future actions on social investment for growth and cohesion are set out in the Social Investment Package and the accompanying staff working document ‘Investing in Health’. Health has also been mentioned in the European Semester and Country Specific Recommendations.
- improving the data and knowledge and mechanisms for measuring, monitoring, evaluating and reporting – by greater focus on improved indicators, policy audit and research (15 EU-funded projects and 13 other projects);
- building commitment across society – by improving the involvement of and cooperation with stakeholders and regions, and supporting professional training;
- meeting the needs of vulnerable groups – by developing policies which include both actions to address he gradient in health across the whole of society and actions targeted to the most vulnerable. In particular, attention went to addressing: migrant health, Roma health, addressing health inequalities through early intervention in childhood, healthy ageing, people experiencing poverty;
- developing the contribution of EU policies – by creating a more cohesive approach to tackling health inequalities across relevant EU policy areas involving cooperation on health (health systems, EU action on chronic diseases, promotion of good health and prevention of diseases), employment and social policy (poverty, pensions, social protection), cohesion policy and Structural Funds (activities to reduce health inequalities between the regions and different socio-economic groups), agriculture and rural development (EAFRD, EU School Fruit Scheme, the Most Deprived Persons Scheme), education and training, global health and social protection in development cooperation.
By focusing on the mentioned actions, the Commission aims to support policy developments and improve the contribution of EU policies in addressing health inequalities. To this end, the EU Joint Action on Health Inequalities 2011-2014 is being carried out (15 EU MS and Norway) and supported by funds from the EU Health Programme (3.2 million EUR).
Since the communication, it has become increasingly clear that, in addition to addressing social determinants of health, major action is needed to improve the sustainability and effectiveness of health systems to make sure access to high-quality healthcare for all is guaranteed.
– Next steps:
- the Social Protection Committee of the Council of the EU has stepped up its work on health inequalities;
- the EU Expert Group on Social Determinants and Health Inequalities is exchanging information on regional and national health inequalities policies. It has also contributed to the review carried out by WHO Europe (to be published mid-September 2013);
- concrete activities of EU MS on health inequalities are to be published separately soon;
- the Commission is currently working with the EU MS in a reflection process on chronic diseases. It has also adopted a proposal for the revision of the Tobacco Products Directive, and is currently evaluating its initiatives on nutrition, alcohol and physical activity.
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– European Commission’ Report on Health Inequalities in the European Union (full report)
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