Publications

The determinants of health shape the conditions in which we are born, grow, live, work, and age, and explain the unfair, systematic, and avoidable differences in health between groups of people: health inequalities. The social determinants of health include income security, social protection, education, food security, housing, early childhood development, social inclusion and non-discrimination, and access to affordable health services of decent quality. Moreover, a lower socioeconomic status is linked to lower health status – the social gradient of health – and health inequalities are connected to wider inequalities and forms of discrimination in society, such as racism, sexism, and economic disbalances.

In 2021, EPHA’s health inequalities advocacy work focussed on three main topics; it continued with its focus on two key population groups – vulnerable children and the Roma community – and addressed the still very concerning issue around vaccine equity; the unequal distribution of and access to COVID-19 vaccinations across countries and groups of people. Other topics covered are gender-based violence during COVID-19, structural inequalities and mental health, and the development of a guide on sustainable funding for civil society organisations.

Whether approaching health inequalities from the angle of a specific population group or a particular health issue, the focus is always on addressing the (multiple) underlying determinants of health and drivers of the inequalities. Across these three topics, the collaboration with key organisations and (policy) stakeholders with a shared ambition, has been a key ingredient for success.

Protecting Children

The 14th of June 2021 was a historic day for the protection of the rights of children growing up in poverty and social exclusion in the European Union. After years of negotiations, evidence-based advocacy, and hard work, the EU has established the European Child Guarantee. The EU Alliance for Investing in Children, of which EPHA is a member, has been advocating for the Child Guarantee for almost the last two years and was delighted to see that the Council of the EU have taken on board the majority of its recommendations. The work, however, is far from over and the adoption of the European Child Guarantee marks a new beginning: the national Child Guarantee Action Plans. By March 2022 the Member States’ governments need submit their national Action Plans to the European Commission and secure adequate resources for its implementation, as well as ensuring children themselves, particularly the most vulnerable are involved in the design, monitoring and evaluation of the Action Plans. The EU Alliance for Investing in Children has already published key recommendations for these national Action Plans to ensure the design of ambitious and comprehensive plans, taking into account the specific challenges of each Member State, and in meaningful consultation with relevant national stakeholders. The Alliance will keep monitoring the developments closely.

A related line of work running in parallel has been the First Years First Priorities Campaign, which is co-lead by Eurochild and the International Step By Step Association, with both EPHA and the Roma Education Fund as associate partners. The campaign pushes to ensure “a fair start for every child in Europe” with a focus on children from birth to 6 years and with a special attention to the first 1,000 days, particularly for the most vulnerable ones such as Roma and Traveller children, children with disabilities, migrant and refugee children, children at risk of entering, or in, alternative care, and those living in extreme poverty. In July 2021, the campaign published the results of a survey on the current state of early childhood development across nine European countries, identifying key challenges preventing a fair start for every child. A main contribution by EPHA this year, has been the joint Eurochild-EPHA organised webinar titled “Reducing inequalities from the first years of life: the role of Early Childhood Development”. The campaign will continue and expand its work and has secured funding until (at least) March 2024.

Roma Health

In March this year, the Council of the European Union adopted a Recommendation on Roma equality, inclusion, and participation; a major policy instrument for advancing equality as an essential component of Roma inclusion which demonstrates higher awareness about the structural character of social exclusion in European countries. EPHA, together with the other members of the European Coalition of Roma and pro-Roma organisations, welcomed the Council Recommendation. The EU Member States are now translating these into National Roma Strategic Frameworks, which were to be submitted in September this year, however during the ‘CSO Consultation Meeting’ organised by the Non-discrimination and Roma Coordination of DG JUST (European Commission) that EPHA attended in December, it was communicated that the process is delayed and only nine out of 26 were submitted in December.

In April, EPHA organised a policy dialogue, bringing in the EU Fundamental Rights Agency and Equinet to discuss the issues around access to health care and the factors responsible for the systemic inequalities that Roma face in health. The speakers reflected on the socio-economic aspects of the COVID-19 pandemic and their consequences for Roma health, and explored policy solutions which could ensure better health for all.

The 14th Platform for Roma Inclusion, a major initiative organised by the European Commission, took place in September. The event was opened by the President of the European Commission, Ursula Von Der Leyen, highlighting the importance of building a ‘Union of Equality’. The COVID19 pandemic, however, has further exacerbated social exclusion leaving many Roma without employment and resources. Digital learning became inaccessible for many Roma students which further increases the gap in education. Existing health and housing inequalities, including access to clean drinking water (a human right), became a severe barrier for ensuring adequate protection of vulnerable Roma adults and older people during the pandemic thus widening the social divide even further.

A workshop, jointly organised EPHA, the Slovenian Coalition for Public Health, Environment and Tobacco Control, and the Center of Community Research and Action at the University of Seville, took place in October as part of the Fundamental Rights Forum 2021. The workshop addressed the importance of investing in Roma youth to advance fairer and healthier European societies. Facing multiple socio-economic disadvantages, Roma youth are disproportionately affected by intersectional inequalities perpetuated within generations. Although new policies aim to ensure Europe’s social and economic recovery, systemic gaps in education, employment, health, housing exacerbated by the pandemic, remain under-addressed within such policies, when it refers to Roma.

Measuring health inequality gaps is essential to build knowledge about their impact, especially in the wake of COVID-19 and national responses to the pandemic; to identify the communities’ health needs, to develop appropriate policy responses, and implement targeted measures proportionate to the challenges that each community/vulnerable group experiences. Therefore, EPHA has called on researchers and policy analysts to submit research articles to help build knowledge about how the health of disadvantaged groups, including Roma, is affected by inequalities in areas such as employment, housing, education, healthcare, environment, and climate.

Vaccine Equity

The COVID-19 pandemic has painfully exposed and worsened the many pre-existing social and health disparities worldwide as well as within the European Union, directly impacting the lives of many underserved communities, such as people experiencing homelessness or living in precarious conditions, those without residence or with irregular migration status (such as refugees, asylum seekers, and undocumented migrants), persons with disabilities, prisoners, Roma, ethnic minorities, and sex workers. Existing barriers to healthcare have also hindered these groups’ access to COVID-19 vaccines: the lack of tailored information campaigns, geographical and infrastructural impediments, as well as administrative difficulties, coupled with low political commitment to mitigate the effects of the pandemic continues to raise concerns many vulnerable communities continue to be excluded from national vaccination deployment strategies.

Not only EPHA is of the opinion that vaccine equity should be the cornerstone of the success of the Europe’s fight against COVID-19, also the European Commission identified “ensuring equitable and affordable access for all in the EU to an affordable vaccine as early as possible” as a key objective of COVID-19 vaccine deployment”. However, December 2021 is still very much characterised by countries’ focus on ‘boostering their own’, as new variants of the virus appear elsewhere in the world, particularly in places with low vaccination rates, low access to vaccines, or low resources for effective vaccination campaigns.

Two EPHA webinars on the topic explored why and how we should prioritise marginalised communities in the rollout of COVID-19 vaccines in Europe and specially how to reach migrants and homeless people.