by | September 26, 2023 | Reports

Transforming the health and social equity landscape

Promoting socially just and inclusive growth to improve resilience, solidarity and peace 


On July 13th, the WHO Regional Office for Europe published a report titled “Transforming the health and social equity landscape: Promoting just and inclusive growth as a means to enhance resilience, solidarity, and peace.” The report, to which EPHA contributed through several stakeholder meetings, explores the interrelationships between health, the economy, and social capital, examining how Member States can foster social cohesion and invest in people’s health to improve resilience and promote an equitable recovery. 

As emphasised in the report, the COVID-19 pandemic has highlighted the interconnection between health, the economy, and the social fabric of our communities, with its effects being widespread and disproportionately affecting the health of people from lower socio-economic backgrounds. Existing vulnerabilities are now being exacerbated, amplifying the enduring impacts of previous crises. This results in further widening disparities in health-, economic-, and social well-being. For instance, since the COVID-19 pandemic, health and inequities in healthcare access have widened considerably, with people on low incomes being affected the most. As highlighted, in the WHO European region people on a low income are three times more likely to report low well-being, compared to people on a high income; a gap that has widened 50% since the pandemic. Further, health services are increasingly under strain while unmet needs are increasing, particularly for the most disadvantaged people. Those with lower incomes are 70% more likely to have unmet healthcare needs compared to those with higher incomes.  

These health inequities have been exacerbated by increased unemployment rates, underscoring the role of economic exclusion in driving poverty and poor physical and mental well-being. Particularly for young people, economic exclusion can have long-term health effects, as they encounter fewer resources and assets to protect themselves against the effects of recent shocks. The pandemic and the rising costs of living have put more people at risk of experiencing financial insecurity, leading to an unprecedented social protection response. If promoted in an equitable way, social protection measures can reduce the cost barriers to health services, promote social cohesion and increase trust in government. However, even though the large increase of investment in social protection measures was partly effective at reducing the immediate impacts of the pandemic on poverty, its effectiveness was not shared equally, leaving the most vulnerable behind. Consequently, this emphasises the importance of applying an equity lens to social protection measures and green and economic mitigation and recovery strategies, and to involve affected communities in designing and coordinating these solutions. This is essential to cover the most vulnerable, reduce inequity and increase trust.  

Particularly, the significance of high trust in others and in the institutions is emphasised. It shapes the political acceptability of policy responses to crises, strengthens good social support networks and is critical to reducing inequalities for societies to be able to recover and prosper sustainably. However, the WHO European Health Equity Report highlighted that differences in trust explain 6% of the health gap between the most and least affluent quartiles of adults in Member States of the WHO European Region. Minority ethnic groups and migrants in particular were disproportionately affected by the pandemic, with reasons being distrust in the government and other institutions due to a history of discrimination, racism, and underlying socioeconomic inequities.  

Based on the highlighted issues of health inequities, economic exclusion and lack of trust in others and in institutions, the report points out five focus areas for action, highlighting options that can be taken jointly across the health, economic and social community sectors.  

  1. Invest in young people
    Nurturing the health and development of young people through economic and social inclusion is essential, as the conditions in which people grow up have long-lasting impacts on future health outcomes and can further provide the greatest returns for a flourishing economy and high-trust societies.
  2. Develop responsive and integrated social and health protection systems
    The pandemic underlined the need for protection measures that have well-being and equity at their core and involve the most affected communities in the design and implementation of these policies and strategies. Responsive and integrated social and health protection systems are fundamental to building resilience, promoting inclusive economic growth and investing in human capabilities.
  3. Ensure that all policies and services deliver higher trust in institutions and a greater policy impact for people 
    Trust is essential to health and wellbeing, and critical to reducing inequalities for societies to be able to recover and prosper sustainably. However, social fractures are widened by loss of trust in others and in the government. This loss of trust can result from discrimination or disadvantages due to a person’s economic position, ethnicity, gender, age or citizenship. Counteracting this can be done by enhancing the participation of affected communities in the decision-making process, and by designing transparent, accessible public health information systems.
  4. Promote equitable and green economic recovery that promotes well-being 
    Green and digital solutions can support livelihoods and bring opportunities for health and social capital. However, when not equitably accessible, digital solutions may not deliver the intended goals but widen inequities. Therefore, it is crucial to apply an equity lens to green economy, to ensure that vulnerable populations benefit from these technologies and to promote population and planetary well-being.
  5. Ensure mechanisms for equitably distributing health and care resources 
    To build the resilience of health systems in an equitable way, and to ensure social inclusion and the creation of social capital, it is fundamental to implement mechanisms to monitor the equitable distribution of health and care resources. Further, standards must be set to measure the quality of care in underserved areas to improve the impact of and access to services. 

Equity, trust and social cohesion are cornerstones of a just and inclusive society yet are not receiving the attention they deserve. In this time of polycrisis, we must take collective action across sectors and communities to transform our health and social equity landscape, promoting resilience, solidarity and peace. With this report, we are once again reminded that the time to act is now. With a focus on health equity based on public, social and economic endeavours, we can make truly inclusive societies a reality. 

Read the full report here.

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