Health inequalities in Europe need action

The LancetSep 10 2012

Health inequality in Europe is resulting in huge social and economic costs to the region, and progress towards reducing health inequalities should be one of the main criteria by which the effectiveness of health systems and governments as a whole are assessed, according to a Review published in The Lancet.

The Review cautions that despite recent progress towards reducing health inequalities in many European countries, significant health disparities remain – both between countries and within them – and that in the current economic downturn, urgent action must be taken if these inequalities are not to worsen.

While several countries in Europe enjoy some of the best and most equitable health provision in the world, other countries in the region still have a long way to go before the health of their citizens reaches the level of those in nations with better developed health systems.  Furthermore, all European countries experience some degree of health inequality within their population, and the Review provides a practical set of policy recommendations which, if implemented, would allow all European countries to improve their progress towards health equality, regardless of their current status or income.

According to lead author Professor Sir Michael Marmot, of the Institute of Health Equity in London, “Taking action to reduce inequities in the social determinants of health would both improve the prospects for health and bring wider social and political benefits that enable people to achieve their capabilities.  Health inequality needs to be one of the main criteria by which we assess the effectiveness of countries’ health systems, and the effectiveness of government as a whole.”

Central to the report’s policy recommendations is the fact that health is largely determined by social factors such as employment, education and welfare systems, and as such, health inequalities (also called health inequities) cannot be reduced by focusing exclusively on the provision of health care in the traditional sense.

“Action is needed on health inequalities across the whole of government, and while health ministers clearly have an important role in ensuring access to high-quality health services, they must also take a leadership role in advancing the case that health is an outcome of policies pursued in other areas,” says Professor Sir Marmot.

The Review was commissioned by the World Health Organisation (WHO) European Office to provide an evidence base for its Health 2020 strategy, which aims to provide a political, administrative and scientific framework to allow all 53 countries in the WHO European Region to take action on the social factors which determine health.

Writing in a linked Comment, Zsuzsanna Jakab, WHO Regional Director for Europe, states that: “Persistent and widespread inequalities in health occur across the whole WHO European region. Health as a key and unique resource for human and societal development has undoubtedly improved overall, yet substantial health inequalities remain, which are worsening. These inequities are unnecessary and unjust, and tackling them should be a high priority at all levels of governance in the WHO European Region.  What is needed now is leadership, new types of governance that support whole of government and whole of society approaches, and capacity for implementing solutions that can make a difference.”