Country profile

Belgium is a small country with over 10 million inhabitants. It is a federal state consisting of a Flemish (Dutch speaking) region (almost 60% of the population), a Walloon (French speaking) region (40%) and the bilingual Brussels region (the capital). The composition of the Belgian population has changed a lot in the last 50 years, apart from the classic demographic transition, as there have been three main waves of immigration.

Since the 1970s, as a result of several state reforms, work in health and combating poverty are complexly divided between the federal state, the regions and the communities. For example, the communities are responsible for disease prevention and risk management but the federal state remains responsible for regulation of finance and care delivery. The different approaches are the result of a bottom-up development.

In the years after the May 1968 student revolution, socially motivated family physicians, nurses and social workers in deprived areas of some cities started to build community health centres integrating curative care, health promotion and patient empowerment. The study of poverty and its relationship with health became a topic for researchers at universities, departments of public health and primary health care facilities. There was an increasing self-organisation by the impoverished and ethnic minorities that resulted in reports that described the living conditions from the perspective of the people involved. Politicians, both at the federal and the local level, started to subsidise projects with a emphasis on deprived areas for the improvement of housing conditions, living conditions and the creation of educational opportunities. It was not a clearly established stepwise approach, but rather an incremental pragmatic approach that inspired development, very often starting at the local level. (Source: DETERMINE project)

In 2010, during the Belgian EU Presidency various high level conferences were organised that directly addressed health inequalities. Despite that endeavour large inequalities persist. At 50 years of age men with the lowest level of education can expect to live 6 years less than those with the highest. The gap among women is 5 years. There is a greater prevalence of risk factors among people with low education or income with higher smoking rates, excessive alcohol consumption, and obesity. In addition, low income groups more often forgo health examinations due to costs, travelling distance or waiting time. Out-of-pocket spending on healthcare is above the OECD average.


Policy responses

In Belgium some aspects of health inequalities are high on the agenda. For example, poverty issues are well addressed at both federal and regional level: action plans are in place and have also been evaluated.

The type of policy responses is different between implementation levels. For example, at the federal level, health inequalities are mainly being addressed in an implicit manner, while at the regional level health inequalities are being addressed more explicitly and cross-sectoral approaches (different among the three regions) have been put in place. A complex concern that relates to inequalities is regarding access to care in Belgium and the shortage of doctors. and other health professionals. To address this concern, the federal government has substantially increased the numerus clausus of medical graduates who are allowed to pursue their post-graduate training to become GPs or specialists. Some innovative measures have also been taken to extend the role of other health professionals, such as nurses, to improve access to health services.

An overview of policy responses addressing health inequalities in Belgium can be found in our Policy Database.


Good practices

An overview of projects and initiatives that are currently taking place in Belgium or that have successfully been finalized, and that are addressing health inequality issues, can be found in our Project Database.

Key actors

Please find below an overview of key actors in Belgium working on health inequality issues:

Are you aware of any other key actors that should be added to this list?
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Key resources

Please find below an short overview of key documents and resources (produced at federal level) addressing health inequality issues in Belgium. More publications can be found in our Publications Database.

Are you aware of any other key resources that should be added to this list?
Please let us know!

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