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.
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.
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.
Please find below an overview of key actors in Belgium working on health inequality issues:
- Ministry of Health, Food Chain Safety and Environment
- King Baudouin Foundation The King Baudouin Foundation is an independent and pluralistic foundation which pursues sustainable ways to bring about justice, democracy and respect for diversity.
- Public centre for social welfare (OCMW/CPAS)
- Scientific Institute of Public Health
Are you aware of any other key actors that should be added to this list?
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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.
- Sociale Ongelijkheid in Gezondheid (SONG) Scan or ISS-lentille – Social Inequalities in Health Scan
The SONG-Scan is a tool that can give support to people who are involved in projects on specific health issues, from the implementation to the completion phase of an initiative. By answering ten questions, people can map and check if they take social inequalities into account, and to adapt their approach if needed. The scan was developed to identify systematic differences between social groups (e.g. ethnic groups, men and women). It is a tool to support the development of good local practices developed by the King Baudouin Foundation in collaboration with the University of Gent for everybody who wants to start a project to combat health inequalities.
- Sociale ongelijkheden op het vlak van gezondheid: vaststellingen op basis van de gegevens van de ziekenfondsen (Dutch) | Inégalités sociales de santé : observations à l’aide de données mutualistes (French)
This is an extensive study (2008) by the Christian mutual insurance amongst her 4,5 million members on social inequalities in health.
- Inégalités en santé. Recommandations politiques (French) | Beleidsaanbevelingen ongelijkheid in gezondheid (Dutch)
The King Baudouin Foundation has mapped in this document the most important initiatives undertaken by the various authorities in Belgium from 1990 to 2006 to reduce the existing health inequalities. Representatives from healthcare and social services in the broadest sense formulate policy proposals for the regional and federal authorities in Belgium. English summary available here.
- National Report on strategies for social protection and social inclusion 2008-2010
- Moving forward equity in health – Action on reducing health inequalities in Belgium (2010)
Presentation by Pol Gerits (Federal Government) during the Spanish EU Presidency high level conference in Madrid.
- Revue belge de sécurité sociale – Belgian social security review (2009)
- Les inégalités sociales de santé en Belgique – Social Inequalities in Health in Belgium
Herman Van Oyen, Patrick Deboosere, Vincent Lorant, Rana Charafeddine, (Eds.)
English summary available here.
- Income-related health inequality in Belgium: a longitudinal perspective (2006)
This paper provides new evidence on the degree of income-related inequality in self-assessed health in Belgium. Income, education, job status and age are the most important contributors to the difference between the short-run and long-run inequality.
- Health Interview Survey in Belgium (1997 – 2008)
Objectives: (1) Identification of health problems; (2) Description of the health status and health needs of the population; (3) Estimation of prevalence and distribution of health indicators; (4) Analysis of social (in)equality in health and access to the health services; (5) Study of health consumption and its determinants; (6) Study of possible trends in the health status of the population
Are you aware of any other key resources that should be added to this list?
Please let us know!