Country profile

The Republic of Bulgaria is a parliamentary democracy in the south-east of Europe with a population of over seven million. The population is predominately concentrated in urban areas. The economy relies on local natural resources with the strongest sectors being heavy industry and agriculture. However, there has been a large expansion in the service industry since joining the European Union.

After nearly 500 years of oppression at the hands of the Ottoman Empire, The Treaty of San Stefano was signed on 3 March 1878 which created an autonomous Bulgarian principality. Full independence was declared in 1908 following which the country was organized into nine provinces or regions. In 1946 Bulgaria became a one-party socialist state as part of the Soviet-led Eastern Bloc. This lasted till December 1989 when the ruling Communist Party allowed multi-party elections that led to the founding of the Republic of Bulgaria.

In 1999 a new administrative structure was adopted which resulted in the country being comprised of 28 provinces. In 2007 Bulgaria became a member of the EU. Since 2001 Bulgaria has experienced rapid economic growth, yet its income levels remain of the lowest within the EU, with a nominal per capita GDP of $23,154 (2018 est.).

Bulgaria’s health system faces several major challenges simultaneously. It has the second lowest life expectancy in the EU and some alarmingly high behavioural risk factors (smoking, drinking, increasing obesity), as well as a rapidly ageing population, workforce shortages and low spending on health. Four out of five deaths are caused by cardio-vascular disease and cancer. There are vast regional inequalities as exemplified by up to six fold differences in infant mortality across the regions. Lack of affordability contributes to most unmet need for medical care. However, in recent years progress has been made particular with regard  health prevention and early detection of chronic diseases. For example, the 2017 budget allocates additional funds for early detection of cardiovascular diseases.



Policy responses

The attention afforded to health inequalities in Bulgaria has been on the increase in recent years. Issues that are particularly high on the political agenda include vulnerable groups (such as the Roma population) and the social determinants of health. Policy responses tend to be planned across sectors at the national level in an implicit manner, and implemented in a multi-sectoral approach at the regional level. Regional health maps have been used to reduce overall inequalities and regional inequalities. The gap in universal population cover hinders disease prevention and control.

A range of measures have been introduced to reduce health inequalities across the population. For example, in the 2012 health budget primary prevention of non-communicable diseases and health promotion accounted for 8,630,900 Лв. spent. This represents 8.87% of the total policy expenditure in the field of ‘Promotion, Prevention and Public Health Control’. In addition, a suite of policies have been enacted into law:

  • The National Programme to Improve Maternal and Child Health 2014-2020 aims to improve the health of children up to 18 years, mothers, young people, couples and pregnant women on key health related indicators by encouraging and supporting good practices, health promotion, and facilitating access to healthcare.
  • The National Strategy for Poverty Reduction and Social Inclusion Promotion 2020 aims to develop and implement a unified, coherent and sustainable policy of social inclusion based on an integrated approach and inter-sectoral collaboration at the national, regional, district and municipal level. The strategy identifies the priority areas and actions for policy development in the field of poverty and social exclusion in Bulgaria until 2020.
  • The National Programme for Prevention of Chronic Non-Communicable Diseases 2014-2020 aims to improve the health of the Bulgarian population and enhance the quality of life by reducing premature mortality, morbidity, and health consequences (disabilities) from major NCDs which are associated with behavioural risk factors such as smoking, alcohol abuse, unhealthy dietary patterns, and physical inactivity.

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


Good practices

An overview of projects and initiatives that are currently taking place 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 Bulgaria working on health inequality issues:

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Key resources

Please find below an overview of relevant documents addressing health inequality issues in Bulgaria. Further publications can be found in our Publications Database.



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