The European Union
The EU institutions significantly contribute to reducing health inequalities across the social gradient through a variety of strategies, policies, programmes and initiatives which affect the socio-economic determinants of health.
In June 2010 the EU adopted Europe 2020: A strategy for smart, sustainable and inclusive growth. The document sets out the proposed economic, social and environmental development for the EU over the next 10 years. Although the strategy does not directly address health inequalities, it clearly acknowledges the need to fight inequalities as a prerequisite for growth and competitiveness. The EU has indeed committed to lift 20 million people out of poverty by 2020. This will be pursued through the European platform against poverty and social exclusion, one of the Commission’s seven ‘flagship initiatives’ i.e. the mechanisms through which the EU 2020 strategy will be delivered. This process will undoubtedly impact health inequalities between and within EU countries.
DG SANTE is responsible for the implementation of EU laws on the safety of food and other products, on consumers’ rights and on the protection of people’s health. It has developed a specific web page on social determinants and health inequalities, which can be found here.
Addressing health inequalities is a key action of the EU Health Strategy “Together for Health: A Strategic Approach for the EU (2008-2013)”. In this document, equity in health is identified as a fundamental value. The EU Health Programme is the European Commission’s main instrument for implementing the EU Health Strategy. The programme aims, through the funding of projects and other actions, to improve the health and well-being of EU citizens and reduce health inequalities throughout the Community.
The European Commission established in 2008 an Expert Working Group on Social Determinants and Health Inequalities. This group of experts – from countries inside and outside the EU, WHO, OECD and the Council of Europe – comes together twice a year to share information and good practices on health inequalities, and to provide input into policy development.
A second group working on health issues is the EU Health Policy Forum. This forum brings together 52 umbrella organisations representing European stakeholders in the fields of public health and healthcare. Its function is to review the EU’s work in various areas of public health and adopts recommendations; to respond to Commission consultations and assists in organising consultations; to enable exchange of views and experience on a wide range of topics; and to assist in implementation and follow-up of specific initiatives.
In 2009 the European Commission published a joint Communication by DG SANTE and DG EMPL entitled: “Solidarity in Health: Reducing Health Inequalities in the EU“. The Communication sets out the Commission’s plans to address health inequalities. These include:
- Collaboration with national authorities, regions and other bodies;
- Assessment of the impact of EU policies on health inequalities to ensure that they help reduce them where possible;
- Regular statistics and reporting on the size of inequalities in the EU and on successful strategies to reduce them;
- Better information on EU funding to help national authorities and other bodies address the inequalities.
Following the adoption of the Communication, the European Commission published in 2013 its “Report on Health Inequalities in the European Union“, which includes an overview of the size of, and trends in, health inequalities in the EU since 2000 with a focus on recent years. The Report also describes the main actions that the Commission has taken to implement the Communication on health inequalities since 2009.
The EaSI programme is the financing instrument at EU level to promote a high level of quality and sustainable employment, guaranteeing adequate and decent social protection, combating social exclusion and poverty and improving working conditions. EaSI is managed directly by the European Commission. It brings together three EU programmes managed separately between 2007 and 2013: PROGRESS, EURES and Progress Microfinance.
Through the Open Method of Coordination (OMC) on social protection and social inclusion, the EU provides a framework for national strategy development and policy coordination between EU countries on issues relating to poverty and social exclusion, health care and long-term care as well as pensions. A key feature of the OMC are the National Reports on Strategies for Social Protection and Social Inclusion that are submitted by the Member States.
Given the multiple dimensions of health inequalities, many other EU instruments and mechanisms can be used to address the issue. One example is the Cohesion Policy, which main objective is to reduce the significant gap between less-favoured regions and affluent ones in Europe. The Structural Funds are the financial tools that were set up to implement Cohesion policy, which include the European Social Fund – a fund that aims to strengthen economic and social cohesion by e.g. supporting employment and education, and social inclusion and the fight against poverty.
There are many more EU policies that either directly or indirectly address health inequalities. You can find these examples in the Policy Database.
In March 2011 the European Parliament adopted the resolution “Reducing health inequalities in the EU“, drafted by Edite Estrela (S&D, PT). The document underlines the need to:
- make a more equitable distribution of health part of our overall goals for social and economic development;
- improve the data and knowledge bases (including measuring, monitoring, evaluation, and reporting);
- build commitment across society for reducing health inequalities;
- meet the needs of vulnerable groups; and
- develop the contribution of EU policies to the reduction of health inequalities.
Pilot Projects funded by the European Parliament
A pilot project is an initiative of an experimental nature designed to test the feasibility and usefulness of action. It is meant to develop evidence-based strategies to address a problem, identify good practices, and provide policy guidance for the benefit of possible future initiatives in the area of health inequalities.
Learn more about the ongoing pilot projects: http://ec.europa.eu/health/social_determinants/projects/ep_funded_projects_en.htm#
Council of the European Union
The Council of the EU addressed health inequalities in several conclusion in the last years. Here a few examples:
In 2014, in the conclusion on “The economic crisis and healthcare“, the Council:
- acknowledged that universal access to healthcare is of essential to tackle health inequalities;
- noted with concern that social spending had decreased in some Member States and that public health expenditures had been reduced in many Member States since the 2009 Communication. It also noted that the number of people at risk of poverty and people living in households without income or with low income had increased, which contributed to the rise of health inequalities and jeopardized social cohesion;
- recalled that investments in health promotion and disease prevention, with a focus on disadvantaged groups, should be preserved, especially in times of economic crisis, due to their short- and long-term positive contribution to population health and health inequalities’ reduction;
- invited Member States and EC to evaluate existing information to assess the role that healthcare benefits play in reducing health inequalities and the risk of the population falling into poverty.
The same year, in the conclusions on “Nutrition and physical activity“, the Council:
- noted with concern that overweight and obesity have a considerable impact in terms of human suffering and that Health and Social inequalities are particularly important in this regard;
- recognised the urgency of addressing inequalities in relation to nutrition and physical activity and recommended addressing nutrition and physical activity in all relevant Union policies;
- invited Member States to promote healthy dietary options and work with stakeholders to make them available, easily accessible, easy to choose and affordable for all citizens towards. It also invited Member States to provide opportunities and places for daily physical activity at homes, schools and workplaces.
In the 2017’s conclusions on “Health in the Digital Society – making progress in data-driven innovation in the field of health“, the Council recommended that the design and implementation of digital tools in healthcare must guarantee quality, safety, security and data protection requirements. To avoid the creation of health inequalities, attention should be given to digital health literacy.
In 2018, in the conclusions on “Integrated early childhood development policies as a tool for reducing poverty and promoting social inclusion”, the Council stressed that investments in early childhood education and care are fundamental for reducing inequalities at a young age, as well as for preventing the risk of poverty and exclusion in adulthood by laying the foundations for successful lifelong learning, social integration and employability.
Many EU Presidencies have addressed issues linked to the social determinants of health. Some have addressed health inequalities explicitly:
- Croatian Presidency (1st semester 2020)
- Finnish Presidency (2nd semester 2019)
- Romanian Presidency (1st semester 2019)
- Austrian Presidency (2nd semester 2018)
- Bulgarian Presidency (1st semester 2018)
- Estonian Presidency (2nd semester 2017)
- Maltese Presidency (1st semester 2017)
- Slovak Presidency (2nd semester 2016)
- Dutch Presidency (1st semester 2016)
– Report: “Integrated approaches to combating poverty and social exclusion – best practices from EU Member States“
- Luxembourg Presidency (2nd semester 2015)
- Latvian Presidency (1st semester 2015)
- Italian Presidency (2nd semester 2014)
– Note: “Investing in Health. the ‘Missing Dimension’ of the Europe 2020 Strategy”
- Greek Presidency (1st semester 2014)
- Lithuanian Presidency (2nd semester 2013)
- Irish Presidency (1st semester 2013)
- Cypriot Presidency (2nd semester 2012)
- Danish Presidency (1st semester 2012)
- Polish Presidency (2nd semester 2011)
– Council Conclusions: “Closing health gaps within the EU through concerted action to promote healthy lifestyle behaviours“
- Belgian Presidency (2nd semester 2010)
– High level conference: “Reducing health inequalities from a regional perspective: what works, what doesn’t?”
– High level conference: “Environmental health and social vulnerabilities“
- Spanish Presidency (1st semester 2010)
– Council Conclusions: “Equity and Health in All Policies: Solidarity in health“;
– High level conference: “Moving Forward Equity in Health”
– Report: “Monitoring Social Determinants of Health and the Reduction of Health Inequalities“
- Swedish Presidency (2nd semester 2009)
– Conference: “Healthy and Dignified Ageing“
- Finnish Presidency (2nd semester 2006)
– Council Conclusions: “Health in All Policies (HiAP)”
– High level conference on Health in All Policies
– Report: “Health in All Policies: Prospects and Potentials“