What are health inequalities?

Health inequalities are avoidable and unfair differences in health status between groups, populations or individuals. Although average levels of health have been improving across the EU for many years, major health inequalities still exist both between and within Member States. Differences in life expectancy at age 30 between people with higher education and those with basic secondary education or less exceed 10 years in many Member States. Avoidable diseases and deaths attributable to inequalities in health are unfair, they waste human capital and must be reduced. Universal access to safe, high quality, efficient healthcare services and better cooperation between social and healthcare services, and effective action on risk factors can all help break the vicious circle of poor health/poverty/exclusion.

Economic inequality and health inequalities

Although globalisation has reduced gaps in income and wealth (the total amount of assets owned by an individual or household)between countries, these are often on the rise within countries. In Europe, rising income and wealth inequalities within countries has been a long-term trend since the 1970s. Rising income and wealth inequalities lead to greater differences in the quality of the neighbourhoods in which people live, the schools children attend, working conditions, etc., which in turn influence their health-related behaviours, their risk of getting ill and the quality health care they can receive. These conditions are called the social determinants of health. There are many models  that show how these determinants are interlinked and how many of the factors affecting health lie beyond the direct influence of health care. Perhaps the most known models is the Rainbow Model by Dahlgren and Whitehead, shown below.

Source: DETERMINE final report


The social gradient of health inequalities

Health inequalities are often observed along a social gradient: “a stepwise or linear decrease in health that comes with decreasing social position” (Marmot, 2004). This gradient exists in all countries, either rich or poor, and the pattern can observed when looking at factors such as income, level of education, geographic region, gender, or ethnicity. This means that the more advantaged and well-off the individuals, the better their health – whether measured in terms of disease and mortality or in terms of self-assessed physical and psycho-social health. Disadvantages in childhood, adolescence and adulthood all play a part in the social gradient in health. It is therefore essential to understand and address the socio-economic determinants that directly and indirectly influence health.

For example, the positive relationship between education and health is widely acknowledged and appears to be reciprocal. Better education results in better health through better jobs, higher income and increased health literacy, and better health enables people to invest more in education. Tackling inequities in education is vital for addressing health inequalities.[1] Another example of such an existing gradient can be found below. This graph shows the death rate (all causes) per 100.000 inhabitants in Scotland,  in relation to the level of deprivation of the area in which people live.

[1] The European Health Report 2015, WHO Regional Office for Europe, p. 31


Source: Equally Well (Scottish Government Report)

Health inequalities persist globally, in the European Union, and between and within countries. They result from the actions of individuals, communities, stakeholders and governments. The health sector cannot in and of itself reduce health inequalities. Action to reduce health inequalities thus means taking a holistic approach, going beyond the health sector, and tackling those factors that can be dealt with through public policies across sectors.

The Health in All Policies (HiAP) strategy targets the key social determinants of health through integrated policy response across relevant policy areas with the ultimate goal of supporting health equity.

Useful resources

Economic Inequalities. European Parliament briefing (July 2016)

The European Health Report 2015. WHO Regional office for Europe (2015)

A conceptual framework for action on social determinants of health. WHO (2010)

Closing the gap in a generation. WHO Commission on the social determinants of health final report (2008)

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