On this page we dive into European action on health inequalities. What are the initiatives, programmes and projects address health inequalities and the socioeconomic determinants of health?
Pandemics, climate change, and growing inequalities pose growing threats to our health. Those challenges cross borders, so transnational collaboration is needed to address them effectively. European countries have collaborated in the field of health for many years, and since the 1992 Maastricht Treaty, the European Union has had responsibilities in the field of health.
The European Health Union
European Commission (EC) President Ursula von der Leyen announced an initiative for a new ‘European Health Union’ (EHU) in the State of the Union address in September 2020. The initiative to build strong EHU came about as the COVID-19 pandemic crisis has shown critical limitations of current structures, services, and approaches to health at the EU level.
In November 2020, the EC proposed a number of initiatives focused on crisis preparedness and response measures.By February 2021, the EC had proposed initial measures to strengthen cooperation and coordination between European Member States towards a European Health Union.
One of the flagship initiatives under the European Health Union Umbrella is Europe’s Beating Cancer Plan - a political commitment to ‘turn the tide against cancer’. It focuses on:
- Early Detection
- Diagnosis and Treatments
- Improving quality of life for cancer patients and survivors.
Preventing cancer is interlinked with reducing health inequalities through actions on the determinants of health. In addition, the plan includes some specific measures to measure and reduce health inequalities – particularly between countries.
The European Semester
The European Semester is the EU’s annual cycle of economic and social policy coordination. In particular, it concerns reforms and legislation related to public expenditure, employment, education, and social- and health-care. Because it influences the socioeconomic determinants of health ands health care reforms, it is an important tool to address health inequalities.
The process starts in November of each year with an assessment of the economic and social context of every Member State. It concludes by July with the adoption by the Council of the EU of a set of country specific recommendations. Over the following year, recommendations are addressed by the Member States which will present National Reform Programmes on the progress.
How the Semester process has evolved
The semester was first created in 2010 as a mechanism to address fiscal and budgetary issues. However, it has slowly but steadily incorporated principles of health and social equity within its priorities over the past decade. This is also linked to the introduction of the European Pillar of Social Rights. In 2019, the European Commission President Ursula von der Leyen’s Political Guidelines committed the Commission to integrate the UN Sustainable Development Goals (SDGs) into the European Semester. This represents a unique opportunity to put people and their health at the centre of economic policy.
COVID-19 and the Resilience and Recovery Facility (RRF)
In 2020, in response to the COVID-19 crisis, the European Semester has been tied to the implementation of a revamped EU structural reform service – the EU Resilience and Recovery Facility (RRF) worth a total of 672.5 million euro. The aim of the EU RFF is:
- to help states to address pre-existing challenges identified in the context of the European Semester (especially the 2019 and 2020 cycles)
- to achieve the EU’s policy objectives, especially the green and digital transitions in view of the recovery from this crisis.
EuroHealthNet and the European Semester
EuroHealthNet produces annual in-depth analyses of the European Semester and health for health agencies and people involved in the Semester process.
The European Pillar of Social Rights
The European Pillar of Social Rights (‘EPSR’ or ‘social pillar’) is a (non-binding) commitment among Member States to address social challenges and guarantee social rights. It covers areas that affect health such as:
- working conditions
The Pillar consists of 20 principles, structured around three categories:
- equal opportunities and access to the labour market
- fair working conditions and
- social protection and inclusion.
An accompanying ‘Social Scoreboard’ measures progress and trends. It also allows for cross-country comparison. The scoreboard includes indicators on things like
- formal childcare
- at-risk-of-poverty or social exclusion rate
- self-reported unmet need for medical care.
Because many of the principles in the Pillar cover the social determinants of health, it plays an important role in addressing health inequalities.
In addition, principle 16 specifically addresses health. It states that: everyone has the right to timely access to affordable, preventive and curative health care of good quality.
The social pillar was introduced in 2017 and an action plan will be launched in March 2021. The social pillar has now also been integrated into the semester process.
Read EuroHealthNet’s Factsheet on the European Pillar of Social Rights for more information.
EU Child Guarantee
The Political Guidelines of the European Commission President Ursula von der Leyen announced the adoption of a Child Guarantee. The goal is to ensure that every child in Europe at risk of poverty or social exclusion (‘children in need’) has access to the most basic of rights like health care and education.
More specifically, the objective is to ensure access to the services that are essential for development and well-being, in particular
- early childhood education and care
- health care
- participation in cultural and leisure activities.
The European Commission, following it's Communication ‘A Strong Social Europe for Just Transitions’, will adopt a proposal for a Council Recommendation on a Child Guarantee in 2021.
In 2020, the EU’s response to the lessons learned from COVID-19 came through the EU4Health funding programme for 2021-2027. This ambitious programme is meant to build resilient health systems through, amongst others, reducing health inequalities. This will include
- disease prevention and health promotion in an ageing population,
- digital transformation of health systems
- access to health care for vulnerable groups.
It aims to:
- boost EU’s preparedness for major cross border health threats;
- strengthen health systems so that they can face epidemics as well as long-term challenges;
- make medicines and medical devices available and affordable
- advocate the prudent and efficient use of antimicrobials
- promote medical and pharmaceutical innovation and greener manufacturing.
Other EU action including programmes, such as the European Social Fund Plus (ESF+) and Horizon Europe will provide additional investments in the health sector to complement EU4Health. For more information about EU4 health and European funding, financing and budgets for health inequalities, visit the EU funding page.
EU Joint Action
A Joint Action is a collaborative action co-funded by EU Member States and the Commission on priority health issues. Some of them work on health inequalities and underlying social determinants of health, such as the ones listed below. The Joint Actions below are examples that EuroHealthNet was part of. You can find more EU Health Programme projects here.
The general objective of JAHEE is to improve health and well-being of European citizens and achieve greater equity in health outcomes across all groups in society in all participants countries and in Europe at large. In addition JAHEE will also include a specific focus on both vulnerable groups and migrants.
Find out more about JAHEE below and at jahee.iss.it
CHRODIS PLUS contributed to the reduction of the burden of chronic diseases by promoting the implementation of policies and practices that have been demonstrated to be successful. The development and sharing of these tested policies and projects across EU countries is the core idea behind this action. Joint Action CHRODIS was the predecessor of CHRODIS PLUS. It was a pan-European collaborative undertaking to identify, validate, exchange and disseminate good practices for chronic diseases across EU Member States and to facilitate their uptake across local, regional and national borders. The focus was on health promotion and primary prevention, as well as the management of diabetes and chronic conditions with multiple morbidities.
The JA MH-WB aimed at building a framework for action in mental health policy at the European level and builds on previous work developed under the European Pact for Mental Health and Well-being. The objective of the JA MH-WB was to contribute to the promotion of mental health and well-being, the prevention of mental disorders and the improvement of care and social inclusion of people with mental disorders in Europe.
This Joint Action aimed to increase the effectiveness of HIV prevention in Europe by using practical Quality Assurance (QA) and Quality Improvement (QI) tools. Quality Action developed and adapted QA/QI tools especially for use in HIV prevention. The project trained trainers and facilitators to support HIV prevention programs and projects across the EU that will be applying the QA/QI tools.
Read more about it in our database.
The Equity Action Joint Action aimed to reduce health inequalities by helping to improve policies at national and regional level and harness the contribution of stakeholders. The aim of the project was to promote a health equity focus in policy making through identifying tools to analyse and influence policy making processes such as Health Impact Assessments with an equity focus and Health Equity Audits, as well as through learning from practices. It identified seven key themes for implementing HiAP more successfully across the EU and produced some top tips for achieving this.
Read more about it in our database:
- Learning from Equity Action Health Impact Assessment (Processing and Training)
- Health Impact Assessment: Pre meeting questionnaire summary Report
- Strengthening Health in All Policies within your organisation – Review Tool
- Health Equity and Regional Development in the EU - Applying EU Structural Funds
Equity Action also produced a tool that provides a format for a structured discussion with key leaders and champions for HiAP within organisations to highlight the role of equity in policies.
Joint Action on Health Equity Europe (JAHEE)
The Joint action on Health Equity Europe (JAHEE) represents an important opportunity for Member States to work jointly to address health inequalities and achieve greater equity in health outcomes across all groups in society, in all participating countries and in Europe at large. It runs from 2018-2021 The general objective of JAHEE is to
- improve health and well-being of European citizens
- achieve greater equity in health outcomes across all groups in society in all participants countries and in Europe at large.
In addition JAHEE will also include a specific focus on both vulnerable groups and migrants The Joint action covers:
- Integrating action on Health Inequalities into national policy
- How to monitor Health Inequalities
- Healthy Living environments
- Migration and health
- Improving access to health and social services for those left behind
- Health and Equity in All Policies – Governance
To find out more, visit jahee.iss.it
Other EU funded initiatives and European action on health inequalities
In addition to EU action on policies, the EU also fosters research, innovation and collaboration at the European level through its Framework Programme (FP) for Research and Innovation, which span 7 years. The current Framework Programme is called Horizon Europe, spanning the period of 2021 – 2027. The FPs provide funding for a variety of projects in the field of health equity. In addition, the European Parliament has offered a number of tenders for projects to address health equity. The projects listed below are examples that EuroHealthNet was part of. You can find more EU-funded research and innovation projects here.
Find more projects in the our health equity resource database.
INHERIT explored the links between our living, moving or consumption patterns and the environment, our health and equity. This large-scale Horizon 2020 initiative, coordinated by EuroHealthNet, brought together experts from the health, environment and other sectors, including technology, to investigate policies, practices and innovations that can influence our behaviours to achieve a ‘triple win’.
The aim of the Health4LGBTI pilot project was to improve our understanding of how best to reduce specific health inequalities experienced by lesbian, gay, bisexual, trans and intersex (LGBTI) people. It focused on overlapping inequalities stemming from discrimination and unfair treatment on other grounds (e.g. age, status, income).
Read more about it in our database.
This was a web-based mechanism used to collect, exchange and analyse information on policy and stakeholder activities in mental health. The Compass communicated information on the European Framework for Action on Mental Health and Well-being. It monitored the mental health and wellbeing policies and activities of EU countries and non-governmental stakeholders.
Read more about it in our database.
VulnerABLE explored ways to improve the health of people who live in vulnerable and isolated situations across Europe. It is focused on nine specific vulnerable and isolated populations such as children and families from disadvantaged backgrounds, the long-term unemployed, the homeless and prisoners.
This project aimed to develop evidence-based guidelines to improve health equity in the ageing population.