Gradient

Although socially excluded and minority groups are particularly vulnerable, the differences in health and illness don’t just affect the worst off in society. People's health status diminishes together with their socio-economic status at each step of the ladder and this is referred to as the social gradient in health. Thus, health inequalities are a concern for the whole population, not just the least fortunate ones.

Rather than diminishing, these differences have grown over the last years. It is therefore clear that work needs to be done to ascertain equal opportunities and health for all (Background doc COM(2009)567). As the subject of health inequalities has recently attracted more attention, there is a lot of research that maps the extent of the problem using demographic data. Information about the underlying mechanisms is rather scarce, however, partly due to the complexity of causal pathways, and so it remains unclear how these inequalities could best be tackled.

Progress is being made, which is shown by the publication of a communication by the European Commission in 2009 regarding health inequalities in the EU and its commissioning of a Joint Action by Member States, a tender on Health Inequalities, and several projects on the topic shortly afterwards (COM(2009)567 final).

A plan of action is also described in the WHO report ‘Closing the gap in a generation. Health equity through action on the social determinants of health’. Upon publication of this report in September 2008, England requested a national review (carried out and published by Prof Michael Marmot's team in February 2010 as 'Fair Society, Healthy Lives') with several Member States following suit. In 2010, WHO EURO commissioned Professor Marmot to conduct a two-year European Review of social determinants and the health divide across the region (53 states including the EU27).

While much is known about the existence of health inequalities, much remains to be done to identify how best to address this problem and to reduce the gradient in health that exists in all EU populations. Contributing to this knowledge is one of EuroHealthNet’s main priorities.