Equity Action High Level Conference €1.3 Trillion - The avoidable cost of health inequalities across the EU

Equity Action High Level Conference €1.3 Trillion - The avoidable cost of health inequalities across the EU

New updated figures released today (Thursday 23 January) show that the avoidable cost of health inequalities (1) to European Union Member States is up to €1.3 trillion every year (2) - larger than the entire GDP of the majority of EU countries, apart from Germany (€2.6 trillion), UK (€1.9 trillion), France (€2 trillion) and Italy (1.5 trillion) (see country table in Editor's Notes). The figures will be released at the EQUITY ACTION final conference in Brussels on 23 January, where Member States will be warned that ignoring the social, economic and health costs of health inequalities will risk economic recovery.

EQUITY ACTION is the result of a three-year EU funded partnership formed to advise Member States on practical solutions to reduce health inequalities across the region. High-level speakers at the conference include the European Health Commissioner, Tonio Borg, the Greek health minister Adonis Georgiadis (Greece currently holds the presidency of the EU), WHO Europe regional director, Zsuzsanna Jakab and global expert on health inequalities, Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity.

Tonio Borg, EU Commissioner for Health, said "We know that differences in social and economic conditions are major drivers of inequalities in health. This is why achieving the goals of the Europe 2020 strategy - smart, sustainable and - very importantly - inclusive growth, are essential to reduce health inequalities. We continue our efforts to push forward the health angle within the European Semester, and redouble our efforts to ensure that health is for everybody, everywhere in the EU."

László Andor, EU Commissioner for Employment, Social Affairs and Inclusion, said: "The persistence of health inequalities is part of a wider pattern of social deprivation and poverty. Such health inequalities are a brake on economic recovery and a barrier to meeting the EU's 2020 targets for inclusive growth and active inclusion. Member States need to take practical steps, such as those outlined in EQUITY ACTION'S manifesto, to reduce health inequalities and to promote inclusive economic growth across Europe. The EU's structural and investment funds are available to support Member States' actions to this end."

Only the wealthiest enjoy better health, with the overwhelming majority of us increasingly and unnecessarily being disabled by ill health, or are dying prematurely as a result of avoidable health inequalities (3). The global expert on health inequalities, Professor Sir Michael Marmot, who led the group that prepared the evidence for the EU (4) said: "We know health inequalities are killing on a grand scale. While the impact of the economic recession is likely to have increased these risks, the start of the recovery is an opportunity to begin to reduce them. There is now overwhelming evidence that everyone in Europe should and could live in better health for longer, provided all government policies prioritise reducing health inequalities. Now we have EQUITY ACTION's manifesto of what has to be done and we have the very much needed assistance from the European Union to Member States. No country has an excuse for inaction."

The Conference will call on Member States to make the best use of the EU's Investment and Structural Funds to support action to reduce health inequalities, including programmes that promote early year's development, quality education and training and fair and safe employment.

Adonis Georgiadis, the Greek health minister (for the Greek Presidency of the EU), said "The economic crisis has taken a heavy toll on the health and wellbeing of citizens across the European Union, particularly in Greece. This is mainly reflected in rising unemployment and the growth of poverty. Lack of work has prevented people - particularly young people - realising their potential and making a fuller contribution to society. Safeguarding social cohesion is a key priority of the Greek presidency and improving health and reducing health inequalities is part of that agenda, and an important factor of the Europe 2020 programme of 'Inclusive Growth'."

Editor's Notes

Eurostat: Member States annual GDP 2012 available in the attached pdf document

Source: Eurostat 2012 here



The cost of health inequalities is the result of Illness and disability through ill health impacting on productivity, lost taxes and higher welfare payments and additional healthcare costs. Evidence shows the most effective way to reduce health inequalities is by addressing the social circumstances in which people are born, grow, live work and age - the social determinants of health (Fair Society, Healthy Lives, 2010 - the strategic review of health inequalities in England) http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review.

Effective action requires government policies that promote: early years development, quality education and training, fair and safe work, quality housing, adequate social protection, social inclusion, equality at older age, cohesive communities and universal health care systems (Review of social determinants and the health divide in the European Union, WHO Europe, 2013) http://www.euro.who.int/__data/assets/pdf_file/0006/215196/Review-of-social-determinants-and-the-health-divide-in-the-WHO-European-Region-final-report-Eng.pdf

A full economic valuation of the costs of health inequalities as measured against GDP was undertaken by Mackenbach and colleagues for the year 2004. He found for the EU-25 - prior to the admission of Bulgaria, Romania and Croatia - losses in labour productivity due to health inequalities to be of the order of 141 billion euros (1.4% GDP), and around 1 trillion euros in terms of losses due to the cost of lives lost prematurely, or 1.3 trillion euros, updated to 2012 (Eurostat data) taking into account of the changes in EU and Member State GDP. Mackenbach et al. (2007)Economic implications of socio-economic inequalities in health in the European Union,European Commission (Final Report)


Closing the Gap in a Generation, WHO 2008 http://www.who.int/social_determinants/thecommission/finalreport/en/index.html,Fair Society Healthy Lives, Department of Health England, 2010 http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review;Review of Social Determinants and the Health Divide, WHO 2013 http://www.instituteofhealthequity.org/projects/who-european-review

Health Inequalities in the EU http://www.instituteofhealthequity.org/projects/eu-review, commissioned by the EC and led by Professor Sir Michael Marmot and published in December 2013, provides evidence on the state of health inequalities across the EU. It assessed Member State responses to the challenge of health inequalities in three clusters (i) positive and active: Denmark, Finland, Ireland, Netherlands, Slovenia and UK (ii) variable: Belgium, Bulgaria, Croatia, Czech Republic, Estonia, France, Germany, Italy, Latvia, Lithuania, Luxembourg, Poland, Portugal, Spain, Sweden (iii) relatively underdeveloped, highlighting the opportunities for practical action: Austria, Cyprus, Greece, Hungary, Malta, Romania, Slovakia (page 119 of report).

(NB this is a separate report to the WHO European region's review of social determinants and the health divide, published in October 2013)

The European Commission Staff Working Document,Report on the Inequalities in Health(2013) reviews the size of, and trends in, health inequalities in the EU since 2000, and particularly since the publication ofSolidarity in Health - the EC communication on Health Inequalities, published in 2009. It notes that the gaps between Member States are larger for the healthy life year's indicator than for life expectancy. In 2011, the healthy life expectancy gap was 19 years for males and 18.4 years for females between MS with the highest and lowest rates. For life expectancy, the gap was 13.4 years for males and 10.6 years for females. http://ec.europa.eu/health/social_determinants/docs/report_healthinequalities_swd_2013_328_en.pdf



Outcomes from Equity Action - the EC joint action programme on health inequalities - are available on the programme website - www.equityaction-project.eu. The website highlights activities along four themes: tools, regions (including the use of EU Structural and Investment Funds), knowledge and stakeholders

The three-year programme brings together the following countries: Belgium, Czech Republic, Finland, France, Germany, Greece, Hungary, Italy, Ireland, Latvia, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom, plus Norway - in a €3.6 million programme funded jointly between the EC Framework Health Programme and the Member States.

EQUITY ACTION has worked to:

  • Develop tools and mechanisms to inform policy development and assess the impact of action
  • Provide guidance to national, regional and local government on how to make the best use of EU funds to support this work
  • Promote knowledge by making the scientific evidence on health inequalities available and usable to policymakers
  • Identify and engage key stakeholders in this work

EQUITY ACTION - examples of programmes across the EU



30 Regions*

Public sector collaboration with other sectors to ensure EU Investment and Structural Funds contribute to the reduction of health inequalities in the EU


New national plan for sustainable development to 2050 includes action to reduce health inequalities


Strategic bid for 2014-2020 European Social Fund monies to tackle poverty through sustainable employment and promote social inclusion


Region of Kefalonia working with new partners to win Investment and Structural Fund support for a Child Prosperity Alliance to improve children's health, education and care


Identified mechanisms to ensure successful intersectoral cooperation on health inequalities - linked to new public health bill that is being developed by the Ministry of Health


National workshop discussed the impact of kindergarten on health inequalities of immigrant children and their families, with special attention to the project 'Free core-time in kindergartens' and established an informal network of partners


Network of health visitors provide preventative and follow-up health care for families with children, which initiated cooperation with the children's welfare services all over the country.


Develop a framework for cooperation to bring greater policy coherence for childhood and adolescent services


Jointly operated multi-professional 'National Centre on Early Prevention' to develop further the field of early childhood intervention and build up and extend support systems across Germany

*Numerous regional partners, eg England and Scotland, actively engaged in raising awareness about Structural Funds amongst their public health authorities to influence the Structural Fund and Investment Programmes being developed in their countries and import opportunities to apply them to initiatives that directly or indirectly address health inequalities


All media enquiries: Felicity Porritt, Communications Lead, EQUITY ACTION

felicity.porritt@gmail.com-UK: +44(0)7739419219 /Brussels:+32(0)478542575