EuroHealthNet calls for more action as European Commission report on health inequalities confirms harmful and costly gaps remain between and within EU Member States

EuroHealthNet welcomes the report on Health Inequalities in the EU released by the European Commission on 9 September. As the organisation set up by EU state and regional bodies to help improve health and tackle social and health inequities, EuroHealthNet work is mentioned throughout via its core work, research projects, support for the EU Joint Actions and work with WHO and other stakeholders. Its Directors Clive Needle and Caroline Costongs today issued the following statement:

'The report by the European Commission fairly demonstrates the extent of work initiated by the most directly responsible Directorates for Health, Social Affairs, and Research in the period reviewed since the CommunicationSolidarity in Healthwas published in 2010. We congratulate all responsible and commit to further support and inform their efforts. Anticipating this report we have launched our new strategic plan to 2020 which will feature a new Platform on Health and Social Equity (PHASE), a new Centre for Innovation and Research for Implementation for Health and Wellbeing (CIRI) and a major development of our core network to become Health Promotion Europe (HPE). While this shows confidence by our members that the EU will continue to play a leading role in tackling inequities and improving health, it also shows there remains a clear and pressing need to do much more, much better.

The key paragraphs of the report are on Page 3: ''...sizeable gaps in health exist within and between EU member states... a social gradient in health status exists where people with lower education, a lower occupational class or lower income tend to die younger and have a higher incidence of most types of health problems. In recent years, the level of inequality has improved for a small number of indicators, while for others there has been no change and, for a few, deterioration.''

And on Page 19: ''For a few key health indicators there has been both an overall improvement and a small narrowing of inequalities between states, although the level of those inequalities remains unacceptably high. But health inequalities between social groups, between rich and poor, between the university educated and those with lower education and between the general population and certain groups including Roma remain high and persistent, and the economic situation in some places poses additional challenges for the future.''

It is clear that efforts need to be redoubled in the new EU strategic period 2014 -2020. Much of the situation which is reported or alluded to, in terms of lack of sufficient data about healthy life years not just life expectancy, falls in living standards for many vulnerable people, increases in poverty particularly among children, massive youth unemployment and cuts to affordable health services, is simply not acceptable and not good enough. It requires urgent policy and practice action within and beyond health sectors.

Therefore we are today writing to leading MEPs, calling on the European Parliament to ensure it organises proper and effective scrutiny of this Report and what is being done not only within EU programmes but also within EU States and how that compares with global initiatives, given that an EU 2020 aim is to be globally dynamic and competitive. We urge that progress is measured against the priority recommendations of Commission on Social Determinants of Health (CSDH) adopted by the World Health Assembly to improve measurement and knowledge, living and working conditions and the balance of wealth, power and resources.

We look forward to the imminent publication of an associated study in which EuroHealthNet has been part of an investigative consortium led by Professor Sir Michael Marmot, and anticipate that its recommendations for improvement will mirror those to be announced by a whole continent report to be published by WHO Europe next week. We call on those recommendations to be given serious consideration by all EU institutions and implemented within EU states and communities.

We urge the early implementation of relevant measures with an equity focus foreseen across all EU programmes and legislation, but especially according to the EU 2020 strategy, EU Health Strategy, the EU Social Investment Package and the Horizon 2020 research programme.

We will now consult further with our members, partners and stakeholders to help take forward the important learning from this and other reports and will make further announcements soon.

Background notes for editors and readers:

The report shows that the gap between the longest and shortest life expectancy found in EU-27 as well as the average infant mortality in the EU decreased between 2006/2007 and 2011. This is a positive trend. Nevertheless, it is worth underlining that the report confirms the persistence of significant and unacceptably large health inequalities between and within EU Member States. The health divide indeed remains persistently large, and in some cases growing, health inequalities exist between regions within countries.

  • Over 9 000 infant lives could be saved each year if all Member States achieved the best infant mortality rate of 2.1 per 1 000 births, as is the case in Sweden;
  • There is a 12 years difference in life expectancy for men between the Member States with the highest and lowest life expectancies, and a 19 years difference among men when it comes to the number of healthy life years lived;
  • The report also refers to evidence reflecting differences in life expectancy between the least and the most educated men which can be up to 13 years (Hungary, Estonia) or even 17 years (Czech Republic) or 9 year among women;
  • Overall, the health gap between regions has not reduced over the last few years. In fact, for some indicators such as life expectancy at age 50 for males, it has increased.

In 2008, the CSDH concluded that social inequalities in health arise because of inequalities in the conditions of daily life and the fundamental drivers that give rise to them: inequities in power, money and resources. The CSDH argued that social and economic inequalities underpin the determinants of health, the range of interacting factors that shape health and well-being. A number of these key socio-economic determinants such as income distribution and unemployment levels have varied in the last few years across EU Member States as a result of the crisis. Of particular concern for health is the variation in long term unemployment, the proportion of citizens with education levels at lower secondary level or below and those suffering material deprivation. The EU statistics on living conditions (EU SILC) demonstrates how, across the EU as a whole and in nearly all Member States, the self-reported level of health is worse for those in lower income and educational levels. Furthermore a gradient can be observed in which health is best for those with the highest levels of income and education and successively worse for those at lower levels.

Action on health inequalities must therefore remain a public health priority for the EU such as attention to, and investment in, the type of priorities recommended by the Commission's Communication, Solidarity in Health: Reducing Health Inequalities in the EU and the recently launched Social Investment Package. The role of the health sector in tackling health inequalities is vital but inequalities in health cannot be reduced by the health sector alone - it requires action on all the social determinants of health. Other sectors are increasingly involved, though further, wider engagement outside the health sector is still necessary.

EuroHealthNet has been contributing to this study on Health Inequalities led by Professor Sir Michael Marmot, which provided input to this Commission Report, as well as supporting the Joint Action on Health Inequalities ( and in particular helping regions accessing EU structural funds for health equity ( A final Joint Equity Action conference setting out priorities for future integrated action to combat health inequalities in the EU will take place in Brussels on 23 January 2014.

The European Commission Report on Health Inequalities is available here.

For more information, contact Clive Needle, EuroHealthNet Director


Or Caroline Costongs, EuroHealthNet Deputy Director


Tel.: + 32-2-235-03-20

Fax: + 32-2-235-03-39

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