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What COVID-19 is teaching us about inequality and the sustainability of our health systems

24 March, 2020
banner used for COVID-19 statement

COVID-19 is painfully exposing the existing and persisting health inequalities in our societies. This pandemic will have the heaviest impact on the lives of people living in deprivation or facing difficult socio-economic circumstances. EuroHealthNet partners – the public bodies responsible for health – are doing their utmost to protect citizens and contain the outbreak. In the difficult days and months to come, the need to work together will be clear. Protecting health is the responsibility of all. Good health starts in the community. In the long term, we must consider how our health systems are structured, their sustainability, and their ability to protect all in times of crisis.

“EuroHealthNet partners are now preventing the spread of the coronavirus to support us all. Now we must join forces with all sectors to make the changes that will protect our workforces, the people at greatest need, and the sustainability of our health systems. We have to be visionary and have to get prepared for the future needs of people, routed in the economic and social changes caused by the virus.” – Dr Mojca Gabrijelcic, President of EuroHealthNet and senior advisor at the National Public Health Institute in Slovenia.

Social inequalities and health outcomes from COVID-19

Research has suggested that most fatalities will be amongst those with underlying illnesses such as high blood pressure, diabetes and heart or respiratory disease. The more socially and economically disadvantaged a person is, the more likely they are to suffer from these diseases1. Diseases that are largely preventable. This also applies to risks of mental ill-health, which will be exacerbated by isolation, fear, and insecurity2. The immediate focus now is on controlling the spread of the disease. Next we will need to act to address high and rising levels of chronic diseases in our societies and reducing pressure on care services.

“Half the calls to emergency lines are from lonely seniors and half of the deceased had at least three chronic diseases and were largely of a lower social background. The most critical shortage these days is that of professionals in intensive care and infectious disease units. Italy hasn’t yet passed the peak of infection and we have more questions than answers, but there are some lessons we can already learn.” Giovanni Gorgoni, Director General, Regional Healthcare and Social Affairs Agency of Puglia (AReSS Puglia), Italy

People in poorer socio-economic circumstances can also be more exposed to infection. They may be unable to self-isolate due to insecure labour conditions which do not allow for teleworking or provide statutory sick or care leave. They also live in closer proximity to each other and are more likely to experience overcrowding3. In both the short and long term, they are more likely to experience unemployment and financial insecurities and are more vulnerable to labour market fluctuations resulting from macroeconomic changes.

Health systems fit for the future

The EuroHealthNet partnership of national and regional public health institutes and authorities has long called for the need to reorient our health systems towards prevention and promotion4, and providing healthcare professionals with the support and training that they need5. This transition, and the reduction of chronic diseases and health inequalities, would relieve pressure on secondary health care services, leaving them more able to respond to crises.

“For now we must all follow instructions and be aware that nobody is protected. After this immediate crisis has passed, we must not forget the hidden inequalities and disadvantages of current health systems which are exposed by epidemics.” – Prof. Dr Hristo Hinkov, Director, Bulgarian National Centre for Public Health and Analyses

COVID-19 lessons tell us yet again to invest in prevention and health promotion, as well as in the wider health workforce, tackling avoidable health inequalities, and boosting health literacy. Solutions to addressing problems in the health system lie beyond it too: it is essential that social protection systems are solid and well-funded. Employment and income support must be provided to cope with additional costs, and consequences of disease and ill health. Investing in these services, means investing in people, in resilience, solidarity and ultimately in the wellbeing of our society and economy.

While the European Commission has earmarked €140 million to support 17 research projects for diagnoses, treatment and vaccine of the disease6, and €50 million to create a stockpile of medical devices such as ventilators and protective masks to help EU countries, €37 billion7 will be dedicated to addressing the pandemic, providing a much-needed boost to overburdened healthcare systems and services and businesses. When the first wave of the crisis passes, we need long-term comprehensive strategies and sustained investment, aligned across all sectors including education, housing, food, environment, economic etc. These strategies should boost health promotion and disease prevention, make our health systems sustainable, and support good health for all.

“EuroHealthNet applauds the strength and expertise of its individual members, their staff, and those caring for the sick. We applaud the leadership of the WHO globally. We pay tribute also to those working in the community – from specialist doctors to local volunteers – to support the mental and physical health of those in their local communities. Good health is not only a responsibility of health systems, but the responsibility of all”Caroline Costongs, Director, EuroHealthNet.



Courtney L. McNamara, Mirza Balaj, Katie H. Thomson, Terje A. Eikemo, Erling F. Solheim, Clare Bambra, The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health, European Journal of Public Health, Volume 27, Issue suppl_1, 1 February 2017, Pages 22–26,

WHO, Social Determinants of mental Health, 2014;jsessionid=2B47C1C22D 562D0C355B71D35DDA0949?sequence=1

 In 2018, 26.2% of the European population with an income below 60 % of median equivalized income lived in overcrowded dwellings. Overcrowding rate by age, sex and poverty status – total population – EU-SILC survey 2018

EuroHealthNet, The European Semester from a Health Equity Perspective, 2019

EuroHealthNet, What role for health professionals to address health inequalities

COVID-19: Commission steps up research funding and selects 

Corona Response Investment Initiative

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