Policy Briefings


The European Semester 2018 from a health equity perspective

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EuroHealthNet has engaged with its national, regional, and local health experts to analyse how the European Semester process can affect the health and wellbeing of European citizens, and address existing inequalities.

The European Semester is the EU’s annual cycle of policy coordination. It reviews the economic and – since recently – social situation in Member States and in the EU as a whole. It makes country specific recommendations at national level to bring Europe towards commonly agreed goals.

EuroHealthNet’s report contains guidance for both the European Commission and public health actors to help to assess and enhance their efforts in making full advantage of using the Semester, the European Pillar of Social Rights and EU funding mechanisms to improve public health and health equity.

Analysis of the Multiannual Financial Framework 2021-2027

MFF analysis

Health is an enabler of social and economic participation. It is therefore vital to address key factors that undermine people’s opportunities for good health and wellbeing.

Earlier this year the European Commission published a set of proposals for the next EU budget 2021-2027, the Multiannual Financial Framework. Many of the areas affected by the EU budget are relevant to health – an issue most Europeans want more EU action on[1]. EuroHealthNet has therefore produced brief analyses of 14 budget proposals from a health and health equity perspective.  They cover a diverse range of topics including research, education, agriculture, investment, the digital agenda, and structural reform as well as those traditionally associated with health and social issues.

Download the report

[1] 70% of Europeans want to see more EU action on health and social security. http://www.europarl.europa.eu/external/html/eurobarometer-052017/default...


The European Semester: A health inequalities perspective

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Will the 2017 European Semester process contribute to improving health equity?

EuroHealthNet’s 2017 analysis of the European Semester

The European Semester is an annually applied mechanism for policy coordination at EU level. It is used to analyse EU Member States’ economic situation, monitor progress and provide country specific recommendations towards the EU2020 strategic objectives.  EuroHealthNet considers more can be done and achieved through the EU Semester process to ensure action is taken which responds to social and health needs of people from different socio-economic groups. By providing recommendations to Member States in social and economic areas, the EU Semester process can be important for addressing health inequalities and the social determinants of health.

In this document EuroHealthNet takes a closer look at three key social determinants of health and how they are represented in the EU Semester while providing examples from the country specific recommendations and the Country Reports of three countries: Austria, Slovakia and Ireland . We analyse the Annual Growth survey 2017, and compare 2016 Country Specific Recommendations with 2017 country progress reports and 2017 recommendations in light of the available evidence in three key themes. What is positive, what is missing and what can be done better? This analysis highlights the entry points and opportunities for tackling health and social inequalities within the EU Semester process. It also considers the relevance of using and applying the principles of the European Pillar of Social Rights (Social Pillar) and its Social Scoreboard to increase the impact of the EU Semester as a coordination tool for social, health and well-being policies.



Will the 2016 EU Semester process contribute to improving health equity?

The European Semester is the EU’s economic policy coordination mechanism of the Europe 2020 Strategy. It undertakes a detailed analysis of EU Member States' reforms plans and provides them with Country Specific Recommendations (CSRs) following extensive consultation with stakeholders at European and national levels. The publication of the CSRs entails a potential political programme for each member state for the coming semester period.

EuroHealthNet’s interest in the EU semester is reinforced by the fact that CSRs also address questions related to the priorities and investments of member states in the field of social affairs and health. As such, CSRs represent an opportunity to ascertain the extent to which they may – or may not – contribute to health equity.

This document brings together two areas amenable to policy actions that can improve health and reduce health inequalities: children and families; and health systems from a health promotion perspective. For children and families, the analysis aims to ascertain the scope and inclusiveness of CSRs related to children and families and to find out whether the suggested measures are a step towards improving health and reducing health inequalities. For health systems we try to examine whether the 2016 CSRs are likely to stimulate reforms that reduce health inequalities and support investment in health promotion and disease prevention.

These topics were selected based on EuroHealthNet’s previous work on health systems, child development and health promotion. This document aims to compare findings of 2016 with those of 2015 analysis and responds to the announcement of the Annual Growth Survey 2017 in November 2016, which marks the beginning of a new EU semester process.

This year analysis found that:

  • There is an increased awareness of the need for policies related to children and families, especially in the light of labour market and social inclusion.
  • The need for fiscally sustainable health care systems is recognised among most CSRs relating to health, yet the call for strengthening primary care, disease prevention and health promotion or looking at health in an integrated way is limited.
  • Access to health is increasingly raised in CSRs related to health in comparison to the analysis of CSRs in 2015. However, vulnerable people, children or migrants are not directly mentioned.
  • Children, vulnerable people and migrants are mentioned in connection with social inclusion and labour market integration.

Several steps have been identified as promoters of greater health equity:

  • Ensure that children and families are on the agenda of all CSRs.
  • More focus should be put on coverage and access to quality of health care.
  • Improve health system governance and support inter-sectoral work and cooperation.
  • A stronger focus and consideration should be given to the impacts of the economic crisis in terms of resources; investing in health promotion and disease prevention should be one of the measures to support health systems fiscal sustainability.

The European Council’s Recommendation on the integration of the long-term unemployed to the labour market

The link between unemployment and ill health is well established[i]. Scientific knowledge goes deeper, suggesting that unemployment is worse for health for lower socio-economic groups, and less deleterious for health for those who have larger social networks[ii]. Unsurprisingly, long-term unemployment sees effects on ill health compounded: people experience negative pressures on their physical and mental health from a variety of sources for longer. Indeed, a recently published review of the scientific literature found that “The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment[i].

Long-term unemployment is not only a tragedy for the individuals concerned but also threatens economies: it reduces tax receipts, increases expenditure on social protection and health, and has negative effects on the skills and knowledge of the workforce – thereby reducing the potential for future economic growth.

This EuroHealthNet policy briefing examines a recent initiative at the European Union level, which has been agreed upon but not yet responded to by national authorities and others responsible for its implementation: The European Council’s Recommendation on the integration of the long-term unemployed to the labour market. The briefing describes the main modalities by which the initiative aims to return the long-term unemployed back to the labour market, and certain avoidable bad practices that could exacerbate the difficulties faced by people experiencing long-term unemployment.

Read our policy briefing published here.

[i] Herbig et al. (2013) - Health in the long-term unemployed. Dtsch Arztebl Int. See here 

[i] See for instance: 1) Wanberg CR: The individual experience of unemployment. Annu Rev Psychol 2012, 63:369–396. 10.1146/annurev-psych-120710-100500PubMedView Article. 2) Jin RL, Shah CP, Svoboda TJ: The impact of unemployment on health: a review of the evidence (Reprinted from Canadian Medical Association Journal, vol 153, pg 529–40, 1995). J Public Health Pol 1997,18(3):275–301. 10.2307/3343311View Article.

[ii] Norström et al. (2014) - How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects. BMC Public Health. Available here


Will the 2015 Country Specific Recommendations contribute to health equity?

EuroHealthNet  has  been  monitoring  the  European  Semester  process  for  a  number  of  years  and working  with  its  members  to  argue  for  a  stronger  focus  on  public  health,  health  promotion  and preventive services . EuroHealthNet’s two main objectives are to improve health between and within European states and to tackle health inequalities.

This  document  brings  together  three  linked  analyses  of  the  CSRs  carried  out  by  EuroHealthNet,  covering  statutory  retirement  ages,  children  and  families,  and  health  promotion  and  sustainable health  systems.  These  three  topics  were  selected  based  on  EuroHealthNet’s  previous  work  on healthy and active ageing, child development, and health promotion. They represent areas amenable to policy actions that can improve health and reduce health inequalities, and areas where inequities in health could challenge policy reform and implementation.



Following the conference organised by EuroHealthNet's Swedish partner - the Swedish Association of Local Authorities and Regions, together with Euregha and EuroHealthnet, EuroHealthNet has published some recommendations on EU support for local and regional action on health equity (attached document).

Health is a value in itself as well as a prerequisite for the achievement of the EU 2020 objectives of smart, sustainable and inclusive growth. People´s health influences economic outcomes in terms of productivity, labour supply, human capital and public spending. In many of the member states of the European Union, however, health inequalities are increasing. This is a joint challenge for society that needs to be addressed and tackled by all levels of government.

For more information, contact Leonardo Palumbo


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