Health Inequalities in Europe (JAHEE)

85 86.1 yrs 85.2 85.6 EU-28 yrs yrs Diﬀerence yrs average of 5.2 83.5 yrs 80 80.6 80.8 80.5 EU-28 yrs yrs 79.6 yrs yrs 78.4 79.7 average 75 Health yrs yrs 78.3 yrs 70 71.4 yrs 70.7 69.8 yrs Inequalities yrs yrs 65 Spain Italy France Bulgaria Latvia Lithuania average average average average average average in Europe yrs yrs yrs yrs yrs yrs 83.4 83.1 82.7 74.8 74.9 75.8

On average people in Europe are living longer and in better health than ever before1. However, many people are being left behind. Big differences remain between groups of people and countries.

LIFE EXPECTANCY AT BIRTH2,3 BETWEEN EU MEMBER STATES 90

85 86.1 EU-28 85.6 85.2 yrs Diﬀerence yrs yrs average yrs 83.5 yrs of 5.2 80 EU-28 80.5 80.8 80.6 yrs 79.6 yrs yrs average 78.4 79.7 yrs 75 78.3 yrs yrs yrs

70 71.4 yrs 70.7 69.8 yrs yrs yrs 65 Bulgaria Latvia Lithuania France Italy Spain average average average average average average 74.8 yrs 74.9 yrs 75.8 yrs 82.7 yrs 83.1 yrs 83.4 yrs

EU-28 average men EU-28 average HEALTHY LIFE YEARS 9.8 yrs women 10.2 yrs or disability-free life years Sweden 15.4 yrs describe the number of years lived in a healthy state. 15.8 yrs

Malta 13.5 yrs Although women in Europe live 14.2 yrs longer, most of the additional years gained tend to be lived Ireland 12.5 yrs with activity limitation/in poorer yrs health, as gender differences 13.4 in Healthy Life Years are much Croatia 5.0 yrs smaller. 4.8 yrs THERE ARE BIG GAPS Latvia 4.1 yrs BETWEEN COUNTRIES 4.2 yrs IN HEALTHY Slovakia 3.8 yrs LIFE YEARS REMAINING 4.1 yrs AT 654

0 yrs 4 8 12 16 In general, the lower a person’s socio-economic status, the worse the health outcomes. This is the social gradient in health. It exists in all countries, but the steepness of the curve varies.

5,6 SELF-PERCEIVED HEALTH IN THE EU (aged 16 or above) GOOD BAD The share of people that describe their health as ‘good’ or ‘very good’ OR VERY FAIR OR VERY GOOD BAD increases with the level of education and income:

20% of the richest 80.4% 15.7% 3.9% population

Average population over 16 69.7% 22% 8.3% in EU-28 in 2017 status 20% socio-economic of the poorest 61.2% 25.6% 13.2% population

0 % 10 20 30 40 50 60 70 80 90 100

Health outcomes and health inequalities HEALTH INEQUALITIES are influenced by the social, economic, are the differences in health and environmental determinants of health between different groups of - the conditions in which we are born, grow, people which are avoidable live, work, and age. by reasonable means.

Percentage of people that experience exposure to pollution (air, grime or other environmental problems; and noise)8 People living in 32.5% socio-economically Air 30.3% deprived areas 27.4% % are more likely to 23.2% 24.5 be exposed to % 15.6% 17.1 higher levels of 14% air pollution7. 20% EU-28+ MALTA GERMANY of theLUXEMBOURG richest population

Average34.5% 32.4% Noise 30.4% population over 16 % 26.2 25.1% in EU-2824.9 in %2017 status 20.9% socio-economic 17.9% 20% AT RISK OF EXPERIENCING POVERTY AND of the poorest POLLUTION EXPERIENCING population - POLLUTION EU-28 MALTA GERMANY NETHERLANDS The WHO Health Equity Status People with lower levels of education Report9 indicates that 90% of health inequalities can be have a higher risk of suffering from certain explained by financial insecurity, illnesses than those with a high level of poor quality housing and education10: neighbourhood environment, social exclusion, and lack of decent work and poor working conditions: 100 3 RISK Depression 10% quality of health care 3.12 3.5 times higher x 35% 80 Financial Insecurity x3 ‘not being able to make ends meet’ 60 2 x 2.5 Diabetes 29% 2.36 Poor quality housing times higher and neighbourhood 40 x2 environment 1 Obesity 1.93 19% 20 times higher Social and human capital LEVELS OF EDUCATION 7% Employment & working conditions 0

Economics of health inequalities

Health inequalities reduce economic and social productivity and lead to higher healthcare and welfare costs.

In the European Union, inequalities in health are estimated to cost €980 billion per year11, or 9.4 percent of European GDP. A 50% reduction in gaps in life expectancy would provide monetized benefits to countries ranging from 0.3% to 4.3% of GDP12.

A Call to Action to reduce Health inequalities: • Reduce individual wellbeing, health inequalities happiness and life satisfaction as well as people’s ability to Health is an enabler of social and economic participation in daily contribute to society. life, the ‘motor’ behind our economies, and a key determinant of a • Undermine economic growth person’s wellbeing, happiness and life satisfaction. In EU surveys, and prosperity, a socially just people systematically value good health above all other aspects transition to a sustainable of their lives. They also consistently indicate being concerned about economy, and the implemen- growing inequalities13. tation of the SDGs agenda. • Increase health and social We must take action to ensure that good health is not simply a care expenditures. prerogative of the well-off, but of everyone. Health inequalities • Challenge European values reveal that market economies are not delivering wellbeing in a of equality (incl gender), fair and effective manner. Reducing health inequalities is possible, solidarity (incl. inter- represents a good investment and has strong public support. generational), and justice. What we can do?

1. Make health equity a central indicator 5. Invest more in health promotion of sustainable development and of health and disease prevention services, and in system performance assessments. It is improving health and digital health covered by UN Sustainable Development literacy, with a focus on reaching those Goals (SDGs) 3 and 10 and is key to in greater need. achieving many other SDGs. 6. Invest in comparable data at local, 2. Build capacities of professionals across regional and national level that can be the health sector to understand health used to measure and address health inequalities in order to deliver appropriate, inequalities. person-centred services and to work across sectors to improve the underlying 7. Develop capacities to analyse data, determinants of health such as and to design and evaluate measures unemployment and social exclusion. that can reduce health inequalities, to e.g. improve understanding of how 3. Engage in efforts to strengthen to apply the principle of ‘proportionate social protection systems and improve universalism’ to policies. living conditions for all, implement the European Pillar of Social Rights, 8. Increase and use public funds achieve the SDGs to make sure that (e.g. European Structural and Investment no-one is left behind, and reduce Funds, European Investment Bank loans) inequalities in education. to develop the capacity of health professionals and administrators to 4. Adopt measures that have been address health inequalities, and to proven to prevent ill health. This includes stimulate investments and collaboration smoke-free legislation and minimum across sectors (including private) unit pricing for alcohol, environmental in human and social capital and the measures (housing, transport) and determinants of health. address commercial determinants of health, by e.g. taxing unhealthy products 9. Engage in cross country dialogue on and subsidising the production of fruits effective approaches to improve health and vegetables. equity, as is done in the Joint Action on Health Inequalities in Europe (JAHEE). Establish benchmarks and exchange good References can be found at www.eurohealthnet.eu practice.

Find out more about health inequalities and health promotion in Europe at eurohealthnet.eu — health-inequalities.eu

This publication has received financial support Building a healthier future for all by addressing the determinants of health and reducing inequalities from the European Union Programme EuroHealthNet is the leading partnership for improving health, equity and wellbeing in Europe. It is a for Employment and Social Innovation ‘EaSI’ not-for profit association of organisations, agencies and statutory bodies working on public health, (2014-2020). For further information please consult disease prevention, promoting health, and reducing inequalities. EuroHealthNet’s work focuses on ec.europa.eu/social/easi.The information contained in this policy, practice, and research. Its unique focus is on reducing health inequalities through action on publication does not necessarily reflect the official position the social determinants of health, integrating sustainable development goals, and contributing to the of the European Commission. transformation of health systems. This document was published in September 2019

References

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