Introduction Environmental health inequalities in Europe Second assessment report a Environmental health inequalities in Europe Second assessment report ABSTRACT Environmental conditions are a major determinant of health and well-being, but they are not shared equally across the population. Higher levels of environmental risk are often found in disadvantaged population subgroups. This assessment report considers the distribution of environmental risks and injuries within countries and shows that unequal environmental conditions, risk exposures and related health outcomes affect citizens daily in all settings where people live, work and spend their time. The report documents the magnitude of environmental health inequalities within countries through 19 inequality indicators on urban, housing and working conditions, basic services and injuries. Inequalities in risks and outcomes occur in all countries in the WHO European Region, and the latest evidence confirms that socially disadvantaged population subgroups are those most affected by environmental hazards, causing avoidable health effects and contributing to health inequalities. The results call for more environmental and intersectoral action to identify and protect those who already carry a disproportionate environmental burden. Addressing inequalities in environmental risk will help to mitigate health inequalities and contribute to fairer and more socially cohesive societies. KEYWORDS ENVIRONMENTAL HEALTH, ENVIRONMENTAL EXPOSURE, HEALTH STATUS DISPARITIES, SOCIOECONOMIC FACTORS, RISK FACTORS, RISK ASSESSMENT, EUROPE Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark. 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If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in Germany Language editing: Lydia Wanstall Layout and design: Imre Sebestyén/Unit Graphics Contents Foreword . iv Acknowledgements . .v Contributors . vi Abbreviations . ix Executive summary . x 1. Introduction . .1 1.1 Equity as a key challenge for the WHO European Region. 1 1.2 Inequalities in environmental health – a cross-cutting agenda for the Region. 2 1.3 Benefits of environmental health inequality assessments for action . 3 1.4 Health impact of environmental inequalities . 4 2. Objective and overview of the report. 7 2.1 Report objective and target audience . 7 2.2 Background information. 7 2.3 Content and coverage of the report . 8 2.4 Report structure. 10 3. Housing inequalities. 12 3.1 Inequalities in lack of a flush toilet in the dwelling. 13 3.2 Inequalities in lack of a bath or shower in the dwelling. 17 3.3 Inequalities in overcrowding . 21 3.4 Inequalities in dampness in the home. 26 3.5 Inequalities in inability to keep the home adequately warm . 30 3.6 Inequalities in inability to keep the home adequately cool in summer . 35 4. Inequalities in access to basic services. 39 4.1 Inequalities in access to basic drinking-water and sanitation services. 40 4.2 Inequalities in energy poverty. 51 5. Urban environment and transport inequalities . 56 5.1 Inequalities in exposure to air pollution. 57 5.2 Inequalities in self-reported noise annoyance. 66 5.3 Inequalities in fatal road traffic injuries (RTIs). 72 5.4 Inequalities in lack of access to recreational or green areas . 79 5.5 Inequalities in chemical exposure . 84 5.6 Inequalities in exposure to and health risks from contaminated sites in Italy . 90 6. Work-related inequalities . 94 6.1 Inequalities in work-related fatal injuries . 95 6.2 Inequalities in health risks in working environments . 101 7. Injury-related inequalities . .107 7.1 Inequalities in fatal poisoning . 108 7.2 Inequalities in fatal falls. 114 8. Changes in environmental health inequalities over time. 119 8.1 Success stories . 120 8.2 Mixed evidence. 122 8.3 Challenges . 125 8.4 Conclusion. 127 9. Key messages and conclusions . 128 9.1 Conclusions. 129 9.2 The way forward. 132 Annex 1. Methods and data sources. 133 Annex 2. Summaries of systematic reviews . .142 iii Foreword A long-term strategic objective of the WHO The evident reduction of many environmental Regional Office for Europe is stronger equity health risks indicates that environmental and better governance for health. The Health governance and regulations in the Region are 2020 European policy framework outlines the generally effective in protecting our population. various dimensions of this goal, and is based on However, this progress.