Health Equity Stagnant Or Declining Across Europe, New WHO Report Finds

Health equity in Europe has stagnated over the past decade, and in some case there are indications of a decline, a first-ever WHO report finds. However, advancing Universal Health Coverage (UHC) along with more inclusive policies for social welfare protection and political participation could put things back on track again.

A family prepares coffee following a power outage in FYR Macedonia. Living conditions are associated with health inequities. Photo: Tomislav Georgiev / World Bank

The Health Equity Status Report (HESR) report cites “financial hardship” as a major driver of health inequity in the WHO European Region, and pointing to “the critical importance of providing universal access to affordable health services.”

Released less than two weeks ahead of the planned UN High-Level Meeting on UHC, 23 September), the report places renewed focus on the third stated objective: of the planned UHC declaration – ensuring that “the cost of using services does not put people at risk of financial harm.”

The wide-ranging study of 53 countries in WHO’s European Region, analyzed data on life expectancy, infant mortality and other health indicators, in relation to socio-economic factors such as education, gender and income.

It found wide variations in equity indicators within and between European countries. For instance, while average infant mortality has decreased across Europe, the infant mortality rate in Azerbaijan (47.8 deaths per 1000 live births) is 25 times higher than the rate in Finland (1.9 deaths per 1000 live births).

Differences in life-expectancy and overall health based on gender, levels of education and income were also identified. The report also highlights inequities that are faced by so-called “new disadvantaged groups” such as adolescents who drop out of school early and people with chronic illnesses.

The retreat by many countries from public housing and social welfare programmes has impacted negatively on key equity indicators, the report notes. For example, 53% of countries in the Region reduced their spending on subsidies for housing and community assistance programs in the past 15 years, despite that among the health equity factors assessed, one-third are driven by poor living conditions.

In order to improve equity trends, the report recommends that countries enact health-promoting policies in 5 thematic areas:

Variations in life expectancy in Europe. Credit: WHO, European Regional Office
  • Invest in quality and affordable housing and safe neighborhoods;
  • Reducing out-of-pocket (OOP) health payments;
  • Reduce unemployment and implement job-promoting labour market policies (LMPs);
  • Equalize opportunities in education across the life course – including investing in adult education;
  • Strengthen social and political representation among marginalized groups.

“The Health Equity Status Report provides governments with the data and tools they need to tackle health inequities and produce visible results in a relatively short period of time, even within the lifetime of a national government of 4 years,” says Dr Zsuzsanna Jakab, regional director for WHO Europe, in a press release.

In a Lancet op-ed, HESR Initiative advisor, Dr Johanna Hanefeld, of the London School of Hygiene and Tropical Medicine, said that governments must, however, focus on deeper and more systemic changes as well.  These include, altering “the governance structures of policy processes to ensure the communities affected… have a meaningful voice that influences outcomes in these processes.”


Image Credits: Tomislav Georgiev / World Bank.

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