Closing the Gap on Health Inequities
Closing the gap on health inequities has been an important part of the work of the EU
since 1992, when specific competencies for public health were included in the Maastricht Treaty.
However, large differences in health still exist between and within all countries in the EU, and
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some of these inequalities are widening. The consortium report has identified many inequalities
among its member states (EU, 2003).
The report examines some of the factors causing health inequalities. The analysis
supports the findings of the WHO CSDH (1) that social inequalities in health arise because of
inequalities in the conditions of daily life and the fundamental drivers that give rise to them.
There are significant differences in mortality between Member States, with higher mortality for
males than females in each Member State. In Bulgaria and Romania, the age-standardized death
rate for males in 2010 exceeded 1 200 per 100 000, while it was below 800 in 17 Member States,
with the lowest values being 561 for Greece and 619 for Sweden. A similar pattern was seen for
females, but at a lower level of mortality. In six Member States the female rate exceeded 600 per
100 000 and in 16 Member States it was below 500 per 100 000. In this case, the highest values
were seen in Bulgaria and Romania. Inequalities in life expectancy between Member States were
smaller for females than for males. Female life expectancy was lowest in Bulgaria — 5.5 years
below that for the EU – and 7.9 years or 10 % higher than in Bulgaria, 2.4 years above the EU
average (EU, 2010).
EU (2012) has indentified many actions for strengthening the existing actions to reduce
health inequalities. They include:
• Distributing health equitably as part of the overall social and economic development;
• Improving the data and knowledge base and mechanisms for measuring, monitoring evaluation
• Improving the exchange of information and coordination of policies between levels of
government and across departments, and creating partnerships that are more effective with
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• Meeting the needs of vulnerable groups; and
• Evaluating the effectiveness of EU policies in tackling health inequalities, directly or indirectly.
There are also health differences in USA, just like in EU. In EU, with its publicly funded
health care systems, the healthy sustainability gap still exists. In the USA, where only about half
of healthcare spending is publicly financed and half privately funded, the excess growth in health
care spending still presents the greatest threat to service provision. If the actions, which have
been identified by the EU will be implemented in my society, the health inequity gap will be
reduced. Distributing health equitably as part of the overall social and economic development
and meeting the needs of vulnerable groups in the community will largely reduce this gap.
Most policies with explicit aims to reduce health inequalities should focus on vulnerable
groups such as immigrants, ethnic minorities, early school leavers, people from lower socio-
economic groups or unemployed or homeless people. Equally, universal policies do not have a
proportionate leveling-up component. The policy implications of the social gradient in health,
and effective methods of addressing these gradients appear to be poorly understood and acted
upon. Greater emphasis should be placed on introducing, monitoring, and evaluating policies that
have this component.