The European region has seen remarkable heath gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist. The review reported here, of inequities in health between and within countries across the 53 Member States of the WHO European region, was commissioned to support the development of the new health policy framework for Europe: Health 2020. Much more is understood now about the extent, and social causes, of these inequities, particularly since the publication in 2008 of the report of the Commission on Social Determinants of Health. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed-on the social determinants of health, across the life course, and in wider social and economic spheres-to achieve greater health equity and protect future generations.
Bibliographical noteFunding Information:
The European Review of Social Determinants and the Health Divide was commissioned by the WHO Regional Office for Europe to inform the new European policy framework for health and well-being—Health 2020. The focus of the review was to identify key policy areas in the European region likely to be most effective in addressing social determinants of health and in reducing health inequities, building on the work of the Commission on Social Determinants of Health. The aim was to make recommendations that can be actioned in all countries in the European region, taking account of their very different social and economic situations. The review was carried out by a consortium chaired by Michael Marmot of the Institute of Health Equity, University College London (London, UK) and supported by a joint secretariat from the Institute and the WHO European Regional Office. The review was informed and shaped by the work of 13 task groups and guided by a senior advisory board whose members are: Guillem Lopez Casanovas, Zsuzsa Ferge, Ilona Kickbusch, Johan Mackenbach, Tilek Meimanaliev, Amartya Sen, Vladimir Starodubov, Tomris Turmen, Denny Vagero, Margaret Whitehead, and ex-officio representatives of WHO, Agis Tsouros, and the European Commission, Michael Huebel. The task groups were based around the major social determinants of health. The available evidence was collated and interpreted by task groups, each comprising experts in the particular social determinant and related areas. The task groups and their chairs were early years, education and family (Alan Dyson and Naomi Eisenstadt), employment and working conditions (Johannes Siegrist), social exclusion, disadvantage, and vulnerability (Jennie Popay), GDP, taxation, income, and welfare (Olle Lundeberg), sustainability and community (Anna Coote), gender issues (Maria Kopp), older people (Emily Grundy), ill health prevention and treatment (Gauden Galea and Witold Zatonski), economics (Marc Suhrcke and Richard Cookson), governance and delivery mechanisms (Harry Burns and Erio Ziglio), global influences (Ronald Labonte), equity, equality, and human rights (Karien Stronks), and measurements and targets (Martin Bobak and Claudia Stein). The authors of the paper formed the UCL Secretariat, supported by Matilda Allen. The WHO Secretariat was led by Agis Tsouros, with Johanna Hanefeld, Piroska Ostlin, Asa Nihlen, Chris Brown, Isabel Yordi, Sarah Simpson, and Richard Alderslade.