Governments turn to WHO for help on health inequality

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The World Health Organisation (WHO) has seen a huge increase in European countries seeking technical assistance in tackling health inequality, as the economic crisis continues to exacerbate the social equity gap.

Of the 53 counties in the European region as defined by the WHO, just six sought help on health equality in 2006. This jumped to 12 in 2008 but now stands at 23.

"We will have a big problem dealing with this unbelievable increase in requests for help," said Erio Ziglio, head of the European office for investment for health and development at the World Health Organisation (WHO).

He warned that the economic downturn could continue to erode health equality if adequate measures are not taken.

Health inequality goes hand-in-hand with other social issues such as unemployment and spending fewer years in education, said Ziglio, but data on the problem remains patchy.

Problem compounded by dearth of data

The WHO cautions that health statistics often present national averages which overlook disparities within countries. Differences of more than a decade in life expectancy can be seen within cities and regions across Europe.

Even in very sophisticated high-income countries there are difficulties in getting high-quality data that takes account of age, gender and social background, Ziglio said, stressing the need for good systems to monitor this at local, regional and national level.

When data is collected some authorities bury their heads in the sand while others try to take action, he said. However, even those that look to respond tend to launch pilot projects which are much too small to have an impact, with only a handful of countries having taken a coordinated approach.

No excuse for inaction, say NGOs

Campaigners warn that the dearth of hard data in some corners of Europe should not be held up as a reason for inaction.

Clive Needle, director of Eurohealthnet, a network of government agencies responsible for health in Europe, said measuring and understanding the problem are key to achieving this.

"But it's not just about building data. We already have enough information to act. All too often policymakers use the lack of data as an excuse not to act," he said.

Needle said there is already enough evidence to show that more equal societies perform better than unequal societies on a huge range of social issues including mortality, murders and teen pregnancies.

He said ironing out inequality in a sustainable and fundamental way would require society to tackle the inequalities in the distribution of power, money and resources – the "structural drivers of health inequality".

In addition, there is concern that political resistance and a skills deficit on the ground in local authorities is blunting the effectiveness of projects designed to tackle social and health inequality.

This is often compounded by the tendency to change policies every time a new government comes to office, sparking calls for a consensus-based approach to the problem which unites political constituencies and civil society.

Speaking at a conference in Brussels hosted by the European Policy Centre (EPC), experts also said the cross-border healthcare directive, which will allow greater patient mobility in Europe, will not exacerbate health inequalities as some critics have claimed.

Charles Price, policy officer for social determinants and health inequalities at the European Commission, noted that while health is not a major feature of the Europe 2020 growth strategy, health inequalities do come under the heading "inclusive growth".

He said the Lisbon Treaty had shored up the EU's role in public health, provided there is "added value" in taking a Community-wide approach and the principles of proportionality and subsidiarity are respected. He said Lisbon requires that Brussels promotes "well being", which is central to the definition of health.

"The EU is also required to pursue the goals of solidarity, equal opportunities and human rights," all of which touch on health inequality, the official suggested.

Price said it was regrettable that spending on the health programme is down from 13c per person per year in 2004 to just 10c per person per year since the major expansion of the EU six years ago.

Clive Needle, director of Eurohealthnet, said building health equity is fundamental to the work of the EU. He called for a greater appreciation of the fact that the developed world is in the midst of a major technological revolution which will bring social upheaval akin to the agrarian and industrial revolutions.

Developing health literacy and providing Internet access to all citizens will be essential in closing the inequality gap, according to Needle. "We are talking about fairness for all," he said.

Fabian Zuleeg, chief economist at the European Policy Centre (EPC), said the economic downturn will make issues around inequality even more pronounced. "We are going through a profound economic crisis which will have a major social impact in the coming years," he said.

Health inequality is estimated to cost around 1.4% of GDP, prompting calls for investment in social and health services in an effort to boost the economy in the longer term (EURACTIV 11/01/10).

Health inequalities between European countries have grown in recent decades, along with inequity within countries. Indeed, there can be up to a 20 year gap in life expectancy from one neighbourhood to another in cities such as Glasgow, where affluence and deprivation live in close proximity.

The WHO has estimated that 50% of the growth differential between rich and poor countries is due to ill-health and shorter life expectancy. Increasing life expectancy at birth by 10% could increase economic growth by 0.35% per year, it says. 

Income, education, living and working conditions, health behaviour and access to health care are cited as contributing factors to lifespan. 

Former EU Health Commissioner Androulla Vassiliou pledged to use EU funds to improve the health of the worst off and narrow health gaps between regions by boosting primary care facilities, water and sanitation services (EURACTIV 11/01/10).

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