Elsevier

The Lancet

Volume 362, Issue 9393, 25 October 2003, Pages 1409-1414
The Lancet

Public Health
Tackling socioeconomic inequalities in health: analysis of European experiences

https://doi.org/10.1016/S0140-6736(03)14639-9Get rights and content

Summary

Effective strategies must be developed to reduce socioeconomic inequalities in health. Most efforts take place in isolation, and only the UK experience has been discussed widely in international published work. We therefore analysed policy developments on health inequalities in different European countries between 1990 and 2001. We noted that countries are in widely different phases of awareness of, and willingness to take action on, inequalities in health. We identified innovative approaches in five main areas: policy steering mechanisms; labour market and working conditions; consumption and health-related behaviour; health care; and territorial approaches. National advisory committees in the UK, the Netherlands, and Sweden have proposed comprehensive strategies to reduce health inequalities. Variations between these packages suggest that policymaking in this area still is largely intuitive and would benefit from incorporation of more rigorous evidence-based approaches. Further international exchanges of experiences with development, implementation, and evaluation of policies and interventions to reduce health inequalities can help to enhance learning speed.

Section snippets

National policy developments

European countries are in widely different phases of awareness of, and willingness to take action on, socioeconomic inequalities in health. The figure shows policy developments in nine countries for which we have gathered information. The first event included in the figure is publication of the Black report in 19803. More than a decade passed before further action was taken in the UK, in the form of national research programmes and important government and non-government reports,4, 5

Innovative approaches

We identified several specific innovative approaches to reduce health inequalities and classified them in five main areas (panel 1). For every innovation (except for some of the more complex approaches) empirical evidence suggests they can help to reduce health inequalities.

Reduction of socioeconomic inequalities in health requires sustained action in many policy areas. Although outcome-oriented targets such as WHO's 25% reduction of health inequalities13, 14 may inspire and motivate, they are

Conclusions

Whether it will actually be possible to substantially reduce socioeconomic inequalities in health remains an open question. European trends in inequalities in mortality during the last decades of the 20th century have generally shown a widening of the gap in relative terms, and at best a stable situation in absolute terms.29 The good news is that during the 1990s, a great amount of progress was made in development of policies and interventions, putting us in a better position to reduce

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