The background

Evidence on social variations in health and life expectancy has accumulated over the last decades (Drever & Whitehead 1997; Marmot & Wilkinson 1999; Mackenbach & Bakker 2002). It points to the fact that, despite overall improvements in population health and welfare policies, an individual’s socio-economic position remains strongly associated with health across the life span: childhood mortality, morbidity and accidents are more prevalent in socially disadvantaged groups; health-damaging behaviours shaped in adolescence like smoking, poor diet and lack of physical activity are more prevalent among the poorer sections of the population; the risk of developing chronic illness in adult life, such as coronary heart disease or depression, is elevated for persons with a lower socio-economic background and premature mortality is more frequent.

International studies show that relative mortality differences between high and low socio-economic groups have increased within European countries (Mackenbach et al. 2003) leading to actual differences in life expectancy of between four and seven years in men and about four years in women. Social epidemiological research indicates that poor health is not simply confined to those at the bottom of the social hierarchy: There is a social gradient of mortality and morbidity that affects all members of society: With each step one moves down the social hierarchy, health worsens (Marmot et al. 1984).

Reducing socio-economic health inequalities is therefore one of the main challenges for the public health sector in Europe. However, what is known and being done in European partner countries is as yet unclear — how do policy processes impact on the health gap? And how should effective interventions be shaped?

The projects

Two projects that are funded by the European Commission from 2004 to 2007 address the issue of tackling health inequalities from a complementary perspective:

‘Closing the Gap: Strategies for Action to tackle health inequalities in Europe’ is being carried out by 22 national public health and health promotion agencies under the auspices of the Federal Centre for Health Education (BZgA) and EuroHealthNet, a network of national organisations with responsibility for public health and health promotion in European countries. The project aims at developing a European knowledge base and infrastructure in order to implement and strengthen strategies and actions to reduce health inequalities. Among questions examined will be:

  • Which processes initiated by the European institutions have an impact on the reduction or widening of the health gap in partner countries?

  • What is the state-of-the-art research and information needed to tackle health inequalities in the partner countries? What are priorities and what are challenges for national policy development?

  • Which good practices, i.e. effective interventions at local level, are transferable to other European countries?

Results will be made available in a European online directory at www.health-inequalities.org. Furthermore, they will be discussed on the occasion of 22 national seminars to be held in 2007. The project benefits from the involvement of an advisory board of leading experts in the field, namely Prof. Hilary Graham, Dr. Andreas Mielck, Prof. Margaret Whithead, Dr. Erio Ziglio and Dr. Joan Benach.

If you need more information, please contact Simone Weyers at BZgA simone.weyers@bzga.de.

‘Tackling health inequalities in Europe: an integrated approach (EUROTHINE)’ is carried out by a research network including about 50 researchers from most EU member states. The project is coordinated by Erasmus MC at Rotterdam. The project aims to collect and analyse information on socioeconomic inequalities in health from a wide range of European countries in order to facilitate mutual learning and to help policy-makers develop rational strategies for tackling health inequalities. It consists of three main parts.

The first is descriptive and will give an overview of inequalities in health and health determinants in all the participant countries, by acquiring and analysing national data sets from each country;

The second part is policy-oriented and will assess evidence on the effectiveness of policies and interventions to tackle health inequalities, through a systematic review of the scientific literature and by re-analysing selected case studies;

The final part will disseminate the results together with recommendations for policies to tackle health inequalities. Results will be made available through presentations and publications in international media such as scientific journals and online at www.eurothine.org.

The project will benefit from the close cooperation of many leading scientists from each participating country. If you need more information, please contact Anton Kunst at Erasmus MC a.kunst@erasmusmc.nl.