08 July 2010
Reducing health inequalities and monitoring social determinants of health in the European Union: a priority of the Spanish Presidency of the European Union 2010
Many health problems and most causes of premature death are conditioned by social factors such as education, employment and working conditions, income, living environment and social exclusion which affect the population unequally and are largely outside of the remit of the health sector. Addressing the social determinants of health and working to achieve health equity are among the most important current public health challenges in Europe and worldwide .
The term ‘health equity’ can be described as relating to differences in population health which can be traced to unequal social and economic conditions. Those differences can be considered as systemic and avoidable and therefore be seen as unjust. Europe could and should demonstrate the potential of public health policies in terms of their benefits for health and health equity. In this sense, special attention needs to be given to vulnerable groups. As an example, protecting the health of vulnerable and marginalised groups is both an end in itself and an essential element of tackling the HIV/AIDS epidemic [2-3].
An important priority of the Spanish Presidency of the European Union (EU), January – June 2010, was to address health inequalities and the monitoring of social determinants of health in the EU. Other EU Presidencies, the European Parliament, the European Commission (EC), the World Health Organization (WHO) and further international organisations have previously addressed socially determined health inequalities through different approaches [4-9]. However, there are indications that such inequalities may be growing, aggravated by increased unemployment and uncertainty arising from the current economic crisis [10-12].
In order to achieve its objective to monitor social determinants of health and reduce health inequities the Spanish Presidency organised a series of events where policy makers and technical experts discussed and exchanged experiences from an intersectoral perspective.
At the March 2010 meeting of the employment, social policy, health and consumer affairs (EPSCO) Council, health ministers came to a common agreement on the importance of finding mechanisms to reduce the socially determined health inequalities in the EU and agreed on possible strategies for working further on the monitoring of social determinants of health . The adoption of the conclusions on “Equity and Health in All Policies: Solidarity in Health” by the June EPSCO Council meeting where the Council of the EU urged all Member States to recognise the impact of the social determinants of health in shaping health status and the implications of this impact for their health and social systems, also progressed discussions . A situation analysis report, commissioned by the European Commission, the WHO, the International Labour Office, universities and other relevant organisations was published and has become a relevant reference in the field .
The Spanish Presidency highlighted the relevance and importance of tackling socially determined health inequalities in the EU. The steps taken during the Presidency will provide a basis for reaching consensus on suggestions and best ways for implementing policies at national and international levels.
Members of the Technical Committee for the priority of the Spanish Presidency on “Monitoring Social Determinants of Health and the Reduction of Health Inequalities” are: D Catalán Matamoros (DGSPySE_inter@msps.es), K Fernández de la Hoz, P Campos Esteban, B Merino Merino, RM Ramírez Fernández, I Hernández Aguado.
- Hernandez Aguado I, Campos Esteban P, Catalan Matamoros D, Fernandez de la Hoz K, Koller T, Merino Merino B et al. Moving Forward Equity in Health: Monitoring social determinants of health and the reduction of health inequalities. Madrid: Ministry of Health and Social Policy; 2010. Available from: http://www.msps.es/en/presidenciaUE/calendario/conferenciaExpertos/docs/haciaLaEquidadEnSalud.pdf
- United Nations Population Fund. Preventing HIV/AIDS. Focus on Especially Vulnerable Groups. Available from: http://www.unfpa.org/hiv/groups.htm.
- Ministry of Health and Social Policy. National AIDS Strategy Secretariat. Conference on ‘Vulnerability and HIV in Europe’. 13 April, Madrid, Spain., 2010. Available from: http://www.msps.es/ciudadanos/enfLesiones/enfTransmisibles/sida/docs/vulnerabilidad/VulnerabilityHIVEuropeConclusionsFinal.pdf
- World Health Organization. Commission on social determinants of health: note by secretariat. Geneva 2004: WHO document number; EB115/35. Available from: http://apps.who.int/gb/ebwha/pdf_files/EB115/B115_35-en.pdf
- European Commission. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Solidarity in health: reducing health inequalities in the EU. Brussels: COM (2009)567/4; 2009.
- European Commission. Expert Group on Social Determinants and Health Inequalities. Background paper from the European Commission: EU action to reduce health inequalities. Brussels:. 2006 Available from: http://ec.europa.eu/health/ph_determinants/socio_economics/documents/ev_060302_co01_en.pdf
- Jennings T, Scheerder G. Report on the Role of Health Promotion in Tackling Inequalities in Health. Brussels: The Flemish Institute for Health Promotion (VIG) in collaboration with the European Network of Health Promotion Agencies (ENHPA); 2001.
- Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K, editors. Health in All Policies: prospects and potentials. Helsinki: Ministry of Social Affairs and Health, and the European Observatory on Health Systems and Policies; 2006.
- Council of the European Union. Presidency Conclusions. Brussels: 11018/1/08; 2008.
- Commission of the European Communities. White paper. Together for Health: A strategic approach for the EU 2008–2013. Brussels: COM(2007) 630 final; 2007.
- European Commission. Solidarity in health: reducing health inequalities in the EU. Brussels: COM (2009)567/4; 2009
- Council of the European Union. Presidency Conclusions. Brussels: 11018/1/08; 2008. Available from: http://www.consilium.europa.eu/ueDocs/cms_Data/docs/pressData/en/ec/101346.pdf
- Council of the European Union. Equity and Health in All Policies: Solidarity in Health. Brussels: 9947/10; 2010. Available from: http://register.consilium.europa.eu/pdf/en/10/st09/st09947.en10.pdf