Health inequalities in the European Health Union

By Dr Milka Sokolović, Director General European Public Health Alliance (EPHA)

Due to their restricted access to basic rights, the COVID-19 crisis has disproportionately hit vulnerable population groups. Existing socio-economic disadvantage and greater exposure to unemployment, poverty and poor health has been only exacerbated by the pandemic1, leading to higher mortality rates and risks of complications from increased prevalence of co-morbidities,2 emphasizing once again the disastrous impact of health inequalities. Nevertheless, despite the evidence demonstrating the greater public health and socio-economic impacts on vulnerable groups, health inequalities have received insufficient attention from policy makers. The issue remains under-addressed in major EU policies aiming to mitigate the effects of the pandemic on European societies and economies, which threatens to leave long-term consequences on health equity and social fairness across the EU.

Reacting to the severity of COVID-19 crisis, and aiming to strengthen coordination between European countries in the context of cross-border health threats, the European Commission has launched a proposal for a European Health Union.

The initiative seeks to support Member States through specific policy and financial mechanisms, to positively impact access to essential health and prevention services, medical supplies, and treatment of non-communicable diseases, showing a notable political will to ensure better protection of people’s health.

It does not, however, seem to allocate sufficient investment in health inequalities despite their systemic and cross-border character, spurring the development of a growing public health challenge.3 Examples include a missed opportunity to invest in equitable distribution of COVID-19 vaccines, and to seriously address the needs of disproportionately affected communities, along with the structural barriers that they face (beyond the exclusion from national vaccine deployment strategies).

Systemic health disparities impacting the quality of life of entire communities remain a severe obstacle for the achievement of the proposed European Health Union’s objectives. The exclusion of these communities from primary healthcare services and national and European crisis response strategies has already generated a heavy burden on national economies4, and in the absence of comprehensive European initiatives, will only continue to hamper the resilience and capacity of our healthcare systems.

Consistently addressing health inequalities in major European policies would be in line with principle 16 of the European Pillar of Social Rights5, and would help lessen the societal, public health, and economic burden.

The European Health Union should look holistically at the resilience of public health systems, and advance integrated policy measures prioritising health equity in EU and national policies. Better developed information, vaccine, and healthcare delivery channels should be identified to address the needs of marginalised populations in global health emergency preparedness and response planning. Making tackling health inequalities one of the top political priorities of the European Health Union is a key prerequisite for achieving its main aims – reinforcing health systems, ensuring their resilience, and building EU preparedness for upcoming health crises.