Diagnosing the EU’s state of health to fight inequalities

European Progressives can be proud of this achievement as it reaffirms the European Union's commitment to further develop the European social.


Social Europe is back. The wind is in our sails. The signal came once again with the joint proclamation last November at the EU Social Summit of Gothenburg of the European Pillar of Social Rights by the Council, the Parliament and the Commission. European Progressives can be proud of this achievement as it reaffirms the European Union’s commitment to further develop the European social model based on 20 core principles.


Given that I am the EU Commissioner responsible for health, it will come as no surprise that I am particularly pleased with the inclusion of principle number 16: “Everyone has the right to timely access to affordable, preventive and curative healthcare of good quality.” The Social Pillar thereby recognises the role of universal access to good quality care, cost-effective provision of care, health promotion and disease prevention – in other words, the need to invest in health.

Key questions 

How can we make the principles of the pillar tangible for our citizens? How can we ensure that people remain as healthy as possible for as long as possible? How can we reduce health inequalities? How can we keep healthcare affordable, accessible in a timely manner and able to deliver better outcomes for all patients? How should we organise and finance our healthcare models to ensure that they are fit to respond to tomorrow’s needs? These are among the many questions that we are collectively responsible for and that we will have to address.

Our populations are ageing, multimorbidity is increasing, leading to growing demand for innovative – and often expensive – technologies. We have to do more with less and for longer.

The pressure on the EU systems will not diminish in the years to come. Our populations are ageing, multimorbidity is increasing, leading to growing demand for innovative – and often expensive – technologies. We have to do more with less and for longer.

EU’s State of Health initiative

In light of this, we made it a key priority to build up country-specific and cross-country knowledge of health systems. Our recent Commission initiative on the State of Health in the EU strengthens country-specific and EU-wide knowledge in the field of health – including through the EU’s Country Health Profiles, which I launched last November. The State of Health initiative gives a broad horizontal overview of the health status of the EU citizens and the performance of our health systems. It contains a wealth of knowledge, including on promoting good health and on access to healthcare, and it helps to identify areas where priority must be given to tackling health inequalities.

Health inequalitiesmore than 10% of low income people in several EU countries report unmet health care needs. 

These persist across and within EU countries. As with the Pillar’s Social Scoreboard, the State of Health initiative notably features the same core indicator for accessibility: unmet need for medical examination – and it shows that in the four best performing Member States only 0.5% of the population or less report having unmet needs, whereas the four EU countries ranking last report figures 8% or higher.

In addition, premature mortality rates from chronic diseases are at least twice as high as the EU average in Bulgaria, Hungary and Latvia. A man of 65 in Bulgaria has a life expectancy of 10 years less than a woman of 65 in France who can expect to live another 24 years. Low spending countries have much higher preventable mortality rates (in Lithuania, Latvia and Romania, these preventable death rates are above 300 per 100,000 population). Workforce shortages are also a challenge in many countries and there are persisting/growing problems regarding the uneven geographic distribution of doctors, with people living in rural and remote areas often being underserved.

Unmet needs: affordability and access to education

Such inequalities are partly due to disparities within countries in access to timely and affordable healthcare: more than 10% of low income people in several EU countries report unmet health care needs. Affordability and access to education are major issues. In 2014, poor people were on average ten times more likely to report unmet medical needs for financial reasons than more affluent people.

More than 10% of low income people in several EU countries report unmet health care needs.

When it comes to prevention and early diagnostics, breast cancer screenings as an example vary between 66% for the lowest educated part of the population to 75.5% in the highest part. The key cause of these inequalities is disparities in exposure to health risks, with unhealthy behaviour being disproportionally prevalent amongst the lower paid and lower educated. Take regular physical activity: it ranges from 26% in the lower income group to 39% in the higher income group.

Universal access to healthcare

These figures illustrate why universal access – not only to medical treatment, but also to preventive care – is so important. As the European Commissioner for Health, ensuring that all citizens have the opportunity to attain the same level of health and well-being is one of my key priorities.

In the European Union, nobody should be left aside and reducing health inequalities is a central dimension of this Social Europe. Access to healthcare should not be defined according to income: people with lower incomes should not be prevented from accessing the care they need because they cannot afford it – and paying to jump the waiting queues is not acceptable either. We should all have access to healthcare when we need it no matter where we live. This is about our common values in Europe.

Preserving our European social model and social cohesion for future generations is a constant fight. The State of Health initiative can help us in this respect as we now have very useful country-specific and cross-country knowledge of health systems. I count on national authorities to further discuss these reports with the experts of the Organisation for Economic Cooperation and Development (OECD) and the European Observatory on Health Systems and Policies early this year so that they can help ministries to better understand the main challenges and develop the appropriate policy responses. With the Commission’s support for national and regional health authorities, such as through the guidance for developing accessible health systems, I hope that all EU countries will engage in the fight against health inequalities.

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