A Europe Sick with Inequalities: The EuroHealthNet Report
REHACARE 2025: Innovations for Mobility and Care
23 September 2025
Égalité's investigation into the accessibility of a primary school in Rome
10 October 2025
Europe has never lived so long. With an average life expectancy of 81,4 years, European citizens are living longer than at any other time in history. However, this figure hides an uncomfortable truth: health, like wealth, is profoundly unequally distributed. It's not just a question of geography—a child born in Spain can expect to live over eight years longer than one born in Bulgaria—but of social class.
This is the picture that emerges from the report 'Social Inequalities in Health in the EU', compiled by EuroHealthNet in collaboration with the Centre for Health Equity Analytics (CHAIN) and based on data from the European Social Survey (ESS).
The abyss of inequality
The first, great mystification is the average. While in Malta you can expect to live 71 years, in good health, in Latvia this milestone stops at 53. A gap of 18 years.
The heart of the problem lies not only between countries, but within them. The ESS reveals that across Europe, a person with a low level of education (middle school qualification) has the 40% chance to declare to be in poor health, against the 20% of those who have a college degree. Double. And it's not a clear boundary between rich and poor, but a 'social gradient': the higher you climb the social ladder, the better your health becomes. Managers are more likely to live longer and healthier than office workers, who, in turn, are better off than workers.
Health as a thermometer of society
Why should we, as citizens and as leaders, care about this? The answer is threefold.
- ethicsHealth is a fundamental human right. The extent of inequalities is a litmus test of how just and supportive a society is:
- Economic SustainabilityA sick population is a less productive population. Direct healthcare costs are added to the indirect costs of absenteeism, presenteeism (working while ill), and workforce loss;
- social and democraticResearch shows a vicious cycle between poor health, distrust of institutions, and democratic disengagement. A sick society is a fragile society, less capable of addressing epochal challenges such as the green and digital transitions or geopolitical crises.
The real culprits are not (only) the geniuses
One of the most enduring myths is that health is the result of individual choices and DNA. The report debunks this narrative: health care accounts for only 10% on the health differences of the population. The remaining 90% is governed by social determinants:
1. financial security
2. accommodation
3. technology
4. social nets
5. working and living conditions.
These factors, in turn, reflect deeper inequalities of power and opportunity. The real problem, the report denounces, is systemic. Political and economic systems determine the equitable distribution of resources through taxation, minimum wages, and welfare policies. Furthermore, business practices play a harmful role: lower socioeconomic groups are the favorite targets of harmful and low-cost products, such as ultra-processed food or l 'alcohol.
Products and business practices are responsible for almost one death in four (24,5%) in the European region. Combating health inequalities, therefore, requires a whole-of-government approach.
The map of malaise
The report analyses ESS data from 2014 and 2024 for 14 EU Member States and 3 other European countries, tracing a decade of evolution.
Physical health: a two-speed Europe
In 2024, nearly one in three Europeans (30%) reported their health to be "fair" to "very poor." The aggregate figure has improved slightly (-1,8% in 10 years), but it hides opposing trends.
The virtuousSlovenia and Poland are beacons of hope. They are the only countries where the gap between the educated and the less educated is narrowing, while at the same time general health is improving for everyone. They have found the formula for growth without leaving anyone behind.
The unequalsAustria, Germany, and Hungary have improved average health, but at a very high price: rising inequality. In Austria and Germany, the benefits have gone exclusively to the most educated, creating an ever-widening divide. In Hungary, everyone is better off, but the rich have improved more than the poor.
The worrying involutionBelgium, Norway, and Lithuania have the worst results: health deteriorates for everyone and inequalities increase. This is a warning sign for social models considered among the most advanced.
The Scandinavian ParadoxSweden and Ireland have seen inequalities decrease, not because the most disadvantaged are better off, but because the health of the most educated has deteriorated. It's a leveling down.
Mental health, the silent pandemic and the burden of the profession
Mental health is the most sensitive indicator of social malaise. On average, 12% of Europeans (one in eight adults) report poor mental health, a figure that has remained stable since 2014. But also
Here, inequalities are marked.
The gap widens based on profession: only the8% of managers and professionals declare problems, a percentage that rises to 18% among those who perform manual or routine work. More than double.
Even in this context, very different national dynamics emerge.
- The modelsHungary and Slovenia continue to shine: stable or improving mental health for all, and narrowing gaps.
- The Iberian turning pointSpain, Portugal, and Lithuania show an interesting pattern: mental health improved for low-skilled groups and worsened for high-skilled ones, reducing inequalities in a context of rising averages.
- The crisis of well-beingBelgium, the United Kingdom, Norway, and Ireland are seeing inequality decline, but only because everyone's mental health is deteriorating, with the decline most pronounced at the top. In Norway, paradoxically, less-skilled workers are doing better mentally than ten years ago, while managers are doing worse.
- The worst in the rankingsGermany, France, Sweden, Switzerland, and Finland show the most alarming trend: average mental health is deteriorating, while at the same time, gaps between professional classes are widening. This is a sign of stressed societies, where pressure is eroding psychological well-being unequally.
The factors that trigger inequalities
The multivariate analysis of the report identifies the factors that most influence inequalities.
For the physical health, the number one factor is the perception of economic security ('Having enough money to live comfortably'). In second place is the body weight, followed by working conditions, smoking and financial difficulties during childhood.
For mental health, once again, the economic security is the main driver. Immediately after, the control over one's work (autonomy, decision-making power) proves crucial. Stress and a sense of powerlessness in daily life complete the picture.
These data confirm that equity policies must start with the wallet and dignity at work.
Ways Out: What Works in the Field
The report does not simply diagnose the disease, but proposes treatments, highlighting virtuous case studies.
The systems approach: welfare economics in Finland
Finland has operationalized the concept of a "well-being economy" with a National Action Plan (2023–2025). It has created indicators and tools to integrate well-being into every policy decision, with a 2050 vision that balances social, economic, and environmental objectives. This means that a Ministry of Transport, before approving infrastructure, must assess its impact not only on GDP, but also on the health and social cohesion of citizens.
The targeted tax: the Polish sugar tax
Poland, with a 2015 amendment, introduced a tax on sugary drinks. The goal was twofold: to discourage consumption (especially among low-income groups, who are more exposed to marketing for these products) and to encourage manufacturers to reformulate recipes. It's a classic example of a "universalist" policy (it affects everyone) that has a "proportional" impact (it helps the most vulnerable more).
Proportionate universalism: the example of Flemish Belgium
The Flemish Institute of Healthy Living supports organizations in applying the principle ofproportionate universalismUniversal services accessible to all, but delivered with an intensity and scale proportional to need. This isn't welfare, it's equity. Programs are offered for everyone, but more resources and attention are dedicated to the most disadvantaged communities.
Targeted interventions: Roma women's health in Greece
In Athens, the Prolepsis Institute runs a health promotion program for Roma women, directly involving them in designing courses (on sexual health, cancer prevention, and vaccinations). This demonstrates that reaching the most marginalized groups requires a tailored approach and direct community involvement.
Healthcare Leadership: Norway and Spain
Even though healthcare is decided outside of hospitals, the healthcare sector has a leading role.
In NorwayThe Public Health Act makes reducing inequalities a legal responsibility at all levels of government, providing municipalities with local health profiles to guide interventions.
In Spain, the Ministry of Health has published a 'health equity checklist', a practical tool to help decision makers and professionals integrate equity into every strategy and program.
The challenge of Brussels and the (too timid) role of the European Union
The EU has the tools to be a decisive player, but its potential is underused.
The European Pillar of Social Rights: A framework to fill
The European Pillar of Social Rights is a set of 20 fundamental principles and rights, promulgated in Gothenburg in 2017. It is the most promising framework. Principle 16 establishes the right to quality and accessible healthcare. Tools such as the European guarantee for children (to combat child poverty) and the plan for aaffordable housing These are concrete initiatives that, if scaled up, can address the social determinants of health. However, the EU cannot impose these policies; it can only monitor progress through the European Semester and the Social Scoreboard, a process that often lacks binding force.
Untapped Powers: Regulating the Giants of Commerce
The EU has the power to regulate the "commercial determinants of health" (tobacco, alcohol, unhealthy foods), but it has done so too slowly and timidly. Industry lobbying has often delayed or watered down legislative proposals. The upcoming Cardiovascular Health Action Plan will be a crucial test.
The Funds: The Cohesion That Can Heal
Cohesion policy, with its structural funds, is the EU's most powerful social investment instrument. The next Multiannual Financial Framework (2028-2034) will be crucial. If the goal is competitiveness and security, as stated in the new guidelines, then investing in health equity is not a cost, but a prerequisite. A sick and stressed workforce cannot compete globally.
Conclusions and recommendations: an agenda for a healthier and fairer Europe
The picture that emerges is worrying. Health inequalities are profound, unjust, and, in many countries, worsening. The fact that mental health is deteriorating and gaps are widening in wealthy nations like Germany and Sweden is a wake-up call that cannot be ignored.
The report's recommendations are a concerted and radical call to action.
Key recommendations to address root causes:
1. income and work. Ensure an adequate minimum income and living wages. Improve working conditions, especially workers' control over their activities;
2. healthy environmentsAddress the housing crisis and ensure access to healthy food by aggressively regulating junk food marketing;
3. Prevention. Reorienting health systems from treatment to primary prevention, investing heavily in mental health promotion.
Recommendations for effective governance:
1. integrate equity into all policies. Incorporate health equity objectives into the EU's anti-poverty strategy, the European Semester, and the structural funds. Organize joint EU Councils between the ministers of Health, Social Affairs, and Finance;
2. health leadershipThe health sector must lead cross-sectoral action, establishing high-level mechanisms and engaging citizens, especially the most marginalized voices;
3. data and transparencyFill data gaps, especially for children. Collect more detailed and comparable information, and report regularly on progress;
4. practical tools. Systematically use health equity impact assessments for all major policies and communicate the results to citizens.
The diagnosis and therapies are identified. The question that remains is whether there will be political will, at national and European level, to act.
Marta Strinati
References
– EuroHealthNet-CHAIN report. Social inequalities in health in the EU. Are countries closing the health gap? September 2025 https://eurohealthnet.eu/publication/social-inequalities-in-health-in-the-eu/
