Socially determined health inequalities (SDHI) in the European region have been increasing (1-5) and are likely to continue to do so without determined action to counter them. Left unchallenged, their negative consequences on vulnerable populations will also impose costs on society as a whole.

These health inequalities are caused by and relate to social determinants such as poverty, unemployment, unsafe working conditions and precarious work, gender norms and standards and level of education (6) as well as activity in the health system itself. While the health system alone cannot reduce health inequalities, it nevertheless has a vital role in achieving that goal, and as part of any overall approach to tackling SDHI. This is by acting to :

  • improve how we do our own business within the health system. This includes ensuring equity of access to health services and providing services that ameliorate and remedy the health disadvantages among sub-groups in the population and that are caused by social determinants such as poverty, poor living conditions and unemployment; and
  • improve our investment and approach to working with other sectors so that we are instrumental in developing collaborative, inter-sectoral solutions that create the conditions for health for all groups in the population (7). 

This resource provides examples of existing health system actions that can be taken to tackle SDHI and as part of an overall approach to putting our own house in order. We suggest you read the "How it can be used" section before entering the resource database.


1, Corsini V. Population and social conditions: Highly educated men and women likely to live longer. Life expectancy by educational attainment. Luxembourg, Eurostat, 2010 (accessed 17 September 2010). (PDF, 213 KB)

2 .Fair society, healthy lives. The Marmot review executive summary. London, The Marmot Review, 2010 (accessed 17 September 2010). (PDF, 7,43 MB)

3. Solidarity in health: Reducing health inequalities in the EU. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Brussels, European Commission, 2009 (accessed 17 September 2010). (PDF, 49.0 KB)

4. Solidarity in health: Reducing health inequalities in the EU. Background document for Press Pack - Launch of Commission Communication. Brussels, European Commission, 2009 (accessed 17 September 2010).  (PDF, 930 KB)

5. Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008 (accessed 17 September 2010). (PDF, 7,3 MB)

6. The European Health Report, 2009: health and health systems. Copenhagen, WHO Regional Office for Europe, 2009 (, accessed 17 September 2010). (PDF, 7,72 MB)

7. Putting our own house in order: Examples of health system action on socially determined health inequalities. Studies on social and economic determinants of population health, No. 6. Copenhagen, WHO Regional Office for Europe