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 {SEC(2009) 1396} {SEC(2009) 1397}
Date: 2009-10-20
Institutions: European Commission
Subjects: health policy, public health, social inequality

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COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 20.10.2009 
COM(2009) 567 final 

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 

{SEC(2009) 1396} 
{SEC(2009) 1397} 

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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 

(Text with EEA relevance) 

1. 

EQUAL OPPORTUNITIES AND SOLIDARITY IN HEALTH  

European  Union  (EU)  citizens  live,  on  average,  longer  and  healthier  lives  than  previous 
generations. However, the EU is faced with an important challenge: the large gaps in health 
which exist between and within EU Member States. Moreover, there are indications that such 
gaps  may  be  growing.  Increased  unemployment  and  uncertainty  arising  from  the  current 
economic crisis is further aggravating this situation. This communication launches the debate 
needed to define potential EU-level flanking measures to support actions by Member States 
and other actors to address this issue. 

Concerns  over  the  extent  and  the  consequences  of  health  inequalities  –  both  between  and 
within Member States - have been expressed by the EU institutions and many stakeholders, 
including  through  the  consultation  on  this  Communication.  The  European  Council  of  June 
2008 underlined the importance of closing the gap in health and in life expectancy between 
and  within  Member  States1.  In  2007  the  EU  Health  Strategy2  set  out  the  Commission's 
intention  to  carry  out  further  work  to  reduce  inequities  in  health.  This  was  reiterated  in  the 
2008  Commission  Communication  on  a  Renewed  Social  Agenda3  which  restated  the 
fundamental  social  objectives  of  Europe  through  equal  opportunities,  access  and  solidarity 
and announced a Commission Communication on health inequalities.  

The  Commission  regards  the  extent  of  the  health  inequalities  between  people  living  in 
different parts of the EU and between socially advantaged and disadvantaged EU citizens as a 
challenge to the EU's commitments to solidarity, social and economic cohesion, human rights 
and  equality  of  opportunity.  Therefore,  the  Commission  is  determined  to  support  and 
complement Member States and other stakeholders in their efforts to tackle them.  

2. 

INEQUALITIES IN HEALTH IN THE EU 

While the average level of health in the EU has continued to improve over the last decades, 
differences in health between people living in different parts of the EU and between the most 
advantaged and most disadvantaged sections of the population remain substantial and in some 
instances have increased. Between EU Member States there is a 5-fold difference in deaths of 
babies under one year of age, a 14 year gap in life expectancy at birth for men and an 8 year 
gap  for  women.  Large  disparities  in  health  are  also  found  between  regions,  rural  and  urban 
areas and neighbourhoods. 

1 
2 
3 

http://tinyurl.com/n2xl6b  
COM(2007) 630. 
COM(2008) 412. 

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Throughout  the  EU  a  social  gradient  in  health  status  exists  where  people  with  lower 
education,  a  lower  occupational  class  or  lower  income  tend  to  die  at  a  younger  age  and  to 
have  a  higher  prevalence  of  most  types  of  health  problems4.  Workers  doing  predominantly 
manual  or  routine  repetitive  tasks  have  worse  health  than  those  doing  non  manual,  less 
repetitive  tasks.  Differences  in  life  expectancy  at  birth  between  lowest  and  highest  socio-
economic groups reach 10 years for men and 6 years for women.  There is also an important 
gender dimension, women in general live longer than men but may spend a longer proportion 
of their lives in ill health. 

Vulnerable and socially excluded groups such as people from some migrant or ethnic minority 
backgrounds,  the  disabled  or  the  homeless  experience  particularly  poor  average  levels  of 
health5. For example Roma have an estimated life expectancy 10 years less than the general 
population6. Reasons for poor health in such groups may include poor housing, poor nutrition 
and  health  related  behaviours  as  well  as  discrimination,  stigmatisation  and  barriers  to 
accessing health and other services7.  

Health  inequalities  are  due  to  differences  between  population  groups  in  a  wide  range  of 
factors  which  affect  health.  These  include:  living  conditions;  health  related  behaviours; 
education,  occupation  and  income;  health  care,  disease  prevention  and  health  promotion 
services as well as public policies influencing the quantity, quality  and  distribution  of these 
factors. Health inequalities start at birth and persist into older age. Inequalities experienced in 
earlier  life  in  access  to  education,  employment  and  health  care  as  well  as  those  based  on 
gender  and  race  can  have  a  critical  bearing  on  the  health  status  of  people  throughout  their 
lives.  The  combination  of  poverty  with  other  vulnerabilities  such  as  childhood  or  old  age, 
disability or minority background further increases health risks. 

Differences  in  health,  are  linked  to  a  number  of  socio-economic  factors  8.  Economic 
conditions  can  effect  many  aspects  of  living  conditions  which  can  impact  on  health.  Some 
areas  of  the  EU  still  lack  basic  amenities  such  as  adequate  water  and  sanitation.  Cultural 
factors which affect lifestyle and health behaviour also differ markedly between regions and 
population  groups.  Many  regions,  in  particular  in  some  of  the  newer  Member  States,  are 
struggling to provide much needed health services to their populations. Barriers to access to 
health  care  can  include  lack  of  insurance,  high  costs  of  care,  lack  of  information  about 
services  provided,  language  and  cultural  barriers.  Some  research  has  suggested  that  poorer 
social  groups  use  health  care  less  for  equivalent  levels  of  medical  need  than  more  affluent 
groups.  

As  health  inequalities  are  not  simply  a  matter  of  chance  but  are  strongly  influenced  by  the 
actions of individuals, governments, stakeholders, and communities, they are not inevitable. 
Action to reduce health inequalities means tackling those factors which impact unequally on 
the health of the population in a way which is avoidable and can be dealt with through public 
policy.  

4 
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6 
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8 

Health inequalities: Europe in profile. Mackenbach J., 2006. 
SEC(2006) 410. 
SEC(2008) 2172. 
Breaking  the  barriers:  Romani  women  and  access  to  public  health  care.  EU  European  Monitoring 
Centre on Racism and Xenophobia 2003. 
Monitoring progress towards the objectives of the European Strategy for Social Protection and Social 
Inclusion, 2008. 

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3. 

CURRENT EU FLANKING POLICIES  

In  2006  the  Council  agreed  conclusions  on  common  values  and  principles  in  EU  health 
systems stressing the overarching goal of reducing health inequalities9. Improving the access 
to health care and to disease prevention and promotion systems could certainly mitigate some 
of the health inequalities as pointed out in the EU Health Strategy. The contribution towards 
reducing health inequalities should be ensured in implementing initiatives such as the Council 
recommendation  on  cancer  screening, 
the 
Communication  on  patient  safety11  or  the  Proposal  for  a  Directive  on  the  application  of 
patients' rights in cross-border healthcare. 

the  Communication  on 

telemedicine10 

Addressing health inequalities is a key action of the EU Health Strategy (2008-2013) which 
identifies  equity  in  health  as  a  fundamental  value  and  has  led  to  an  orientation  towards 
addressing  health  inequalities  in  areas  such  as  mental  health,  tobacco,  youth,  cancer,  and 
HIV/AIDS.  The  EU  public  health  programme  has  supported  the  identification  and 
development  of  activities  to  address  health  inequalities  including  a  European  directory  of 
good practices12. First steps have been taken to improve data collection and the networking of 
Member states and key stakeholders.  

Through the Open Method of Coordination for Social Protection and Social Inclusion (social 
OMC)13 EU Member States have agreed to the objective of addressing inequalities in health 
outcomes.  This is supported by a set of common indicators based on Eurostat work on public 
health  statistics.  The  EU  level  analysis  of  Member  States'  National  Strategies  Reports  on 
Social  Protection  and  Social  Inclusion  has  helped  stimulate  debate  and  action  in  Member 
States. At EU level an expert group has worked since 2005 to review evidence and exchange 
information  on  policies  and  practice14.  EU  health  programmes  have  supported  a  number  of 
initiatives  on  health  inequalities.  The  Research  Framework  Programmes  (currently  FP7) 
provide  important  support  for  research  in  this  field,  and  a  variety  of  action  programmes 
including the Health Programme and the EU's employment and social solidarity programme 
PROGRESS15, finance studies, examples of good practice and policy innovations.  

Other  EU  policies  can  also  contribute  to  reducing  health  inequalities.  Reducing  health 
inequalities  is  also  an  objective  for  the  public  health  challenges  identified  in  the  EU 
Sustainable  Development  Strategy16.  The  goal  of  a  more  equal  distribution  of  health  is 
underpinned  by  the  EU's  overarching  objectives  to  create  economic  growth  with  social 
solidarity,  the  Lisbon  strategy.  EU  legislation  in  the  areas  of  labour  law  and  occupational 
health  and  safety  contributes  to  reducing  accidents  at  work  and  occupational  diseases.  EU 
environment policy and the market policies under the Common Agricultural Policy support a 
range  of  initiatives  which  can  contribute  to  improving  health.  The  EU  provides  financial 
support via the Cohesion policy and the European Agricultural Fund for Rural Development 
which can be used to reduce disparities between regions through investment in determinants 
of health inequalities, such as living conditions, training and employment services, transport, 

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OJ C 146, 22.6.2006, p. 1.  
COM(2008) 689. 
COM(2008) 836. 
European Directory of Good Practices to reduce health inequalities. http://tinyurl.com/ybrpdy2 
COM(2005) 706. 
http://tinyurl.com/dmycvx 
OJ L 354, 31.12.2008, p. 70. 
Council of the European Union. Doc 10117/06. 9 June 2006. 

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technologies, health and social care infrastructure. Further consideration of the contribution of 
this 
the 
existing  EU  policies 
Communication.  

impact  assessment  accompanying 

is  contained 

in 

4. 

TAKING ACTION ON HEALTH INEQUALITIES: A COLLABORATIVE APPROACH 

The  need  for  further  action  arises  because  of  increasing  evidence  on  the  size  and 
pervasiveness  of  health  inequalities  across  the  EU  and  concerns  about  the  negative 
consequences for health, social cohesion and economic development if health inequalities are 
not effectively tackled. Existing actions appear to have had only limited impact and there is a 
risk that these gaps could widen as a result of recent economic difficulties. Moreover better 
levels  of  health  across  all  population  groups  are  critical  in  the  context  of  an  ageing  EU 
population to contribute to the sustainability of social protection systems. 

While the principal responsibility for health policy rests with Member States, not all of them 
have the same available resources, tools or pools of expertise to address the different causes to 
health  inequalities.  The  European  Commission  can  contribute  by  ensuring  that  relevant  EU 
policies and actions take into account the objective of addressing the factors which create or 
contribute to health inequalities across the EU population.  

The  EU  should  use  to  that  extent  in  the  most  efficient  way  the  mechanisms  and  tools 
available.  For  instance  it  can  play  an  important  role  in  raising  awareness,  promoting  and 
assisting the exchange of information and knowledge between the concerned Member States, 
identifying  and  spreading  good  practices  and  in  facilitating  the  design  of  tailored  made 
policies  for  the  specific  issues  prevailing  in  Member  States  and/or  special  social  groups.  It 
shall also monitor and evaluate the progress in the application of such policies. 

5. 

KEY ISSUES TO ADDRESS  

Experience  to  date  suggests  a  number  of  important  challenges  which  must  be  addressed  to 
strengthen existing action to reduce health inequalities. 

An equitable distribution of health as part of overall social and economic development 

In broad terms the level of health is associated with wealth. Richer countries and regions have 
on average better health as measured by various indices. But this relationship does not hold 
consistently.  More  economic  resources  provide  greater  potential  for  maintaining  and 
improving health but only if deployed in a way which enables this to occur. It is clear that not 
all groups have benefited to the same extent from economic progress. What is important is to 
create a pattern of overall economic and social development which leads to greater economic 
growth, as well as greater solidarity, cohesion and health. The EU structural funds have a vital 
role to play in this regard.  

Achieving  the  objectives  of  economic  growth  and  greater  social  cohesion  is  the  aim  of  the 
Lisbon agenda. The healthy life years indicator is the current measure to monitor progress on 
the  Lisbon  agenda  in  relation  to  the  health  dimension.  Consideration  could  be  given  to 
whether a sound monitoring of health inequalities indicators would be a useful tool to monitor 
its social dimension. 

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Improving  the  data  and  knowledge  base  and  mechanisms  for  measuring,  monitoring 
evaluation and reporting 

Measurement  of  health  inequalities  is  a  fundamental  first  step  to  effective  action.  Although 
robust  evidence  exists  in  a  number  of  areas,  more  detailed  information  is  required  on  the 
effect and importance of various health determinants to implement effective action in relation 
to particular population groups and determinants.  

Knowledge  on  the  effectiveness  of  policies  to  tackle  inequalities  also  needs  improving. 
Despite a body of research on the effectiveness of public health interventions and of the effect 
of other policies and actions on health, only a small number have been specifically evaluated 
for their differential health impacts on social groups or areas. The assessment of the impact of 
policies outside the public health sector is even more limited. 

Lack  of  routinely  available  and  comparable  EU  data  and  research  knowledge  poses  an 
obstacle  to  assessing  the  current  situation,  rethinking  policy  priorities,  establishing 
comparisons, deriving best-practices, and reallocating resources where they are most needed. 
Existing and future data available at the EU level notably through the full implementation of 
EU surveys such as the EU Survey on Income and Living Conditions (EU-SILC), European 
Health Interview Survey and the EU survey on disability and the implementation regulations 
on all fields of public health statistics should be used to create measures of health inequalities 
which  will  enable  comparison  over  time  and  across  the  EU.  Coherence  with  other 
international datasets should also be ensured. 

Causes of Health inequalities vary between Member States and between specific population 
groups. Member States should aim to establish, in close collaboration with the Commission, a 
common set of indicators to monitor health inequalities and a methodology to audit the health 
situation in Member States aimed to identify and prioritizing areas of improvement and best 
practices.  The  Commission  could  support  Member  States  to  achieve  their  objectives  by 
providing analysis and support on the basis of available information. This could prove to be a 
useful tool for Member States when designing, prioritizing and implementing more efficient 
and  effective  policies  adjusted  to  their  specific  situation,  and  to  better  use  the  existing  EU 
tools to support their actions. 

Funding pilot and twinning projects and peer review programs could help Member States to 
implement  such  policies.  Peer  reviews  should  encompass  scrutiny  of  existing  policies, 
programs or institutional arrangements that have been identified as good practices. 

EU level Actions: 

Support the further development and collection of data and health inequalities indicators by 
age, sex, socio-economic status and geographic dimension. 

Develop  health  inequality  audit  approaches  through  the  Health  Programme  in  joint  action 
with Member States willing to participate. 

Orient  EU  research  towards  closing  knowledge  gaps  on  health  inequalities  –  including 
activities under the themes of Health and Socio-economic Sciences and Humanities of the 7th 
EU Framework Programme for Research. 

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Emphasise  research  and  dissemination  of  good  practices  relevant  to  addressing  health 
inequalities  by  EU  Agencies,  including:  the  European  Foundation  for  the  Improvement  of 
Living and Working Conditions, the European Centre for Disease Prevention and Control and 
the European Agency for Health and Safety at Work. 

Building commitment across society  

Reducing health inequalities means having an impact on the health of people in their everyday 
lives, at work, at school, and at leisure in the community. In addition to national governments, 
regional  authorities  in  many  countries  have  an  important  role  in  public  health  and  health 
services and thus need to be actively involved. The health sector has a leading role to play, 
both  in  ensuring  equitable  access  to  health  care  and  in  supporting  knowledge  and  training 
both  to  health  professionals  and  to  other  sectors.  Local  governments,  workplaces,  and  other 
stakeholders also have a vital contribution to make.  

Thus, improving the exchange of information and knowledge and improving the coordination 
of  policies  between  different  levels  of  government  and  across  a  number  of  sectors  (health 
care,  employment,  social  protection,  environment,  education,  youth  and 
regional 
development)  can  create  more  effective  action  and  achieve  a  larger  and  consistent  impact. 
There is also a need to create more effective partnerships with stakeholders that can help to 
promote action on various social determinants and thus improve health outcomes.  

This  is  an  area  where  Member  States  can  learn  from  each  other  when  devising  their  own 
policy strategies. The EU can help through strengthening policy coordination mechanisms and 
facilitating  the  exchange  of  information  and  good  practice  between  Member  States  and 
stakeholders. Initiatives like the EU Health Policy Forum, the Partnership against Cancer, the 
Alcohol  Forum  or  the  EU  Platform  on  Diet  Physical  Activity  and  Health  are  important 
instruments to address the health inequalities policy agenda. 

The Commission has indicated17 its intention, within the Social OMC, to make more use of 
peer reviews and PROGRESS funding as well as to consider targets on health status to sustain 
commitment and the achievement of common objectives.  

The Commission will also take up the interest shown by the Committee of the Regions in the 
consultation on this communication and will aim to build a focus on health inequalities into 
regional cooperation arrangements on health. 

EU level Actions: 

Develop  ways  to  engage  relevant  stakeholders at  European  level  to  promote  the  uptake  and 
dissemination of good practice. 

Include  health  inequalities  as  one  of  the  priority  areas  within  the  ongoing  cooperation 
arrangements on health between the European regions and the Commission. 

Develop  actions  and  tools  on  professional  training  to  address  health  inequalities  using  the 
health programme, ESF and other mechanisms. 

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COM(2008) 418. 

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Stimulate  reflection  on  target  development  in  the  Social  Protection  Committee  through 
discussion papers. 

Meeting the needs of vulnerable groups 

Addressing  health  inequalities  effectively  requires  policies  which  include  both  actions  to 
address  the  gradient  in  health  across  the  whole  of  society  as  well  as  actions  which  are 
specifically targeted to vulnerable groups. Particular attention needs to be given to the needs 
of  people  in  poverty,  disadvantaged  migrant  and  ethnic  minority  groups,  people  with 
disabilities, elderly people or children living in poverty. For some groups, the issue of health 
inequality  including  reduced  access  to  adequate  health  care,  can  be  qualified  as  one  which 
involves their fundamental rights.  

The  European  Charter  of  Fundamental  Rights  specifies  the  right  to:  social  and  housing 
assistance to ensure a decent existence for all those who lack sufficient resources; access to 
preventive  health  care  and  the  right  to  benefit  from  medical  treatment;  and  to  working 
conditions  which  respect  health.  The  United  Nations  Charter  on  the  Rights  of  the  Child 
specifies several key rights relating to children's basic needs which in turn affect their health 
while  the  UN  Convention  on  the  Rights  of  Persons  with  Disabilities  specifies  the  rights  of 
access for persons with disabilities to health services. Health inequalities are included as one 
of four priorities of the Commission's youth health initiative launched in 2009.  

Demographic change and the ageing of our societies will create new health challenges.  

The Council has identified the need for additional action on the health needs of migrants, and 
Roma18  and  young  people  with  fewer  opportunities19.  The  Commission  is  starting  a  pilot 
project  on  Roma  inclusion,  including  health  and  integrated  interventions  in  the  educational, 
social, and economic areas and cross border cooperation 

Further use of the Cohesion Policy and associated structural funds to promote interventions in 
favour of the health of vulnerable groups such as Roma should be developed.  

EU level Actions: 

Launch  initiatives  in  collaboration  with  Member  States  to  raise  awareness  and  promote 
actions  to  improve  access  and  appropriateness  of  health  services,  health  promotion  and 
preventive  care  for  migrants  and  ethnic  minorities  and  other  vulnerable  groups,  through  the 
identification and exchange of good practice supported by the health and other programmes. 

Ensure  that  the  reduction  of  health  inequalities  is  fully  addressed  in  future  initiatives  on 
healthy ageing. 

A Report on the use of Community instruments and policies for Roma inclusion including a 
section on health inequalities will be prepared for the 2010 Roma summit.  

Examine how the Fundamental Rights Agency could, within the limits of its mandate, collect 
information on the extent to which vulnerable groups may suffer from health inequalities in 
the EU, particularly in terms of access to adequate health care, social and housing assistance. 

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19 

Council Conclusions on inclusion of the Roma. http://tinyurl.com/kne9s5 
Council Resolution of 20 November 2008 on the health and well-being of young people. 

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Carry out activities on health inequalities as part of the European Year for Combating Poverty 
and Social Exclusion 2010.  

Developing the contribution of EU policies 

As mentioned in Section 3 a number of EU policies which can contribute directly or indirectly 
to tackling health inequalities, and there are a number of tools available at community level 
that  could  be  use.  There  is  further  scope  for  improving  the  contribution  of  EU  policies 
through better understanding of their impact on health and via greater policy integration. This 
would lead to a better prioritisation and more efficient use of the existing tools. 

While there is general agreement on the principle of reducing health inequalities, the level of 
awareness and the extent to which action is being taken varies substantially. Over half of the 
EU Member States do not place policy emphasis on reducing health inequalities and there is a 
lack  of  comprehensive  inter-sectoral  strategies20.  In  addition,  policies  implemented  lack 
evaluation and dissemination which limits knowledge of policy effectiveness. The EU has a 
role to improve the coordination of polices and promote the sharing of best practices. 

Different  Commission  policies  should  continue  to  support  Member  States  to  create  more 
equitable access to high quality health care and prevention and promotion systems. The EU 
could  play  a  role  promoting  better  cooperation  between  health  systems  as  envisaged  in  the 
Proposal  for  a  Directive  on  the  application  of  patients'  rights  in  cross-border  healthcare.  It 
could also contribute to better understand and propose solutions for the challenges facing by 
the  health  systems  regarding  the  capacity  of  the  European  health  work  force;  and  can  also 
contribute to asses how to use efficiently the new technologies in the health sector. 

EU Cohesion policy is important in achieving the Lisbon objectives of economic and social 
cohesion  and  can  be  a  powerful  tool  to  address  health  inequalities.  The  current  Community 
Strategic Guidelines set out the possible use of the funds for health related actions. Member 
States  have  allocated  around  €  5  billion  (1.5%  of 
the  total  available)  from  the  funds  in  the 
category  Health  Infrastructure  for  the  period  2007-2013.  An  increased  use  of  the  funding 
opportunities  offered  by  the  Cohesion  Policy  to  address  health  inequalities  would  require 
improvements  in:  knowledge  of  the  opportunity  to  use  funds  in  this  area;  coordination 
between  national  policy  departments;  and  technical  capacity  to  develop  investments  in  this 
field. An effort should be made to increase the health focus for the next programming period 
and achieve a better alignment of the strategic documents under EU Cohesion Policy with the 
priorities identified in the Social OMC.  

The national implementation of Community Legislation on Health and Safety at Work and the 
Community  Strategy  on  Health  and  Safety  at  Work  2007-2012  provide  an  opportunity  to 
reduce health inequalities in the EU by protecting worker's health and reducing the negative 
impact of some of its determinants. Further attention should be placed on health inequalities 
within the context of promoting equal opportunity between men and women. 

Currently few EU policy actions are evaluated after implementation in relation to their impact 
on health inequality. Building on existing work more development is needed of mechanisms 
to evaluate the health impact of existing policies (ex post) on different population groups to 
produce information for further policy development Such mechanisms cannot be "one size fits 

20 

SEC(2006) 410. 

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all" and would draw on good practice developed in Member States. In addition, the EU can 
make use of existing reports including the Cohesion Report, the Employment Report and the 
Lisbon Report to analyse the relationship between these policies and health outcomes across 
EU areas and population groups. 

The EU is also committed to supporting other countries in health and related fields. The WHO 
Commission  on  the  Social  Determinants  of  Health21  recently  described  the  massive  health 
differences between countries and social groups worldwide and called for concerted action at 
all levels of government to address them. EU activities may affect health in third countries in 
a  variety  of  ways  including  trade,  development  assistance,  work  with  international 
organizations, and exchange of knowledge. EU experience on tackling health inequalities may 
also  have  relevance  outside  the  EU.  Possible  synergies  between  the  Commission's 
development  aid  and  the  work  within  the  EU  on  inequalities  in  health  should  therefore  be 
explored. The EU should also liaise with relevant international organisations on work in this 
area. 

EU level Actions: 

Provide further support to existing mechanisms for policy coordination and exchange of good 
practice on health inequalities between Member States such as the EU expert group on Social 
Determinants  of  Health  and  Health  Inequalities22,  linking  both  to  the  Social  Protection 
Committee  and  the  Council  Working  Party  on  Public  Health  and  the  Social  Protection 
Committee.  

Review  the  possibilities  to  assist  Member  States  to  make  better  use  of  EU  Cohesion  policy 
and structural funds to support activities to address factors contributing to health inequalities. 

Encourage  Member  States  to  further  use  the  existing  options  under  the  CAP  rural 
development policy and  market policy (school milk, food for most deprived persons, school 
fruit scheme) to support vulnerable groups and rural areas with high needs.   

Hold  policy  dialogues  with  Member  States  and  stakeholders  on  equity  and  other  key 
fundamental values in health, as set out in the EU Health Strategy. 

Provide  funding  under  PROGRESS  including  for  peer  reviews  and  a  call  for  proposals  in 
2010 to assist Member States in developing relevant strategies.  

Run  a  forum  on  health  and  restructuring  to  examine  appropriate  measures  to  reduce  health 
inequalities. 

Commission initiative on the EU role in global health 

6. 

NEXT STEPS 

Tackling  health  inequalities  is  a  long  term  process.  The  actions  in  this  Communication  are 
intended  to  lay  the  framework  for  sustained  action  in  this  area.  On  the  basis  of  this 
Communication  and  the  future  discussions  in  the  Council  the  Commission  intends  to  work 

21 
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Commission on Social Determinants of Health Final Report. WHO 2008. 
Current mandate at http://tinyurl.com/l947z8 

EN 

10 

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actively  in  partnership  with  Member  States  and  stakeholders  in  the  coming  period.  A  first 
progress report on the situation will be produced in 2012. 

EN 

11 

   EN