Trend: Widening health-related inequalities

A trend indicates a direction of change in values and needs which is driven by forces and manifests itself already in various ways within certain groups in society

The link between education, income and life expectancy is likely to become stronger. The COVID-19 pandemic exposed the unequal exposure to health risks in populations and these inequalities are likely to continue and possibly widen. 

There is a geographical dimension to the growing health inequalities: regions most affected by depopulation and ageing have seen the dismantling of their health care services and a decline in the quality of care. EU countries whose health-care professionals migrated to other countries for better work opportunities are now facing shortages in hospitals, with dire consequences for their response to the crisis. 

There is evidence of a mental health pandemic going on in parallel to COVID-19 that will also have long-lasting social and economic effects. People who have experienced discrimination tend to have lower trust in institutions and are less likely to get vaccinated.

This Trend is part of the Megatrend Widening inequalities

Manifestations

Developments happening in certain groups in society that indicate examples of change.

Unequal access to health services

At least half of the world’s population cannot obtain essential health services and each year, large numbers of households are being pushed into poverty because they must pay for health care out of their own pockets. There are wide gaps in the availability of services in Sub-Saharan Africa and Southern Asia. In other regions, basic health care services such as family planning and infant immunization are becoming more available, but cannot be accessible for many families because they need to pay for these services from their own pockets. Inequalities in health services are seen not just between, but also within countries. Access to health tends to worsen from society's richest to poorest, and people with low household income, low educational level, unemployment, low socioeconomic status, poverty (or at risk of poverty), migrant background and ethnic minority background, often have poorer health status.

Signals of change: WHO, Social Science and Medicine

Is everybody living longer and healthier?

There is strong association between education and overall population health. The relationship between income and life expectancy is also well established. Although the overall trend globally for people is that of improved health and longer lives, growing inequalities in education and income are translating into growing health inequalities.

Socio-economic inequalities underpin major risk factors that cause premature death: exposure to air pollution, smoking and obesity. The COVID-19 pandemic has disproportionately affected older and poorer people, those living in deprived areas and ethnic minorities. These clear links between existing inequalities and exposure to health risks have become more difficult to ignore. 

Signals of change: OECD, Mackenback, JRC, Demos Helsinki, EURO-HEALTHY

Mental health pandemic is looming 

The COVID-19 pandemic and the resulting economic crisis have hugely affected many people’s mental health. It has also created new barriers for people suffering from mental illness and substance use disorders. Isolation, job loss, premature death of loved ones, greater exposure to domestic violence, or general anxiety caused by the various stresses of the ongoing pandemic are among the factors that are driving this parallel mental health pandemic and have already resulted in increased depression levels, sleeping and eating disorders, alcohol consumption and substance abuse. It is expected that the psychological distress will last for many years after the pandemic is under control. It is also likely that, as with the other effects of the pandemic, these negative mental health outcomes will reflect and heighten existing inequalities.

Signals of change: OECD, Centre for Mental Health, Kaiser Family Foundation

Geographical inequalities in health are widening

Health inequalities between rich and poor areas have widened in a number of developed countries, including in Europe. Although life expectancy has increased overall, many regions are witnessing increased spatial polarization in health status. A range of factors contribute to such disparities, including differences in general health, exposure to risk factors, health-seeking behaviour influencing early detection, access to healthcare, and other factors related to socioeconomic and geographic factors. There are growing inequalities related to risk exposure such as pollution, and availability of quality health care facilities. While the number of doctors per capita increased in all EU countries over the past decade, territorial inequalities in access to healthcare is being exacerbated by intra-EU mobility of healthcare professionals. This improves access to health in some areas while creating healthcare staff shortages in others and was particularly acute in some Central and Eastern EU countries during the COVID-19 pandemic.

Signals of change: JRC, OECD, EP, Independent

Interesting questions

What might this trend imply, what should we be aware of, what could we study in more depth? Some ideas:

• Could health become the new ‘sorting mechanism’ further driving inequalities?

• If vaccination passports and health tests become necessary to access basic services and rights, what will happen to those who won’t comply with the new health requirements?

• Will the uneven impact of the pandemic towards disadvantaged populations drive changes in the provision of and access to health care for these groups?