The context of inequalities

In 2008, the final report of the WHO Commission on Social Determinants of Health (CSDH)1 concluded that achieving equity in health is a major challenge for health governance. The need to monitor and take action on inequalities was confirmed by the World Conference on Social Determinants of Health held in Brazil in October 2011.2

The environmental dimension of inequality—known as environmental justice or environmental equity—has also been increasingly recognised and documented in recent years.3–6 In early 2012, the WHO Regional Office for Europe published its first assessment report on environmental health inequalities,7 with the following main findings:

• environmental health inequalities exist in all Member States, although to varying extents;

• environmental health inequalities are accumulative, with disadvantaged population groups showing increased prevalence of exposure for various risk factors in parallel;

• socioeconomic variables (especially income) were found to be especially strong determinants of environmental health risks;

• there is no association between the level of exposure for the total population and the magnitude of relative inequalities between population subgroups (ie, inequalities between subgroups can be very large in countries where total population exposure levels are rather low);

• inequality patterns are very different between countries and national assessments are needed to inform national priorities for action;

• the causality of environmental exposure disparities—the mechanism of how social determinants operate—cannot be identified based on the available data; and

• there are significant gaps in data on the distribution of environmental exposure across population subgroups in many European countries and especially outside the European Union (EU).

Inequality assessments and their relevance for action

Evidence and practice have shown that health equality will not be achieved without specific action.8 Indeed, the population groups most affected by inequalities are rarely in a position to effect required policy changes and thus political action at local, regional and national level is needed. In particular, …