Review of Social Determinants and the Health Divide in the WHO European Region

The WHO European Region has seen remarkable health gains, though inequities persist both between and within countries. Much more is understood now about the extent and social causes of these inequities, particularly since the 2008 report of the Commission on Social Determinants of Health.

This review of inequities in health across the 53 Member States of the Region was commissioned to support the development of the new European policy framework for health and well-being, Health 2020. It builds on the global evidence and recommends policies to reduce health inequities and the health divide across all countries, including those with low incomes.

The report is presented in four parts. Part I provides the context and background to the review, and sets out the key principles underpinning the recommendations and the rationale for grouping them into four broad themes: life-course stages, wider society, the broader macro-level context, and governance, delivery and monitoring systems. Part II summarizes current evidence on the magnitude of the health divide among European Region countries, describing the inequities in health and their social determinants. Part III focuses on the four themes, making recommendations with supporting evidence. Part IV outlines the implementation issues, summarizes the framework for action, discusses reasons for failure, provides guidance on good practice and summarizes the review's conclusions and recommendations.

The review is a wake-up call to political and professional leaders alike, an opportunity for them to facilitate the work of those dedicated to improving health outcomes and narrow the health gap between and within the countries of the Region.