Promoting health and reducing health inequities in Europe.

Persistent and widespread inequities in health occur across the WHO European region. Health as a key and unique resource for human and societal development has undoubtedly improved overall, yet health inequities remain substantial and in many instances are worsening. These inequities are unnecessary and unjust, and tackling them should be a high priority at all levels of governance in the WHO European region. Since I became WHO Regional Director for Europe in February, 2010, I have focused on our shared goal of equitably improving the health of the populations of all 53 countries in the region. This goal guides the new health policy for Europe: Health 2020. This valueinformed and evidence-based health policy framework has been developed through a participatory process involving our member states and other partners, including the European Union, public health associations, professional and academic networks, and civil society. Health 2020 takes into account the changing patterns of disease burden in Europe, which are increasingly dominated by non-communicable diseases. The framework off ers policy and practice interventions that have been shown to work, giving politicians and policy makers opportunities to improve health and wellbeing and health equity, sensitive to each country’s situation and political and organisational circumstances. Health 2020 presents a wealth of new evidence, generating legitimacy for practical action at all levels of society. The policy framework is relevant for low-income, middle-income, and high-income countries. Inequities in health are substantially socially determined, arising from diff erences in life circumstances and inequities in opportunities to lead a full and meaningful life. Understanding of the eff ects of these social determinants is growing. The human-rightsbased approaches at the core of Health 2020 prioritise improvement of health and reduction of inequities. To address these issues, I commissioned the European review of social determinants of health and the health divide, led by Michael Marmot who, with colleagues, presents the fi ndings and recommendations of this review in The Lancet. These fi ndings have informed Health 2020, which aims to provide a political, administrative, and scientifi c framework within which action on the social determinants of health can be taken forward across all countries in the European region. The review shows clearly that the European region contains countries with some of the best health and narrowest health inequities in the world, related to a long period of improvement in the lives people lead, through socially cohesive and increasingly affl uent societies, developed welfare states, and high-quality education and health services, which create conditions for people to have the freedom to lead lives they value. Substantial health gains have been the result. Nevertheless, not all countries in the European region have shared fully in this process of social, economic, and health development. The review also shows that some countries, and some groups in all countries, have not shared in this improvement. A gradient in health exists across the region, with signifi cant gaps between men and women of diff erent social groups. Addressing these health inequities requires dealing with their root causes; as Marmot and colleagues note “the conditions in which people are born, grow, live, work, and age and the inequities in power, money, and resources that are responsible”. These inequities, and their social and economic costs, pose a direct challenge to solidarity and social cohesion. Furthermore, the review shows that the European economic crisis and the response to it have adversely aff ected the social determinants of health. We must Published Online September 8, 2012 http://dx.doi.org/10.1016/ S0140-6736(12)61481-0