Health inequalities are systematic differences in health between groups of people or across populations. They can include differences in ill-health, mortality, health behaviours and access to health care. Because they are often connected to wider inequalities (e.g., racism, gender inequality), health inequalities are considered to be unjust and avoidable. Monitoring health inequalities is therefore a crucial public health objective.
What are health inequalities?
Health inequalities are systematic differences in people’s health occurring between populations (e.g., different countries) and between groups within society (e.g., people with a low income vs. a high income). These differences can be found in health risks, health behaviours, disease occurrence, disease progression, mortality, as well as the access to health prevention and health care.
Health inequalities are linked to social, economic, and environmental inequalities as they are the product of the conditions in which people grow, live, work and age. As such, health inequalities are considered to be unjust and avoidable (also referred to as health inequities).
Social gradient in health
Health inequalities are often observed following the same stepwise pattern by social group. The social gradient in health refers to the phenomenon whereby less advantaged individuals experience worse health, higher mortality and poorer health care access compared to those who are more advantaged. In other words, with greater social deprivation comes poorer health status. Social health gradients have been found in many different contexts when investigating factors such as educational achievement, income, employment status, gender, ethnicity, and living situation.
The causes of health inequalities
The causes of health inequalities are numerous, multidimensional and interlinked. Health inequalities arise due to differences in the distribution of power, money and other valuable resources between different groups of people. These resources are also referred to as social determinants of health, as they affect the conditions of people’s daily life, as well as their vulnerability to ill health and its consequences.
Examples of social determinants of health include:
- Income and social status
- Employment and working conditions
- Education and literacy
- Childhood experiences
- Physical environments
- Social supports and coping skills
- Healthy behaviours
- Access to health services
The social determinants of health can play a role at the different levels of society. Hence, actions to reduce health inequalities must intervene at all levels of society, from the individual to the household, community, regions and countries.
World Health Organization. Regional Office for Europe. (2019). Healthy, prosperous lives for all: the European Health Equity Status Report. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/326879 .
Commission on Social Determinants of Health. (2008). Closing the gap in a generation. Health equity through action on the social determinants of health. World Health Organization.