Equity and the Social Determinants of Health in European Cities

Abstract

Equity in health has been the underlying value of the World Health Organization's (WHO) Health for All policy for 30 years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003IV ( -2008 of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.

Risk of Several Cancers is Higher in Urban Areas after Adjusting for Socioeconomic Status. Results from a Two-Country Population-Based Study of 18 Common Cancers

“…Since inequalities need to be identified before they can be addressed, such analyses also inform the health equity agenda promoted in many countries 7 and, increasingly, in individual cities. 8 One approach in investigating the geographical distribution of cancer within countries has been to describe variations in rates between those resident in urban and rural areas. Many studies suggest that cancer rates are higher in urban than rural areas (see for example [9][10][11][12] ).…”

Social and health policies or interventions to tackle health inequalities in European cities: a scoping review

“…Europe was the only World Health Organization (WHO) Region to develop its own targets for the Health For All (HFA) strategy in 1985, with Target 1 of the 38 Targets focusing on the reduction of inequalities in health [9,12]. …”

“…Socioeconomic inequalities in health have been recognized at least since the 1980s as being an important public health issue [ 11 ]. Europe was the only World Health Organization (WHO) Region to develop its own targets for the Health For All (HFA) strategy in 1985, with Target 1 of the 38 Targets focusing on the reduction of inequalities in health [ 9 , 12 ].…”

Prioritizing the Determinants of Social-health Inequality in Iran: A Multiple Attribute Decision Making Application

“…The 2008 report of this commission encouraged action against health inequality in different countries to fill the gaps between socioeconomic and political factors through research about and identification of social determinants of health ( 28 - 31 ). Commitment to health justice requires a health-gradients approach in which not only the cause of inequality is studied but also the differences in lifestyles and living standards among different socioeconomic groups are accounted ( 32 - 35 ). Despite the 20th century improvements in the global general health, health inequality has increased and evidence shows that in order to prevent health inequality, social determinants of health should be attended to.…”