The WHO European Region has seen remarkable health gains in populations that have experienced progressive improvements in the conditions in which people are born, grow, live and work. Inequities persist, however, both between and within countries. This review of inequities in health between and within countries 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. Much more is understood now about the extent and social causes of these inequities. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed on the social determinants of health, across the life-course and in wider social and economic spheres to achieve greater health equity and protect future generations.

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.

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Inequality and poverty have returned with a vengeance in recent decades. To reduce them, we need fresh ideas that move beyond taxes on the wealthy. Anthony B. Atkinson offers ambitious new policies in technology, employment, social security, sharing of capital, and taxation, and he defends them against the common arguments and excuses for inaction.

Evidence indicates that actions within four main themes (early child development fair employment and decent work social protection and the living environment) are likely to have the greatest impact on the social determinants of health and health inequities. A systematic search and analysis of recommendations and policy guidelines from intergovernmental organizations and international bodies identified practical policy options for action on social determinants within these four themes. Policy options focused on early childhood education and care; child poverty; investment strategies for an inclusive economy; active labour market programmes; working conditions; social cash transfers; affordable housing; and planning and regulatory mechanisms to improve air quality and mitigate climate change. Applying combinations of these policy options alongside effective governance for health equity should enable WHO European Region Member States to reduce health inequities and synergize efforts to achieve the United Nations Sustainable Development Goals.