EUR/RC62/wd08 (Eng) - WHO/Europe - World Health Organization

EUR/RC62/8
page 12
49. These socioeconomic effects are much better understood than previously. Health
experience disaggregates by socioeconomic condition, and the key determinants of the
inequities in health lie in a toxic mix of poor social policies and programmes, low levels of
education and unfair economic arrangements. Vulnerability results from exclusionary processes
related to inequities in power, education, money and resources, and the conditions in which
women and men are born, grow, live, work and age, which taken together constitute the social
determinants of health. These processes operate differentially across the whole of society, create
a continuum of inclusion or exclusion and give rise systematically to the social gradient in
health. This gradient increases with the level of deprivation, rather than simply being linear.
50. That is to say, the lower a person’s social position, the worse his or her health is. People
in the most disadvantaged groups and communities, who are subject to many different types of
exclusionary processes, experience much worse health than those subject to a single process or
in a more advantaged social group. This would imply a gradient that increases with the level of
deprivation, rather than being linear. Furthermore, in some societies the disadvantaged groups
may be in the majority – not simply an excluded minority. Inequities accumulate over the lifecourse
and often continue across generations, leading to persistent shortfalls in health and
development potential in families and communities. Exclusionary processes produce barriers to
releasing and enhancing individual and collective capabilities. When such groups as Roma, 2
migrants, people with disabilities and the very old experience multiple exclusionary processes,
they become particularly vulnerable and such vulnerability becomes entrenched.
51. Individuals, communities and countries may have active “coping strategies” for creating
sound conditions in which health and well-being can flourish. These draw on cultural resources
and a wide range of positive social and environmental assets, and they should be preserved and
nurtured. The focus is on resilience, on assets that protect against harm, and on reducing or
altering exclusionary processes. Health assets refer to any factors (or resources) that enhance the
ability to maintain and sustain health and well-being. Asset-based approaches enable and
promote the protective factors that create and support health and well-being at the level of the
individual, group or entire community. These factors therefore operate as a protective buffer
against life’s stresses and as promoting factors to maximize opportunities for health and wellbeing.
They are linked to the control that people and communities have over their lives, and the
extent to which they are empowered to exercise that control.
The emerging drivers, demography and epidemiology, and the
social, technological and economic case for action
The emerging drivers of health: trends, opportunities and risks
52. Despite the real health improvements across the European Region, the challenge that
health poses to governments is greater than ever. People have come to expect protection from
health risks – such as unhealthy environments or products – as well as access to high-quality
health care throughout the life-course. Nevertheless, the financial pressures on health and
welfare systems make it ever harder to respond. In many countries, the health share of
government budgets is larger than ever before, and health care costs have grown faster than
gross national product (GNP). Any health reform must contend with deeply entrenched
economic and political interests, as well as with social and cultural processes. Getting the
2 In this document, and in accordance with the Council of Europe’s Roma and Travellers glossary (18),
the encompassing term “Roma” refers to various communities that self-identify as Roma and others (such
as Ashkali) that resemble Roma in certain aspects but insist that they are ethnically different.