Health for Everyone?

Social Inequalities in Health and Health Systems

In series:OECD Health Policy Studiesview more titles

Published on September 27, 2019

Good health is a key component of people’s well-being. It is a value in itself but – through its influence on social, education and labour market outcomes – being in good or bad health has also wider implications on people’s chances of leading a fulfilling and productive life. Yet, even in the OECD countries, health inequality persists with severe consequences on the goal of promoting inclusive growth. This report documents a comprehensive range of inequalities in health and health systems to the detriment of disadvantaged population groups in a large set of OECD and EU countries. It assesses the gaps in health outcomes and risk factors between different socio-economic groups. When it comes to health systems, the report measures inequalities in health care utilisation, unmet needs and the affordability of health care services. For each of these different domains, the report identifies groups of countries that display higher, intermediate, and low levels of inequality. The report makes a strong case for addressing health-related inequalities as a key component of a policy strategy to promote inclusive growth and reduce social inequalities. It also provides a framework for more in-depth analyses on how to address these inequalities at country level.


Acronyms and abbreviations
Executive summary
Health-related inequalities: Framework and key findings
Inequalities in health and its determinants
Inequalities in the utilisation of health care services
Inequalities in unmet needs for health care
Affordability and financial protection: Insights from Europe
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  • Smoking rates are twice as high for people with lower education level compared to those with tertiary education, on average in EU and OECD countries.
  • Overweight and obesity are also more of a problem for those with lower education level, especially among women. One in two women with lower education are overweight or obese, compared to one in three with a university degree.
  • A person with low income – and with the same level of health care needs as a rich person – is less likely to see a specialist doctor. The gap between the rich and the poor is 12 percentage points, on average across OECD and EU countries.
  • There are substantial inequalities in access to preventive care depending on a person’s income. For cervical cancer, the difference in screening rates reaches on average 17 percentage points across income groups.
  • When accessing the health system, nearly 17% of households in EU countries declare they have difficulties in affording care but the proportion stands at 30% for those below the poverty line. Everywhere, households in the bottom income quintile are more likely to incur catastrophic health spending.
  • Tackling health-related inequalities can make societies more inclusive. To make this happen, health systems can adopt a wide range of policy options, ranging from moving towards patient-centred primary care delivery, to extending health care coverage, improving health literacy and public health interventions. Beyond the health sector, policies related to labour market, education, environment, housing and social policies, can also contribute to tackling inequalities in health.


Inequalities in risky health behaviour frequently go hand in hand with inequalities in health status. In all 33 countries included in the study, the lower-educated consider themselves to be in worse health than those with tertiary education, with a 21 percentage points difference between the two groups.

Probability of reporting a poor self-assessed health status by education level

Notes: Results correspond to age-sex standardised predicted probabilities.
Differences between education groups are significant at the 95% confidence level for all countries.
Source: OECD estimates based on national survey data.

Note by Turkey: The information in this document with reference to “Cyprus” relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of the United Nations, Turkey shall preserve its position concerning the “Cyprus issue”.
Note by all the European Union Member States of the OECD and the European Union: The Republic of Cyprus is recognised by all members of the United Nations with the exception of Turkey. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus.



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