Across most countries, people in the lowest education category are twice as likely to view their health as poor compared to those with post-secondary education. Similar patterns emerge for other variables of health status, such as limitations in daily activities and prevalence of multiple chronic conditions. This is partly explained by poorer health behaviour, like smoking and being overweight, being more prevalent among less educated people, as well as poorer working and living conditions.
Health inequalities
Large inequalities in health and life expectancy exist between different groups of people. These health inequalities can be related to the unequal exposure to health risk factors, such as smoking, as well as unequal access to healthcare, among other aspects. They are often linked to a range of social, economic and environmental factors which require large-scale government action to tackle effectively.
Key messages
A person in the lowest income group is less likely to see a doctor when having the same level of healthcare needs compared to someone in the highest income group. Similarly, preventive services such as cancer screening or dental care are used more by higher income groups in the vast majority of OECD countries.
COVID-19 has put disadvantaged populations at greater risk of getting sick and of dying from COVID-19 than the rest of the population. Those living in deprived areas, the migrant population and ethnic minorities are at higher risk of catching and dying from the virus than other groups, and they also face significant indirect health impacts of the COVID-19 pandemic, both in terms of mental health impacts and disruption of routine care.
Context
Health and income
People on lower incomes are on average less positive about their health than those on higher incomes in all OECD countries. More than 80% of adults in the highest income quintile rated their health as good or very good in 2021, compared to 60% of adults in the lowest income quintile, on average across OECD countries. This gap is particularly large in Estonia, Lithuania and Latvia, at over 40 percentage points.
Differences in smoking, harmful alcohol use and other risk factors are likely to explain much of this disparity. However, the differences in perceptions of health between the rich and poor are relatively low in New Zealand, Greece, Luxembourg, Italy and Türkiye, which have a gap of less than 8 percentage points.
Breast cancer screening
Across Europe, there are large inequalities between different groups of people in terms of accessing breast cancer screening. In 2019, 66% of women aged 50 to 69 in the EU reported having undergone screening examination in the previous three years.
However, self-reported participation varies nearly nine-fold across countries. For example, in Romania, only 10% of women reported participation in breast cancer screening, compared to more than 90% in Finland and Sweden. Self-reported participation also varies by socio-economic status, with participation rates at 58% for low-income women on average in the EU, versus 74% among high-income women.
Vulnerable populations suffered disproportionately from the pandemic
Vulnerable populations have borne a disproportionate burden from the COVID-19 pandemic. In some countries, the mortality rate for those living in the most deprived areas doubled compared to those in the least deprived ones. There are multiple reasons why vulnerable populations have suffered disproportionately. These include increased exposure to SARS-CoV-2 through working and living conditions; a higher prevalence of health conditions and risk factors, such as diabetes, obesity and smoking; and barriers to access and use of healthcare.
In addition, people in the most deprived area also face significant indirect health impacts of the COVID-19 pandemic, both in terms of mental health impacts and disruption of routine care. For example, the prevalence of depression was more than twice as high among the least well-off than the most well-off in Austria, Canada, Czechia, France and the United States.
