Health begins long before people enter a healthcare system
Major differences in health persist both between EU countries and between population groups within individual countries.
Medical care matters, but health is also shaped by the conditions in which people are born, grow, study, work, live and age. Income, employment, education, housing, social protection, environmental conditions and social inclusion can all influence exposure to disease, healthy behaviour and access to prevention and treatment.
These factors interact throughout the life course. Disadvantage in one area can reinforce disadvantage elsewhere, creating persistent differences in health outcomes and life expectancy.
The EU's original health-inequalities framework
In 2009, the European Commission adopted COM(2009) 567 – Solidarity in Health: Reducing Health Inequalities in the EU.
The Communication established an EU-level framework to support Member States and other actors by improving cooperation, assessing how European policies affect health inequalities, strengthening data and reporting and making better use of EU funding.
In 2013, the Commission followed with SWD(2013) 328 – Report on Health Inequalities in the European Union. It assessed progress since 2009 and concluded that further action was needed at local, national and European level.
Those documents remain the historical foundation of EU work on health inequalities, but they do not by themselves describe the current policy environment.
Health equity is now embedded in broader EU prevention policy
The Healthier Together – EU Non-Communicable Diseases Initiative 2022–2027 gives social determinants a more current operational role.
Health equity runs across all five strands of the initiative. Its integrated approach explicitly identifies the reduction of health inequalities through action on social determinants, health literacy and digital literacy as a priority.
This reflects an important evolution in EU policy: reducing health inequalities is increasingly treated not as an isolated programme but as a horizontal objective of prevention, disease management and health-system policy.
Social factors that shape health
Access to healthcare is itself a social determinant
Universal or broad health coverage does not automatically eliminate inequalities in access.
Eurostat data for 2024 show a clear social gradient: people at risk of poverty were substantially more likely to report an unmet need for medical examination or treatment because of cost, waiting times or distance.
This issue is increasingly relevant to EU health-system policy. A Commission report published in September 2025, The Role of Healthcare in Reducing Inequalities and Poverty in the EU, developed new methodology using the EUROMOD model to assess the distributional impact of healthcare-related social transfers in kind.
The analysis highlights that resilient health systems are also instruments of social policy. Decisions concerning access, public financing and universal health coverage can influence inequality and poverty as well as health.
Migrants, refugees and access to healthcare
Migrant health is a specific strand of the Commission's work on social determinants. Health needs may be shaped by conditions before departure, experiences during travel, reception conditions, legal status, language barriers and the ability to enter national healthcare systems.
The legal framework changed substantially in 2026. The EU Pact on Migration and Asylum, adopted in 2024, entered into application on 12 June 2026.
The new Regulation (EU) 2024/1356 on screening at the external borders includes both a preliminary health check and a preliminary vulnerability check as part of the screening procedure.
The recast Directive (EU) 2024/1346 on reception conditions also strengthens the relevant framework for applicants for international protection. Member States must ensure access to necessary healthcare, including emergency care, essential treatment of illnesses and serious mental disorders, and must take special reception needs into account.
The previous eEuropa page referred to several elements of the Pact as legislative proposals. That description is no longer current: the new system is now in application.
Projects, funding and practical implementation
EU action on social determinants also includes projects, pilot initiatives and the transfer of effective practices. EU4Health and other European funding instruments support actions designed to reduce barriers and improve access for vulnerable groups.
A recent example is an EU4Health-funded project implemented with the International Organization for Migration, WHO, national authorities and civil-society partners. Results presented by the Commission in July 2026 included strengthened coordination mechanisms, national action plans and targeted health support for refugees and people displaced from Ukraine.
