Social Determinants of Health in Europe Institute of Health Equity

Article by Zsuzsanna Jakab and Michael Marmot, published in The Lancet online on 19th October 2011, and in the print edition 14th January 2012.

The WHO European region is often, wrongly, assumed to be mainly made up of wealthy countries. Therefore, so the argument goes, health problems associated with poverty and disadvantage are less than in other regions. But, in a region that stretches from Iceland to the Bering Strait, there are gross social and economic inequalities within and between countries, and health inequity accompanies these inequalities. For example, male life expectancy in Russia is 20 years less than in Iceland; maternal mortality varies from 70 per 100 000 livebirths in Kyrgyzstan to less than five in some countries in the region. There are health inequities within all countries in the region—eg, in Norway in 2001, life expectancy at age 30 years was around 5 years greater for men with university education than for those with lower secondary education.

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