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1.3 Benefits of environmental health inequality assessments for action
Action to tackle inequalities needs to be informed by evidence on the population groups most affected and disadvantaged by the unequal distribution of environmental risks and opportunities. Highquality evidence on the magnitude of such inequalities and adequate identification of the specific target groups can therefore help to make interventions more effective. Table 1 indicates the potential benefits of using evidence on environmental health inequalities for policy action and interventions, suggesting that such actions can be taken in various sectors, focusing on societal structures and processes, universal environmental policies, targeted interventions, social welfare measures, urban planning and increased intersectoral collaboration.
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Since transformation of the societal structures and social exclusion that cause environmental disadvantage may be a long-term objective, reduction of environmental health inequalities specifically requires short-term interventions to reduce the exposure levels of the most affected population subgroups. In this context, Table 1 indicates that in many cases the decision will be between two separate approaches: interventions ensuring environmental conditions for all or targeted interventions tackling environmental conditions specific to most affected population groups or geographical areas. Although both approaches can often be combined to achieve the best outcome (Dahlgren and Whitehead, 2006; Carey, Crammond & De Leeuw, 2015), either the universal or the targeted approach can be justified according to the relevant inequality situation.
Inequality assessments are essential to inform the decision-making process and provide guidance on the most appropriate way forward, which can be identified based on the findings. When inequalities are not strong and also affect a relevant proportion of the “advantaged” population, universal actions may be most appropriate. Conversely, targeted measures may be the first choice when disadvantaged subgroups have a marked increase in environmental risk exposure that distinguishes them from all others and/or more advantaged subgroups have none or very little of that exposure.
Table 1. Benefits of environmental inequality data for effective action
Inequality evidence Policy actions
Evidence on societal structures and mechanisms leading to environmental inequalities • Review and learn from examples of good/equitable societal practices. • Formulate equitable policy options on environmental protection. • Improve public participation in planning and decision-making processes affecting people’s local environment. • Incorporate environmental and health equity issues into economic, social and infrastructural regulations, strategies and plans.
Evidence on differential exposure to environmental health risks • Enforce environmental standards where they are exceeded. • Implement appropriate interventions to improve environmental conditions for the whole population. • Target action on pollution hot spots and population subgroups with the highest exposures. • Shift attention to policies that assure environmental protection and population health. • Support intersectoral action and extend Health in all Policies approaches. • Review the equity impacts of regulations directly or indirectly affecting environmental conditions (such as urban and infrastructure planning, taxation and social welfare) and their implementation.
Evidence on differential vulnerability to environmental health risks • Ensure that adequate environmental and infrastructural services and conditions are accessible for all. • Provide environmental resources and social benefits to compensate for the influence of environmental risks or social stressors. • Increase targeted protection measures in areas or settings with a high density of vulnerable, sensitive or disproportionately affected populations. • Improve environmental standards in the vicinity of child care centres, schools, hospitals, nursing homes and similar.
Source: based on WHO Regional Office for Europe (2012).
