1.2 Inequalities in environmental health – a cross-cutting agenda for the Region

and commits to the reduction of inequalities on a global scale as well as in countries and at the local level (United Nations, 2019). This is a key framework for action on equity and addresses a wide range of basic conditions for a healthy life. The lack of fulfilment of the Sustainable Development Goals (SDGs) has direct and indirect consequences for health and well-being, through both social disadvantage (such as poverty, lack of decent employment, low levels of education and gender inequality) and environmental problems (such as lack of access to water and sanitation, climate impacts, urban and housing conditions and pollution levels). Clearly, full implementation of all SDGs is necessary to achieve SDG 3, which calls for health and well-being for all as precondition for sustainable development.

The WHO Regional Office for Europe has intensified its efforts to promote health equity, given the relevance of equity for health and well-being, and the relevance of healthy societies for sustainable development. Health equity is increasingly understood as a facilitator of development for the Region, creating the conditions for all people to prosper and flourish in health and in life. The opportunities associated with health equity, and the key policy areas for equity action, will be presented in the first WHO European Health Equity Status Report (WHO Regional Office for Europe, forthcoming).

The burden of disease of environmental conditions is not equally distributed, as certain population groups – in most cases those with some form of disadvantage – have higher levels of risk exposure and are therefore likely to suffer from a higher share of the associated health outcomes. Environmental inequalities are therefore a direct contributor to health inequalities, and the provision of safe and adequate environments for all could significantly reduce the disparities in health currently observed. This is especially important in places where overall progress is observed for both health status and environmental conditions but does not benefit all population groups equally.

Acknowledging the increasing relevance of unequal distribution of environmental risks, environmental health inequalities have been recognized as a cross-cutting challenge for the European Environment and Health Process, as highlighted at the 2010 and 2017 Ministerial Conferences on Environment and Health. In the conference declarations, Member States stressed the need to address environmental justice, and committed to:

• act on socioeconomic and gender inequalities in environment and health and tackle health risks to children and other vulnerable groups posed by poor environmental, working and living conditions (WHO Regional Office for

Europe, 2010); and • consider equity and social inclusion in environmental and health policies and prevent inequalities related to environmental pollution and degradation (WHO Regional Office for

Europe, 2017a).

These commitments provide a mandate for WHO to address environmental inequalities and reduce health inequality through environmental action; they call for cross-cutting and intersectoral approaches, as inequalities occur across all environmental domains. To provide an initial overview of the status of environmental health inequalities in the WHO European Region, a baseline assessment report (WHO Regional Office for Europe, 2012) was published as a follow-up to the Fifth Ministerial Conference on Environment and Health of 2010. This compiled statistical data to describe and quantify the magnitude of inequalities in environmental risk and in injuries, and established the first systematic assessment of environmental health inequalities within countries in the Region. Two years after the Sixth Ministerial Conference on Environment and Health, this second assessment report aims to update the 2012 report, providing recent data and insights into the current presence and magnitude of environmental health inequalities. In doing so, this report also takes up the Conference theme – “Better Health. Better Environments. Sustainable Choices” – acknowledging that better environments are yet to be achieved for the most disadvantaged in society, and that better health and sustainable choices can only be realized when fundamental requirements such as adequate environmental conditions and access to basic services are implemented for all.