8.1 Success stories

Based on a similar approach, individual country profiles have been developed to show the changes in environmental and injury inequalities for all countries in the Region over time. The profiles will be accessible as an online supplement via the report website and present – for each country – the environmental risks and injury types for which inequalities have increased and those for which they have declined (WHO Regional Office for Europe, 2019).

For some indicators a significant reduction in the magnitude of inequalities can be observed over recent years for a majority of countries (i.e. the number of countries seeing a reduction in inequalities is at least twice the number of countries seeing an increase). Success stories indicate that it is possible both to improve the environmental conditions of the most exposed and most affected population groups and to reduce the inequalities overall. Two examples of such success stories across the WHO European Region are shown below, presenting the reduction in inequalities in transport-related mortality between males and females (Fig. 62) and in access to less than basic drinking-water services between people living in rural and urban areas (Fig. 63).

A reduction – often a strong one – in RTI-related mortality differences between males and females over time was reported by 42 countries. In most of these a reduction in mortality was observed for both sexes (indicated by the vertical arrows ↓↓), but the reductions among males, who represent the major risk group for RTIs, were stronger. The largest reduction in inequalities was observed in Andorra, Estonia and Lithuania (noting that in Andorra the inequality reduction is caused by both a mortality decrease in males and an increase in females). In seven countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, Luxembourg, San Marino and Turkey), however, the inequality increased. The examples of Armenia, Bosnia and Herzegovina, Georgia and Turkey show that a mortality rate increase for both sexes (↑↑) can still be associated with a rising level of inequalities in mortality. Only Andorra, Kyrgyzstan, Malta and San Marino show diverging mortality trends for males and females, with a reduction among males and an increase among females (↓↑) in the last reporting year for the first three countries (hence showing inequality reductions) and an increase in males versus a decrease in females for the second reporting year in San Marino, where the highest increase in inequality over time is found. For the drinking-water inequality indicator (Fig. 63), 22 countries showed a reduction and 8 an increase in inequalities between people living in rural and urban areas in 2005–2015. The largest decreases were observed in Tajikistan, Albania, Lithuania, Azerbaijan and Armenia, but in few countries the inequality increased, with the largest rise in Serbia. For many EU countries full coverage is reported and thus no inequality can be illustrated; in EU countries without full coverage inequalities tend to be small, but they can still – as in Bulgaria, Spain and Portugal – be increasing.

In this indicator profile † indicates reversed inequalities in the first reporting year (2005), with people living in urban areas more affected than those in rural areas, which was observed in Belarus, Ireland, North Macedonia and Serbia. A ‡ indicates reversed inequalities in the second reporting year (2015), which was observed, for example, in Croatia and Spain. In Belarus, Ireland, North Macedonia and Serbia both symbols (†‡) are displayed, indicating a reverse of inequalities in both reporting years.

Similar success stories, reflecting a reduction in inequalities across the majority of countries in the WHO European Region, are also observed for these indicators:

• lack of bath and shower, stratified by income quintile (a decrease in inequalities is seen in 21 and an increase in 9 countries); • lack of flush toilet, stratified by above versus below the relative poverty level (decrease in 19, increase in 6 countries); • poisoning mortality, stratified by sex (decrease in 35, increase in 8 countries); • mortality from falls, stratified by sex (decrease in 34, increase in 10 countries); • difficulty accessing recreational or green areas, stratified by low versus high education level (decrease in 22, increase in 11 countries).

Fig. 62. Changes in magnitude of inequality in RTI-related mortality, male versus female, 2006 to 2016 (or closest reporting year to each)

Andorra ‡ [a][b][c] Bosnia and Herzegovina [a][b] San Marino [a][b][c] Georgia [b] Tajikistan Turkmenistan [b][c] Norway [b] Malta [b] Ireland [a][b] United Kingdom [b] Sweden Armenia Denmark [b] Netherlands Switzerland [b] Estonia [b] Iceland Germany [b] Israel [b] Greece [b] Austria Finland [b] Spain [b] France [b] Luxembourg [b] Turkey [a][b] Belgium [b] Czechia North Macedonia [b] Serbia [b] Cyprus Albania [b] Italy [b] Slovenia [b] Bulgaria [b] Slovakia [b] Poland [b] Lithuania Uzbekistan [a][b] Hungary Portugal [a][b] Republic of Moldova Romania Croatia Belarus [a][b][c] Latvia [b] Ukraine [b][c] Kyrgyzstan [b]

Russian Federation [b][c] Kazakhstan [b][c]

Change in magnitude of inequality in mortality 0/100000 2016 Increase of inequality di erence Decrease of inequality di erence Inequality gap (one year only)

5/100000 10 /100000 15 /100000 20/100000 25/100000 30/100000 35/100000

Notes: [a] the first reporting year was 2005 for Uzbekistan, 2007 for Belarus, Ireland and Portugal, 2009 for Turkey, 2011 for Andorra, Bosnia and Herzegovina and San Marino; [b] the second reporting year was 2010 for Albania, 2012 for Kazakhstan, 2013 for Greece and North Macedonia, 2014 for Belarus, Bosnia and Herzegovina, Bulgaria, France, Ireland, Portugal, Slovakia and Uzbekistan, 2015 for Andorra, Belgium, Denmark, Estonia, Finland, Georgia, Germany, Israel, Italy, Kyrgyzstan, Latvia, Luxembourg, Malta, Norway, Poland, Russian Federation, San Marino, Serbia, Slovenia, Spain, Switzerland, Turkey, Turkmenistan, Ukraine and United Kingdom; [c] for Albania, Belarus, Greece, the Russian Federation, San Marino, Turkmenistan and Ukraine, transport mortality data are used instead of road traffic mortality data; ‡ represents reversed inequality in the last reporting year; vertical arrows (↑ or ↓) represent the increase or decrease of RTIrelated mortality for the second time point (last year available): the first vertical arrow refers to the change in RTI-related mortality for males and the second to the change for females.