8.2 Mixed evidence

Fig. 63. Changes in magnitude of inequality in access to less than basic drinking-water services, rural versus urban areas, 2005 to 2015

France Greece Spain ‡ Croatia ‡ Czechia Hungary Portugal Ireland †‡ Slovenia Bosnia and Herzegovina ‡ Bulgaria Luxembourg Latvia Armenia Belarus †‡ Estonia Turkey ‡ Montenegro ‡ Ukraine ‡ North Macedonia †‡ Slovakia Serbia †‡ Albania Poland Turkmenistan ‡ Lithuania Russian Federation Georgia Uzbekistan Kazakhstan Kyrgyzstan Republic of Moldova Azerbaijan Tajikistan Change from 0.25 to 0 (↓↕)

Change from 0 to 0.07 (↕↑)

Change from 0.21 to 0.09 (↓↓)

0.10

Change from 0.20 to 0.26 (↓↓)

Change from 0.36 to 0.25 (↑↑)

0.50

Change from 0.96 to 0.79 (↓↓)

2.10

3.45

Change from 6.31 to 6.21 (↓↓) Increase of inequality di erence Decrease of inequality di erence No change in inequality di erence (value)

Change in magnitude of inequality in prevalence 0% 5% 10% 15% 20% 25% 30% 35% 40%

Notes: countries with full coverage of water supply in both reporting years are not depicted; [a] the first reporting year was 2010; [b] the second reporting year was 2010; † represents reversed inequality in 2005; ‡ represents reversed inequality in 2015; vertical arrows (↑ or ↓) represent the increase or decrease in reported access to less than basic drinking-water for the second time point (2015); the first refers to the change in prevalence for rural and the second to the change in prevalence for urban areas.

For most of the environmental health inequality indicators in this report, countries show diverse and contrasting performances (i.e. the number of countries with a decrease in inequalities is approximately the same as those with an increase), so no clear change patterns over time are observed. Fig. 64 and Fig. 65 present two examples of this mixed evidence pattern, depicting the indicators

ability to keep the home cool in summer (stratified by income quintile) and overcrowding (stratified by single-parent households versus households with dependent children). Fig. 64 shows that income-related inequalities in ability to keep the home cool in summer have decreased in 15 countries but increased in 12 countries, with no specific patterns found (such as similar trends in southern or eastern European countries).

Fig. 64. Changes in magnitude of inequality in ability to keep the home cool in summer, lowest versus highest quintile, 2007 to 2012

Ireland (↓↓) Estonia (↑↑) Increase of inequality di erence Romania ‡ 2016 Decrease of inequality di erence Inequality gap (one year only) United Kingdom (↓↓) Slovakia Change from 1.56 to 1.40 (↓↓) Lithuania †‡ (↓↓) Iceland (↑↑) Denmark (↓↓) Poland (↓↓) Norway Change from 3.17 to 3.10 (↑↑) Finland (↑↑) Hungary † (↑↓) France (↓↓) Sweden (↓↓) Luxembourg (↓↓) Switzerland 2016 Latvia (↓↓) Malta (↑↑) Czechia (↓↓) Slovenia Change from 7.30 to 7.20 (↓↓) Austria (↓↓) Belgium (↓↓) Netherlands (↓↓) Spain (↑↓) Germany (↓↓) Cyprus (↓↓) Portugal (↓↓) Croatia 2016 Italy (↓↓) Greece (↑↑) Bulgaria 2016 Change in magnitude of inequality in prevalence 0% 5% 10% 15% 20% 25% 30% 35% 40%

Notes: † represents reversed inequality in 2007; ‡ represents reversed inequality in 2012; vertical arrows (↑ or ↓) represent the increase or decrease in reported ability to keep the home cool for the second time point (2012); the first refers to the change in prevalence for the lowest income quintile and the second to the change in prevalence for the highest.

For inequalities in overcrowding, 14 countries report an increase in inequalities, but 16 show a reduction (including countries in northern, eastern, southern and western Europe). The largest increases were observed in France, Iceland, Latvia, Poland and Romania; the largest decreases in Germany, Greece, Lithuania, Luxembourg and Slovenia (Fig. 65).

Fig. 65. Change in magnitude of inequality in overcrowding by single-parent households versus households with dependent children, 2009 to 2016

Spain Cyprus † Ireland United Kingdom Malta Portugal †‡ Bulgaria Switzerland † Italy Serbia Netherlands Croatia Belgium Greece ‡ Romania Iceland Finland Luxembourg Denmark Norway France Estonia Latvia Hungary North Macedonia ‡ Slovakia Austria Sweden Germany Lithuania Slovenia Poland Czechia Change in magnitude of inequality in prevalence 0% 4% 8% 12% 16% 20%

2016

2016

2016 Increase of inequality di erence Decrease of inequality di erence Inequality gap (one year only)

Notes: † represents reversed inequality in 2009; ‡ represents reversed inequality in 2016; vertical arrows (↑ or ↓) represent the increase or decrease in reported overcrowding for the second time point (2016); the first refers to the change in overcrowding prevalence for single-parent households and the second to the change in prevalence for households with dependent children.

Other environmental health inequality indicators that show the mixed evidence pattern are:

• less than basic sanitation, stratified by rural versus urban populations (decrease in 20, increase in 19 countries); • lack of bath and shower, stratified by singleparent households versus households with dependent children (decrease in 13, increase in 16 countries); • lack of flush toilet, stratified by single-parent households versus all households (decrease in 15, increase in 14 countries); • dampness in the home, stratified by singleparent households versus all households

(decrease in 13, increase in 17 countries); • overcrowding in the home, stratified by singleparent households versus households with dependent children (decrease in 16, increase in 14 countries); • inability to keep the house warm, stratified by single-parent household versus all households (decrease in 14, increase in 16 countries); • alcohol poisoning mortality, stratified by sex (decrease in 16, increase in 12 countries) and by age group (decrease in 11, increase in 16 countries); • mortality from falls, stratified by age group (decrease in 20, increase in 26 countries).