8.3 Challenges

Four environmental health inequality indicators show an increase in inequalities for the vast majority of countries in the WHO European Region (i.e. the number of countries with an increase in inequalities is at least twice the number of countries with a decrease), indicating key challenges of environmental health inequality that seem to be a concern across the Region. Two such examples are energy poverty, stratified by below versus above the relative poverty level (Fig. 66) and complaints about noise, stratified by below versus above the relative poverty level (Fig. 67). Poverty-driven inequalities in energy payments have increased in 24 and decreased in only 10 countries, with the increases often more strongly expressed than the decreases (Fig. 66). The largest increases in inequality were observed in Croatia, followed by Cyprus, Greece, Lithuania and Portugal with an inequality gap increase of more than 10%. A similarly strong reduction of inequality is only found for Romania, with a decrease of the inequality gap by more than 10%.

Fig. 66. Changes in magnitude of inequality in difficulty paying energy bills, below versus above relative poverty level, 2008 to 2016

Lithuania (↑↑) Denmark Change from 2.8 to 2.9 (↑↑) Increase of inequality di erence Cyprus (↑↑) Decrease of inequality di erence Norway (↓↓) Luxembourg (↑↑) Sweden (↓↓) Portugal (↑↑) Netherlands (↓↕) Latvia (↑↓) Estonia (↓↑) Switzerland (↑↓) Croatia [a] (↑↓) Malta (↑↑) Germany (↓↓) Spain (↑↑) Iceland (↑↑) Romania (↓↓) Austria (↑↑) Finland (↕↑) Slovakia (↑↑) United Kingdom (↑↑) Czechia Change from 7.8 to 8.0 (↑↑) Ireland (↑↑) Belgium (↑↓) Slovenia (↑↑) Italy (↓↓) Poland (↑↓) France (↓↓) Turkey (↑↑) Greece (↑↑) Bulgaria (↑↓) Serbia [a] (↓↓) Hungary (↑↑)

North Macedonia [a] (↑↑) Change in magnitude of inequality in prevalence 0% 5% 10% 15% 20% 25% 30% 35% 40%

Notes: [a] the first reporting year for Croatia and North Macedonia was 2010, for Serbia was 2013; vertical arrows (↑ or ↓) represent the increase or decrease in reported difficulty paying energy bills for the second time point (2016); the first refers to the change in prevalence for those below the relative poverty level and the second to the change in prevalence for those above.

Fig. 67. Changes in magnitude of inequality in self-reported noise annoyance, below versus above relative poverty level, 2009 to 2016

Italy Iceland Latvia Lithuania † North Macedonia ‡ Portugal † Slovakia † Poland ‡ Spain Bulgaria Croatia ‡ Estonia † Slovenia Serbia ‡ Cyprus United Kingdom Malta Sweden Czechia Austria France Switzerland Hungary Greece †‡ Finland Norway Ireland Belgium Luxembourg Germany Denmark Romania †‡ Netherlands Change in magnitude of inequality in prevalence 0% 2016

2016

2016

2% 4% 6% Increase of inequality di erence Decrease of inequality di erence Inequality gap (one year only)

8% Change from 9.20 to 9.19(↓↓)

10% 12%

Notes: † represents reversed inequality in 2009; ‡ represents reversed inequality in 2016; vertical arrows (↑ or ↓) represent the increase or decrease in self-reported noise annoyance for the second time point (2016); the first refers to the change in prevalence for those below the relative poverty level and the second to the change in prevalence for those above.

For self-reported noise annoyance the inequality between people below and above the relative poverty level increased in 21 countries and decreased in 9 (Fig. 67). The largest increases were observed in Iceland, France, Slovakia, Spain and Belgium, where the inequality gap increase ranged from 3% to 8%. Most of the decreases had a smaller magnitude, except in Portugal and Lithuania, which had reductions of 4% and 3%, respectively.

The other two environmental health inequality indicators defined as challenges across the Region are: • dampness in the home, stratified by income quintile (decrease in 10, increase in 20 countries); • inability to keep the house warm, stratified by below versus above the relative poverty level (decrease in 7, increase in 23 countries).

For these four environmental health risks, countries across the Region have not been able to mitigate inequalities and provide effective policies and interventions to protect the most disadvantaged population groups.