OECD - Health for Everyone?

Promoting a better sharing of the benefits of growth and equality of opportunities are key components of a strategy to foster social cohesion and the sustainability of economic growth. Yet, in many aspects of life, inequalities between different population groups have persisted at high level or even widened further over the last decade. Across the OECD, the top 10% of income earners now take home nearly ten times more pay than the bottom 10%. Wage inequality has reached record-high levels in some OECD countries, related to the workers skills but also type of contract. There is also a clear geographical dimension to income inequalities and job quality. And more than in the past, inequality of opportunities feeds into inequality of outcomes and vice versa reducing social mobility from one generation to the next.

Health plays a key role in shaping inequality of opportunities and outcomes. The socio-economic context in which people live affects their health. But this is not a one-way street: health is not only a result of social changes, it also drives them. If health inequality increases, so will inequality in social outcomes. For example, the difference in lifetime earnings between people in poor health and good health is the same as between low-skilled and medium-skilled workers. To address the latter, promoting access to education and training opportunities for disadvantaged groups is key to foster their employment prospects and boost economic growth more generally. However, addressing health inequality is equally important to enable individuals to aspire to a fulfilling life, but this is not always recognised. This needs to change. Making sure that people live as many years as possible in good health should not just be an argument for social justice but at the core of overarching health, social and employment policies.

The OECD Inclusive Growth agenda has long made the case for the need for policy to promote equal opportunities and address income inequalities. With Preventing Ageing Unequally the OECD examined in 2017 how the two global mega-trends of population ageing and rising inequalities have been developing and interacting, both within and across generations. The 2018 OECD publication A Broken Social Elevator? How to Promote Social Mobility has shed light on social mobility, another key angle of the inequality challenge. The report provides evidence of low social mobility across and within generations at the top and the bottom of the income ladder, particularly since the early 1980s.

Health for everyone? addresses one missing piece of the puzzle on the links between inequalities of opportunities and outcomes. A considerable body of academic studies demonstrates the existence and extent of inequalities related to health, sometimes looking at trends and/or undertaking comparisons across groups of countries but typically looking at one aspect of the issue: How is obesity distributed across social groups? Do people have equal access to care? Are the well-off in better health? This report provides evidence on health-related inequality across a range of dimensions in a large set of OECD and EU countries. The report identifies groups of countries that display higher (and lower) levels of inequality in health and health systems, setting priorities for more in-depth discussion on how to address them. Overall, the report demonstrates that if policy makers want to promote inclusive growth, increasing attention should go to ensuring that health policies benefit the least well-off.