Health inequalities remain one of the most persistent public health challenges across Europe. To better understand the social roots of these disparities, the European Social Survey (ESS) has taken a major step forward with the launch of its second Health Inequalities Module in 2023/24. This follows the first module from 2013/14, which has already provided significant data on how factors like income, education, housing, and employment shape health outcomes across the continent.
The ESS is a biannual, cross-national survey that collects high-quality, comparative data from over 30 European countries. With the new module, researchers can now assess how social inequalities in health have evolved over a decade marked by major disruptions—COVID-19, economic uncertainty, increased migration, and political polarization. By repeating core questions from the first module and introducing new ones, this survey enables comparisons over time and between countries with different welfare regimes and public policies.
One of the key findings from earlier analyses is that social health inequalities follow a gradient—people at every level of socioeconomic status tend to have worse health than those above them. The data also show that chronic conditions, such as diabetes, cardiovascular disease, and cancer, are not randomly distributed but strongly associated with social disadvantage. Mental health concerns, particularly depression, are shown to be more prevalent among socially marginalized groups, including those in insecure employment or with migrant backgrounds.
The module explores not just health outcomes, but also the social determinants behind them. This includes educational level, income, job type, childhood conditions, healthcare access, housing quality, and psychosocial stress. For example, respondents with lower educational attainment tend to smoke more and binge drink more frequently, while also facing more barriers to accessing specialist healthcare. The 2023/24 module includes improvements such as more nuanced questions on smoking intensity, cancer survivorship, housing problems, and personal sense of control.
Importantly, the new module enables the evaluation of national and EU-wide policies. Researchers can now explore how changes in cancer care, employment policy, housing regulation, and migration policy have influenced population health and health equity. For instance, the data allow researchers to analyze whether EU Cohesion Fund investments have led to better health outcomes in underdeveloped regions.
However, the survey has some limitations. As a cross-sectional study, it does not follow the same individuals over time, and relies on self-reported health data, which can introduce bias. Also, while the sample sizes are large, they may be insufficient for detailed sub-national or intersectional analyses in some countries. Nonetheless, with improved spatial modeling and data integration strategies, these gaps can be addressed in future research.
The second Health Inequalities Module of the ESS offers a timely and powerful tool for social and health scientists. It provides an empirical foundation for designing better policies and interventions to reduce avoidable health disparities across Europe.
Reference:
Hoven, H., Eikemo, T. A., Backhaus-Hoven, I., Riebler, A., Fitzgerald, R., Martino, S., Huijts, T., Heggebø, K., Vidaurre-Teixidó, P., Bambra, C., & Balaj, M. (2025). The second Health Inequalities Module in the European Social Survey (ESS): Methodology and research opportunities. Social Science & Medicine, 380, 118228. https://doi.org/10.1016/j.socscimed.2025.118228
