Tackling the gradient: Applying public health policies to effectively reduce health inequalities among families and children

GRADIENT (2009-2012) was a collaborative research project involving 12 institutions (universities, research institutes and public health institutes) from all over Europe. The project was coordinated by EuroHealthNet and received funding from the European Community’s Seventh Framework Programme (FP7 2007-2013) – Health Research, under grant agreement No 223252.

The GRADIENT project had the overall goal of identifying what measures could be taken to level-up the socio-economic gradients in health among children and young people in the EU. The main objectives were to develop a consensus based European Framework to monitor and evaluate public health policies, to assess if and why children and families from different socio-economic groups respond and act differently to public policy interventions, to make a review of protective factors for the health of children and young people and their families focusing on social capital, and to analysedifferent welfare regimes and general policies in different EU countries and compare the impact for families and children. Findings and results of the project were formulated into policy recommendations and disseminated at EU, national and regional level.


In all EU countries there is a systematic correlation between the level of health and social status - a step-wise decrease in health that comes with decreasing social position. This correlation exists amongst children and young people as well as amongst adults. These social gradients in health are harmful and unjust, particularly when it comes to children and young people, since adversity during the early years negatively impacts on health across the life-course. This also means that the majority of children growing up in the EU are falling short of achieving their full health potential.


The GRADIENT project has generated a number of important findings and outcomes that can contribute to learning and action on how to level-up the health gradient among children and young people.

While governments and other actors in the EU increasingly recognize the need for action on health inequalities, the focus remains on improving conditions of the poorest segments of society, rather than looking across the gradient and at the large numbers of children and youth whose health is worse than it could be. Gradients in health reflect the systematic nature of the association between socio-economic status and health status, and therefore highlight the unjustness of this situation; people who are comparatively less well-off do not, by and large, choose to live in ways that undermine their health.

Health inequalities amongst children and young people are particularly unjust in light of the large body of evidence that reveals that the adverse effects of disadvantage on health in the early years is compounded over the life-course. Even where people who grew up under difficult circumstances manage to do better in later life, they will still have poorer health than their counterparts who grew up under better conditions. The GRADIENT  project therefore looked at different aspects of what can be done to improve this situation. It is clear that the solutions do not lie in measures that focus exclusively on health, since a very wide range of policies impact upon their lives.

A crucial step to levelling-up the health gradient is to look at policies that can affect the well-being of children and youth through a “Gradient Evaluation Lens”. The GRADIENT therefore developed such a tool, The Gradient Evaluation Framework, which highlights key factors that policy makers and practitioners must consider to ensure measures are ‘gradient friendly’. The need to ensure that universal policies are designed to address proportionally greater needs with greater intensity, as well as the need for coordinated action across different sectors that reinforce rather than undermine one another is in this respect very important.

Another significant GRADIENT outcome is the insight that community social capital matters to the health of children and young people. This was previously an understudied area. Evidence from the GRADIENT shows that health gains incurred by increasing social capital is particularly marked for disadvantaged or vulnerable children and youth in communities with low social capital. Measures to promote the development of community organizations and that e.g. foster interaction amongst parents in areas where community social capital is low can help to level-up socioeconomic gradients in health. This evidence can be applied to encourage investments in community development through e.g. the EU Structural Funds.

GRADIENT outcomes also support the premise that the nature of welfare states matters; the findings that countries that invest most in family friendly policies have more level socio-economic gradients comes as no surprise. The GRADIENT highlighted however that Slovenia is a good example of a country which currently has many ‘gradient-friendly’ policies. It also appears that many welfare states are still based on outdated models of single male-bread winners that undermine the potential of women and children. Important measures to improve the health of children and young people are those for example that stimulate ‘mama working’. This is only effective of course, if women have quality employment that allows for good work-life balances and if this is paired with a good availability of affordable and high quality early child care and education programmes.

The outcomes of the four research components have been synthesized and brought together into a book – The Right Start to a Healthy Life – which includes a set of policy recommendations which are widely disseminated to policy makers and professionals in a user-friendly format across the EU. This information is particularly timely in the context of the financial crises, when austerity programmes are leading to public spending cuts that tend to fall hardest on lower income families. The steepness of socio-economic gradients in health among children, young people and families in a country are a clear barometer of that country’s current and future well-being. This barometer should be at the forefront of policy maker’s minds as they respond to the current economic crisis.

We hope that the findings and results of the GRADIENT project encourage policy makers and practitioners across the EU to adopt such measures, to ensure that European children and young people get the right start to a healthy life and can live in and contribute to prosperous, cohesive and sustainable European societies.

The Right Start to a Healthy Life

The GRADIENT Evaluation Framework

Finnish translation

Translation courtesy of Marjorita Sormunen.

 The GRADIENT Evaluation Framework - Online Tool & Apps

Gradient Evaluation Framework - Online Tool




Download the Gradient Evaluation Framework Application.

Academic papers

Download paper: Does neighbourhood social capital aid in levelling the social gradient in the health and well-being of children and adolescents? A literature review (by Vyncke et al., 2013)