Policy background: Health inequalities are recognised as an issue in most countries around the world and they are a major concern for policymakers. Many countries have developed strategies to reduce the differences in health seen across populations with a major focus on tackling socioeconomic health inequalities. However, despite the steps taken by governments around the world, the English cross-government strategy implemented between 1997 and 2010 remains the most ambitious policy attempt to date.

International trends in health inequalities: Recent studies show that many high-income countries have experienced a widening in health inequalities. Studies of gaps in adult and infant mortality within a range of high-incomes countries typically show that the most deprived areas and groups have had a slower rate of improvement in life expectancy compared to the least deprived areas and groups. In the United Kingdom and Germany, data suggests that improvements in life expectancy have slowed in recent years.

The policy context for action on health inequalities: A commitment to act on health inequalities requires high-level political will and a strong culture of intersectoral collaboration inside and outside of government. In Wales, the strategic and policy context for action has been strengthened by key pieces of enabling legislation that support a greater focus on prevention and addressing inequalities. However, there are also major challenges and constraints to what policy actions are possible within the powers that the Welsh Government can exercise under devolution.

The World Health Organization health equity policy tool is structured around five policy action areas: Health, Services
Income Security & Social Protection, Living Conditions, Social & Human Capital, Employment & Working Conditions. We have summarised key examples of policy actions across seven high-income countries of a similar population size and with similarities in their political systems and policy choices to Wales: Finland, New Zealand, Iceland, Slovenia, Scotland, Ireland, and Belgium.

Conclusion: The international data highlights the persistent and complex nature of health inequalities, particularly those driven by socioeconomic factors. Despite various strategies and policies, significant differences in health outcomes remain across population groups in high-income countries, exacerbated by recent challenges such as the responses to the global financial crisis and the COVID-19 pandemic. The key findings from this report highlight the need for comprehensive and multi-faceted policy approaches to address health inequalities. The evidence highlights the importance of preserving equitable healthcare access, expanding the welfare state, and targeting health-related behaviours through coordinated intersectoral strategies. By learning from international examples and adapting successful policies, Wales can work towards effective actions to reducing health inequalities and improving overall population health and wellbeing. Addressing health inequalities requires high-level political will, strong intersectoral collaboration, and a commitment to long-term, sustainable policy actions. These efforts will not only improve health outcomes but also contribute to a more equitable and just society.