Gaps and inequities in child health across the European Union

The European Union (EU) includes some of the world’s wealthiest nations and has enjoyed some of the world’s best health outcomes for children and adolescents for decades. 

The EU has also made significant progress on recognizing the right of every child to quality health care – a right that is embedded in a raft of regional and national policies. Recent years, however, have seen deteriorating outcomes across a wide range of child health indicators across the EU. This is particularly concerning, as child health is a critical foundation for lifelong well-being, influencing not only quality of life in early years but also long-term health, educational attainment, and life expectancy. 

Many children in Europe face developmental challenges that are recognized too late for timely and effective intervention. This delay not only limits their ability to reach their full potential but also reflects significant shortcomings in the systems designed to monitor and support child and adolescent health across the region. Global data on the prevalence of developmental delays among children under five in high-income countries indicate high figures of 10–15 per cent.^1,2 

The disparity in disability identification – with only 2.7 per cent of children aged 0–4 having disabilities identified, compared to 4.3 per cent in the 5–9 age group – suggests that many developmental difficulties remain undetected during the early years, when interventions are most impactful.³ 

Meanwhile, immunization coverage is faltering and measles, once in full retreat, is reappearing to threaten children’s lives and long-term health. Measles cases surged ninefold across the EU in 2024, with 35,263 people diagnosed, up from 3,968 cases in 2023.⁴ Europe and Central Asia accounted for one-third of the global measles burden, marking the highest regional total since 1997.⁵ 

There are growing concerns about choices affecting health outcomes, with one in three primary school children in Europe now being overweight or living with obesity,⁶ with those from disadvantaged backgrounds disproportionately affected.⁷ Children and adolescents are also exposed to aggressive marketing of unhealthy food, alcohol, tobacco and nicotine-containing products such as e-cigarettes, which contributes to the increasing trends in obesity, non-communicable disease and the use of alcohol, tobacco and nicotine among children.⁸ More than half of all 15-year-olds have experimented with alcohol, 15 per cent have smoked at least once in the past month, and one in five has recently used e-cigarettes, with clear risks for their health.⁹ 

Mental health concerns have doubled since the COVID-19 pandemic to affect one child in every four, exacerbated by social isolation and anxiety about the future in uncertain times.¹⁰ Girls, older adolescents and children in low-income households report the worst mental health. In some countries in the region, nearly half of young people have unmet mental health care needs. Suicide now ranks among the top three leading causes of death among adolescents in Europe.¹¹ 

The need for an equitable and holistic approach 

These challenges to health are not distributed evenly across Europe’s child population. Health gaps and inequities persist within and between countries: some children are consistently left behind, unable to access vital support for their physical and mental health. 

To nurture every stage of a child’s development and safeguard the well-being of future generations, we need inclusive approaches and strong systems. This requires the integration of health promotion and prevention through primary healthcare; the leveraging of schools as health-promoting environments; the strengthening of social services that are integrated with health systems; and the creation of safe, empowering and developmentally appropriate digital platforms. To effectively support children and adolescents, a holistic and multisectoral approach is needed that reaches every single child, that spans every aspect of their health and that accompanies them through every stage of their infancy, childhood and adolescence.

This approach must reach children in their earliest years of life if it is to build a firm foundation for lifelong health and development. Early childhood is a critical period for development, with the brain reaching 90 per cent of its adult size by the age of five.¹² The environment around the young child is crucial for their development and key interventions at this time in their lives – such as maternal mental health support, proper nutrition, immunization and early identification of challenges – help create a launch pad for lifelong wellbeing and reduce the risk of chronic conditions. 

As children grow into adolescents, they experience another transformative stage of brain development – one that will shape their self-identity, decision-making and social interactions. In today’s increasingly digital world, this pivotal moment also coincides with an increased use of, and reliance on, social media and other technologies. While these are powerful tools for education, social engagement and entertainment, their impact on well-being is problematic and complex. 

Mental and physical health are deeply intertwined. Early-life factors such as poor nutrition, inadequate prenatal care and exposure to prolonged stress can contribute to long-term health challenges, including diabetes, cardiovascular diseases and obesity. Similarly, mental health disorders can lead to unhealthy coping mechanisms – such as poor diet and lack of physical activity – which further escalate the risk of non-communicable diseases. Studies show that adversity during childhood increases the likelihood of developing chronic conditions, including depression, heart disease and neurodegenerative disorders.¹³ As a result, holistic support systems that integrate physical and mental health interventions are needed. 

The most vulnerable children and adolescents who are at greatest risk of poor physical and mental health are also the most likely to miss out on comprehensive, prevention-focused health services. Barriers to accessing services may differ between different vulnerable groups such as children living in poverty or in hard-to-reach areas, those affected by migration or from migrant backgrounds, those with disabilities or those from minority communities, such as the Roma in Eastern Europe. The impacts can be felt for decades in the lost potential of individual children and the loss of human capital that is vital for the social and economic well-being of all countries.

Current European policy framework

A framework of global and regional policies compels every EU member state to protect the rights of every child to good quality health care. Under this framework, every child in the EU has the right to health and well-being from their earliest days, throughout their childhood and during adolescence.¹⁴

The impact of these policies depends on their interconnectedness and combined support for a comprehensive and holistic approach that strengthens protective factors while addressing vulnerabilities that threaten child and adolescent health. However, translating them all into national policies and practices in a coherent manner is challenging. 

The ‘Promoting a comprehensive, prevention-oriented approach to children’s health’ partnership between the EU and UNICEF aims to support governments in the adaptation and adoption of strong policies and good practices that uphold the above policy framework in a coherent and integrated way. 

Promoting a comprehensive, prevention-oriented approach to children’s health 

A three-year partnership between the European Commission and UNICEF, Promoting a comprehensive, prevention-oriented approach to children’s health, will support the efforts of EU member states, Iceland and Norway to improve children’s health, prevent health problems and ensure that no child or adolescent is left behind. By identifying gaps and inequities in access to health services, the partnership will promote solutions that support children and adolescents through every stage of life.

This paper highlights current health inequities and gaps in these five key areas, framing the needs that this EU-UNICEF partnership aims to address. In each area, it lays out the challenge, explores current EU approaches to tackling these inequities and gaps, and assesses the costs of inaction.