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International audience ; Background In order to support the case for intersectoral policies to tackle health inequalities, we have explored the economic costs of socioeconomic inequalities in health in the European Union, Methods Using recent data on inequalities in self-assessed health and mortality covering most of the European Union, we calculated the health losses due to socioeconomic inequalities in health by applying a counterfactual scenario in which the health of those with lower secondary education or lower (roughly 50% of the population) would be improved to the average level of health of those with at least higher secondary education. We then calculated various economic effects of those health losses: health care costs, costs of social security schemes, losses to Gross Domestic Product through reduced labour productivity, and the monetary value of total losses in welfare. Results Inequalities-related losses to health amount to more than 700,000 deaths per year, and 33 million prevalent cases of ill-health, in the European Union as a whole. These losses account for 20% of the total costs of health care, and 15% of the total costs of social security benefits. Inequalities-related losses to health reduce labour productivity and take 1.4% off GDP each year. The monetary value of health inequalities-related welfare losses is estimated to be €980 billion per year, or 9.4% of GDP. Conclusion Our results suggest that the economic costs of socioeconomic inequalities in health in Europe are substantial. As this is a first attempt at quantifying the economic implications of health inequalities, the estimates are surrounded by considerable uncertainty, and further research is needed to reduce this uncertainty. If our results are confirmed in further studies, the economic implications of health inequalities warrant significant investments in policies and interventions to reduce them.

Abstract Background Comprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts. Methods National spending on health-related primary and secondary preventive activities was examined by funding source with the use of national statistics, government reports, sector reports, and data from individual health associations and corporations, public services, occupational health services, and personal prevention. Costs were broken down by diseases, age groups and gender using population-attributable risks and other key variables. Results Total expenditures on prevention were €12.5 billion or €769 per capita in the Netherlands in 2003, of which 20% was included in the national health accounts. 82% was spent on health protection, 16% on disease prevention, and 2% on health promotion activities. Most of the spending was aimed at the prevention of infectious diseases (34%) and acute physical injuries (29%). Per capita spending on prevention increased steeply by age. Conclusion Total expenditure on health-related prevention is much higher than normally reported due to the inclusion of health protection activities beyond the national health accounts. The allocative efficiency of prevention spending, particularly the high costs of health protection and the low costs of health promotion activities, should be addressed with information on their relative cost effectiveness.