Environmental health inequalities and health system responses in CEE: exposome and equity
I Miskulin, V MatkovicAbstract
Background
CEE countries carry a disproportionate burden of environmentally driven disease. Air pollution and broader exposome-related hazards interact with socioeconomic disadvantage to amplify health inequalities, yet their social and spatial distribution and health system responses remain insufficiently studied across the region.
Objectives
To provide a cross-country overview of environmental health inequalities in CEE, focusing on air pollution and exposome-related risks, and to critically examine health system responses across the life course.
Methods
Narrative synthesis of epidemiological studies, national and European monitoring data (EEA, WHO), and health system policy analyses for CEE countries. Evidence was organised around: distribution of environmental exposures by socioeconomic position and geographic area, covering children and older adults; and policy and programmatic responses within health systems.
Results
Environmental health inequalities are evident across CEE. Disadvantaged groups and peripheral regions face higher exposures to PM2.5, NO2, and combined exposome risks, alongside reduced access to preventive health services. Children in lower-income households and older adults in rural and post-industrial areas are particularly vulnerable. Health system responses remain fragmented: national action plans rarely incorporate an equity lens, and intersectoral governance is weak. Nevertheless, emerging examples confirm that equity-oriented environmental health action is feasible within existing institutional frameworks.
Conclusions
A life-course approach integrating exposome research with health system strengthening and equity-sensitive policymaking is needed. Harmonised cross-country data collection and interdisciplinary collaboration are essential to reduce the persistent environmental health gap between CEE and Western Europe.