The figure below shows the causal pathway by which employment affects health. Structural Fund spending for employment can influence different parts of this pathway. Possible approaches and actions for Structural Funds to improve health gains are shown in the blue box.

Please note that this causal pathway is still in development. The topic boxes will be filled in the next revision of the site.


Understanding the policy context

This provides an overview of the main policy and legislation items that need to be considered in order to comply with the ex-ante conditionalities for spending of Structural Funds on employment.

European Employment Strategy and its “employment guidelines”

  • Active and healthy ageing
  • Small Business Act
  • Directive 2000/78/EC establishing a general framework for equal treatment in employment and occupation
  • Directive 2000/43/EC implementing the principle of equal treatment between persons irrespective of their racial or ethnic origin

It also focuses on health-relevant aspects of some of Europe’s 2020 flagship initiatives and the 2007-2012 Community Strategy on Health and Safety at Work.



Strategic analysis and programming

There are a number of ways in which Structural Fund investment in the employment sector can affect public health. These include:

  • Provision of specialist outreach engagement and support for vulnerable groups, such as people with low skills, people with disabilities and mental ill-health, single parents, and older/younger workers to find lasting employment will have a positive impact on the overall health status of these groups
  • Enhancing access to affordable and appropriate support for people with caring responsibilities (e.g. childcare)
  • Development of innovative approaches to help overcome transport barriers, including support for home working as well as flexible transport solutions
  • Support to employers to help existing employees (including part-time and temporary workers) to develop their skills and move into longer-term positions
  • Activities and support services that address the quality of work life, providing support to employers and employees for improvements occupational health and safety; work/family life balance; and access to health care through employment.

For examples of some of the linkages between health and employment that can be considered within the Operational Programmes, and links to good examples from case studies and actual programme documents, please go to the Approaches to Consider page.


Developing Projects

The causal pathway for employment has shown that sustainable, high quality employment is an important determinant of public health conditions. Most of the projects developed and financed through the Structural Fund programmes that target employment will - indirectly – generate positive impacts on health. 

The Approaches to Consider page shows a few good practice examples of projects that clearly demonstrate the positive impacts of employment on health gains, as well as those that directly target health as a cause of long-term economic inactivity.


Demographic change and employment structure

The ageing population

The impact of population ageing within the EU is likely to be of major significance in the coming decades.

From (Eurostat, 2010: 159)

Low birth rates and higher life expectancy will lead to a much older population, already apparent in several Member States such as Germany, Greece, Italy and Sweden.

As a result, the proportion of people of a working age in the EU-27 is shrinking at the same time as those who are considering retirement expands (see Figure 1 below)

Between 2001 and 2009, average retirement ages in the EU-27 rose from 59.9 years to 61.4 years of age (Eurostat, 2011h: 183), whereas life expectancy at age 65 rose from 19.5 to 20.7 years for women, and from 15.9 to 17.2 years for men between 2002 and 2008 (Eurostat, 2011h: 195). Hence, the number of people expected to reach retirement age is growing at an average of 0.3% per year, whereas life expectancy is growing at around 1.0% per year for women and 1.3% for men. The combination of these two trends implies that future cohorts will face longer periods in retirement unless the average age of retirement rises faster than it did during the 2000s


Figure 1: Moving age pyramids, EU-27

From (Eurostat, 2010: 167)


Low birth rates and rising life expectancy will likely result in a much older population structure, such that the ratio of the number of working-age people to those aged over 65 will be reduced from 4:1 in 2008 to less than 2:1 by 2060.

Persons aged 65 or over will account for 30.0 % of the EU-27’s population by 2060, compared with a 17.0 % share in 2008.

The importance of the very old (80 years or more) will be considerable by 2060, when this age group is likely to account for 12.0 % of the EU-27’s population.

(Eurostat, 2010: 162)

Life expectancy at birth refers to the mean number of years that a newborn child can expect to live if subjected throughout his/her life to current mortality conditions. A similar indicator can be analysed for persons aged 65, reflecting the mean number of years still to be lived by these persons conditional on survival to age 65 (following current mortality conditions).

Life expectancy increases as people age, as a result of surviving and/or avoiding potential causes of death (for example, infectious diseases when young, smoking- related illness, car or occupational accidents).

Many Europeans enjoy a longer and healthier life than previous generations: average life expectancy in EU27 countries rose from 73.65 in 1980 to 79.05 in 2006.

Gender differences persist: in 2006 EU 27 life expectancy of a boy at birth was 75.8 years; and of a girl at birth 82.0 years.

Major inequalities exist between countries and regions: life expectancy at birth for men varied by 14.2 years between Member States in 2007, while the corresponding figure among women was 8.3 years.

The lowest male life expectancy was recorded in Lithuania (64.9 years) and the highest in Sweden (79.0 years), while for women, the range varied between a low of 76.5 years in Latvia and a high of 84.8 years in France.

The process of enlargement has, and continues, to increase the diversity in patterns of health across Europe.

(Eurostat, 2010: 185-186;Mladovsky et al., 2009: 10)


Economic efficiency


Global and regional economy



Population growth in the EU-27 amounted to 2.1 million persons in 2008, comprising a 1.5 million net increase from migration and a 0.6 million increase from natural change. In 2008, 3.8 million people migrated to and between the EU-27 member states.

There are two components of population change in any given period of time (Eurostat, 2010: 170-171):

  • Natural population change: the difference between births and deaths
  • Net migration: the difference between immigration and emigration

Net migration has been the main driver of population change in the EU-27 during the past decade, in particular since 2002, although net migration has fallen sharply since 2006 (Eurostat, 2011f: 13). It is expected to become an increasingly important factor for demographic change over the next 50 years (European Environment Agency, 2010: 12).

Figure 2: Population change by component, EU-27, 1990-2009 (per 1,000 population)

From (Eurostat, 2011f: 13)

Patterns of population change vary considerably between the Member States: in some cases, natural changes are compensated for by changes in net migration, whereas in others, the two components of population change move in the same direction, increasing the momentum with which population levels change.

The majority of EU-27 member states in 2008 reported more immigration than emigration, but in Bulgaria, Germany, Poland, Romania and the three Baltic states, Estonia, Latvia and Lithuania, emigrants outnumbered immigrants.

In absolute terms, Spain, Germany and the United Kingdom were the EU countries with the highest immigration. They received more than half (53 %) of all immigrants in 2008, but at the same time they also experienced high emigration.

Relative to the size of the resident population, Luxembourg (with 36.3 immigrants per 1 000 inhabitants) had the highest immigration in the EU in 2008, followed by Malta with 21.9 and Cyprus with 17.8.

From (Eurostat, 2011f: 19).

Migration caused by environmental factors will assume greater significance during this century [see Climate Change pathway] and this will have a particularly strong effect on Europe, due to its proximity to some of the world's poorest regions and those likely to be worst affected by climate change and natural resource constraints (Commission of the European Communities, 2008: 3;European Environment Agency, 2010: 10).


Income poverty and relative deprivation


Life expectancy


Living conditions


Access to labour markets




Income inequality


Physical activity at work


Poverty and low pay




Children and young people


Low income and socially excluded groups


Older people


Stress at work




Working age adults






Health impacts of informal work






Work and mental ill health