Populations vary in their vulnerability to health impacts, and they also vary in the resources available for adaptive responses. These differences in vulnerability, between and within populations, reflect a wide range of demographic, cultural, political, socioeconomic and technological circumstances.
Socioeconomic inequalities in health (mortality and morbidity) exist in all countries. There are differences in life expectancy of 5 to 10 years between those at the top and those at the bottom of the social scale. There is mounting evidence that these divides are widening. Many factors contribute to these inequalities, including environmental, educational, social, economic, behavioural and cultural ones.
The health and demographic situation is marked by such features as: population growth; an increase in the number of vulnerable people, such as elderly people, immunocompromised individuals, and malnourished people; and rapid urbanization, in some areas without the necessary infrastructure.
National impact assessments should be undertaken, to describe and identify the means by which the vulnerability of populations and subgroups could be reduced and to select priorities for monitoring.
Article 5 of the Draft Protocol on Water and Health (1999) to the Convention on the Protection and Use of Transboundary Watercourses and International Lakes (1992), states: (k) Special consideration should be given to the protection of people who are particularly vulnerable to water-related disease; and (l) Equitable access to water, adequate in terms both of quantity and of quality, should be provided for all members of the population, especially those who suffer a disadvantage or social exclusion.
In the European Region as a whole, the proportion of the population aged 65 years and over increased by 9% and the proportion aged 0-14 years decreased by 6% from 1990 to 1995. In many countries of central and eastern Europe (CCEE) and the newly independent states (NIS), socioeconomic indicators such as unemployment, inflation and gross domestic product reflected associated undesired changes in wellbeing in the 1990s. According to the Human Development Report (1997), the number of poor people in the countries of central Europe and the newly independent states increased from about 15 million at the start of the 1990s to about 120 million. An important marker of inequality in health is the gradient of health indicators across socioeconomic levels. The factors leading to such differences include elements of a broadly defined environment, such as exposure to poor living conditions (especially in childhood), work-related exposure to health hazards, exposure to stress and unhealthy behaviour.