Health inequalities are unjust and avoidable, and for too long, have been preventing people from living longer, healthier lives. Cardiovascular diseases are the leading cause of death in Europe, but the vast majority of them are preventable.

Structural heart disease (SHD) is a set of cardiovascular conditions that affect the structure of the valves, atria, ventricles and blood vessels in the heart. It can be treated, but our research finds that age, socio-economic status, gender, ethnicity, and geographical location significantly reduce the likelihood of being diagnosed and receiving treatment. Left untreated, SHD has a high mortality rate and decreases quality of life for those living with the condition.

This report follows on from our flagship report: The invisible epidemic: rethinking the detection and treatment of structural heart disease in Europe. In this report, we take an even deeper dive to highlight the barriers that certain demographic groups face that prevent them from receiving timely treatment, including what must be done to ensure that everyone, not just the privileged few, benefits from living longer and healthier lives. This research pulls together evidence from existing evidence, expert stakeholders, and global health pioneers attending the 17th World Congress on Public Health. The aim of the report is to put a spotlight on inequalities in SHD, a topic that has received very little research or policy attention in Europe so far.

Evidence suggests that:

• Across 11 European countries women are less likely to regularly receive a heart check with a stethoscope by their GP than men, (24.2% women receive heart checks vs 31.3% men).
• In the UK, valvular heart disease, one of the most common forms of structural heart disease, is twice as likely to go undiagnosed in the most deprived socio-economic groups than in the most affluent group.
• Across 57 countries (including in Europe, Central Asia and North Africa) mitral valve disease, one form of structural heart disease, is nearly five times as high in middle-income countries as in high-income countries.

Our recommendations include:

• The WHO should encourage all countries to update or develop their cardiovascular strategies to specifically include structural heart disease to raise awareness of the condition and how inequalities are driving disparities in detection and diagnosis.
• The EU should develop a Cardiovascular Health Plan, emulating the EU Cancer Plan, including an EU-wide target for early detection of structural heart disease.
• All countries should pilot screening programmes, which should include an objective to reduce inequalities to ensure diagnosis at an earlier stage.