Principle 12

Social protection

"Regardless of the type and duration of their employment relationship, workers, and, under comparable conditions, the self-employed, have the right to adequate social protection."

- Principle 12 of the European Pillar of Social Rights

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12. Umbrella

Social protection as a determinant of health

P12_Woman watering tree_yellow green

Social protection shapes health, equity, and wellbeing. It protects individuals from financial hardship and improves access to essential services like healthcare, education, and housing. It also helps people develop their skills and social connections.

When social insurance and assistance support are integrated in one, universal system, they can support people across all life stages, acting not just as poverty relief but also as a foundation for long-term wellbeing.

However, as government budgets become tighter, this support is becoming more restricted and conditional, even as the evidence shows that broad-based social protection measures are most effective in preventing and reducing health inequalities. They promote stability, resilience, and social cohesion, allowing societies to better face crises and giving people better opportunities to live healthier, more prosperous lives.

Health equity and universal social protection

Social protection and health are closely linked, as good health supports economic stability. Poor health limits a person's job opportunities and increases financial vulnerability. This, in turn, increases the risk of early retirement and old-age poverty. Although European welfare systems aim to provide access for everyone, new challenges are putting pressure on them. These include an ageing population, changes in the job market, digitalisation, as well as economic and climate shocks challenge. As a result, inequalities may grow, leaving behind the poorest, the least skilled and the least resilient individuals—the youth, women, migrants and people living in rural areas.

Universal social protection combines social insurance, assistance, and job inclusion programs. It helps people find good jobs, earn stable incomes, and access important services. The specific measures may vary, but they all aim to prevent exclusion through in-kind or cash benefits, service subsidies, and targeted support for vulnerable groups. Since anyone may face vulnerability at some point in their life—due to illness, job loss, parenthood, or ageing—comprehensive protection is vital.

Proportionate universalism ensures that everyone benefits from social protection, but those who need it most get the most support. By safeguarding access to healthcare, education, food, and housing—key social determinants of health—broad-based coverage strengthens work productivity and wellbeing. It also fosters economic stability at individual and community levels and generates high return on investment, thereby tackling structural health inequities. This is one of the pillars of a Wellbeing Economy approach to health. Better (healthy) life expectancy, maternal and child health, and mental wellbeing strengthen trust, social cohesion, and resilience against health, economic, and climate shocks. Countries with strong systems respond and recover faster from emergencies.

However, as public budgets shrink, resources are being more narrowly targeting, limiting broader societal support. Social protection should not only focus on the poor. A well-funded system that is open to all and adapts to people’s needs at different life stages is key to reducing inequality. A fair approach helps break cycles of disadvantage and help create healthier, more equal societies.

Barriers to participation in education and training

Future frontiers of social protection

Ensuring sustainable funding for social protection is one of the main challenges for the European social model, especially with limited public budgets and an ageing population.While public spending on social protection in the EU has remained stable at about 20% of GDP, many systems were built for full-time, permanent jobs and now struggle to include non-standard workers.

In 2021, almost 40% of the EU workforce—about 77 million people—were in temporary, part-time, or self-employed roles, and many of them did not have access to unemployment benefits. This meant that 5.6 million non-standard workers and 15.3 million self-employed people were left without coverage. 

Gaps in social protection increase socioeconomic and health inequalities, especially for young people, migrants, and women, who are less likely to have full-time, permanent contracts. Well-designed programs that provide timely income replacement help people maintain their living standards and avoid the negative health effects of poverty. This is especially important because part-time, temporary, and precarious workers face higher material and social deprivation and in-work poverty.

Future frontiers of social protection

Protecting health through economic and income security

People with lower incomes often live shorter and less healthy lives. They have a higher risk of illness and disability. The worst outcomes are found among those living in poverty, but the pattern can be seen at all income levels. This clear link between income and health shows how important income support is for reducing financial stress, improving access to healthcare, and preventing social exclusion.

Income support mechanisms, such as unemployment benefits, minimum income, pensions, and disability allowances, play a key role in protecting people from financial hardship while supporting better physical and mental health. By providing a stable income, these programs reduce stress for individuals and families, improve access to healthcare and other essential services, and help people maintain a basic standard of living. This financial stability also helps prevent deeper social exclusion and economic insecurity, making sure that people who are unemployed, disabled, or elderly are not left without the resources they need to live with dignity.

Robust social protection systems act as a vital buffer against financial, health, and climate-related crises by mitigating income loss. They ensure the basic needs of disadvantaged or vulnerable groups are met, with the overall aim of reducing their economic and social vulnerability. During economic downturns, pandemics, or environmental disasters, well-designed social protection policies help maintain household stability and prevent vicious cycles of poverty. By redistributing income fairly throughout people's lives and across society, these systems build social cohesion and economic security, reinforcing the state-citizen contract in which both parties share rights and responsibilities. Strong social protection frameworks not only protect individuals but also contribute to resilient economies and societies.

Protecting health through economic and income security

Aligning social protection with health

In the EU, health, care, and social protection systems are strongly connected, helping people access essential health services—especially those who are most vulnerable. This integration helps reduce health inequalities and remove or lower financial and social barriers to care. Evidence shows that measures like cash transfers, unemployment benefits, and countercyclical policies not only protect people from financial hardship but also lower sickness and disability rates for future generations.

Children growing up with socio-economic disadvantage are 3-6% less likely to be employed, earn 20% less as adults, and report worse health—equal to two weeks of lost full health per year. This results in a 3.4% GDP loss, 7% lower tax revenues, and 6% higher social benefit spending. EU countries investing more in social protection achieve better health outcomes, are better prepared and recover faster from crises.

The link between employment policies, decent work, and occupational health highlights social protection’s key role in public health. Safe working conditions, job security, and fair pay help reduce physical and mental health risks at work. Social protection supports individuals at all life stages by ensuring income security, healthcare access, job-seeking support, and the supply of vital public goods and services. It helps prevent poverty, vulnerability, and exclusion while upholding the right to social security.

Aligning social protection with health
About principle 12

What does the EPSR Action Plan say?

The EPSR Action Plan sets out several overarching goals for EU Member States for Principle 12:

  • Strengthen and expand social safety nets: Align with the Council Recommendation on Access to Social Protection to ensure adequate coverage and access to essential services, especially for the most vulnerable.

  • Increase employment: By 2030, at least 78% of those aged 20-64 should be employed, focusing on young, female and low-skilled workers vulnerable to labour market shifts and economic shocks.

  • Reduce poverty and social exclusion: By 2030, lift at least 15 million people, including 5 million children, out of poverty or exclusion through an integrated, life-course approach tackling its root causes.

  • Improve social impact assessments: Member States should use distributional impact assessments to ensure transparency, evaluate reforms and allocate resources so that the needs of different population groups are met.

  • Enhance digital skills: By 2030, at least 80% of those aged 16-74 should have basic digital skills to ensure inclusion and participation in the labour market and digital society.

Where are we now?
12. crowd

Where are we now?

The Social Scoreboard measures progress on the Principles of the EPSR. Linked to principle 12 on access to social protection, the Scoreboard outlines that in the EU:

  • The unemployment rate was 6.1% among the total EU population, with 2.1% of all unemployed long-term, while 11.2% of young people aged 15-29 were not in employment, education or training (NEETs).

  • 6% of EU population aged 16-74 had basic or above basic digital skills.

  • 21.3% of the EU population were at risk of poverty or social exclusion (AROPE), including 24.8% of children living in poverty (19.9 million).

  • 19.4% of the total EU governments expenditure was allocated to social protection programmes and social assistance measures. The poverty reduction rate of social transfers (excluding pensions) in the EU was 34.7%.

  • 8.8% of the EU population spent 40% or more of their disposable income on housing costs, including rent, mortgage, and utilities.

  • The EU unmet need for medical care stood at 2.4% of the population; 14.3% of total EU healthcare spending was due to out-of-pocket spending incurred directly by individuals.

  • 8.3% of employed individuals were in-work poor, meaning earning an income that is below the poverty threshold, despite having a job.

What are public health actors doing?
12. hands

What are public health actors doing?

12. chain

The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 12.

France - 'A roof over your head, a job in your pocket'

In early 2022 the French region of Lyon, introduced a targeted social inclusion programme for vulnerable youth aged 18 to 25.

Funded by the European Commission's Employment and Social Innovation Programme (EaSI), over a 2.5 year period, €1.2 million will be invested to promote access to housing and employment, through three key elements:

  1. Minimum income benefits,
  2. Labour market activation measures
  3. Adequate support for housing and employment

It is anticipated that over 300 young people will be supported through this initiative.

France - 'A roof over your head, a job in your pocket'

Ireland - Housing First and homeless health

The Department of Public Health (DPH) and National Social Inclusion Office (NSIO) in Ireland have collaborated on a number of health and equity-oriented social protection policies with an overall aim to reduce inequalities in health and improve access to mainstream and targeted health services for vulnerable and excluded groups. One of such groups are people experiencing homelessness.

Housing First (HF) is a recovery-focused, evidence-based approach to ending homelessness. It provides housing as a basic human right, without requiring preconditions such as sobriety or readiness. This approach supports individuals with long-term homelessness and complex health needs.

The DPH and NSIO issued three guiding documents for health professionals, mental health professionals, and addiction health professionals, highlighting how mainstream health services can support the Housing First programme. The initiative aligns with the Housing First National Implementation Plan 2022-2026, as well as the new National Strategic Plan to Improve the Health of People Experiencing Homelessness in Ireland (2024-2027).

Ireland - Housing First and homeless health

Germany, Berlin – Solidarity basic income

Launched in July 2019, the State of Berlin’s solidary basic income (SGE; Solidarisches Grundeinkommen) pilot offers 1,000 long-term unemployed individuals jobs in socially beneficial sectors, alongside career development and training opportunities to programme participants to support their transition into non-subsidised employment. The income is set at a fair wage level and serves as an alternative to receiving unemployment benefits, and the jobs are created locally in public administrations, public companies, and social service providers.

By December 2025, the program aims to evaluate its effectiveness in helping participants transition into regular employment and its potential as an alternative to traditional unemployment benefits.

Employers receive financial incentives and support, including HR coaching for working with long-term unemployed individuals. A €2,500 bonus is offered for each SGE employee who secures an unsubsidised job.

Positive impact on health and wellbeing:

  • Participants report high job satisfaction and a willingness to continue working.
  • Stable employment can reduce stress, improve mental health, and enhance overall wellbeing.
  • Meaningful work fosters social inclusion, self-worth, and financial stability, key factors in preventing long-term health issues.

The SGE pilot is a promising model that integrates employment, economic security, and health benefits, potentially transforming support for long-term unemployed individuals.

Germany – Solidarity basic income

Wales - Mass unemployment events: a public health informed response and support

In early 2022 the French region of Lyon, introduced a targeted social inclusion programme for vulnerable youth aged 18 to 25.

Funded by the European Commission's Employment and Social Innovation Programme (EaSI), over a 2.5 year period, €1.2 million will be invested to promote access to housing and employment, through three key elements:

  1. Minimum income benefits,
  2. Labour market activation measures
  3. Adequate support for housing and employment

It is anticipated that over 300 young people will be supported through this initiative.

Wales - Mass unemployment events

Flanders social protection

The Flemish social protection system provides three key allowances: for high care needs, people with disabilities, and elderly individuals requiring care. Since 2019, mobility aids have also been included, allowing individuals to buy or rent necessary equipment.

All adult residents in Flanders are required to contribute annually to the system, ensuring its sustained funding, affordability, and universal coverage. Future expansions will further strengthen access to fiscally viable, high-quality care for all who need it and where they need it. 

Flanders social protection

Finland - One-stop-shop guidance centres

Young people face multiple challenges transitioning from school to work, including navigating the job market, securing housing, and accessing education or training. To support them, Finland launched Ohjaamo, a network of free, universal one-stop comprehensive guidance centres for young people under 30. The initiative was piloted in 2014 as part of the EU Youth Guarantee and expanded to 70 local centres by 2022. It brings together 1,000 professionals from public, private, and third sectors to provide integrated services in employment, education, housing, and wellbeing.

Recognising that poor health can both cause and result from unemployment, Ohjaamo includes mental health and social support alongside employment assistance, making the health sector a key player in tackling youth unemployment. Services are available in-person, online, and through home visits, ensuring accessibility. The program is expanding e-guidance services to complement traditional face-to-face support.

With 140,000 young participants in 2019 and €5 million in annual government funding, plus EU and project-based support, Ohjaamo demonstrates both a strong demand from users and a commitment from both Finland and the EU to investing in sustainable models for breaking cycles of unemployment, social exclusion, and poor health.

Finland - One-stop-shop guidance centres
What EU tools are out there?

EU tools that help implement Principle 12

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 12.

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

Adequate minimum income ensuring active inclusion
Adequate minimum income ensuring active inclusion

The Council Recommendation on adequate minimum income encourages Member States to:

  • Improve the adequacy, coverage, and take-up of income support.
  • Improve access to inclusive labour markets and essential services.
  • Promote individualised support.
  • Increase the effectiveness and monitoring and reporting. mechanisms of social safety nets at EU, national, regional, and local level.

The Commission will monitor implementation progress in the context of the European Semester. A European Parliament resolution adopted in March 2023 asks the European Commission to consider an EU Directive in this field.

The future of social protection and of the welfare state in the EU
Social Protection Committee (SPC)
Establishing a European Child Guarantee
Access to social protection
Digitalisation in social security coordination
Read about EU funding and contact points

Available resources

For more supportive policy instruments on the topic, consult our other flashcards:

More information about the EU institutions and programmes is available on EuroHealthNet’s Health Inequalities Portal.

Available EU funding

Available EU funding

Contact points for further assistance

The following contact points and resources may be useful:

Contact points for further assistance

Technical resources

Technical resources
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Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

What's next?

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