Principle 14

Minimum income

"Everyone lacking sufficient resources has the right to adequate minimum income benefits ensuring a life in dignity at all stages of life, and effective access to enabling goods and services. For those who can work, minimum income benefits should be combined with incentives to (re)integrate into the labour market."

- Principle 14 of the European Pillar of Social Rights

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Minimum income as a determinant of health

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Adequate financial means are fundamental to ensure a healthy and decent quality of life. Various forms of minimum income have been found to reduce poverty, destitution, and insecurity, while promoting population-wide and intergenerational equality, making it an important determinant of health.

Minimum income as a determinant of health

Minimum income schemes are an integral component of universal effective social protection and can support an individual's financial security.

Furthermore, by providing a basic living standard for the most vulnerable and discriminated, including single parents and women, (long-term) unemployed without access to benefits, low-skilled wage earners and long-term ill, minimum income acts as a last resort social safety net.

In economic downturns, with increasing energy prices and inflation, minimum income schemes are one of the strongest social tools to lift people out of poverty and mitigate its impact on people's health. Such schemes can support a sustainable and inclusive recovery, and represent a good return on investment. According to Eurostat data, social transfers (excluding pensions) reduced the at-risk-of-poverty rate by 37.08% in 2021 in the EU 27 member states.

Broadly speaking, various forms of minimum income have been found to reduce poverty, destitution, and insecurity, simultaneously promoting population-wide and intergenerational equality, making it an important social determinant of health.

Minimum income as a determinant of health

Minimum income and physical health

Income and socioeconomic status are intrinsically linked to an individual's quality of life and life expectancy. Studies have found that less affluent households are three times more likely to report unmet health needs due to financial reasons, compared to high-income earners.

Without sufficient financial resources, individuals are unable to afford essential goods and services that enable their own, families and communities' health. This includes nutritious foods, physical activity, access to green spaces and warm, safe, and sanitary living conditions. In consequence, individuals with limited resources are more likely to be exposed to infections, illness or disability caused by inadequate living conditions, poor physical and food environments.

Lack of financial resources may also limit access to care, treatment and pharmaceuticals, resulting in delayed, missed or discarded diagnoses. At an individual level, this may have costly, and potentially life-threatening implications whilst at population level this risks further increasing health costs (hospitals are seeing sicker patients) and inequity between more and less affluent populations.

Minimum income and physical health

Minimum income across EU Member States

All EU Member States have enforced some sort of minimum income scheme. However, there are big differences between countries in how adequate they are to allow for a decent standard of life, who is able to access and benefit from them, and how effective they are in reducing the populations from risk of poverty and social exclusion.

To be considered 'adequate', minimum income must be set in line with or above the 'poverty threshold', which is at 60% of national median income. In practice however, minimum income benefits in EU Members States vary from 20% to a little less than 60% of the national median income in four countries (Ireland, Germany, the Netherlands, Denmark).  Under this value, the funds provided usually fail to cover the cost of all basic goods and services required to live a life of quality.

Overall, the uptake and eligibility for minimum income schemes in the EU, while varied, remains low, particularly among the poorest populations, and differs between populations and regions within the same country. Across the EU, 35% of the working age population at risk of poverty do not have access to minimum income or any other social benefits.

As a result, effective minimum income schemes not only lift people out of poverty but instigate social inclusion, mental health, wellbeing and participation in society. Consequently, this helps to reintegrate people into training, skills-acquisition, and the labour market. Yet research suggests that minimum income support in most EU countries remains too low in helping to do so.

Minimum income across EU Member States

Minimum income and mental health

A well-established body of research has demonstrated the links between inequality, financial insecurity, poverty and poor mental health outcomes. The stresses associated with financial insecurity, social isolation, and living in poverty can have negative impacts on mental health, sense of depreciation and self-esteem, which in the short term may lead to uptake of risky behavious, stress-induced addictions, self-harm, life-threatening situations, or suicides.

While policies have often - and rightly - focused on improving coping strategies and increasing the efficiency of services, there's a growing demand to address the social drivers of poor mental health, anxiety and depression notably. Evidence indicates that those health conditions are strongly affected by social determinants as income, wealth (distribution), education, social capital and opportunity. This is of particular importance for the young generation. Challenging the mental health crisis: How Universal Basic Income can address youth anxiety and depression report makes a prediction showing that a universal basic income designed to meet minimum income standards would avoid or delay over 500,000 cases of anxiety and depression amongst young people in a 10-year period in the UK.

Minimum income and mental health
About principle 14

What does the EPSR Action Plan say?

The EPSR Action Plan sets out five key goals for EU Member States:

  • Member States have committed to reduce the number of people at risk of poverty or social exclusion by 15.6 million by 2030.

  • When planning the allocation of financial resources, Member States are recommended to make greater use of distributional impact assessments to better account for the impact of reforms and investments on the income of different groups and to increase transparency on the social impact of budgets and policies.

  • In 2022, a Council Recommendation on adequate minimum income was proposed to support support and complement the policies of Member States effectively. This Recommendation was published and adopted on 30th of January 2023 (see 'Other tools supporting the implementation of Principle 14' below).

Where are we now?
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Where are we now?

The Social Scoreboard measures progress on the principles of the EPSR. Linked to the principle of minimum income, the Scoreboard outlines that in the EU:

  • The income quintile share ratio (S80/S20 ratio**) in 2021 in the 27 member states in the EU was 4.99

  • The in-work-at-risk-of-poverty rate was 8.9%.

  • 7% of European citizens were at risk of poverty or social exclusion, while 6.3% were in severe material and social deprivation.

  • 4% of children aged 0 to 17 were at risk of poverty or exclusion, while 7.5% of children lived in severe material and social deprivation.

  • Unemployment rate was 6.1%, while long-term unemployment rate stood at 2.4%.

What are public health actors doing?
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What are public health actors doing?

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The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 14.

Click on a country to learn about initiatives taking place.

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: minimum income benefits, labour market activation measures, and adequate support for housing and employment.

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

France - targeted social inclusion programme

The Netherlands - Person-oriented and integral approach to work, income and health

Several Dutch municipalities are experimenting with forms of:

  1. low-regulation threshold assistance ('regelluwe bijstand').
  2. basic jobs.

People with social assistance benefits (temporarily) are not required to apply for jobs and/or are given more room to earn (extra) money on top of it.

In a basic job, people on social assistance perform socially valuable work, often financed by the government. Both types of experiments show that participants benefit in terms of long-term, positive well-being, health, and social inclusion.

Evaluation studies show that a person-centred approach should become an essential part of a new people-centred and less complex social protection systems.

The Netherlands - municipal action

Czech Republic - Accessible and affordable nurseries in the workplace

The General University Hospital in Prague used European Social Funds (2012-2014) to support employees who had babies or young children by founding its own affordable nursery to accommodate their needs.

Priority for places was given to the children of nurses working at the hospital, who are considered the most disadvantaged group among health professionals.

The Czech Republic - workplace nurseries

Italy - e-Voucher Scheme

Between 2018 and 2022, the Italian city of Brescia, supported by the Fund for European Aid to the Most Deprived (FEAD), distributed e-vouchers to help over 500 citizens meet their basic needs while removing the stigma of poverty.

Monthly vouchers were distributed to individuals identified by social services and social worker's outreach activities. The amount of financial help was individually tailored to the needs of each participant, including additions of €100 per child under the age of three.

As the vouchers could be used to purchase most necessities, including food, pharmaceuticals, household utilities and clothing, the scheme provided financial support to empower individuals to make their own decisions.

The newly launched Citizenship Guaranteed Minimum Income and Citizenship Guaranteed Minimum Pension, although means-tested and conditional, can be seen as one of good practice examples in the Italian Health Equity Status Report Initiative (IHESRi), 'Healthy, prosperous lives for all in Italy . The report's analysis shows that in 2022 43% of the population in Italy struggles with income security and social protection, and calls for increasing sustainable household income.

Italy - e-voucher scheme

Scotland: Informing Interventions to reduce health Inequalities (Triple I)

'Triple I' provides national and local decision-makers with practical tools and interpreted research findings about investing in interventions to reduce health inequalities in Scotland (e.g. taxation policies, benefits policies, various forms of universal basic income, minimum wage, negative income tax, and increasing benefits uptake through psychosocial support).

The tools can be used to produce detailed results for different entities at national, city and council levels, health and integrated joint boards. Outcomes are measured by figures of premature mortality, years of life lost, hospital stays.

In addition, a Basic Income for Scotland policy document explores how Scotland can move towards a basic income by examining at how effective, desirable, and feasible a basic income could be, including for promoting health equity.

Scotland - supporting local decision-makers
What EU tools are out there?

EU tools that help implement Principle 14

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 14 on minimum income

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

Council Recommendation on adequate minimum income
Council Recommendation on adequate minimum income

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.

In addition, a European Parliament resolution adopted in March 2023 asks the European Commission to consider an EU Directive in this field.

Recovery and Resilience Facility
High-level Group on the future of social protection and of the welfare state in the EU
European Social Fund Plus (ESF+)
Social Protection Committee
Read about EU funding and contact points

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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