Principle 15
Old age income and pensions
“The right to a pension that ensures an income enabling dignity in old age is enshrined in the European Pillar of Social Rights. A number of EU policies seek to achieve progress towards a more social Europe. The EU ensures coordination and monitoring, and provides analyses, guidance and funding to support social area reform and to co-finance projects.”
Old age income and pensions as a determinant of health
Adequate income in older age is a key social determinant of health. It affects living conditions, access to essential goods and services, and the ability to remain independent in daily life. Pensions provide the primary source of income for most older people in the EU, enabling them to afford housing, energy, food, and health and long-term care.
Pension levels also have implications beyond individuals themselves. When older adults have insufficient resources, families often step in with financial help and informal care, increasing pressure across generations, especially on women. At the same time, unequal employment histories — including low wages, career breaks, or non-standard work — lead to significant differences in pension income, especially for women, contributing to disparities in poverty risk, health outcomes, and access to services in later life.
What does the EPSR Action Plan say?
The EPSR Action Plan sets out several overarching goals for EU Member States for Principle 15:
At least half the gender employment, pay, and pensions gaps compared to 2019 to progress on gender equality and achieve the employment target for the entire working age population.
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.
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.
Map best practices in providing pension rights for care-related career breaks in pension schemes and promote the exchange of practices among Member States, social partners and pension stakeholders.
Where are we now?
The Social Scoreboard measures progress on the Principles of the EPSR. Linked to the Principle on Old age income and pensions, the Scoreboard outlines that in the EU:
The EU’s aggregate replacement ratio stood at approximately 0.6, meaning that older people aged 65–74 receive, on average, around 60 per cent of the earnings of workers aged 50–59.
The income quintile share ratio (S80/S20 ratio*) in 2024 in the 27 Member States in the EU was 4.66, meaning the wealthiest 20% in the EU earn 4.66 times more than the poorest 20%.
21% of the EU population was at risk of poverty or social exclusion
* Measure of the inequality of income distribution calculated as the ratio of total income received by the 20% of the population with the highest income (the top quintile) to that received by the 20% of the population with the lowest income (the bottom quintile).
What are public health actors doing?
The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 15.
Slovenia - Active Ageing Strategy 2017
Slovenia’s Active Ageing Strategy 2017, coordinated by the Ministry of Labour, Family, Social Affairs and Equal Opportunities, provides a framework for addressing demographic change through coordinated action across sectors. It promotes longer working lives, healthy lifestyles, and social inclusion, linking employment, social protection, and health policies to ensure wellbeing in older age.
The strategy rests on four pillars: labour-market participation, lifelong learning, social protection and health, and supportive environments for ageing.
The Ministry of Health contributes to actions that support independent, healthy, and safe living for all generations (systems of social protection, accessibility of healthcare and long-term care services, health concern, and reducing inequalities in healthcare). These include initiatives supporting healthy lifestyles, reducing chronic disease risks, and maintaining functional ability in older age.
In parallel, the Ministry of Labour, Family, Social Affairs and Equal Opportunities focuses on ensuring adequate income and access to social services for older adults, including those with limited work histories or lower pensions.
Collaboration between the two ministries is reflected in programmes such as the Protection of the Elderly, which integrates health and social care services to support older people at home, provides counselling for families, and ensures access to care for those with dementia or limited mobility. These measures strengthen the link between income security and health, recognising that adequate pensions, community-based care, and preventive health services are essential for maintaining independence and reducing inequalities among older adults.
Germany – Aligning health, ageing and income security policies
The German government is very active in the field of active ageing, with several activities and measures that can be seen as best practices. The main reference framework is the 2007 National Plan of Action on Ageing, forming the foundation for coordinated national ageing policies over the years.1 This strategy brings together multiple ministries — including the Federal Ministry of Health, the Federal Ministry of Labour and Social Affairs, and the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth — to address demographic change through joint, cross-sectoral policies.
The Ministry of Health promotes active, healthy ageing through interventional programmes to reduce chronic disease incidence by improving physical and mental health, with particular attention to equity. It is also acknowledged throughout the various initiatives2 that health status affects one’s capacity to work longer and retirement outcomes. Meanwhile, the Ministry of Labour and Social Affairs supports the extension of working life and secures pension adequacy by raising labour market participation of older workers and adapting the statutory pension system.
Long-term care insurance policies complement these efforts by addressing the interconnections between ageing, health, and income security.3 As older adults with low pensions are more likely to struggle with care co-payments, integrating health and care services helps prevent a cycle of declining health, dependency, and income poverty.
1. It implements the Second UN World Ageing Plan (MIPAA) and the UNECE Regional Implementation Strategy “Challenges and Opportunities of Ageing Societies.” While this plan remains a key reference, it has evolved into a broader framework under the Federal Government’s Demographic Strategy “Every Age Counts – For Greater Prosperity and Quality of Life for All Generations”, launched in 2012 and updated in 2015.
2. Initiatives such as the National Dementia Strategy (2020), the Concerted Action for Nursing (2019), and the Strategy to Counter Loneliness (2023) extend the demographic strategy’s reach by linking health, care, and social inclusion.
3. Through the Long-Term Care Strengthening Acts (Pflegestärkungsgesetze I–III, 2015–2017), Germany expanded benefits and established a capital reserve, recognising the overlap between care needs, older age, and pension adequacy.
Finland - National Programme on Ageing 2030
In Finland, the Ministry of Social Affairs and Health oversees both the pension system and social and health care, ensuring strong policy coherence across sectors. This institutional structure facilitates integrated planning between the Finnish Centre for Pensions (ETK), the National Institute for Health and Welfare (THL), and local wellbeing counties. Pension policy is designed not only to guarantee financial security in old age but also to support wellbeing, longer working lives, and equitable access to care.
Under the National Programme on Ageing 2030 – For an Age-Competent Finland, the government promotes ‘a society for all ages,’ combining economic sustainability with health promotion and social participation. THL and the Finnish Institute of Occupational Health collaborate on monitoring the health impacts of retirement-age reforms and on preventive strategies to maintain work ability and reduce premature exit from the labour market.
At the regional level, wellbeing counties implement integrated services that link income security, prevention, and social support for older adults.
Portugal – Active and Healthy Ageing Action Plan
Portugal’s approach to active and healthy ageing is set out in the Active and Healthy Ageing Action Plan 2023–2026, building on the 2017–2025 National Strategy. The plan defines six strategic pillars:
- Health and wellbeing, focusing on prevention, surveillance and management of chronic conditions
- Autonomy and independent living, through age-friendly environments and community services
- Lifelong development and learning
- Healthy working life, supporting older workers and adapting workplaces
- Income and financial security, by strengthening pension adequacy and social benefits
- Social participation and inclusion.
Under the Ministry of Health, the Directorate-General of Health (DGS) implements the National Programme for Health of Older People, which promotes disease prevention, health literacy, vaccination and fall-prevention initiatives. The Ministry of Labour, Solidarity and Social Security complements this with income-support instruments such as the Solidarity Supplement for the Elderly (CSI) and the Social Integration Income (RSI), which protect older people with low pensions from poverty and exclusion.
The plan also commits to fostering age-friendly cities and communities, though national implementation is currently developing through municipal pilots such as Porto’s Age-Friendly City Action Plan.
EU tools that help implement Principle 15
There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 15.
More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.
The triennial Pension Adequacy Report, produced by the European Commission and the Social Protection Committee, provides an overview of pension policies, focusing on the adequacy of old-age incomes today and in the future. The 2024 edition reviews current and future adequacy, gender gaps, and links between pensions and long-term care. The report is divided into a comparative analysis (Volume I) and detailed country profiles (Volume II). It is developed alongside the Ageing Report to align insights on pension adequacy and the financial sustainability of ageing-related expenditure.
Available resources
For more supportive policy instruments on the topic, consult our other flashcards:
- Principle 2: Gender equality
- Principle 12: Social protection
- Principle 14: Minimum income
- Principle 18: Long-term care
- Principle 20: Access to essential services
More information about the EU institutions and programmes is available on EuroHealthNet’s Health Inequalities Portal.
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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