Principle 20

Access to essential services

"Everyone has the right to access essential services of good quality, including water, sanitation, energy, transport, financial services and digital communications. Support for access to such services shall be available for those in need."

- Principle 20 of the European Pillar of Social Rights

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Access to essential services as a determinant of health

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Principle 20 of the European Pillar of Social Rights (EPSR) highlights a non-exhaustive list of essential services, including water, sanitation, energy, transport, financial services, and digital communications.*

These services are key to wellbeing and social inclusion, fulfilling the most basic human needs. They are especially important for disadvantaged groups, as they set the basis for meaningful participation in society and healthy living. Essential services are enablers for good quality of life and for accessing other services, such as healthcare, education and social inclusion services.

* Essential services can be much broader and entail more aspects. For the purpose of this flashcard we refer only to the ones mentioned directly in the EPSR Action Plan. We have produced other flashcards on other essential services, such as access to healthcare, education or long-term care.

Water, sanitation and hygiene (WASH) 

Access to water, sanitation and hygiene (WASH) is a basic human right recognised by the United Nations. Currently, 1.5% of the EU population lives without basic sanitary facilities. Limited or no access to good-quality drinking water, as well as the presence of polluted water, negatively impact human health and significantly increase the potential for diseases.  

Lack of clean water leads to several diseases. For example, more than one million diarrhoeal deaths occur globally every year as a result of insufficient WASH conditions. It is crucial to invest in improving drinking water and sanitation services through regulated piped water or connections to sewers, as this can significantly improve people’s health. 

People at risk of poverty or social exclusion and people experiencing homelessness are particularly affected by a lack of access to water and sanitation, given that the provision of drinking water and sanitary spaces are not always available in public spaces. People from Roma communities—Europe’s largest ethnic minority, which continues to face prejudice and social exclusion—who live in informal urban and rural settlements are particularly likely to live in conditions with poor WASH.  

Safe drinking water, sanitation and hygiene are crucial to health and have positive impacts on the wider community. For example, better WASH has been associated with more resilient communities and better school attendance, leading to reduced health inequalities. 

Water, sanitation and hygiene (WASH)

Digital exclusion

Lack of investment in fast broadband connections, especially in remote and deprived areas, as well as lack of digital skills and insufficient income, result in 2.4% of the EU’s population not having access to the internet. People who are already disadvantaged are even affected three times as much.  

Digital poverty is increasing a problem, as key services—for instance, education, training, health services and telemedicine, as well as municipal services, and access to employment, housing, and transport—are increasingly digitalised. Hence, the importance of digital determinants of health is becoming increasingly apparent and important to consider. 

In line with the EU Health Data Space strategy, essential health information and data are increasingly digitalised. Not being able to receive and understand health information can lead to poor health outcomes. Ensuring high levels of digital health literacy—the ability to use and confidently navigate digital technologies—can support patients in accessing health information, enhancing disease prevention, healthier lifestyles and overall improvement of wellbeing. Access to digital tools is also crucial for socioeconomic participation in society, given that a large number of activities require online interaction. 

As many people still suffer from digital exclusion, it is important for decision-makers to maintain some provision of non-digital services, especially in health, and invest more in improving people’s digital skills.  

Digital exclusion

Transport and financial services

Public transport is essential for accessing education, training, job opportunities, and recreational and sports facilities. Commuting is a normal part of many people’s lives, and the provision of quality, affordable, and accessible public transport is a key precondition for quality of life and accessing other services.  

The quality and accessibility of public transport depend on the provision of extensive and well-connected infrastructure. Peripheral and deprived urban areas, rural areas, and remote regions typically suffer from underinvestment in public transport.  

Another concerning issue is affordability: it is estimated that 2.4% of the EU population experiences transport poverty, as they cannot afford regular use of public transport. This number doubles for people at risk of poverty, further increasing their social exclusion. Challenges in accessing public transport also exist for people with special needs, such as persons with disabilities, older people, and parents with small children.  

Over 10% of the population in certain European countries such as Bulgaria, Hungary, and Romania faces exclusion from financial services. High fees for bank accounts, lack of information on the services available, and legal requirements such as the need for an official address are among the main reasons for exclusion from financial services. Not having a bank account makes it very challenging to receive income support and other monetary social benefits, pushing people into extreme poverty.  Receiving salary and monetary welfare benefits without a bank account is also significantly difficult.  

Transport and financial services

Energy poverty

Healthy housing is strongly linked to people’s good health and wellbeing. Recently, high energy prices have made housing affordability a critical issue, especially for people in vulnerable situations.  People’s energy bills for heating and cooling their houses have skyrocketed, impacting a considerable proportion of their disposable income.   

Climate change is exacerbating the problem, as summer heatwaves are increasingly prevalent. Housing adaptation to hot temperatures requires upfront investment in expensive insulation and air–conditioning systems– resulting in higher energy bills.  People living with low incomes, including pensioners and single parents with small children, are simply struggling to cool their houses. The number of heat strokes and heat-related deaths has increased dramatically: in the summer of 2022, 61,672 heat-related excess deaths were recorded in Europe.  

Likewise, energy poverty can significantly impact people’s health in colder months. Living in a cold and humid indoor environment is linked to a higher prevalence of respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD).  

High energy costs erode disposable income for healthcare, healthy food and access to education and training. The situation has also negatively impacted people with disabilities and health issues that require living in a house with a reasonable temperature, as well as energy-intensive assistive technologies, such as wearable devices and home sensors.  

While there are alternative ways to heat a house, these come with their own health risks. Household air pollution is responsible for 3.2 million deaths per year worldwide. Using open fires or inefficient stoves at home can lead to a higher number of non-communicable diseases, including stroke, COPD and lung cancer. 

Energy poverty
About principle 20

What does the EPSR Action Plan say?

The EPSR Action Plan sets out several overarching goals for EU Member States for Principle 20:

  • Public authorities should ensure effective and adequate coverage of social safety nets, as well as access to enabling services, especially for the most vulnerable. 

  • Member States should extend access to social protection in line with the Council Recommendation on Access to social protection to further increase access to essential services for the most vulnerable groups of people. 

  • In 2023, an EU report on access to essential services was presented, highlighting the significant challenges in access, particularly for people in vulnerable situations. The report presents several recommendations for improving access to essential services, such as the provision of a minimum income. 

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 Principle 20, the Scoreboard outlines that in the EU:

  • 3.04% of the population aged 16-74 have no overall digital skills.  

  • The prevalence of housing cost overburden, meaning more than 40% of someone’s disposable income is used for housing costs, has increased by more than one per cent to 8.8% from 7.8% in 2020. 

  • In 2023, 21.3% of the EU population was at risk of poverty or social exclusion, and 24.8% of children were affected. While the overall rate has slightly decreased in the last few years, more children have been at risk of poverty or social exclusion since 2019. 

  • The self-reported unmet need for medical care has risen from 1.6% of the population in 2017 to 2.4% in 2023. 

* Latest figures - 2023

Other sources tell us that:

  • 1% of Europe’s population had no access to at least basic drinking water services in 2022. (Statista) 

  • The share of populations unconnected to the internet differs drastically, from 33.5% in Eastern Europe to 2.7% in Northern Europe. (Statista) 

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 20.

The Netherlands - clean drinking water

Access to healthy and clean water resources is a key determinant of health. In the Netherlands, the Fairway project reviews current approaches to protecting drinking water resources. Pesticides and nitrates from agricultural practices can pollute drinking water. As part of the project, stakeholders from different sectors have come together to investigate the links between agriculture and drinking water, offering suggestions for improving the management of water resources and keeping them free from pollution.  

As part of the project, the Dutch National Institute for Public Health and the Environment (RIVM), prepared several policy recommendations for improving governance frameworks to better protect drinking water. Among these are recommendations to improve local-level capacities for ensuring good quality of drinking water and asking for better coherence in EU policy, including within the EU’s Common Agricultural Policy (CAP). 

The Netherlands - clean drinking water

UK - Energy poverty and health

Energy poverty significantly affects people's physical and mental health. Due to rising prices, house heating and cooling as well as cooking and bathing, can become unaffordable for people with lower incomes and socioeconomic status. Living in poor housing conditions further worsens respiratory and circulatory illnesses and leads to significant harm to physical and mental health.  

To help people deal with these issues, the UK has set up energy cafés to provide energy-saving advice, free of charge. In these cafés, experts in energy saving provide ideas and solutions for saving energy at home. These cafés were established within the Horizon Europe research project Step-In. Through the low-threshold approach of the project, the energy cafés also target vulnerable people to provide advice on the reduction of energy usage. By raising awareness of energy-saving measures and reducing a household’s energy bill, people’s quality of life can be significantly improved. 

Read more about energy cafés in EuroHealthNet Magazine. 

UK - Energy poverty and health

Preventing cold homes in Wales

A new report by Public Health Wales has identified the negative impacts on health and wellbeing for people living in homes with a temperature below 18° C. People who are older or who have pre-existing health conditions and/or disabilities are particularly affected. One in ten people with a thermostat reported living in a home with a temperature below 18°  C. Renters were twice as likely to report living in a colder home than homeowners. 

The high costs of heating a home can force people to choose between food or a warm home, exacerbating the situation. At the same time, cold homes can have social impacts on people as there can be a reluctance to invite guests into one’s home. 

In order to cushion the effects of cold homes, the Welsh government has introduced various support mechanisms such as the Warm Home Discount Scheme, which supports households in vulnerable situations with 150£, as well as the Winter Fuel and Cold Weather Payments. Additionally, the Energy Company Obligation (ECO) 4 scheme provides grants to fund energy-efficient home upgrades to increase energy efficiency and reduce fuel poverty and energy costs. For example, by supporting homeowners in installing heat pumps, the scheme aims to improve efficiency and lower energy costs so that people can afford to heat their homes. 

Preventing cold homes in Wales

BlueAdapt - Water quality and health

As part of the Horizon Europe BlueAdapt project, researchers evaluate how water-borne pathogens disperse and decay in coastal environments. They also look into how such pathogens are impacted by climate change and environmental pollution and the related implications for human health. For instance, poor water quality can affect recreational activities and shellfisheries in the Conwy estuary in North Wales. In turn, this can impact the health of those who use the waters or consume shellfish from this area. 

To raise awareness of these issues and protect people’s health, BlueAdapt creates models to predict the risk of exposure to pathogens, working towards a public health risk real-time alert system. Through live data on weather conditions, river flows, tides, waste discharge rates, and tourism activities, people using the waters will have access to accurate information on health risks, allowing them to adapt their use accordingly. 

By combining both coastal and catchment water interactions in one model, the project creates a better understanding of how bacteria and viruses move from inland sources to the coast, offering a clear picture of the importance of water safety for one’s health. 

EuroHealthNet is part of the BlueAdapt consortium. Its role is to help extend the framework by leading the policy work, engaging with policymakers and developing recommendations to facilitate the uptake of BlueAdapt results.

BlueAdapt - Water quality and health

Scotland - Financial service provision

Money Matters is a holistic financial support programme in Glasgow, Scotland, that aims at supporting people, particularly those in vulnerable situations, when it comes to financial literacy and information. 

Offering welfare and financial capability services, the project sets out to offer advice to people in need so that they can budget and manage their money properly, effectively, and with confidence. Setting up a low threshold for consultation, Money Matters tries to be accessible to as many people as possible, offering financial advice. While doing so, it offers a holistic approach that not only focuses on financial guidance but also providing the necessary support to make these changes possible. This can happen by, for example, accompanying people to court hearings and helping them articulate their needs. 

As part of the program, Money Matters offers a free financial health check-up. Additionally, with the Glasgow Helps programme, organisations such as Money Matters successfully set out to identify the underlying factors of one’s financial problems and have a system in place that refers people in need directly to other agencies and organisations to address other determinants of health such as lack of access to quality housing, limited employment possibilities or access to physical activities.

Money Master was one of the promising practice examples presented during a 2023 EuroHealthNet Country Exchange Visit on the topic of preventing child poverty. 

Scotland - Financial service provision
What EU tools are out there?

EU tools that help implement Principle 20

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 20.

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

Social Climate Fund
Social Climate Fund

The Social Climate Fund provides targeted funding to support structural measures and investments in various sectors, including transport and buildings, among others. This especially supports vulnerable groups, such as households in energy or transport poverty. The funds are invested in the infrastructure of various essential services, advancing low- and zero-emission mobility, among other things. For instance, funds can be used to invest in the infrastructure for recharging, refuelling and incentivising the provision of affordable and accessible zero-emissions public transport.

To cushion the financial impact of changes connected to the transition towards a more sustainable Europe, Member States can use part of the Social Climate Fund to temporary direct income support for people in vulnerable situations. As energy poverty increases across Europe, the Social Climate Fund can be a useful tool for supporting disadvantaged people and communities in accessing energy services. Nonetheless, more financial support is needed to improve the situation of people exposed to energy poverty significantly.

EU Accessibility Act
Climate neutrality transition
Wifi4EU Initiative
Payment Accounts Directive
Energy poverty
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?

Read more flashcards
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EuroHealthNet is the Partnership of public health agencies and organisations building a healthier future for all by addressing the determinants of health and reducing inequalities. Our focus is on preventing disease and promoting good health by looking within and beyond the health system.

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