11 General Introduction of equals, which argues for “equal treatment for equal medical need, irrespective of other characteristics such as income, race, place of residence, etc.” [45]. However, the need for (mental health) treatment is a complex dimension to capture. Data on clinical diagnoses are essential because diagnosis guides most of the treatment provision but should be complemented with information on symptom severity, distress, functioning and disability, among others. This information is usually only measured in cohorts/surveys of limited sample sizes, which do not include detailed information about treatment practices. On the other hand, electronic health records providing larger samples and rich treatment information will usually miss data to measure need and characterise socioeconomic status comprehensively. MENTAL HEALTH AND INEQUALITIES: TWO CONTEMPORARY POLICY CHALLENGES From a policy perspective, mental health has been underrepresented in most health (and public) policy agendas for decades mainly when compared to physical health. With some of the first pivotal declarations and reports dating from the 1990s and early 2000s, the frequency of calls for policy action started increasing around the 2010s [1]. These calls advocate for an entire transformation of the global mental health agenda: from the basis of recognising mental health as a fundamental human right [46, 47] to the need to act on children´s and youth’s mental health [48, 49], and to transform mental health systems by shifting care towards the community and increasing service coverage to reduce the treatment gap [50]. Nevertheless, it was just during the COVID-19 pandemic that mental health started to get full attention from governments and societies, although still heterogeneously across countries. Several grand challenges persist in transforming this attention into action at both government and societal levels. These challenges are interconnected and include the stigma faced by people with experience of mental health conditions, limited mental health system leadership and governance, and the lack of an integrated multi-sectoral approach requiring cross-ministerial commitment and funding to integrate mental health policy across education, labour and welfare systems [51-53]. Mental health inequalities are also yet to receive the appropriate attention in policy agendas, as most discussion has been devoted to disparities in general health measures. This discussion has been partially supported by research findings comparing inequalities between countries. International comparisons of mortality and morbidity by educational level and income have shown substantial differences and unexpected country rankings, and well as unpredictable trends. Examples of these findings include the fact that countries with more developed welfare such as the Nordic countries do not have smaller inequalities [54]. Or the contrast between countries that have made substantial progress in mortality inequalities by educational level (e.g. Finland, England and Wales, France) and countries that experienced considerable setbacks from very small to substantial disparities, in the 1
RkJQdWJsaXNoZXIy MjY0ODMw