Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy

Abstract Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity. Key messages • The EPHF framework as an innovative tool to strengthen public health in border regions. • Take the geographical living space of citizens in a border region into account to achieve health equity.