Workshop 33: Social Inequalities in HealthThe 33rd Global Conference of the July 2, 2008: Tours, France

Catherine M. JonesProgramme Director

cjones@iuhpe.org

Reducing social inequalities in health: The role of international professional networks in advocating for effective inter-sectoral collaboration at all levels

Highlighting the case of DETERMINE: an EU Consortium for Action on the socio-economic determinants of health

Working for more than 50 years to connect and support everyone committed to advancing health promotion and to achieving equity in health globally

What do we do?

Strategies

Advocate for health and health promotion

Build knowledge base for health promotion

Professional and technical development, research, tools for supporting

practice

Advance the quality of policy and practice

Projects networks, partnership building,

Develop capacity globally, regionally, locally

Short courses, conferences, training, policy dialogues

How we support our work

Regional Offices

EMRO(in development)

NARO

EURO

AFRO(in development)

ORLA

SEARB (in development)

SWP

NPWP

Common values,

principles & concepts:

Social protection & social welfare

-Social justice

-Balanced social & economic development, cultural diversity

-Recognition & protection of fundamental rights

-Focus on the most vulnerable

Health promotion

-Pre-requisites for health

-Health as a resource

-Emphasis on social &

personsonal resources

- Equity

Determinants of Health

from Ottawa to Bangkok - one chart for 2 Charters

COMMUNITY

NATIONAL

GLOBAL

Personalskills

Supportive environments

Community action

Corporate investment in healthHealthy globalization

Healthy international policy across governement

OTTAWA CHARTER

BANGKOK CHARTER

CORPORATESECTOR

PUBLIC SECTOR

REALPEOPLE

Global citizenship for health

Healthy public policy

Health-promoting health services

Our work must be able to adapt & reflect approaches to new challenges in a changing

world

(adapted from Pierre Arwidson, WHO Kyoto meeting, 2005)

WHO Commission on the Social

Determinants of Health

« The causes of the causes »

Health is not simply about individual behaviour or exposure to risk, but how the

socially and economically structured way of life of a population shapes its health.

http://www.who.int/social_determinants/en/

(WHO CSDH, 2008)

DETERMINEan EU Consortium for Action on the socio-economic

determinants of health

Special thanks to Ingrid Stegeman, Project Coordinator, EuroHealthNet , and Serena Fasso, Policy Officer, for their contributions to these slides

The unequal distribution of determinants underlies health inequalities

• Inequalities in ‘general socioeconomic & environmental conditions’ – unequal access to good education, secure employment, income etc

• Inequalities in living & working conditions from childhood to old age• Inequalities in community resources• Inequalities in lifestyle factors like cigarette smoking, diet & physical activity

Professor Hillary Graham

inequalities in

Health determinants model (Dahlgren & Whitehead, 1991)

DETERMINE – who are we?

• EU Consortium for ACTION on Socio-economic Determinants for Health (2007 – 2010)

– Contract holder: National Institute for Public Health in Czech Republic

– Coordinator: EuroHealthNet– 5 additional WP co-leaders (FI, DE, IE, ENG, IUHPE)– Co-funder: EC DG Sanco (54%)– 30 main partner organisations from 21 EU MS– 26 collaborating partners (WHO, OECD, 6 Ministries,

7 European networks)

DETERMINE - Our AIMS

1. To take forward existing work on the socio-economic determinants of health as an approach to reduce health inequities in the EU.

2. To make concrete progress towards policy developments that positively influence these determinants.

– To contribute to the current knowledge base on HiAP approaches,

including issues such as transferability and cost-effectiveness.

– To identify innovative approaches using social marketing and public private partnership models and pilot 3 of them

– To raise the awareness of health determinants in other policy sectors and to build the capacity of Consortium members to act upon them.

– To develop www.health-inequalities.eu as the main EU online resource for socio-economic determinants and health inequalities.

Current Situation: What are some countries doing to address the SDHI?

• Do policies exist to tackle the Social Determinants of Health Inequalities (SDHI)?

– Across government

– Health sector

– Other sectors

• Are actions in place to support these policies– Structures– Personnel– Funding– Mechanisms

Belgium, Czech Republic, England, Estonia, Finland, Iceland,

Ireland, Netherlands, Northern Ireland, Norway, Poland, Scotland, Slovenia, Spain,

Wales

Current Situation

Cross Government Approaches driven by National Government: A few countries, e.g. Scotland, where government objectives are: Wealthier & Fairer; Smarter; Healthier; Safer and Stronger; Greener

Cross Government Approaches driven by Health Sector:

Most partners have national health strategies with explicit reference to addressing health inequalities; 5 have national or regional strategies which focus on this entirely, 3 where such strategies under development

Other Policy Sectors:

Implicit and explicit initiatives in – Education, Employment, Economy, Urban and regional planning, Neighbourhood renewal and housing policy, Social inclusion, Tourism

EU Policy areas outside of health sector

The Lisbon Strategy(2000 – 2010)

Cohesion PolicyCommon

Agricultural PolicySocial Policy Economic Policy

-Convergency & competitivenes-Regional compet.& employment

-European territorial coop.

Structural funding:ERDFESF

The cohesion fund

The EU Social Protection and Social Inclusion Process

National Action Plans on Social Inclusion

Health & Safety at work

Instruments for support

Open Method of Collaboration

Joint Report on Social Protection and Social Inclusion 2008

- child poverty,

-health inequalities, access to health care and evolving long-term care needs, and

- longer working lives and privately managed pensions.

Through this process, the EU coordinates & encourages Member State actions to combat poverty and social exclusion, and to reform their social protection systems on the basis of policy exchanges and mutual learning. As such, it underpins the achievement of the Union’s strategic goal of sustained economic growth, more and better jobs, and greater social cohesion by 2010.

Experience from policy and decision-makers from other sectors

Success Factors

NeedsBarriers

New Health Inequalities Portal

Questions for Discussion

• How can different frameworks be reconciled to achieve similar goals (i.e. social justice/rights-based lens vs. economic development lens)?

• What is the priority attached to addressing SDHI in the social sector?

• How can the social and health sectors better collaborate in order to engage with and convene other critical sectors to contribute to reducing social inequalities in health (i.e. Treasury, Finance, Internal Affairs, Justice, Safety and Security, Internal Affairs, Foreign Policy)?

• How can the social and health sectors better collaborate to develop capacity to engage in better advocacy and policy dialogue processes?

• How can civil society be mobilized more effectively in the advocacy process to support the development and accountability of political will to address social inequalities in health?