Reducing Health Inequalities in Europe; What can be done?
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Reducing Health Inequalities in Europe;
What can be done?
Dr. Martijntje Bakker
Public Health Fund
the Netherlands
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Content
• Background
• Inequalities in health in Europe
• How do countries deal with SEIH
• An example: healthcare
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History of the Network
• King’s Fund report (1995)
• BMJ editorial (1995)
• Malmö 1996, London, 1997, Rotterdam 1998
• EU funding, 1999
• Helsinki 1999, Barcelona 2000
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Purposes of the network
• To exchange the various national experiences with interventions and policies to reduce SEIH
• To explore opportunities for developing comparative or collaborative research to evaluate such interventions and policies
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Network members
• 40 members
• 13 European countries (Belgium, Denmark, Finland, France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Spain, Sweden and UK)
• WHO representatives
• New-Zealand and USA
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Reducing inequalities in healthA European perspective
Edited by Johan Mackenbachand Martijntje Bakker
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Content
I IntroductionII Interventions and policies to reduce socio-
economic inequalities in healthIII National experiencesIV Evaluation issuesV ReflectionsVI Key messages
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SEIH in Europe
• Morbidity
• Mortality
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Morbidity (1) (Kunst et al., 2000)
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Morbidity (2) (Kunst et al., 2000)
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Mortality (1) (Kunst,1997)
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Mortality (2) (Kunst et al., 2000)
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How do countries in Europe deal with socio-economic inequalities
in health?
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The Action spectrum
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Situation in 8 European countries
• Greece: pre-measurement
• Spain: denial/ indifference
• France, Italy: concern
• Lithuania: will to take action
• The Netherlands, Sweden: more structured developments
• England: comprehensive coordinated policy
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An explanatory model
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Examples of comprehensive packages (1)
• British Independent Inquiry into inequalities in health (1998)• 39 main recommendations (123 with sub-clauses)• Seven policy areas reviewed: Taxation and social security, Education,
Employment, Housing and environment, Mobility, transport and pollution, Nutrition and the common agricultural policy, National Health Service
• Demographic factors over the life course considered, including: Mothers, children and families, Young people and adults of working age, Older people, Ethnicity, Gender
• Three priority areas emphasized:– 1. Health inequalities impact assessment– 2. A high priority for the health of families with children– 3. Reduction in income inequalities and improvement of living standards
of poor households
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Examples of comprehensive packages (2)
• Swedish National Public Health Commission (2000)• 18 health policy objectives • Six overarching themes:
– 1. Strengthening social capital2. Growing up in a satisfactory environment3. Improving conditions at work4. Creating a satisfactory physical environment5. Stimulating health-promoting life habits6. Developing a satisfactory infrastructure for health
• Development of ‘indicators for achievement’ recommended.
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Examples of comprehensive packages (3)
• The Dutch program committee on socio-economic inequalities in health (2001)
• 26 recommendations• Four specific strategies:
– 1. Reduction of inequalities in education, income and other socio-economic factors2. Reduction of the negative effects of health problems on socio-economic position
– 3. Reduction of the negative effects of socio-economic position on health– 4. Improve access and quality of healthcare for lower socio-economic
groups
• 11 quantitative targets relating to intermediate outcomes.• Strong emphasis on continuation of research, development, monitoring
and evaluation.
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An example: health care
• Access to healthcare– Financial– Physical– Cultural
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Access to primary care
• UK: inequalities in access and provision of care (Goddard & Smith, 1998)
• Spain: no clear picture (De La Hoz and Leon, 1996)• NL: more GP contacts for low SES (Van der Meer et al.,
1996)• Sweden: more GP contacts for high SES (Whitehead et al.,
1997)• Germany: more GP contacts for low SES (Bormann &
Schreuder, 1994)• Finland: high SES: private practices and occupational
healthcare; low SES: GP’s at municipal health centres (Keskimäki, 1997)
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Access to hospital care
• In general, access seems equitable• However, this might not be true for access to and
quality of care in specialist or intensive services• Examples:
• UK: specialist cardiac services, survival cancer treatment (Goddard, Smith, 1998)
• Finland: coronary bypass operations, hip replacement operations, cataract surgery (Keskimäki, 1997)
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Review
• 36 interventions (aimed at low SES groups, or aimed at general population with results reported by SES)
• Aims: cancer screening, hypertension or substance abuse treatment programs, improving maternal and child outcomes
• Interventions: hospital-based education programs, community outreach activities, personalised contacts with target groups by healthcare personnel
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Starting Well, Glasgow
• Early intervention program• Target group: children up to 5 years in deprived
areas• Aim: Improving health and well-being• Activities:
– Intensive home support to families with a new baby– Improved network of community services– Stronger linkages between families and support
structures and services
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Nurse practitioners, NL
• Target group: Patients with COPD/ Asthma in deprived areas
• Aim:compliance with therapy, reduced complications
• Activities: Counseling of COPD/ Asthma patients by nurse practitioner in GP practice