Health Equity: 03/16/09

Monday, March 16, 2009

[EQ] Conference: Reducing Health Inequalities - What Do We Really Know About Successful Strategies?

Conference:

Reducing Health Inequalities
What Do We Really Know About Successful Strategies?

8–9 May 2009 School of Public Health, University of Bielefeld, and Hertie School of Governance, Berlin

Website: http://www.hertie-school.org/binaries/addon/1085_rhi.pdf

“….socioeconomic status which enhance inequalities in health outcomes are a growing problem. The result is a loss of educational and economic competences in large parts of the population which reduces the economic prosperity of the whole country. Therefore, tackling health inequalities and implementing health equity strategies are the main objectives of public health policy in welfare states around the globe.

The conference will focus on the comparative analysis of public health strategies in different states.

The leading questions are:

- What do we know about the interaction of welfare regimes and health outcomes?
- Do regime types influence the results of health equity strategies?
- Do they have consequences for the overall burden of disease?
- Which strategy is appropriate in order to reduce health inequalities?
- How can the particularly heavy burden of disease faced by families, children, adolescents, the elderly, the migrant population,
and other vulnerable parts of the population in low economic and educational status be reduced?
- What do we really know about successful strategies?

PROGRAM

Friday, 8 May

09.30 h Opening

Michael Zürn, Dean of the Hertie School of Governance

Bertram Häussler, Director of IGES Institute

Frank Lehmann, Bundeszentrale für gesundheitliche Aufklärung

10.00 h Plenary Session

Welfare States and Their Public Health Strategies

Klaus Hurrelmann: Why should we tackle health inequalities?

Espen Dahl: Health inequalities related to types of welfare states

Richard Brown: Health inequalities and public health in the USA

Seppo Koskinen: Health inequalities and public health in Finland

14.00 h Workshops

Workshop I:

Public Health Strategies for Families of Low Socioeconomic Status

Petra Kolip: Public health strategies for families

Alexandra Sann: Early prevention: Health care and welfare services

Maya Mulle: Public health strategies for women in Switzerland

Muhamad Zakria Zakar: Public health strategies for families in Pakistan

Workshop II:

Health Inequalities Among Children and Adolescents

Matthias Richter: Health inequalities among children and adolescents

Alessio Zambon: Welfare regimes and health inequalities in adolescence

Patrick West: Equalisation of health in youth

Laura Kestilä: Life-course determinants of health, health behaviour, and

health inequalities in adulthood

Leena Koivusilta: Critical periods in the development of educational

careers: implications for health inequality

Workshop III:

Public Health Strategies for Vulnerable Groups of the Population

Ullrich Bauer: Public health strategies for vulnerable groups

Orna Baron-Epel: Inequalities in health in vulnerable populations in Israel

Nico Dragano: Occupational health of elder workers in Europe

Angie Hart: Resilient therapy: Parent-professional communities

Andreas Mielck: Tackling health care disparities

18.00 h Keynote Lecture

Ilona Kickbusch: The growing burden of disease: Reaching out for a global health diplomacy

Saturday, 9 May

09.30 h Plenary Session

Welfare States and Health Equity Strategies

Clare Bambra: Welfare states and health equity policies

Bertram Häussler: Reducing inequalities in supply with health care services

11.00 h Keynote Lecture

Martin McKee: Reducing health inequalities – What do we really know about successful strategies?

12.00 h Discussion

Starting with invited statements by the plenary speakers

Clare Bambra, Richard Brown, Espen Dahl, Bertram Häussler, Ilona Kickbusch, Seppo Koskinen

13.00 h End of the Conference

Registration

Please send an email with your name, your address, and your professional affiliation to
Prof. Klaus Hurrelmann: hurrelmann@hertie-school.org

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[EQ] From the Global AIDS Response towards Global Health? -Taskforce: Innovative International Financing for Health Systems

From the Global AIDS Response towards Global Health?

High Level Taskforce on Innovative International Financing for Health Systems

A discussion paper For the Hélène de Beir foundation and the International Civil Society Support group

Written by Gorik Ooms - January 2009

Available online as PDF file [47p.] at:

http://www.internationalhealthpartnership.net/pdf/IHP%20Update%2013/Taskforce/taskforce/090101_Ooms_Global_Health_Discussion_Paper%20(2).pdf

“………..Global Health’ has recently become a fashionable term. New Global Health institutes have been created, and new Global Health trainings organised. But what does the term Global Health really mean? Perhaps it is best defined by the World Health Organization (WHO)’s mandate: “health is a shared responsibility, involving equitable access to essential care and collective defence against transnational threats”.2

There are two ‘global’ elements in this description: a globally shared responsibility for the health of all people, and global threats posed by infectious diseases. However, these two global elements of an emerging Global Health paradigm are not mutually exclusive. The fact that viruses do not respect national borders contributes to an awareness of global responsibility for the health of all people. Further, the risk of uncontrolled epidemics proliferating from low-income to middle- and high-income countries motivates the more wealthy to help poor people because the more wealthy do not want to get poor people’s diseases. It is probably not a coincidence that Official Development Assistance (ODA) for health seems to focus on infectious diseases disproportionately.3 However, a global responsibility for the health of all people should extend beyond a willingness to tackle the global threats posed by infectious diseases and ensure that there is equal attention and solidarity for non-infectious diseases. In this discussion paper, I will examine the emerging Global Health paradigm as one that addresses a global responsibility for the health of all people….”

In the first section of this paper, I will argue how a Global Health paradigm – through the global AIDS response – is emerging from a synthesis of the medical relief and health development paradigms.

In the second section, I will discuss how the Global Health paradigm is promoting the extension of social health protection, as intended by some of the major donor countries and the International Labour Office (ILO).8 I will argue that if the extension of social health protection is understood as the export of social health protection models – in the sense of promoting national social health protection schemes as a strategy to achieve domestic self reliance – it is doomed to fail, at least in the low-income countries. But I will also argue that if the extension of social health protection is understood as the expansion of present national social health protection schemes beyond their borders, it could become a real Global Health paradigm.

In the third section, I will argue that a new philosophical, ethical or legal basis for a Global Health paradigm is not needed. If we simply recognise and treat health as a human right, the underlying conceptual framework of this approach encompasses trans-national obligations, on which a Global Health paradigm can be built…..”

Table of contents

General introduction and overview

Section 1. The global AIDS response: a synthesis of medical relief and health development paradigms

1.1. Introduction

1.2. The health development paradigm: aiming for sustainability, defined as self sufficiency

1.3. The medical relief paradigm: not aiming for sustainability

1.4. The global AIDS response: technical sustainability at the national level, financial sustainability at the international level

1.5. The expanding mandate of the Global Fund

1.6. ‘Fiscal space’ and ‘fiscal sustainability’: a straitjacket to ensure self-sufficiency

1.7. Conclusions of the first section

Section 2. Global Health: moving towards global social health protection?

2.1. Introduction

2.2. A global social health protection floor: an inclusive and a minimalist design

2.3. The Global Fund, seen as an emerging global social health protection floor

2.4. Conclusions of the second section

Section 3. Global Health: if health is a human right, there is a globally shared responsibility for the health of all people

3.1. Introduction

3.2. Defining the right to health

3.3. Progressive Realisation: what it does and does not mean

3.4. Core obligations and the obligation to provide assistance

3.5. Collective entitlement, collective obligation and ways to manage them

3.6. Conclusions of the third section

Section 4. Global Health in practice: moving towards a single Global Health Fund?

4.1. Introduction

4.2. From the global AIDS response to Global Health, through a single Global Health Fund?

4.3. Ten pragmatic reasons for a single Global Health Fund

4.4. Conclusions of the fourth section

Section 5. General conclusions

References

Who is in the High Level Taskforce?
http://www.internationalhealthpartnership.net/taskforce.html

The members of the Taskforce comprise a small number of leading figures in the international community selected on the basis of the perspectives they can each offer on innovative financing, health systems or political feasibility. They will be serving the Taskforce acting in their individual capacity and not as representatives of their government or agency:

Prime Minister Gordon Brown (United Kingdom) (co-chair)

Robert Zoellick (President of the World Bank) (co-chair)

President Ellen Johnson-Sirleaf (Liberia)

Prime Minister Jens Stoltenberg (Norway)

Tedros Adhanom Ghebreyesus (Health Minister, Ethiopia)

Bernard Kouchner (Foreign Minister, France)

Giulio Tremonti (Finance Minister, Italy)

Heidemarie Wieczorek-Zeul (UNSG Special Envoy for Finance for Development Conference & Development Minister, Germany)

Stephen Smith (Foreign Affaires Minister, Australia)

Margaret Chan (Director-General of the World Health Organization)

Graça Machel (President and Founder, Foundation for Community Development, Mozambique)

Also at: International Civil Society Support group:

http://www.icssupport.org/PDF/Global%20Health%20Discussion%20Paper.pdf

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[EQ] UK Health Inequalities Report 2008-09

Health Inequalities

Third Report of Session 2008-09 Volume 1

House of Commons Health Committee

15 March 2009

Available online PDF [143p.] at: http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf

“……..Health inequalities are not only apparent between people of different socio-economic groups—they exist between different genders, different ethnic groups, and the elderly and people suffering from mental health problems or learning disabilities also have worse health than the rest of the population. The causes of health inequalities are complex, and include lifestyle factors—smoking, nutrition, exercise to name only a few—and also wider determinants such as poverty, housing and education. Access to healthcare may play a role, and there are particular concerns about ‘institutional ageism’, but this appears to be less significant than other determinants.

Lack of evidence and poor evaluation

One of the major difficulties which has beset this inquiry, and indeed is holding back all those involved in trying to tackle health inequalities, is that it is nearly impossible to know what to do given the scarcity of good evidence and good evaluation of current policy.

Policy cannot be evidence-based if there is no evidence and evidence cannot be obtained without proper evaluation. The most damning criticisms of Government policies we have heard in this inquiry have not been of the policies themselves, but rather of the Government’s approach to designing and introducing new policies which make meaningful evaluation impossible.

Even where evaluation is carried out, it is usually “soft”, amounting to little more than examining processes and asking those involved what they thought about them. All too often Governments rush in with insufficient thought, do not collect adequate data at the beginning about the health of the population which will be

affected by the policies, do not have clear objectives, make numerous changes to the policies and its objectives and do not maintain the policy long enough to know whether it has worked. As a result, in the words of one witness, ‘we have wasted huge opportunities to learn’. Simple changes to the design of policies and how they are introduced could make all the difference, and Chapter 3 of this report sets these out. Professor Sir Michael Marmot’s forthcoming review of health inequalities offers the ideal opportunity for the Government to demonstrate its commitment to rigorous methods for introducing and evaluating new initiatives in this area which are ethically sound and safeguard public funds….”

Report

Summary

1 Introduction

2 Health inequalities – extent, causes, and policies to tackle them

The extent of health inequalities

Measuring health inequalities

Causes of health inequalities

Access to healthcare

Lifestyle factors

Socio-economic factors

3 Designing and evaluating policy effectively

Lack of evidence

Inadequacy of evaluation

Difficulties in evaluating complex interventions

Poor design and introduction of interventions

Better evaluation

The ethical case for evaluation

Solutions

Conclusion

4 Funding for health inequalities

To what extent should health spending be redistributed to tackle health inequalities?

5 Specific health inequalities initiatives 50

6 The role of the NHS in tackling health inequalities

Clinical interventions to tackle health inequalities

7 Tackling health inequalities across other sectors and departments

8 A new approach to tackling health inequalities

Conclusions and recommendations

List of written evidence

List of further written evidence

List of unprinted evidence

List of Reports from the Health Committee

The report can be downloaded in pdf or HTML at: http://www.publications.parliament.uk/pa/cm/cmhealth.htm

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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.