Health Equity: 07/24/09

Friday, July 24, 2009

[EQ] Voices from other fields - non-health policy makers and politicians across Europe on tackling the socio economic determinants of health inequalities

Voices from other fields

DETERMINE is an EU Consortium for Action on the Socio-economic Determinants of Health (SDH). 2009

An account of 40 consultations with non-health policy makers and politicians across Europe on tackling the socio economic determinants of health inequalities.

Available online at: http://www.health-inequalities.eu/pdf.php?id=f40efb2b87649ac8c6b7e25abbf1215b

This working document presents the results of consultations that DETERMINE partners undertook with policy makers from other fields, to assess their awareness of SDH and health inequalities, their readiness and capacity to take action on these issues, and the information and support tools they require. The outcomes of this document contribute to DETERMINE’s awareness raising and capacity building activities.

Table of Contents

Summary

Existing capacity and readiness for intersectoral cooperation

Understanding socio-economic determinants of health inequalities

Challenges

1. Introduction

2. Methodology

3. Respondents’ existing experience of intersectoral Cooperation

4. Respondents’ awareness of health equity and health Inequalities

The perceived importance of tackling health inequalities

Understanding the socio-economic determinants of health inequalities

5. Opportunities and barriers to address the socio-economic determinants of health inequalities

Obstacles to successful cooperation on health inequalities

6. Necessary factors to facilitate integrated policies on the socioeconomic determinants of health inequalities

Table 1: Information requirements

Table 2: Institutional support tools

Box 1: Health Impact Assessment

Take away messages for the health sector: how to successfully coordinate integrated policies

7. Conclusions

Appendix 1: The semi-structured questionnaire that guided these consultations

Policy-Maker Consultation Guide

Select bibliography

For more information on DETERMINE see: www.health-inequalities.eu

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Policies and actions addressing the social determinants of health inequalities

Policies and actions addressing the social determinants of health inequalities:
Examples of activity at EU and member state level in Europe

DETERMINE is an EU Consortium for Action on the Socio-economic Determinants of Health (SDH). 2009

Available online at: http://www.health-inequalities.eu/pdf.php?id=3d14434d4f7ba34b262eab73cdfe0a50

“…..The first working document is based on an analysis of 16 questionnaires in 10 policy fields, and identifies and explores actions being taken at the regional, national and EU level on the SDH which contribute to reducing health inequalities. The results reflect that although there is no systematic way to address the SDH to reduce health inequalities, many different measures are being taken in other policy areas that can contribute to this goal. The report points to different kinds of mechanisms, such as inter-sectoral committees and impact assessments that facilitate inter-sectoral work

“….The aim of this analysis was to get a better insight into EU governments’ experiences with cross-sectoral collaboration to address the social determinants of health inequalities, in order to build on these experiences.

The outcomes point to a wide range of action on the social determinants of health across Europe. Some of the factors which appear likely to contribute to action include:

• Where addressing SDHI is a stated government priority e.g. in the case of Scotland.

• Where there is a cross departmental strategy to address SDHI e.g. the Investing for Health strategy in Northern Ireland.

• Where there is reference to SDHI in policy documents – many examples are available.

• Where there are cross-government mechanisms in place which support the establishment and maintenance of partnerships
– e.g. Social Partnership Agreement in the Republic of Ireland.

• Where there are policy tools in place to facilitate action, such as IA and evaluation.

• Where there is evidence available which demonstrates clear links between health and social inequalities – e.g. Netherlands, UK, Scandinavia

• Where there is leadership at both EU and national level – e.g. Finland and UK in EU presidency….”

Table of Contents

Introduction

Clarification of terms

Building on the existing knowledge base

Task 1 outline

Overview of findings

Section one: Policy

Health Inequalities Strategies

Health Strategies referring to SDHI

Addressing SDHI in education strategies

Addressing SDHI in employment strategies

Addressing SDHI in economic strategies

Addressing SDHI in environment strategies

Addressing SDHI in urban and regional planning

Addressing SDHI in neighbourhood renewal and housing policy

Social Inclusion strategies

Section two: Structures

Ministerial and Cabinet Groups

Offices and Committees located within or driven by health ministries

Offices and Committees located within or driven by non-health ministries

Consultation and collaboration in developing policy

Tools and methodologies

Section three: EU level

EU Health Strategy and Public Health Programmes

Tools and Mechanisms

Internal Market

Conclusion

Appendix 1: Work Package Partners

Appendix 2: Abbreviated questionnaire

Appendix 3: Other policies

For more information on DETERMINE see: www.health-inequalities.eu

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[EQ] Experiences with Primary Health Care in Canada

Experiences with Primary Health Care in Canada

The Canadian Institute for Health Information (CIHI) - July 2009

Available online at:
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2250_E&cw_topic=2250&cw_rel=AR_2991_E

Every day a large number of Canadians receive primary health care (PHC) services. PHC is usually the first place people go when they have health concerns, often to a general practitioner (GP) or family physician (FP). PHC typically includes routine care, care for urgent but minor or common health problems, mental health care, maternity and child care, psychosocial services, liaison with home care, health promotion and disease prevention, nutrition counseling and end-of-life care. PHC is also an important source of chronic disease prevention and management and may include other health professionals such as nurses, nurse practitioners, dietitians, physiotherapists and social workers.

“……Access to a Regular Source of Primary Health Care

Access to a regular source of care is an important aspect of PHC. Canadians identify the following features of primary care as important: access, comprehensiveness, continuity, coordination, interpersonal communication, patient-centred care, technical quality, outcomes and satisfaction. As just one of many examples, continuity of care has been shown to be associated with patient experiences (such as patient satisfaction)….”

Additional Resources

Primary Health Care (PHC) Indicators Chartbook: An Illustrative Example of Using PHC Data for Indicator Reporting

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_2490_E&cw_topic=2490

Pan-Canadian Primary Health Care Indicator Development Project

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1489_E

Primary Health Care Information

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=indicators_phc_e

Health Indicators

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=indicators_e

Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_1690_E&cw_topic=1690&cw_rel=AR_2509_E

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[EQ] Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health.

Are Americans Feeling Less Healthy?
The Puzzle of Trends in Self-rated Health.

Salomon JA, Nordhagen S, Oza S, Murray CJL
Am J Epidemiol 2009;170:343-351 (doi:10.1093/aje/kwp144)

American Journal of Epidemiology Advance Access originally published online on June 29, 2009

Open Access: http://aje.oxfordjournals.org/cgi/content/abstract/170/3/343?etoc

“…….Although self-rated health is proposed for use in public healthmonitoring, previous reports on US levels and trends in self-ratedhealth have shown ambiguous results. This study presents a comprehensivecomparative analysis of responses to a common self-rated healthquestion in 4 national surveys from 1971 to 2007: the NationalHealth and Nutrition Examination Survey, Behavioral Risk FactorSurveillance System, National Health Interview Survey, and CurrentPopulation Survey.

In addition to variation in the levels ofself-rated health across surveys, striking discrepancies intime trends were observed. Whereas data from the BehavioralRisk Factor Surveillance System demonstrate that Americans wereincreasingly likely to report "fair" or "poor" health over thelast decade, those from the Current Population Survey indicatethe opposite trend. Subgroup analyses revealed that the greatestinconsistencies were among young respondents, Hispanics, andthose without a high school education. Trends in "fair" or "poor"ratings were more inconsistent than trends in "excellent" ratings.

The observed discrepancies elude simple explanations but suggestthat self-rated health may be unsuitable for monitoring changesin population health over time. Analyses of socioeconomic disparitiesthat use self-rated health may be particularly vulnerable tocomparability problems, as inconsistencies are most pronouncedamong the lowest education group. More work is urgently neededon robust and comparable approaches to tracking population health….”

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