Public health policy for disadvantaged target groups

1. Public health policy for disadvantaged target groups Trine Andrea Els Helle

2. Public health policy (1) • The debate is no longer if inequalities in health do exist, but what can be done about them. • WHO Europe By the year of 2020, the health gaps between socio-economic groups within countries should be reduced by at least one quarter in all Member states, by substainigly increasing the level of health of disadvantaged groups.

3. Public health policy (2) • Measurement → recognition → awareness and concern is raising → isolated action → structural policy programs 1. Curative 2. Prevention and health promotion • Disadvantaged target groups living in poverty: • Elderly • Children • Homeless people • Immigrants and newcommers

4. Elderly in poverty (1) • Socio-demographic process of aging: group is increasing↑ • ↑ chronic diseases → long term medical care need → ↑ risk of poverty • Problems • acces problems (physical), isolation • need of additional benifits for increasing health care • lack of knowledge of entitlement benifits • Most relevant to single-living women

5. Elderly in poverty (2) • Health problems • Loss of independence in everyday life activities (crucial turning points), physical disabilities, falling, trauma • Athroses, chronic artritis, cardiovascular diseases, bronchitis, gastro-intestinal diseases • Mental diseases (dementsia) • Dental problems (loosing all teeth)

6. Campaigns for elderly • Health promotion homevisits at the age of 75 (DK). • Information about health care benefits, nutritional education, evaluation of the elderlies situation • Community Health Care Centers (B). • Fall prevention • National fund elderly help (NL). • Personal bound help from the INFO PLUSBUS • Home visiting whereby elderly people can be helped with their finance • Elderlyhelpline, phone-number

7. Children living in poverty (1) • Health problems of children • Nutrition diseases (obesity and underfeeding) • Infectious diseases • Caries • Severe injuries • Psychosomatic health problems (insomnia, anorexia, headache, sickness, nausea) • Behavioural problems

8. Children living in poverty (1) • Social causation of health problems • Inadequat primary care and psycho-socialwelbeing provided by the parents • Low familiy budget or no work related income, especially: • Unemployed parents • Single parents • Large families >3 children (sometimes) • Detrimental health behavior of parents(smoking, nutrition) • → relevant restrictions on famliy budget • → negative impact on health status of children

9. Campaigns for children • Project ‘Houten skutsje’ (Friesland) (NL) • Stimulate development of children • Requirements for Activities for children who needs help • ‘Niets aan de tand’ (B) • Community health centers (Genth) • Dental problems due to feeding by bottle, access to dentist, education • ‘Kind en gezin’ • Registration of children living in poverty and organisation of care at home • Groups for children with special needs (DK) • Sexual education for teenagers (all countries)

10. Homeless people (1) • Extreme form of poverty • Unwanted? • Figures. only estimations (2006) • Europe: 3 million • The Netherlands: 50.000, Amsterdam: 2600 • Belgium: 12.000, Brussels: 1200 • Denmark: 11.000-13.000, Copenhagen: 3.500

11. Homeless people (2) • Health problems • Multi morbidity • Addictions (alcohol, drugs) and addiction related diseases • Mental disorders (3 times higher than for general pop) • psychological distress • self reported depression • anxiety • Shizophrenia (mostly young people) • Physical diseases (TBC, bronchitis, skin diseases, infections)

12. Medical care for homeless people • Denmark: • Street nurses and shelter nurses • Free medical care • Belgium: • ID-registration and obligated health insurance at the adress of Public Centre of Social Welfare (OCMW) • Urgent medical care is free of charge • Voluntary working doctors in cities • The Netherlands: • Everybody has the same right receiving health care, also homeless people • AMT: Ambulant (social) Medical Team : help without an insurance.

13. Campaigns for homeless people • Shelters (B and NL) • Paid by community government • Free donations • Voluntary workers • Salvation army (christian church) (NL) • Organisation for disadvantaged people, also homeless people. • Offer a lot of help, also medical care • The mobile Café (DK) • Meals-on-wheels • Project social Nurse (DK)

14. Immigrants and new comers (1) • Number has reduced last 2 decades in Europe • Stricter immigrant regulations • Border controls • Forced deportation of person • High risc of poverty • Difficulties finding a pyed job • Exploitation • Poor housing • Poor social net

15. Immigrants and new comers (2) • Examination at moment of arrival • Health problems • Diseases of respiratory tract (TBC) • Skin diseases • Dental problems • Aids, hepatitis, sexally transmitted diseases

16. Campaigns for immigrants and newcomers (1) • Ijsbreker (B) • Community health care centre • Improve information and communication • Medimmigrant (B) • Brochures about healt care and health care system in different languages • 50% of total medical cost is payed back • Second hand medical equipment

17. Campaigns for immigrants and newcomers (2) • NIGZ: National Institute Health care promotion and prevention (NL) • Translated brochures • Interpreter for own language • Education to health care providers • Equal access to health care system, 6 weeks after application as etnical danish citizens • Exercise programmes & nutritional education (DK) • Interpreter is mandatory by law and free of charge the first 7 years in the country (DK)

18. Site visit: Nyirő Gyula hospital

19. Site visit at psychiatric departmentof Nyirő Gyula hospital in Budapest Facts: • Open unit; 72 patients, 3 nurses • Closed unit; 18 patients, 3 nurses • 144 beds in the whole department • 18 “special treatment beds” • 2000 patients admitted in 1 year • 613 social problems (2006) • 200 financial problems • 39 homeless

20. Target groups in departmentof Nyirő Gyula hospital in Budapest • Elderly • A lot of elderly people admitted • 5 year waiting list for nursing home • Homeless people • a few, some of them don’t want help • Single parents • rooming in with mother-child (creative problem solving) • Immigrants • Not a real target group in Hungary

21. Interdisciplinarity work at the psychiatric unit (1) • Nurses • 3 nurses per unit per shift  Main job tasks • Prepare and give out medication • Basic care (daily hygiene) • Administration! • Social worker • 2 for the whole department • Main job tasks • Take care of complex social problems; housing, jobs, income, social network • Relations with private connections is very important • Creative problem solving, playing games

22. Interdisciplinarity work at the psychiatric unit (2) • Psychiatrist/ physician • 1-2 per unit • Psychologist • 1-2 for the whole department • Physiotherapist • 2 for the whole department • Occupational therapist • ???

24. Interdisciplinarity work at the psychiatric unit (3) • Teammeeting Head nurse, physician, social worker, psychologist Discuss: • patients: current problems (social and health)  therapeutic progress • new patients • problematic patients • Etc.

25. Discussion • Are public health programs effective on public level, or local level? • Should the government interfere in health promotion or is it an individual responsibility? • Does illness lead to social problems, or do social problems lead to illness?

26. Conclusion • National public health policies and programs are needed to educate and inform the whole population. • Campaigns on local level are necessary to reach specific target groups. • Preventive programs are not only a task for the health care sector, there should be a cooperation with the social sector as well. (job-opportunities, housing, etc.) • Site visit: • The visions of the psychiatric hospital head nurse is the same as in our own countries, but the implementation is limited by financial recourses and structure.

27. references • De Decker Pascal (2004), Belgium National report 2004 for the European Observatory on Homelessness: statistical update, Feantsa • Menk Ralph et all (2003), Report on socio-economic differences in health indicators: health inequalities in Europe and the situation of disadvantaged groups, Bielefeld • Tasma Nicoline and Berman Philip (2004),The role of the health care sector in tackling poverty and social exclusion in Europe, European Health Net, Brussels • European community (2007), Closing the gap: strategies for action to tackle health inequalities, European Health Net, Brussels • Benjaminsen Lars and Christensen Ivan (2007), Hjemloeshed i Danmark 2007 – National kortlaegning (homelessness in Denmark 2007– National survey), SFI Kopenhagen

28. www.eurohealthnet.eu • http://epp.eurostat.ec.europa.eu • www.armoedebestrijding.be • www.medimmigrant.be • www.wvgc.be • www.vig.be • www.minsoc.fgov.be • www.sst.dk • http://www.udenfor.dk • http://nigz.nl • http://crossroads.journalismcentre.com/2007/fewer-homeless-people-in-the-netherlands/ • www.legerdesheils.nl • http://www.vvdamsterdam.nl/artikel/368.htm • www.ggd.nl