Reducing Health Inequalities for Children Living in Europe

1. Reducing Health Inequalities for Children Living in Europe Dorota Sienkiewicz EPHA EUPHA 3rd Conference Integrated Public Health 11 November 2010, Amsterdam

2. Introduction • “Inequalities are a matter of life and death, of health and sickness, of well-being and misery” (The Marmot Review, 2010) • “Poverty makes us sick and ill; sickness and illness make us poor” (Flemish Minister of Health, BE EU Presidency Health Inequalities conference) • “Social injustice is killing people on a grand scale” (WHO 2008) • “It is unreasonable to expect people to change their behaviour when the environment discourages such change” (Schmid, 1995) • “What if social inequalities caused health inequalities are intrinsic characteristic of human societies? What if this is just the way it is because of natural selection, biology, or the survival of the fittest, you name it… Should we quietly step back and accept the status quo?” (BE EU Presidency Health Inequalities conference)

3. Introduction • “These serious health inequalities do not arise by chance, and they cannot be attributed simply to genetic makeup, ‘bad’, unhealthy behaviour, or difficulties in access to medical care, important as those factors may be. Social and economic differences in health status reflect and are caused by, social and economic inequalities in society” (The Marmot Review, 2010) (add political inequalities?)

4. Children and Health • “the generation of children born at the turn of the 21st century could be the first to have a lower health and life expectancy than their parents” (Kickbusch, 2007) • The moral test for our societies is not how well they care about their most well-off, but how well they care about their most vulnerable, voiceless and disengaged. => see the EU2020 strategy…

5. Political recognition WHO CSDH (2005-2008) WHO Euro Review 2012? EC Communication: Solidarity in Health Trio EU Presidency But: focus on Health Inequalities and Children?

6. So why nothing has been done so far? • Rejection? • Figures not believed in? • Lack of capacity and know how? • Unimportant voters? • Economic growth better for everyone? • Short-term vision? • Politicians are only politicians? • Hidden poverty under-rated? • Poverty has a female face?

7. Children , poverty, social inequalities • Of the 80 million (17%) Europeans living in poverty (below 60% average income), 19 million children live under threat of poverty – it is one child out of five • Poor conditions in which children are born, grow up, learn and play diminish physical, mental and social chances for them to live optimal lives • Poverty makes us sick, and sickness makes us poor – circle of intergenerational poverty

8. Children , poverty, social inequalities – how linked? • Poverty and jobless, low educated and working poor households • Poverty and exposure to environmental hazards • Poverty and access to health services and primary healthcare • Poverty and malnutrition • Poverty and risk and unhealthy behaviours • Poverty and mental health • Poverty and housing and deprived neighborhoods

9. Children as a vulnerable group • Poor nutrition • Traffic injuries and accidents in the home • Poisoning • Second-hand tobacco smoke • Sedentary lifestyle • Advertising and marketing to children • Having a child – a risk of poverty esp. numerous families

10. All children vs. sub-groups C H I L D R E N

11. What could be done at EU level • EP Written Declaration on Children’s Health Inequalities • 1 million citizens initiative • EC Communication on Children’s Health Inequalities • EU Action Plan on Children’s Health Inequalities • Children’s health, children in poverty (incl. relative) as indicators for measuring the progress • EY on Children’s Health Inequalities • Civil Society Thematic Platform or Coalition • MS encouraged, supported, funded • CS encouraged, supported, funded

12. What could be done at EU level • To a great extent addressing children’s health inequalities means addressing them through their families, mothers, social protection, employment, education • Eg. Maternity Leave Directive

13. Six Recommendations where to fit in Children’s Health Inequalities (after WHO CSDH 2008) • Give every child the best start in life (early child development) • Enable all children, young people, and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure a healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill-health prevention

14. By any means, movement is urgently needed from all across Europe • If we want to avoid having instead of the current vision for Europe 2020 or 2030, a situation of Europe in 1931, the US and Japan in 1937 • In 2030 the population of productive age will be either too old, too sick, too unskilled or prematurely dead • There will be none left to achieve “economic, green, inclusive growth”; there will be no “highly competitive” Europe

15. On an optimistic note… • This crisis should be used as an opportunity, re-frame • Investing is cost-effective • 20-80 pay-offs with initiatives aimed at children (compared to 80-20 adult) • Innovative, creative, intergenerational, socially healing and purifying, funny, robust, hand-in-hand with EU values, and… • They/we all will love you for that!

16. Thank you for your attention and invite you to a discussion! For more information please see www.epha.org or contact Dorota Sienkiewicz at d.sienkiewicz@epha.org