“Implementing Strategies on Reducing Health Inequalities”

1. “Implementing Strategies on Reducing Health Inequalities” “More Equal and Healthier Societies” Budapest, Hungary, 30th November 2010 Helene Reemann Federal Centre for Health Education, BZgA

2. Inequalities are observed in all European member states as well as in Germany

3. Content • Health inequalities in Germany • Structures and strategies to tackle health inequalities • Evaluation and quality development • Summary

4. Prevalence of smoking by income and sex Men Women % age Income group (SOEP Study; Lampert et al. 2005)

5. Prevalence of physical inactivity by income and sex Men women % age Income group (SOEP Study; Lampert et al. 2005)

6. Risk of chronic diseases in low educatedmen and women Disease Men women Myocardial infarction Stroke Angina Pectoris Hypertension Cancer Diabetes Chronic Bronchitis Arthrosis Arthritis Chronic back pain Dizziness (Federal Health Survey; Lampert et al. 2005)

7. Childrens participation in checkups in the first six living years by parental socio-economic status % Socioeconomic status Low Medium high Checkup (Berlin, school enrolment examination 2005)

8. Risk of premature mortality in lower income men and women Odds Ratio Income group (SOEP Study; Kroll & Lampert 2009)

9. BZgA aims at tackling health inequalities by providing structures and implementing low barrier strategies

10. Federal Centre for Health Education (BZgA) Quality assurance and research Effectivity and efficency in prevention, Evaluationof measures and campaigns Communication Planning, implementation and evaluation of national prevention campaigns and programmes on health promotion National and international Cooperation / Coordination Intersectoral cooperation with governmental/non-govenmental organisations of the health sector with science and other policy sectors

11. Tackling health inequalities • …is one central aim of the Federal Centre for Health Education • 3 main drivers: • Attitudes and skills of individual person • Social environment and settings • Socio-cultural conditions • Promote healthy behaviour in daily life! • Networking structures & low barrier strategies

12. Providing structures in Germany: Cooperation Network „Health promotion for the socially disadvantaged“

13. 16 Regional Hubs

14. Structures enable transfer • Good practices on internet platform www.gesundheitliche-chancengleichheit.de • Project examples and quality criteria in publications • Knowledge exchange at events and conferences • Workshops in selected settings (e.g. Kita) • Congress Poverty and Health

15. Structure development in Germany and Europe Europe Federal Level Länder Level EU Project ‚DETERMINE‘ with 26 partner countries EU-, national and local level German project ‘Health Promotion for socially disadvantaged people’ Regional Hubs ‚Poverty and Health‘ in 16 federal states European Directory www.health- inequalities.eu National Directory with some 1,700 projects www.gesundheitliche- chancengleichheit.de Länder – platforms within the national directory

16. Providing structures in Europe: EU projects ‚Closing the Gap‘ and Determine‘ www.health-inequalities.eu

17. Implementing strategies: National Centre on Early Prevention • Aim • Protect children 0-3 years early and effective by linking services • Methods • Coordinate local public health and youth welfare services • Identify families with educational needs and in stressful situations • Develop and improve effective interventions on strenthening parental skills • Results (preliminary) • More than 50 % of youth welfare and public health are active in early prevention • Expressed need in terms of financial consulting, data protection, risk idenfication, qualification of employees

18. Implementing strategies: Gut Drauf (In good mood) • Aim • Improve nutrition, physical activity and stress management in adolescents 12-18 years • Methods • Offer high quality activities in adolescent settings (school & business, sports & leisure time…) • Behaviours AND circumstances • Link and qualify intermediaries • Quality criteria and certification

19. Implementing strategies: Komm auf Tour („Get going – my strengths, my future“) • Aims • Strengthening self-confidence among students on lower educational levels • Promoting vocational orientation combined with life and familiy planning, prevention of teen-age pregnancies • Methods • Students discover personal strengths and occupational orientation in joint-in-circuit • Include parents, teachers and local collaborators • Results • Change of attitudes in terms of gender role, occupational aptitude, sexuality and family planning

20. Landkreis Uelzen Land Brandenburg Pilot Salzwedel/Sachsen-Anhalt Land Berlin LandkreisHavelland Nordrhein-Westfalen Pilot Leipzig/ Sachsen Pilot Ilmenau/Thüringen LandBaden-Württemberg Lernende Region Bodensee Reach 650-700 persons/each regional measure 100.000 persons in 152 regional measures from 2006 to 2010

21. Children and adolescents • Health problems as consequence of problems to fulfil developmental tasks (primary and secondary socialisation) • Social change: increase of broken families, poverty • Support parents and educators • Nutrition, physical activity and stress regulation main issues

22. Implementing strategies: Districts with special development needs – The Socially Integrative City • Aim • Support district managers in terms of health promotion/prevention • Methods • Federal-Länder-programme to counteract the widening socio-spatial rifts in the cities • Strategies for action regarding: healthy settings, problems and solutions; project development, prevention of poor diet, phyiscal inactivity and stress, quality development

23. Evaluation is still a challenge. Individual projects show that improving health behaviour in socially disadvantaged is possible. Quality criteria can support this process

24. Quality criteria for health promotion with the socially disadvantaged 3 / Sustainability and quality development • Innovation but sustainability • Multidisciplinary collaboration • Quality management • Documentation and Evaluation • Cost efficiency 1 / Basic criteria • Concept • Target group • Settings 2 / Work with the target group • Snowballing • Low barriersParticipation • Empowerment Recognized by statutory health insurances as criteria for projects to be promoted!

25. German Health Survey of Children and Adolescents (KIGGS) • Aim: Representative survey of children and adolescent health 0 – 17 years • Baseline: 2003 - 2006 • Response: 17.641 boys and girls and their parents from 167 cities • Data and recommendations from a public health perspective

26. Strategy of the Federal Government for the Promotion of Child Health Main goals • To promote health equity among all children and adolescents • To improve the overall conditions, to motivate and to integrate a healthy lifestyle into the everyday life of children • To reduce health risks • To support the physical and psychological development of children and adolescents • To raise awareness for the issue of child health

27. 4. Summary • Data on health inequalities show the need of tackling health inequalities in Germany • Tackling health inequalities ideally combine sustainable structures and accessible and acceptable strategies and interventions • Structures of cooperation are based on a broad range of actors from the health field and other political sectors • Strategies should be implemented in daily life of target groups AND reduce barriers while providing options for empowerment and participation.

28. Thank you for your attention! helene.reemann@bzga.de