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Reducing Health Inequalities in Europe; What can be done?. Dr. Martijntje Bakker Public Health Fund the Netherlands. Content. Background Inequalities in health in Europe How do countries deal with SEIH An example: healthcare. History of the Network. King’s Fund report (1995)
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Reducing Health Inequalities in Europe; What can be done? Dr. Martijntje Bakker Public Health Fund the Netherlands
Content • Background • Inequalities in health in Europe • How do countries deal with SEIH • An example: healthcare
History of the Network • King’s Fund report (1995) • BMJ editorial (1995) • Malmö 1996, London, 1997, Rotterdam 1998 • EU funding, 1999 • Helsinki 1999, Barcelona 2000
Purposes of the network • To exchange the various national experiences with interventions and policies to reduce SEIH • To explore opportunities for developing comparative or collaborative research to evaluate such interventions and policies
Network members • 40 members • 13 European countries (Belgium, Denmark, Finland, France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Spain, Sweden and UK) • WHO representatives • New-Zealand and USA
Reducing inequalities in healthA European perspectiveEdited by Johan Mackenbachand Martijntje Bakker
Content • I Introduction • II Interventions and policies to reduce socio-economic inequalities in health • III National experiences • IV Evaluation issues • V Reflections • VI Key messages
SEIH in Europe • Morbidity • Mortality
How do countries in Europe deal with socio-economic inequalities in health?
Situation in 8 European countries • Greece: pre-measurement • Spain: denial/ indifference • France, Italy: concern • Lithuania: will to take action • The Netherlands, Sweden: more structured developments • England: comprehensive coordinated policy
Examples of comprehensive packages (1) • British Independent Inquiry into inequalities in health (1998) • 39 main recommendations (123 with sub-clauses) • Seven policy areas reviewed: Taxation and social security, Education, Employment, Housing and environment, Mobility, transport and pollution, Nutrition and the common agricultural policy, National Health Service • Demographic factors over the life course considered, including: Mothers, children and families, Young people and adults of working age, Older people, Ethnicity, Gender • Three priority areas emphasized: • 1. Health inequalities impact assessment • 2. A high priority for the health of families with children • 3. Reduction in income inequalities and improvement of living standards of poor households
Examples of comprehensive packages (2) • Swedish National Public Health Commission (2000) • 18 health policy objectives • Six overarching themes: • 1. Strengthening social capital2. Growing up in a satisfactory environment3. Improving conditions at work4. Creating a satisfactory physical environment5. Stimulating health-promoting life habits6. Developing a satisfactory infrastructure for health • Development of ‘indicators for achievement’ recommended.
Examples of comprehensive packages (3) • The Dutch program committee on socio-economic inequalities in health (2001) • 26 recommendations • Four specific strategies: • 1. Reduction of inequalities in education, income and other socio-economic factors2. Reduction of the negative effects of health problems on socio-economic position • 3. Reduction of the negative effects of socio-economic position on health • 4. Improve access and quality of healthcare for lower socio-economic groups • 11 quantitative targets relating to intermediate outcomes. • Strong emphasis on continuation of research, development, monitoring and evaluation.
An example: health care • Access to healthcare • Financial • Physical • Cultural
Access to primary care • UK: inequalities in access and provision of care (Goddard & Smith, 1998) • Spain: no clear picture (De La Hoz and Leon, 1996) • NL: more GP contacts for low SES (Van der Meer et al., 1996) • Sweden: more GP contacts for high SES (Whitehead et al., 1997) • Germany: more GP contacts for low SES (Bormann & Schreuder, 1994) • Finland: high SES: private practices and occupational healthcare; low SES: GP’s at municipal health centres (Keskimäki, 1997)
Access to hospital care • In general, access seems equitable • However, this might not be true for access to and quality of care in specialist or intensive services • Examples: • UK: specialist cardiac services, survival cancer treatment (Goddard, Smith, 1998) • Finland: coronary bypass operations, hip replacement operations, cataract surgery (Keskimäki, 1997)
Review • 36 interventions (aimed at low SES groups, or aimed at general population with results reported by SES) • Aims: cancer screening, hypertension or substance abuse treatment programs, improving maternal and child outcomes • Interventions: hospital-based education programs, community outreach activities, personalised contacts with target groups by healthcare personnel
Starting Well, Glasgow • Early intervention program • Target group: children up to 5 years in deprived areas • Aim: Improving health and well-being • Activities: • Intensive home support to families with a new baby • Improved network of community services • Stronger linkages between families and support structures and services
Nurse practitioners, NL • Target group: Patients with COPD/ Asthma in deprived areas • Aim:compliance with therapy, reduced complications • Activities: Counseling of COPD/ Asthma patients by nurse practitioner in GP practice