How to reduce health inequalities? Results of 4 EU funded projects: DEMETRIQ, DRIVERS, SILNE and...

HOW TO REDUCE HEALTH INEQUALITIES?Results of 4 EU funded projects

www.demetriq.eu www.health-gradient.eu

www.sophie-project.euwww.silne.ensp.org

demetriq.eudemetriq.eu

Margaret WhiteheadUniversity of Liverpool, UK

The health inequalities impact of natural policy experiments

Developing Methodologies to Reduce Inequalities in the Determinants of Health

Demetriq received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 278511


• Policies that promote financial security for the worst off boost their employment chances

• Better job security reduces adverse effects of recession

• Smart public investments in health and social protection return up to 3 Euros for each 1 Euro of spending

• Fairer pay reduces mental health inequalities

Beneficial impacts of policies: findings


Improved mental health

Source: Reeves, Stuckler et al, 2014

• Introduction of National Minimum Wage improves GHQ scores

• People felt significantly less under financial stress


• Some social welfare and labour market reforms have had adverse effects, falling most heavily on the most disadvantaged

• Governments have real policy options to deal with recession while protecting the worst off

• Changes in national policies need to be assessed for their impact on the health and wellbeing of different socioeconomic groups in society

Policy messages

Reducing health inequalities by improving work and employment conditionsJohannes SiegristSenior Professor of Work Stress Research,University of Düsseldorf, Germany

DRIVERS is co-ordinated by EuroHealthNet and has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°278350

The life course approach of DRIVERS

Health

Equity

Early childhood

Working conditions

Social Protection

Social gradient of health-adverse work stress across Europe

Source: Wahrendorf M et al. (2013) European Sociological Review 29:792-802. Wahrendorf M, Siegrist J. (2014) BMC Public Health 14:849.

Level of national labour market integration and work stress score

Epidemiological evidence

• Work stress is associated with elevated risks of depression, CHD, and disability in employed populations across Europe (OR varying between 1.3 and 2.0).

• Work stress is a mediator in the relationship of socioeconomic position (SEP) with health.

• SEP moderates the effect of work stress on health: stronger effects among lower SEP groups.

Policy recommendations

• Improve monitoring of health-adverse working conditions and the provision of occupational health services, especially among lower SEP groups.

• Promote health equity by tackling structural determinants of the work-related burden of disease.

• Prioritise social and labour policies that strengthen sustainable employment in national budgets, particularly in contexts of neoliberal policies and strong fiscal austerity measures.

Smoking inequalities: learning from natural experiments

Anton KunstDepartment of Public HealthAMC / University of Amsterdam

Key finding 1:In 2013, socioeconomic disadvantage was intimately related to smoking initiation across all Europe

Key finding 2:Despite strong developments in tobacco control since 2000, inequalities in smoking cessation have not diminished

Key finding 3:Specific tobacco control measures do reduce smoking in all groups, though not more in lower groups

• The ‘equity impact’ tobacco tax is mostly positive,

though variable

• The ‘equity impact’ of smoking cessation services is variable but often negative

Key message:We need new strategies to stop this addictive, toxic, commercial product affecting disadvantaged people

• Stronger supply-side policies (product composition, sales, advertisement)

• Equity-oriented demand-side programs(focus on disadvantaged youth)

www.sophie-project.eu

@sophieproject

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More info

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The Neighbourhoods Law (2004-2011), implemented by the Government of Catalonia, led to large-scale urban renewal interventions in deprived neigbhbourhoods across Catalonia. It focused on physical improvement, social integration and economic gains, in order to improve living conditions of residents.143 neighbourhoods participated in the initiative (approximately, 1.3billion € invested).

SOPHIE researchers have analyzed the effects of the Neighbourhoods Law on the well-being of neighbours. We have conducted two studies (quantitative and qualitative) to assess the evolution of health status of residents in 5 renewed neighbourhoods in Barcelona and compared them to people of non-intervened neighbourhoods with similar socio-economic conditions.

The Neighbourhoods law in the City of Barcelona15 of 73 neighbourhoods participated, which represents the 10% of Barcelona’s population

The Neighbourhoods Law (Llei de barris), an integrated urban renewal program

Distribution of Neighbourhoods Law funding by type of interventions

The effects of the Neighbourhoods Law on health and health inequalities

Qualitative study: perception of neighbours towards changes in their neighbourhoods• The majority of projects within the Neighbourhood Law were perceived as having both positive and

important effects on the well-being of participants. • The study also highlights the importance of incorporating participants with different characteristics

(age, gender, socioeconomic positions, etc.) in order to better understand the effects of the intervention on different populations.

Quantitative study: changes in two health indicators (self-rated health & mental-health)• In areas intervened by the Neighbourhoods Law, self-rated health improved amongst residents of both

sexes and especially those in the manual social classes. • Similar observations were made for mental health status in women, while in men, the

Neighbourhoods Law appeared to prevent the increase in poor mental health observed in men from the comparison group.

Mehdipanah, R., Malmusi, D, Muntaner, C., and Borrell, C. “An evaluation of an urban renewal program and its effects on neighborhood resident’s overall wellbeing using concept mapping”. Health and Place, 2013; 23: 9-17. http://www.sciencedirect.com/science/article/pii/S1353829213000695

Mehdipanah, R., Rodriguez-Sanz, M., Malmusi, D, Muntaner, C., Diez, E., Bartoll, X., and Borrell, C. “The effects of an urban renewal project on health and health inequalities: A quasi-experimental study in Barcelona”. Journal of Epidemiology & Community Health, 2014; 68: 811-817 http://jech.bmj.com/content/early/2014/04/30/jech-2013-203434

This research has helped to show how urban renewal policies can improve population’s health. In Barcelona, Neighbourhoods Law has improved health and reduced health inequalities.Urban renewal projects that include improved accessibility, walkability, social integration programs, among other interventions, are effective to improve the health of their residents.

Conclusions

http://www.sciencedirect.com/science/article/pii/S1353829213000695

http://jech.bmj.com/content/early/2014/04/30/jech-2013-203434

How to reduce health inequalities? Results of 4 EU funded projects: DEMETRIQ, DRIVERS, SILNE and...

Healthcare

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