What is EQUITY ACTION and what has it done ?

Ray Earwicker, Department of Health, England (UK) www.health-inequalities.eu

This work is part of EQUITY ACTION which has received funding from the European Union,

in the framework of the Health Programme. The sole responsibility for this work lies with the author

EQUITY ACTION - an appetite to tackle health inequalities ?

• UK Presidency of the EU (2005) • • EC Expert health inequalities group (2006) Finnish Presidency – health in all policies (2006) • EU Public Health Strategy (2008) • WHO report

Closing the gap in a generation (2008)

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A growing appetite to tackle health inequalities(continued)

• • • • • EC Communication on health inequalities

Solidarity in Health

(2009) Spanish Presidency – equity and health in all policies (2010) EQUITY ACTION commences (2011) Polish Presidency – closing the gap (2011) Rio Political Declaration on the social determinants of health (2011) www.health-inequalities.eu

EQUITY ACTION –

Solidarity in health

(2009)

•

The need for further action on health inequalities arises because of increasing evidence on the size and pervasiveness of health inequalities across the EU…Not all Member States have the same available resources, tools or pools of expertise to address the different causes of health inequalities…The EU can play an important role in promoting good practice

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Establishing EQUITY ACTION

• • Successful Framework Programme bid From ‘why’ and ‘where’ to ‘what to do and how to do it’ • Approach seen as key to engaging policy makers – and promoting change • • EQUITY ACTION launched April 2011 3.6m. euro EC joint action programme with 16 participating Member States www.health-inequalities.eu

Structure of the programme

• • • • WP 4 (“tools”) lead = DH, England WP 5 (“regions”) lead = Eurohealthnet, Brussels WP 6 (“knowledge”) lead = RNVI, Netherlands WP 7 (“stakeholders”) lead = BZgA, Germany and OEFI, Hungary www.health-inequalities.eu

WORK PACKAGE 4

• The challenge: to get equity into the frame • The approach: to develop existing public health tools to take account of equity • • Three tools – – – (i) health impact assessment (HIA) (ii) health equity audit (iii) health in all policies Tested across the social determinants www.health-inequalities.eu

(i) Health Impact Assessment – the process

• • • Designed to build understanding and capacity of HIA process Build confidence – ‘learning through doing’ Four stages – – – – rapid review/expert guidance for use training and support review – identification of issues worked through case studies www.health-inequalities.eu

Health Impact Assessment – guiding principles

• • Developed by expert HIA group, which concluded – – – HIAs mostly poorly carried out equity not included as a factor good HIAs automatically consider equity Five stages of expert tool – – – – scoping/screening appraisal reporting evaluation www.health-inequalities.eu

Health Impact Assessment – case studies

• ‘Learning by doing’ • • Range across the social determinants across 16 partner organisations – – – – England – fuel poverty Sweden – tobacco Belgium – sustainability Ireland – fizzy drinks tax Range of skills and experience www.health-inequalities.eu

Health Impact Assessment – key issues

• • Opportunities – – – assess likely impact before decision highlight unintended consequences reach out across the social determinants Barriers – – – – available data/evidence time/resources(to consider) timing (to complete) winning attention (engagement) www.health-inequalities.eu

(ii) Health Equity Audit (HEA) process

• EU wide (EC) policy audit • • Retrospective Initial scoping (from 30 subjects to five) • • Develop criteria against available evidence Assess impact/value of undertaking an HEA • Test findings against prospect of engagement from EC leads www.health-inequalities.eu

HEA – Air quality audit

• • Air quality met criteria – – – Fit with available data Timely – fit with policy development and strategy renewal Geographical and socio-economic inequalities Results – – – overall reductions in EU pollution levels modest reductions in geographical inequalities socio-economic inequalities unchanged www.health-inequalities.eu

(iii)Health in all policies

• • • Literature review of available evidence Lessons from Equity Action partners – Work within overarching strategy/action plan – Identify win-win policies – delivering the policy objectives – Need political leadership to thrive Other considerations: stakeholders, technical skills, culture and examples www.health-inequalities.eu

WORK PACKAGE 5 (“regions”)

• • The challenge to identify good practice to show health inequalities can be tackled at regional (and municipal) level, and • to promote support of this activity through the use of EU structural funds The approach to promote dialogue with regional network – 30 regions across 10 Member States www.health-inequalities.eu

Work Package 5 – activity and results

• Activity around WP5 consisted of partner meetings and workshops to develop regional good practice and explore use of structural funds • Results – – – regional case studies report structural funds (SF) analysis report SF online guidance tool (available, under development www.health-inequalities.eu

WORK PACKAGE 6 (“knowledge”

• The challenge to strengthen policy development by using best available evidence across social determinants of health • The approach to develop a dialogue between research and policy experts (the scientific reference group) in partnership with 8 Member States www.health-inequalities.eu

Work Package 6 – activity and results

• • Activity around WP6 consisted of – – – identifying existing knowledge gaps around ‘what works’ through • literature reviews of the evidence covering early • years, employment, debt/poverty and housing fact sheets making knowledge real to policy makers feeding into the EU research agenda Results – 10 reviews and factsheets available soon www.health-inequalities.eu

WORK PACKAGE 7 (“stakeholders”)

• The challenge to develop a systematic approach to stakeholder engagement across the social determinants of health, and • facilitate stakeholder engagement at MS and EU level • Approach engaging 10 MS partners with national stakeholders, and share experience across work package www.health-inequalities.eu

Work Package 7 – activity and results

• • The activity around WP7 consisted of – holding WP7 stakeholder debates around ‘together for health equity from the start’ – promoting national workshops – creating fact sheets/guides Results – fact sheets on inter-sectoral collaboration on education, built environment and social welfare – stakeholder engagement guide – out soon www.health-inequalities.eu

Summing Up EQUITY ACTION

• • • • Systematic – – capturing learning through case studies using iterative processes Engaged – – developing tools based on partners experience working across sectors Authoritative – – working with experts to assess quality reflecting the evidence Is it enough ?

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EQUITY ACTION – What next?

• Some questions for the future – health inequalities are not going away so • How can we champion the findings and lessons of Equity Action across MSs and the EU?

• What can local and national partners, MSs and the Commission do to help www.health-inequalities.eu

EQUITY ACTION – the end?

• Final conference 23 January, Brussels –

Addressing Health Inequalities 2014 and beyond

• Programme ends February 2014 • For more details about the programme and the January conference • www.equityaction.eu

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