Quitlines and Social Exclusion in Europe Addressing Health Inequalities

Definitions-Social Exclusion The inability of an individual, group or community to participate effectively in economic, social, political and cultural life- an alienation and distance from the mainstream society [1][1] A multi-dimensional process, in which various forms of exclusion are combined: participation in decision making and political processes, access to employment and material resources, and integration into common cultural processes. [2][2] Social exclusion occurs when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown [3][3] The dynamic process of being shut out... from any of the social, economic, political and cultural systems which determine the social integration of a person in society [4][4] [1][1] DUFFY, K. (1995) Social Exclusion and Human Dignity in Europe. Background report for the proposed initiative by the Council of Europe. Strasbourg: Council of Europe. [2][2] Madanipour A., Social Exclusion and Space in A. Madanipour, G. Cars and J. Allen (eds.) Social Exclusion in European Cities. London: Kingsley [3][3] Social Exclusion Unit –Cabinet Office UK 1997 [4][4] Walker, A. and Walker C., (eds.) Britain Divided: The Growth of social Exclusion in the 1980s and 1990s. London: Child Poverty Action Group

A mood swing across Europe In days of right wing governments in Europe “there was no such thing as society” (Mrs Thatcher UK PM 1980) We now know that that the healthiest and happiest societies are those with the most equal distribution of income- (BMJ 1999;319:953) Governments are more likely to acknolwdege links between poverty, housing and health (BMJ 1995;311:1177)

Caution- Paradise awaits! BUT, despite promises of action, health inequalities (in life expectancy) have continued to widen across Europe, alongside widening inequalities in income and wealth Likewise, are we the health professionals hiding behind the comfort zone of scientific medicine, having lost the sight of the wider problems in our society?

Big Goals On the 20th anniversary of the World Health Organization's Global Strategy for Health for All by the Year 2000, 38 target goals identified to reduce inequalities in health. 1 In Europe, the four corner stones of this Health For All were: Ensuring equity in health-reducing gaps Inter-Intra Countries Adding life years-enriching lives Adding health to life-reducing disease and disability Adding years to life-increasing life expectancy 2 1) World Health Organization: Targets for health for all. Copenhagen: WHO, ) World Health Organization. Health in Europe Copenhagen: WHO, 1998

Where are we as European? 2006 UNDP Human Development Index Looks at quality of life and socio- economic data Wide gaps-North-South: East-West See Results: Norway 1st Romania 60th

Human Development Index 2006 * Norway1 Iceland2 Ireland4 Sweden5 Switzerland7 Netherlands10 Finland11 Luxembourg12 Belgium13 Austria14 Denmark15 France16 Italy17 United Kingdom18 Spain19 Germany21 Greece24 Slovenia27 Portugal28 Czech Republic30 Malta32 Hungary35 Poland37 Estonia40 Lithuania41 Slovakia42 Latvia45 Bulgaria54 Romania60 Human Development Report-UNDP 2006

HDR 2006’s Summary Inequalities in health widened in Europe despite intentions to reduce these inequalities The health inequalities targets that have been set are symbolically important, but may be little more than that Analysis shows that inequalities in life expectancy between rich and lower income countries in Europe continue to widen, alongside widening inequalities in wealth inside them This suggests that more potent and redistributive policies are needed It is not adequate simply to compare the worst off with the average, nor to pull some of the worst off out of poverty and assume inequalities in health will reduce Raising the living standards of some of the poorest people in Europe has not reduced overall inequalities in health, while inequalities in wealth have continued to grow and are likely to be transmitted to the next generation

Smoking 1 By the year 2000 smoking was more common in men in lower socio-economic groups in all EU countries. These inequalities in smoking were highest in the north of Europe, particularly in the United Kingdom, but although they were less pronounced in other parts of Europe, especially Italy and Spain, they are emerging among the younger generations. (1) 1.Cavelars, A et al Educational differences in smoking : international comparison. British Medical Journal, Faggiano, F., E. Versino, and P Lemma. Decennial trends of social differentials in smoking habits in Italy. Cancer Causes and Control 2001 ; Fernandex, E., et al. widening socioeconomic inequalities in smoking cessation in Spain, Journal of Epidemiology and Community Health 2001.

Smoking 2 A EU wide survey in 1998 showed that two thirds of all male smokers had incomes below the national median.(2) Even larger differences were seen in relation to education levels. In Finland in 2001 men from a lower educational background were 1.5 times more likely to smoke than men with higher levels of education.(3) 2 -Huisman, M, AE Kunst, and JP Mackenbach. Education compared to income as predictors of smoking in 12 members states of the EU. Journal of Epidemiology and Community Health Huisman, M, AE Kunst, and JP Mackenbach. Educational differences in smoking among men and women in 12 members states of the EU 2004

Smoking 3 Inequality among women smokers emerged or widened dramatically between 1985 and In the northern part of Europe including Ireland, the United Kingdom, the Netherlands, and Scandinavian countries inequalities became as large among women as among men. In the more southern countries smoking was more common among highly educated women in the 1980s but this pattern reversed and inequalities in smoking emerged, especially in Spain and Italy, as high-educated women quit.(4) 4. Giskes K et al., Trends in smoking inequalities in eight European countries.1985 –

QUITLINES Easy arm-chair access: A phone call away (or some are a click-away) Cheap-toll free to local call costs (Skype Free) Population based intervention up to 10% of target reached when combined as „call to action“ on broadcast media: Call

QUITLINES 2 Confidential Acceptable method- non threatening Testing-toe-in-water before diving in to access other services Mobile SMS now youth culture Other innovations: Tailored programmes and proactive call back services