1 Using Structural Funds to reduce health inequalities: lessons from EUREGIO III Prof Jonathan Watson HE2020 Workshop (WP4) Brussels 17 October 2012 HCN Executive Director; EUREGIO III Project Director; HealthEquity-2020 Project Director,; Special Professor of Health & Public Policy, University of Nottingham; External Partner to European Masters degree in Sustainable Regional Health Systems (Deusto, Vilnius, Corvinus, Verona)

disadvantaged groups limited evidence that SF have reduced inequities for disadvantaged groups short-lived projects have undertaken innovative actions but these have rarely been mainstreamed and sustained (Degryse, 2010)

EUREGIO III evidence EUREGIO III ( )WHO/EU Equity Project Policy briefing (2010) EU Council Conclusions ‘Towards modern, responsive and sustainable health systems’ (2011) Guide for DG REGIO desk officers (2011)High Level Reflection sub group 2 (2012+) 3

Tackling trends: demographics and chronic illness Poverty Housing Diet Smoking Cardiovascular disease Treatment Death Current bias towards curative investment Transformational investment Patient centred interventional support

Rethinking healthcare care – an alternative model The ‘wellness park’ model, Kymenlaasko,Finland Rethinking the acute hospital Repositioning services, from illness to wellness support Healthy ageing

Remote community strategies

critical success factors Strategic vision Accountability Financial realism Integration Measurable ROI Technology diffusion Social cohesion 3 integrated elements of health care delivery: service delivery models Workforce Capital (infrastructure; technology; ICT Population health status Health outcomes Economic outcomes

“Objectives are European, funds are national and needs are local” National Reform Programme Partnership Contract Joint Action Plans Individual projects Operational Programmes STRUCTURAL FUNDS Project instrument or strategic development? Conditionalities Ad hoc stakeholder engagement? Spend or added value COMMUNITY EXPERIENCE Clay Cross 1984: do not listen to us Drumchapel 1996: isolation & frustration South Lanarkshire CP 2000: no pooling of funds Skelmersdale 2004: community cliques

Thematic objectives for Cohesion Policy

missed opportunities with Structural Funds? Direct Indirect non-health sector investment

11 organisational response

12 What MS and Regions need to think about Realistic starting points - taking into consideration the peculiarities of socialised, non-reformed health systems especially in the EU10 Commitment to transformational change – prioritising the shift away from a hospital-centric model of care to more pluralistic community-based and integrated models of care contributing to sustainable health systems Affordable investment priorities – how ERDF/ESF spending can contribute to changes in structure and delivery of health services. This is likely to include e- health, infrastructure and equipment Address health inequalities - this will include access to basic health services (GP, outpatient clinic, polyclinic, community based care) by poor and marginalised communities Multiple roles for regional health systems – economic growth, renewable energy, environmental quality, social cohesion

REGIO checklist

principles for action Engage stakeholders – it’s a long conversation Plan – map the intervention logic Innovate – create and do the right thing Be transparent - accountable decision-making Disinvest to reinvest – financial realism Build capacity – processes, procedures, people Return on investment – deliver added value

15 thank you