Workshop 33: Social Inequalities in Health The 33rd Global Conference of the July 2, 2008: Tours, France Catherine M. Jones Programme Director Reducing social inequalities in health: The role of international professional networks in advocating for effective inter-sectoral collaboration at all levels Highlighting the case of DETERMINE: an EU Consortium for Action on the socio-economic determinants of health

Working for more than 50 years to connect and support everyone committed to advancing health promotion and to achieving equity in health globally

What do we do? Strategies Advocate for health and health promotion Build knowledge base for health promotion Professional and technical development, research, tools for supporting practice Advance the quality of policy and practice Projects networks, partnership building, Develop capacity globally, regionally, locally Short courses, conferences, training, policy dialogues

How we support our work Regional Offices EMRO (in development) NARO EURO AFRO (in development) ORLA SEARB (in development) SWP NPWP

Common values, principles & concepts: Social protection & social welfare -Social justice -Balanced social & economic development, cultural diversity -Recognition & protection of fundamental rights -Focus on the most vulnerable Health promotion -Pre-requisites for health -Health as a resource -Emphasis on social & personsonal resources - Equity Determinants of Health

from Ottawa to Bangkok - one chart for 2 Charters COMMUNITY NATIONAL GLOBAL Personal skills Supportive environments Community action Corporate investment in health Healthy globalization Healthy international policy across governement OTTAWA CHARTER BANGKOK CHARTER CORPORATE SECTOR PUBLIC SECTOR REAL PEOPLE Global citizenship for health Healthy public policy Health- promoting health services Our work must be able to adapt & reflect approaches to new challenges in a changing world (adapted from Pierre Arwidson, WHO Kyoto meeting, 2005)

WHO Commission on the Social Determinants of Health « The causes of the causes » Health is not simply about individual behaviour or exposure to risk, but how the socially and economically structured way of life of a population shapes its health. (WHO CSDH, 2008)

DETERMINE an EU Consortium for Action on the socio-economic determinants of health Special thanks to Ingrid Stegeman, Project Coordinator, EuroHealthNet, and Serena Fasso, Policy Officer, for their contributions to these slides

The unequal distribution of determinants underlies health inequalities Inequalities in ‘general socioeconomic & environmental conditions’ – unequal access to good education, secure employment, income etc Inequalities in living & working conditions from childhood to old age Inequalities in community resources Inequalities in lifestyle factors like cigarette smoking, diet & physical activity Professor Hillary Graham inequalities in Health determinants model (Dahlgren & Whitehead, 1991)

DETERMINE – who are we? EU Consortium for ACTION on Socio-economic Determinants for Health (2007 – 2010) –Contract holder: National Institute for Public Health in Czech Republic –Coordinator: EuroHealthNet –5 additional WP co-leaders (FI, DE, IE, ENG, IUHPE) –Co-funder: EC DG Sanco (54%) –30 main partner organisations from 21 EU MS –26 collaborating partners (WHO, OECD, 6 Ministries, 7 European networks)

DETERMINE - Our AIMS 1.To take forward existing work on the socio-economic determinants of health as an approach to reduce health inequities in the EU. 2.To make concrete progress towards policy developments that positively influence these determinants. –To contribute to the current knowledge base on HiAP approaches, including issues such as transferability and cost-effectiveness. –To identify innovative approaches using social marketing and public private partnership models and pilot 3 of them –To raise the awareness of health determinants in other policy sectors and to build the capacity of Consortium members to act upon them. –To develop as the main EU online resource for socio-economic determinants and health inequalities.

Current Situation: What are some countries doing to address the SDHI? Do policies exist to tackle the Social Determinants of Health Inequalities (SDHI)? –Across government –Health sector –Other sectors Are actions in place to support these policies –Structures –Personnel –Funding –Mechanisms Belgium, Czech Republic, England, Estonia, Finland, Iceland, Ireland, Netherlands, Northern Ireland, Norway, Poland, Scotland, Slovenia, Spain, Wales

Current Situation  Cross Government Approaches driven by National Government: A few countries, e.g. Scotland, where government objectives are: Wealthier & Fairer; Smarter; Healthier; Safer and Stronger; Greener  Cross Government Approaches driven by Health Sector: Most partners have national health strategies with explicit reference to addressing health inequalities; 5 have national or regional strategies which focus on this entirely, 3 where such strategies under development  Other Policy Sectors: Implicit and explicit initiatives in – Education, Employment, Economy, Urban and regional planning, Neighbourhood renewal and housing policy, Social inclusion, Tourism

EU Policy areas outside of health sector The Lisbon Strategy (2000 – 2010) Cohesion Policy Convergency & competitivenes Regional compet.& employment European territorial coop. Structural funding: ERDF ESF The cohesion fund Common Agricultural Policy Social Policy The EU Social Protection and Social Inclusion Process National Action Plans on Social Inclusion Health & Safety at work Economic Policy

Instruments for support Open Method of Collaboration Joint Report on Social Protection and Social Inclusion child poverty, -health inequalities, access to health care and evolving long-term care needs, and - longer working lives and privately managed pensions. Through this process, the EU coordinates & encourages Member State actions to combat poverty and social exclusion, and to reform their social protection systems on the basis of policy exchanges and mutual learning. As such, it underpins the achievement of the Union’s strategic goal of sustained economic growth, more and better jobs, and greater social cohesion by 2010.

Experience from policy and decision-makers from other sectors Success Factors Needs Barriers

New Health Inequalities Portal

Questions for Discussion How can different frameworks be reconciled to achieve similar goals (i.e. social justice/rights-based lens vs. economic development lens)? What is the priority attached to addressing SDHI in the social sector? How can the social and health sectors better collaborate in order to engage with and convene other critical sectors to contribute to reducing social inequalities in health (i.e. Treasury, Finance, Internal Affairs, Justice, Safety and Security, Internal Affairs, Foreign Policy)? How can the social and health sectors better collaborate to develop capacity to engage in better advocacy and policy dialogue processes? How can civil society be mobilized more effectively in the advocacy process to support the development and accountability of political will to address social inequalities in health?