Impact of Socio-Economic Science and Humanities - an example: Health and inequality Athens 26-27th February 2014 John Yfantopoulos Professor of Social Policy & Health Economics University of Athens 1

HEALTH IMPACT ANALYSIS DATA SOURCES HEALTH INEQUALITIES CONCEPTUAL MODELS

THE HOLLY FATHERS Hippocrates Platon Aristotle's

Aristotle 384-322: On equity and equality The first page of Ethics – Nicomchia in Latin 1566 Edition

Major Health Inequalities between and within Member States EU Communication October 2009 « Solidarity in health: reducing health inequalities in the EU” 14-year difference in life expectancy for men and 8 year gap for women between EU Member States Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit

Regional Inequalities in Greece Men Life Expectancy Men Range 5.7 years Min= 71,92 Max=77,62

Regional Inequalities in Greece Women Life Expectancy Women Range= 3.88 Min = 77.88 Max = 81.76

Health Inequalities Gini Coefficients EU-SILC 2005

Health Inequalities Gini Coefficients EU-SILC 2009

Example 3: Self perceived Health Inequalities EU-SILC 2010 and 2005

Data Sources

Data Sources

Self-rated health European Union Statistics on Income and Living Conditions (EU-SILC) How is your health in general? Is it: Very good/Good/Fair/Bad/Very bad European Social Survey (ESS) How is your health in general? European Health Interview Survey (EHIS) Survey of Health, Ageing and Retirement in Europe (SHARE) Would you say your health is: Excellent/Very good/Good/Fair/Poor

Methodology

Measures of Dispersion

CONCEPTUAL FRAMEWORK

The Conceptual Framework of EU

Health Impact Analysis

Definition proposed by Louise Saint Pierre (from Canada ) "The assessment of impact on health is a structured and collaborative approach that, using different tools and methods, mobilizes the knowledge of public health and other types of relevant knowledge, to estimate the potential effects of a project or a policy on the health of the population"", and the distribution of those effects within it, to provide information useful to policy makers."

The Dutch Approach Multilevel Local National International “A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population. The HIA is a flexible method, which is well suited to study, and examine broad policy objectives as well as concrete policy intentions. The application of the method is multi-level: local, national and international.”

Health Impact Analysis There is a mixed picture of the HIAs across different countries. France, Belgium, Latvia, and Greece there is little known or happening at a national level Italy and Hungary it is known by experts in public health Emerging use of HIAs in Basque Country, Portugal, and Spain particularly in regional settings

Well Established Health Impact Analysis Well established processes Scotland, Wales, England, Ireland, Wales, Norway and Sweden There are methodological or process requirements on how assessment should be carried out.

Well Developed Bodies of HIA Sweden has undertaken HIAs and has been part of the project “the effectiveness of health impact assessment. Scope and limitations of supporting decision-making in Europe”. Ireland has an extensive range of expertise in HIA, have annual training, produced a number of publications and support and undertake a number of HIAs. England, there is a range of expertise and a number of HIAs have been undertaken,

Health Impact Analysis in Portugal In Portugal, there are links with some academic institutions like: the Institute of Hygiene and Tropical Medicine the Lisbon Faculty of Medicine and the National Health Institute Doutor Ricardo Jorge (INSA) and the Directorate-General for Health (DGH), which are under the Ministry of Health´s direct responsibility.

HIA in ITALY In Italy epidemiologists and public health professionals are well aware of HIA and have tried to introduce it within the frame and regulation of Environmental Impact Assessment and Strategic Impact Assessment. Moreover a recent project on the Health in All Policies (HiAP) Strategy has put together experts from different fields (social sciences, economic sciences, technical engineering sciences and epidemiology and public health) to scrutinize the impact on health of different categories of policies

Health Impact Analysis in ITALY 2013 Italian review on Equity in Health submitted Evidence Implications Health Impact Analysis in ITALY International benchmarking Cost Analysis Actions Barriers: (who is gaining?) … in time of crisis

THANKS FOR YOUR ATTENTION EMAIL; yfantopoulos@gmail.com