DETERMINE an EU Consortium for Action on the socio-economic determinants of health Dorothee Heinen Federal Centre for Health Education, BZgA Reducing Health Inequalities, 8-9 May 2009, Berlin

DETERMINE – who are we? An EU Consortium for ACTION on Socio-economic Determinants for Health (2007 – 2010) Contract holder: National Institute for Public Health in Czech Republic Coordinator: EuroHealthNet Dissemination: Federal Center for Health Education, BZgA 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 (SDH) as an approach to reduce health inequalities (HI) in the EU 2.To make concrete progress towards policy developments that positively influence SDH To contribute to the current knowledge base on Health in All Policies (HiAP) approaches, including issues such as transferability and cost-effectiveness To identify innovative approaches using social marketing and public private partnership models and carry out 3 pilot projects To raise awareness of SDH 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 SDH and HI.

DETERMINE activities so far: We explored Social Determinants of Health Inequalities (SDHI) policy examples at national and EU level. There is no systematic way to address SDHI in countries, but many measures taken in different policy areas contribute to the reduction of HI. High level cross-governmental strategies on HI stimulate action Mechanisms to facilitate work on SDHI: Inter-sectoral committees, health/equity impact assessments, consultations across policy sectors, EU actions (e.g. social OMC on health and long-term care)

DETERMINE activities (cont.) We are now investigating examples of economic evaluations on policies / actions addressing SDHI Aim: to find additional economic arguments to act on SDHI Results representing 12 partner countries  Relatively low levels of economic evaluations being conducted overall  Limited to countries already focusing on SDH and HI  Complexity of economic analysis on SDHI Evidence Transferability / Cost-effectiveness

DETERMINE activities (cont.) Innovative Approaches We selected and supported 3 pilot projects using social marketing and public private partnership models :  Low educated workers in deprived communities (Denmark)  Healthy and sustainable housing in a Roma community (Hungary)  addressing determinants of health for homeless (Slovenia) We support a 4 th initiative on social tourism: cooperation with social and private sector (Flanders-BE)

18 public health organisations 40 non-health policy makers talking to… Policy makers Consultation Voices from the Field Health Inequalities in All Policies

Existing cooperation across sectors & awareness of SDH and HI All policy makers engage with other sectors Entry points not health or HI per se HI are understood as focus on low socio-economic status (SES) groups, not as gradient Equity and equality are sensitive (political) concepts Social determinants are more recognized if there is clear link with physical factors, such as environment, transport, urban planning Still heavy emphasis on lifestyle factors & behavior change, rather than underlying structural determinants

What is the role and contribution of the health sector? Central leadership & pro-active role Better clarify the unique contribution and added value of SDH and HI to other strategies (e.g. anti-poverty, social inclusion) Better ‘listening mode’ regarding other sectors Ability to identify win-win solutions, build trust, create common language, networking Move beyond lifestyle issues

To have successful cross-sectoral health equity strategies… Data analysed and mae available in better ways Awareness Raising to improve understanding Capacity building to work with other sectors DETERMINE Consortium Members running Awareness Raising / Capacity Building activities in 2009

For more information: Health Inequalities Portal:

Thank your for attention!