1. HEALTH EQUITY EUROPE JOINT ACTION
WP4: Integration of JAHEE results into policies
WP9: Governance for Health Equity in All Policies
Giuseppe Costa, University of Torino
on behalf of WP4 (Italy) and WP9 (Finland)
Co-founded by the Health Program of the European Union - CHAFEA 1 1

2. Deaths attributable to lower education
EU COUNTRIES ACCORDING TO THEIR ADVANCEMENT IN TACKLING HEALTH
INEQUALITIES (DG SANTE Expert Group, country templete )
Agenda
Type
Evaluation
Target
Deaths attributable to lower education
Countries A
High
Comprehensive cross-government strategies
Social gradient
30-35% M
30% F
Finland ● Ireland ● Norway ● Sweden ● Austria ● Germany ● UK B
Medium/High
Public health and Isolated Cross-government
Mostly vulnerable
25-30%M
15-25% F
apart FR/ES males 45%
Belgium ● Denmark
Spain ●Netherlands ● Italy ● France ● Estonia C
Medium
Health sector
Low/medium
Vulnerable
Regional
45-55% M
35-45% F
but CY 20-30
Croatia ● Cyprus ● Czech ● Hungary D
Low
Health sector direct/indirect
Society as whole
Poland ● Romania ● Slovakia
Why good intentions have not translated into improved health outcomes for all through adequate policy responses from all sectors? E
Missing
20-50% M
15-45% F
Latvia● Greece ● Portugal

3. Barriers in engaging policy makers/stakeholders (in reducing health inequalities):
It is not our concern (evidence, description)
We don’t know what to do (evidence, links)
We don’t know how to do it (delivery, networks)
We don’t want to – (levers, incentives, regulations)
We really don’t want to – (ideology, no pressure)
We cant afford to – (cost efficacy, cross sectoral, prevention and other things matter more) 3

4. where evidence matters where governance matters
Barriers in engaging policy makers/stakeholders (in reducing health inequalities):
where evidence matters where governance matters
It is not our concern (evidence, description) (WP5)
We don’t know what to do (evidence, links) (WP6-WP8)
We don’t know how to do it (delivery, networks)
We don’t want to – (levers, incentives, regulations) (WP9)
We really don’t want to – (ideology, no pressure)
We cant afford to – (cost efficacy, cross sectoral, prevention and other things matter more) (WP5) 4

5. TO BE WP4 (Policy Framework for Action)
HiAP
Healthy living environments
Health systems
Migration
Monitoring
HiAP

6. of Equity in All Policies
TO BE WP9
Level of integration
of Equity in All Policies
Actions on mediators (WHO 2014)
- critical dedicated mass of capacities on information (WP5) and methods for advocacy (DRIVERS)
- public health reporting
- awareness and harmonization of priorities between sectors
- awareness of potential co-benefits
- H(E)iAP intersectoral committees
- formal procedures for policy review/assessment (HLA, HEIA, HEA)
- consultative process
- accessibility to sensitive data
- prospective impact assessment
Mediators
Lack of knowledge on HI
Lack of understanding
Lack of will
Lack of knowledge about what to do
Lack of resources/structure
Lack of political/management support
Lack of mandate towards sectors
Professional boundaries
Lack of comprehensive coordinated policy
Outcomes
Progression in policy response
Health Equity integrated into policies
All sector more accountable
Intersectoral integration

7. AS IS (Country Assessment)
WP4-WP9
WP9
Updating the European review 2013: are the mechanisms of Governance for H(E)iAP in place?
Choose an action
Analyse it with the 5 I’s approach
information that is needed for conducting health/equity policy,
ideologies that underlie and affect health/equity policy,
interests connected with health/equity policy,
institutions operating in the field of health/equity policy,
problems of implementation of health/equity policies and policy programmes.

8. What looks like the implementation (Italian example)
WP4
WP9
A platform of stakeholder and decision makers sharing and agreeing the “TO BE” and initiating actions, under the mandate of the MoH
Exemplary actions in H(E)iAP
HEA in new regulation of retirement age (unions, industries, government, parliament)
Pilot experiences of “generative welfare” in local communities (Trieste, Torino, Bologna)