1. This presentation arises from the project HEALTH EQUITY – 2020 which has received funding from the European Union, in the framework of the Health Programme. Tackling health inequalities in Europe Mariëlle Beenackers Frank van Lenthe Johan Mackenbach

2. WP 4: TRANSLATIONAL EVIDENCE AND POLICY Aim: develop tools for drawing up evidence-based regional action plans to reduce health inequalities: –a case-by-case needs assessment, taking into account current exposure to the determinants of health inequalities and to policies tackling these determinants, –selection of actions known or expected to be effective in addressing these entry-points, and –a case-by-case analysis of the potential impact of these actions on population health and economic performance.

3. Build on knowledge, experience, and lessons learned from other EU projects  inform entry points to action within the Health Equity 2020 project Gain insight on available methods and their advantages and disadvantages for: –conducting of a regional needs assessment of health inequalities and its determinants –assessment of the potential health & economic impact of actions (HIA) –what are best practices with respect to reducing health inequalities –how to use structural funds to target factors contributing to health inequalities WORKSHOP AIM

4. TOOLKIT - PART 1 Challenges needs assessment Estimate inequalities –Determine most important indicators to include –Measures of association Explanation of inequalities –Which explanation to include Challenges data –availability & validity of regional data –Sensitivity for regional differences User friendliness

5. MEASUREMENT ISSUES VALUE JUDGEMENTS Relative vs. absolute inequalities “Inequality as such should be avoided” Best vs. average as reference point “We should strive for upward leveling” Social group size accounted or not “Larger groups are more important” Gradient vs. extreme groups “Middle class should not be neglected”

6. RELATIVE INEQUALITIES IN EUROPE Total mortality - men Mackenbach et al. 2008

7. RELATIVE INEQUALITIES BY EDUCATION Total mortality, women Mackenbach et al. 2008

8. CAUSES OF DEATH: 3 DIFFERENT “REGIMES” Northwest: large inequalities for cancer (m/w) and CVD (m/w) South: small inequalities for cancer (w) and CVD (m/w) East: huge inequalities for cancer (m), CVD (m/w), injury (m/w)

9. PATHWAYS OF HEALTH INEQUALITIES Behavioural/cultural pathways –Smoking, physical inactivity, alcohol, diet Psychosocial pathways –Work stress, lack of social support, negative life events Material pathways –Financial resources –Living circumstances –Working circumstances –General environment –Health care

10. DETERMINANTS: 3 DIFFERENT “REGIMES” Northwest: large inequalities for smoking (m/w), alcohol (m/w), obesity (m/w); small inequalities for health care (m/w) South: small inequalities for smoking (m/w), alcohol (w), health care (m/w); large inequalities for obesity (m/w) East: large inequalities for smoking (m), alcohol (m/w), health care (m/w); small inequalities for obesity

11. RELATIVE INEQUALITIES BY EDUCATION Smoking-related mortality Mackenbach et al. 2008

12. RELATIVE INEQUALITIES BY EDUCATION Obesity Mackenbach et al. 2008

13. TOOLKIT - PART 2 Health and economic impact assessment Use and translate existing initiatives Economic impact Quantitative assessment –Determine most important indicators to include –Challenges with availability & validity of regional data –Sensitivity for regional differences –User friendliness

14. TOOLKIT - PART 3 Policy and intervention database Policies and interventions should –Reduce health inequalities –Increase development Evidence is scarce Grading evidence Universal vs targeted approached, tailored Make existing initiatives accessible –Screening / grading existing databases

15. TOOLKIT - context Using structural funds (SF) Key role SF: reduce regional economic and social disparities and promote economic growth and employment Innovative approaches Direct and indirect health investments

16. AGENDA 09.30 – 10.00Welcome with coffee and tea 10.00 – 10.15Presentation of Health Equity 2020 10.15 – 10.30Presentation on inequalities in health and its major determinants 10.30 – 10.45Introduction to the workshop, the participants and the related projects 10.45 – 11.00Coffee break 11.00 – 12.00Discussion 1: Analysing determinants of health inequalities 12.00 – 13.00Discussion 2: Demonstrating (potential) effects of regional actions 13.00 – 13.45Lunch (buffet lunch) 13.45 – 14.45Discussion 3: Developing regional action plans – best practices 14.45 – 15.45Discussion 4: Using structural funds to reduce health inequalities 15.45 – 16.00Coffee break 16.00 – 17.30 Summary and overall discussion

17. REPRESENTED PROJECTS Discussion 1: Analysing determinants of health inequalities –ECHIMAntti Tuomi-Nikula –I2SAREAndré Ochoa –EURO-GBD-SERasmus Hoffmann Discussion 2: Demonstrating (potential) effects of regional actions –EPHIAAlex Scott-Samual –DYNAMO-HIAMargarete Kulik Discussion 3: Developing regional action plans – best practices –Equity ActionIngrid Stegeman –Crossing BridgesYoline Kuipers –Marmot ReviewPeter Goldblatt Discussion 4: Using structural funds to reduce health inequalities –DARTPertti Hermannek –EUREGIO IIKai Michelsen –EUREGIO IIIJonathan Watson Also represented: –HE2020Johan, Frank, Carole, Edit, Jonathan, Margit, Kinga, Przemyslaw, Mojca, Helmut, Hartmut, Kai, Kasia, Mariëlle –AIRLuc Berghmans –SILNEVincent Lorant –NDA HungaryMelinda Reich