What is EQUITY ACTION and
what has it done ?
Ray Earwicker, Department of Health,
England (UK)
www.health-inequalities.eu
This work is part of EQUITY ACTION which has received funding from the European Union,
in the framework of the Health Programme. The sole responsibility for this work lies with the author
EQUITY ACTION - an appetite
to tackle health inequalities ?
• UK Presidency of the EU (2005)
• EC Expert health inequalities group (2006)
• Finnish Presidency – health in all policies
(2006)
• EU Public Health Strategy (2008)
• WHO report Closing the gap in a
generation (2008)
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A growing appetite to tackle
health inequalities(continued)
• EC Communication on health inequalities
Solidarity in Health (2009)
• Spanish Presidency – equity and health in
all policies (2010)
• EQUITY ACTION commences (2011)
• Polish Presidency – closing the gap (2011)
• Rio Political Declaration on the social
determinants of health (2011)
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EQUITY ACTION – Solidarity
in health (2009)
• The need for further action on health
inequalities arises because of increasing
evidence on the size and pervasiveness of
health inequalities across the EU…Not all
Member States have the same available
resources, tools or pools of expertise to
address the different causes of health
inequalities…The EU can play an
important role in promoting good practice
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Establishing EQUITY ACTION
• Successful Framework Programme bid
• From ‘why’ and ‘where’ to ‘what to do and
how to do it’
• Approach seen as key to engaging policy
makers – and promoting change
• EQUITY ACTION launched April 2011
• 3.6m. euro EC joint action programme with
16 participating Member States
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Structure of the programme
• WP 4 (“tools”) lead = DH, England
• WP 5 (“regions”) lead = Eurohealthnet,
Brussels
• WP 6 (“knowledge”) lead = RNVI,
Netherlands
• WP 7 (“stakeholders”) lead = BZgA,
Germany and OEFI, Hungary
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WORK PACKAGE 4
• The challenge: to get equity into the frame
• The approach: to develop existing public
health tools to take account of equity
• Three tools
– (i) health impact assessment (HIA)
– (ii) health equity audit
– (iii) health in all policies
• Tested across the social determinants
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(i) Health Impact Assessment
– the process
• Designed to build understanding and
capacity of HIA process
• Build confidence – ‘learning through doing’
• Four stages
–
–
–
–
rapid review/expert guidance for use
training and support
review – identification of issues
worked through case studies
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Health Impact Assessment –
guiding principles
• Developed by expert HIA group, which
concluded
– HIAs mostly poorly carried out
– equity not included as a factor
– good HIAs automatically consider equity
• Five stages of expert tool
–
–
–
–
scoping/screening
appraisal
reporting
evaluation
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Health Impact Assessment –
case studies
• ‘Learning by doing’
• Range across the social determinants
across 16 partner organisations
–
–
–
–
England – fuel poverty
Sweden – tobacco
Belgium – sustainability
Ireland – fizzy drinks tax
• Range of skills and experience
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Health Impact Assessment –
key issues
• Opportunities
– assess likely impact before decision
– highlight unintended consequences
– reach out across the social determinants
• Barriers
–
–
–
–
available data/evidence
time/resources(to consider)
timing (to complete)
winning attention (engagement)
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(ii) Health Equity Audit (HEA) process
• EU wide (EC) policy audit
• Retrospective
• Initial scoping (from 30 subjects to five)
• Develop criteria against available evidence
• Assess impact/value of undertaking an
HEA
• Test findings against prospect of
engagement from EC leads
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HEA – Air quality audit
• Air quality met criteria
– Fit with available data
– Timely – fit with policy development and
strategy renewal
– Geographical and socio-economic inequalities
• Results
– overall reductions in EU pollution levels
– modest reductions in geographical inequalities
– socio-economic inequalities unchanged
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(iii)Health in all policies
• Literature review of available evidence
• Lessons from Equity Action partners
– Work within overarching strategy/action plan
– Identify win-win policies – delivering the policy
objectives
– Need political leadership to thrive
• Other considerations: stakeholders,
technical skills, culture and examples
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WORK PACKAGE 5
(“regions”)
• The challenge to identify good practice to
show health inequalities can be tackled at
regional (and municipal) level, and
• to promote support of this activity through
the use of EU structural funds
• The approach to promote dialogue with
regional network – 30 regions across 10
Member States
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Work Package 5 – activity and
results
• Activity around WP5 consisted of partner
meetings and workshops to develop
regional good practice and explore use of
structural funds
• Results
– regional case studies report
– structural funds (SF) analysis report
– SF online guidance tool (available, under
development
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WORK PACKAGE 6
(“knowledge”
• The challenge to strengthen policy
development by using best available
evidence across social determinants of
health
• The approach to develop a dialogue
between research and policy experts (the
scientific reference group) in partnership
with 8 Member States
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Work Package 6 – activity and
results
• Activity around WP6 consisted of
– identifying existing knowledge gaps around
‘what works’ through
• literature reviews of the evidence covering early
years, employment, debt/poverty and housing
• fact sheets
– making knowledge real to policy makers
– feeding into the EU research agenda
• Results – 10 reviews and factsheets
available soon
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WORK PACKAGE 7
(“stakeholders”)
• The challenge to develop a systematic
approach to stakeholder engagement
across the social determinants of health,
and
• facilitate stakeholder engagement at MS
and EU level
• Approach engaging 10 MS partners with
national stakeholders, and share
experience across work package
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Work Package 7 – activity and
results
• The activity around WP7 consisted of
– holding WP7 stakeholder debates around
‘together for health equity from the start’
– promoting national workshops
– creating fact sheets/guides
• Results
– fact sheets on inter-sectoral collaboration on
education, built environment and social welfare
– stakeholder engagement guide – out soon
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Summing Up EQUITY ACTION
• Systematic
– capturing learning through case studies
– using iterative processes
• Engaged
– developing tools based on partners experience
– working across sectors
• Authoritative
– working with experts to assess quality
– reflecting the evidence
• Is it enough ?
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EQUITY ACTION – What next?
• Some questions for the future – health
inequalities are not going away so
• How can we champion the findings and
lessons of Equity Action across MSs and
the EU?
• What can local and national partners, MSs
and the Commission do to help
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EQUITY ACTION – the end?
• Final conference 23 January, Brussels
– Addressing Health Inequalities 2014 and
beyond
• Programme ends February 2014
• For more details about the programme and
the January conference
• www.equityaction.eu
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