Health Equity 2020:
Action Learning & Capacity Building in EU10 Regions
(WP 7 & 8)
Advisory Board Meeting
Brussels 16.10.2012
Aims of Presentation
• Brief introduction WP7 and WP8
• Relevance WPs for planning & implementation of regional
policies
• Challenges to link to wider regional development plans
• Main considerations to maximise effectiveness of work with
regions
…with a focus on the situation in pilot regions.
Introduction WP7 and WP8
WP 7 – Action Learning Programme (1)
• 4 workshops & virtual action learning sets (“Elluminate Live!”):
–
–
–
–
Needs assessment
Entry points
Economic evidence
Action planning
• 20 participants per workshop
– Each region gets travel costs & subsistence allowances: 700 € for
one person, up to 1.000 if more than one person participates
• Workshops hosted by Polish & Slovene pilot regions &
two other EU10 locations
WP 7 – Action Learning Programme (2)
• Target audience: Stakeholders in participating regions
• Approach:
– Taking regions from their starting points (what has been achieved)
– Exchange between regions & of region-specific development
scenarios
– Translation of evidence & experience into action
• Starting with pilot regions (see also WP8)
WP 8 – Capacity Building
• Practical support to access/use knowledge & experience
• Key elements:
– Capacity building audit & re-audit in participating regions
– Development & review of policy matrix (with key stakeholders)
– Creation and coordination of expert networks for workshops,
virtual action learning sets, mentoring
Cross-links with WPs 4-7
• WP 4
–
–
–



Conceptual framework health inequities
Approaches to measure health inequities
Evidence-based approaches to address health inequities
Tool box
Policy matrix
Key domains of needed expert knowledge
• WP 5 and WP 6
– Baseline capacity audit conducted in pilot regions
 Development of self assessment tool for capacity audit
– Informing action learning process
– Provision of experiences and practical knowledge to prepare and “validate” content of
workshops
– Identification & recruitment of experts for key policy domains identified in WP4
 Organization of two workshops / action learning activities
Next step:
Concept for capacity audit and capacity building
Which capacities / fields for action /
policies / actors should be taken into
account?
–
–
•
Health governance vs. governance for health
(Kickbusch/Gleicher 2012)
Universal vs. selective policies
Not place-based vs. place based policies
Screening existing tools for capacity
audits and assessments
–
–
Evidence
What works?
Tool Box
(WP4)
Formative
evaluation
–
Screening
existing
tool
•
Capacity Audit / Assessment Tools
Health system Performance Assessment Tools
•
Exchange of experiences with capacities,
capacity assessment / capacity building
in pilot regions
•
Formative evaluation
Know how
of pilot
regions
And now:
capacities to address health inequities –
status, experiences, challenges, opportunities the perspective of the pilot regions.
Thank you.
Materials for flexible use if demanded
Time schedule: First year (2012/13)
7
July
Revision capacity audit tool
Test tool in pilot regions (incl. visit in region)
Pilot regions preparing actions plans with UM
8
9
10
X
X
11
12
1
2
3
5
6
June
X
X
Revision of capacity audit tool with feedback from
pilot regions
X
Short guide on the process and use of tool
X
Tool and guide made available on Health 2020
website
4
X
Time schedule: Second year (2013/14)
7
July
Online workshop to introduce tool and guide
Regions conduct capacity buidling audits
8
9
10
X
X
X
11
12
X
Regions provide audit reports
X
Analysis of reports
X
Interim capacity building report
X
Regions prepare action plans for improvements
locally and via WP 7 and 8
X
1
2
3
4
5
6
June
Time schedule: Third year (2014/15)
7
July
2 pilot regions conduct re-audit
Final revision of capacity building tool and guide
8
9
10
11
12
1
X
X
2
3
X
4
5
6
June
For Discussion: Policy Matrix
1. Action spectrum on “inequalities” in health
2. Intervention map for comprehensive policies
to reduce social inequalities in health
3. Regional capacities to address health inequities in a
multilevel context
4. The European context of Health Equity 2020
Ad 1.: Action spectrum on inequalities in health
Measurement
Recognition
Awareness raising
Concern
Mental block
Denial / indifference
Will to take action
Isolated Initiative
More structured developments
Comprehensive coordinated policy
What about the
situation in the
pilot regions?
(Whitehead 1998: 471)
Ad 2: Intervention map for comprehensive
policies to reduce social inequalities in health
Social reform
Upstream
Universal
measures
Public system for
education, taxes,
labour market
policies etc.
1
Selective
measures
Means-tested
social benefits etc
Risk reduction
Midstream
Effect reduction
Downstream
Working and living
environment, broad
lifestyle measures
etc.
2
Health systems
Targeted lifestyle
measures
Targeted health
services
3
What are the current priorities in the pilot regions?
(Torgersen et al. 2007: 8)
Ad 3: Combining relevant policies in a multilevel context
(draft)
Where to look for
what kind of
capacities?
Territorial Policies EU
Territorial Policies MS
Not Place-based
Policies of MS
Not Place-based
Policies of EU
Regional
Administration
Horizontal Regional
Cooperation
Horizontal regional networks
in MS
Horizontal Regional Networks
in EU
Regional Policies EU
Regional Policies:
Actors in Regions
Intra-Regional
Governance for
Adressing
Inequities in
Regions
and at the
Local Level
Regional Policies MS
Regional
Planning
What is going on in
the pilot regions?
Ad 4: The European Context of Health Equity 2020
• … EU and “Europe 2020”
– 7 Flagships
– “Health is Growth”
Programme
– EU SF: direct and indirect
investments in health
(infrastructure)
• … WHO and “Health 2020”
–
–
–
–
–
2 goals
4 policy priorities
6 proposed targets
10 EPHOs
10 know-how areas
How are the activities framed in pilot regions?
Annex
Europe 2020 – 7 flagships initiatives
• Smart
– Innovation Union
– Youth on the MOVE
– Digital Agenda
• Sustainable
– Resource efficiency
– Industrial policy
• Inclusive
– Agenda for new skills and jobs
– Platform against poverty
 (How) Will this influence the Health
Programme?
COM (2010) 2020 final
The New Proposal for the “Health for Growth” Program
Health
•
•
Driver for growth
Economic relevance of
– healthy population
– research and development
– healthcare sector
Promoting good health as an
”integral part of the smart and
inclusive growth objectives
Proposal Health for Growth Program
Direct links with flagship
agendas
•
Innovation Union
•
Digital Agenda
•
New Skills and New Jobs
Proposal Health for Growth Program
Objective 1:
“to develop common tools and mechanisms at
EU level to address shortages of resources, both
human and financial and to facilitate up-take of
innovation in healthcare in order to contribute
to innovative and sustainable health
systems”
•
Health Technology Assessment in the context of patients’
rights in cross-border healthcare
•
Interoperability of e-Health applications
•
Sustainability of EU health workforce (planning,
recruitment)
•
Expertise for health system reforms
•
European Innovation Partnership on Active and Healthy
Ageing (Innovation Union)
•
EU legislation (medical devices, e-Health, Health
Technology Assessment in cross border healthcare)
•
Health knowledge system
Proposal Health for Growth Program
Objective 2:
“to increase access to medical expertise and
information for specific conditions also beyond
national borders and to develop shared solutions
and guidelines to improve healthcare quality and
patient safety in order to increase access to
better and safer healthcare for EU citizens”
•
European Reference Networks
•
Rare diseases
• Patient safety, quality of healthcare (information to
patients, exchange of best practices, guidelines)
•
Use of antimicrobials (resistance)
• EU legislation (tissues and cells, blood, organs,
medicinal products in cross-border healthcare)
•
Health knowledge system
Proposal Health for Growth Program
Objective 3:
“to identify, disseminate and promote the uptake of validated best practices for costeffective prevention measures by addressing
the key risk factors, namely smoking, abuse of
alcohol and obesity, as well as HIV/AIDS, with a
focus on the cross border dimension, in order to
prevent and promote good health”
•
Exchange of best practices on key issues (smoking,
alcohol, obesity)
•
Prevention of chronic diseases including cancer
(sharing knowledge, best practice, joint activities)
•
EU legislation (tobacco products and advertisement)
•
Health knowledge system
Proposal Health for Growth Program
Objective 4:
“to develop common approaches and
demonstrate their value for better preparedness
and coordination in health emergencies in order
to protect citizens from cross-border
health threats”
•
Strengthen preparedness and response for serious
cross border health threats;
•
Risk assessment capacity (scientific expertise,
mapping existing assessments)
•
Capacity building against health threats in Member
States (planning and coordination, vaccination,
medical countermeasures)
•
EU legislation (communicable diseases, other health
threats)
EU Structural Funds
WHO Health 2020: Main strategic objectives
1. Improving health for all and reducing health inequalities
2. Improving leadership and partcipatory governance for health
WHO Health 2020: Priority action areas
• Investing in health through a life-course approach and
empowering people
• Tackling Europe´s major health challenges of
noncommunicable and communicable diseases
• Strengthening people-centred health systems, public health
capacity and emergency prepearedness, surveillance and
response
• Creating resilient communities and supportive environment
WHO Health 2020: Proposed targets
Broad target area
Target
Links
1. Burden of disease and risk factors
1. Reduce premature mortality in
Europe by 2020
Linked with strategic objective 1 and
policy priority 2
2. Healthy people, well-being and
determinants
2. Increase life expectancy in Europe
Linked with strategic objective 1 and
policy priorities 1 and 4
3. Reduce inequities in health in Europe
Linked with strategic objective 1 and
policy priorities 1 and 4
4. Enhance the well-being of the
European population
Linked with strategic objective 1 and
policy priorities 1 and 4
5. Universal coverage and the right to
health
Linked with strategic objective 2 and
policy priority 3
6. National tarets/goals set by Member
States
Linked with strategic objective 2 and
policy priority 3
3. Processes, governance and health
systems
10 Essential Public Health Services
•
•
•
•
•
•
•
•
•
•
Monitor health status to identify and solve community health problems.
Diagnose and investigate health problems and health hazards in the community.
Inform, educate, and empower people about health issues.
Mobilize community partnerships and action to identify and solve health problems.
Develop policies and plans that support individual and community health efforts.
Enforce laws and regulations that protect health and ensure safety.
Link people to needed personal health services and assure the provision of health care
when otherwise unavailable.
Assure competent public and personal health care workforce.
Evaluate effectiveness, accessibility, and quality of personal and population-based health
services.
Research for new insights and innovative solutions to health problems.
(Centers for Disease Control and Prevention)
… and health inequities?
http://www.cdc.gov/nphpsp/essentialservices.html
WHO Health 2020:
10 Essential Public Health Operations (EPHOs)
1.
2.
Surveillance of population health and well-being
Monitoring and response to health hazards and
emergencies
3. Health protection including environmental,
occupational, food safety and others
4. Health promotion, including action to address social
determinants and health inequity
5. Disease prevention, including early detection of
illness
6. Assuring governance for health and well-being
7. Assuring a sufficient and competent public health
workforce
8. Assuring sustainable organizational structures and
financing
9. Advocacy, communication and social mobilization
for health
10. Advancing public health research to inform policy
and practice
… and
health
inequities?
(WHO Regional Office for Europe 2012b)
WHO RHN: Know-how areas
1.
2.
3.
4.
5.
6.
7.
How to foster and sustain regional commitment?
How to secure policy coherence?
How to develop skilled human resources?
How to scale up from isolated regional projects?
How to foster long-term regional investment?
How to strengthen regional health systems?
How to increase capacity for regional health
diplomacy?
8. How to create incentives for a regional whole of
government approach?
9. How to develop knowledge transfer among regions?
10. How to reposition health within regional
development?
… and
health
inequities
http://www.euro.who.int/en/who-we-are/networks/regions-for-health-network-rhn/workplan2
References (to be accomplished)
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