Health Equity 2020: Action Learning & Capacity Building in EU10 Regions (WP 7 & 8) Advisory Board Meeting Brussels 16.10.2012.

Health Equity 2020:Action Learning & Capacity Building in EU10 Regions(WP 7 & 8)

Advisory Board MeetingBrussels 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

– Capacity Audit / Assessment Tools– Health system Performance Assessment Tools

• Exchange of experiences with capacities, capacity assessment / capacity building in pilot regions

• Formative evaluationAnd now:

capacities to address health inequities – status, experiences, challenges, opportunities -

the perspective of the pilot regions.

EvidenceWhat works?

Tool Box(WP4)

Scr

een

ing

exis

tin

g

tool

Know how of pilot regions

Form

ati

ve

evalu

ati

on

Thank you.

Materials for flexible use if demanded

Time schedule: First year (2012/13)

7July

8 9 10 11 12 1 2 3 4 5 6June

Revision capacity audit tool X X

Test tool in pilot regions (incl. visit in region) X

Pilot regions preparing actions plans with UM 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

X

Time schedule: Second year (2013/14)

7July

8 9 10 11 12 1 2 3 4 5 6June

Online workshop to introduce tool and guide X

Regions conduct capacity buidling audits X X 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

Time schedule: Third year (2014/15)

7July

8 9 10 11 12 1 2 3 4 5 6June

2 pilot regions conduct re-audit X X

Final revision of capacity building tool and guide X

For Discussion: Policy Matrix

1. Action spectrum on “inequalities” in health

2. Intervention map for comprehensive policiesto 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 Will to take action

Isolated Initiative

More structured developments

Comprehensive coordinated policy

Denial / indifference

(Whitehead 1998: 471)

What about the situation in the pilot regions?

Ad 2: Intervention map for comprehensive policies to reduce social inequalities in health

Social reform Upstream

Risk reduction Midstream

Effect reduction Downstream

Universal measures

Public system for education, taxes,

labour market policies etc.

Working and living environment, broad lifestyle measures

etc.

Health systems

Selective measures

Means-tested social benefits etc

Targeted lifestyle measures

Targeted health services

(Torgersen et al. 2007: 8)

1 2

3

What are the current priorities in the pilot regions?

Ad 3: Combining relevant policies in a multilevel context (draft)

Intra-RegionalGovernance for

Adressing Inequities in

Regions and at the Local Level

Regional Planning

Horizontal RegionalCooperation

Re

gio

na

l A

dm

inis

tra

tion

Re

gio

na

l Po

licies:

Acto

rs in R

eg

ion

s

Territorial Policies MS

Territorial Policies EU

Not

Pla

ce-b

ased

Pol

icie

s of

MS

Not

Pla

ce-b

ased

Pol

icie

s of

EU

Horizontal regional networks in MS

Horizontal Regional Networks in EU

Regiona

l Po

licies MS

Regiona

l Po

licies EU

Where to look for what kind of capacities?

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 up-take of validated best practices for cost-effective 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

• 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: Priority action areas

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

3. Processes, governance and health systems

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

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. Surveillance of population health and well-being2. Monitoring and response to health hazards and

emergencies3. Health protection including environmental,

occupational, food safety and others4. Health promotion, including action to address

social determinants and health inequity5. Disease prevention, including early detection of

illness6. Assuring governance for health and well-being7. Assuring a sufficient and competent public health

workforce8. Assuring sustainable organizational structures and

financing9. Advocacy, communication and social mobilization

for health10. Advancing public health research to inform policy

and practice

… and health

inequities?

(WHO Regional Office for Europe 2012b)

WHO RHN: Know-how areas

1. How to foster and sustain regional commitment?2. How to secure policy coherence?3. How to develop skilled human resources?4. How to scale up from isolated regional projects?5. How to foster long-term regional investment?6. How to strengthen regional health systems?7. 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?

http://www.euro.who.int/en/who-we-are/networks/regions-for-health-network-rhn/workplan2

… and health

inequities

References (to be accomplished)

• Bertollini, Roberto/Brassart, Celine/Galanaki, Chrysoula (2012): Review of the commitments of WHO European Member States and the WHO Regional Office for Europe between 1990 and 2010. Copenhagen: WHO Regional Office for Europe (www.euro.who.int/__data/assets/pdf_file/0020/171902/Review-of-the-commitments-of-WHO-European-Member-States-and-the-WHO-Regional-Office-for-Europe-between-1990-and-2010.pdf) WHO Regional Office for Europe (2012): Executive summary of the European health report 2012: Moving Europe towards health and well-being. Information document. Regional Committee for Europe, Sixty-second session, Malta, 10–13 September 2012 (EUR/RC62/Inf.Doc./1, 29 June 2012) (www.euro.who.int/__data/assets/pdf_file/0017/170108/RC62-id01-Eng.pdf)

• Kickbusch, Ilona/Behrendt, Thorsten (2012): Interim report Supporting Health 2020: governance for health in the 21st century. WHO Regional Office for Europe (www.euro.who.int/__data/assets/pdf_file/0019/171901/Interim-report-Supporting-Health-2020-governance-for-health-in-the-21st-century.pdf )

• Kickbusch, Ilona/Gleicher, David (2012): Governance for health in the 21st century. Copenhagen: WHO Regional Office for Europe (www.euro.who.int/__data/assets/pdf_file/0019/171334/RC62BD01-Governance-for-Health-Web.pdf)

• McQueen, David V./Wismar, Matthias/Lin, Vivian/Jones, Catherine M./Davies, Maggie (ed.) (2012): Intersectoral Governance for Health in All Policies. Structures, Actions and Experiences. Observatory Studies Series 26. Copenhagen: World Health Organization 2012, on behalf of the European Observatory on Health Systems and Policies (http://www.euro.who.int/__data/assets/pdf_file/0005/171707/Intersectoral-governance-for-health-in-all-policies.pdf)

• Whitehead, Margaret (1998): Diffusion of Ideas on Social Inequalities in health: A European Perspective. The Milbank Quarterly 76 (3): 469-492• Whitehead, Margaret/Dahlgren, Göran (2006): Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health.

Studies on social and economic determiants of population health No. 2. Copenhagen: WHO Regional Office for Europe• Whitehead, Margaret/Dahlgren, Göran (2006): Levelling up (part 2): a discussion paper on concepts and principles for tackling social inequities in health.

Studies on social and economic determiants of population health No. 3. Copenhagen: WHO Regional Office for Europe• WHO Regional Office for Europe (2012): Implementing Health 2020. Information document. Regional Committee for Europe, Sixty-second session, Malta, 10–

13 September 2012 (EUR/RC62/Inf.Doc./3, 23 July 2012) (www.euro.who.int/__data/assets/pdf_file/0017/170504/RC62-id03-Eng.pdf) • WHO Regional Office for Europe (2012): Monitoring framework for Health 2020 targets and indicators. Information document. Regional Committee for Europe,

Sixty-second session, Malta, 10–13 September 2012 (EUR/RC62/Inf.Doc./4, 9 July 2012) (www.euro.who.int/__data/assets/pdf_file/0010/170110/RC62-id04-Eng.pdf)

• WHO Regional Office for Europe (2012): Report on social determinants of health and the health divide in the WHO European Region. Executive Summary. Copenhagen: WHO Regional Office for Health (http://www.euro.who.int/__data/assets/pdf_file/0004/171337/RC62BD05-Executive-summary-Report-on-social-determinants-of-health-and-the-health-divide-in-the-WHO-European-Region.pdf)

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• WHO Regional Office for Europe (2012): Web consultation on the Global Monitoring Framework for Noncommunicable Diseases. Information document. Regional Committee for Europe, Sixty-second session, Malta, 10–13 September 2012 (EUR/RC62/Inf.Doc./6, 5 September 2012) (http://www.euro.who.int/__data/assets/pdf_file/0004/172678/RC62-id06-Eng.pdf)

• WHO Regional Office for Europe (2012a): Addressing the social determinants of health: the urban dimension and the role of local government. Copenhagen: WHO Regional Office for Europe

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