Federal Centre for Health Education BZgA BZgA “Implementing Strategies on Reducing Health Inequalities” “More Equal and Healthier Societies” Budapest, Hungary, 30th November 2010 Helene Reemann Federal Centre for Health Education, BZgA
Feb 14, 2016
Federal Centre for Health EducationBZgABZgA
“Implementing Strategies on Reducing Health Inequalities”
“More Equal and Healthier Societies” Budapest, Hungary, 30th November 2010
Helene Reemann
Federal Centre for Health Education, BZgA
Federal Centre for Health EducationBZgABZgA
Inequalities are observed in all European member states as well as in Germany
Federal Centre for Health EducationBZgABZgA
Content
1. Health inequalities in Germany2. Structures and strategies to tackle health
inequalities3. Evaluation and quality development4. Summary
Federal Centre for Health EducationBZgABZgA
Prevalence of smoking by income and sex Men Women
Income group
%
age
(SOEP Study; Lampert et al. 2005)
Federal Centre for Health EducationBZgABZgA
Prevalence of physical inactivity by income and sex
Men women
Income group
%
age
(SOEP Study; Lampert et al. 2005)
Federal Centre for Health EducationBZgABZgA
Risk of chronic diseases in low educatedmen and women
Disease Men women
Myocardial infarctionStroke
Angina PectorisHypertension
CancerDiabetes
Chronic BronchitisArthrosisArthritis
Chronic back painDizziness
(Federal Health Survey; Lampert et al. 2005)
Federal Centre for Health EducationBZgABZgA
Childrens participation in checkups in the first six living years by parental socio-economic status
%
Socioeconomic status
Low
Medium
high
Checkup
(Berlin, school enrolment examination 2005)
Federal Centre for Health EducationBZgABZgA
Risk of premature mortality in lower income men and women
0
0,5
1
1,5
2
2,5
3
Men Women
<60%<80%<100%<150%>=150%
Odds Ratio
Income group
(SOEP Study; Kroll & Lampert 2009)
Federal Centre for Health EducationBZgABZgA
BZgA aims at tackling health inequalities by providing structures andimplementing low barrier strategies
Federal Centre for Health EducationBZgABZgA
CommunicationPlanning, implementation and
evaluation of national prevention campaigns and programmes on
health promotion
Quality assurance and researchEffectivity and efficency in prevention,
Evaluation of measures and campaigns
National and international Cooperation / Coordination
Intersectoral cooperation with governmental/non-govenmental
organisations of the health sector with science and other policy
sectors
Federal Centre for Health Education (BZgA)
Federal Centre for Health EducationBZgABZgA
Tackling health inequalities
…is one central aim of the Federal Centre for Health Education
3 main drivers:- Attitudes and skills of individual person- Social environment and settings- Socio-cultural conditions
Promote healthy behaviour in daily life! Networking structures & low barrier strategies
Federal Centre for Health EducationBZgABZgA
Providing structures in Germany: Cooperation Network „Health promotion for the socially disadvantaged“
Federal Centre for Health EducationBZgABZgA
16 Regional Hubs
Federal Centre for Health EducationBZgABZgA
Structures enable transfer
Good practices on internet platform www.gesundheitliche-chancengleichheit.de
Project examples and quality criteria in publications
Knowledge exchange at events and conferences
Workshops in selected settings (e.g. Kita)
Congress Poverty and Health
Federal Centre for Health EducationBZgABZgA
Structure development in Germany and Europe
Europe Länder LevelFederal Level
EU Project ‚DETERMINE‘ with 26 partner countriesEU-, national and
local level
Regional Hubs‚Poverty and Health‘ in
16 federal states
German project ‘Health Promotion for
socially disadvantaged people’
European Directorywww.health-
inequalities.eu
National Directory with some 1,700 projects
www.gesundheitliche-chancengleichheit.de
Länder – platforms within the national directory
Federal Centre for Health EducationBZgABZgA
Providing structures in Europe: EU projects ‚Closing the Gap‘ and Determine‘
www.health-inequalities.eu
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Implementing strategies: National Centre on Early Prevention
Aim- Protect children 0-3 years early and effective by linking services
Methods- Coordinate local public health and youth welfare services- Identify families with educational needs and in stressful situations- Develop and improve effective interventions on strenthening
parental skills Results (preliminary)
- More than 50 % of youth welfare and public health are active in early prevention
- Expressed need in terms of financial consulting, data protection, risk idenfication, qualification of employees
Federal Centre for Health EducationBZgABZgA
Implementing strategies: Gut Drauf (In good mood) Aim
- Improve nutrition, physical activity and stress management in adolescents 12-18 years
Methods- Offer high quality activities in adolescent settings
(school & business, sports & leisure time…) - Behaviours AND circumstances- Link and qualify intermediaries - Quality criteria and certification
Federal Centre for Health EducationBZgABZgA
Implementing strategies: Komm auf Tour („Get going – my strengths, my future“)
Aims- Strengthening self-confidence among students on lower
educational levels- Promoting vocational orientation combined with life and familiy
planning, prevention of teen-age pregnancies Methods
- Students discover personal strengths and occupational orientation in joint-in-circuit
- Include parents, teachers and local collaborators Results
- Change of attitudes in terms of gender role, occupational aptitude, sexuality and family planning
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Reach
650-700 persons/each regional measure
100.000 persons in 152 regional measures from 2006 to 2010
Nordrhein-Westfalen
LandBaden-Württemberg
Land Brandenburg
Land Berlin
Pilot Ilmenau/Thüringen
Landkreis Uelzen
LandkreisHavelland
Pilot Leipzig/ Sachsen
Lernende Region Bodensee
Pilot Salzwedel/Sachsen-Anhalt
Federal Centre for Health EducationBZgABZgA
Children and adolescents
Health problems as consequence of problems to fulfil developmental tasks (primary and secondary socialisation)
Social change: increase of broken families, poverty Support parents and educators Nutrition, physical activity and
stress regulation main issues
Federal Centre for Health EducationBZgABZgA
Implementing strategies: Districts with special development needs – The Socially Integrative City Aim
- Support district managers in terms of health promotion/prevention
Methods- Federal-Länder-programme to counteract the widening
socio-spatial rifts in the cities- Strategies for action regarding: healthy settings,
problems and solutions; project development, prevention of poor diet, phyiscal inactivity and stress, quality development
Federal Centre for Health EducationBZgABZgA
Evaluation is still a challenge. Individual projects show that improving health behaviour in socially disadvantaged is possible. Quality criteria can support this process
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1 / Basic criteria Concept Target group Settings
2 / Work with the target group Snowballing Low barriers
Participation Empowerment
3 / Sustainability and quality development
Innovation but sustainability Multidisciplinary collaboration Quality management Documentation and Evaluation Cost efficiency
Quality criteria for health promotion with the socially disadvantaged
Recognized by statutory health insurances as criteria for projects to be promoted!
Federal Centre for Health EducationBZgABZgA
Aim: Representative survey of children and adolescent health 0 – 17 years
Baseline: 2003 - 2006 Response: 17.641 boys and girls and their parents
from 167 cities Data and recommendations from a public health
perspective
German Health Survey of Children and Adolescents (KIGGS)
Federal Centre for Health EducationBZgABZgA
Strategy of the Federal Government for the Promotion of Child HealthMain goals
To promote health equity among all children and adolescents
To improve the overall conditions, to motivate and to integrate a healthy lifestyle into the everyday life of children
To reduce health risks
To support the physical and psychological development of children and adolescents
To raise awareness for the issue of child health
Federal Centre for Health EducationBZgABZgA
4. Summary
Data on health inequalities show the need of tackling health inequalities in Germany
Tackling health inequalities ideally combine sustainable structures and accessible and acceptable strategies and interventions
Structures of cooperation are based on a broad range of actors from the health field and other political sectors
Strategies should be implemented in daily life of target groups AND reduce barriers while providing options for empowerment and
participation.