CHRODIS IN CONTEXT:

ACTIONS FOR HEALTH PROMOTION IN EUROPE

CHRODIS in Context

• EuroHealthNet is committed to support CHRODIS and help implement objectives by working in partnerships.

• Despite health gains in Europe, inequalities persist and increase. Without tackling this, objectives will not be successfully achieved.

• The context is rapidly changing: urgency and adaptability in policy and practice is needed.

• Models for progress exist globally and in Europe, but focus and support is needed between and within states and communities.

• CHRODIS can help to demonstrate and stimulate ‘’How’’.• Practice with a purpose: best of the new and known.

EuroHealthNet supports JA CHRODIS• Provide a picture of the health promotion landscape across EU

(2014-2015);• Identify common gaps and needs (2015)• Support coordinated action (2016)

Lessons learned? Need for ACTIONS….

Foresight

Good practiceCost-

effectiveness

Needs and priorities

Stakeholders

Policies

Health for all policies

Social equity actions

Partnerships

EuroHealthNet - three pillars in an action partnership

Research studies

Using evidence

Evaluations

EU Joint Actions etc.

Capacity building

Core support

Our approach

• Health determinants have a cumulative impact across the life course

• Health determinants span multiple policy areas & stakeholders

• Relevant research comes from different academic disciplines and methodologies

Life expectancy across EU Eurostat and OECD

Gaps in life expectancy between people with high and low level of education at 65 years old Eurostat

Inequalities persist and rise

Social gradients in health and wellbeing

Trends for health promotion

• Impacts of economic crisis are becoming evident as anticipated

• There are decreasing real and proportional investments in promoting health and wellbeing

• Many worsening impacts on determinants in but also beyond health systems

- Environmental factors

- Rapid demographic, social and technological change

= Increases in the prevalence of chronic diseases

= Increasing health inequalities between and within Member States, regions and municipalities.

Healthy and sustainable lifestyles

Environmental degradation – increased risks for health and well-being, influenced by our lifestyles (e.g. EU SPREAD study)

Green environments Climate changeActive Air pollutionTravel Obesogenic

environmentsEnergy savings Water Food waste Soil depletion

Moving

Living

Consuming

Chronic diseases

Increased prevalence of chronic diseases. Factors include:• The EU - obesity affects one in six adults (16.7%), increase from

one in eight a decade ago (considerable M-S variations).• The EU – 53% of adults are now overweight or obese. • The EU obesogenic environments: sugars, fats, salt.• The EU - highest level of alcohol consumption in the world -

average of 10.1 litres per person ( M-S variations). • Evidence of need to act smartly is clear and growing.• Credit for tobacco progress. Now other factors.

Commitments have been made: not only 3….

Unemployment rate, % of labour force, annual average, total population (15-74 years), EU 27, in 2008 and 2014

EU impact of economic crises on health and health systems

‘Between 2009 and 2012 health spending in real terms (adjusted for inflation) decreased by 0.6% per year on average. This was due to cuts in health workforce and salaries, reductions in fees paid to health providers, lower pharmaceutical prices, and increased patient co-payments’.

Self-reported unmet needs for medical examination (too expensive) Source: EU-SILC, accessed 2015

2008 2009 2010 2011 2012 20130.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

European Union (27 countries)

Greece

Italy

AustriaFinland

Germany

Romania

Latvia

Bulgaria

European Union (27 countries) Greece ItalyAustria Finland GermanyRomania Latvia Bulgaria

2005

2006

2007

2008

2009

2010

2011

2012

2013

0

2

4

6

8

10

12Poorest quintile

Unemployed

Least educated

Older people (65+)

Women and girls

Total population

Richest quintile

Impacts across social gradientShare (%) of people reporting unmet need for health care

due to cost, travel distance or waiting time, EU28

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Many countries have shifted medicine costs onto households

Source: WHO HFA database; earlier year is lowest OOP share before 2007; later year is most recent year of data (usually 2011)

Before and after the crisis:lower vs higher out-of-pocket share

The evidence and data shows that…

• Health is distributed across the social gradient. Focusing solely on the most disadvantaged is not sufficient – we need ‘proportionate universalism’ .

• Investments are needed across the social gradient.• Action is needed to deal with the ‘causes of the causes’

of ill health, which include poverty, long-term unemployment, poor working conditions, early school leaving, household deprivation…….. as well as risks.

• Link with sustainable development for affordable health and equity for all

Frameworks for action exist – act in context

Capacities to act

Coverage & affordability

Availability of services

Timely availability

Key factors in meeting needs

Accessible facilities, language, literacy, waiting time guarantees

(severity)

Quality of patient-provider interaction, cultural

competence, e-health

Data issues, marked socio-economic gradient, role of underlying inequalities – requires attention because it affects already underserved people

Availability

• What is measured is not always useful

• Data systems inadequate

• Need for disaggregated data

and a population-wide perspective

• Little transparency, large interests

• Need to address professional and organisational structures: training, working conditions, skill mix,

• Rational clinical practice and prescribing

Effective, accessible, resilient and accountable public systems

A new generation of data collection for better monitoring: Robust, relevant, comparable indicators disaggregated by

region and sub-groups of people Timely, visible, harmonised data collection that safeguards

privacy Focus on unmet need, utilisation, user experience, financial

protection and hard-to-reach people

ActionContext-specific policy analysis

CHRODIS can make strategic contribution

A common purpose to act in context

• Priorities• Partnerships• Policies• Practices

Thanks and links

Thanks to

• Dr Sarah Thompson, WHO Europe, Eurostat, OECD and ECDA.

• Caroline Costongs, Cristina Chiotan, Anne Pierson and Anna Gallinat plus Ingrid Stegeman

• EuroHealthNet members – join them? • www.eurohealthnet.eu