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

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Presentation on theme: "Health Equity 2020: Action Learning & Capacity Building in EU10 Regions (WP 7 & 8) Advisory Board Meeting Brussels 16.10.2012."— Presentation transcript:

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

2 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.

3 Introduction WP7 and WP8

4 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 if more than one person participates Workshops hosted by Polish & Slovene pilot regions & two other EU10 locations

5 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)

6 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

7 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

8 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 evaluation And now: capacities to address health inequities – status, experiences, challenges, opportunities - the perspective of the pilot regions. Evidence What works? Tool Box (WP4) Screening existing tool Know how of pilot regions Formative evaluation

9 Thank you.

10 Materials for flexible use if demanded

11 Time schedule: First year (2012/13) 7 July June Revision capacity audit tool XX 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

12 Time schedule: Second year (2013/14) 7 July June Online workshop to introduce tool and guide X Regions conduct capacity buidling audits XXX 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

13 Time schedule: Third year (2014/15) 7 July June 2 pilot regions conduct re-audit XX Final revision of capacity building tool and guide X

14 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

15 Ad 1.: Action spectrum on inequalities in health Measurement Recognition Awareness raising Concern Mental blockWill to take action Isolated Initiative More structured developments Comprehensive coordinated policy Denial / indifference (Whitehead 1998: 471) What about the situation in the pilot regions?

16 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) 12 3 What are the current priorities in the pilot regions?

17 Ad 3: Combining relevant policies in a multilevel context (draft) Intra-Regional Governance for Adressing Inequities in Regions and at the Local Level Regional Planning Horizontal Regional Cooperation Regional Administration Regional Policies: Actors in Regions Territorial Policies MS Territorial Policies EU Not Place-based Policies of MS Not Place-based Policies of EU Horizontal regional networks in MS Horizontal Regional Networks in EU Regional Policies MSRegional Policies EU Where to look for what kind of capacities? What is going on in the pilot regions?

18 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?

19 Annex

20 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

21 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

22 Proposal Health for Growth Program Direct links with flagship agendas Innovation Union Digital Agenda New Skills and New Jobs

23 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

24 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

25 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

26 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)

27 EU Structural Funds

28 WHO Health 2020: Main strategic objectives 1.Improving health for all and reducing health inequalities 2.Improving leadership and partcipatory governance for health

29 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

30 WHO Health 2020: Proposed targets Broad target area TargetLinks 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

31 10 Essential Public Health Services Monitor health status to identify and solve community health problems.Monitor Diagnose and investigate health problems and health hazards in the community.Diagnose and investigate Inform, educate, and empower people about health issues.Inform, educate Mobilize community partnerships and action to identify and solve health problems.Mobilize Develop policies and plans that support individual and community health efforts.Develop policies and plans Enforce laws and regulations that protect health and ensure safety.Enforce Link people to needed personal health services and assure the provision of health care when otherwise unavailable.Link Assure competent public and personal health care workforce.Assure Evaluate effectiveness, accessibility, and quality of personal and population-based health services.Evaluate Research for new insights and innovative solutions to health problems.Research (Centers for Disease Control and Prevention) … and health inequities?

32 WHO Health 2020: 10 Essential Public Health Operations (EPHOs) 1.Surveillance of population health and well-being 2.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)

33 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? … and health inequities

34 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 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)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.pdfwww.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)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)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)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): 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 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)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)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)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 WHO Regional Office for Europe (2012): Strengthening public health services across the European Region – a summary of background documents for the European Action Plan. Information document. (EUR/RC62/Inf.Doc./5, 27 August 2012). Regional Committee for Europe, Sixty-second session, Malta, 10–13 September 2012 (www.euro.who.int/__data/assets/pdf_file/0017/172016/RC62-id05-final-Eng.pdf)www.euro.who.int/__data/assets/pdf_file/0017/172016/RC62-id05-final-Eng.pdf WHO Regional Office for Europe (2012): The evidence base of Health Information document. Regional Committee for Europe, Sixty-second session, Malta, 10–13 September 2012 (EUR/RC62/Inf.Doc./2, 23 July 2012) (www.euro.who.int/__data/assets/pdf_file/0015/170502/RC62-id02-Eng.pdf)www.euro.who.int/__data/assets/pdf_file/0015/170502/RC62-id02-Eng.pdf 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)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 WHO Regional Office for Europe (2012b): Healthy cities tackle the social determinants of inequities in health: a framework for action. Copenhagen: WHO Regional Office for Europe


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