HEALTH EQUITY EUROPE JOINT ACTION WP4: Integration of JAHEE results into policies WP9: Governance for Health Equity in All Policies Giuseppe Costa, University of Torino on behalf of WP4 (Italy) and WP9 (Finland) Co-founded by the Health Program of the European Union - CHAFEA 1 1

Deaths attributable to lower education EU COUNTRIES ACCORDING TO THEIR ADVANCEMENT IN TACKLING HEALTH INEQUALITIES (DG SANTE Expert Group, country templete 2015-16)   Agenda Type Evaluation Target Deaths attributable to lower education Countries A High Comprehensive cross-government strategies Social gradient 30-35% M 30% F Finland ● Ireland ● Norway ● Sweden ● Austria ● Germany ● UK B Medium/High Public health and Isolated Cross-government Mostly vulnerable 25-30%M 15-25% F apart FR/ES males 45% Belgium ● Denmark Spain ●Netherlands ● Italy ● France ● Estonia C Medium Health sector Low/medium Vulnerable Regional 45-55% M 35-45% F but CY 20-30 Croatia ● Cyprus ● Czech ● Hungary D Low Health sector direct/indirect Society as whole Poland ● Romania ● Slovakia Why good intentions have not translated into improved health outcomes for all through adequate policy responses from all sectors? E Missing 20-50% M 15-45% F Latvia● Greece ● Portugal

Barriers in engaging policy makers/stakeholders (in reducing health inequalities): It is not our concern (evidence, description) We don’t know what to do (evidence, links) We don’t know how to do it (delivery, networks) We don’t want to – (levers, incentives, regulations) We really don’t want to – (ideology, no pressure) We cant afford to – (cost efficacy, cross sectoral, prevention and other things matter more) 3

where evidence matters where governance matters Barriers in engaging policy makers/stakeholders (in reducing health inequalities): where evidence matters where governance matters It is not our concern (evidence, description) (WP5) We don’t know what to do (evidence, links) (WP6-WP8) We don’t know how to do it (delivery, networks) We don’t want to – (levers, incentives, regulations) (WP9) We really don’t want to – (ideology, no pressure) We cant afford to – (cost efficacy, cross sectoral, prevention and other things matter more) (WP5) 4

TO BE WP4 (Policy Framework for Action) HiAP Healthy living environments Health systems Migration Monitoring HiAP

of Equity in All Policies TO BE WP9 Level of integration of Equity in All Policies Actions on mediators (WHO 2014) - critical dedicated mass of capacities on information (WP5) and methods for advocacy (DRIVERS) - public health reporting - awareness and harmonization of priorities between sectors - awareness of potential co-benefits - H(E)iAP intersectoral committees - formal procedures for policy review/assessment (HLA, HEIA, HEA) - consultative process - accessibility to sensitive data - prospective impact assessment Mediators Lack of knowledge on HI Lack of understanding Lack of will Lack of knowledge about what to do Lack of resources/structure Lack of political/management support Lack of mandate towards sectors Professional boundaries Lack of comprehensive coordinated policy Outcomes Progression in policy response Health Equity integrated into policies All sector more accountable Intersectoral integration

AS IS (Country Assessment) WP4-WP9 WP9 Updating the European review 2013: are the mechanisms of Governance for H(E)iAP in place? Choose an action Analyse it with the 5 I’s approach information that is needed for conducting health/equity policy, ideologies that underlie and affect health/equity policy, interests connected with health/equity policy, institutions operating in the field of health/equity policy, problems of implementation of health/equity policies and policy programmes.

What looks like the implementation (Italian example) WP4 WP9 A platform of stakeholder and decision makers sharing and agreeing the “TO BE” and initiating actions, under the mandate of the MoH Exemplary actions in H(E)iAP HEA in new regulation of retirement age (unions, industries, government, parliament) Pilot experiences of “generative welfare” in local communities (Trieste, Torino, Bologna)