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

2. Aims of Presentation …with a focus on the situation in pilot regions.
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 WP 5 and WP 6
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
Evidence
What works?
Tool Box
(WP4)
Screening existing tool
Formative evaluation
Know how of pilot regions
And now: capacities to address health inequities – status, experiences, challenges, opportunities -
the perspective of the pilot regions.

9. Thank you.

10. Materials for flexible use if demanded

11. Time schedule: First year (2012/13)
7 July 8 9 10 11 12 1 2 3 4 5
6 June
Revision capacity audit tool X
Test tool in pilot regions (incl. visit in region)
Pilot regions preparing actions plans with UM
Revision of capacity audit tool with feedback from pilot regions
Short guide on the process and use of tool
Tool and guide made available on Health 2020 website

12. Time schedule: Second year (2013/14)
7 July 8 9 10 11 12 1 2 3 4 5
6 June
Online workshop to introduce tool and guide X
Regions conduct capacity buidling audits
Regions provide audit reports
Analysis of reports
Interim capacity building report
Regions prepare action plans for improvements locally and via WP 7 and 8

13. Time schedule: Third year (2014/15)
7 July 8 9 10 11 12 1 2 3 4 5
6 June
2 pilot regions conduct re-audit X
Final revision of capacity building tool and guide

14. For Discussion: Policy Matrix
Action spectrum on “inequalities” in health
Intervention map for comprehensive policies to reduce social inequalities in health
Regional capacities to address health inequities in a multilevel context
The European context of Health Equity 2020

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

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 1 2 3
What are the current priorities in the pilot regions?
(Torgersen et al. 2007: 8)

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

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
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
Improving health for all and reducing health inequalities
Improving leadership and partcipatory governance for health

29. WHO Health 2020: Priority action areas
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

30. 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
4. Enhance the well-being of the European population
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

31. 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?

32. WHO Health 2020: 10 Essential Public Health Operations (EPHOs)
Surveillance of population health and well-being
Monitoring and response to health hazards and emergencies
Health protection including environmental, occupational, food safety and others
Health promotion, including action to address social determinants and health inequity
Disease prevention, including early detection of illness
Assuring governance for health and well-being
Assuring a sufficient and competent public health workforce
Assuring sustainable organizational structures and financing
Advocacy, communication and social mobilization for health
Advancing public health research to inform policy and practice
… and health inequities?
(WHO Regional Office for Europe 2012b)

33. WHO RHN: Know-how areas
… and health inequities
How to foster and sustain regional commitment?
How to secure policy coherence?
How to develop skilled human resources?
How to scale up from isolated regional projects?
How to foster long-term regional investment?
How to strengthen regional health systems?
How to increase capacity for regional health diplomacy?
How to create incentives for a regional whole of government approach?
How to develop knowledge transfer among regions?
How to reposition health within regional development?

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 ( 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) (
Kickbusch, Ilona/Behrendt, Thorsten (2012): Interim report Supporting Health 2020: governance for health in the 21st century. WHO Regional Office for Europe (
Kickbusch, Ilona/Gleicher, David (2012): Governance for health in the 21st century. Copenhagen: WHO Regional Office for Europe (
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 (
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) (
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) (
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 (
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 (
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) (
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) (
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