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Using Structural Funds to reduce health inequalities: lessons from EUREGIO III

Prof Jonathan Watson

HE2020 Workshop (WP4)Brussels 17 October 2012

HCN Executive Director; EUREGIO III Project Director; HealthEquity-2020 Project Director,; Special Professor of Health & Public Policy, University of Nottingham; External Partner to European Masters degree in Sustainable Regional Health Systems (Deusto, Vilnius, Corvinus, Verona)

disadvantaged groupslimited evidence that SF have reduced inequities for disadvantaged groups

short-lived projects have undertaken innovative actions but these have rarely been mainstreamed and sustained (Degryse, 2010)

EUREGIO III evidence

EUREGIO III (2009-2011)

WHO/EU Equity Project Policy briefing (2010)

EU Council Conclusions ‘Towards modern, responsive and sustainable health systems’ (2011)

Guide for DG REGIO desk officers (2011)

High Level Reflection sub group 2 (2012+)

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Tackling trends: demographics and chronic illness

Poverty Housing

Diet Smoking

Cardiovascular disease

Treatment

Death

Current bias towards curative investment

Transformational investment

Patient centred interventional support

Rethinking healthcare care – an alternative model

The ‘wellness park’ model,

Kymenlaasko,Finland

• Rethinking the acute hospital

• Repositioning services, from illness to wellness

support• Healthy ageing

Remote community strategies

critical success factors

Strategic vision

Accountability

Financial realism

Integration

Measurable ROI

Technology diffusion

Social cohesion

3 integrated elements of health care delivery:• service delivery

models• Workforce• Capital

(infrastructure; technology; ICT

Population health statusHealth outcomesEconomic outcomes

“Objectives are European, funds are national and needs are local”National Reform

ProgrammePartnership

Contract

Operational Programme

s

Joint Action Plans

Individual projects

STRUCTURAL FUNDSProject instrument or strategic development?ConditionalitiesAd hoc stakeholder engagement?Spend or added valueCOMMUNITY EXPERIENCEClay Cross 1984: do not listen to us Drumchapel 1996: isolation & frustrationSouth Lanarkshire CP 2000: no pooling of fundsSkelmersdale 2004: community cliques

Thematic objectives for Cohesion Policy 2014-2020

Thematic objective Pathways to health equity

1. strengthening research, technological development and innovation;

Access to health care, living and working conditions

2. enhancing access to, and use and quality of, information and communication technologies;

Access to health care, living and working conditions

3. enhancing the competitiveness of small and medium-sized enterprises, the agricultural sector (for the EAFRD) and the fisheries and aquaculture sector (for the EMFF);

Working conditions

4. supporting the shift towards a low-carbon economy in all sectors;

Living and working conditions

5. promoting climate change adaptation, risk prevention and management;

Living and working conditions

6. protecting the environment and promoting resource efficiency;

Living and working conditions

7. promoting sustainable transport and removing bottlenecks in key networkinfrastructures

Access to health care, living and working conditions

8. promoting employment and supporting labour mobility; Living and working conditions

9. promoting social inclusion and combating poverty; Access to health care,, living and working conditions

10. investing in education, skills and lifelong learning; Access to health care, working conditions

11. enhancing institutional capacity and an efficient public administration.

Access to health care

missed opportunities with Structural Funds?

Direct Indirect

non-health sector investment

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organisational response

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What MS and Regions need to think about

Realistic starting points - taking into consideration the peculiarities of socialised, non-reformed health systems especially in the EU10

Commitment to transformational change – prioritising the shift away from a hospital-centric model of care to more pluralistic community-based and integrated models of care contributing to sustainable health systems

Affordable investment priorities – how ERDF/ESF spending can contribute to changes in structure and delivery of health services. This is likely to include e-health, infrastructure and equipment

Address health inequalities - this will include access to basic health services (GP, outpatient clinic, polyclinic, community based care) by poor and marginalised communities

Multiple roles for regional health systems – economic growth, renewable energy, environmental quality, social cohesion

REGIO checklist

principles for action

Engage stakeholders – it’s a long conversation

Plan – map the intervention logic

Innovate – create and do the right thing

Be transparent - accountable decision-making

Disinvest to reinvest – financial realism

Build capacity – processes, procedures, people

Return on investment – deliver added value

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thank you

www.euregio3.eu

www.healthclusternet.eu