Evaluating Equity Action Geoff Wykurz and Sue Atkinson

EU Report on Health Inequalities Health inequalities between countries, regions and social groups

•  Sweden has the highest life expectancy for men – 79.9 years, a difference of nearly 12 years vis-à-vis the Member State with the lowest expectancy (68.1)

•  Life expectancy for women is highest in France – 85.7, a difference of 8 years vis-à- vis the Member State with the lowest expectancy (77.8 years)

•  When it comes to healthy life years in men, there is a difference of 19 years between the lowest and highest values in the EU (2011 figures). For women, this was nearly as high at 18.4 years.

•  In 2010, the gap between life expectancy at birth between most and least advantaged regions in the EU was 13.4 years for men and 10.6 years for women.

•  In the same year, there were seven EU regions with infant mortality rates greater than 10 per 1000 live births. More than 2.5 the EU average of 4.1/1000.

•  In 2010, the estimated gap in life expectancy at age 30 for men between the least and the most educated varied from around three years up to 17 years in different Member States. For women the gap was slightly smaller, varying from 1 to 9 years

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Source: EU press release 9 September 2013 (see final slide for web link

EU Report on Health Inequalities

The wide variation in life expectancy and infant mortality historically found between EU countries is narrowing:

  The gap between the longest and shortest life expectancy found in EU-27 decreased by 17% for men between 2007 and 2011 and 4% for women between 2006 and 2011.

  The gap in infant mortality between the EU countries with the highest and the lowest rates went down from 15.2 to 7.3/ per 1000 live births between 2001 and 2011.

  Average infant mortality in the EU also fell during this period - from 5.7 to 3.9 per 1000 live births.

  The report points to some positive developments in implementing the EU strategy on health inequalities, 'Solidarity in Health', while concluding that more action is needed at local, national and EU levels.

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Source: EU press release 9 September 2013 (see final slide for web link

Solidarity in Health Five Main Challenges

1.  An equitable distribution of health as part of overall social and economic development

2.  Improving the data and knowledge base

3.  Building commitment across society

4.  Meeting the needs of vulnerable groups

5.  Developing the contribution of EU policies

EU Report on Health Inequalities

European Health Commissioner, Tonio Borg:

"Inequalities in health in terms of life expectancy

and in particular in infant mortality have been

significantly reduced in the European Union in the

past few years.

This is encouraging. However, our commitment

must be unwavering in order to address the

continued gaps in health between social groups and

between regions and Member States, as shown in

this report.

Action to bridge health inequalities across

Europe must remain a priority at all levels."

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Equity Action – Joint Action on Health Inequalities

Aims:

•  Identify what works in promoting effective action on the underlying causes of socio-economic health inequalities

•  Apply learning across the EU through 24 partners and 16 Member States

•  Duration: Feb 2011 – 2014

•  Budget: €3 million

Equity Action – Joint Action on Health Inequalities

Strategic Relevance: EU Actions

•  Develop health inequalities audit approaches

•  Include health inequalities as a priority area between European regions and the commission

•  Review possibilities to assist Member States to make better use of structural funds to address health inequalities

•  Develop ways to engage relevant stakeholders at European level to promote good practice

Equity Action – Joint Action on Health Inequalities

Structure: Work Packages

•  Tools – to improve the health equity focus in cross government policy making, developing and using tools: Health Impact Assessment with an equity focus and Health Equity Audits

•  Regions - Developing a regional network to share learning; examine use of structural funds

•  Knowledge – Developing an active scientific and technical network to provide advice to the EU and MS

•  Stakeholders – Facilitating broad stakeholder engagement to address health inequalities

Equity Action – Joint Action on Health Inequalities

 Train partners on Health Impact Assessment with an equity focus

 Create methodologies for Health in All Policies (HiAP)

 Share learning from partners’ case studies

 Organise 3 Regional network meetings

 Prepare Regional case studies on tackling health inequalities

 Develop Structural Funds Guidance Tool

 Create Scientific Reference Group

 Commission literature reviews and publish fact sheets on impact of actions

 Develop a European research agenda on inter-sectoral action on social determinants

 Support partners to map stakeholders in their Member State

 Convene 2 EU-wide ‘stakeholder debates’

 Organise Final Equity Action Conference (January 2014)

Evaluating Equity Action – the brief

Aims

•  To identify the impact the programme has on the capability of Member States to produce effective policies to tackle health inequalities

•  To identify the elements of the Joint Action programme that work best to support Member State development

Evaluating Equity Action – our approach

Phase 1 – initial baseline

  Action research – assist review and planning

  Discover expectations and concerns of those involved:

•  WP Leads and Partners to the Joint Action

•  EU Commissions and representatives of Member States

•  Stakeholders

  Discussion of outcome indicators

  Phone interviews with WP Leads and questionnaires were sent to other partners (13)

Evaluating Equity Action

Phase 1 – Challenges

 Who are the representatives of Member States

  Equity Action to identify these

 Who are the key stakeholders?

  Partners to be asked to identify key stakeholders

 How should we interpret the outcome indicators

  To be discussed with WP Leads

Evaluating Equity Action

Phase 1 Evaluation – Question Areas

  Role and involvement

  Views on purpose and key actions of Equity Action

  Hopes and expectations of what EA will achieve

  Views on evidence of Equity Action’s success

  Perceptions of shared understanding between partners

  Impact on partner’s country and influencing change

  Barriers and obstacles in promoting action to address health inequalities

  Who are the key stakeholders?

  Interpretation of outcome indicators (WP Leads)

  Sustainability after the Equity Action project ends

Evaluating Equity Action

Phase 1 – Who are the key stakeholders?

Response:

•  Member States •  Politicians, policy-makers and government •  Government at all levels: national, regional and local •  Health sector •  Public health institutions •  Social Services •  Education •  Child welfare services •  Environment •  Finance and economics •  Employment •  Third Sector and NGOs •  Academics •  Children, young people, adults and older people •  The media

Evaluating Equity Action

Phase 1 – Influencing change

  Who is the most influential person to whom you have access that could

make the greatest impact on inequalities in health in your country?

Response:

✻  Ministers

✻  Civil servants

✻  Academics

Action expected from those identified:

✻  Vision – raising awareness, providing support

✻  Structure – strengthening inter-sectoral collaboration

✻  Strategy – make HIAs a requirement before making decisions

Evaluating Equity Action – Interpreting Outcomes

Specific Objective 2

  Exploring and supporting the role of sub-national actors in tackling health inequalities

Outcome indicator:

“More regions with an active and effective plan for tackling health inequalities.”

Specific Objective 5

  Engaging wider network of stakeholders

Outcome indicator:

“A broader range of stakeholders recognise their role in tackling health inequalities”

Evaluating Equity Action

Phase 1 – Some of the issues raised by partners

✻  Differences in context and perspective - defining terms

“We are trying to build a knowledge and understanding in an area where

definitions are fundamental and difficult, which requires leadership and

requires bridging across disciplines.”

✻  Working across sectors - barriers and obstacles

✻  Empowering partners - enhancing capability

✻  Developing a network - shared purpose

“It’s no good having a perfect project, but nobody has either any ownership

of it, knows about it, or is engaged in it, because really we end up

missing the point”

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Evaluating Equity Action: Phase 1 -Key Messages

Working Together

Sharing the

Vision

Building Capability

Increasing Visibility

Planning for the future

Making an Impact on Policy

Evaluating Equity Action – What next?

Phase 2 – reviewing Work Packages: issues for EA

  Addressing visibility

  Focussing on legacy

  Dissemination of what has been learned

  Improving the website – but for whom?

  Who are the primary stakeholders?

  Support to partners – facilitating country-to country exchanges

  How to embed the work of EA in the Member States?

  But who are the representatives of the Member States?

  Planning for the Final Conference (January 2014)

Evaluating Equity Action – What next?

Phase 3 – issues for the evaluation

  Identifying representatives of Member States

  Identify primary stakeholders of Equity Action

  Assessing achievement of stated objectives

  Promoting a health equity focus on policy

  Supporting the role of sub-national (Regional) actors

  Developing knowledge of how to use structural funds

  Scientific and technical transfer to policy engaging a wider network

  Legacy - tension between delivering outputs and achieving outcomes

  Evaluators’ dependency on material gathered by EA

  Communication

  Resources for the evaluation

Evaluating Equity Action – Website links

Equity Action http://www.health-inequalities.eu/HEALTHEQUITY/EN/projects/equity_action/

European Union Press release: Report on health inequalities: gaps in life expectancy and infant mortality

narrow across Europe – 9 September 2013: http://europa.eu/rapid/press-release_IP-13-823_en.htm?locale=en

Solidarity in Health: Reducing Inequalities in the EU http://ec.europa.eu/health/social_determinants/policy/

commission_communication/

PHAST Evaluation Report on Equity Action Phase 1 (September 2012) (may be accessed from Equity Action site above)