evaluating equity action equity action... · was nearly as high at 18.4 years. • in 2010, the gap...
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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)