Social determinants and health inequalities

Pilot projects funded by the European Parliament

 
 

A pilot project is an initiative of an experimental nature designed to test the feasibility and usefulness of action. It is meant to develop evidence-based strategies to address a problem, identify good practices, and provide policy guidance for the benefit of possible future initiatives in the area of health inequalities.

The European Commission's contracts with various contractors are based on their approaches in the chosen proposals and provide them with the necessary scope for their execution. Boards of scientific experts have been set up from a variety of disciplines for each project to provide robust guidelines for the project intervention and to validate its tools including the project websites which reflect the views of the authors and not necessarily the official opinion of the Commission.

Feel free to browse the ongoing projects below

VulnerABLE: Improving the health of those in isolated and vulnerable situations

This European initiative shall increase our understanding of how best to improve the health of people who are living in vulnerable and isolated situations across Europe.
The project targets specific vulnerable and isolated populations such as children and families from disadvantaged backgrounds; those living in rural/isolated areas; those with physical, mental and learning disabilities or poor mental health; the long-term unemployed; the inactive; the 'in-work poor'; older people; victims of domestic violence and intimate partner violence; people with unstable housing situations (the homeless); and prisoners.

Due to their circumstances, these groups may be more at risk of poor health and/or face barriers in accessing healthcare services. The project will assess their particular health needs and challenges, as well as identify best practices to support them and ultimately improve their health.

Over its two-year lifetime, the 'VulnerABLE' project will involve:

  • Interviews with individuals and organisations who work first-hand in the field of health inequalities (such as the World Health Organisation and local authority networks);
  • Detailed research into the health needs of people in isolated and vulnerable situations, including a face-to-face survey and in-depth focus groups with them;
  • Bringing together the leading thinkers in this area and enabling them to contribute to future strategies to prevent isolation and vulnerability;
  • Training materials and capacity-building workshops for national and regional authorities who are active in delivering healthcare services and who have a vital role to play in tackling health inequalities;
  • Regular news updates, direct communication with experts and a one-day conference to spread awareness of the project's findings amongst national and regional authorities; public health experts; health professionals; and other non-governmental organisations (NGOs).

Work has begun with a series of interviews with individuals and organisations active in the field of health inequalities, such as the World Health Organisation (WHO), academia, local authority networks and non-profit organisations representing the specific target groups of this research. These interviews formed part of a scoping phase to better understand the health needs and challenges faced by vulnerable and isolated groups. Insights from these interviews will be used to inform the later stages of the project.

Cook & Learn - Danish model of self-catering in correctional facilities

Of Denmark's total prison population of 3,481 about 64.5% are serving their sentences in prisons with 'Self-catering', a model allowing prisoners to be responsible for preparing their own food. Prisoners purchase ingredients from the prison grocery store from their weekly allowance of € 67 for food, then cook and clean for themselves in communal kitchens shared by around 20 prisoners.

This initiative is run since the 1970s in all Danish prisons as part of a national strategy to reduce re-offending by ‘normalising’ prison conditions. At 29%, re-offending rates in Denmark are among the lowest in Europe. In the past few years the programme has even been expanded to include cooking lessons to

  • match the consumption of meals more closely to life outside of prison;
  • help prisoners acquire cooking skills that will enable them to eat more healthily;
  • teach prisoners skills that will help them once they leave prison. By participating in cookery courses, prisoners can become certified chefs.

Through its focus on improving the food consumed by the prison population, this may help tackle health problems experienced by prisoners e.g. overweight and obesity, particularly in female prisoners who are often given too many calories.

Funding for the programme comes from the Danish Prison and Probation Service, as part of the overall budget allocated for running Danish prisons.

There is indicative evidence that Denmark’s approach has a positive impact upon prisoners’ self-perception, their behaviour inside and outside of prison and their physical and mental health. Qualitative evaluations of Denmark’s system of self-catering have found that it enables prisoners to eat more healthily than centralised prison catering.

Evaluations of the cookery lesson programmes have found them to have

  • helped some prisoners to find employment both inside and outside prison;
  • taught prisoners how to prepare healthy and inexpensive meals; and
  • helped spread knowledge of healthy eating to other prisoners, as programme participants pass on this knowledge to their peers.

While the full impact of this is yet to be evaluated, these findings do give some indication that access to healthier ingredients, as well as the knowhow to prepare healthy food, have created the potential for Danish prisoners to improve their diets.

It also appears that self-catering is a cost-effective method of feeding prisoners.

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HEPP – Maintaining a focus on health inequalities

This pilot project will contribute to maintaining an EU and Member State focus on health inequalities and help to mainstream measures to address them. The project will have a particular focus on alcohol, nutrition and physical activity, related to the socio-economic gradient and disadvantaged areas. The pilot project will work closely with

  • the Joint Action on Reducing Alcohol Related Harm (JA RARHA),
  • the Joint Action on Nutrition and Physical Activity (JANPA), and 
  • the EU Expert Group on Social Determinants and Health Inequalities.

The project, by sharing knowledge and developing policy guidance, will have an impact on better understanding what can be done to address health inequalities related to alcohol consumption, nutrition and physical activity in the European Union. It will also help Member States to better address the associated behaviours and risks, and their drivers (‘ the causes of the causes’). It will train countries to overcome barriers to inter-sectoral action through information exchange and collaboration between experts in research, policy and practice.

In 2016

HEPP will produce two scientific reports that focus on updating the evidence on the status of health inequalities in Europe concerning:

  • Nutrition and physical activity (and sedentary behaviour)
  • Alcohol consumption

For each EU Member State it will also produce a fact sheet on health inequalities relating to the above determinants.

HEPP will work with the Joint Action RARHA to analyse their data from a health inequalities perspective.

To ensure the outcomes are useful and appropriately focused as well as effectively disseminated, HEPP will contact organisations and individuals recognised as European experts in those fields, and keep interested experts and policy makers engaged in the project.

In 2017

HEPP will develop a range of detailed case studies to showcase effective action, and the strategies and skills needed to implement them. It will provide up-to-date advice and support to Member States in their policy development and implementation process to ensure its high impact.

Similarly HEPP will identify suitable Member States with a specific focus to hold training workshops. Those workshops will develop capacity within the Member States involved, and will also pilot the on-line training resources.

HEPP will compile all information in short ‘policy briefs’ to clearly outline the rationale for action. The potential costs and benefits of a focus on health inequalities in relation to alcohol, nutrition and physical activity will also be analysed.

This work will be finalised in 2018 ahead of a high-level conference in Brussels.

If you would like to find out more please contact chris.brookes@ukhealthforum.org.uk

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Health4LGBTI: Reducing health inequalities experienced by LGBTI people

This pilot project will increase our understanding of how best to reduce specific health inequalities experienced by lesbian, gay, bisexual, transgendered and intersex (LGBTI) people, focussing in particular on overlapping inequalities stemming from discrimination and unfair treatment on other grounds (e.g. older, younger, refugee, immigrant, disability, rural, poverty).

The project will explore the particular health needs and challenges faced by LGBTI people and analyse the key barriers faced by health professionals when providing care for LGBTI people. The aim is to raise awareness of the challenges and provide European health professionals with the tools that give them the right skills and knowledge to overcome these barriers and contribute to the reduction of health inequalities.

The Health4LGBTI project commenced in March 2016. Over its two-year lifespan, activities will include:

  • A state‐of‐the‐art review of the health inequalities experienced by LGBTI people and the barriers faced by health professionals in providing healthcare for LGBTI people;
  • Two focus group studies in 6 geographically diverse EU Member States (Poland, Italy, UK, Belgium, Bulgaria, and Lithuania) to map the barriers faced both by LGBTI people and health professionals. A further aim of the focus group studies is to generate data including stimulus materials to inform the development of training module(s) for healthcare professionals; 
  • Development of training module(s) aimed at increasing the knowledge, attitudes and skills of healthcare professionals when providing healthcare to LGBTI people.  The module will be developed in such a way so as to be potentially replicable across the EU; 
  • Piloting of the training module(s) in the same Member States where the focus groups will be conducted, in order to fine-tune and finalise the modules;  
  • A final European conference, and wide dissemination and communication targeting civil society organisations representing or working with key population groups, healthcare professionals, European health organisations including the EU as well as national, regional and local policy and decision makers in the area of health.

There is substantial evidence demonstrating that LGBTI people experience significant health inequalities that have impact on their health outcomes. LGBTI people continue to experience stigma and discrimination combined with social isolation and limited understanding of their lives by others, leading to significant barriers in terms of accessing health and social care services. These experiences can translate into a risk of alcohol abuse, depression, suicide and self‐harm, violence, substance misuse and HIV infection. Depression, anxiety, alcohol and substance misuse are at least 1.5 more common in LGBTI people, with lesbian and bisexual women at particular risk of alcohol abuse.

One of the most common issues for LGBTI people in accessing health and social care services is that many healthcare and other professionals commonly assume that LGBTI people’s health needs are the same as those of heterosexual people, unless their health needs are related to sexual health. LGBTI people have unique healthcare concerns which frequently go unacknowledged by service providers. A further significant barrier in accessing health services by LGBTI people concerns disclosure of identity, as many LGBTI people fear that if they disclose their sexual orientation or gender identity status to a healthcare worker they will experience discrimination and/or poorer treatment.

Whereas lots of attention has been paid to describing and measuring the problem of health inequalities within and across Europe, relatively little attention has been paid to how most effectively reduce health inequalities in populations. Clearly, there is a need both at Member State and European levels to tackle these inequalities experienced by LGBTI people, as the right thing to do to support some of the most vulnerable populations within our societies, but also as a work towards the development of high quality health services across the Union that are equally accessible to all.

For more information, please contact Massimo Mirandola, Verona University Hospital (massimo.mirandola@ospedaleuniverona.it). 

'Health4LGBTI' focus groups discussed barriers to equal access to healthcare

The first focus groups of the EU funded pilot project met in Brighton and Warsaw to explore the barriers faced both by LGBTI people and health professionals, when seeking and providing healthcare respectively.

The first of the series took place in June in Brighton, UK, and brought together eight health and social care professionals, some of whom are involved in promoting LGBTI health in their respective fields. At their meeting, health professionals presented specialist perspectives in working with LGBTI patients and identified knowledge gaps in LGBTI health issues amongst health and social care professionals. They also discussed the need for improved training in LGBTI health. In a second focus group, also in Brighton, LGBTI people themselves discussed the barriers and provided examples of challenges they encounter when seeking healthcare.

Two focus group discussions each are being organised in Poland, Italy, UK, Belgium, Bulgaria, and Lithuania. The next ones are scheduled to take place in Ghent, Vilnius, Verona and Sofia in the coming two months, Warsaw having made a start already on 7th September.

For further information contact Clotilde Cattaneo

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GenCAD: Gender-specific mechanisms in coronary artery disease in Europe

This European pilot aims to improve the understanding of sex and gender differences in chronic diseases, using coronary heart disease (CAD) as an example to highlight these differences regarding treatment and prevention activities in European countries.

As with other chronic diseases, CAD differs significantly in women and men throughout Europe, in age distribution, risk factors, prevention, clinical manifestation, response to therapies and outcomes. However, the existing evidence regarding sex and gender differences is sometimes incomplete and the existing findings are frequently not convincingly presented to the medical community and public.

Our target audiences are healthcare professionals, gender-based organisations, policy makers and the general population.

The GenCAD project commenced in February 2015. Over its three-year period, the GenCAD project aims to:

  • Analyse existing knowledge about gender differences in CAD risk factors, disease mechanisms, clinical manifestations, treatment options, access to health care, as well as management and outcomes.
  • Assess awareness of health professionals and general population to identify the most effective practices to raise awareness about sex and gender manifestations of CAD, its specific risk factors and available treatments in the member states using two types of surveys.
  • Develop information material based on the outcomes of the studies, surveys, and comprehensive needs assessment. Easily understandable factsheets will be disseminated in all official 24 EU languages.
  • Communicate & disseminate results of the surveys and the resulting factsheets to different target audiences and the health care community in all member states at various workshops and international conferences.

The GenCAD project will investigate published information, European databases and existing health policies in different countries to provide novel insights as to how and why different forms of CAD affect women and men, which preventive approaches are most effective in a gender-specific context and how this is already integrated into health policies. Also to be included are social determinants of health contributing to the inequalities between women and men, potentially affecting CAD outcomes. It will assess awareness of different groups of the population on these facts and use this knowledge to optimize structured information in factsheets for target groups and to develop the best strategies to raise awareness at all societal levels.

The project aims to ensure long-term sustainability and transfer of the results and products into practice by encouraging the use of its results by national stakeholders.

For this purpose, the project is organizing conferences and will disseminate its findings to all stakeholders in all Member States.

Long-term availability of the produced factsheets will be assured through this website and, international societies and institutions. A report will also be made available focusing on gender aspects in CAD and its prevention that assembles the European activities, highlights, gaps and opportunities.

If you are interested in joining the GenCAD project, you can get involved in the conferences and workshops by contacting Nicholas Alexander, Institute for Gender in Medicine, Charité Universitaetsmedizin Berlin (info[a]gencad.eu).

Meetings