The need to deal with health inequalities is now on the agenda of key supranational institutions. To tackle the so-called “causes of the causes of health inequity”, the focus should be put on structural policies, policies that – especially in the current times of financial and employment crisis – influence patterns of social stratification, living and working conditions, and thus people's health.
The SOPHIE project aims to generate new evidence on the impact and effectiveness of structural policies in reducing health inequalities, and to develop innovative methodologies for the evaluation of these policies in Europe.
We are studying major policy areas, including macro-economy, welfare state, labour market and employment relations, built environment, housing, as well as gender-oriented and immigration-related policies. We are examining examples of these policies at the European, national and local levels and analysing their impacts on health inequalities by social class, gender and migrant status.
The project is developing theoretical frameworks as well as quantitative and qualitative methods for evaluating the effectiveness of such policies in different contexts. Novel methods that are useful for evaluating the impact of complex social interventions are being employed, including realist reviews, explanatory case studies and concept mapping.
Particular attention is given to increasing the involvement of affected stakeholders (civil society and deprived population groups) in the identification, design and evaluation of policies to tackle health inequalities, as well as in activities of dissemination of results, knowledge transfer and translation of findings into policy recommendations.
Through SOPHIE, the European Commission will gain knowledge on the impact on health and health inequalities of social and economic policies that may be implemented or recommended to Member States.
Health inequalities are avoidable and unfair differences in health status, morbidity and mortality determined by the circumstances in which people of different social groups are born, live, work and age. The need to deal with health inequalities is now on the agenda of key supranational institutions. Recent experiences such as WHO Commission on Social Determinants of Health, specific country reviews or other past European projects have contributed to put the health inequalities issue in the agenda.
To go further and tackle the so-called “causes of the causes of health inequity”, the focus should be put on structural policies, and understand how these policies – especially in the current times of financial and employment crisis – influence patterns of social stratification, living and working conditions, and thus people's health and health inequalities.
The SOPHIE project (www.sophie-project.eu) aims to generate new evidence on the impact of structural policies on health inequalities in Europe, through the use, combination and further development of innovative methodologies.
Specific objectives include:
Since the start of the project we have analysed the impact of policies in a very diverse range of domains, including macroeconomics, social protection, labour market, built and social environment, housing, gender equity and immigrant integration. We try to consider health equity impacts according to several dimensions, primarily socio-economic position and gender, as well as age, ethnicity and migrant status when applicable.
We have been developing general and specific conceptual frameworks of how policies can impact on health equity and we are testing and applying several combinations of quantitative, qualitative and mixed methods for policy evaluation, to assess not only whether programs and policies have an effect, but also why and how. Examples of such methods are systematic review, realist synthesis, realist evaluation, cross-country panel analysis, concept mapping and quasi-experimental studies. Moreover, we are reviewing what works to engage stakeholders, mainly from civic society and vulnerable populations, in the research process and results dissemination.
All Work Packages (WPs) have prepared and shared their protocols during 2012, delivered a final version to the Commission in January 2013, and prepared a shorter and updated summary in April 2013 for discussion with the Advisory Board of the project. Collaborations of country partners across WPs have been established mainly through the identification and evaluation of local policy case studies. Stakeholders from different sectors are being involved to assess the impact of policies, including academic experts, civil society organisations and affected residents, who in this way came to know the project.
While many studies are still in a preliminary or working paper stage, the first scientific outputs have emerged, including the publications of 11 papers in peer-reviewed journals and 13 conference communications. A full, updated list is available on the website. Reviews of the existing literature (systematic reviews, scoping reviews and realist syntheses) have been completed and delivered to the Commission in January 2014.
Dissemination activities so far include the launch and update of the website, which received a monthly average of over 500 visits during 2013, the management of a Twitter account which currently has more than 160 followers, the printing and distribution of a leaflet, and the preparation of a newsletter including a video and two Slideshare presentations.
Four press releases have been issued, the first taking the chance of a Steering Committee meeting in Barcelona, the second to present a report, and the latter two to disseminate the main results of two scientific articles. All of them have received substantial coverage in the local and national press. Further activities and stakeholders contacts will be performed as far as new solid results appear to be shared.
The results of SOPHIE will provide evidence-based information on which structural policies are more effective to tackle health inequalities in different contexts. Some examples of the policies that we are analysing include fiscal policies, welfare entitlements, unemployment insurance, active labour market policies, urban renewal programs or gender equity policies. The differential health impacts of policies according to social class, gender and migrant status will be considered throughout the project.
Through SOPHIE, the European Commission, the scientific community and other stakeholders including vulnerable populations should gain knowledge on the impact on health and health inequalities of social and economic policies that may be implemented, recommended or discouraged.
Examples of recommendations that can be derived from results obtained so far include:
Such recommendations will be useful not only for policy makers and EU stakeholders, but also for others such as unions, the civil society or neighbourhood associations. Current approaches to stakeholder participation have been focused on influential high level researchers and government officials, with scarce involvement of civil society and deprived population groups in the identification, design and evaluation of policies to tackle health inequalities. We are reviewing methods to increase the participation of affected stakeholders in the policy process, and on dissemination strategies of research results that allow the whole population and particularly the more deprived to take profit from them.
We consider dissemination an essential component of the project to achieve the purpose of fostering policy change based on research findings. Our main target audiences will include:
In a first place, the results are prepared to be presented under the form of scientific manuscripts to be submitted to conferences and peer-reviewed journals, and at this regard, we expect the scientific production of SOPHIE to be wide and relevant. Thereafter, as described earlier, different tools are used to reach different type of audiences, as for example presence in social network, press releases, videos, seminars and talks at meetings of local and civil society associations. These activities will be reinforced in the final stage of the project.