Déterminants sociaux et inégalités en matière de santé

Pilot projects funded by the European Parliament

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Pilot projects are designed to test the feasibility and usefulness of specific activities. They are used to try out different approaches, develop evidence-based strategies, identify good practices, and provide policy guidance for the benefit of possible future initiatives in health.

The European Commission's agreements 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 provide robust guidelines for projects and validate their tools, including websites.

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

Implemented between 2015 and 2017, the project aimed to explore ways to improve the health of people who are living in vulnerable and isolated situations across Europe.

Its focus was on nine specific vulnerable and isolated populations, namely children and families from disadvantaged backgrounds, those living in rural/isolated areas, with physical disabilities or poor mental health, the long-term unemployed, the inactive, those from lower income brackets, the elderly, victims of domestic violence and intimate partner violence, the homeless, and prisoners.

Project implementation

Over its two-year lifespan, the 'VulnerABLE' project involved:

  • Interviews with individuals and organisations working on health inequalities
  • Detailed research into the health needs of people in isolated and vulnerable situations, through a face-to-face survey and in-depth focus groups
  • 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
  • Regular news updates, direct communication with experts and a one-day conference to spread awareness of the project's findings.

If you would like to find out more please contact vulnerABLE@icf.com

Project output

Related information

HEPP – Maintaining a focus on health inequalities

This pilot is aimed at focusing EU and national attention on health inequalities and helping to mainstream measures to address them. It is hoped that by sharing knowledge and developing policy guidance, the project will provide solutions to health inequalities related to alcohol consumption, nutrition and physical activity in the EU.

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

Project output

A number of scientific reports provide information on evidence-based interventions to reduce health inequalities in Europe relating to:

The introduction to the evidence review on health inequalities and nutrition and physical activity provides information on the context, status and effective approaches to addressing health inequalities across Europe.

An executive summary and background document is also available on these four scientific reports highlighting their main points and recommendations.

The 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

Case studies

The following cases studies have been developed as part of the HEPP project, through a careful process of selection. They were  identified as part of the development of the scientific literature reviews, and involved the High-level Group on Nutrition and Physical Activity,  and European Commission officials, in prioritising which case studies would be of most interest to countries wishing to reduce health inequalities resulting from poor nutrition, low physical activity, and harmful alcohol consumption patterns.  They have been written up in an agreed case study format, and have undergone a rigorous appraisal through both by the European Commission and with country representatives.

This case study describes how a Dutch retail group has reformulated its own-brand products to reduce the levels of macronutrients of concern to public health (salt, saturated fat and sugar). The intervention is population wide, but will have an effect in proportion to the consumption of the products being reformulated, and therefore greatest among the lower socio-economic groups who are likely to be making most purchases . In principle this is a universal, proportionate intervention.

In July 2011, Hungary passed legislation to impose taxes applied on the salt, sugar and stimulant content of various categories of foods and beverages including sugar-sweetened drinks, energy drinks and pre-packaged sugar-sweetened products. Two evaluations were used in the case study. One by Biro comparing the pattern of household purchases of ‘processed’ (including taxed) foods and ‘unprocessed’ (not including taxed foods) during the previous five years. The other from WHO Regional Office for Europe using research based on a sub-sample of the 2014 Hungarian National Diet and Nutritional Status Survey of adults. In every product group, a greater proportion of adults with lower (primary) education than with higher education changed their consumption in one way or another.

New legislation in Romania is seeking to protect breastfeeding as the most appropriate source of nutrition in the first 6 months. The new law will not only help reduce inequalities in maternal and young child health in Romania but may act as an exemplar for implementation by other EU Member States. The case study builds the rationale, and the process by which the legislation was developed and passed; a law which particularly supports poor and vulnerable groups from the influence of the marketing of baby feeding products, a group who generally breast-feed less in Europe.

This case study covers the aims and aspirations of City administration of Krakow, as expressed through its new sustainable transport master plan, with policies and projects that cover walkability, cycling and public transport, and improving road safety. It’s a prospective case study where changes have been implemented but formal evaluation is yet to take place. There is significant potential in reducing socio-economic inequalities as increasing walkability improves mobility for people without access to a car (or public transport) and potentially could reduce road traffic casualties.

Finland is one of the few countries to have reported a consistent long-term increase in physical activity in recent years7. Between the late 1970s and 2014, the proportion of people classed as regularly active rose from around 40% to over 60% among both men and women. The case study explores the long-term development of promotion of physical activity in Finland to the present day, which has followed clear principles, such as creating a broad and supportive national policy framework; focusing on the notion of health enhancing physical activity (in contrast to a focus on competitive sport); modifying the environment; and applying a ‘health in all policies’ approach.  Effective and carefully targeted promotion of physical activity has the potential to reduce differences between socioeconomic groups and inequalities between men and women.

This case study details modelling work conducted in Scotland to appraise the potential impact of a Minimum Unit Pricing policy, which is due to be implemented in Scotland on 1st May 2018. To carry out the work, the Scottish Government sought the expertise of the Sheffield Alcohol Policy Unit, who had developed a model of minimum unit pricing and other alcohol taxation policies, capable also of allowing for comparisons across different socio-economic groups. This case study focuses on the 2015 modelling work and its effects on health inequalities in alcohol-related harm.

The Amsterdam Healthy Weight Programme was established in 2013 by the Amsterdam Municipality. Its overall objective is to achieve a healthy weight for all children in Amsterdam by 2033. It is a universal programme aiming to impact on children across Amsterdam by changing some of the environmental drivers of obesity, but targeted to those neighbourhoods with the highest proportion of overweight and obese children, and those schools with the highest proportion of overweight or obese pupils. The programme is also targeted at those children with the risk factor for obesity of lower income or education parents, and parents of non-Dutch origin. Preliminary results suggest that the programme has had a greater impact to date on lower socio-economic population, though causality cannot be proven at this point.

Related information

Health4LGBTI: Reducing health inequalities experienced by LGBTI people

Implemented between 2016 and 2018, this pilot is aims to improve our understanding of how best to reduce specific health inequalities experienced by lesbian, gay, bisexual, transgendered and intersex (LGBTI) people. It focuses on overlapping inequalities stemming from discrimination and unfair treatment on other grounds (e.g. age, status, income).

LGBTI people continue to experience stigma and discrimination combined with social isolation and limited understanding, 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.

Project implementation

The Health4LGBTI project activities include:

  • Development of training module(s) aimed at increasing the knowledge, attitudes and skills of healthcare professionals when providing healthcare to LGBTI people
  • Piloting of the training module(s) in the 6 EU countries
  • A final European conference, presenting the results.

Project output

The project produced the following results:

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

Related information

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

This European pilot aims to improve the understanding of gender in addressing chronic diseases, using coronary heart disease (CAD) as an example to highlight differences in treatment and prevention. Existing evidence is sometimes incomplete, and findings are rarely presented to the medical community and public.

Over its three-year lifespan (from February 2015), the GenCAD project aims to:

  • Analyse existing knowledge on 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
  • Develop and disseminate information material based on the outcomes of the studies, surveys, and comprehensive needs assessment.

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@gencad.eu).

Related information

Publications