Social determinants

VulnerABLE - Articles


April 2017

Asking the experts - focus groups offer insights into the health needs of vulnerable people

VulnerABLE held eight focus groups in Brussels, London, Athens and Marseilles, bringing together academics, medical practitioners, national and European non-governmental organisations, and key health organisations, such as the World Health Organisation and the European Federation of National Organisations Working with the Homeless.

Participants exchanged ideas on the health needs of the eight vulnerable groups mentioned below and the main barriers affecting their access to healthcare. They put forward suggestions on the most effective ways of supporting those target groups. An emerging theme from all the focus groups is the importance of engaging with target groups at all stages of service, policy design and implementation to ensure that their needs are really met.

Other key findings:

  1. A holistic approach drawing on health, education and employment policy is necessary to improve the health of children and families from disadvantaged backgrounds.
  2. Rural doctors and policy makers are starting to adopt more creative strategies such as mobile health units, screening services, and e-prescriptions to reach patients in rural/isolated areas.
  3. Campaigns and the media can be effective tools in raising awareness, avoiding stigma and changing society’s perceptions of those with physical, mental and learning disabilities or poor mental health.
  4. Health-related training should be provided for all professionals who work with the long-term unemployed, the inactive and, the ‘in-work poor’, to inform these groups about their health rights, prevention and available primary health services.
  5. Creating ‘age friendly environments’ can maintain the independency and mobility of older people, for example ‘dementia-friendly municipalities’ where there is an awareness of dementia across all services such as supermarkets, retailers and transport.
  6. Effective training programmes support doctors to identify and respond to individuals who have experienced domestic and intimate partner violence.
  7. Peer-to-peer networks and interaction between people in different types of accommodation can empower homeless people and improve their health.
  8. Human rights principles should underpin the treatment of prisoners, such as ensuring prisoners' rights to privacy, person-centred care and adequate patient choice over their treatment.

The findings from the focus groups, along with results from the project's survey and literature review, will be used to develop capacity-building sessions for regional and national authorities, offering practical guidance on how to support vulnerable groups in policy decisions. 

February 2017

Special Olympics Youth Unified Sports programme – A win-win game for all

This programme helps children and young people with intellectual and physical disabilities to participate in sport combining players with and without intellectual disabilities on the same sports teams, playing mainly football and basketball. It seeks to involve young people aged 12-25, their families and the wider community in training and competitions to contribute to healthy lifestyles as well as to increase their social integration, by creating bonds between people with disabilities and their non-disabled peers.

Competitions offer both the athletes with disabilities and their partners the opportunity to travel and represent their local communities.

This approach challenges discrimination and promotes a culture of acceptance and inclusion of people with disabilities in the communities.

The ongoing programme was developed in 2005 and is financed by grants from Sport Olympics partners. The Special Olympics Europe Eurasia Foundation supports the programme in 58 European and Eurasian countries.

The University of Ulster evaluated the effectiveness and impact of the practice in 2010, covering five European countries. As part of this evaluation, interviews were conducted with participants of the programme, who reported the following:

  • improved social integration through making friends with other players as well as interacting with people outside their families;
  • improved sport skills and physical fitness; and
  • improved independence, in many cases also better communication skills as well as more self-confidence through e.g. the new experiences of travelling to competitions.

Players with no disabilities reported a change in their attitude towards people with disabilities. Being motivated by their interest in the chosen sport allows differences between them to become less important and their focus on commonalities to increase instead. Parents of the disabled team members acquired more support in their day-to-day life.

January 2017

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.

September 2016

'Find & Treat Unit' helps TB patients of socially disadvantaged groups in London

The mobile health unit offers diagnosis and treatment of Tuberculosis (TB) directly to the homeless, ex-prisoners, and drug or alcohol users.

'Find & Treat' is an innovative outreach service that promotes access to better and safer healthcare for socially disadvantaged groups in London, by identifying and responding to Tuberculosis (TB) cases early. Its mobile digital x-ray unit screens 10,000 high risk individuals a year and supports the treatments of around 300 'complex' cases of TB.

'Find & Treat' developed a screening tool that delivers TB test results within 2 hours. As a result of its support 84% of patients went on to fully complete treatment within 12 months.

According to an assessment of the Health Protection Agency in 2011, both the screening and case management components of the 'Find & Treat' service are likely to be cost effective in London, also dubbed the ‘TB capital of Western Europe’. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.

Since 2005 the Unit has evolved into a multi-dimensional service, which focuses on

  • supporting patients to complete their daily drug treatment and remain healthy afterwards;
  • bringing detection services to high risk individuals;
  • raising awareness of TB enabling people to identify their symptoms and access treatment more quickly.

It also helps to overcome some of the complex challenges involved in treating these socially vulnerable groups, such as individuals not returning for follow up or being resistant to drug treatment. 'Find & Treat' works alongside over 200 NHS and NGO frontline services. The project also recruits and trains TB patients with experience of being homeless to support others with their treatment. The social and outreach workers as well as peer mentors of 'Find & Treat' also provide guidance and support to help individuals out of homelessness.

The success of 'Find & Treat' has led to plans for a mobile service, to be used across England in areas of high TB incidence as well as a research programme to improve the management of Hepatitis and Latent TB (HALT Study).

This project is one of the 'VulnerABLE' case studies on different strategies to tackle health inequalities and improve access to healthcare across Europe.

June 2016

European countries are waking up to health inequalities

Mobile health units or teaching prisoners how to cook are amongst 100+ selected practices promoting better health to people living in vulnerable and isolated situations.

Several initiatives across Europe are improving access to healthcare by a mobile health unit travelling to where it is needed. In Finland the 'Mallu' bus, a converted campervan, provides healthcare to residents of rural South Karelia. In Greece a mobile mental health unit serves the residents of the Trikala countryside. Such mobile units combat the isolation of small rural communities, but serve the cities just as well.

'MedMobil' in Stuttgart (Germany) offers immediate primary health care advice for disadvantaged people across the city. Likewise, 'Find & Treat' travels across London to screen homeless people for TB, providing a diagnosis in just 30 seconds. 'Informal' healthcare might be more appealing than traditional healthcare to city dwellers without permanent address, or those with unpredictable work schedules juggling more than one job, making it difficult to keep appointments.

Apart from mobile health services, countries are testing many other approaches to tackle health inequalities, from community based projects at local level to partnerships across countries:

  • sports schemes for disadvantaged people, 
  • advocacy services, such as help to find the right health service or to complete complicated forms, etc., 
  • training and support for professionals to recognise mental health issues or intimate partner violence,
  • innovative schemes to teach prisoners how to cook and learn more about what they eat.

'VulnerABLE' identified those initiatives by speaking to experts and reviewing the latest evidence in this area. As a next step, the project will develop 30 detailed case studies on different strategies to tackle health inequalities and improve access to healthcare across Europe.

May 2016

Leading health organisations warn that health inequalities are worsening

Recent interviews with health experts, local authorities and member organisations have highlighted the extent of health inequalities amongst vulnerable and isolated groups in the European Union, as well as the negative impacts of the economic crisis.

The interviews held with prominent European and National organisations shed light on the difficult health situation and degree of poor health amongst particular vulnerable and isolated groups.

Some organisations warned of the high rates of suicide and depression amongst elderly people in the EU, related to the level of social and physical isolation that this group can experience. Others highlighted the extent of communicable diseases and mental health issues amongst the homeless, as well as their shortened life expectancy. The interviews also considered the difficulties facing people with disabilities, children from disadvantaged backgrounds, prisoners and others.

Many interviewees drew attention to the impact of the crisis in worsening health inequalities across Europe. For instance, some warned of the reductions to healthcare access for some groups, due to increased co-payment for medicines and medical exams, lower benefits and the rollback of anti-poverty strategies in some countries.

The move towards greater private healthcare provision and increased payments by patients within systems was also a cause for concern for some interviewees, as well as the rise in child poverty, and the rise in homelessness in some EU Member States.

These insights will be taken into account for the upcoming work, such as the transnational survey to be carried out directly with people in isolated and vulnerable situations and the collection of good practices to improve health of vulnerable and isolated persons.