Practice
There are many proven practices and actions to reduce health inequalities. Such practices can come from within health systems, for example through increasing cancer screening amongst vulnerable groups. They can also involve collaboration between and within sectors, such as taking transport measures to reduce urban pollution in deprived areas.
Examples of successful health inequalities practices taking place throughout Europe are available in our resource database.
Practices to reduce health inequalities
A significant amount of knowledge about how to address health inequalities has emerged over the past few decades. New ideas are still being developed.
The historical context, approaches to governance, and ‘traditions’ of countries differ, and influence the extent and nature of their response to health inequalities. Equally, different settings and contexts have different needs.
Collecting and sharing examples of practices to reduce health inequalities and their outcomes can inform and inspire further action to encourage governments to “do something, do more, or do better”1WHO/Europe | Publications - Review of social determinants and the health divide in the WHO European Region. Executive summary (2013) to reduce them, in particular while planning the recovery of the current pandemic.
Practices to reduce health inequalites include comprehensive strategies - with established targets, as well as more specific initiatives and programmes. For example:
Comprehensive strategies:
The Scottish and Welsh governments take ‘whole of government’ approaches, with specific strategies for collaboration between sectors at national and community levels.2See: Stegeman,I and Kuipers Y. Health Equity and Regional Development in the EU. Applying EU Structural Funds. Equity Action. 2013
- In Wales for example, under the Future Generations Act, all public bodies must work towards seven ‘well-being goals’. These include things like ‘a healthier Wales’, ‘a more equal Wales’, ‘building skills and jobs’, and ‘creating an innovative, productive and low carbon society’. As part of the legislation, public services boards must bring the key partners and delivery agencies together. Together, they undertake a ‘well-being assessment’ for their area, considering health, social, economic, environmental and cultural issues. They then plan how they will work together to improve wellbeing and address the issues they’ve identified. Tackling adverse childhood experiences (ACEs) has for example emerged as a focus for most of the public service boards3A voice for future generations in Wales. The Health Foundation
The national government of Denmark4Health Inequality - determinants and policies - Finn Diderichsen, Ingelise Andersen, Celie Manuel, , Anne-Marie Nybo Andersen, Elsa Bach, Mikkel Baadsgaard, Henrik Brønnum-Hansen, Finn Kenneth Hansen, Bernard Jeune, Torben Jørgensen, Jes Søgaard, 2012 (sagepub.com) and the city of Malmö in Sweden carried out reviews of why health inequalities were increasing within their borders. They were inspired by the WHO Commission on the Social Determinants of Health 5http://malmo.se/Kommun--politik/Socialt-hallbart-Malmo/Kommission-for-ett-socialt-hallbart-Malmo/Commission-for-a-Socially-Sustainable-Malmoe-in-English.html. The commission's recommendations in Malmö cover 24 objectives and 72 actions
divided into six domains:
- improving conditions in childhood and adolescence;
- residential environment and urban planning;
- education;
- income and work;
- health care;
- sustainable development6Commission for a Socially Sustainable Malmö - Malmö stad (malmo.se)
A network of local authorities in England are also working together to develop an in-depth ‘Marmot’ approach.
Specific programmes:
Promoting affordable, high quality prenatal and early yeas provision is generally considered to be one of the most effective approaches to reducing health inequalities. The EU Horizon 2020 DRIVERS research project for example found that early childhood interventions offering intensive support and that are aimed at developing parent and children’s skills show the best outcomes. The Positive Parenting Intervention in Spain is such a programme. It strengthens parent’s capacities to nurture, empower, guide, and recognise children as individuals in their own right. Additionally, it includes an 8-hour online training course that is available online, free of charge. It also includes a website on healthy lifestyles ‘estilos de vida saludable’ with quality information and practical tools such as examples of weekly physical activity schedules for children aged 3-4 years.
Healthy Overvecht was developed in a deprived neighbourhood in Utrecht (Utrecht Overvecht), in response to the needs of local primary health care professionals (including e.g., general practitioners, physiotherapists, midwives, Youth Health Care Services, district nurses). Addressing what they considered to be unsustainable work-related pressures, they defined a shared vision of how to solve these problems. They all agreed to all use the same interview model (4D model) to methodically map their patients’ problems. The model explores the body, mind, social and relations/network, and what problems there are. They also created direct lines of communication across sectors. Healthy Overvecht is a success. It has now been piloted in twelve other deprived neighbourhoods in the cities of Utrecht, Rotterdam, Amsterdam, and the Hague.
In Finland all schools are in principle multi-service7Kangas, O. (2020d). In-depth assessment of policies/programmes/projects: Multiservice schools in Finland. Internal document, Second Phase of the Feasibility Study for a Child Guarantee (FSCG2).. That means that besides high-quality education, they also offer a wide variety of health and social services like free meals and recreational activities. They might also provide housing for children that need it because of long travelling distances (i.e. children living in Lapland). The goal is to contribute to healthy eating habits and promote overall student health through the provision of school meals. School healthcare, with its regular health check-ups, aims to support the pupils’ health and discover potential health problems as early as possible. According to all analyses based on Programme for International Student Assessment (PISA), the Finnish school system has performed very well not only in learning results but also as regards to equal opportunities.
The Youth Aware of Mental Health (YAM) programme is helping teenagers explore how to protect their own mental health and support those around them. YAM shows promising results – groups that have completed the programme show with significantly reduced levels of moderate to extreme depression, and reductions in suicide attempts and ideation. YAM is distributed globally through a research and development company, Mental Health in Mind International AB (MHiM), an SME founded by the Karolinska Institute researchers who developed the programme with support from Karolinska Institute in Sweden. It is currently being implemented and evaluated throughout Europe (Sweden, Austria, France, Norway, and the U.K.) as well as in Australia, India, and the United States. To date, more than 100,000 youth have participated in YAM.
Additional Practices
Additional Practices that can contribute to reducing health inequalities can be found in the EU Best Practice Portal in the field of Health Promotion, Disease Prevention and Management of Non-Communicable Diseases. Equity is a core-criteria for inclusion.
EuroHealthNet has established a Thematic Working Group (TWIG) on “good” or “best practice portals” where members will explore the ‘core criteria’ that are central to all portals. The Health Promotion Documentation Centre (DoRS) and the National Institute of Health (ISS) have for example developed such a Portal that is focused specifically on sharing equity-oriented practices: The Catalogue of Equity-Oriented Actions (CARE).
Projects which strengthen employment and mobility, improve education and give everyone a chance and are funded by the European Social Fund (ESF) can be found online.
The EU Joint Action on Health Inequalities is also implementing and evaluating a wide range of actions EU Member States relating to monitoring, healthy living environments, migration and health, improving access to health and social services, and governance / Health in All Policies.
Looking for more information on EU-funded actions that address health inequalities?
COVID-19 and Health Equity Practices
Some specific practices that can contribute to reducing existing health inequalities as a result of Covid-19 pandemic include:
- Primary health care helplines set up to locally to support mental health during COVID-19 in Slovenia.
- Interventions by Riga City Council that deliver interpersonal relationship counselling and addiction prevention to parents and children during the pandemic.
The EuroHealthNet Practice Platform
EuroHealthNet’s Practice Platform supports actions to reduce health inequalities in countries and across Europe. The Platform looks at how research and policy can be applied.
The Platform helps organisations to build capacity and share knowledge about ‘what works’. Through this exchange they are able to reinforce resources, collaborate, and shape international initiatives. The platform supports members to use EU funding instruments to impliment cost-effective and sustainable health practices, policies, and programmes.
Every year, EuroHealthNet organises 'Country Exchange Visits' in which senior staff from EuroHealthNet member organisations visit each other to discuss how they address common problems. These visits are an opportunity to showcase good practices, analyse, receive feedback, and initiate follow up actions. Although the visits are available for members only, you can find reports of the meetings and descriptions of the practices by searching 'study visit' in our database. Recent events have covered:
- The promotion of psycho-social health: multidisciplinary, integrated and institutional approaches to prevent violent behaviours and support victims of violence. Hosted by The Directorate for Citizenship Rights and Social Cohesion of the Region of Tuscany, Italy.
- Promoting Healthy Diets amongst children. Hosted by the Austrian Health Promotion Foundation (FGÖ).
- Health Inequalities, de-institutionalisation and social inclusion of people with chronic diseases and mental ill health. Hosted by the Bulgarian National Centre of Public Health and Analyses in Sofia (NCPHA).
- Giving all young children a healthy start: an exchange on evidence-based interventions. Hosted by Santé Publique France in Saint-Maurice, France.
- Migrant and refugee health, hosted by Prolepsis.
- Approaches to suicide prevention and Mental Health Promotion in Stockholm and in the European Union. Hosted by Stockholm County Council: Health Care Services and the National Centre for Suicide Research and Prevention of Mental lll-Health (NASP).
To find out more about the work of the Platform and how to take part, visit our website.
