CHRODIS IN CONTEXT: ACTIONS FOR HEALTH PROMOTION IN EUROPE CHRODIS in Context EuroHealthNet is committed to support CHRODIS and help implement objectives by working in partnerships. Despite health gains in Europe, inequalities persist and increase. Without tackling this, objectives will not be successfully achieved.

The context is rapidly changing: urgency and adaptability in policy and practice is needed. Models for progress exist globally and in Europe, but focus and support is needed between and within states and communities. CHRODIS can help to demonstrate and stimulate How.

Practice with a purpose: best of the new and known. EuroHealthNet supports JA CHRODIS Provide a picture of the health promotion landscape across EU (2014-2015); Identify common gaps and needs (2015) Support coordinated action (2016) Policies tss Cos tivene c effe N e e ds an

priorit d ies Good practice Foresight Lessons learned? Need for ACTIONS. ders l o h e Stak

EuroHealthNet - three pillars in an action partnership Research studies EU Joint Actions etc. Health for all policies Using evidence Capacity building Social equity actions

Evaluations Core support Partnerships Our approach Health determinants have a cumulative impact across the life course

Health determinants span multiple policy areas & stakeholders Relevant research comes from different academic disciplines and methodologies Life expectancy across EU Eurostat and OECD Gaps in life expectancy between people with high and low level

of education at 65 years old Eurostat Inequalities persist and rise Social gradients in health and wellbeing Trends for health promotion Impacts of economic crisis are becoming evident as anticipated

There are decreasing real and proportional investments in promoting health and wellbeing Many worsening impacts on determinants in but also beyond health systems - Environmental factors - Rapid demographic, social and technological change = Increases in the prevalence of chronic diseases = Increasing health inequalities between and within Member States, regions and municipalities. Healthy and sustainable lifestyles

Environmental degradation increased risks for health and wellbeing, influenced by our lifestyles (e.g. EU SPREAD study) Green environments Active Travel environments Energy savings Food waste Climate change Moving Air pollution Obesogenic Living Water Consuming

Soil depletion Chronic diseases Increased prevalence of chronic diseases. Factors include: The EU - obesity affects one in six adults (16.7%), increase from one in eight a decade ago (considerable M-S variations). The EU 53% of adults are now overweight or obese. The EU obesogenic environments: sugars, fats, salt. The EU - highest level of alcohol consumption in the world average of 10.1 litres per person ( M-S variations). Evidence of need to act smartly is clear and growing. Credit for tobacco progress. Now other factors. Commitments have been made: not only 3. Unemployment rate, % of labour force, annual average, total

population (15-74 years), EU 27, in 2008 and 2014 EU impact of economic crises on health and health systems Between 2009 and 2012 health spending in real terms (adjusted for inflation) decreased by 0.6% per year on average. This was due to cuts in health workforce and salaries, reductions in fees paid to health providers, lower pharmaceutical prices, and increased patient co-payments. Self-reported unmet needs for medical examination (too expensive) Source: EU-SILC, accessed 2015 16.0 14.0 12.0 10.0

8.0 6.0 4.0 2.0 0.0 2008 2009 2010 2011 European Union (27 countries) Austria

Romania Greece Finland Latvia 2012 Italy Germany Bulgaria 2013 Impacts across social gradient Share (%) of people reporting unmet need for health care

due to cost, travel distance or waiting time, EU28 8 6 4 2011 2010 2009 2008 2007

2005 0 2006 2 Poorest quintile Unemployed Least educated Older people (65+) Women and girls

IE (total population) NL (total population) 2013 15 million people 10 Source: EU-SILC; EU-wide data only available from 2005 18 million people

2012 12 % m e d ic in e c o s ts p a id o u t-o f-p o c k e 100 90 80 70 60 50 40 30 20

10 0 L u x e m b o u rg N e th e rla n d s G e rm a n y S p a in S lo v a k ia EU15 F ra n c e G re e c e EU28 C z e c h R e p u b lic Sweden S lo v e n ia

P o rtu g a l H u n g a ry EU13 D e n m a rk Ita ly P o la n d L ith u a n ia M a lta U n ite d K in g d o m Ir e la n d A u s tria F in la n d B e lg iu m E s to n ia

L a tv ia Many countries have shifted medicine costs onto households Before and after the crisis: lower vs higher out-of-pocket share Source: WHO HFA database; earlier year is lowest OOP share before 2007; later year is most recent year of data (usually 2011) The evidence and data shows that Health is distributed across the social gradient. Focusing solely on the most disadvantaged is not sufficient we need proportionate universalism .

Investments are needed across the social gradient. Action is needed to deal with the causes of the causes of ill health, which include poverty, long-term unemployment, poor working conditions, early school leaving, household deprivation.. as well as risks. Link with sustainable development for affordable health

and equity for all Frameworks for action exist act in context Capacities to act Coverage & affordability Timely availability Availability of services Key factors in meeting needs

Accessible facilities, language, literacy, waiting time guarantees (severity) Quality of patient-provider interaction, cultural competence, e-health Data issues, marked socio-economic gradient, role of underlying inequalities requires attention because it affects already underserved people Availability

What is measured is not always useful Data systems inadequate Need for disaggregated data and a population-wide perspective Little transparency, large interests Need to address professional and organisational structures: training, working conditions, skill mix,

Rational clinical practice and prescribing Effective, accessible, resilient and accountable public systems A new generation of data collection for better monitoring: Robust, relevant, comparable indicators disaggregated by region and sub-groups of people Timely, visible, harmonised data collection that safeguards privacy Focus on unmet need, utilisation, user experience, financial protection and hard-to-reach people Context-specific policy analysis

Action CHRODIS can make strategic contribution A common purpose to act in context Priorities Partnerships Policies Practices Thanks and links Thanks to Dr Sarah Thompson, WHO Europe,

Eurostat, OECD and ECDA. Caroline Costongs, Cristina Chiotan, Anne Pierson and Anna Gallinat plus Ingrid Stegeman EuroHealthNet members join them?

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