“Implementing Strategies on Reducing Health Inequalities”

Federal Centre for Health EducationBZgABZgA

“Implementing Strategies on Reducing Health Inequalities”

“More Equal and Healthier Societies” Budapest, Hungary, 30th November 2010

Helene Reemann

Federal Centre for Health Education, BZgA


Inequalities are observed in all European member states as well as in Germany


Content

1. Health inequalities in Germany2. Structures and strategies to tackle health

inequalities3. Evaluation and quality development4. Summary


Prevalence of smoking by income and sex Men Women

Income group

%

age

(SOEP Study; Lampert et al. 2005)


Prevalence of physical inactivity by income and sex

Men women

Income group

%

age

(SOEP Study; Lampert et al. 2005)


Risk of chronic diseases in low educatedmen and women

Disease Men women

Myocardial infarctionStroke

Angina PectorisHypertension

CancerDiabetes

Chronic BronchitisArthrosisArthritis

Chronic back painDizziness

(Federal Health Survey; Lampert et al. 2005)


Childrens participation in checkups in the first six living years by parental socio-economic status

%

Socioeconomic status

Low

Medium

high

Checkup

(Berlin, school enrolment examination 2005)


Risk of premature mortality in lower income men and women

0

0,5

1

1,5

2

2,5

3

Men Women

<60%<80%<100%<150%>=150%

Odds Ratio

Income group

(SOEP Study; Kroll & Lampert 2009)


BZgA aims at tackling health inequalities by providing structures andimplementing low barrier strategies


CommunicationPlanning, implementation and

evaluation of national prevention campaigns and programmes on

health promotion

Quality assurance and researchEffectivity and efficency in prevention,

Evaluation of measures and campaigns

National and international Cooperation / Coordination

Intersectoral cooperation with governmental/non-govenmental

organisations of the health sector with science and other policy

sectors

Federal Centre for Health Education (BZgA)


Tackling health inequalities

…is one central aim of the Federal Centre for Health Education

3 main drivers:- Attitudes and skills of individual person- Social environment and settings- Socio-cultural conditions

Promote healthy behaviour in daily life! Networking structures & low barrier strategies


Providing structures in Germany: Cooperation Network „Health promotion for the socially disadvantaged“


16 Regional Hubs


Structures enable transfer

Good practices on internet platform www.gesundheitliche-chancengleichheit.de

Project examples and quality criteria in publications

Knowledge exchange at events and conferences

Workshops in selected settings (e.g. Kita)

Congress Poverty and Health


Structure development in Germany and Europe

Europe Länder LevelFederal Level

EU Project ‚DETERMINE‘ with 26 partner countriesEU-, national and

local level

Regional Hubs‚Poverty and Health‘ in

16 federal states

German project ‘Health Promotion for

socially disadvantaged people’

European Directorywww.health-

inequalities.eu

National Directory with some 1,700 projects

www.gesundheitliche-chancengleichheit.de

Länder – platforms within the national directory


Providing structures in Europe: EU projects ‚Closing the Gap‘ and Determine‘

www.health-inequalities.eu


Implementing strategies: National Centre on Early Prevention

Aim- Protect children 0-3 years early and effective by linking services

Methods- Coordinate local public health and youth welfare services- Identify families with educational needs and in stressful situations- Develop and improve effective interventions on strenthening

parental skills Results (preliminary)

- More than 50 % of youth welfare and public health are active in early prevention

- Expressed need in terms of financial consulting, data protection, risk idenfication, qualification of employees


Implementing strategies: Gut Drauf (In good mood) Aim

- Improve nutrition, physical activity and stress management in adolescents 12-18 years

Methods- Offer high quality activities in adolescent settings

(school & business, sports & leisure time…) - Behaviours AND circumstances- Link and qualify intermediaries - Quality criteria and certification


Implementing strategies: Komm auf Tour („Get going – my strengths, my future“)

Aims- Strengthening self-confidence among students on lower

educational levels- Promoting vocational orientation combined with life and familiy

planning, prevention of teen-age pregnancies Methods

- Students discover personal strengths and occupational orientation in joint-in-circuit

- Include parents, teachers and local collaborators Results

- Change of attitudes in terms of gender role, occupational aptitude, sexuality and family planning


Reach

650-700 persons/each regional measure

100.000 persons in 152 regional measures from 2006 to 2010

Nordrhein-Westfalen

LandBaden-Württemberg

Land Brandenburg

Land Berlin

Pilot Ilmenau/Thüringen

Landkreis Uelzen

LandkreisHavelland

Pilot Leipzig/ Sachsen

Lernende Region Bodensee

Pilot Salzwedel/Sachsen-Anhalt


Children and adolescents

Health problems as consequence of problems to fulfil developmental tasks (primary and secondary socialisation)

Social change: increase of broken families, poverty Support parents and educators Nutrition, physical activity and

stress regulation main issues


Implementing strategies: Districts with special development needs – The Socially Integrative City Aim

- Support district managers in terms of health promotion/prevention

Methods- Federal-Länder-programme to counteract the widening

socio-spatial rifts in the cities- Strategies for action regarding: healthy settings,

problems and solutions; project development, prevention of poor diet, phyiscal inactivity and stress, quality development


Evaluation is still a challenge. Individual projects show that improving health behaviour in socially disadvantaged is possible. Quality criteria can support this process


1 / Basic criteria Concept Target group Settings

2 / Work with the target group Snowballing Low barriers

Participation Empowerment

3 / Sustainability and quality development

Innovation but sustainability Multidisciplinary collaboration Quality management Documentation and Evaluation Cost efficiency

Quality criteria for health promotion with the socially disadvantaged

Recognized by statutory health insurances as criteria for projects to be promoted!


Aim: Representative survey of children and adolescent health 0 – 17 years

Baseline: 2003 - 2006 Response: 17.641 boys and girls and their parents

from 167 cities Data and recommendations from a public health

perspective

German Health Survey of Children and Adolescents (KIGGS)


Strategy of the Federal Government for the Promotion of Child HealthMain goals

To promote health equity among all children and adolescents

To improve the overall conditions, to motivate and to integrate a healthy lifestyle into the everyday life of children

To reduce health risks

To support the physical and psychological development of children and adolescents

To raise awareness for the issue of child health


4. Summary

Data on health inequalities show the need of tackling health inequalities in Germany

Tackling health inequalities ideally combine sustainable structures and accessible and acceptable strategies and interventions

Structures of cooperation are based on a broad range of actors from the health field and other political sectors

Strategies should be implemented in daily life of target groups AND reduce barriers while providing options for empowerment and

participation.


Thank you for your attention!

[email protected]

Documents

“Implementing Strategies on Reducing Health Inequalities”