How to reduce health inequalities? Recommendations to government ministers from four EU-funded projects: DEMETRIQ, DRIVERS, SILNE and SOPHIE, by Margaret Whitehead, United Kingdom; Johannes Siegrist, Germany; Anton Kunst, The Netherlands; Carme Borrell, Spain. Presented at the 7th European Public Health Conference: "Mind the gap: Reducing inequalities in health and health care". Glasgow, 20th to 22nd November 2014.

1. HOW TO REDUCE HEALTH
INEQUALITIES?
Results of 4 EU funded projects
Edited by Johan Mackenbach

2. Developing Methodologies to Reduce Inequalities in the Determinants of Health
The health inequalities impact of
natural policy experiments
Margaret Whitehead
University of Liverpool, UK
demetriq.eu
Demetriq received funding
from the European
Union’s Seventh
Framework Programme
(FP7/2007-2013) under
grant agreement no.
278511

3. Beneficial impacts of policies: findings
• Policies that promote financial security for the
worst off boost their employment chances
• Better job security reduces adverse effects of
recession
• Smart public investments in health and social
protection return up to 3 Euros for each 1 Euro of
spending
• Fairer pay reduces mental health inequalities
demetriq.eu

4. Improved mental health
demetriq.eu
Source: Reeves, Stuckler et al, 2014
• Introduction of
National Minimum
Wage improves
GHQ scores
• People felt
significantly less
under financial
stress

5. Policy messages
• Some social welfare and labour market reforms
have had adverse effects, falling most heavily on
the most disadvantaged
• Governments have real policy options to deal with
recession while protecting the worst off
• Changes in national policies need to be assessed
for their impact on the health and wellbeing of
different socioeconomic groups in society
demetriq.eu

6. demetriq.eu

7. www.demetriq.eu

8. Reducing health inequalities by
improving work and employment
conditions
Johannes Siegrist
Senior Professor of Work Stress Research,
University of Düsseldorf, Germany
DRIVERS is co-ordinated by EuroHealthNet and has received funding from the European
Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°278350

9. The life course approach of DRIVERS
Early
childhood
Health
Equity
Working
conditions
Social
Protection

10. Social gradient of health-adverse
work stress across Europe
Level of national labour market
integration and work stress score
Source: Wahrendorf M et al. (2013) European Sociological Review 29:792-802. Wahrendorf M, Siegrist J. (2014) BMC Public Health 14:849.

11. Epidemiological evidence
• Work stress is associated with elevated risks of depression,
CHD, and disability in employed populations across Europe
(OR varying between 1.3 and 2.0).
• Work stress is a mediator in the relationship of socioeconomic
position (SEP) with health.
• SEP moderates the effect of work stress on health: stronger
effects among lower SEP groups.

12. Policy recommendations
• Improve monitoring of health-adverse working conditions and
the provision of occupational health services, especially among
lower SEP groups.
• Promote health equity by tackling structural determinants of the
work-related burden of disease.
• Prioritise social and labour policies that strengthen sustainable
employment in national budgets, particularly in contexts of
neoliberal policies and strong fiscal austerity measures.

13. www.health-gradient.eu

14. Smoking inequalities:
learning from natural experiments
Anton Kunst
Department of Public Health
AMC / University of Amsterdam

15. Key finding 1:
In 2013, socioeconomic disadvantage was intimately related to
smoking initiation across all Europe

16. Key finding 2:
Despite strong developments in tobacco control since 2000,
inequalities in smoking cessation have not diminished

17. Key finding 3:
Specific tobacco control measures do reduce smoking
in all groups, though not more in lower groups
• The ‘equity impact’ tobacco tax is mostly positive,
though variable
• The ‘equity impact’ of smoking cessation services is
variable but often negative

18. Key message:
We need new strategies to stop this addictive, toxic,
commercial product affecting disadvantaged people
• Stronger supply-side policies
(product composition, sales, advertisement)
• Equity-oriented demand-side programs
(focus on disadvantaged youth)

19. www.silne.ensp.org

20. More info
www.sophie-project.eu
@sophieproject
info@sophie-project.eu
Play video

21. www.sophie-project.eu