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 annual European Public Health Conference "Mind the gap: Reducing inequalities in health and health care",Glasgow, 20th November 2014.

1. HOW TO REDUCE HEALTH INEQUALITIES?
Results of 4 EU funded projects
www.demetriq.eu www.health-gradient.eu
www.silne.ensp.org www.sophie-project.eu

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 www.health-gradient.eu
www.silne.ensp.org www.sophie-project.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.demetriq.eu www.health-gradient.eu
www.silne.ensp.org www.sophie-project.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.demetriq.eu www.health-gradient.eu
www.silne.ensp.org www.sophie-project.eu

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

21. The Neighbourhoods Law (Llei de barris), an integrated urban renewal program
The Neighbourhoods Law (2004-2011),
implemented by the Government of Catalonia,
led to large-scale urban renewal interventions in
deprived neigbhbourhoods across Catalonia.
It focused on physical improvement, social
integration and economic gains, in order to
improve living conditions of residents.
143 neighbourhoods participated in the initiative
(approximately, 1.3billion € invested).
Distribution of Neighbourhoods Law funding by
type of interventions
The Neighbourhoods law in the City of Barcelona
15 of 73 neighbourhoods participated, which represents the 10% of Barcelona’s population
The effects of the Neighbourhoods Law on health and health inequalities
SOPHIE researchers have analyzed the effects of the Neighbourhoods Law on the well-being
of neighbours. We have conducted two studies (quantitative and qualitative) to
assess the evolution of health status of residents in 5 renewed neighbourhoods in
Barcelona and compared them to people of non-intervened neighbourhoods with similar
socio-economic conditions.

22. Conclusions
Qualitative study: perception of neighbours towards changes in their neighbourhoods
• The majority of projects within the Neighbourhood Law were perceived as having both positive and
important effects on the well-being of participants.
• The study also highlights the importance of incorporating participants with different characteristics
(age, gender, socioeconomic positions, etc.) in order to better understand the effects of the
intervention on different populations.
Mehdipanah, R., Malmusi, D, Muntaner, C., and Borrell, C. “An evaluation of an urban renewal program and its effects on neighborhood resident’s
overall wellbeing using concept mapping”. Health and Place, 2013; 23: 9-17. http://www.sciencedirect.com/science/article/pii/S1353829213000695
Quantitative study: changes in two health indicators (self-rated health & mental-health)
• In areas intervened by the Neighbourhoods Law, self-rated health improved amongst residents of both
sexes and especially those in the manual social classes.
• Similar observations were made for mental health status in women, while in men, the
Neighbourhoods Law appeared to prevent the increase in poor mental health observed in men from
the comparison group.
Mehdipanah, R., Rodriguez-Sanz, M., Malmusi, D, Muntaner, C., Diez, E., Bartoll, X., and Borrell, C. “The effects of an urban renewal project on health
and health inequalities: A quasi-experimental study in Barcelona”. Journal of Epidemiology & Community Health, 2014; 68: 811-817
http://jech.bmj.com/content/early/2014/04/30/jech-2013-203434
This research has helped to show how urban renewal policies can improve population’s health.
In Barcelona, Neighbourhoods Law has improved health and reduced health inequalities.
Urban renewal projects that include improved accessibility, walkability, social integration
programs, among other interventions, are effective to improve the health of their residents.

23. www.demetriq.eu www.health-gradient.eu
www.silne.ensp.org www.sophie-project.eu