"SOPHIE conclusions: Social and economic policies can change health inequalities", by Carme Borrell. The final conference of the European research project SOPHIE took place on 29th September 2015, in Brussels. Here are presented the main findings and policy implications of the project.

1. Carme
Borrell
SOPHIE
conclusions:
Social
and
economic
policies
can
change
health
inequali9es

2. Economic
recessions,
fiscal
policies
and
health
• The
health
impact
of
the
recent
Great
Recession
in
Europe
depends
on
the
health
indicator,
country
level
of
social
protec<on,
and
individual
socioeconomic
posi<on
and
gender.
• Social
protec<on
policies
appear
to
be
effec<ve
in
limi<ng
the
sensi<vity
of
mortality
to
macroeconomic
fluctua<ons.
• Interven<ons
to
protect
and
promote
mental
health,
to
prevent
suicides,
to
treat
mental
disorders
and
to
prevent
harmful
drinking
become
especially
relevant
in
<mes
of
economic
hardship.
• Even
though
recessions
may
reduce
mortality
in
the
short
term,
those
posi<ve
effects
may
be
more
than
compensated
by
the
mortality
increasing
effect
of
austerity
policies,
at
least
as
far
as
some
causes
of
mortality
are
concerned.

3. Generous
social
protec9on
policies
reduce
poverty
and
improve
health
• Generous
unemployment
insurance
policies
reduce
material
hardship
and
psychological
distress
for
the
unemployed
and
the
employed.
• Health
benefits
can
arise
from
increasing
unemployment
insurance
generosity,
specifically
to
ensure
that
the
majority
of
unemployed
individuals
receive
unemployment
benefits.
• A
large
propor<on
of
new
onset
of
chronic
illness
is
aJributable
to
unemployment.
Policy
interven<ons
that
maintain
employment,
and
rapidly
return
the
unemployed
back
into
the
workforce,
can
reduce
the
burden
of
chronic
condi<ons
in
European
health
care
systems.
• Generous
family
support
policies
are
predic<ve
of
less
child
poverty.
Increased
ac<ve
labour
market
policies
spending
is
linked
to
beJer
popula<on
health.
Opposi<on
efforts
to
social
protec<on
cuts
are
successful
when
the
target
group
is
poli<cally
powerful.

4. High
quality
employment
in
a
regulated
labour
market
is
beneficial
for
workers’
health
and
reduces
inequality
• To
measure
and
monitor
precarious
and
informal
employment
and
their
health
impact,
standardised
defini<ons
and
indicators
have
to
be
developed
as
well
as
strongly
improved
surveys
and
informa<on
systems.
• Employment
condi<ons
and
quality
of
employment
and
their
rela<on
with
health
inequali<es
differ
between
and
within
EU-­‐countries.
The
growth
of
precarious
employment
must
be
halted,
and
jobs
should
become
more
secure
and
of
beJer
quality
in
order
to
protect
the
health
and
well-­‐being
of
workers,
and
reduce
social
inequali<es
in
health.
• Employment
security
and
the
quality
of
psychosocial
working
condi<ons
and
work-­‐family
balance
should
be
improved,
also
for
self-­‐employment
and
micro-­‐enterprises.
Labour
market
policies
such
as
employment
protec<on
legisla<on,
part-­‐<me
arrangements
or
workers'
safety
representa<ves
impact
on
workers’
health.

5. Urban
planning
maFers
for
health
equity
• Social
and
func<onal
mix,
density,
safety
and
accessibility
all
maJer
for
health,
therefore
the
way
ci<es
manage
urban
planning
makes
a
difference
in
the
health
of
residents,
especially
women
and
elderly.
• Policies
aiming
at
equal
access
to
recrea<onal
facili<es,
markets
and
other
core
public
services
may
not
be
enough:
deprived
neighbourhoods
may
need
more
tailored
investments
for
benefi<ng
from
the
health
promo<ng
role
of
urban
density,
access
to
public
spaces
and
facili<es,
and
a
vital
mix
of
func<ons.
• As
an
example,
the
popula<on
health
in
the
more
deprived
areas
could
benefit
from
investments
in
urban
regenera<on.
Different
urban
renewal
projects
have
been
shown
to
have
a
posi<ve
impact
on
self-­‐reported
health
and
the
reduc<on
of
socioeconomic
health
inequali<es,
or
to
s<mulate
healthy
behaviours,
but
not
to
reduce
traffic
injuries.

6. Housing
policies
can
reduce
health
inequali9es
• A
large
body
of
literature
shows
the
link
between
inadequate
housing
condi<ons
and
poor
physical
and
mental
health.
• In
Europe,
housing
condi<ons
related
to
fuel
poverty
are
unevenly
distributed
and
affect
health.
• Housing
insula<on
for
fuel-­‐poor
households
can
improve
health
and
reduce
cold-­‐related
mortality.
Policies
need
to
be
free
to
users,
targe<ng
the
most
affected
groups
and
adapted
to
their
needs.
• Public
policies
that
tackle
housing
instability
and
their
consequences
are
urgently
needed
especially
in
Southern
European
countries,
where
people
facing
housing
exclusion
experience
drama<c
levels
of
mental
distress.
Access
to
secure
and
adequate
housing
can
improve
health
of
these
popula<ons.

7. Gender
policies
influence
gender
inequali9es
in
health…
• Gender
inequali<es
in
health
are
larger
in
countries
with
policies
less
oriented
towards
gender
equity.
• Policies
that
support
women’s
par<cipa<on
in
the
labour
force
and
decrease
their
burden
of
care,
as
for
example
increasing
public
services
and
support
for
families
and
en<tlement
for
fathers,
are
related
to
lower
levels
of
gender
inequali<es
in
health.
• Parental
leave
reserved
for
both
parents
with
universal
coverage
and
earning
replacement,
and
working
<me
flexibility
to
balance
family
demands
seem
to
contribute
to
equalising
gendered
<me
use.
• Public
services
and
benefits
for
disabled
and
dependent
people
can
reduce
the
burden
placed
on
their
family
caregivers,
improving
their
health.

8. Integra9on
policies
make
a
difference
on
immigrants’
health
• Different
integra<on
policy
models
across
Europe
appear
to
make
a
difference
on
immigrants’
health.
• Immigrants
in
"exclusionist"
countries,
with
severe
restric<ons
in
access
to
ci<zenship
and
liJle
policies
for
integra<on,
suffer
poorer
health,
more
depression
and
higher
mortality.
Therefore,
adop<ng
restric<ve
policies
in
areas
related
with
immigrants’
integra<on
may
have
health
consequences.
• Within
the
healthcare
sector,
legal
barriers
in
the
en<tlement
to
public
systems
hinder
immigrants’
access
to
necessary
care.

9. The
assessment
of
health
equity
impact
of
structural
policies:
evalua9on
of
research
methods
• Mixed
methods
are
essen<al
to
the
evalua<on
of
structural
policies.
• Quan<ta<ve
compara<ve
approaches
yielded
novel
knowledge.
• Realist
approaches
help
to
address
new
and
vital
ques<ons.
• If
the
health
impact
can
be
assessed
for
a
popula<on
at
large,
it
is
possible
in
principle
to
also
assess
this
impact
according
to
socioeconomic
posi<on
or
other
axes
of
inequality.
• Most
compara<ve
studies
would
not
have
been
possible
without
the
European-­‐wide
surveys
that
were
ini<ated
in
the
last
10
to
15
years.
We
strongly
recommend
further
development
of
these
surveys.

10. Maximising
the
social
impact
of
health
equity
research
• Par<cipatory
data
collec<on
methods
gather
important
perspec<ves
that
enrich
the
evalua<on
of
the
impact
of
social
policies.
• Several
barriers
can
be
found
in
the
recruitment
of
vulnerable
groups
affected
by
the
policy.
Frontline
professionals
can
help
to
reach
them
and
may
be
a
complementary
source
of
informa<on.
• Research
involvement
of
social
organisa<ons
like
Caritas
requires
a
mutual
understanding
and
constant
dialogue
with
academic
groups,
and
a
balance
between
research
needs,
its
priority
mission
of
social
care,
and
avoiding
false
expecta<ons
in
par<cipa<ng
users.
Nevertheless,
the
voice
of
these
organisa<ons
is
highly
valued
by
society
and
can
maximise
research
impact.
• Researchers
should
make
efforts
to
ac<vely
disseminate
through
emerging
social
channels
their
work
and
knowledge,
and
funding
agencies
and
research
ins<tu<ons
should
back
these
efforts.

11. Social
and
economic
policies
can
change
the
extent
of
social
inequali9es
in
health
• SOPHIE
has
contributed
to
the
accumula<on
of
evidence
regarding
the
influence
of
social
and
economic
policies
on
the
level
of
health
of
the
popula<on
and
on
the
extent
of
inequali<es
in
health
status
on
grounds
of
socioeconomic
posi<on,
gender
or
immigrant
background.
• At
the
same
<me,
SOPHIE
has
shown,
through
the
analysis
of
several
examples
across
Europe,
how
equity-­‐oriented
policies
can
achieve
a
reduc<on
of
these
health
inequali<es.
• These
studies
provide
a
strong
case
for
fairer
social
and
economic
policies
as
a
way
to
reach
the
reduc<on
of
health
inequali<es
which
many
governments
are
puang
among
their
targets.

12. www.sophie-­‐project.eu
www.slideshare.net/sophieproject
SOPHIE
website:
All
about
SOPHIE:
News,
Themes,
Publica<ons,
Media
(press
releases
and
impacts)
and
more…
TwiFer:
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To
share
#HealthInequali<es
related-­‐issues,
own
ar<cles,
#ar<cleofheweek,
news,
and
any
interes<ng
informa<on
about
#SOPHIE,
and
similar
research
projects.
Slideshare:
PRESENTATIONS
and
REPORTS
in
OPEN
ACCESS
www.twiFer.com/sophieproject
Online
resources
on
SOPHIE
and
Health
Inequali9es
:
our
main
dissemina9on
channels
Youtube
and
Vimeo:
SHORT
VIDEOS
to
explain
our
research
findings
www.youtube.com/sophieprojecTp7

13.
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