Congress report - European Health Forum Gastein

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50 European Health Forum Gastein 2001 Hardly any of the ‘health sector’ reforms underway in many European countries address these four questions in a systematic manner. (77,45). IFH is a practical attempt to answer the above-mentioned questions by: identifying relevant policy attributes; considering factors that may enhance or inhibit policy change; assessing options that benefit both health and the specific policy sector; and planning the political process of achieving the necessary legislative, regulatory, financial, organizational or educational changes (76). In some circumstances IFH will require substantial policy change, which may involve major financial, institutional, human, regulatory, or educational efforts. Ensuring and managing these changes is a key part of IFH practice. In summary, IFH is a deliberate attempt to address the main “causes” of health in a credible, effective and ethical manner that engages other sectors of society as well as the health care sector (40,76). The approach develops policies and programmes that are based on, and address, key determinants of health. Such determinants are mainly linked to economic and social factors (61,66,68,73). Stimulating and securing the self-interest of other relevant sectors of society is critical. Positive changes for health should be facilitated at both individual and community level. Therefore, unhealthy life conditions (e.g. poverty, inequalities and social exclusion) should be modified not only bio-medical risk factors! Finally, it should be emphasized that IFH does not take a narrow view of solely utilitarian aspects of investment and economic trade-offs. It places the protection and promotion of the health of the population firmly within a human right perspective, as well as an indictor of human and social development. Thus, IFH is not confined to mere issues of costs-benefits analysis of selected prevention and health promotion programmes. Indeed, Investment for Health focuses on maximization of assets for health. This issue will be explored in more detail below. Likewise, IFH is sensitive to the removal of social, economic and environmental barriers to the promotion of health. These adverse conditions can be associated with a wide range of factors, including lack of democracy and infringement of human rights, the burden of the external debt of many developing countries, or the unequal distribution of resources and opportunities for social and personal development. 2. Social and economic determinants of health: The evidence for IFH Until quite recently, public health practice, including the range and selection of interventions, has been guided almost exclusively by evidence drawn from medical epidemiology (60; 68). Far less attention has been given to the effect of economic and social development on a population’s health. The notion that public health decisions must be profoundly linked to wider social and economic goals to ensure sustainable benefits is still not widely appreciated. Nevertheless, an expanding literature has been making a powerful case for the relationship between health and economic development (11,12,21,30,31,33,34,41,43,44,56). 2.1 Evidence from the Past In the last 150 years, in the European Region, there has been a dramatic change in the epidemiological patterns of ill-health. Much has been published already on the fact that in the more advanced industrialized nations of Europe (as well as world-wide) there has been a reduction in the massive toll of infectious diseases such as cholera, poliomyelitis, tuberculosis, etc. These were the epidemics which typically affected populations in earlier stages of urbanization (33). Using data from England and Wales (similar results have been obtained in studies carried out in several other European countries), McKeown (34) confirms that the halving of mortality rates (from 23/1000 in 1851 to 11/1000 in 1980) and the doubling of life expectancy (females: from 40 years in 1840 to 76 years in 1980; males: from 43 years to 70 years) are explained by the reduction of infectious causes of death associated with International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org
Plenary Session I + II improvements in the environment (e.g. the introduction of sanitation measures), living conditions (e.g. better housing and nutrition), and other factors related to social and economic development (e.g. increased family income). Medical breakthroughs, such as the availability of vaccination and immunization, came after the Second World War, by which time the major drop in mortality rates had already occurred (35). In developed countries, the receding pandemics of infection during the 18th and 19th centuries were attributable more as a response to social, economic and environmental changes than to medical breakthroughs (34). The latter were few and came too gradually and too late to be responsible for the changes in health and disease patterns. The policy implications of all this are still largely overlooked. There is no doubt that the explanation for this reduction in mortality is strongly linked to improvements in living and working conditions brought about by social and economic development (14,33,34,35,41,43,79). To argue that falls in death rates and the decline of pandemics in the last two centuries have been primarily related to changes in the environment, in the nutritional status of the population, in the supply of clean water, in the effective disposal of excreta, rather than to a specific medical intervention is not to downplay the role of the medical profession in achieving these successes. In many cases it was physicians who saw the relationships between nutrition, water supply, sanitation, poverty and illness and forced the authorities to take action (46,47). Health professions have played, and continue to have, an important role to play in changing disease patterns. What is important to recognize is that the actions to control or eradicate diseases are often social, economic or environmental interventions. 2.2 Evidence from the Present Turning to the present, a number of recent studies focus specifically on the issue of social and economic development as key categories of health determinants (8,9,13,31,35,48,53,54,56). Several studies point out that the early signs of deterioration in the health status of populations are, in general, determined by changes in their social, economic and environmental conditions (see for example: 23,48,50,56,57,58). At national level, there is a demonstrable relationship between economic performance, income distribution, and health status, which has significant implications for social and economic policy-making. The higher a country’s average income per capita and the more equal its income distribution, the greater the likelihood of longer and healthier lives for its population (61,64). Maternal and child health patterns often reflect general economic trends. For example, child and infant mortality rates have been found to be sensitive to economic hardship. Studies in developing countries have shown that a 10% increase in income per capita corresponds to a 3.5% fall in child mortality rates (57). According to the World Bank, this estimate reflects the total impact of income on health. It includes efforts working directly through income (e.g. food consumption), as well as indirectly through factors that are themselves mainly determined by income (e.g. access to safe water and sanitation, availability of health care, etc.). There is now overwhelming evidence that much of contemporary illnesses and death (and thus the potential for the promotion of the health of the population) are rooted in the prevailing type of economic development and linked to social factors (8,9,11,12,13,30,48,53). In general, if economic development goes hand in hand with decreasing social inequalities, is environmentally friendly and strengthens social capital, it will have positive impact on a wide range of social and health indicators. In both developed and developing countries the number of people in poverty is an especially important reason for differences (inequalities) in health. In every society the income and status of women exact a powerful influence on population health. Especially in the poorest countries, policies that accelerate family income International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org 51
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Page 12 and 13: 12 Preface David Byrne European Hea
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Page 84 and 85: 84 Key Issues There are a number of
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100 European Health Forum Gastein 2
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104 Identifying EEA Doctors and Nur
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106 Figure 3: Nurses registered wit
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214 Summary Report of Forum V Stipe
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238 Main features of this database:
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242 DRAFT GUIDELINES ON QUALITY CRI
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244 Petra Wilson Statement not avai
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Inserat DaMe
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276 Final Programme 2001 Programme
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278 Friday, September 28th , 2001 0
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280 Forum II: Globalisation, World
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308 Ms. Regina Sauto Information an
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