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Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe

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Göran Dahlgren at University of Liverpool
Göran Dahlgren
Margaret Whitehead at University of Liverpool
Margaret Whitehead
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Abstract

This is the second in a series of discussion papers from the WHO Regional Office for Europe. The first covers concepts and principes of equity in relation to health, and should be read in conjunction with this paper (Whitehead 1990). The present paper sets out to develop the discussion further by outlining a strategic approach to promote greater equity in health between different social and occupational groups. This draws on the work of WHO advisory groups and associated litterature listed at the back, together with practical examples from industrialized countries where strategies have been put into action. The first part (section 1-9) of the paper outlines why equity is seen as a priority and distinguishes different policy levels for interventions. Specific equity aspects related to each policy level are then highlighted as well as some case studies. The second part of the paper (section 10-14) deals with putting policy into practice. Special attention is then paid to the need for comprehensive approaches to combat social and occupational inequities in health as illustrated in terms of a strategy matrix. Furthermore the democratice process within which healthy public policies are to be discussed and determined is discussed as well as organizational aspects as regards the implementation of an equity oriented health policy. Finally checklists are presented focusing upon how to make things happen.
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Dahlgren, Göran & Margaret Whitehead
Policies and strategies
to promote social
equity in health
Background document to WHO – Strategy paper
for Europe
This working paper was originally published in print form in September 1991. The figure
“The Main Determinants of Health” has been revised in this version.
Arbetsrapport/Institutet för Framtidsstudier; 2007:14
ISSN: 1652-120X
ISBN: 978-91-85619-18-4
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ISSN: 1652-120X
ISBN: 978-91-85619-18-4
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Generation Victoria (GenV): protocol for a longitudinal birth cohort of Victorian children and their parents
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Full-text available
  • Dec 2024
Статья посвящена обобщению и уточнению классификации факторов качества жизни населения. В качестве методологической основы исследования избран дискурс‐анализ, позволивший провести изучение научных работ, опубликованных в академической литературе. Показан континуум понятий «фактор», «причина», «условие», «предпосылка», поскольку применительно к прикладным исследованиям социально‐экономических процессов данные понятия рассматриваются исследователями в качестве синонимов. Предложено разграничить понятия «фактор» и «индикатор» применительно к категории качество жизни населения. Определено, что индикаторы, как показатели, позволяют оценить состояние качества жизни населения, измерить результат влияния факторов, как «движущих сил», на уровень и качество жизни общества, но не равны им. Приведена условная типология факторов качества жизни населения по расширенному набору признаков. В дополнение к рассматриваемым в литературе типологизациям факторов по признаку источника возникновения (деление факторов на внешние и внутренние, а также объективные и субъективные) предложено классифицировать факторы качества жизни населения по значимости – на основные и второстепенные; по времени действия – на временные и постоянные; по возможности количественного измерения – на количественно измеряемые и трудно поддающиеся количественным измерениям. Расширена и дополнена классификация факторов качества жизни населения, построенная по принципу выделения групп факторов в соответствии со сферами жизни общества. На основе существующих подходов к классификации факторов качества жизни населения были выделены социальные, экономические, финансовые, институциональные (в том числе политико‐правовые), инфраструктурные, культурные (в том числе духовно‐нравственные), природно‐климатические, экологические и технологические. Проанализированы взаимосвязи факторов как внутри групп, так и во вне. Предложенные в исследовании признаки типологизации, а также расширенная классификация факторов качества жизни населения помимо приращения научного знания носят практический характер, поскольку позволяют усовершенствовать методологию оценки качества жизни, что позволяет учитывать более широкий спектр аспектов, влияющих на благополучие населения, тем самым повышая полноту и достоверность оценок.
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Social prescribing initiatives connecting general practice patients with community-based physical activity: A scoping review with expert interviews
Article
  • Dec 2024
  • SCAND J PUBLIC HEALT
Aims The World Health Organization states that physical inactivity is one of the leading behavioural risk factors for disability and mortality in Europe. Social prescribing holds promise as a possible solution by connecting patients from general practice to community-based physical activity. Although research within social prescribing exists, the process of connecting general practice patients to community-based physical activity is not well investigated. This scoping review aimed to summarise and synthesise knowledge on social prescribing provided by health professionals in general practice towards community-based physical activity. Methods A systematic search for literature in PubMed, Embase, Scopus, SportsDiscus and other sources was conducted to identify initiatives connecting general practice to community-based physical activity. Semi-structured interviews were then conducted with subject-specific national experts. Finally, preliminary findings from the literature and the interviews were used in a co-creation process with experts to synthesise and finalise the results of a thematic analysis across data sources. Results Based on 19 records, five expert interviews and subsequent co-creation, we identified three themes: (a) barriers and facilitators, (b) organisational perspectives and (c) value-based considerations. Conclusions This review illuminates the complex nature of social prescribing programmes that connect general practice patients to community-based physical activity in Denmark. It also presents practical and fundamental considerations when applying social prescribing across different settings.
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The Sustainable Society in Swedish Politics: Renewal and Continuity
Research
Full-text available
  • Jul 2015
The aim of this article is to study how the ideas of a sustainable society have developed and adapted to Swedish politics. It starts with the assumption that new ideas have a greater possibility to make a difference if they adapt to the political culture, and if important actors make the ideas their own. This issue is studied for the years 1988-2004. One conclusion is that social democratic welfare ideology has given its imprint in the rhetoric of a sustainable society. Another conclusion is that the ideas has been obtained in party ideology from left to right and been adapted to traditional ideological differences.
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Det effektiva samhället eller det goda livet? Svenska framtidsstudier om arbetsliv och fritid från 1970- till 1990-tal
Article
Full-text available
  • Jan 2007
The study analyzes three generations of future studies on work life and leisure, performed at the Secretariat and later the Swedish Institute for Future Studies. The ideal types of Tore Frängsmyr, “The efficient society” and “The good life”, are used as analytical tools. The primary information consists of program declarations and reports from projects in the 1970- 1980- and 1990s. In the 1970s the original plan to produce a final report failed, and the analyses here show that differences in terms of the ideal types here used could explain the failure. While in one of the reports studied, the focus is on how Sweden is to maintain a high export ratio and a prominent position in international competition, the two other reports are written from an explicit Marxist perspective and discuss how the sharp split between work and leisure in modern capitalist societies could be remedied. That is, while the first report is focused on “The efficient society”, the two latter deal exclusively with a version of “The good life”. The final report from the project of the 1980s is characterized by a reserved, but still in some sense accepting, attitude towards the high-technological society. Utopian thoughts of a completely different society are non-existing, but the discussion mainly focuses on ways to make high-technological society as tolerable as possible to humans. In terms of the here used terminology the report can be said to deal with “The good life” within the realms of “The efficient society”. In the final report from the 1990s the point of departure is that industrial society is being replaced by a new post-industrial one. Unlike in earlier projects here studied, the entire discussion of driving forces behind societal development is on the structural level. The possibilities of individuals to shape their future seem small or non-existing. Neither are consequences at the individual level of structural development in focus. It’s is diffi
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The Swedish Conservative Party and the Welfare State. Institutional Change and Adapting Preferences
Article
Full-text available
  • Jan 2006
The paper argues that the Swedish ‘neo-liberal’ party (Moderaterna) has adapted its policies because of the popularity of the ‘universal’ Swedish welfare state. The party has come to accept that the modern welfare state is irreplaceable. We furthermore argue that the party’s moderate electoral platform in 2006 is earnest. In the “short run” the party can only hope to achieve incremental changes and it recognises this. Simultaneously however, the party in the “long run” wants to gradually change society. Over time the party in its rhetoric and ideological statements has emphasised the short and the long run differently. These differences between the ‘neo-liberal’ 1980s and 2006 should not conceal that the mechanism of welfare popularity largely remains the same. The party’s actual policy proposals tend to suggest incremental changes only in both periods.
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Age structure and productivity growth
Article
  • Jan 2007
Among the most central questions at the intersection of demography and economics is the impact of large scale demographic processes on long-run economic performance. The classical version of this inquiry, occupying thinkers from Malthus towards those from the mid-to-late 20th century, had to do with whether rapid population growth threatened economic growth. This classical inquiry has been superseded by more sophisticated questioning in which the focus on growth rate of the aggregate population has been replaced by focus on the growth rates of age-specific population sub-groups. Disaggregating the effects of population growth by age-group is generally accepted to be a fundamental improvement over classical inquiry because people’s economic roles and contributions vary by age: the young are net consumers and beneficiaries of human capital investments, adults are net producers and savers, and the old are (at least in theory or to a greater degree than adults) net consumers. Thus the economic consequences of rapid growth in the population size of the young and the elderly could potentially have a depressing impact on growth, while rapid growth in the population size of adults could stimulate growth. The demographic transition brings with it a three stage process in which a baby boom cohort moves through the population’s age pyramid. The life cycle of this cohort creates a first stage in which there is rapid growth in youth population, then a second stage in which there is rapid growth in the adult population, and finally a third stage in which there is rapid growth in the elderly population. The first and third stages can be thought of as the challenging stages since economies must confront the challenge of providing for large dependent populations. However, the second stage can be thought of as a demographic gift or dividend stage since growth in the productive adult population can potentially boost economic growth. The traditional mechanisms for the demog
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Pension Systems and Pension Reform in an Aging Society. An Introduction to the Debate
Article
  • Jan 2007
Traditionally, pension systems aim to fulfill a number of functions which include income security and consumption smoothing in old age, as well as income redistribution. The main rationale for pension reform lies in the interaction between current demographic trends (e.g. increasing old age dependency ratios) and the design of existing pension systems (particularly, the so called Pay-As-You-Go public systems). Under certain conditions, population aging can in fact undermine the ability of a pension system to fulfill those very aims for which it was created, putting pensioners at risks of higher poverty and inequality, besides creating large fiscal pressures on governments and threaten economic growth. In the literature, we find two main approaches to this debate. On the one hand, economic theory helps us formalize the mechanisms through which aging affects a pension system, given its possible features (e.g. type of benefit offered, degree of actuarial fairness or type of financing); it also helps us quantify costs or returns associated to different pension designs and, consequently, to different pension reform options. On the other hand, the policy debate is centered on models of reform which take from concrete country experiences; overall, it focuses mostly on whether funding pensions (i.e. privatizing and individualizing retirement savings, away from Pay-As-You-Go systems) is the best option for reducing many of the negative economic impacts associated to population aging. After having illustrated both sides of the debate – the theoretical and the empirical - our paper makes two main claims. Firstly, the debate should be re-framed away from whether funding is the best option for pension reform in the face of population aging, towards a redefinition of the problem which rather focus on the type of benefit offered, its coverage, its eligibility conditions and actuarial design (as this controls important behavioral and efficiency implications). Secondly, an
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Has the youth labour market deteriorated in recent decades? Evidence from developed countries
Article
  • Jan 2007
There is nowadays a widespread sense that things have gone badly wrong for young workers in advanced economies, and that the difficulty is caused by a fall in their appeal to employers. It is tempting to attribute the problem to a trend in labour demand that favours older, more experienced workers over younger, less experienced ones. The same line of interpretation has been widely favoured for the other major dimension of employee skill: educational attainment. The contemporary fall in the pay of less educated workers, as compared to more educated ones, in the US and the UK in particular, has been widely attributed to the spread of information technology and globalisation, both of which are taken to raise the productivity of more educated workers relative to less educated ones. An influential account of developments in the US claims that ‘relative demand shifts favouring more skilled workers are … essential to understanding longer-run changes in the US wage structure’ (Katz and Autor 1999: 1513). The same factors might had similar effects in the experience dimension of skill, thereby impairing labour market prospects for young workers. The validity of these propositions has however been contested. Doubts have been raised concerning the existence of skill-bias in technical change (Card and DiNardo 2002). Some commentaries deny the existence of an underlying trend unfavourable to youth (OECD 2002: 20-29). This paper investigates the evidence concerning trends in youth relative pay and employment in developed economies since the mid-1970s, focusing on structural change on the demand-side of the labour market. It improves on previous research by including more countries, and by controlling for macroeconomic fluctuations, which affect youth employment particularly keenly. It then considers the growth of educational participation, as a further, supply-side, influence that complicates the interpretation of changes in youth outcomes.
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Making their mark. Disentangling the Effects of Neighbourhood and School Environments on Educational Achievement
Article
  • Jan 2007
One subject that has received ample attention in recent years is the potential negative effects of spatial concentrations of disadvantage on participation in society, particularly in terms of labour market participation and educational careers. This study contributes to the literature on the effects of neighbourhood and school on individual educational outcomes by examining whether and to what extent adolescent educational achievement is determined by neighbourhood and school population characteristics. By using an unusually rich administrative data set of leaving certificates for around 26,000 upper secondary school students who were registered as residing in any of the three metropolitan areas of Sweden in the school year 2004, cross-classified multilevel analyses show that characteristics attributable to upper secondary schools matter much more for the variability in achievement than do neighbourhoods. There are also indications of contextual effects at each level (particularly among boys with an immigrant background) that operate above and beyond the impact of observed individual-level background attributes. Since the estimated effects of concentrations of (dis)advantage and immigrant density at neighbourhood and school level point in different directions, this study demonstrates the benefits of analysing the effects of neighbourhood and school on individual educational outcomes at the same time.
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Labour Supply Response to Spousal Sickness Absence
Article
  • Jan 2007
This study examines labour supply responses to spousal sickness absence (SSA) using a Swedish longitudinal panel data, from 1996-2002. The overall results present an evidence of a decrease in labour supply in response to spousal sickness absence. The effect on labour supply increases with spousal earnings level. Women react stronger than men, and more often respond to current shorter term SSA, whereas men mostly react to longer term SSA.
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Child Health and Family Income: Physical and Psychosocial Health
Article
  • Jan 2007
This paper contributes to the important policy related literature on income and health by providing a detailed investigation of the family income/child health relationship using matched parent–child survey data from the Swedish Survey of Living Conditions (ULF). This study differs from previous work in the field in a number of respects. First, we focus on both physical as well as on the psychosocial health of the child. Second, we focus on the parent’s socioeconomic background as well as on the liquidity constraint problems the household faces. We find little evidence of an income gradient or effect on children’s physical and psychosocial health. However, our study suggests that the occurrence of liquidity constraints in the household increases the likelihood of the child having a lower psychosocial health status.
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Does Size of Local Labour Markets Affect Wage Inequality? A Rank-Size Rule of Income Distribution
Article
  • Nov 2006
The questions addressed in this paper are: (i) does wage inequality increase with local population size, and if so, (ii) what are possible factors behind this increase? In a cross-section analysis of Swedish local labour markets using unique full population data, the article shows that urban scale, i.e. size of local population, has significant positive effects on wage inequality. Testing for potential explanations, labour market diversification, human capital, migration, age structure and employment are shown to be significantly associated with inequality. Given these effects, the article raises the question of how to understand and incorporate scale effects into models of long-term change in wage inequality.
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