Lluís Camprubí

Municipal interventions against inequalities in health: The view of their managers

Background: European city councils are increasingly developing interventions against health inequalities. There is little knowledge about how they are perceived. This study describes and analyses good practices and challenges for local interventions on inequalities in health through the narratives of European city managers. Methods: A qualitative study was conducted. Each participating city (Amsterdam, Barcelona, Cluj-Napoca, Helsinki, Lisbon, London, Madrid, Rotterdam) selected interventions following these criteria: at least 6 months of implementation; an evaluation performed or foreseen; the reduction of health inequalities among their objectives, and only one of the interventions selected could be based on health care. Managers of these local interventions were interviewed following an outline. Eleven individual in-depth interviews describing nine local interventions were obtained. A thematic content analysis was performed. Results: One or more local interventions against health inequalities were identified in each city. Most relied on quantitative data and were linked to national strategies. Few interventions addressed socio-economic determinants. Health care, employment and education were the main determinants addressed. With variable depth, evidence-base, participation and intersectorality were regular components of the interventions. Half of them targeted the city and half some deprived neighbourhoods. Few interventions had been evaluated. Scarcity of funding and sustainability of the projects were the main perceived barriers by the managers. Conclusions: City intervention managers were familiar with health inequalities and concepts as intersectorality, participation and evidence-based action, but others such as socioeconomic aims, gradient approach, evaluation and sustainability were not so widely applied. Managers’ capacities and political leadership in governance for health should be reinforced.

Housing Policies and Health Inequalities

A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed. Housing conditions related to fuel poverty are associated with poorer health and are unevenly distributed across Europe. We found possible positive effects of façade insulation interventions on cold-related mortality in women living in social housing; but not in men. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most vulnerable groups and be adaptable to their needs.

El proyecto Ineq-Cities de investigación en desigualdades urbanas en salud: diseminación y transferencia de conocimiento en España

The Ineq-Cities project analyzed inequalities in mortality in small areas and described interventions to reduce inequalities in health in 16 European cities. This field note describes the dissemination of the project in Spain. In accordance with the recommendations of the project, the objective was to translate relevant results to key stakeholders - mainly technical staff, municipal officers and local social agents - and to provide an introduction to urban inequalities in health and strategies to address them. Twenty-four workshops were given, attended by more than 350 professionals from 92 municipalities. Knowledge dissemination consisted of the publication of a short book on inequalities in health and the approach to this problem in cities and three articles in nonspecialized media, a proposal for a municipal motion, and knowledge dissemination activities in social networks. Users rated these activities highly and stressed the need to systematize these products. This process may have contributed to the inclusion of health inequalities in the political agenda and to the training of officers to correct them.

The Role of Dissemination as a Fundamental Part of a Research Project: Lessons Learned From SOPHIE

Dissemination and communication of research should be considered as an integral part of any research project. Both help in increasing the visibility of research outputs, public engagement in science and innovation, and confidence of society in research. Effective dissemination and communication are vital to ensure that the conducted research has a social, political, or economical impact. They draw attention of governments and stakeholders to research results and conclusions, enhancing their visibility, comprehension, and implementation. In the European project SOPHIE (Evaluating the Impact of Structural Policies on Health Inequalities and Their Social Determinants and Fostering Change), dissemination was an essential component of the project in order to achieve the purpose of fostering policy change based on research findings. Here we provide our experience and make some recommendations based on our learning. A strong use of online communication (website, Twitter, and Slideshare accounts), the production of informative videos, the research partnership with civil society organizations, and the organization of final concluding scientific events, among other instruments, helped to reach a large public within the scientific community, civil society, and the policy making arena and to influence the public view on the impact on health and equity of certain policies.

Impact of energy efficiency interventions in public housing buildings on cold-related mortality: a case-crossover analysis

Background Interventions to mitigate fuel poverty and particularly energy efficiency façade retrofitting (EEFR) have demonstrated positive impacts on health but the impacts of EEFR interventions on cold-related mortality have not been studied in depth. We evaluated the impact of EEFR interventions in Barcelona on the association between cold outdoor temperatures and mortality (from all natural causes and from neoplasms, circulatory system and respiratory system causes) from 1986 to 2012. Methods A time-stratified case-crossover analysis was used. Relative risks (RR) for death related to extreme cold (lowest fifth percentile) in the no-intervention and intervention groups were obtained for temperature lag windows covering the day of the death and the previous 20 days (0-2, 3-5, 6-8, 9-11, 12-14, 15-17, 18-20). The statistical significance of the observed changes was evaluated using the RR for the cold temperature-intervention interaction. Results In men, interventions significantly increased the extreme cold-death association for the lag window 15-17 [interaction RR 2.23, 95% confidence interval (CI) 1.14-4.36]. The impacts were stronger for respiratory system causes and in men aged 75 or older. In women, on lag window 0-2, the extreme cold-death association was not significantly reduced when analysing all natural causes of death (interaction RR 0.46, 95% CI 0.21-1.01), but it was reduced significantly when analysing only deaths from neoplasms, circulatory system and respiratory system causes together. The impacts were stronger in women who died from circulatory system causes, in women with no education and in those aged 75 or older. Conclusions EEFR interventions had differentiated effects on cold-related mortality in men and women. Differentiated effects were also observed by cause, educational level and age.

Social and economic policies matter for health equity : Conclusions of the SOPHIE project

Since 2011, the SOPHIE project has accumulated evidence regarding the influence of social and economic policies on population health levels, as well as on health inequalities according to socioeconomic position, gender, and immigrant status. Through comparative analyses and evaluation case studies across Europe, SOPHIE has shown how these health inequalities vary according to contexts in macroeconomics, social protection, labor market, built environment, housing, gender equity, and immigrant integration and may be reduced by equity-oriented policies in these fields. These studies can help public health and social justice advocates to build a strong case for fairer social and economic policies that will lead to the reduction of health inequalities that most governments have included among their policy goals. In this article, we summarize the main findings and policy implications of the SOPHIE project and the lessons learned on civil society participation in research and results communication.