Final Report Summary - GRADIENT (Tackling the gradient: applying public health policies to effectively reduce health inequalities amongst families and children)
Executive summary:
The aim of the GRADIENT project is to evaluate and recommend public health policy options which tackle health inequalities and address the gradients in health determinants among families and children.
The main objectives were to develop a consensus based European framework to monitor and evaluate public health policies, to investigate if and why children and families from different socio-economic groups respond and act differently to public policy interventions, to identify protective factors for the health of children and young people and their families focusing on social capital and to analyse different welfare regimes and general policies in different European Union (EU) countries and compare the impact for families and children. Findings and results of the project were formulated into policy recommendations and disseminated at EU, national and regional level.
The main findings and results have shown that no single policy or strategy can achieve a reduction of health inequalities and contribute to levelling the health gradient. Instead, it requires cross-governmental strategies or whole of government approaches, to develop holistic approaches to improving the life circumstances of children and young people. As such, governments, the private sector and other social actors should promote equity in health and education as a top-level policy goal. They should develop coherent approaches across policy sectors which reinforce one another to achieve this goal. Investments in addressing the systematic underlying causes of ill health among children and young people will generate social and economic returns.
While analysing different welfare systems and universal policies for children and families in different countries in Europe, the findings illustrated how national differences with respect to the design and generosity of policies aimed at children and families are reflected in variations of (amongst others) poverty rates, the number of working mothers and in early school drop-out rates. The GRADIENT recommends that universal policies should be designed to address proportionally greater need with greater intensity and / or link service fees or taxes to ability to pay; moreover, activating labour markets and expanding the provision of quality early child education and care programmes so that they are accessible and affordable for all, to ensure that mothers, particularly those in low income groups, is important in levelling up the health gradient.
Interviews with policy makers and policy users groups have showed that participation of children, young people and families across the socio-economic gradient in the design and implementation of policies and interventions is very important to ensure their effectiveness and impact in levelling up the health gradient. Governments, policy makers and practitioners must also communicate their policies in clear and understandable ways, to facilitate the participation and uptake of all users groups across the social gradient.
GRADIENT found that heath gains incurred by increasing social capital are particularly marked for disadvantaged children and young people in communities with low social capital. The relationship between community social capital and health implies that policy makers should ensure that they do not develop and implement measures that undermine social cohesion. It also suggests that they should develop and refine measurement tools to record the presence or absence of social capital in the community, assess the effects of existing programmes on social capital and integrate information about social relationships into the design and implementation of new programmes.
The GRADIENT evaluation framework (GEF) has been developed as a European-action oriented, self-assessment policy tool. Governments must get better at assessing the prospective and post facto impacts of policies and measures of health across different socio-economic groups the GEF can be applied as a tool to facilitate this. Moreover, the use of common indicators across EU Member States (MS) and the regular collection of relevant data to monitor health inequalities could ensure a continuous measurement of the ?fairness? in our societies.
The GRADIENT project findings and results have been brought together in a book 'The right start to a health life'. We hope that the findings and results, this book, to encourage policy makers and practitioners across the EU to adopt such measures, to ensure that European children and young people get the right start to a healthy life and can live in and contribute to prosperous, cohesive and sustainable European societies.
Project context and objectives:
Applying public health policies to effectively reduce health inequalities amongst families and children
There are established and growing inequalities in health both between, and within, most EU MS, even though their populations are healthier than at any time in their history. These inequalities are growing and form a systematically patterned gradient between health and social circumstances across entire populations. It is not just that the poorest people experience less than optimal health; there is a social gradient of risk across the whole population. This gradient in health affects all individuals. Such health differences are rarely the result of individual behavioural choices but of wider factors and determinants, and may therefore be inequitable and unfair. This is important, as inequality can apply to any variation but inequity is applied to these variations which are deemed to be unjust and preventable.
Health inequalities are regarded as one of the most important public health challenges in the EU, but there is not sufficient knowledge of which actions are effective to level up the gradient in health inequalities. Research, however, indicates that the greatest impact on reducing the health gradient can be achieved through early life policy interventions and creating equal opportunities during childhood and adolescence, which is the reason why the GRADIENT project focuses on families and children.
Project overview:
The main aim of the GRADIENT project was to evaluate and recommend public health policy options which tackle health inequalities and address the gradients in health determinants among families and children. The GRADIENT project addressed the following objectives:
- develop a consensus based European framework to monitor and evaluate public health policies and their impact on the gradients that exists in the social determinants that generate health inequalities;
- investigate if and why children and families from different socio-economic groups respond and act differently to public policy interventions;
- identify protective factors for the health of children and young people and their families focusing on social relations and social networks, in order to explore alternative policy options that moderate social inequities in health;
- analyse and compare the impact of general policies for families and children with the impact of policies targeted at 'at risk' families and children;
- formulate policy recommendations and disseminate the findings.
To achieve the above mentioned objectives, the work has been undertaken within six work packages (WPs):
WP1 has ensured the overall project management and coordination of a research consortium comprising scientists, policy makers and practitioners; a scientific advisory board has been established involving global experts in the field.
WP2 focused on the development of a European GEF to monitor and evaluate public health policies and their impact on the gradients that exists in health determinants and related health inequalities (GEF). The work comprised a comprehensive review of the literature in the area of public health policy evaluation in relation to health inequalities and the health gradient. A European consensus building process was held through three expert meetings and a pre-test of GEF was carried out in different countries.
The objective of WP3 was to investigate the differential impact of public health policies among children and families from various socio-economic groups. The work comprised a literature review to determine the state-of-the-art knowledge in this field. Focus groups and interviews were organised with policy makers and policy users in Sweden, the Netherlands, Spain and Czech Republic and a quality matrix with success factors and barriers for policy participation at individual and policy level was developed.
WP4 identified protective factors for the health of children and families, focusing on social capital. The work included a research review on social capital, secondary data analysis of the 'Health behavioural school aged children' (HBSC) survey and other relevant surveys and databases, to identify the role of neighbourhood social capital as a protective factor for child health.
WP5 comprised a comparative analysis of the impact of universal policies versus policies targeted at 'at risk' groups. The work included a literature review and comparative analysis of national policies for families and children in Sweden, the Netherlands, the United Kingdom (UK) and Slovenia, including interviews with policy makers from different sectors in the selected countries.
WP6 had the role to collate project results, to develop policy recommendations and to ensure their dissemination at European, national, regional and local level. The dissemination strategy included a website, electronic newsletters and other publicity materials (brochure, poster), the publication of a book collecting all findings and recommendations.
The GRADIENT project focuses its efforts on seeking to reduce health inequalities by levelling up the social gradient in health inequalities across the whole population. The term 'tackling the gradient' is often used in the literature but the GRADIENT project uses the term 'levelling up the gradient' to be clearer about the goals of the project (i.e. improving the health of all).
Project results:
Health inequalities and socio-economic gradients in health are receiving growing attention in many EU MS and at EU level. Nevertheless, social inequalities, which underlie health inequalities, continue to grow in most EU MS. EU MS generally recognise the need to take action on health inequalities, but too often regard this as improving the health of the poorest segments of society. As such, they are not taking action across the socio-economic gradient so that everyone can enjoy their right to ?the highest attainable standard of health.
Since levelling-up the socio-economic gradient in health amongst children and young people is the best strategy to address health inequities in general, The GRADIENT project investigated various aspects around how this can be achieved. A general overview of the social gradient in health amongst children and young people in the EU has been developed. The project looked at the impact of different welfare state regimes and their effectiveness in achieving good health outcomes across the social gradient, and what kinds of policies and interventions are effective in levelling-up health gradients. The role of community social capital as a 'health asset' has been investigated together with its effect on mediating the impact of socio-economic status on health inequalities among children and young people a previously understudied topic. The GEF has been developed to boost the evidence based on levelling-up social gradients in health. It can be applied to facilitate and stimulate more evaluations of policies and interventions on their distributional impacts and effects on health. Finally, the project investigated what is being done at EU level to ensure that all children and youth in the EU get the right start to a healthy life.
The aim of the GRADIENT project is to evaluate and recommend public health policy options which tackle health inequalities and address the gradients in health determinants among families and children.
The main objectives were to develop a consensus based European framework to monitor and evaluate public health policies, to investigate if and why children and families from different socio-economic groups respond and act differently to public policy interventions, to identify protective factors for the health of children and young people and their families focusing on social capital and to analyse different welfare regimes and general policies in different European Union (EU) countries and compare the impact for families and children. Findings and results of the project were formulated into policy recommendations and disseminated at EU, national and regional level.
The main findings and results have shown that no single policy or strategy can achieve a reduction of health inequalities and contribute to levelling the health gradient. Instead, it requires cross-governmental strategies or whole of government approaches, to develop holistic approaches to improving the life circumstances of children and young people. As such, governments, the private sector and other social actors should promote equity in health and education as a top-level policy goal. They should develop coherent approaches across policy sectors which reinforce one another to achieve this goal. Investments in addressing the systematic underlying causes of ill health among children and young people will generate social and economic returns.
While analysing different welfare systems and universal policies for children and families in different countries in Europe, the findings illustrated how national differences with respect to the design and generosity of policies aimed at children and families are reflected in variations of (amongst others) poverty rates, the number of working mothers and in early school drop-out rates. The GRADIENT recommends that universal policies should be designed to address proportionally greater need with greater intensity and / or link service fees or taxes to ability to pay; moreover, activating labour markets and expanding the provision of quality early child education and care programmes so that they are accessible and affordable for all, to ensure that mothers, particularly those in low income groups, is important in levelling up the health gradient.
Interviews with policy makers and policy users groups have showed that participation of children, young people and families across the socio-economic gradient in the design and implementation of policies and interventions is very important to ensure their effectiveness and impact in levelling up the health gradient. Governments, policy makers and practitioners must also communicate their policies in clear and understandable ways, to facilitate the participation and uptake of all users groups across the social gradient.
GRADIENT found that heath gains incurred by increasing social capital are particularly marked for disadvantaged children and young people in communities with low social capital. The relationship between community social capital and health implies that policy makers should ensure that they do not develop and implement measures that undermine social cohesion. It also suggests that they should develop and refine measurement tools to record the presence or absence of social capital in the community, assess the effects of existing programmes on social capital and integrate information about social relationships into the design and implementation of new programmes.
The GRADIENT evaluation framework (GEF) has been developed as a European-action oriented, self-assessment policy tool. Governments must get better at assessing the prospective and post facto impacts of policies and measures of health across different socio-economic groups the GEF can be applied as a tool to facilitate this. Moreover, the use of common indicators across EU Member States (MS) and the regular collection of relevant data to monitor health inequalities could ensure a continuous measurement of the ?fairness? in our societies.
The GRADIENT project findings and results have been brought together in a book 'The right start to a health life'. We hope that the findings and results, this book, to encourage policy makers and practitioners across the EU to adopt such measures, to ensure that European children and young people get the right start to a healthy life and can live in and contribute to prosperous, cohesive and sustainable European societies.
Project context and objectives:
Applying public health policies to effectively reduce health inequalities amongst families and children
There are established and growing inequalities in health both between, and within, most EU MS, even though their populations are healthier than at any time in their history. These inequalities are growing and form a systematically patterned gradient between health and social circumstances across entire populations. It is not just that the poorest people experience less than optimal health; there is a social gradient of risk across the whole population. This gradient in health affects all individuals. Such health differences are rarely the result of individual behavioural choices but of wider factors and determinants, and may therefore be inequitable and unfair. This is important, as inequality can apply to any variation but inequity is applied to these variations which are deemed to be unjust and preventable.
Health inequalities are regarded as one of the most important public health challenges in the EU, but there is not sufficient knowledge of which actions are effective to level up the gradient in health inequalities. Research, however, indicates that the greatest impact on reducing the health gradient can be achieved through early life policy interventions and creating equal opportunities during childhood and adolescence, which is the reason why the GRADIENT project focuses on families and children.
Project overview:
The main aim of the GRADIENT project was to evaluate and recommend public health policy options which tackle health inequalities and address the gradients in health determinants among families and children. The GRADIENT project addressed the following objectives:
- develop a consensus based European framework to monitor and evaluate public health policies and their impact on the gradients that exists in the social determinants that generate health inequalities;
- investigate if and why children and families from different socio-economic groups respond and act differently to public policy interventions;
- identify protective factors for the health of children and young people and their families focusing on social relations and social networks, in order to explore alternative policy options that moderate social inequities in health;
- analyse and compare the impact of general policies for families and children with the impact of policies targeted at 'at risk' families and children;
- formulate policy recommendations and disseminate the findings.
To achieve the above mentioned objectives, the work has been undertaken within six work packages (WPs):
WP1 has ensured the overall project management and coordination of a research consortium comprising scientists, policy makers and practitioners; a scientific advisory board has been established involving global experts in the field.
WP2 focused on the development of a European GEF to monitor and evaluate public health policies and their impact on the gradients that exists in health determinants and related health inequalities (GEF). The work comprised a comprehensive review of the literature in the area of public health policy evaluation in relation to health inequalities and the health gradient. A European consensus building process was held through three expert meetings and a pre-test of GEF was carried out in different countries.
The objective of WP3 was to investigate the differential impact of public health policies among children and families from various socio-economic groups. The work comprised a literature review to determine the state-of-the-art knowledge in this field. Focus groups and interviews were organised with policy makers and policy users in Sweden, the Netherlands, Spain and Czech Republic and a quality matrix with success factors and barriers for policy participation at individual and policy level was developed.
WP4 identified protective factors for the health of children and families, focusing on social capital. The work included a research review on social capital, secondary data analysis of the 'Health behavioural school aged children' (HBSC) survey and other relevant surveys and databases, to identify the role of neighbourhood social capital as a protective factor for child health.
WP5 comprised a comparative analysis of the impact of universal policies versus policies targeted at 'at risk' groups. The work included a literature review and comparative analysis of national policies for families and children in Sweden, the Netherlands, the United Kingdom (UK) and Slovenia, including interviews with policy makers from different sectors in the selected countries.
WP6 had the role to collate project results, to develop policy recommendations and to ensure their dissemination at European, national, regional and local level. The dissemination strategy included a website, electronic newsletters and other publicity materials (brochure, poster), the publication of a book collecting all findings and recommendations.
The GRADIENT project focuses its efforts on seeking to reduce health inequalities by levelling up the social gradient in health inequalities across the whole population. The term 'tackling the gradient' is often used in the literature but the GRADIENT project uses the term 'levelling up the gradient' to be clearer about the goals of the project (i.e. improving the health of all).
Project results:
Health inequalities and socio-economic gradients in health are receiving growing attention in many EU MS and at EU level. Nevertheless, social inequalities, which underlie health inequalities, continue to grow in most EU MS. EU MS generally recognise the need to take action on health inequalities, but too often regard this as improving the health of the poorest segments of society. As such, they are not taking action across the socio-economic gradient so that everyone can enjoy their right to ?the highest attainable standard of health.
Since levelling-up the socio-economic gradient in health amongst children and young people is the best strategy to address health inequities in general, The GRADIENT project investigated various aspects around how this can be achieved. A general overview of the social gradient in health amongst children and young people in the EU has been developed. The project looked at the impact of different welfare state regimes and their effectiveness in achieving good health outcomes across the social gradient, and what kinds of policies and interventions are effective in levelling-up health gradients. The role of community social capital as a 'health asset' has been investigated together with its effect on mediating the impact of socio-economic status on health inequalities among children and young people a previously understudied topic. The GEF has been developed to boost the evidence based on levelling-up social gradients in health. It can be applied to facilitate and stimulate more evaluations of policies and interventions on their distributional impacts and effects on health. Finally, the project investigated what is being done at EU level to ensure that all children and youth in the EU get the right start to a healthy life.