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Shaping EUROpean policies to promote HEALTH equitY

Periodic Reporting for period 1 - EURO-HEALTHY (Shaping EUROpean policies to promote HEALTH equitY)

Reporting period: 2015-01-01 to 2016-06-30

"Health inequities have been increasing in Europe, across and within countries and regions, particularly in a context of an ageing society and economic crisis, thus creating significant policy challenges. It is well known that social, economic, environmental and healthcare factors cause considerable inequalities in health, which are avoidable to the extent that they stem from identifiable policy options applied by governments. The EURO-HEALTHY project which stands for ""Shaping EUROpean policies to promote HEALTH equitY,"" focuses on the need to evaluate and select policies for improving health and health equity across European regions and within metropolitan areas. This project has brought together fifteen institutions from twelve European countries, supported by a Project Advisory Board, thus assuring a mul¬ti-sectoral and comprehensive approach to the evaluation of population health and health inequalities. Underlying this project is the adoption of an approach to population health that characterises the health of a population in a wide range of health dimensions (and respective health determinants and health outcome indicators).
EURO-HEALTHY aims to evaluate which policies have the highest potential to improve health and health equity across European regions and within metropolitan areas. To achieve this, the project will develop tools based on a Population Health Index (PHI) to evaluate population health at different geographical levels (for NUTS 2 regions and for 10 metropolitan areas - Athens, Barcelona, Berlin, Brussels, Lisbon, London, Paris, Prague, Stockholm and Turin). Its construction considers the multiple dimensions of population health (socio-economic, physical and built environment, demographic change, lifestyles, healthcare services and health outcomes), the scientific evidence on the relationship between determinants and health outcomes, and the points of view of various health experts and stakeholders. Accounting for population health scenarios, the PHI will be used to both foresee and discuss the impact of policies and how different combinations of policies can influence population health and health equity, thus providing a basis for policy dialogue. Two case studies (Lisbon and Turin) will allow for study in greater detail of the impact of multi-level policies at the local level. To increase the range of options for displaying, analysing and understanding health inequalities comparing and monitoring population health (current and future), a web-based geographic information system (WebGIS) will be developed to make available all project-related health spatial data. This interactive tool will give a snapshot of PHI outputs on regional and metropolitan scales.
The tools and scientific evidence generated will enable an understanding of major health challenges, while taking into account Europe’s geographical diversity, will provide appropriate information to support the elaboration of future strategies and policies (NUTS 2) and will help policy-makers to allocate available resources according to the identified health challenges (two case studies - Lisbon and Turin).

Work performed
Over the last 18 months, EURO-HEALTHY has comprised:
1. Systematic reviews on:
a) what contributes to population health, in terms of social determinants of health and health outcomes, organized by: (i) areas of concern, (ii) dimensions, and (iii) indicators related to socio-economic, demographic changes, health behaviours/lifestyles, environmental public health risks, healthcare access and avoidable mortality);
b) construction of health indices;
c) multi-level policies to improve health and reduce health inequalities in Europe;
d) scenario studies in health;
2. a Glossary to organize knowledge, consolidate the language and make the terms and concepts uniform;
3. the Formation of the EURO-HEALTHY panel: a multidisciplinary panel of experts and key stakeholders to be involved in the participatory processes;
4. the Implementation of a web-survey to collect the opinions of the EUROHEALTHY panel on which dimensions should be considered to appraise population health;
5. the Implementation of a web Delphi process to select indicators to be considered in the PHI structure;
6. the Design of a MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) Socio-technical Approach to build the PHI, including the:
a) structuring of the areas of concern, key dimensions and indicators in which the European population health should be appraised;
b) design of a web Delphi for building value functions converting indicators into (partial) value scores;
c) design of a web Delphi for building weighting coefficients within and across areas with MACBETH;
7. Development and implementation of a web-based platform for applying participatory processes, including:
a) a web Delphi process to select indicators to be considered in the PHI structure;
b) a web Delphi process for weighting coefficient’s indicators considered in the PHI;
c) a web Delphi process for value functions, considered in PHI.
8. Development of a web-based platform for supporting the database store and data exchange between partners along with common procedures for data collection and management, which included conducting training on INSPIRE directives;
9. Data collection of selected indicators at NUTS 2 (269 regions) and metropolitan levels (10 metropolitan areas);
10. Geospatial analyses on the indicators selected by the EURO-HEALTHY panel (5.) collected at the European regional level (e.g. spatial cluster analysis with Moran’s I and LISA to identify geographical patterns);
11. the Preparation of the case studies' methodological framework (e.g. identification of local panel of stakeholders in Lisbon and Turin and methodology discussions between the responsible partners: WP5, WP6, WP7);
12. Starting the methodological framework for scenario building, including a socio-technical approach;
13. Conducting several dissemination activities:
a) development of the project identity;
b) establishment of several forms of dissemination as the website and social networks accounts (Twitter and Facebook);
c) production of a video providing an overview of the project and with partners’ interviews;
d) organization of (and participation in) main project meetings (the Kick-off meeting and the 1st Annual meeting) to review the work plan progress and discuss further developments;
e) organization of several meetings between project beneficiaries (IST; CSI; UM; CUP; PHE; UCL; UPO; ASPB; EUBA), to improve collaboration and interchange of knowledge and data;
f) organization and preparation of a relevant expert policy forum on “Addressing health inequities across Europe: from evidence to policy”, during the 9th European Public Health Conference, involving invited stakeholders and policy-makers;
14. the Establishment of ways of regular collaboration with the FRESHER project (e.g. the participation on main project meetings – Marseille and Vienna, workshops, interchange of information on data, methods and stakeholders).

Main results
As for the main results achie
EURO-HEALTHY presents a ground-breaking concept related to the multi- and trans- disciplinary approach and methods used to appraise population health and to advance knowledge on policies with the highest potential to promote health and health equity.
So far, the findings of the project highlight the importance of the holistic understanding of population health and inequalities, evaluating health on multiple geographical scales and in multiple areas of concern, dimensions and indicators, and the need to account for the points of view and value judgements of experts and stakeholders, from different backgrounds and expertise (integrating SSH and Health Sciences).
The web Delphi process conducted to obtain consensus on the set of indicators considered relevant to include in the Population Health Index (PHI) resulted in the selection of 80 indicators from a preliminary list of 130 indicators, previously proposed by the thematic WP2, 3 and 4. The researchers noted that obtaining data for selected indicators, at regional level (NUTS 2) and for the period of 15 years (2000-2014), is time consuming, difficult and presents several constraints due to the lack of comparable and available data, which varies hugely between European regions. The data collection of multiple indicators revealed an important gap between the indicators considered relevant to appraise population health and inequalities and the indicators that are routinely collected and available through official data sources, namely at European regional level. This is especially critical in indicators related with housing conditions (e.g. building dampness), water and sanitation (e.g. water quality) and lifestyle behaviours (e.g. physical activity). Mainly due to this constraints, the PHI structure will include only 42 indicators from the 81 indicators considered relevant by the EURO-HEALTHY panel. The identification of major gaps between the indicators that experts and stakeholders considered relevant to be included in the PHI and the data that effectively is collected at regional level, represent an asset on defining future needs on European indicators where data collection is needed, leading in the future to a better evaluation of policies’ impact on health.
The construction of the web platforms to support the data management and communication processes improved the quality and speed of the project workflow, allowing effective collaboration, improved communication, social networking, interactive workflow and knowledge.
Regarding the methodology to construct the PHI, the research noted the value of applying the MACBETH socio-technical approach, allowing to go beyond the simple and common aggregation of indicators, commonly used to build indices, and to overcome key challenges identified in the literature for the development of indices in the health sector. Under this approach, building the PHI considers: i) the technical elements of a multi-criteria model built with the Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), which is grounded on the principles of multi-criteria value measurement, and ii) the social elements of participatory approaches for involving and to capture experts and stakeholders views on what is relevant for appraising population health.
With the development of an evaluation model to appraise population that makes use of Web-
Delphi and decision conferencing (participatory) processes, the participants are expected : i) to develop a sense of ownership of the PHI results; ii) to improve their knowledge about what influences population health, health variations in Europe, the need for developing different types of policies, and how experts and stakeholders are keen to use the outputs of the EUROHEALTHY project.
Furthermore, the highly participatory components have the potential to improve communication between researchers, experts and stakeholders, to develop a shared understanding about what is important for analysing and
Logo of the EURO-HEALTHY project
The interrelations between work packages
Transdisciplinarity in EURO-HEALTHY