Regional Committee for Europe Fifty-Second Session
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Regional Committee for Europe Fifty-second session Copenhagen, 16–19 September 2002 Provisional agenda item 7(a) EUR/RC52/BD/1 24 July 2002 22898 ORIGINAL: ENGLISH FINAL DRAFT POVERTY AND HEALTH – EVIDENCE AND ACTION IN WHO’S EUROPEAN REGION This document contains the full report of the case studies on poverty and health which have been carried out as a follow-up to resolution EUR/RC51/R6 adopted by the Regional Committee at its fifty-first session. The case studies aim at providing factual descriptions of action taken by the Member States, and they document evidence that health systems can take effective action in this complex area. This report should be read in conjunction with document EUR/RC52/8 on the same subject. WORLD HEALTH ORGANIZATION • REGIONAL OFFICE FOR EUROPE Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Telephone: +45 39 17 17 17 Telefax: +45 39 17 18 18 Telex: 12000 who dk Electronic mail: [email protected] World Wide Web address: http://www.euro.who.int WHO European Office for Investment for Health & Development FINAL DRAFT Poverty and Health: Evidence and Action in WHO’s European Region Edited by: R. Barbosa Y. Charpak S. Turner E. Ziglio Table of contents Page Foreword ......................................................................................................................................................iv Acknowledgements .......................................................................................................................................v Credits for photographs.............................................................................................................................. vii Figures, boxes and tables........................................................................................................................... viii Introduction ...................................................................................................................................................1 Poverty and health: an overview of selected case studies in Member States ................................................3 Poverty and health case studies: an analytical framework ............................................................................7 Case study 1. Tackling cultural barriers to health care service delivery in Croatia.................................11 Case study 2. Couverture maladie universelle: reaching the poorest In France ......................................21 Case study 3. The Mainz Model: bringing health care to the homeless...................................................31 Case study 4. Health care and social reintegration of the poor: exploring new pathways in Buda Hills, Hungary..........................................................................................................39 Case study 5. From misinformation and ignorance to recognition and care: immigrants and homeless in Rome, Italy ....................................................................................................49 Case study 6. Mobilizing resources for health: the first phase of Kyrgyzstan’s co-payment policy .......57 Case study 7. Primary health care in homeless shelters in àódĨ, Poland ................................................71 Case study 8. Prevention and social acceptance: managing sexually transmitted diseases in the Republic of Moldova ...............................................................................................83 Case study 9. Poverty and tuberculosis: a pilot partnership in Orel, Russian Federation........................95 Case study 10. The hanging gardens of St Petersburg, Russian Federation: improving nutrition and food security in impoverished urban settings.............................................103 Case study 11. Combined social support and health care in deprived areas: the Citizen’s Advice Bureau in Blackpool, United Kingdom ...........................................................................111 Case study 12. “Fit for Work”: linking city regeneration and health in Newham, London, United Kingdom ..............................................................................................................117 Conclusions ...............................................................................................................................................127 Annex 1. List of invited experts......................................................................................................129 Annex 2. Template provided to the writers.....................................................................................131 Annex 3. Template used for group discussions...............................................................................135 iii Foreword At its fifty-first session, held in Madrid, Spain, in September 2001, the WHO Regional Committee for Europe recognized that, in view of the overwhelming evidence of the link between poverty and health, health systems have a responsibility to contribute to efforts to reduce poverty. The Regional Committee decided to take up this challenge by adopting a resolution in which, as Regional Director, I was asked to initiate a systematic process for gathering, analysing and disseminating information on direct action taken by health care systems in the European Member States, with the explicit aim of reducing the effects of poverty on health. The magnitude of the problem of poverty in the European Region today is beyond dispute: gross inequities in health and wellbeing persist in all our countries and, in many, the gap between rich and poor is widening still further. The problem is complex and daunting, but nevertheless much has been, and is being, done by health care systems across the Region to tackle the issues involved. To date, however, these efforts have been sporadic, and even where results have been encouraging they have received little visibility. In order to implement the Regional Committee’s resolution on poverty and health, the WHO Regional Office for Europe decided to adopt an innovative approach by giving priority, in this first phase of collecting information, to initiatives already undertaken by health care systems in a sample of Member States. Responsibility for this task was assigned to the new WHO European Office for Investment for Health and Development in Venice. This report is the fruit of our efforts in this new area over the past year, and it documents WHO’s preliminary findings on how health care systems can have a positive impact on alleviating poverty. The analysis of the case studies documented leads to three main conclusions: (a) that health care systems can indeed take effective action to improve the health of the poor; (b) that in some cases health care systems can actually represent an additional barrier for the poor; and (c) that there is an urgent need for more knowledge, training and capacity-building in this area. In the spirit of solidarity expressed in the Regional Committee’s resolution, it is now my sincere hope that the Regional Office, in collaboration with Member States, can build on this initial experience and proceed to the next phase of its work: to tackle poverty through the direct intervention of health care systems. We need to expand our collection of data and case studies to include all our Member States. We need to set up a database through which these experiences and analyses can be made available to all for suggestions, discussion, inspiration and action. We need to transform our new knowledge into training materials to increase the know-how and confidence of health professionals in all our Member States, so that we can address the issue of poverty. The path to equitable development is a long one, but I am convinced that we have taken an important step in the right direction. Alongside ongoing work at WHO headquarters in response to the Report of the Commission on Macroeconomics and Health – established by the WHO Director-General, Dr Gro Harlem Brundtland, in January 2000 – we are also playing our part in fulfilling the goals of the Millennium Declaration endorsed by the world community. I see our work in the area of poverty and health as a key to making the right to health a reality for every one of the people living in the European Region today. Marc Danzon WHO Regional Director for Europe iv Acknowledgements This publication was undertaken by the WHO European Office for Investment for Health and Development, Venice, Italy, and it is the result of the contribution of many experts and professionals from a wide range of disciplines. The editors and the WHO Regional Office for Europe are indebted to all of them for their interest and dedication, so essential for completing this work within the time frame of just over 6 months. We also would like to acknowledge that the work presented here benefited a great deal from the interest expressed by the Member States of the WHO European Region on the issue of poverty and health. We are thankful to the WHO Regional Committee for Europe for their support and for providing the impetus for this work. The case studies presented here were written by Sigrún Davídsdóttir, Frederika van Ingen, Dario Manfellotto, Susan Poizner, Jelena Sedlak, Jen Tracy, Steve Turner and Katalin Zoldhegyi. Steve Turner also edited the first drafts and contributed to the coordination of the work carried out by the authors. We are also grateful to a large number of people in Croatia, France, Germany, Hungary, Italy, Kyrgyzstan, Poland, the Republic of Moldova, the Russian Federation