The Right Start to a Healthy Life Levelling-up the Health Gradient Among Children, Young People and Families in the European Union – What Works? Tackling the Edited by Ingrid Stegeman and Caroline Costongs inin healthhealth THE RIGHT START TO A HEALTHY LIFE Levelling-up the Health Gradient Among Children, Young People and Families in the European Union – What Works? Edited by Ingrid Stegeman and Caroline Costongs 1 EuroHealthNet is a not-for-profit network of organisations, agencies and statutory bodies working to promote health and equity by addressing the factors that determine health directly and indirectly. We support our members’ work in European Union (EU) and associ- ated states through policy and project development, networking and communications. www.eurohealthnet.eu Tackling the inin healthhealth GRADIENT (2009-2012) is a collaborative research project involving 12 partners: BZgA (Federal Centre for Health Education – Germany), Embaetti landlaeknis (Directorate of Health - Iceland), EuroHealthNet (Belgium), KI (Karolinska Institutet - Sweden), NIGZ (Netherlands Institute for Health Promotion), NIPH (National Institue of Public Health - Czech Republic), UBerg (University of Bergen - Norway), UGent (University of Gent - Belgium), ULL (University of La Laguna – Spain), UoB (University of Brighton - UK), VIGeZ (the Flemish Institute for Health Promotion - Belgium), ZZVMS (The Institute of Public Health Murska Sobota – Slovenia). The project is co-ordinated by EuroHealthNet and has received funding from the European Community’s Seventh Framework Programme (FP7 2007-2013) Health Research under grant agreement No 223252. www.health-gradient.eu March 2012 © EuroHealthNet Contact: [email protected], [email protected] EuroHealthNet, Rue de la Loi 67, 1040 Brussels, Belgium Tel: +32 2 235 0323 Unless otherwise stated, the views expressed in this publication do not necessarily reflect the views of the European Commission 2 COnTEnts Acknowledgments .............................................................................................................................. 4 Forewords .................................................................................................................................................... 5 Executive Summary ........................................................................................................................... 7 CHAPTER 1: HEALTH InEQUALITIES AMOnG CHILDREn, YOUnG PEOPLE AnD FAMILIES In THE EU ........................................................................................ 17 Ingrid Stegeman, Giorgio Barbareschi, Caroline Costongs CHAPTER 2: UnDERSTAnDInG THE POLITICAL COnTEXT .............................. 55 Elisabeth Fosse, Torill Bull, Bo Burström, Sara Fritzell, Tatjana Krajnc-Nikolic CHAPTER 3: EXAMPLES OF POLICIES AnD InTERvEnTIOnS to ADDRESS THE health GRADIEnT ....................................................................................... 89 Ingrid Stegeman, Annemiek Dorgelo, Janine Vervoordeldonk, Jan Jansen CHAPTER 4: WORKInG WITH THE COMMUnITY TO IMPROvE CHILD HEALTH EQUITY ................................................................................................................................ 123 Lea Maes, Bart De Clercq, Veerle Vyncke, Sara Darias Curvo, Stefán Hrafn Jónsson, Vladimir Kebza, Veerle Stevens CHAPTER 5: EvALUATInG POLICIES: APPLYInG THE GRADIEnT EQUITY LEnS .......................................................................................................................................... 153 John Kenneth Davies, Nigel Sherriff CHAPTER 6: What IS THE EU DOInG to ADDRESS THE health GRADIEnT OF CHILDREn, younG PEOPLE AnD families? .................................................. 177 Ingrid Stegeman, Cristina Chiotan, Caroline Costongs COnCLUSIOnS AnD RECOMMEnDATIOnS .............................................................. 197 Ingrid Stegeman, Caroline Costongs GLOSSARY ............................................................................................................................................. 205 Giorgio Barbareschi, Aagje Ieven 3 The Right Start to a Healthy Life ACKnOWLEDGMEnts The present book was developed within the framework of the GRADIENT project (www.health-gradient.eu) and co-ordinated by EuroHealthNet (www. eurohealthnet.eu). It has received funding from the European Commission DG Research (FP7 2007-2013) under grant agreement No 223252. The editors would like to thank all the authors for their contributions to the book: Annemiek Dorgelo, Bart De Clercq, Prof. Bo Burström, Cristina Chiotan, Prof. Elisabeth Fosse, Jan Jansen, Janine Vervoordeldonk, Prof. John Kenneth Davies, Prof. Lea Maes, Dr Nigel Sherriff, Prof. Sara Darias Curvo, Dr Sara Fritzell, Dr Stefan Hrafn Jonsson, Dr Tatjana Krajnc-Nikolic, Dr Torill Bull, Prof. Vladimir Kebza, Dr Veerle Stevens and Veerle Vyncke. We would particularly like to thank Dr Giorgio Barbareschi for his many contributions to the content and for co-ordinating the publication process, and to Aagje Ieven for developing the first outline of the book. They both worked as project co-ordinators for GRADIENT. We are thankful to the other partners of the GRADIENT consortium, who directly or indirectly contributed to the book through their work in the project, including Dr Ann-Sofie Bakshi, Caren Wiegand, Dr Hana Janatova, Helene Reemann, Linda de Boek, Dr Miloslav Kodl, Dr Rana Charafeddine, Sarah Pos, Dr Runar Vilhjalmsson, Dr Ursula von Rueden and Clive Needle. We are grateful for the valuable input of our scientific advisors Prof. Göran Dahlgren and Prof. Richie Poulton, and to Linden Farrer for his comments on the final manuscript. Thanks to Hawraa Al-Rufaye for developing the protocol for the inter- views with adolescents and for conducting the first round of interviews, and to Hana Janatova, Mikaela Persson, Zdenka Verban-Buzeti and Mikaela Törnar for contacting the schools and conducting interviews respectively in Czech Republic, Sweden and Slovenia. Our thanks also go to Anne-Katrin Habbig, Krista Salimnen and Wouter Van Dongen, whose work on the GRADIENT project contributed to the content of the book. We are also grateful to the schools, which kindly gave permission and helped us to get the consent of children and their parents: Lillholmsskolan in Stockholm- Sweden, Lutgardiscollege Oudergem in Brussels- Belgium and Osnovna Šola II Murska Sobota in Slovenia. Finally we would like to thank all the people (children, adolescents, fami- lies, and policy makers) who participated in GRADIENT for their personal and unique contribution, which has helped develop new knowledge and to apply this knowledge to new policies for equity in health. 4 FOREWORDS “Thank you for reading this book. The fact you have taken the time to consider the information contained within these pages shows that you believe, as we do, that the inequalities faced by children and young people within the 27 member states of the European Union in the twenty-first century are unacceptable. Parents have always known that their child’s future will be influenced by the conditions the family finds itself in. Their ability to influence and improve these conditions is also dependent on the support of society and its various institutions. From health and social care systems, to schools, employers and civil society, the ability to understand the complex nature of inequalities within a country and the impacts these have on citizens can literally mean the difference between a short and a long life. This book draws on a wide partnership across Europe, and was funded as part of the GRADIENT project managed by EuroHealthNet. The book’s six chap- ters will enable you to consider not only the extent of the inequalities faced by our children and young people, but also what governments and organisations are doing to address and reduce these inequalities across Europe. You will no doubt find this book useful if you work for/with children, young people and their families or create policies and strategies which affect them. It is not aimed at just at academics or researchers it is directly written so that you can use it to help you plan and implement actions to reduce the unacceptable long-term negative impacts inequalities have on children and young people. Some countries have a phrase: ‘Our children are our future’. I believe our children are our present – it is their children who are the future! Surely they deserve the best possible start to that future. This book can contribute to that future, the authors and contributors to this book have a commitment to making these changes, and by reading this book we believe that you are also committed to change. Thank you.” David L Pattison President, EuroHealthNet March 2012. 5 The Right Start to a Healthy Life “Overall life expectancy for men and women in the EU has risen by four years between 1993 and 2009- from 75.6 to 79.6 years. In 2008, 17% of the EU population was aged 65 and above and this is likely to rise to around 24% by 2030. However, the odds of living longer are not equally distributed in the EU. The reasons for these differences are complex and involve a wide range of factors including income, level of education, living and working conditions, and health behaviour in accessing healthcare. Tackling health inequalities is high on the agenda of the European Union. I recommend reading “The Right Start to a Healthy Life” as a guide for possible action. This publication aims to identify measures that can be taken to even-out