“Inequalities in health exist both within and between countries.  They are both unnecessary and unjust.  They also create a great cost to societies…”  These are the opening words of the latest Eurohealth; the quarterly publication of the WHO-hosted European Observatory on Health Systems and Policies.  Reporting on the 7th European Public Health Conference, this special edition for 2015 focuses on the issues discussed at the November 2014 event in Glasgow, Scotland.  With the theme of the conference being “Mind the Gap: Reducing Inequalities in Health and Health Care”, EuroHealth articles look at:
  • How Roma communities are responding to inequalities;
  • The adaptation of health promotion and disease prevention interventions for migrant and ethnic minority populations;
  • The Glasgow Declaration;
  •  Learning from each other – where health promotion meets infectious diseases;
  • Public health monitoring and reporting;
  • Changing your health behaviour – regulate or not;
  • Developing the public health workforce;
  • Building sustainable and resilient health care systems;
  • Leaving a legacy in Glasgow;
  • Conclusions; and Eurohealth Monitor.
The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, the United Kingdom and the Veneto Region of Italy, the European Commission, the World Bank, UNCAM (French National Union of Health Insurance Funds), London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine. Read more about inequalities and other significant health issues in Eurohealth Number 1, 2015 here.

The 2014 Child Poverty Monitor released this month shows that reducing child poverty will require bold and sustained commitment from government. Child Poverty Action Group welcomes the latest Child Poverty Monitor and congratulates the Office of the Children’s Commissioner, the JR McKenzie Trust and the University of Otago’s NZ Child and Youth Epidemiology Service on their commitment to measuring and monitoring child poverty. The Monitor brings together all the known statistics about child poverty in Aotearoa New Zealand with current statistics on health outcomes. CPAG health spokesperson Dr Nikki Turner says, “The 2014 Child Poverty Monitor shows there has been little change over the past year and far too many New Zealand children still live in poverty.  This problem is too difficult to be addressed by piecemeal measures – substantial commitment is needed to improve incomes and housing for families with children.” Nikki Turner says, “We know childhood poverty has life-long consequences for people’s health and well-being.  For children to stay healthy, families need enough money for affordable, decent and stable housing, nutritious food, doctor’s visits and prescription fees.  They need cooking and laundry facilities, access to hot water, soap, clean towels, clothing, shoes, bedding and basic first aid.   Income adequacy is pivotal and insufficient money continues to affect children’s health, as the statistics in the Child Poverty Monitor show.  There are a range of issues to be tackled and some progress is being made, such as the reduction in costs for GP visits, but income adequacy is an urgent need, particularly for our most vulnerable children.” Child Poverty Action Groups calls on the government to lead a cross-party agreement on an action plan to reduce child poverty, including: •    Treating all low-income children equally. •    Improving incomes significantly for low income families and access to affordable housing and healthcare for all children •    Ensuring an accelerated rate of poverty reduction for Mäori and Pasifika, so they achieve equity with other children. •    Introducing child poverty legislation to ensure proper, regular measurement of child poverty on a range of measures. In addition, targets and timelines for child poverty reduction should be set with annual reporting to Parliament on progress towards these targets by the responsible Minister.  

Economics, News, Policy
Health professionals are calling for a comprehensive health impact assessment of the Trans-Pacific Partnership (TPP) agreement to protect the health of New Zealanders. According to leaked information, international big business – such as the tobacco or alcohol industries – could sue the New Zealand government if the country’s health-based policies threaten their profits. Clauses designed to protect the intellectual property rights of the pharmaceutical industry would apparently prevent PHARMAC purchasing cheaper generic drugs; making medicines more expensive in New Zealand. health-review-of-tpp-image “The negotiations are all being carried out in secret, and the little that has leaked out is very worrying,” says Dr Joshua Freeman, a spokesperson for the ten health organisations involved. “New Zealand should have the sovereign right to make laws and policies for the wellbeing of its people without interference. Under the TPP it appears that New Zealand could find itself in the international trade tribunal if it brings in new policy around, for example, tobacco, alcohol, unhealthy food, or environmental regulation.” Read the full media release.   28 October 2014 Jo Lawrence-King  

In the report from the Equity at the Centre Congress in Alice Springs (4-5 September 2014), HPF Senior Health Promotion Strategist Karen Hicks Martin Laverty’s presentation. According to Martin Lavety, CEO of Catholic Health Australia; equity is an economic asset for a country and should be valued as such.  His advice to those advocating equity with governments that focus on indivicual respoinsibility was to argue the case that investiment in social capital (e.g. housing, safe pregnancy, economic development) is necessary in order to make individual responsibility possible. “If we want people to be productive and to have economic growth,” said Lavety, “we need a healthy population.”  He pointed out that people are unable to take individual responsibility for their health if it is already compromised.

Abstract for Martin Laverty’s presentation

The 2008 World Health Organisation’s Commission on Social Determinants of Health Closing the Gap report provided a road map for governments to improve population wide health outcomes. The WHO’s work received little attention in Australia when Closing the Gap was released, and its recommendations were ignored by the then Federal Government. In 2011, 40 social determinant advocates contributed to the book Determining the Future: A fair go and health for all. The book outlined actions Australia could take to implement the WHO’s recommendations and argued a Senate Inquiry should inform Australia’s next steps. Associated with the book’s publication was the emergence of the Social Determinants of Health Alliance (SDOHA), which is today leading national advocacy for action on social determinants. In mid-2012, a tri-partisan Senate Inquiry with backing of the Liberal Party, Labor Party, and Greens recommended the Australian Government adopt the 2008 WHO Closing the Gap report and commit to addressing the social determinants of health relevant to the Australian context. The Senate said government should adopt administrative practices that ensure consideration of the social determinants of health in all relevant policy development activities, particularly education, employment, housing, family, and social security policy. The Senate further said the National Health and Medical Research Council (NHMRC) should give greater emphasis in grant making to social determinants research. It concluded its recommendations by saying annual progress reports to Federal Parliament should be a key requirement of addressing the social determinants of health. With tri-partisan support for these Senate recommendations on social determinants, this presentation will state the social and economic case for adoption of the WHO social determinants framework, outline success to date in working to instil social determinants within government decision making, and also propose the next stages of an advocacy campaign to see the Senate recommendations implemented nationally.


Martin Laverty is the CEO of Catholic Health Australia, a network comprising ten percent of the nation’s not-for-profit hospital and aged care beds. He is also the inaugural Chair of the Social Determinants of Health Alliance and co-editor of the 2011 book Determining the Future: A Fair Go & Health for All, a book that contributed to a Senate Inquiry being established on social determinants of health. He is a member of the National Disability Insurance Scheme board, a member of the NSW Public Service Commission board, and a member of the Federal Government’s Aged Care Sector Committee. He is the Board Chair of the NSW Heart Foundation, and a member of the National Heart Foundation Board. He is also a member of the National Health Performance Authority Advisory Committee for Private Hospitals, and a member of the Australian Catholic University Faculty of Health Sciences advisory board. Martin is a lawyer by training, and is near to completing a PhD in governance of not-for-profit health services.         25 September 2014 Jo Lawrence-King

Economics, News, Policy
    In a consultation draft published this month, the Ministry of Health (MoH) has renewed its commitment to health promotion as one of five core functions for public health.  It is inviting submissions on the service specification by 16 May.   In the Public Health Service Health Promotion Tier Two Service Specification, published by the National Health Board Business Unit, the MoH emphasised the importance of tackling the factors that determine health:  “Because of the focus on determinants of health, there should be less focus on the activities in personal knowledge and skills section, and a move toward approaches such as health in all policies,” it says.   The Health Promotion Forum of New Zealand (HPF) welcomed this new emphasis.  “It is encouraging to see the Ministry recognise the foundations of health promotion in the social factors that determine the hauora of an individual, community or population,” says HPF Executive Director Sione Tu’itahi.  “We will certainly be putting forward a submission to the Ministry to encourage this crucial approach to hauora and would encourage all organisations in health promotion to do the same.”   As the National leaders in health promotion, HPF has 25 years’ experience in the area; providing training and capacity-building to thousands of individuals and organisations. Tu’itahi continues:  “Health promotion is most effective when all five strands of the Ottawa charter are applied in an integrated way.  HPF would love to work alongside the Ministry to help it gain the best outcome from this crucial work here in Aotearoa New Zealand.”   As part of the Ministry’s greater focus on the health inequity and the social determinants of health, Health Minister Hon Tony Ryall recently announced a proposed new initiative Healthy Families New Zealand.  See our news article about the initiative here.   The consultation document is part of a review of public health service specifications.     Jo Lawrence-King 18 March 2014  

Economics, Evidence, News, What is HP
who_logo_c300   A new policy summary, issued by the WHO (World Health Organisation) on 4 November, reveals substantial evidence to support the economic case for health promotion and prevention of non-communicable diseases. The document summarises data from a major international study by the European Observatory on Health Systems and Policies, OECD and WHO/Europe.   The findings demonstrate the effectiveness of a wide range of actions, addressing some of the main risk factors to health including:
  • tobacco and alcohol consumption
  • impacts of diet and patterns of physical activity
  • children’s exposure to environmental harm
  • the protection of mental health
  • road safety.
While some of these interventions generate direct cost savings, many will require increased investment but generate additional health (and other) benefits. The study will be published in 2014 as a book “Health Promotion, Disease Prevention: The Economic Case”.  It forms the basis for one of the evidence pillars for WHO’s Health 2020 strategy.   Published: 5 December 2013 Jo Lawrence-King  

Community, Economics, News, Policy
tony-ryall-crown-copyright   An article published in the 20 November edition of NZ Doctor suggests the Government may be considering funding a community based health promotion programme in Aotearoa New Zealand.   Follow a visit to the “Healthy Together Victoria” obesity prevention programme in Australia, Health Minister Tony Ryall has acknowledged the value of implementing preventative health at a community, grass roots level here.  “This actually works,” says Ryall; “and if it can work in Australia, it can work in New Zealand.”   The programme’s success is attributed to an approach that values contribution and buy in from the local community, leaders and groups.  “Healthy Together Victoria” uses local councils to coordinate a team of health promoters, who work with local community groups. “It’s being evaluated, it works and it’s based on evidence,” says Ryall, who told NZ Doctor his officials have been looking at the Victorial model for several months.   The Victorian State Government provides communities with four or five year contracts.  Ryall believes the contract length is fundamental: allowing capacity-building at the local level.   The Minister stopped short of committing to the programme, but said “… I’m sure we could afford to do something.”   Subscribe to NZ Doctor   Article adapted from NZ Doctor article by Karen Hicks Edited by Jo Lawrence King Published: 2 December 2013 Photo: Crown copyright  

Economics, Evidence, What is HP
“The Health Promotion Forum originally asked us to develop a full cost-benefit analysis (CBA) of measures to prevent smoking and obesity in young adults in New Zealand, as two examples of public health programmes. We lacked the funding or resources to do this.   This report is to pave the way for such a cost-benefit analysis. We argue that health promotion has for too long been stymied by a perception that they lack the data and indeed the funds to do a perfect cost benefit analysis.   This is a scoping study which seeks to illustrate that building a case for health promotion need not be excessively costly, nor does it need to wait for the perfect data. We illustrate the ideas using obesity and smoking as exemplars. We would however caution the use of the results.”  Savings from Prevention