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Healthy cities: promoting health and equity: evidence for local policy and practice
- Author:
- et al
- Editor:
- DE LEEUW Evelyne
- Publisher:
- World Health Organization
- Publication year:
- 2014
- Pagination:
- vi, 23
- Place of publication:
- Copenhagen
This publication summarises the evaluation of Phase V (2009–2013) of the WHO European Healthy Cities Network. The evaluation process was designed in collaboration with city representatives, academic institutions and public health experts. It adopted a realist synthesis approach, being responsive to the unique social, cultural, political, health and epidemiological circumstances in the 99 cities in the WHO European Healthy Cities Network and 20 accredited national networks. The evaluation findings are rooted in the enduring healthy city values such as equity, governance, partnership, participation and sustainability. Considering also the core Phase V themes, this publication focuses on policy and governance, healthy urban environments and design, caring and supportive environments, healthy and active living, national network performance and effects on health and equity. The evaluation finds good progress among cities and networks but differing in scale and quality. The study concludes that the healthy cities movement adds value and allows local governments to invest in health and well-being and address inequities through novel approaches to developing health (Edited publisher abstract)
The economic costs of childhood socio-economic disadvantage in European OECD countries
- Authors:
- CLARKE Chris, et al
- Publisher:
- OECD Publishing
- Publication year:
- 2022
- Pagination:
- 69
- Place of publication:
- Paris
Growing up in socio-economic disadvantage has important and long-lasting effects on children' lives. Children from disadvantaged households often fall behind in many areas of well-being and development, with effects that continue to limit their opportunities and outcomes - including their health and labour market outcomes - long after they reach adulthood. Drawing on Europe-wide survey data from 27 countries, this paper explores how childhood socio-economic disadvantage affects later adult labour market and health outcomes, and evaluates the country-level GDP-equivalent cost of childhood disadvantage due to lost employment, lost earnings, and lost health, as well as the costs of lost government revenue and benefit spending. Results point to large costs for societies from childhood socio-economic disadvantage, totalling on average the equivalent of 3.4% of GDP annually. (Edited publisher abstract)
COVID-19 and older people: impact on their lives, support and care
- Authors:
- DUBOIS Hans, et al
- Publisher:
- European Foundation for the Improvement of Living and Working Conditions
- Publication year:
- 2022
- Pagination:
- 92
- Place of publication:
- Luxembourg
This report captures the impact of the COVID-19 crisis on the quality of life of older citizens, including the impact on their well-being, finances, employment and social inclusion. It explores the effects on the use of care services and older people's reliance on other support. The report presents policy measures that have been implemented in EU Member States to support older people along all of the above-mentioned dimensions. These include measures to support independent living and schemes to support the labour market integration of older people or to prevent unemployment, all of which play a role in the quality of life of older citizens. During the COVID-19 pandemic, social contacts decreased in all age groups in the EU; mental health deteriorated for people of all ages during the pandemic, but affected young people and the 80+ age group most severely; both decreases and increases in income were less common among older people, for whom pensions proved to be a stable source of income - however, pandemic-related expenditure, such as spending on private transport and care services, caused financial difficulties, especially for low-income groups; during the pandemic, the likelihood of reduced physical activity increased with age; low-tech e-healthcare (by phone) facilitated access to healthcare during COVID-19, however, many older people still preferred face-to-face consultations and almost half of users aged 50+ who opted to use e-healthcare reported that it did not fully meet their needs. (Edited publisher abstract)
Co-developing and contextualising long-term care innovations in Europe using theory of change: lessons from InCARE
- Authors:
- BREUER Erica, et al
- Publisher:
- InCARE
- Publication year:
- 2022
- Pagination:
- 11
- Place of publication:
- Vienna
Ensuring affordable and high-quality care to all those who need it, a goal enshrined in the European Pillar of Social Rights, remains a considerable challenge for all EU Member States and other European countries. In the aftermath of the devastating effects of the COVID-19 pandemic on long-term care systems, considerable reforms are being implemented or planned across the region - including the first European Care Strategy, with sustainability and appropriateness of care recognized as paramount concerns. At the same time, there is growing recognition of the need to deliver care in the community and to reimagine traditional care models through socially innovative approaches, grounded in local community strengths and reflecting their needs and preferences. As momentum for re-imagining long-term care systems continues to build, strategies to empower stakeholders and co-develop contextually relevant and scalable solutions are important to ensure sustainability, relevance and fit of long-term care innovations. Theory of Change, a planning and evaluation approach which is increasingly used in planning health and long-term care provides a systematic and robust way to approach this. We have successfully applied Theory of Change in InCARE (https://incare.euro.centre.org), a multicountry project which aims to develop and design co-ordinated approaches to local and regional care services and national level policy for long term care. Our experience offers a proof of concept for the applicability and usefulness of this approach in long-term care service and policy development. In this policy brief, we describe the Theory of Change process in InCARE and focus on formulating transferable lessons and recommendations for expanding Theory of Change approaches in this field. (Edited publisher abstract)
Social innovation in LTC in Europe: towards a common narrative for change
- Authors:
- Ilinca S., et al
- Publisher:
- InCARE
- Publication year:
- 2021
- Pagination:
- 11
- Place of publication:
- Vienna
Long-term care systems throughout Europe are facing the challenge of ensuring affordable and high-quality care to diverse ageing populations, while responding to the societal effects of the Covid-19 pandemic. As sustainability is of paramount concern, interest in socially innovative approaches that build on local community strengths has been steadily rising. In this short report, we step back, take stock and synthesize the key insights that can be derived from the decades long journey of promoting social innovation in Europe, with a view to supporting policy-makers and organizational stakeholders that wish to engage directly in the implementation of social innovation initiatives in long-term care. We identify three core elements that make long-term care initiatives socially innovative and we propose a broad conceptualization of successful implementation. We argue that local innovators should shift focus away from 'best practice' initiatives and towards defining the 'best fit for purpose' initiative. Successful social innovation in long-term care is built through the process of identifying innovative ideas, adapting them to match the characteristics of local settings and creating a flexible policy framework that supports local implementation. Furthermore, we highlight the need to match investment in social innovation design and development with investment in scale-up and sustainability of social innovation approaches, in order to increase societal impact. We propose four key principles that can guide social innovators in long-term care: start with the end in mind - shape a common and inclusive vision for progress; invent the right solution - redesign the best ideas to best-fit local circumstances; bring all aboard - engage meaningfully with as many relevant local stakeholders as possible; think big from the very beginning - partner early on with regional and national stakeholders. European institutions and national governments can play key roles by focusing their efforts on: supporting knowledge sharing and mutual learning on social innovation within and between countries; dedicating resources and attention to the creation of broad partnerships and ally networks that actively focus their efforts not on implementation but on scale-up and long-term sustainability of social innovation initiatives; agreeing to ambitious targets at EU level and financially supporting the development of accessible, affordable and high-quality community-based long-term care services across Europe. (Edited publisher abstract)
Beyond the COVID-19 pandemic for working carers across the European Union: work, policy and gender considerations
- Authors:
- PHILLIPS Dominique, et al
- Journal article citation:
- International Journal of Care and Caring, 6(1-2), 2022, pp.289-298.
- Publisher:
- Policy Press
Most caring responsibilities fall to women, many of whom provide care to sick and dependent relatives while also in paid employment. Some European countries have introduced policies that promote the sharing of caring responsibilities between men and women, better work–life balance, and gender equality. Since March 2020, the COVID-19 pandemic has significantly impacted the way we live and work. In some ways, it has helped progress some of these policy goals, but in others, it may have hindered their progression. This article considers some of the work, policy and gender implications of the COVID-19 pandemic for working carers across the European Union (EU). (Edited publisher abstract)
Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN
- Authors:
- BILLINGS Jenny, et al
- Journal article citation:
- BMC Health Services Research, 20(971), 2020, Online only
- Publisher:
- BioMed Central Ltd
Background: Despite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat ‘illusive’ impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015–2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators. Conclusions: Lessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analysis. (Edited publisher abstract)
Health and social care near the end of life: can policies reduce costs and improve outcomes?
- Authors:
- NORMAND Charles, et al
- Publisher:
- World Health Organization
- Publication year:
- 2021
- Pagination:
- 24
- Place of publication:
- Copenhagen
This brief reviews the evidence on health and social care needs and expenditures at the end of life. End of life costs are the main reason for high per person spending levels observed at older ages in many European countries. However, there is huge variation between individuals, with estimates suggesting that just 10% of people near the end of life are responsible for over 60% of total end of life health and social care expenditures. High-cost individuals tend to be frail people with multiple chronic illnesses who use considerable hospital and social care services. In most European countries, there will be large increases in annual deaths in the coming years as the ‘baby boom’ generation ages and improved survival ultimately leads to more deaths each year. This will inevitably lead to growth in end of life needs and, ultimately, spending levels. However, there are a number of strategies available to address these challenges. Hospital care is the largest component of end of life care expenditures, but not all of it is necessary or appropriate: many admissions can be prevented, while some hospital care is inappropriate for people with complex needs and multiple chronic diseases. Some end of life needs can be reduced with more active public health measures and active rehabilitation, much of which can be very cost-effective. More active assessment of care needs can also significantly improve the experiences of patients and families, reduce unnecessary tests and interventions, will not shorten survival, and can help to limit the growth in costs. (Edited publisher abstract)
Social work and the Roma community: elements to improve current practices
- Authors:
- VALERO Diana, et al
- Journal article citation:
- European Journal of Social Work, 24(6), 2021, pp.978-989.
- Publisher:
- Taylor and Francis
Although the Roma community is the largest ethnic minority in Europe, it continues to experience inequality and exclusion in all social areas. In social work, the literature identifies limitations in providing effective responses to the problems faced by this community. The identification and analysis of practices that have demonstrated a positive impact in overcoming the inequalities of the Roma community become crucial for improving the design and implementation of interventions in social work. This article identifies and analyses three practices related to social work that contribute to the improvement of the Roma community situation and discusses the elements that characterise each practice: the need to implement evidence-based actions, the role of solidarity and respect, and the recognition of the Roma identity. The results show that these three elements contribute to the impact of interventions in improving the lives of Roma people, thus generating useful recommendations to guide the interventions of social work professionals working with this community. (Edited publisher abstract)
Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis
- Authors:
- HUGHES Karen, et al
- Journal article citation:
- Lancet Public Health, 6(11), 2021, pp.e848-e857.
- Publisher:
- Elsevier
Background: Adverse childhood experiences (ACEs) are associated with increased health risks across the life course. We aimed to estimate the annual health and financial burden of ACEs for 28 European countries. Methods: In this systematic review and meta-analysis, we searched MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and Education Resources Information Center for quantitative studies (published Jan 1, 1990, to Sept 8, 2020) that reported prevalence of ACEs and risks of health outcomes associated with ACEs. Pooled relative risks were calculated for associations between ACEs and harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular disease, stroke, and respiratory disease. Country-level ACE prevalence was calculated using available data. Country-level population attributable fractions (PAFs) due to ACEs were generated and applied to 2019 estimates of disability-adjusted life-years. Financial costs (US$ in 2019) were estimated using an adapted human capital approach. Findings: In most countries, interpersonal violence had the largest PAFs due to ACEs (range 14·7-53·5%), followed by harmful alcohol use (15·7-45·0%), illicit drug use (15·2-44·9%), and anxiety (13·9%-44·8%). Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in many countries. Total ACE-attributable costs ranged from $0·1 billion (Montenegro) to $129·4 billion (Germany) and were equivalent to between 1·1% (Sweden and Turkey) and 6·0% (Ukraine) of nations’ gross domestic products. Interpretation: Availability of ACE data varies widely between countries and country-level estimates cannot be directly compared. However, findings suggest ACEs are associated with major health and financial costs across European countries. The cost of not investing to prevent ACEs must be recognised, particularly as countries look to recover from the COVID-19 pandemic, which interrupted services and education, and potentially increased risk factors for ACEs. (Edited publisher abstract)