Advancing tools to promote health equity across European Union regions: the EURO-HEALTHY project

Abstract

Background: Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods: Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results: The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced-(1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions: The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.

The Role of Cohesion Policy Funds in Decreasing the Health Gaps Measured by the EURO-HEALTHY Population Health Index

“…The Horizon 2020 EU-funded project EURO-HEALTHY (shaping EUROpean policies to promote HEALTH equitY), among other projects, looked to CP funds as resources with significant potential to decrease the health gap between the EU regions [4,34]. The project aimed to advance knowledge regarding population health across Europe, with particular attention at NUTS (Nomenclature of Territorial Units for Statistics) level 2 regions, the geographical and administrative level corresponding to the category of eligibility for receiving CP funds.…”

“…These dimensions correspond to policy intervention areas with impact on population health (positive or negative) and are associated to one or more determinants of health ( Table 1). The value scores range between 0 (worse health) and 100 (better health) and were obtained through the application of a socio-technical methodological approach for the construction of indices, combining the multicriteria method MACBETH with Web-Delphi and decision conferencing processes [4,34,36,37]. These processes, using intuitive protocols of questioning, informed the shape of value functions (added value of improvements in indicators) and the weighting coefficients (importance of closing gaps in indicators).…”

Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project

“…Informed by the EURO-HEALTHY project [3,49,50,53], eight independent intervention axes for appraising health were considered: (i) Economic Conditions, Social Protection and Security, (ii) Education, (iii) Demographic Change, (iv) Lifestyle and Health Behaviours,…”

“…The EURO-HEALTHY project (Shaping EUROpean policies to promote HEALTH equity) was a 3-year project (2015–2017) funded by the European Commission to advance knowledge on policies with the highest potential to promote health equity across European regions, with a specific focus on urban areas. At its core is the application of a multidimensional and participatory approach to population health with the goal of understanding the key drivers of health inequities and advancing evidence and methods to better inform policymakers at different decision-making levels, the European Union (EU), national, regional and local [ 3 , 49 , 50 ]. The flagship tool of this project is a Population Health Index (PHI), a measure that characterizes European population health across multiple areas of concern, dimensions and indicators of health determinants and health outcomes [ 50 – 53 ].…”

Development of a scalable and extendable multi-dimensional health index to measure the health of individuals

“…Zhau constructed a 15-item health index from domains of health conditions, health behaviors and social determinants to measure health changes at county-levels [11]. Santana and colleagues developed a multi-dimensional measure for evaluating health based on equity in health determinants and health outcomes [12]. The Health Determinants and Health Outcomes indices are divided into 10 sub-indices that are areas of concern for population health.…”