November 30 and December 1, 2015, projekt UDENFOR participated in the Nordic conference ’Social Inequality within Health – From Knowledge to Action’. The conference that was held at the UN City of Copenhagen, focused on how to implement initiatives against social health inequality at local level. This sounds like a question with a simple answer. It is not.
At the conference, the report ’Tackling Health Inequalities Locally: the Scandinavian Experience’ was presented. The report and the research was carried out by three scientists from the University of Copenhagen on request by the Scandinavian health authorities, who has to realise that they have not yet succeeded in restraining the increasing social inequality within public health.
The research of the report includes experience from Norway, Sweden and Denmark. Some of this experience was shared in various forums at the conference.
The report puts forward a number of recommendations for increased efforts against the social health inequality. Get the report here www.sst.dk/nordisk
What can the three Nordic countries, who have practically the same welfare models learn from each other when it comes to checking the progress of increasing social health inequality? A great deal, actually. On the practical, local level in various parts of Scandinavia, you see development which could hold the seeds of deceleration of social health inequality.
However, some of the contributions to the conference criticised that the central, regional and local levels do not speak the same language. The welfare society is under pressure and ‘silo thinking’ occurs; for instance in the labour market and health areas that do not share the same purpose. To put it a bit bluntly you could say that the health system “owns” the effect of health inequality whereas the other policy areas “own” the solutions.
The ownership of the health system in proportion to the effect of inequality is well illustrated – we have extensive knowledge of the element, which may reduce the social health inequality. The challenge lies within getting those who “own” the solutions to (want to) cooperate. We therefore need to bring all relevant policy areas into play, hereby establishing joint ownership of an effort that works and moves ahead.
Unfortunately, the road ahead is quite bumpy. Local councils are challenged in more than one way because they have tasks that are hard to balance. On one side, they have to implement the politics of central government and on the other hand, they must strive to meet local requirements and wishes.
In spite of this, the conference gave examples of local authorities in the Nordic countries who presently are gaining positive experience in this field. One of these is the Municipality of Aalborg who, through a transversal health policy, is including all policy areas in the effort against social health inequality.
In Denmark, the knowledge of vulnerable citizens’ health is extensive. We know that homeless people who have been examined by doctors, have an average of 13 different diagnoses. We also know that the lifetime of homeless men is approximately 20 years shorter than men, who have a residence. Using an expression from the conference, we can say that the health system ‘owns’ the intensely increased ill-health and too early mortality of the homeless. And this includes all financial costs and undignified waste of human life.
The conference gave examples that it is actually possible to combine local force and resources in the effort of improving public health and reduce health inequality.
So, when will the policy areas ‘owning’ the solutions enter the scene? When will we create a common, permanent and sustainable ownership for the fight against social health inequality?
Soon is not fast enough.
Jane Laustsen, projekt UDENFOR 2. December 2015.