We are witnessing a general decline in the health of people in vulnerable and isolated situations. In this article, David Pattison looks at the common challenges experienced by these groups and what can and is being done to reverse the trend.
By David Pattison
Across Europe there has been a growing recognition of the particular health and social inequalities faced by our most vulnerable communities and individuals. These include older people, people in prisons, people who are homeless, families with children at risk of poverty, migrants, people living with physical disabilities or poor mental health, victims of domestic violence, the unemployed and in-work poor, and those living in rural or isolated areas.
While each group faces its own specific challenges, there are common issues experienced by all groups and individuals facing vulnerable situations. These include, among others, limited or no access to health care systems and services; pressures due to co-financing requirements in some Member States, leading to increased poverty rates; growing levels of poor mental health and wellbeing; lack of easy-to-navigate integrated services; escalating isolation particularly for people who are homeless or in insecure housing conditions, and for those people who are unemployed or in very low-income employment. These issues have been exacerbated in recent years.
As a result of this, the health of individuals and families has deteriorated, especially for those with low socio-economic status, increasing their poor circumstances in an ever escalating spiral marginalisation and isolation as well as impacting on the ability of authorities to provide adequate and accessible services. We should consider both the negative impacts on individual health, but also the negative impact on societal cohesion and inclusive growth. If we are to ensure the sustainability of our health systems, universal targeted action to address the issues faced by people in vulnerable situations should be taken without further delay.
One of the areas where immediate engagement is needed is providing better training to all health care professionals working with vulnerable groups. In addition, intersectoral collaboration and client-centred health care service planning represent key challenges to be addressed both within and between organisations. For effective service design, there is a need for capacity building activities aimed at key staff who have responsibility for health at national, regional and local level. These activities should enable them to provide services and further training within their own areas in partnership with other actors.
In the past few years, much work has been done to identify good practices that can be used as material for intersectoral collaboration and participatory service design capacity building. For example, PROLEPSIS’ DIATROFI programme on food aid and nutrition education in Greece, is a well organised, managed and evaluated project aimed at providing meals to children in disadvantaged areas while improving the nutritional value and content of their school meals. Work on embedding co-production into health and social care is being carried out by Public Health Wales, which provides a clear understanding of the process required to undertake a true participative approach to co-production with clients and service providers. The Italian Casa Aurora intersectoral and integrated approach to support mothers with addictions, poor mental health, and who are often victims of domestic violence. Finally, the Jablíčko project developed and implemented by the Czech National Institute of Public Health to educate pre-school and school children living in social excluded areas to healthy lifestyles. These examples clearly demonstrate the benefits of intersectoral collaboration and client centred health care service planning.
The European Commission has also been implementing work in this specific area. For instance, The VulnerABLE project carried out by ICF Consulting Service Ltd and EuroHealthNet, with the support of GfK, UCL’s Institute of Health Equity, the Social Platform, and the European Public Health Alliance. The aim of the project was to increase knowledge and understanding of how to best improve the health of people who are living in vulnerable and isolated situations, and to identify the most effective strategies for progress.
VulnerABLE drew on research findings to design and deliver capacity building modules which gave national, regional, and local authorities as well as stakeholders (e.g. programme designers or developers) insight on, and ability to increase capacities in, specific policies and practices. These activities included information on how to develop and implement actions to improve health, prevention and service delivery to people in isolated or vulnerable situations. They went beyond simply training or providing technical assistance as they helped people to gain the knowledge and experience needed to solve problems, implement change, build effective actions and achieve sustainability, while delivering a current ‘snapshot’ of the reality of citizens within the EU.
This work has highlighted current commonalities in issues faced by health authorities when it comes to caring for vulnerable communities. Challenges include that of standard health and social care services and staff proactively engaging with and redesigning services with vulnerable people and communities. Further, differing funding mechanisms and bureaucratic systems discriminate against some of our most vulnerable citizens and communities. There is limited experience of intersectoral collaboration with shared outcomes; there is a need for more staff training and development and accessing politicians and policy makers before manifesto’s or policies are developed.
The key challenge now is to maintain this momentum, to build on findings, and to take advantage of available tools to improve ways to care about people in vulnerable situations. It is essential to have further dialogue with the European Commission, including DG EMPL, the Social Protection Committee, and DG SANTE, and other partners to identify opportunities to develop this approach in the coming years.
Our most vulnerable citizens deserve no less.
David Pattison
David was EuroHealthnet’s President from 2010 until 2014 was also the Head of International Development, NHS Health Scotland – UK, he is now a freelance consultant in Management and Health.