DRIVERS (2012-2015) was a three-year research project funded by the EU’s Seventh Framework Programme. It aimed to find solutions to improve health equity through policy and practice in early childhood, fair employment, and income & social protection. It was co-ordinated by EuroHealthNet and involved leading centres of research and organisations representing public health, civil society and business.
By Linden Farrer
DRIVERS has now ended and it is possible to reflect on its many achievements: 19 peer-reviewed papers in leading academic journals and more to come, three public scientific reports, 19 case studies carried out across Europe involving many EuroHealthNet members, five synthesised case study reports, publication of three concise and high-quality policy briefs explaining the issue, solutions and opportunities to take action in the DRIVERS areas, a set of recommendations laying out how policy makers can implement policies across sectors to improve health equity across the life course, three final events involving many important stakeholders and decision makers, and finally translations of the policy briefs and recommendations into several different European languages.
The project had some very strong and clear messages to disseminate, which EuroHealthNet will work hard to promote. These were informed by an innovative package of work – led by EuroHealthNet – that focused exclusively on advocacy for health equity, and whose main ‘lessons’ are provided on a tailor-made section of the DRIVERS website, the “Advocacy for health equity toolkit”.
In the final recommendations the project and its partners described four key principles by which policy makers can implement cross-sectoral policies to improve health equity:
- Univerality of access,
- Addressing disadvantage,
- Accounting for context and respecting rights,
- Evidence-based policy.
These four principles are reflected in the solutions put forward for improving health equity in the DRIVERS areas:
Universal, quality early childhood programmes that are responsible to need. A range of services and policies are required to reduce health inequalities in early childhood. This includes parenting and family support, high-quality early childhood education and good healthcare in the pre- and postnatal period. These need to be tailored to social and economic need and recognise and build on the knowledge, skills and capacities of parents. Interventions that are particularly effective appear to be those that augment parental capacities, improve housing conditions, and those that provide day care, speech and psychological therapies for children. The earlier these programmes are offered, the better the outcomes will be.
Improvements in quality of work, particularly for people in lower occupational groups. No single sector can tackle ‘unfair’ work and employment (defined by material and psychosocially stressful conditions). It requires the active involvement of many stakeholders, including employers, trade unions and occupational health and safety professionals. As a first step, adversities at work need to be systematically monitored. As a second, organisational-level interventions should tackle the multiple sources of adversity and take a participatory approach involving employers and employees. Finally, EU-level policies are needed to reduce the variations in the quality of work seen in different parts of Europe. Particular efforts are for those lower occupational groups that suffer workplace adversities the most.
Well-designed social protection systems. Higher levels of social spending are generally linked to smaller health inequalities. However, DRIVERS’ research goes further, and suggests that the proportion of those covered by social protection is crucial. This means that 1) countries with low coverage rates should increase them to 90 per cent or higher, 2) countries should strive to increase replacement rates once an almost complete coverage rate is attained. Social protection should be designed to protect against a variety of risks and particular efforts need to be paid to those at risk of being marginalised. One way of doing this is minimum income benefits, and another is to invest in active labour market programmes. Finally, the case studies suggested that helping people to obtain the protection they are legally entitled to, providing integrated support to those with complex needs, and providing front line staff with the means to treat their clients appropriately are also important aspects of a well-designed social protection system.
Linden is part of the team co-ordinating DRIVERS and is involved in EuroHealthNet’s on-going evaluation activities. His particular focus is on the relationship between income and social protection and its relationship to health and health inequalities. Within DRIVERS, he worked closely with other colleagues to develop work on advocacy methodologies.