‘’Unpicking complexity’’: Acting for inclusive, integrated health and care across Europe

We often report events in which we participate in our online newsletter Health Highlights. As the title suggests, that gives brief notices of the most important relevant happenings in Brussels or wherever our Partnership is involved. But sometimes we should dig a little deeper to explain the issues that are discussed, not only how they are presented. In November, EuroHealthNet was involved in a cluster of meetings in Brussels which all had different titles involving health, care, ageing, poverty, inclusion or social protection. I enjoyed the debates and heard wonderful contributions at each. But taken together, there is an important strategic thread running through them we should consider: how, in a complex world, can we realistically work together better to meet needs?

By Clive Needle

Logo AFE InnovnetThe first event where this was clear was organised by the European Commission Directorate for Employment, Social Affairs & Inclusion (DG EMPL) and the World Health Organisation (WHO) for Europe. Together they are working to produce recommendations on Age Friendly Environments for Europe in a project known as AFEE. I am pleased to be part of its advisory board, which was consulted on progress so far towards a report at the end of 2015. EuroHealthNet is connected by being part of a related research project AFE-INNOVET linked to the EU Innovation partnership for active healthy ageing (EIP-AHA), run by the AGE platform which represents ageing peoples across Europe. Already you see so many groups, so many initiatives, and so many acronyms – a typical complexity in itself when working at large scale EU levels.

Much of the AFEE thinking is very much in line with the ‘’health in all policies’’ approaches with which EuroHealthNet partners and health promoters are familiar. The WHO is currently consulting member states on that subject, to which our Executive Board is contributing what we have learnt, through our Crossing Bridges project plus our own experiences of working in the EU social inclusion fields through its PROGRESS programme 2011 -13 and now the Employment and Social Investment (EaSI) programme 2014-17. The report itself remains internal so I cannot share links, but it became clear in discussions that work and evidence on how to implement widely agreed principles is crucial. This may well be based around wellbeing, sustainability for systems and equity, the main principles we have advocated in our response to the recent EU consultation on its priority economic strategy, EU2020. So already you can see how all these things need to fit together, yet have distinct purposes. It underlines why we regard working with the EC and WHO as so important – we are all interdependent and the days have gone when simple, linear solutions were available.

OurWork_HAgeing_SQSo we will follow up on AFEE and AFE-Innovet by updating our own Healthy Ageing website with examples of good practices and innovations, and re-launching our technical working group of expert partners on the subject in 2015. When we do that, we will surely include examples from evaluations from our pilot projects in Slovenia and Italy, plus learning from our study visit to Tuscany which is reported elsewhere in this magazine. Each of those show a basis in health, but reliance on links with other sectors, from social care to economic development, food systems, transport and so on, all of which are important factors for generally good environments with a special focus on the needs of older people.

Although the second meeting in this group had a wider reach concerning care throughout the life course, it was inevitable that much discussion would focus on ageing populations. This was a very welcome new partnership process we could launch with Eurodiaconia, the network of ecumenical and church organisations working on social policies, plus again AGE Europe, all of us partners in the EU Platform against Poverty group of stakeholders. Again we learnt from contributions from DG EMPL about its joint report with the EU Social Protection Committee on social protection and long term care, which is important reading for us all and on which EuroHealthNet is actively working. Again we heard from WHO Europe, which is compiling an index on integrated care showing enormous variations across the continent plus a need for better evaluation, which is helpful. We also heard from the newly named EC Directorate for health and food safety, DG SANTE, on how it is leading work within the EIP-AHA, although equity seemed to have a less prominent role than we would hope as innovative examples are promoted.
But perhaps the most telling contributions were from people experiencing realities at the difficult end, in communities from Ireland, Greece, Scotland and France, who had come to Brussels to tell their tales. They were not only critical but also full of ideas and hope about what can be done, for carers and patients. This was underlined by an empassioned call for action for people with disabilities by Gunta Anca, a representative from the Economic & Social Committee, plus an MEP from Slovenia, Ivo Vajgl, who listened carefully and asked for more information about his own country, which of course we are happy to ensure.

The next day I joined Mr Vajgl’s elected colleagues in the European Parliament, where representatives from all the leading political groups spoke at a seminar ‘’Which welfare for Europe?’’ to discuss a report on EU 2020 objectives commissioned by Caritas Europa, the charitable humanitarian organisation. The recommendations focus on tackling three major aspects of poverty, among children, young people and in work, which is a growing concern amid the financial and economic crisis. It could not be said there was political agreement: there is a very different approach from social democrats and trades unionists to that advocated by liberals and conservatives, based around the European Commission’s new private funding initiative with the European Investment Bank. I reminded participants about the role of health systems and the need to tackle inequalities, and made a plea to not let administrative barriers between systems, departments and committees block progress. People don’t live in such old ‘’silos’’ in our rapidly changing communities, and I pointed out new evidence on how health systems, as broadly defined by WHO Europe, can contribute to tackle poverty.

Picture-povertyThe fourth meeting in the busy week was the biggest and encapsulated elements of all the previous three. EuroHealthNet has been an active participant in the EU Platform against Poverty since its inception five years ago when the EU 2020 strategy was launched with its flagship target of cutting the numbers of people at risk of poverty. It – we – have failed not only to hit that limited target, but instead of reducing by 20 million there are actually now over 4 million more. 123 million of our fellow citizens are at risk of poverty, which is shameful in a wealthy continent. In 2010 WHO produced its report on poverty and social inclusion, after a consultative process run by its Venice office in which I and our former President David Pattisson were proud to be involved. So I had no hesitation in committing EuroHealthNet to work within the Platform, and in its annual Convention. This was held as usual in Brussels with over 700 participants, including our splendid EuroHealthNet partners from BZgA from Germany, Vigez from Flanders in Belgium, and Prolepsis from Greece, all contributing national knowledge and taking back good learning. As Helene Reemann from BZgA commented to EuroHealthNet’s Leo Palumbo: ‘’The Convention highlighted a range of innovative and integrated approaches in order to tackle poverty and many attached problems, primarily at local and regional level in member states, where the people are living. In terms of implementing integrated services- a central issue which has been discussed during the conference – it would be important to intensify the collaboration between the different policy sectors, especially with health sector. ‘’

So there is that crucial word again which is trending in all our work: ‘’integrated’’. I spoke on this and the role health systems can play in one of the many workshops full of informed panels, again on long term care. There was a real buzz about the event; people spoke from all corners of the EU and from many perspectives; there were ‘’speed dating events’’ for project partners which Leo found particularly useful; there were ‘’world café ‘’ discussions; there were innovative global examples from India, South Africa and Paraguay; there were the grandest mayors and simplest citizens alike. The President of the European Parliament Martin Schulz and the new Commissioner Marianne Thyssen set out their very different priorities. And there was a moving ceremony to mark the 25th anniversary of the UN Convention of the Rights of the Child, in which young people directly involved spoke and challenged us all to do something, do more, do better.

Clearly this all matters greatly and we can all see the continuing and growing needs. But at each of the four meetings, all too easily I found people slipping into their own comfort zones, their own policy areas, not ‘’thinking beyond the box’’ in the horrible business jargon of our times, not connecting what they were arguing to the available processes like the Poverty Platform. That was widely ignored outside the Convention. They say: ‘’you are from health – why are you here?’’

We cannot let that happen. Ideas are not enough, though there are many not yet evaluated; scaling up is notoriously difficult, although I learnt of examples in Denmark and Scotland that we can follow up; breaking down administrative and cultural and even language issues is going to be tough; urgency matters – we cannot wait for generational studies and complex evidence. Over a hundred million Europeans are suffering now – and you will probably read this at a time of winter festivals and commercial pressures, which we might enjoy but which will add to misery, stress and exclusion for many.

At yet another event recently I was pleased to meet again with Dr Pekka Puska, well known in health circles as among the leading thinkers of the ‘’health in all policies’’ concepts in Finland and globally. Those are not new, untested notions, but established. That is why we are acting to win support for implementation of integrated effective methods and practices before it is too late. That is why we ourselves get out of our comfort zones and into such complex areas. That is why we forge new partnerships with AGE, with Eurodiaconia, with the European Social Network, with the European Forum for Primary Care, with EuroChild, with the European Network against Poverty, with many others who don’t have ‘’health’’ in their titles. I hope that in 2015 you, dear Reader, will join us in that integrated approach towards our implementing our founding mission of improving health and tackling inequalities.

Clive Needle
Policy & Advocacy Director at EuroHealthNet | + posts

Clive advises the EuroHealthNet Executive Board and managing director on policies relating to health for all EU activities and actions on social, economic and environmental determinants of equity and wellbeing. He was formerly overall EuroHealthNet director for thirteen years and continues to work in support of WHO and other international organisations and projects in Europe.

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