Public health policy for disadvantaged target groups Trine Andrea Els Helle
Public health policy (1) • The debate is no longer if inequalities in health do exist, but what can be done about them. • WHO Europe By the year of 2020, the health gaps between socio-economic groups within countries should be reduced by at least one quarter in all Member states, by substainigly increasing the level of health of disadvantaged groups.
Public health policy (2) • Measurement → recognition → awareness and concern is raising → isolated action → structural policy programs 1. Curative 2. Prevention and health promotion • Disadvantaged target groups living in poverty: • Elderly • Children • Homeless people • Immigrants and newcommers
Elderly in poverty (1) • Socio-demographic process of aging: group is increasing↑ • ↑ chronic diseases → long term medical care need → ↑ risk of poverty • Problems • acces problems (physical), isolation • need of additional benifits for increasing health care • lack of knowledge of entitlement benifits • Most relevant to single-living women
Elderly in poverty (2) • Health problems • Loss of independence in everyday life activities (crucial turning points), physical disabilities, falling, trauma • Athroses, chronic artritis, cardiovascular diseases, bronchitis, gastro-intestinal diseases • Mental diseases (dementsia) • Dental problems (loosing all teeth)
Campaigns for elderly • Health promotion homevisits at the age of 75 (DK). • Information about health care benefits, nutritional education, evaluation of the elderlies situation • Community Health Care Centers (B). • Fall prevention • National fund elderly help (NL). • Personal bound help from the INFO PLUSBUS • Home visiting whereby elderly people can be helped with their finance • Elderlyhelpline, phone-number
Children living in poverty (1) • Health problems of children • Nutrition diseases (obesity and underfeeding) • Infectious diseases • Caries • Severe injuries • Psychosomatic health problems (insomnia, anorexia, headache, sickness, nausea) • Behavioural problems
Children living in poverty (1) • Social causation of health problems • Inadequat primary care and psycho-socialwelbeing provided by the parents • Low familiy budget or no work related income, especially: • Unemployed parents • Single parents • Large families >3 children (sometimes) • Detrimental health behavior of parents(smoking, nutrition) • → relevant restrictions on famliy budget • → negative impact on health status of children
Campaigns for children • Project ‘Houten skutsje’ (Friesland) (NL) • Stimulate development of children • Requirements for Activities for children who needs help • ‘Niets aan de tand’ (B) • Community health centers (Genth) • Dental problems due to feeding by bottle, access to dentist, education • ‘Kind en gezin’ • Registration of children living in poverty and organisation of care at home • Groups for children with special needs (DK) • Sexual education for teenagers (all countries)
Homeless people (1) • Extreme form of poverty • Unwanted? • Figures. only estimations (2006) • Europe: 3 million • The Netherlands: 50.000, Amsterdam: 2600 • Belgium: 12.000, Brussels: 1200 • Denmark: 11.000-13.000, Copenhagen: 3.500
Homeless people (2) • Health problems • Multi morbidity • Addictions (alcohol, drugs) and addiction related diseases • Mental disorders (3 times higher than for general pop) • psychological distress • self reported depression • anxiety • Shizophrenia (mostly young people) • Physical diseases (TBC, bronchitis, skin diseases, infections)
Medical care for homeless people • Denmark: • Street nurses and shelter nurses • Free medical care • Belgium: • ID-registration and obligated health insurance at the adress of Public Centre of Social Welfare (OCMW) • Urgent medical care is free of charge • Voluntary working doctors in cities • The Netherlands: • Everybody has the same right receiving health care, also homeless people • AMT: Ambulant (social) Medical Team : help without an insurance.
Campaigns for homeless people • Shelters (B and NL) • Paid by community government • Free donations • Voluntary workers • Salvation army (christian church) (NL) • Organisation for disadvantaged people, also homeless people. • Offer a lot of help, also medical care • The mobile Café (DK) • Meals-on-wheels • Project social Nurse (DK)
Immigrants and new comers (1) • Number has reduced last 2 decades in Europe • Stricter immigrant regulations • Border controls • Forced deportation of person • High risc of poverty • Difficulties finding a pyed job • Exploitation • Poor housing • Poor social net
Immigrants and new comers (2) • Examination at moment of arrival • Health problems • Diseases of respiratory tract (TBC) • Skin diseases • Dental problems • Aids, hepatitis, sexally transmitted diseases
Campaigns for immigrants and newcomers (1) • Ijsbreker (B) • Community health care centre • Improve information and communication • Medimmigrant (B) • Brochures about healt care and health care system in different languages • 50% of total medical cost is payed back • Second hand medical equipment
Campaigns for immigrants and newcomers (2) • NIGZ: National Institute Health care promotion and prevention (NL) • Translated brochures • Interpreter for own language • Education to health care providers • Equal access to health care system, 6 weeks after application as etnical danish citizens • Exercise programmes & nutritional education (DK) • Interpreter is mandatory by law and free of charge the first 7 years in the country (DK)
Site visit at psychiatric departmentof Nyirő Gyula hospital in Budapest Facts: • Open unit; 72 patients, 3 nurses • Closed unit; 18 patients, 3 nurses • 144 beds in the whole department • 18 “special treatment beds” • 2000 patients admitted in 1 year • 613 social problems (2006) • 200 financial problems • 39 homeless
Target groups in departmentof Nyirő Gyula hospital in Budapest • Elderly • A lot of elderly people admitted • 5 year waiting list for nursing home • Homeless people • a few, some of them don’t want help • Single parents • rooming in with mother-child (creative problem solving) • Immigrants • Not a real target group in Hungary
Interdisciplinarity work at the psychiatric unit (1) • Nurses • 3 nurses per unit per shift Main job tasks • Prepare and give out medication • Basic care (daily hygiene) • Administration! • Social worker • 2 for the whole department • Main job tasks • Take care of complex social problems; housing, jobs, income, social network • Relations with private connections is very important • Creative problem solving, playing games
Interdisciplinarity work at the psychiatric unit (2) • Psychiatrist/ physician • 1-2 per unit • Psychologist • 1-2 for the whole department • Physiotherapist • 2 for the whole department • Occupational therapist • ???
Interdisciplinarity work at the psychiatric unit (3) • Teammeeting Head nurse, physician, social worker, psychologist Discuss: • patients: current problems (social and health) therapeutic progress • new patients • problematic patients • Etc.
Discussion • Are public health programs effective on public level, or local level? • Should the government interfere in health promotion or is it an individual responsibility? • Does illness lead to social problems, or do social problems lead to illness?
Conclusion • National public health policies and programs are needed to educate and inform the whole population. • Campaigns on local level are necessary to reach specific target groups. • Preventive programs are not only a task for the health care sector, there should be a cooperation with the social sector as well. (job-opportunities, housing, etc.) • Site visit: • The visions of the psychiatric hospital head nurse is the same as in our own countries, but the implementation is limited by financial recourses and structure.
references • De Decker Pascal (2004), Belgium National report 2004 for the European Observatory on Homelessness: statistical update, Feantsa • Menk Ralph et all (2003), Report on socio-economic differences in health indicators: health inequalities in Europe and the situation of disadvantaged groups, Bielefeld • Tasma Nicoline and Berman Philip (2004),The role of the health care sector in tackling poverty and social exclusion in Europe, European Health Net, Brussels • European community (2007), Closing the gap: strategies for action to tackle health inequalities, European Health Net, Brussels • Benjaminsen Lars and Christensen Ivan (2007), Hjemloeshed i Danmark 2007 – National kortlaegning (homelessness in Denmark 2007– National survey), SFI Kopenhagen
www.eurohealthnet.eu • http://epp.eurostat.ec.europa.eu • www.armoedebestrijding.be • www.medimmigrant.be • www.wvgc.be • www.vig.be • www.minsoc.fgov.be • www.sst.dk • http://www.udenfor.dk • http://nigz.nl • http://crossroads.journalismcentre.com/2007/fewer-homeless-people-in-the-netherlands/ • www.legerdesheils.nl • http://www.vvdamsterdam.nl/artikel/368.htm • www.ggd.nl