Investment in health equality early in childhood pays off in Austria


“There is increasing evidence that the first 3 years of life is key for health, even for adults. So it is a vulnerable phase on one hand, but one with good possibilities to promote health equality” - Sabine Haas

A holistic approach is proving successful in limiting future health inequality and public spending in Austria

In Austria, early help to families with small children is proving a success. It is not only successful in reducing inequality in health, but is also a good investment. By investing early, the goal of Frühe Hilfen, as the programme is called, is to reduce the health inequality that starts in early childhood but often last through the lifespan.

Sabine Haas, Head of the National Centre for Early Childhood Intervention, explains: “The phase of early childhood is an essential phase, not just when it comes to health but also education and other aspects of life. If it is not possible to have good opportunities in this phase, then children will have greater difficulties through their entire life”.

A holistic approach

The aim is to improve early childhood development in children from economic and socially disadvantaged families, as well as families with specific needs. Frühe Hilfen uses a holistic point of view with a multiprofessional approach, coordinating between public services such as housing, schools and midwifes, to help families raise healthy children. It covers families with children under 3 years old, and about half the population of Austria lives within easy reach of a Frühe Hilfen network. The programme is voluntary and gets in touch with the families through direct outreach and through professionals, like health and social workers, who can identify and refer them.

Preventing inequality

So why is early help so important when it comes to equality in health?

According to Ms Haas – who is also Deputy Head of the Department for Health and Society at Gesundheit Österreich, the National Research and Planning Institute for Health – early childhood offers a chance at bridging part of the health divide. “There is increasing evidence that the first 3 years of life are key for health, even for adults. So, it is a vulnerable phase on the one hand, but one with good possibilities to promote health equality.”

A cost effective investment

Since the launch of Frühe Hilfen in 2015, the number of families in the programme has steadily increased. In 2016, a total of 931 families were receiving help, and in the first half of 2017 that number had risen to 1068. These numbers cover 8 out of the 9 provinces in Austria, as one province has a separate but similar programme.

It seems that extending the use of programmes like Frühe Hilfen could help not just more families but also the national budget. “Last year we looked at how much money we spend on a typical family, and looked to the evidence and the experts working with similar families that didn’t get the support. And depending on the constellation of the family, the return on investment is between 1:5 and 1:22 over the lifespan,” Ms Haas explains.

Impressive results

When asked about the results of the programme, Ms Haas proudly states that the results of an external evaluation, as well as feedback from the families, have impressed her. The National Centre for Early Childhood Intervention gets evaluations directly from the families supported, and according to Ms Haas they see a clear benefit. In fact, 98% of the families that have sent in evaluations are very satisfied with the help, and have improved their situation since getting in touch with Frühe Hilfen. Better access to services, an improved social network, or simply feeling relieved and empowered because someone was expressing that they were doing a good job are some of the results Ms Haas and her team have received in the evaluations.

Stakeholders ensure a successful investment in early childhood

Ms Haas is in no doubt about the value of early childhood prevention. But the investment has to be done right, she also points out. Any initiative has to be built on an existing need and on the structures and services already in place. “From our experience, a broad stakeholder process was extremely useful and was instrumental in ensuring commitment by taking into account the knowledge, ideas and experiences that are already there.”

Many other countries have similar programmes, but simply copying one of these would be a waste of resources in Ms Hass’ opinion. She mentions the Sure Start programme from the United Kingdom, which has been a source of inspiration. “Sure Start from the UK is perfect, but it might not work in Austria. You have to adapt and involve people.”