Health equity case studies
These case studies were compiled for the Healthy, Prosperous Lives for all in the WHO European Region – High-level Conference on Health Equity on 11–13 June 2019 in Ljubljana, Slovenia. They illustrate some of the ways countries have taken concrete action to address the 5 conditions necessary for healthier, more equitable and prosperous societies.
- The Healthy Generation project – promoting accessible health services for health equity
- The B-MINCOME project – promoting income security and social protection for health equity
- The PRISMA-7 project – promoting accessible health services for health equity
- Arbed and Nest schemes, Warm Homes Programme – promoting decent living conditions for health equity
- The TOY for Inclusion initiative – promoting social and human capital for health equity
- The Partnerships for Youth Employment initiative – promoting decent employment and working conditions for health equity
The Healthy Generation project – promoting accessible health services for health equity
Republic of Moldova
This project seeks to increase young people’s access to health information and high-quality health services through a network of 41 youth-friendly health centres. These centres provide health services to address a range of issues, including sexual and reproductive health, nutritional disorders, mental health problems, and problems resulting from violence. They also offer general medical examinations, information and counselling for mental health, and contraceptives.
While only 5% of young people in the country used the centres in 2011, that figure had risen to 25% by 2017. By increasing geographical access and providing good-quality health services, Healthy Generation has helped to reduce young people’s unmet health needs – particularly for those in low-income areas.
Ecaterina, a 19-year-old student and youth-friendly health centre volunteer, says, “The centres have given me confidence in myself. They have changed my life, contributed to my personal development as a young adult, and helped me get answers to many questions. After counselling, I felt a whole range of positive feelings and forgot about my fear and shame of talking about taboo subjects.”
The B-MINCOME project – promoting income security and social protection for health equity
This 2-year pilot project aims to invest in people and improve their immediate surroundings by providing a guaranteed minimum income. It focuses activities in 10 deprived neighbourhoods in the Eix Besòs area of Barcelona, characterized by lower average income, high unemployment and significant school drop-out rates.
The support that B-MINCOME provides goes beyond financial benefits to include:
- training and support to increase employment opportunities for residents;
- house renovations;
- community social and cooperative activities; and
- a local currency to benefit the local economy.
Manuela*, a 38-year-old unemployed mother of 2, participates in the project. She says, “B-MINCOME is helping, at least regarding the children. You know that you have milk, food, you know that you can pay for the nursery or food canteen. In that sense, it’s really helping me, but it’s not enough to pay for anything else.”
* Name has been changed.
The PRISMA-7 project – promoting accessible health services for health equity
Friuli Venezia Giulia, Italy
Frailty makes older people more prone to minor physical stresses and can increase the risk of falls and disability. Started in 2018, PRISMA-7 seeks to detect frailty early in older people and improve the response of health and social services. It aims to improve older people’s quality of life, promote their independence, and prevent or delay hospitalization and functional dependency.
The project has 2 phases:
- identifying individuals at risk of frailty among people over 75 years of age (26% of the population in Friuli Venezia Giulia) through short telephone interviews using a 7-question screening tool; and
- talking with those identified as at risk about their condition and ensuring better-integrated support by, for example, involving a general practitioner and social services.
In 2018, more than 23 000 older people were interviewed and 38% were identified as potentially frail. Giorgio, a 75-year-old man from Trieste who cares for his wife with dementia, participated in the project. He says, “The strength of this project is that it not only provides services in the home, but above all teaches us to keep ourselves healthy and gives us the tools to do so.”
Arbed and Nest schemes, Warm Homes Programme – promoting decent living conditions for health equity
Wales, United Kingdom
The Welsh Government developed the Warm Homes Programme to help eradicate fuel poverty, reduce carbon emissions and accelerate economic development and regeneration in Wales. Through the Arbed scheme, households take part in a survey to assess the energy performance of their property. If selected, an official installer fits the home with central heating and insulation and quality-checks the new system.
Through the Nest scheme, households answer questions to assess their eligibility for free home energy-efficiency improvements. If eligible, they can access a package of measures at no cost, including a new gas boiler, central heating system and/or insulation. If ineligible, they receive free advice on saving energy, managing money and reducing energy tariffs. Thus far, the Warm Homes Programme has made energy improvements to over 50 800 households and provided energy-related advice to more than 113 000 households.
Mrs H., a homeowner near Caerphilly, Wales, had a combi-boiler installed and thermostatic radiator valves fitted to her radiators through the Nest scheme. She says, “It’s wonderful, it’s like magic for me. I’ve never had hot water instantly. The last system took about an hour to heat up before you felt the warmth. Now you can feel it straight away. I have Raynaud’s disease, so I feel the cold more than someone else, so this has made a massive difference to me.”
The TOY for Inclusion initiative – promoting social and human capital for health equity
Belgium, Croatia, Hungary, Italy, Slovakia and Slovenia
The TOY for Inclusion initiative aims to ease the transition from home to preschool for young children, including Roma children, who often experience segregation and discrimination from a very early age. It sets up play hubs in areas accessible to both Roma and non-Roma families so that children and their families can take part in community-based, integrated services. The play hubs provide equal access to safe, health-enabling environments.
Local committees and teams run the play hubs with representatives from schools, preschool teachers, community development workers, civil society representatives, health professionals and other local stakeholders and authorities. In 2018, 3000 children took part in play hub activities, and 2000 parents and grandparents took part in activities with practitioners.
“The play hub is ideal for parents who cannot afford the kind of quality toys that are available here. It is great that we can borrow games or toys for children to play with, learn or build something new,” says Anela, a mother of 2 living in the Murska Sobota Roma settlement in Slovenia.
The Partnerships for Youth Employment initiative – promoting decent employment and working conditions for health equity
Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan, Turkmenistan and Uzbekistan
In eastern Europe and central Asia, the youth unemployment rate is 15–17% – 3 times higher than the adult unemployment rate. Youth unemployment is strongly associated with mental health problems and risky behaviour, and can also have a long-term impact on health and well-being.
The Partnerships for Youth Employment initiative, organized by the International Labour Organization and the private sector, aims to improve youth employment through local partnerships and strategic alliances at a subregional level across 10 countries.
Participating countries focus on developing effective youth employment policies and strategies; implementing action plans and programmes to create more and better jobs; building partnerships at the local level; and sharing knowledge and experiences with other countries.
Elbrus, a 25-year-old electronic sports (e-sports) club owner from Azerbaijan, says, “Although I only took part in the project for 3 months, it has changed my life completely. I was unemployed for a long time, but now I have my own business. Being financially independent is the most precious thing in the world. Having a job gives you satisfaction and happiness.”