Criteria for implementing interventions to reduce health inequalities in primary care settings in European regions.

BACKGROUND: The current social and political context is generating socio-economic inequalities between and within countries, causing and widening health inequalities. The development and implementation of interventions in primary health care (PHC) settings seem unavoidable. Attempts have been made to draw up adequate criteria to guide and evaluate interventions but none for the specific case of PHC. This methodological article aims to contribute to this field by developing and testing a set of criteria for guiding and evaluating real-life interventions to reduce health inequalities in PHC settings in European regions. METHODS: A literature review, nominal group technique, survey and evaluation template were used to design and test a set of criteria. The questionnaire was answered by professionals in charge of 46 interventions carried out in 12 European countries, and collected detailed information about each intervention. Third-party experts scored the interventions using the set of evaluation criteria proposed. RESULTS: Nine criteria to guide and evaluate interventions were proposed: relevance, appropriateness, applicability, innovation, quality assurance, adequacy of resources, effectiveness in the process, effectiveness in results and mainstreaming. A working definition was drawn up for each one. These criteria were then used to evaluate the interventions identified. CONCLUSIONS: The set of criteria drawn up to guide the design, implementation and evaluation of interventions to reduce health inequalities in PHC will be a useful instrument to be applied to interventions under development for culturally, politically and socio-economically diverse PHC contexts throughout Europe.

[The architects of change: a plenary session exchange]. / Les artisans du changement: autour d'un echange plenier.

The closing plenary of the colloquium was an occasion for exchange between the four panelists and the participants. The panelists included Luc Berghmans, a doctor and director of the regional health observatory of Hainaut, Belgium; Louise Bouchard, a sociologist and professor in the Sociology and Anthropology Department, University of Ottawa, Canada; Michel O'Neill, a sociologist and professor at the Faculty of Nursing Sciences, Laval University, Quebec City, Canada; and Philippe Lorenzo, director general of IREPS, the regional bureau for health education and promotion of Picardie in Amiens, France. Louise Potvin, who moderated the plenary, provides the summary that follows. During the colloquium, three main questions were debated: 1. At what point should health be placed at the forefront of local actions, if we wish to promote the values of equity? 2. How should actions at the local, regional, national and global levels be organized and articulated? Who are the partners, and what forms of governance need to be put into place? 3. What are the parameters needed in order to define the roles, tasks and competencies of the implementers of local and regional health programs, the architects of change? Each panelist had to respond to two out of the three questions. We report on the answers that panelists gave to these questions. As it is impossible to verify the exactitude of information given by audience members in support of their viewpoints, only the content of the remarks is given, without mentioning the examples that were provided.

Health indicators in the European regions--ISARE II.

BACKGROUND: Most comparisons of health data in Europe take place at the national level. However, there is increased interest in looking at health data at a sub-national level. This is because of the increased importance in many European countries, of regions and devolved powers to them. This study aimed to establish the availability of health data at a regional level and to construct an experimental database. METHODS: Using a network of country correspondents, data were collected on a series of topics from all the regions of that country. In addition, a supplementary list of data was collected from one region of each country. RESULTS: Out of the then 15 Member States of the European Union (EU), 14 countries participated in the study. Thirteen countries were able to supply data. Where data were available, using the criteria we developed, these were of relatively good quality. Data on mortality was most readily available, but data on the important public health topics such as obesity was much more difficult to obtain, and absent in many cases. CONCLUSIONS: It is possible to construct a database and a resultant set of indicators for relevant sub-national areas of Member States in the EU. This is not likely to be achieved through current routine data collection systems unless significant changes are made to the data collection processes such as those undertaken by Eurostat. There is, also, an urgent need to introduce comprehensive sub-national data collections on important public health topics such as obesity and smoking.