Problems of health inequalities. European Union perspectives

In European Union democratic values have been approved unquestionably. They may be derived from many sources like from its own, dignified tradition linking back to Declaration of the Rights of Man and of the Citizen of 1789 or United Nations documents. In the Lisbon Treaty on functioning of European Union there are words about the space of freedom, safety and justice, equality between men and women, and equality of chances. UE has obliged itself fighting against all forms of inequalities and discrimination. As one of authors said: equality, cohesion and social justice this is the material of which Europe is constructed. They are not only the object of declarations and recommendations, but active implementation attentively watched by the whole world.
In this paper I deal with two aspects of the workings undertaken within the UE which are aimed at reduction of health inequalities. First refers to actions resulting from common initiatives, therefore activities belonging to responsibility shared by EU and member countries. In second part questions raised from initiatives promoted by countries holding presidency are analysed. Rather frequently these countries made a very essential influence on the way of perception and solving the problems of health inequalities.

Mobilising action for health equity across the European Union – the story of DETERMINE project

The DETERMINE project (2007–2010) was coordinated by EuroHealth-Net and there were 24 countries involved. It was an EU consortium for action on the socio-economic determinants of health (SDH). The overall objective was to mobilize action for health equity in the European Union, especially through achieving greater awareness and capacity amongst decision makers in all policy sectors to take health and health equity into consideration when developing policy and to strengthen collaboration between health and other sectors.
Several phases of activities were carried out e.g.: identification of actions and policies addressing the socio-economic determinants of health inequalities (SDHI) in UE member states, recognition of innovative approaches in the context of SDH and selection of three small pilot projects with promising approach, consultations with politicians and policy makers outside the health sector on their attitude towards SDHI and their role in achieving health equity, identification of economic analyses addressing SDHI. There were also capacity building and awareness raising activities carried out by DETERMINE partners, such us: skills development, partnership development, leadership, awareness raising and
advocacy.

Social determinants of health status in Poland

The article is devoted to recognition of social inequalities in health status in Poland in 1998 and 2004 based on statistical analysis of survey data collected by the Central Statistical Office (GUS). Social inequalities in health are discussed in the framework of theoretical approaches explaining health variations. Social gradient is measured by the level of education. The analysis shows that educational inequalities in health are not only existing, but persistent and – as in other developed countries – tend to increase over time even though the overall health status of the population has been improving. Poor health can be attributed to poverty, involvement in unhealthy behavior (especially smoking) and insufficient social networking resulting in poor social support.

A spatial dimension of health inequality and the cohesion policy

The spatial perspective of health inequality gained in importance as a result of the European cohesion policy, a significant dimension of which is equalization of spatial living conditions, and among them an equal access to the health services. The cohesion policy reflects a new approach to the health policy, in which impact on factors determining health is taken into account, and not only on creating a better health care system for people who already have health problems. In this context, the article is aimed at presenting new directions of both health and spatial European policy and more general strategies of Europe development. It shows new methodological approach in presentation of territorial division and indicators used. It also presents the results of research on health inequalities between regions in the European countries. The article is an expression of a concern for insufficient perceiving in Poland a phenomenon of health inequalities in the spatial dimension, whereas there are possibilities and means to diminish them within the European strategy, European cohesion policy and European funds.

Psychosocial determinants of health inequalities

The article presents selected research results on differences in self assessed state of health and the role of social class related psychosocial factors that may be responsible for health inequalities. Among discussed variables are: differences in lifestyles, health care utilization patterns and perceived access to health care and social support network. Their relative value to predict health differences is weighted against the role of social position indicators. The empirical base for considering above issues is the representative study of Warsaw inhabitants conducted in 2004.

Social inequalities in health – the result of the medicalization of health promotion?

Differentiation of social positions leads to the differentiation of health status in the social structure. This relationship results in the phenomenon of social inequalities in health. Health promotion has been created to improve health status and reduce the social inequalities in populations through building resources for health and healthy lifestyles and ensuring their egalitarian distribution. Taking into account the tasks of health promotion we can premise that the implementation of it creates opportunities for the reduction in social inequalities in health, but on condition that health promotion is not being medicalized. In this article we attempt to substantiate the hypothesis speaking that there is the relationship between the medicalization of health promotion and the sustaining of social inequalities in health over time.

System transformation and inequality in health. A perspective of an ordinary man

This text is the effort of having a look at the system transformation and inequalities in health cused by it from the perspective of Eliot Freidson’s theory. The author wants to show the makrosocial process and their costs from the ordinary people’s point of view. The empirical material will be the fragments of letters sent to TVP program II by the viewers systematically watching the programs of non conventional therapist A.M. Kaszpirowski. This kind of personal documents among others gives the possibility of subjective experiencing the financial difficulties in the first phase of transformation, registration of impressions connected with the trauma of the “big change”, finally allowes to follow the examples of new thinking about the social and economic problems: increase of civil activity, autocreative and innovative attitudes.

Diversification of the attitude towards health education according to the education status. Poles in relation to the employees in Spain, Latvia and Slovenia

This article presents a problem of diversification of the attitudes towards health education of Polish employees in relation to those who work in Spain, Latvia and Slovenia.
The empirical base are the study conducted in 2009 (questionnaire interview) in sample of the employees population (1691 people: 400 respondents per country), ages 25-54. Analysis were conducted by comparison of low (primary, lower secondary, basic vocational) and higher educated (secondary or post secondary, tertiary) employees. There is a lack of basic dichotomy between different educated employees in Poland according to the acquisition of knowledge about health, however at the same time it was diagnosed some detailed differences. There were also observed significant differences between employees from countries under the survey, especially in the group of the low educated employees. The attention was called on the need to take into account cultural differences in the international projects concerning health education

Financing of the most expensive drug therapies in Poland. Analysis of the funding level of the therapeutic health programs

One of the most discussed topics about organization of the Polish health care system is providing full accessibility to the financing of the latest drug therapies. According to the institutions implementing the programs most serious causes of problems in access to innovative pharmacotherapy are too low level of funding programs and their low profitability, or even hospitals pay the extra to such benefits. Due to the increasingly high cost of treatment of severe illnesses and ongoing development of new medical technologies, in choosing the method of treatment are taken into account the results of economic analyzes.
The authors, by analyzing the level of funding and implementation of treatment programs, have attempted to answer the question whether the claims are true, and health care providers and Polish patients have equal access to the most expensive drug therapies? To verify the above hypothesis also performed an cost analysis of selected therapeutic programs. Cost analysis conducted based on the identification and analysis of the costs of four therapeutic health programs indicated that the refund value of National Health Fund for providers implementing health programs may be substantially higher than the costs incurred by them.
The current way of financing most expensive innovation therapy has many weaknesses, but most frequently mentioned causes of the problems with the availability of treatment programs are not supported by actual data.

Prevention for the poor. The case of gynecological prevention

Poland belongs to European countries characterized by the highest mortality of women caused by cervical cancer – neoplasm that is fully curable if early enough detected.
It happens so despite of several, broadly designed prevention actions addressed to women, encouraging them to participate in preventive screenings. All these actions particularly fail among women from lower social strata, especially living in poverty. The question is therefore, what are the main obstacles behind this behavior? What is the cause of their reluctance to prevention of the life threatening disease, even if it is not related to any expenses? The article tries to answer these questions looking for the answer among structural and socio-cultural variables influencing women’s approach to health and disease. Presented research results demonstrate problems of gynecological prevention among women threatened with social exclusion.

Migrant and diseases

In the article main health problems specific for migration process and migrants strategies in case of illness were presented: self-treatment, limited access to health care services in immigration country and shifting the health care onto the country of origin. Mass migration together with migrants’ needs deprivation points at the need of inclusion of consequences of migration into the health policy of both sending and receiving countries.

Social support, social network, and inequalities in health status in older age, based on mortality and health related quality of life

Relations between social support, social network, social ties, and risk of death and health-related quality of life have been shoved based on well-documented data from different countries as well as using the data coming from studies performed in different cohorts of older citizen of Krakow

Social genesis of coronary artery disease in the life-course perspective

The results of research on the social genesis of coronary artery disease (CAD) based on life-cycle approach indicate that low socioeconomic status during early phases of ontogenesis is connected with increased risk of developing CAD in adulthood. It means that genesis of social health inequalities, concerning unequal social distribution of CAD, should be considered including early-life social influences. Scientific data concerning the developmental origins of non-communicable chronic diseases, especially those well described regarding CAD, constitute a significant complement to traditional research approach to social health inequalities, focused on middle-aged populations and socioeconomic influences in adulthood, and put emphasis on the role of assessment of the cumulative psychosocial risk of somatic diseases throughout the human life-cycle. This approach is particularly useful in understanding the social processes related to etiopathogenesis of chronic diseases with long latency periods, especially atherosclerosis. Health policy actions, aimed at effective diminishing of social health inequalities, should take into account the above mentioned data and should be directed not only at standard, behavioral coronary risk factors, but also at poor families and their children, who, in the light of the current knowledge, are highly predisposed to suffer from CAD in adulthood.