Advertisement

Journal of Public Health Policy

, Volume 34, Issue 1, pp 100–120 | Cite as

Comparison of health policy documents of European cities: Are they oriented to reduce inequalities in health?

  • Carme Borrell
  • Joana Morrison
  • Bo Burstrom
  • Mariona Pons-Vigués
  • Rasmus Hoffmann
  • Ana Gandarillas
  • Pekka Martikainen
  • M Felicitas Domínguez-Berjón
  • Lasse Tarkiainen
  • Èlia Díez
Original Article

Abstract

Health policies are specified in documents that contain values, objectives, strategies, and interventions to be implemented. The objective of our study was to analyse health policy documents of six European cities and one county council published around 2010 to determine (i) how cities conceptualize health inequalities, and (ii) what strategies are proposed to reduce them. We performed a qualitative document analysis. We selected Health or Health Inequalities policy documents and analysed the following aspects: general characteristics of the document, inclusion and definition of health inequalities, promotion of good governance and participation, number of objectives, and evaluation. We also described specific objectives. Rotterdam, London, and Stockholm use a conceptual framework. Two of them define health inequalities as a social gradient. Intersectoral action, participation, and evaluation are included in most documents. Interventions focus mainly on the socioeconomic context.

Keywords

health policy cities socioeconomic factors Europe 

Notes

Acknowledgements

This article has been partially funded by the project INEQ-CITIES, ‘Socioeconomic inequalities in mortality: evidence and policies of cities of Europe’; project funded by the Executive Agency for Health and Consumers (Commission of the European Union), project no. 2008 12 13.

References

  1. Whitehead, M. (1998) Diffusion of ideas on social inequalities in health: A European perspective. Milbank Q 76 (3): 469–492, 306.CrossRefGoogle Scholar
  2. Moberg, H. (2008) Comparative studies of policies on health inequalities – A literature review. In: C. Hogstedt, H. Moberg, B. Lundgren and M. Backhans (eds.) Health for All? A Critical Analysis of Public Health Policies in Eight European Countries. Östersund, Sweden: Swedish National Institute of Public Health.Google Scholar
  3. Mackenbach, J.P., Bakker, M.J. and European Network on Interventions and Policies to Reduce Inequalities in Health (2003) Tackling socioeconomic inequalities in health: Analysis of European experiences. Lancet 362 (9393): 1409–1414.CrossRefGoogle Scholar
  4. Hogstedt, C., Lundgren, B., Moberg, H., Pettersson, B. and Agren, G. (2004) The Swedish public health policy and the National Institute of Public Health. Scandinavian Journal of Public Health 64 Supplement: 6–64.Google Scholar
  5. Peiró, C. et al (2002) Rapid appraisal methodology for ‘health for all’ policy formulation analysis. Health Policy 62 (3): 309–328.CrossRefGoogle Scholar
  6. WHO. (2000) Using the health for all framework to explore the development of health policy in the European Region of WHO. In: A. Ritsatakis, R. Barnes, E. Dekker, P. Harrington, S. Kokko and P. Makara (eds.) Exploring Health Policy Development in Europe. World Health Organization Regional Publications European Series, no 86, Finland.Google Scholar
  7. Vallgärda, S. (2008) Social inequality in health: Dichotomy or gradient? A comparative study of problematizations in national public health programmes. Health Policy 85 (1): 71–82.CrossRefGoogle Scholar
  8. State of the world's cities 2010/2011 – cities for all: bridging the urban divide (2010). United Nations Human Settlements Programme/UN-HABITAT.Google Scholar
  9. WHO/UN-HABITAT. (2010) Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings. Geneva, Switzerland: World Health Organization.Google Scholar
  10. Collins, P.A. and Hayes, M.V. (2010) The role of urban municipal governments in reducing health inequities: A meta-narrative mapping analysis. International Journal for Equity in Health 25 (9): 13.CrossRefGoogle Scholar
  11. Conceptual framework of INEQ-CITIES project. http://www.ucl.ac.uk/ineqcities/about/conceptual_framework, accessed 20 October 2012.
  12. Creswell, J.W. (2003) Research Design: Qualitative, Quantitative, and Mixed Method Approaches. Thousand Oaks, CA: Sage Publications.Google Scholar
  13. All inhabitants of Amsterdam healthy! Framework Policy Document for Amsterdam's Public Health Policy 2008–2011 (2007). Geemente Amsterdam, http://www.gezond.amsterdam.nl/GetDocument.ashx?DocumentID=2441&name=All-inhabitants-of-Amsterdam-he, accessed 23 March 2012.
  14. Working Together on Good Health. Strengthen health, reduce inequalities. Long-term action plan for Rotterdam Health 2011–2014 (2012). Rotterdam, http://www.instituteofhealthequity.org/projects/actionplan-rotterdam-health, accessed 31 July 2012.
  15. Consorci Sanitari de Barcelona, Agència de Salut Pública de Barcelona. (2008) Pla de salut de Barcelona Ciutat a l’horitzó 2010 (Barcelona Health Plan 2010). Barcelona, http://www10.gencat.cat/catsalut/rsb/arxius/pla_salut_bcn_1.pdf, accessed 23 March 2012.
  16. Instituto de Salud Pública de Madrid. (2010) Plan de intervención en prevención y promoción de la salud de los Centros Madrid Salud 2010–2015 (Intervention plan for health prevention and promotion in the Health Centers of Madrid, 2010–2015). Madrid, http://www.madridsalud.es/prev_prom_saludambiental/pdfs/Plan_intervenciones_prevencion_promocion%20de%20los%20CMS_7_06_2010.pdf, accessed 23 March 2012.
  17. Helsinki Health Centre. (2012–2014) Helsinki Health Centre's strategic plan 2012–2014, http://www.hel.fi/wps/wcm/connect/13a1ef8047cf4c5d8676b715283d9a1a/4_Strategiasuunnitelma12_14.pdf?MOD=AJPERES&lmod=-1466217692, accessed 23 March 2012.
  18. Greater London Authority. (2010) The London Health Inequalities Strategy. London, http://www.london.gov.uk/sites/default/files/HISdeliveryplan.pdf, accessed 23 March 2012.
  19. Stockholm Centre for Public Health. Public Health Policy for Stockholm county council (Greater Stockholm), http://www.folkhalsoguiden.se/upload/folkh%C3%A4lsoarbete/Public%20Health%20Policy.pdf, accessed 23 March 2012.
  20. Peiró, R. et al (2004) Gender sensitivity in the formulation of Spanish health plans: What it could have been but wasn’t. Gac Sanit 18 (Supplement 2): 36–46.CrossRefGoogle Scholar
  21. Borrell, C. et al (2005) Socioeconomic inequalities and health plans in the Autonomous Communities of Spain. Gac Sanit 19 (4): 277–285.CrossRefGoogle Scholar
  22. Dalghren, G. and Whitehead, M. (1991) Policies and strategies to promote social equity in health. Background document to WHO – Strategy paper for Europe. Stockholm: Institute for Future Studies, http://scholar.googleusercontent.com/scholar?q=cache:tfpxXYUL78AJ:scholar.google.com/+%22Policies+and+strategies+to+promote+social+equity+in+health.%22+author:Dahlgren&hl=en&sciui=1&as_sdt=0,5, accessed 27 September 2012.
  23. Comisión Para Reducir Las Desigualdades Sociales En Salud En España. (2012) A proposal of policies and interventions to reduce social inequalities in health in Spain. Gac Sanit 26 (2): 182–189.Google Scholar
  24. Garcia Rada, A. (2011) European financial crisis. Is Spanish public health sinking? BMJ 343: d7445.CrossRefGoogle Scholar
  25. Borrell, C., Villalbí, J.R., Díez, E., Brugal, M.T. and Benach, J. (2003) Municipal policies: The example of Barcelona. In: J.P. Mackenbach and M.J. Bakker (eds.) Reducing Inequalities in Health: A European Perspective. New York: Roudledge, pp. 77–84.Google Scholar
  26. Commission on Social Determinants of Health. (2008) Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva: World Health Organization. Final Report of the Commission on Social Determinants of Health.Google Scholar
  27. Collins, P.A. (2012) Do great local minds think alike? Comparing perceptions of the social determinants of health between non-profit and governmental actors in two Canadian cities. Health Education Research 27 (3): 371–384.CrossRefGoogle Scholar
  28. Ståhl, T., Wismar, M., Ollila, E., Lahtinen, E. and Leppo, K. (eds.) (2006) Health in All Policies. Prospects and Potentials. Finland: Ministry of Social Affairs and Health.Google Scholar
  29. Fuertes, C., Pasarín, M.I., Borrell, C., Artazcoz, L. and Díez, E. (2012) Feasibility of a community action model oriented to reduce inequalities in health. Health Policy 107 (2-3): 289–295.CrossRefGoogle Scholar
  30. Nebot, M., López, M.J., Ariza, C., Villalbí, J.R. and García-Altés, A. (2011) Effectiveness assessment in public health: Conceptual and methodological foundations. Gac Sanit 25 (Supplement 1): 3–8.CrossRefGoogle Scholar
  31. Stuckler, D. and McKee, M. (2012) There is an alternative: Public health professionals must not remain silent at a time of financial crisis. European Journal of Public Health 22 (1): 2–3.CrossRefGoogle Scholar

Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2012

Authors and Affiliations

  • Carme Borrell
    • 1
    • 2
    • 3
    • 4
  • Joana Morrison
    • 1
    • 3
    • 4
  • Bo Burstrom
    • 5
  • Mariona Pons-Vigués
    • 1
    • 4
    • 6
    • 7
  • Rasmus Hoffmann
    • 8
  • Ana Gandarillas
    • 9
  • Pekka Martikainen
    • 10
  • M Felicitas Domínguez-Berjón
    • 9
  • Lasse Tarkiainen
    • 10
  • Èlia Díez
    • 1
    • 3
    • 4
  1. 1.Agència de Salut Pública de Barcelona, Universitat Pompeu Fabra, CIBER Epidemiologia y Salud Publica (CIBERESP)BarcelonaSpain
  2. 2.Universitat Pompeu Fabra, Parc de Recerca Biomedica de Barcelona (PRBB)BarcelonaSpain
  3. 3.CIBER Epidemiologia y Salud Publica (CIBERESP)MadridSpain
  4. 4.Institut d’Investigacio Biomedica (IIB Sant Pau), Sant Antoni Maria ClaretBarcelonaSpain
  5. 5.Department of Public Health Sciences, Division of Social MedicineKarolinska InstitutetStockholmSweden
  6. 6.Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDAP Jordi Gol), Gran Via Corts CatalanesBarcelonaSpain
  7. 7.Universitat de Girona, Campus de MontiliviGironaSpain
  8. 8.Erasmus Medical Centre, RotterdamRotterdamThe Netherlands
  9. 9.Subdireccion General de Promocion de la Salud y Prevencion, Consejeria de Sanidad, MadridSpain
  10. 10.Department of Social ResearchPopulation Research Unit, University of HelsinkiHelsinkiFinland

Personalised recommendations