La pagina Progetto HIA21 e` online

Nella strategia generale sui rifiuti dell'Unione (1996) si stabilisce la gerarchia preferenziale delle operazioni di gestione. Al terzo gradino di tale gerarchia è previsto lo “smaltimento finale ottimale e il migliore monitoraggio”. La strategia sottolinea anche la necessità di prevedere nuovi e migliori strumenti di gestione del ciclo dei rifiuti. Nello stesso documento la DG Ambiente dell'UE sostiene che il cittadino può, e deve, chiedere costantemente all'amministrazione locale quali interventi essa compie per migliorare la situazione dei rifiuti a livello locale.

Da qui nace il Progetto HIA21

Toscana e Abruzzo, le regioni nelle quali sono ubicati i due impianti pilota del progetto HIA21, hanno una produzione annuale di RSU di circa 2.545.014 e 699.265 tonnellate, con una produzione procapite rispettivamente di 686 e 524 chilogrammi per abitante.

Le azioni di HIA21
• monitoraggi sulle varie matrici ambientali come aria, acqua, suolo e agenti fisici, indagini epidemiologiche sui principali indicatori sanitari, indagini di carattere economico e sociale.
• consultazioni periodiche e costanti con i portatori d'interesse (stakeholders) e con le popolazioni locali.
• incontri con la popolazione per discutere gli stati di avanzamento dei lavori, per pianificare insieme le azioni da intraprendere per la valutazione degli impatti e recepire suggerimenti e istanze da parte delle popolazioni locali.

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda

Really interesting paper and as it's open access I've highlighted the thing bit that caught my eye rather than the summary points (abstract).

Some of it seems really hard to me! The whole paper is worth a read.

Characteristics of Third Wave Health Research Strategies and Methodologies

1. Go beyond the behavioral and other individual determinants of illness.
2. Examine the intersections among different social hierarchies, such as class and gender, and their cumulative impacts on health status and health inequities.
3. Examine the levels, pathways, and power connections across the “upstream” determinants or root causes of health inequities—that were central to the CSDH's conceptual framework—and the more traditionally investigated determinants of health inequities, such as risk factors or access to care.
4. Treat patterns of health inequity as a social reality in their own terms, requiring social (economic, sociological, political, and cultural) explanation that adds on to the aggregation and interpretation of individual biomedical processes and outcomes.
5. Consider the dynamic (rather than static) nature of equity in different country contexts, introducing a temporal dimension when investigating social structures, public policies, and impacts over the life course.
6. Describe the social institutions and processes that influence the generation and allocation of resources related to health and its social determinants.
7. Focus on how the global context affects choices about resource allocation at national and sub-national levels.
8. Build on active collaboration among researchers and other knowledge producers from different disciplines.
9. Recognize that certain kinds of evidence, such as results from randomized controlled trials, cannot be generated with respect to many interventions that address social determinants of health; therefore, a need exists to embrace diverse methodologies—fit for purpose—including a wide range of study designs, generating qualitative and quantitative data, that provide critical insight on the questions being examined.
10. Involve affected populations, which is often essential to appropriate research designs and their execution.

Source:

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda.

Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, et al. (2011)

PLoS Med 8(11): e1001115. doi:10.1371/journal.pmed.1001115

Click here to go to the full article.

Hat tip: David McDaid, Health Equity Email Network, UK

How Can We Get the Social Determinants of Health Message on the Public Policy and Public Health Agenda?

A study from Utah, USA that has relevance globally and published as a background WHO paper for the World Conference on Social Determinants of Health in Brazil this month.


The social gradient is deeper 
Inequalities in health resulting in disparities in life expectancies are evident even at the lowest reportable data level, down to the small area or zip code-level. The challenge has always been what to do about it.


Communicating contextualised and actional data
In as much as comprehensive epidemiology reports are helpful and serve various purposes, to act on the evidence, policy makers and public health practitioners need simple, precise, accurate, easy-to-understand,
easy-to-learn, visualizeable information at their constituents’ level. Where reliable data are already available and regularly reported; use technology and  existing health metrics to support the SDH message.  A succinct and visualize-able demographic and health landscape that focuses on vital priorities at the community level can be a mechanism by which the social determinants of health message  could be recognized, acted upon, directed, and evaluated down to the local levels of governance.

Framing the message according to local needs: “What’s wrong? Why does it matter? What should be done about it?”

The problem is not always the lack of data as much as how they are communicated. How we communicate the evidence is strategic in engaging both policy makers and the public. Presented wisely, used effectively, directed to the right audience, within the context of the social determinants of health, data can elicit interest, help inform, engage, advocate, and initiate action. Existing data framed in a manner that speak to community needs and issues that the people can connect with and in a language that people can understand is more likely to resonate across the political spectrum.

Keep repeating the message.

The social determinants of message can get lost in a flurry of competing political and health issues. Marketing the message calls for repeatedly disseminating and reiterating the information to counter the fatalistic mindset towards effecting change.

Engaging the right people in doing the right thing: Having a shared vision and focus of improved health and reduction of health disparities. 

The social determinants of health result from “the way we organize our affairs in society.”7 These factors are so intricately embedded in the realities of daily living that reducing the inequities we have created means partnering with the right people from various sectors ---those who share a vision and have the skills, courage, and resolve to bring about change in the system or with the system.

Click here to download the paper.

Social Determinants and the Health Divide in the WHO European Region

Interesting conceptual model linking policies and practices to social determinants of health (Pages 13 and 11).

My take home paragraph is (Pages 21-22):

"A human rights–based approach to health equity is needed Oldring & Jerbi (66) discussed human rights and health.

Today there is growing recognition of the links between health and a wide range of human rights, as well as a growing appreciation of the right to the highest attainable standard of health itself. There is broad agreement that health policies, programmes and practices can have a direct bearing on the enjoyment of human rights, while a lack of respect for human rights can have  serious health consequences. Protecting human rights is recognized as key to protecting public health.

The right to health means that governments must generate conditions in which everyone can be as healthy as possible. A human rights–based approach to health gives importance not only to goals and outcomes but also to the processes in trying to achieve these goals and outcomes. Health policy-making should be guided by human rights standards and aim at developing the capacity of those in positions of responsibility – for policy-making and delivery – to meet their obligations and empower rights-holders (the public) to effectively claim their rights.

Eliminating all forms of discrimination is at the core of a human rights–based approach, with a particular focus on gender equity in all policies. Human rights standards and principles, such as participation, equality, non-discrimination, transparency and accountability, should be integrated into all stages of policy-making and implementation.

The human rights principles and efforts to improve  health equity should be mutually reinforcing. The right to health complements the health equity concept by aiming for everyone to enjoy his or her full health potential. Moreover, the human rights principles of nondiscrimination and equality strengthen the conceptual foundation of health equity for the groups in society for whom inequities in health are related to wider vulnerability. "

Click here to download the 2nd Interim Report - Interim second report on social determinants of 
health and the health divide in the WHO European Region, WHO, 2011.


Click here to download the 1st Interim Report - Interim first report on social determinants of health and the health divide in the Regional Office for Europe WHO European Region

Rio Political Declaration on Social Determinants of Health

The bits that really resonated with me are:

We reaffirm that health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security.

We reiterate our determination to take action on social determinants of health as collectively agreed ... three overarching recommendations of the Commission on Social Determinants of Health:

• to improve daily living conditions;
• to tackle the inequitable distribution of power, money and resources; and
• to measure and understand the problem and assess the impact of action.

We are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies. Positioning human health and well-being as one of the key features of what constitutes a successful, inclusive and fair society in the 21st century is consistent with our commitment to human rights at national and international levels.

Click here to go to the WHO conference website and download the Declaration.