Public health policy for disadvantaged target groups

1
Public health policy for disadvantaged target
groups

• Trine
• Andrea
• Els
• Helle

2
Public health policy (1)

• The debate is no longer if inequalities in health
  do exist, but what can be done about them.
• WHO Europe
• By the year of 2020, the health gaps between
  socio-economic groups within countries should be
  reduced by at least one quarter in all Member
  states, by substainigly increasing the level of
  health of disadvantaged groups.

3
Public health policy (2)

• Measurement ? recognition ? awareness and concern
  is raising ? isolated action ? structural policy
  programs
• 1. Curative
• 2. Prevention and health promotion
• Disadvantaged target groups living in poverty
• Elderly
• Children
• Homeless people
• Immigrants and newcommers

4
Elderly in poverty (1)

• Socio-demographic process of aging
• group is increasing?
• ? chronic diseases ? long term medical care need
  ? ? risk of poverty
• Problems
• acces problems (physical), isolation
• need of additional benifits for increasing health
  care
• lack of knowledge of entitlement benifits
• Most relevant to single-living women

5
Elderly in poverty (2)

• Health problems
• Loss of independence in everyday life activities
  (crucial turning points), physical disabilities,
  falling, trauma
• Athroses, chronic artritis, cardiovascular
  diseases, bronchitis, gastro-intestinal diseases
• Mental diseases (dementsia)
• Dental problems (loosing all teeth)

6
Campaigns for elderly

• Health promotion homevisits at the age of 75
  (DK).
• Information about health care benefits,
  nutritional education, evaluation of the
  elderlies situation
• Community Health Care Centers (B).
• Fall prevention
• National fund elderly help (NL).
• Personal bound help from the INFO PLUSBUS
• Home visiting whereby elderly people can be
  helped with their finance
• Elderlyhelpline, phone-number

7
Children living in poverty (1)

• Health problems of children
• Nutrition diseases (obesity and underfeeding)
• Infectious diseases
• Caries
• Severe injuries
• Psychosomatic health problems (insomnia,
  anorexia, headache, sickness, nausea)
• Behavioural problems

8
Children living in poverty (1)

• Social causation of health problems
• Inadequat primary care and psycho- social
  welbeing provided by the parents
• Low familiy budget or no work related income,
  especially
• Unemployed parents
• Single parents
• Large families gt3 children (sometimes)
• Detrimental health behavior of parents
  (smoking, nutrition)
• ? relevant restrictions on famliy budget
• ? negative impact on health status of children

9
Campaigns for children

• Project Houten skutsje (Friesland) (NL)
• Stimulate development of children
• Requirements for Activities for children who
  needs help
• Niets aan de tand (B)
• Community health centers (Genth)
• Dental problems due to feeding by bottle, access
  to dentist, education
• Kind en gezin
• Registration of children living in poverty and
  organisation of care at home
• Groups for children with special needs (DK)
• Sexual education for teenagers (all countries)

10
Homeless people (1)

• Extreme form of poverty
• Unwanted?
• Figures. only estimations (2006)
• Europe 3 million
• The Netherlands 50.000, Amsterdam 2600
• Belgium 12.000, Brussels 1200
• Denmark 11.000-13.000, Copenhagen 3.500

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Homeless people (2)

• Health problems
• Multi morbidity
• Addictions (alcohol, drugs) and addiction related
  diseases
• Mental disorders (3 times higher than for general
  pop)
• psychological distress
• self reported depression
• anxiety
• Shizophrenia (mostly young people)
• Physical diseases (TBC, bronchitis, skin
  diseases, infections)

12
Medical care for homeless people

• Denmark
• Street nurses and shelter nurses
• Free medical care
• Belgium
• ID-registration and obligated health insurance at
  the adress of Public Centre of Social Welfare
  (OCMW)
• Urgent medical care is free of charge
• Voluntary working doctors in cities
• The Netherlands
• Everybody has the same right receiving health
  care, also homeless people
• AMT Ambulant (social) Medical Team help
  without an insurance.

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Campaigns for homeless people

• Shelters (B and NL)
• Paid by community government
• Free donations
• Voluntary workers
• Salvation army (christian church) (NL)
• Organisation for disadvantaged people, also
  homeless people.
• Offer a lot of help, also medical care
• The mobile Café (DK)
• Meals-on-wheels
• Project social Nurse (DK)

14
Immigrants and new comers (1)

• Number has reduced last 2 decades in Europe
• Stricter immigrant regulations
• Border controls
• Forced deportation of person
• High risc of poverty
• Difficulties finding a pyed job
• Exploitation
• Poor housing
• Poor social net

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Immigrants and new comers (2)

• Examination at moment of arrival
• Health problems
• Diseases of respiratory tract (TBC)
• Skin diseases
• Dental problems
• Aids, hepatitis, sexally transmitted diseases

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Campaigns for immigrants and newcomers (1)

• Ijsbreker (B)
• Community health care centre
• Improve information and communication
• Medimmigrant (B)
• Brochures about healt care and health care system
  in different languages
• 50 of total medical cost is payed back
• Second hand medical equipment

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Campaigns for immigrants and newcomers (2)

• NIGZ National Institute Health care promotion
  and prevention (NL)
• Translated brochures
• Interpreter for own language
• Education to health care providers
• Equal access to health care system, 6 weeks after
  application as etnical danish citizens
• Exercise programmes nutritional education (DK)
• Interpreter is mandatory by law and free of
  charge the first 7 years in the country (DK)

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Site visit Nyiro Gyula hospital
19
Site visit at psychiatric department of Nyiro
Gyula hospital in Budapest

• Facts
• Open unit 72 patients, 3 nurses
• Closed unit 18 patients, 3 nurses
• 144 beds in the whole department
• 18 special treatment beds
• 2000 patients admitted in 1 year
• 613? social problems (2006)
• 200 financial problems
• 39 homeless

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Target groups in department of Nyiro Gyula
hospital in Budapest

• Elderly
• A lot of elderly people admitted
• 5 year waiting list for nursing home
• Homeless people
• a few, some of them dont want help
• Single parents
• rooming in with mother-child (creative problem
  solving)
• Immigrants
• Not a real target group in Hungary

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Interdisciplinarity work at the psychiatric unit
(1)

• Nurses
• 3 nurses per unit per shift
• ? Main job tasks
• Prepare and give out medication
• Basic care (daily hygiene)
• Administration!
• Social worker
• 2 for the whole department
• Main job tasks
• Take care of complex social problems housing,
  jobs, income, social network
• Relations with private connections is very
  important
• Creative problem solving, playing games

22
Interdisciplinarity work at the psychiatric unit
(2)

• Psychiatrist/ physician
• 1-2 per unit
• Psychologist
• 1-2 for the whole department
• Physiotherapist
• 2 for the whole department
• Occupational therapist
• ???

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Interdisciplinarity work at the psychiatric unit
(3)

• Teammeeting
• Head nurse, physician, social worker,
  psychologist
• Discuss
• patients
• ?current problems (social and health)
• ? therapeutic progress
• new patients
• problematic patients
• Etc.

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Discussion

• Are public health programs effective on public
  level, or local level?
• Should the government interfere in health
  promotion or is it an individual responsibility?
• Does illness lead to social problems, or do
  social problems lead to illness?

26
Conclusion

• National public health policies and programs are
  needed to educate and inform the whole
  population.
• Campaigns on local level are necessary to reach
  specific target groups.
• Preventive programs are not only a task for the
  health care sector, there should be a cooperation
  with the social sector as well.
  (job-opportunities, housing, etc.)
• Site visit
• The visions of the psychiatric hospital head
  nurse is the same as in our own countries, but
  the implementation is limited by financial
  recourses and structure.

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references

• De Decker Pascal (2004), Belgium National report
  2004 for the European Observatory on
  Homelessness statistical update, Feantsa
• Menk Ralph et all (2003), Report on
  socio-economic differences in health indicators
  health inequalities in Europe and the situation
  of disadvantaged groups, Bielefeld
• Tasma Nicoline and Berman Philip (2004),The role
  of the health care sector in tackling poverty and
  social exclusion in Europe, European Health Net,
  Brussels
• European community (2007), Closing the gap
  strategies for action to tackle health
  inequalities, European Health Net, Brussels
• Benjaminsen Lars and Christensen Ivan (2007),
  Hjemloeshed i Danmark 2007 National
  kortlaegning (homelessness in Denmark 2007
  National survey), SFI Kopenhagen

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• www.eurohealthnet.eu
• http//epp.eurostat.ec.europa.eu
• www.armoedebestrijding.be
• www.medimmigrant.be
• www.wvgc.be
• www.vig.be
• www.minsoc.fgov.be
• www.sst.dk
• http//www.udenfor.dk
• http//nigz.nl
• http//crossroads.journalismcentre.com/2007/fewer-
  homeless-people-in-the-netherlands/
• www.legerdesheils.nl
• http//www.vvdamsterdam.nl/artikel/368.htm
• www.ggd.nl