health and the city in times of COVID-19 Webinar #6 6 July 2020 1 - PowerPoint PPT Presentation

Webinar: Ageing, health and the city in times of COVID-19 Webinar #6 – 6 July 2020 1

Frank Van Lenthe, Associate Professor of Social Epidemiology at the Department of Public Health, Erasmus University Medical Center Rotterdam (Co-coordinator of MINDMAP project)

PROMOTING MENTAL WELL- BEING IN OLDER AGE IN THE CITY Frank J. van Lenthe Erasmus MC Rotterdam Mauricio Avendano King’s College London for the MINDMAP Consortium

APPROACH CONCEPTUAL MODEL

APPROACH PARTICIPATING COHORTS

VARIATION ACROSS STUDIES PROBABLE DEPRESSION RESIDENTIAL DENSITY 30% 25% 20% 15% 10% 5% 0% GLOBE HAPIEE-CZ HAPIEE-LT HAPIEE-RU HUNT LASA-1 LASA-2 RECORD * Ruiz et al., in preparation Noordzij et al., in preparation

GREEN SPACE AND MENTAL HEALTH CHANGES IN GREEN SPACE 2004 - 2011 Noordzij et al., submitted

POLICY DATABASE POLICY DOMAINS ▪ Employment Social Policies ▪ Participation ▪ Outdoor space Urban Policies ▪ Transport ▪ Housing Mental Health Policies

PUBLIC TRANSPORT AND DEPRESSION RESEARCH QUESTIONS ▪ Did the introduction of free bus fares increase transport use among the eligible population? ▪ Does the increase in transport use as a result of bus fare eligibility reduce depressive symptoms Reinhard et al., JECH 2018; 72 (5): 361-368

POLICY RELEVANCE SYSTEMS APPROACH ▪ Adopt a systems approach

FURTHER INFORMATION www.mindmap-cities.eu @MindmapCities f.vanlenthe@erasmusmc.nl

Giuseppe Costa, Professor of Public Health, Turin University Medical School (MINDMAP partner)

EVIDENCE AND STAKEHOLDER ENGAGEMENT: LESSONS FROM THE MINDMAP CITIES Giuseppe Costa On behalf of the MINDMAP Consortium

CITY STAKEHOLDER PLATFORMS Seven MINDMAP cities have been involved in stakeholder engagement Turin and Trieste with two case studies Amsterdam, Rotterdam, London, Hamburg and Helsinki with local dissemination

THE THREE STEPS TURIN CASE STUDY: PROSPECTIVE

THE TURIN CASE STUDY FROM DATA TO ACTION What to do? How to do? PUBLIC COMMITTMENT The main policy makers take the responsibility to drive and bring the change: New commitment “setting targets and priorities”

THE TURIN CASE STUDY (CO- DECISION) Ranking of 23 actions according to expected impact on reducing social inequalities in premature mortality and do-ability. Higher potential from interaction between actions that are more promising in reducing health inequalities To focus a pilot on the more deprived area of the city To search for the best window of opportunity (the new chronic disease strategy: unequal diabetes epidemic as a trigger)

THE TURIN CASE STUDY (CO- CREATION) • These inequalities, if well communicated, are able to motivate and push the local stakeholders in co-investigating causes and solutions – Why diabetes prevalence is so unequal? – Which are the mechanisms generating these inequalities – Who’s the responsibility for avoiding these mechanisms? • Two local communities of practice have been committed this mandate – health professionals (GPs, specialists, pharmacies, nurses, primary care districts) as for their responsibility in equal early diagnosis and treatment, – local community actors (social housing, employment, poverty, schools, culture, leisure time facilities, green spaces, urban planning, food retails, voluntary sector) as for their responsibility in equal prevention

TURIN IN TIMES OF COVID 19 Education Education Prevalence of Prevalence of mental diabetes* disorders MOST (hospitalization)* CHRONIC High 1 DISEASES … High 1 Medium 1.44 Medium 1.35 Low 2.90 Low 1.31 RELATIVE INDEX OF EDUCATIONAL INEQUALITIES IN MORTALITY AMONG OVER 65 IN TURIN DURING THE PANDEMIC * RR age adjusted

A CHECK LIST FOR HEALTH EQUITY AUDIT OF THE PANDEMIC IN TURIN (!!! over65) Unequal mechanisms on health and care • Exposure to risk of infection • Health vulnerability to Covid-19 !!! • Barriers in access and use of good quality health responses to Covid-19 !!! • Impact of displacement of non-urgent part of pathways of care not Covid-19 !!! • Impact of less demand of health and social care support (risk and anxiety) !!! Unequal mechanisms out of the health sector (!!! over65) • Impact of the lockdown on social determinants of health • Capacities to face challenges and opportunities of isolation !!! • Impact on education of the schools lock-down !!! • Impact of lock-down at the community level • Impact of lock-down on social care !!! • Impact on social mobility of the experience of disease during the pandemic

THE TRIESTE CASE STUDY: RETROSPECTIVE Programme HM (Habitat MicroAree MA) – A Caring City INTERVENTION Total costs between €100 -200.000 per year/MA 1 . Outreach a) "Door to door" home visits to Austerity: sustainability? meet the resident population, b) joint home visits recommended by socio-sanitary services and c) QUALITATIVE ASSESSMENT proactive visits to specific population groups - action research with 40 professionals of the local teams 2. Community Development a. socialization - social mechanisms activated activities (informal thematic groups), b. valuing - increasing specific properties of individual inhabitants' skills useful to the SOCIAL CAPITAL community (eg. time bank) - enforcing CAPABILITIES 3. Health intervention a. Monitoring the health - to face CRITICAL PROBLEMS (24) of those most vulnerable (health centre), b. Health education and promotion, c. integration QUANTITATIVE ASSESSMENT with socio-sanitary services on individual cases. How and why the intervention improved the capacity to face the 24 problems? Among - 200 treated in MA - 200 untreated in MA - 200 untreated out of the MA

THE TRIESTE CASE STUDY: RETROSPECTIVE RESULTS - Treatment addressed more affected by the 24 problems - Treated benefited more from the mechanisms of generation of social capital - Mental health among treated was better than expected had they never been treated IMPACT - SOCIAL CAPITAL as a resource generator (more active and passive relationships capable to solve problems and more sense making) - TRUST as a positive expectation of cooperation - PUBLIC SERVICES capable of activation of people and of improving QUALITY AND INTEGRATION of the interventions

LESSONS FROM LOCAL EXPERIENCES • Although heterogeneous – Drivers : person, policy, professional, grass root – Focus : care/wellbeing, community, environment – Core ingredients : home, place, assets, partnership • Common intended impact – Co-production : change agents, local alliances, individual/community oriented – Strenghten communities : more equal public health at the core of investment, through investing in social infrastructure, enabling co-creation – Evaluation/adaptation of process/impact (action research) • Six common qualities of intentional strategic actions – Integrated action (btw professionals/sectors) centered on (equal) need of the person – Active and pair role of the person (resources, competences, voice) – Professionals generating horizontal relationships btw persons – Active role of the place/environment close to the person – Collective rites integrated in daily life, shaping identity btw professional and people – Alliances/partnership btw sectors to facilitate access and use of available resources

Paul McGarry, Assistant Director, Greater Manchester Ageing Hub (EUROCITIES working group Urban Ageing)

Greater Manchester: “Living with Covid - 19” and “Build Back Better” 1.Focus rigorously on understanding and 4. Deliver a social recovery that meets the highlighting the inequalities faced by older needs of those older people who continue to be socially isolated residents; identifying action to address these, working with our most marginalised ➢ Accelerate delivery of Ageing in Place communities and highlighting that impact is to provide the combination of support different for different groups of older people and opportunities needed over the next few months to meet demand from older people: 2.Changing the narrative: tackling the e.g. dementia support, strength exacerbation of pervasive and stark ageism and and balance, nutrition and promoting strong intergenerational hydration, access to voluntary roles, approaches mental wellbeing 3.Deliver an economic recovery inclusive of 5. Ensure older residents are a priority for older people and those approaching later life digital inclusion and partners continue to ➢ Continue to develop models of in-work meet the needs of those who are digitally and unemployment support for older excluded workers ➢ Understand impact on the financial security 6. Contribute to economic recovery by of older people and those approaching delivery of the longevity dividend later life and actions that can be taken to ➢ Take forward the proposals set out in the address; including scoping a pension credit GM-Local Industrial Strategy on healthy take-up campaign ageing

Residents at Brookdale Court, Wigan

Julia Wadoux, Policy Coordinator for Health, New Technologies and Accessibility, AGE Platform Europe

AGE Platform Europe The voice of older persons at EU level Challenges and opportunities for healthy urban ageing in a post- pandemic world: EU-level initiatives Julia Wadoux EuroHealthNet & MindMap Webinar, 6 July 2020

COVID-19 A game changer?