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

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

Frank J. van Lenthe Erasmus MC Rotterdam Mauricio Avendano King’s College London for the MINDMAP Consortium

PROMOTING MENTAL WELL- BEING IN OLDER AGE IN THE CITY

APPROACH CONCEPTUAL MODEL

APPROACH PARTICIPATING COHORTS

VARIATION ACROSS STUDIES PROBABLE DEPRESSION RESIDENTIAL DENSITY

0% 5% 10% 15% 20% 25% 30%

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 ▪ Employment ▪ Participation ▪ Outdoor space ▪ Transport ▪ Housing POLICY DOMAINS

Social Policies Urban Policies Mental Health Policies

PUBLIC TRANSPORT AND DEPRESSION ▪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 RESEARCH QUESTIONS

Reinhard et al., JECH 2018; 72 (5): 361-368

POLICY RELEVANCE ▪ Adopt a systems approach 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”

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- DECISION)

Ranking of 23 actions according to expected impact on reducing social inequalities in premature mortality and do-ability.

• 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

THE TURIN CASE STUDY (CO- CREATION)

Education

Prevalence of diabetes* High 1 Medium 1.44 Low 2.90

TURIN IN TIMES OF COVID 19

Education

Prevalence of mental disorders (hospitalization)* High 1 Medium 1.35 Low 1.31

* RR age adjusted

MOST CHRONIC DISEASES …

RELATIVE INDEX OF EDUCATIONAL INEQUALITIES IN MORTALITY AMONG OVER 65 IN TURIN DURING THE PANDEMIC

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

• 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

A CHECK LIST FOR HEALTH EQUITY AUDIT OF THE PANDEMIC IN TURIN

!!! !!! !!! !!! !!! !!! !!! (!!! over65) (!!! over65)

Programme HM (Habitat MicroAree MA) – A Caring City

Austerity: sustainability?

THE TRIESTE CASE STUDY: RETROSPECTIVE

Total costs between €100-200.000 per year/MA INTERVENTION

• 1. Outreach a) "Door to door" home visits to

meet the resident population, b) joint home visits recommended by socio-sanitary services and c) proactive visits to specific population groups

• 2. Community Development a. socialization

activities (informal thematic groups), b. valuing individual inhabitants' skills useful to the community (eg. time bank)

• 3. Health intervention a. Monitoring the health
• f those most vulnerable (health centre), b.

Health education and promotion, c. integration with socio-sanitary services on individual cases. QUALITATIVE ASSESSMENT

• action research with 40

professionals of the local teams

• social mechanisms activated
• increasing specific properties of

SOCIAL CAPITAL

• enforcing CAPABILITIES
• to face CRITICAL PROBLEMS (24)

QUANTITATIVE ASSESSMENT 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

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

THE TRIESTE CASE STUDY: RETROSPECTIVE

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 highlighting the inequalities faced by older residents; identifying action to address these, working with our most marginalised communities and highlighting that impact is different for different groups of older people 2.Changing the narrative: tackling the exacerbation of pervasive and stark ageism and promoting strong intergenerational approaches 3.Deliver an economic recovery inclusive of

• lder people and those approaching later life

➢Continue to develop models of in-work and unemployment support for older workers ➢Understand impact on the financial security

• f older people and those approaching

later life and actions that can be taken to address; including scoping a pension credit take-up campaign

• 4. Deliver a social recovery that meets the

needs of those older people who continue to be socially isolated ➢Accelerate delivery of Ageing in Place to provide the combination of support and opportunities needed over the next few months to meet demand from older people: e.g. dementia support, strength and balance, nutrition and hydration, access to voluntary roles, mental wellbeing

• 5. Ensure older residents are a priority for

digital inclusion and partners continue to meet the needs of those who are digitally excluded

• 6. Contribute to economic recovery by

delivery of the longevity dividend ➢Take forward the proposals set out in the GM-Local Industrial Strategy on healthy ageing

Residents at Brookdale Court, Wigan

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

Julia Wadoux EuroHealthNet & MindMap Webinar, 6 July 2020

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

COVID-19 A game changer?

• Solidarity as the best response (across generations,

across countries, etc. )

• Physical distancing should not mean social

distancing (isolation)

• Human rights: older persons must be equally

protected → Challenging period for a paradigm shift (e.g. older people described as vulnerable)

More information: https://www.age-platform.eu/coronavirus- covid-19

Our main messages

Some of the reaction at EU level

Older people have the same rights to life and health as everyone else. All social, economic and humanitarian responses must take the needs of older people fully into account, from universal health coverage to social protection, decent work and pensions. Let’s not treat older people as invisible or powerless. António Guterres, UN Secretary General, 1 May

Overview of the EU and global context

EU initiatives in the pipelines…

End 2020/First half 2021

• Green Paper on Ageing – social protection and

social inclusion, opportunities

• Action plan to support the European Pillar of

Social Rights for 2021 (Link to the Portuguese Presidency of the EU (first semester 2021) – health, long-term care, housing, etc.

• Joint report of the European Commission and

the Social Protection Committee on Long-Term care - access, quality and sustainability

• Disability Strategy 2020-2030 – accessibility
• Long-term vision for rural areas – infrastructure

and access to services

« Change the way we think, feel and act towards age and ageing »

Rights-based approach 1- ageism 2- age-friendly environments 3- integrated care 4- long-term care: provide access for older people who need it

Want to know more about us? www.age-platform.eu Julia.wadoux@age-platform.eu @AGE_PlatformEU AGE Platform Europe

AGE work is co-funded by the Rights, Equality and Citizenship Programme of the European Union. The contents of this document are the sole responsibility of AGE Platform Europe and cannot be taken to reflect the views of the European Commission.