Webinar: Ageing, health and the city in times of COVID-19 - Webinar #6 - 6 July 2020 - EuroHealthNet
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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%
HAPIEE-LT
HUNT
HAPIEE-CZ
HAPIEE-RU
LASA-1
LASA-2
RECORD
GLOBE
*
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 ConsortiumCITY 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 disseminationTHE THREE STEPS TURIN CASE STUDY:
PROSPECTIVETHE 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 preventionTURIN IN TIMES OF
COVID 19
Education Prevalence of Education Prevalence of mental
diabetes* disorders
MOST
High 1 CHRONIC (hospitalization)*
DISEASES
… High 1
Medium 1.44
Low 2.90 Medium 1.35
Low 1.31
RELATIVE INDEX OF EDUCATIONAL
INEQUALITIES IN MORTALITY AMONG OVER
65 IN TURIN DURING THE PANDEMIC
* RR age
adjustedA CHECK LIST FOR HEALTH EQUITY AUDIT OF THE
PANDEMIC IN TURIN
Unequal mechanisms on health and care (!!! over65)
• 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 pandemicTHE 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
meet the resident population, b) joint home visits Austerity: sustainability?
recommended by socio-sanitary services and c) QUALITATIVE ASSESSMENT
proactive visits to specific population groups - action research with 40
2. Community Development a. socialization professionals of the local teams
activities (informal thematic groups), b. valuing - social mechanisms activated
individual inhabitants' skills useful to the - increasing specific properties of
community (eg. time bank) SOCIAL CAPITAL
- 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 MATHE 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 interventionsLESSONS 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 resourcesPaul 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
residents; identifying action to address to be socially isolated
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
2.Changing the narrative: tackling the people:
exacerbation of pervasive and stark ageism and e.g. dementia support, strength
promoting strong intergenerational and balance, nutrition and
approaches hydration, access to voluntary roles,
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
of older people and those approaching 6. Contribute to economic recovery by
later life and actions that can be taken to delivery of the longevity dividend
address; including scoping a pension credit ➢Take forward the proposals set out in the
take-up campaign GM-Local Industrial Strategy on healthy
ageingResidents 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 2020COVID-19 A game changer?
Our main messages • 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
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
Rights-based approach
1- ageism
2- age-friendly environments
3- integrated care
4- long-term care: provide access
for older people who need it
« Change the way we think, feel and act towards age and
ageing »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.You can also read
