Health 2020: social protection and health: sector brief on social protection

Synergy between sectors: fostering better social and health outcomes The Health 2020 policy framework has been adopted by all Member States of the WHO European Region in order to address Europe’s great social and health challenges, calling upon the health sector to reach out to, and work with, all the various sectors and parties in the continuous work of improving people’s health and well-being. More equal societies are happier, healthier and wealthier. By working together, the health and social sectors can contribute to improving the living and working conditions of individuals, families and communities in the European Region, reduce inequalities and support human development, not only improving good health and well-being but also fostering healthy and resilient communities and economies. The social sector can help create healthier people and communities by: • adopting countercyclical policies to re- duce the effects of economic cycles that strengthen the safety net for individuals and groups at risk of poverty; • working with the health sector to support children, their families and communities to ensure the best start in life; • working with the health sector to support young adults to help them transition into work; • working with the health sector to provide integrated and adequate support for old- er people and to foster an active healthy older population; • working with the health sector to ensure that groups at risk of poverty and exclu- sion, including people with disabilities, are empowered and enabled; and • working with the health sector to reduce gender-based inequalities, including in their roles as key employers of women. Summary Health 2020: Social protection and health July 2015 Sector brief on Social protection 5 Social progress is best mea- sured by objective indicators of health, health equity and well-being, and this includes the conditions in which people are born, live and work. 1 Health and wellbeing are public goods and assets for human development that contribute to strong, dynamic and creative societies. 2 Health and well-being are best achieved if the whole of government works together, and Health 2020 promotes whole- of-government and whole-of- society approaches. 3 Health and well-being can be improved and health inequalities reduced, through the right policies and working with other sectors. 4 Different countries, cities and communities are at different starting-points; each is unique and can pursue common goals through different pathways. Key messages The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality. 2 Health 2020: Social protection In 2012, all 53 Member States in the European Region adopted Health 2020, the new common European health policy framework, and committed themselves to developing integrative policies that engage with all sectors in addressing the social and economic determinants of health and well-being. The most effective actions to achieve greater equity in health outcomes are those that ensure an adequate level and distribution of social protection over the life-course and according to need. Social protection refers to policies aimed to protect against the risks and needs as- sociated with unemployment, parental and caring responsibilities, sickness and health care, disability, old age, housing and social exclusion in the form of social assistance and social insurance. Social protection can create a buffer against income loss and redistribute income both over the life-course and between individuals. Comprehensive social protection policies can be especially powerful in protecting health in economic crises. Evidence shows that investing in social protection helps to protect individuals and families from the adverse effects of economic crises. Social protection and social investment present an opportunity to prevent sickness and disability and, ultimately, to improve health and reduce health inequalities. Societies investing in social protection, including countercyclical measures, achieve greater health progress overall and can also more rapidly improve the health of the most vulnerable people. Strengthening the link between health and social protection over the life-course World Health Organization 3 All Member States of the WHO European Region have agreed to monitor progress against six common targets: 1. Reduce premature mortality in the European Region by 2020 2. Increase life expectancy in the European Region 3. Reduce health inequalities in the European Region 4. Enhance the wellbeing of the European Region population 5. Ensure universal health coverage and the right to the highest attainable level of health 6. Set national goals and targets related to health in Member States. What makes societies prosper and flourish can also make people healthy, and policies that recognize this have more impact. Building awareness and capacity to make health objec- tives part of society’s overall socioeconomic and human development is essential. All policy fields, including health, need to reform their ways of working and use new forms and approaches to policy at the global, national and local levels.new forms and approaches to policy at the global, national and local levels. The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are uni- versal, equitable, sustainable and of high quality. Health 2020: a framework for action 4 Health 2020: Social protection Strengthening the link between social protection and health over the life-course Health is a powerful lever for achieving social protection and inclusion. Good health is the most powerful correlate of well-being throughout the life-course. Better health enables people to work and participate fully in their communities and to support themselves financially and therefore can potentially break the cycle of ill health and poverty. When health suffers, so do other social targets. Robust evidence indicates that ill health reduces people’s employment prospects and working hours and increases the likelihood of premature retirement and of experiencing poverty in old age. Likewise for children, poor family health correlates with lower performance in school and earlier and more frequent dropout from education, which in turn increases their risk of exclusion throughout adulthood. The health sector can therefore play a key role in supporting the social sector in its goals of reducing poverty and reducing social exclusion. Social protection is closely related to mental health, which is the leading cause of disability and the largest contributor to missed workdays in the WHO European Region. When left untreated, mental health problems such as depression increase the risks of unemployment and exit from the workforce, in addition to being one of the Synergy between sectors: supporting social protection for healthier people and communities most common reasons for premature re- tirement, compounding the risks of poverty. Many people living with mental illness face stigma, discrimination and social exclusion, yet cost-effective, health-promoting and disease-preventive interventions can signifi- cantly improve mental health. In turn, such interventions have been found to support people’s ability to seek re-employment and to allow them to transition into higher-qual- ity jobs, thereby achieving both better social protection and inclusion. Several studies show that, during the recent economic crisis, the countries that experienced the lowest effects on the mental health of their populations were those with the strongest social safety net. Protecting the most disad- vantaged populations through strong social protection measures proved to be effective in decoupling the link between job losses and suicide. Social protection programmes have made substantial strides in reducing unemploy- ment, poverty and social exclusion in recent decades. There is an opportunity to strengthen the role of health and health promotion in their delivery. Health promo- tion substantially influences activating and enabling people – two core components of social protection – and building empow- ered, resilient communities. Investing in health is critical to fostering the develop- ment of an active, educated and productive generation of young people, to empower and enable groups at risk of poverty and ex- clusion, including people with disabilities, to reduce gender inequalities and to maintain an active and enabled older population. Health and social affairs ministers can work together to address the needs of vulnerable groups and ensure a healthier future for all, particularly when political priorities change and during periods of fiscal consolidation, economic decline and austerity. The health and social sectors have numerous types of synergy and overlapping objectives and targets, and working together would enable better outcomes for individuals, communi- ties and societies. World Health Organization 5 How can social protection make a difference to health? Health 2020 provides a platform for such joint working between the social and health sectors. Working together, we have the power to intervene to address some of today’s greatest health challenges, including health inequalities, social exclusion and support sustainable development while ensuring that individuals and communities are able to fulfil their highest potential. Synergy between sectors: fostering human development and well-being KEY AREAS TO EXPLORE TOGETHER INCLUDE: • developing joined-up policy responses to support target populations; • developing joint regulatory frameworks that are flexible, enabling specificities and social innovation and change at the local level; • adopting common systems for monitor- ing policy implementation and outcomes across sectors, including indicators; and • Making better use of existing resources to ensure that populations have adequate care and support. • Provide adequate social support for women, mothers-to-be and young families • Give children the best start in life by focusing on parenting skills and ensuring access to high-quality education and a smooth, secure transition from education to employment • Provide parental leave that is paid and of adequate length to enable bonding, breastfeed- ing and adequate postnatal care without a risk of income loss • Increasing access to affordable childcare and housing • Prevent income insecurity through unemployment protection • Prevent in-work poverty by ensuring minimum income • Promote safe working conditions through strong occupational health schemes and paid sick leave • Provide adequate social protection for people with disabilities and people engaged in both paid and unpaid care work How can the sectors work together? 6 Health 2020: Social protection How can health make a difference to the social sector? Collaborating to improve the well-being of people and communities THE CHALLENGE Fostering a healthy start for children Increasing labour market participation, including for young people Reducing poverty and social exclusion Promoting active ageing Reducing gender-based inequalities • Promote preventive health measures, such as vaccines, good nutrition and healthy life- styles, to encourage the development of healthy individuals, families and communities • Increase access to prevention and treatment in mental health services • Continue to improve health-care delivery and quality by expanding and integrating the roles of health and social care professionals • Strengthen social protection policies for health-care workers and their families THE RESPONSE NEEDED Strengthening social protection and integrated health and social services for women, young mothers and families Working together with the education sector to create supportive environments in key settings such as schools Providing joined-up services, including mental health and employ- ment to facilitate the transition to employment Exploring innovative policy approaches to support young people as they transition into the workforce Jointly developing coherent investment strategies in national health and social protection systems for preventing and responding to health challenges Contributing to developing a trade environment that is coherent with social and health objectives Developing joint approaches on human resources for health Providing joined-up health and social care services to ensure early detection of health problems and to encourage an active lifestyle and independent living Implementing occupational health policies and apaid sick leave to support healthy ageing throughout the life-course Exploring support to caregivers, including labour market policies Ensuring joined-up end-of-life services Ensuring access to adequate social protection to reduce the risk of poverty throughout the life-course Ensuring joined-up services against domestic violence Supporting equal pay for equal work and parental, maternity and paternity leave policies World Health Organization 7 The Health 2020 policy framework has a political mandate. It has been adopted by all European Member States and can be adapt- ed to the different settings and realities that make up the European Region. It describes how health and well-being can be advanced, sustained and measured through action that creates social cohesion, security, a good work–life balance, good health and good ed- ucation. It calls on the health sector to reach out to the many different actors within and outside government and provides inspiration and direction on addressing the complex health challenges of the 21st century. The framework confirms values, is informed by evidence and identifies strategic directions and essential actions. It builds on the expe- riences gained through previous Health for All policies and guides the actions of both Member States and the Regional Office. Across Europe, there is a strong, significant association between greater investment in social protection and reduced premature mortality rates, particularly for heart disease, tuberculosis and suicide. Wherever social protection systems with wide population coverage and adequate and affordable benefit levels are in place, they have been effective in reducing poverty and inequality; welfare policies that provide more generous transfers and better-quality services are likely to improve public health and reduce health inequities. Studies show that individuals and families are healthier when they have access to sufficient income to lead a healthy life, liv- ing wages, quality employment, safe working conditions and affordable housing and are equally protected from social exclusion. Where existing levels of social spending and social rights are in the low-to-moderate range, even small improvements in legislated social rights and social spending are associat- ed with improved health. This suggests that lower-income countries with the least-de- veloped social protection systems can make gains most easily. The evidence shows that, without investing in social protection, eco- nomic growth is unlikely to result in sustained and equally distributed health gains. Better resourced and more comprehensive social protection systems are critical drivers of progress in promoting health and reducing health inequalities in all countries. Govern- ments that invest in social protection and the welfare of the population also invest in health, manifesting in lower poverty rates, greater social cohesion, better educational outcomes for children, a more productive workforce and higher levels of health attain- ment over the life-course. Health 2020 recognizes the social sector as a co-producer of health; a partner in support- ing healthy, empowered families, schools, workplaces and communities; an employer of women and a growing care workforce; a key influencer of the human development of a population; and a partner in striving for investment in government policies that are coherent in their policy goals. Using Health 2020 as a platform for joint work: a political mandate and evidence base LIFE-COURSE STAGE • Social protection for women, mothers- to-be and young families • Universal, high-quality and affordable early-years education and care system • Eradication of unsafe work and access to employment and high quality work • Coherent and effective intersectoral action to tackle inequalities at older ages WIDER SOCIETY • Improved social protection, according to need • Co-creation and partnership with those targeted, civil society and civic partners • Action to reduce social exclusion • Gender equity approach BROADER CONTEXT • Promoting equity through tax and trans- fer payments • Long-term planning through links with other policies SYSTEMS • Greater coherence across sectors • Comprehensive responses • Regular reporting and public scrutiny Reducing health inequalities To reduce health inequalities, addressing the following is a good start: WORLD HEALTH ORGANIZATION | REGIONAL OFFICE FOR EUROPE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: contact@euro.who.int Website: www.euro.who.int Document number: WHO/EURO:2015-6165-45930-66207 © World Health Organization 2015. 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