Evaluating the Impact of Structural Policies on Health Inequalities and their Social Determinants, and Fostering Change (SOPHIE) Health inequalities are unfair and avoidable differences in health between population groups defined socially, economically, demographically or geographically. They are strongly affected by the circumstances in which people are born, grow, live, work and age, and by the policies influencing these circumstances. SOPHIE aims to generate new evidence on the impact of structural policies on health inequalities, and to develop innovative methodologies for the evaluation of these policies in Europe. Particular attention will be put in increasing the involvement of affected stakeholders (civil society and deprived population groups) in the identification, design and evaluation of policies to tackle health inequalities. This project is coordinated by Agència de Salut Pública de Barcelona and funded from the European Community's Seventh Framework Programme (FP7/2007-2013, call Health-2011) under grant agreement n° 278173. Prsented at the Meeting of the Expert Group on Social Determinants and Health Inequalities. Luxembourg, 21-22 January 2013

1. SOPHIE
Project
Project
coordinator:
Carme
Borrell
Project
manager:
Davide
Malmusi
Agència
de
Salut
Pública
de
Barcelona

3. Objec/ve
SOPHIE
(acronym
for
Structural
Policies
for
Health
InequaliBes
EvaluaBon)
aims
to
generate
new
evidence
on
the
impact
and
effecBveness
of
structural
policies
in
tackling
health
inequaliBes
and
to
develop
innovaBve
methodologies
for
the
evaluaBon
of
these
policies
in
Europe.
We
consider
structural
policies
as
all
those
policies
with
a
powerful
influence
on
the
structural
determinants
of
health
inequaliBes,
such
as
paLerns
of
social
straBficaBon
and
living
and
working
condiBons.

4. Conceptual
framework

5. Work
Packages

6. Specific
objec/ves
1.
To
generate
new
evidence
on
how
structural
policies
impact
the
determinants
of
health
inequaliBes
by
socio-­‐economic
posiBon,
gender
and
migraBon
status.
2. To
develop,
refine
and
apply
innovaBve
methods
for
the
evaluaBon
of
European,
naBonal
and
local
policies.
3.
To
increase
the
involvement
of
affected
stakeholders
in
the
idenBficaBon
and
evaluaBon
of
policies
to
reduce
inequaliBes.
4.
To
disseminate
the
findings
by
implemenBng
strong
knowledge
translaBon
approaches
with
affected
communiBes,
stakeholders
and
responsible
policymakers.

7. Examples
of
methods
Realist
reviews
Unemployment
benefits
systems.
Realist
evaluaBon
Service
Voucher
for
domesBc
work
(Belgium)
Mixed
methods:
Quasi-­‐experiments
+
Concept
Mapping
Llei
de
Barris
urban
renewal
program
(Catalonia)
Ley
de
Dependencia
public
care
services
for
the
dependent
(Spain)
Typology-­‐guided
cross-­‐naBonal
analyses
Gender
equity
policies
ImmigraBon
policies
Housing
policies

8. Realist
approach
to
evalua/on
and
review
of
evidence
TradiBonal
evaluaBon
methods
test
programmes
by
asking
‘does
it
work?’
Realist
evaluaBon
aims
at
discerning
why,
how,
for
whom
and
in
what
circumstances
a
program
can
impact
health.
Pawson
and
Tilley
1997

9. Examples
of
methods
Realist
reviews
Unemployment
benefits
systems.
Realist
evaluaBon
Service
Voucher
for
domesBc
work
(Belgium)
Mixed
methods:
Quasi-­‐experiments
+
Concept
Mapping
Llei
de
Barris
urban
renewal
program
(Catalonia)
Ley
de
Dependencia
public
care
services
for
the
dependent
(Spain)
Typology-­‐guided
cross-­‐naBonal
analyses
Gender
equity
policies
ImmigraBon
policies
Housing
policies

10. Concept
Mapping
• To
engage
stakeholders
and
communiBes
early
in
the
research
process
• To
get
informaBon
on
the
lived
experience
of
a
policy
and
its
mechanisms
(how
does
it
work?)
Trochim
1989.
Burke
et
al
2005.

11. Concept
Mapping
Example
–
Urban
renewal
in
Barcelona
Cluster Layer
Layer Value
1 2.99 to 3.22
2 3.22 to 3.44
3 3.44 to 3.67
4 3.67 to 3.89
5 3.89 to 4.12
Decrease of economic activity
Abandoned areas
Sense of insecurity
Accessibility by car
Cleaning and repair of streets
Neighbourhood
relations
Reform of buildings
and plazas
Public events and spaces
Community and senior centers
Immigrants
Neighbourhood
Police relations
POPULATION & SOCIAL CHANGE
URBAN RENEWAL PROJECTS
Senior Center Group – Casc Antic
Youth Center Group – Casc Antic
Cluster Layer
Layer Value
1 2.99 to 3.22
2 3.22 to 3.44
3 3.44 to 3.67
4 3.67 to 3.89
5 3.89 to 4.12
Cluster Layer
Layer Value
1 2.99 to 3.22
2 3.22 to 3.44
3 3.44 to 3.67
4 3.67 to 3.89
5 3.89 to 4.12
Decrease of economic activity
Abandoned areas
Sense of insecurity
Accessibility by car
Cleaning and repair of streets
Neighbourhood
relations
Reform of buildings
and plazas
Public events and spaces
Community and senior centers
Immigrants
Neighbourhood
Police relations
POPULATION & SOCIAL CHANGE
URBAN RENEWAL PROJECTS
Senior Center Group – Casc Antic
Youth Center Group – Casc Antic
Mehdipanah
et
al.,
under
review

12. Cluster Layer
Layer Value
1 2.99 to 3.22
2 3.22 to 3.44
3 3.44 to 3.67
4 3.67 to 3.89
5 3.89 to 4.12
Cleaning and repair of streets
Reform of buildings
and plazas
Community and senior centers
Cluster Layer
Layer Value
1 2.90 to 3.10
2 3.10 to 3.30
3 3.30 to 3.50
4 3.50 to 3.70
5 3.70 to 3.90
Neighbourhood image
Sense of
insecurity
Immigrants
Neighbourhood
relations
Police relations
Resources,activities
and courses
Public space
POPULATION & SOCIAL CHANGE
URBAN RENEWAL PROJECTS
Employment
Decrease in economic activity
Transportation
Vandalism and sense of insecurity
Youth Center Group – Casc Antic
Community Center Group – Roquetes
POPULATION & SOCIAL CHANGE
URBAN RENEWAL PROJECTS
Cluster Layer
Layer Value
1 2.99 to 3.22
2 3.22 to 3.44
3 3.44 to 3.67
4 3.67 to 3.89
5 3.89 to 4.12
Cluster Layer
Layer Value
1 2.99 to 3.22
2 3.22 to 3.44
3 3.44 to 3.67
4 3.67 to 3.89
5 3.89 to 4.12
Cleaning and repair of streets
Reform of buildings
and plazas
Community and senior centers
Cluster Layer
Layer Value
1 2.90 to 3.10
2 3.10 to 3.30
3 3.30 to 3.50
4 3.50 to 3.70
5 3.70 to 3.90
Cluster Layer
Layer Value
1 2.90 to 3.10
2 3.10 to 3.30
3 3.30 to 3.50
4 3.50 to 3.70
5 3.70 to 3.90
Neighbourhood image
Sense of
insecurity
Immigrants
Neighbourhood
relations
Police relations
Resources,activities
and courses
Public space
POPULATION & SOCIAL CHANGE
URBAN RENEWAL PROJECTS
Employment
Decrease in economic activity
Transportation
Vandalism and sense of insecurity
Youth Center Group – Casc Antic
Community Center Group – Roquetes
POPULATION & SOCIAL CHANGE
URBAN RENEWAL PROJECTS
Concept
Mapping
Example
–
Urban
renewal
in
Barcelona
Mehdipanah
et
al.,
under
review

13. Examples
of
methods
Realist
reviews
Unemployment
benefits
systems.
Realist
evaluaBon
Service
Voucher
for
domesBc
work
(Belgium)
Mixed
methods:
Quasi-­‐experiments
+
Concept
Mapping
Llei
de
Barris
urban
renewal
program
(Catalonia)
Ley
de
Dependencia
public
care
services
for
the
dependent
(Spain)
Typology-­‐guided
cross-­‐naBonal
analyses
Gender
equity
policies
ImmigraBon
policies
Housing
policies

14. Policy
evalua/on
case
studies
Examples

15. Differences
with
other
FP7
projects
Some
themes
Macroeconomic
(monetary
and
fiscal)
policies
Built
environment
and
urban
regeneraBon
Housing
(quality,
access,
cost)
Gender
equity
ImmigraBon
policy
Some
methods
And
more
generally
,
the
realist
approach
to
evaluaBon
Beyond
socioeconomic
inequaliBes:
intersecBonality
The
focus
on
vulnerable
/
affected
stakeholders
Such
as
groups
affected
by
the
policy,
local
communiBes,
European
and
naBonal
themaBc
NGOs

16. Expected
/meline
for
results
Project
duraBon:
Nov-­‐11
to
Oct-­‐15
Deliverables
Jan-­‐14:
Reviews
Oct-­‐14:
Methods
of
stakeholders’
involvement
Jan-­‐15:
Cross-­‐country
analyses*
Apr-­‐15:
Case
studies
of
evaluaBon*
Oct-­‐15:
Final
scienBfic
report
*
Some
results
available
in
2013-­‐2014

18.
sophie-­‐project.eu
@sophieproject
info@sophie-­‐project.eu
dmalmusi@aspb.cat
Thank
you!
Grazie!
Gràcies!