A large-scale study, led by Milagros Ruiz from University College London as a part of DRIVERS, sought to advance the state-of-the-art knowledge in this area. The study examined the health of over 75,000 babies from 12 countries (Czech Republic, Finland, France, Greece, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, the United Kingdom and Ukraine) representative of the cultural, geographical and historical diversity across Europe. The study looked at the effect of low maternal education upon babies’ risk of being born either too soon, or too small for their gestational age.

The study found that low maternal education was linked with a discernible risk of pre-term and small for gestational age births in Europe. There is substantial evidence that both preterm (and small for gestational age) births are critical aspects of foetal nutrition and health among newborns. In fact, these aspects have been attributed to impaired child development and an increased risk of chronic diseases in adult life. On average, the increased risk of poor health at birth associated with low maternal education was 48% greater for preterm births and 55% greater for small for gestational age births across 12 countries.

However, the associations between low maternal education and poor health at birth within each country were most robust in the Netherlands, Spain, Sweden and the UK, for both health outcomes. These associations were weaker in the other countries studied. The study authors are continuing their work for DRIVERS, and are further assessing the differential effect of mother’s education as a social determinant of newborn health in participating countries.

These findings provide a clearer picture of inequalities in newborn health associating with low maternal education in distinct European settings. Such inequalities may be alleviated by universal and high-quality care and education for babies and their families, which would contribute to creating more supportive environments for disadvantaged communities.

The study published in the Journal of Epidemiology and Community Health, ‘Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts’, can be accessed here: http://jech.bmj.com/content/early/2015/04/23/jech-2014-205387.long.

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They gather the latest evidence from the project, provide a synopsis of the issue, solutions, and opportunities to advocate. The briefs have been informed by the findings of work on advocacy for health equity, and are meant for policy makers and practitioners at the European, national and sub-national levels. Translations of the policy briefs into several different European languages are under way, and will be made available from the Translations page.

Download links:

• Early Child Development - Universal, quality early childhood programmes that are responsive to need promote better and more equal outcomes in childhood and later life.
• Fair Employment - Improvements in quality of work, particularly for people in lower occupational groups, would contribute to a significantly healthier and more productive Europe.
• Income & Social Protection - Well-designed social protection systems can improve the lives of people and reduce health inequalities.

Slideshare links:

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The event, co-hosted by Julie Ward MEP (S&D, UK) and Eider Gardiazabal Rubial MEP (S&D, ES), brought together European and national policy-makers, civil society, industry and academics to discuss how DRIVERS’ latest evidence can be taken forward and integrated into existing and future policy initiatives.

For more than three years, scientists, civil society organisations, and representatives from public health and businesses have collaborated to explore how health equity can be improved across policy sectors, through action on three of the most important drivers of health: early childhood, employment & working conditions, and income & social protection.

As a result of their efforts, DRIVERS has identified four principles by which decision makers can design better and ‘healthier’ policies addressing the challenges of our time to help create a fairer Europe. These overarching principles can be applied to any policy context and can bring potential added value especially during times of crisis and cuts to public social spending.

Prof. Sir Michael Marmot in his keynote speech outlined how the principles of ensuring universality of access to services while addressing disadvantage, accounting for context and respecting rights of people concerned and ensuring that policies are evidence-based can guide the development and implementation of policies to improve health and reduce health inequalities. 

Application of these principles would enable children and families to live better and have adequate social protection coverage, enable workers to stay in the labour market for longer, improve productivity at work, reduce social exclusion and, hence, foster greater social cohesion. 

The importance of the life-course should be taken into account in the application of these principles as social inequalities start having an impact on individuals before birth, through early childhood and through life, influencing later life chances and outcomes. Moreover, the systematic deprivation of health for certain social groups, denying them the possibility to participate fully in economic and social life, results in even worse health.

The conference was composed of a scientific and a policy expert panel. During the first panel on taking stock of the evidence base advanced by DRIVERS, representatives from three DRIVERS’ partners (University of Dusseldorf, Centre for Health Equity Studies & University College London) explained how the DRIVERS project enabled them to gain new insights on employment, social protection and early child development & inequalities within and between different EU countries. 

Throughout the discussions, there was a general consensus that solutions to improve health equity solutions do not simply reside within the health sector and that public spending should strengthen sustainable employment and address health-adverse working conditions.

Moreover, other messages echoed that more spending on active labour market policies is correlated with better jobs and lower health inequalities in the same way that more spending on unemployment benefits is linked to a narrower social gradient in health.

In the panel dedicated to policy and how recommendations from DRIVERS can be taken forward to inform EU policy agendas, members of the European Parliament argued that the European Parliament's work can help improve health, but real moves towards health equity require action across sectors and at different levels of governance.

The DRIVERS policy recommendations received broad support and endorsement and several EU policy makers, including a member of the Social Protection Committee, and made concrete proposals and commitments to taking them forward.

Conference co-host Eider Gardiazabal Rubial MEP pledged to make efforts to ensure that the Commission and the Council boost investment in social and health needs and continue to tackle inequalities rather than allow a widening of existing disparities as a result of the crisis.

Ralf Jacob (DG EMPL, European Commission) stated that DRIVERS’ recommendations are in synergy with many of the Commissions priority areas. He also argued that the mid-term review of the Europe2020 Strategy represents a real opportunity for using new knowledge to inform the next phase of the Strategy.

All in all, the conference was an excellent opportunity to disseminate the latest pan-European evidence arising from the DRIVERS project and stimulate debate on how action to help reduce health inequalities across sectors can be maximized.

Reducing inequalities and enhancing social cohesion during this economic climate requires collective commitment and co-operation. DRIVERS and EuroHealthNet, a network of agencies and organisations dedicated to improving health equity across Europe, would like to thank all those who have supported us in the execution of our work within DRIVERS. Following the conference, interviews were conducted with several of our speakers. Video footage will be available soon.

“DRIVERS’ recommendations are impressive, very detailed, evidence-based, and integrated across the life course…” Rudi Van Dam (Social Protection Committee)

Did you miss the DRIVERS conference and want to know more? Please visit our Storify page (see below), which summarises the conference key messages that were produced via Twitter.

The news release issued following the conference can be found here.

The key note speech by Sir Michael Marmot can be found here.

The policy recommendations document 'Improving health equity through action across the life course' can be found here.

More information on DRIVERS publications (policy briefs, reports) can be found here.  The policy recommendations and policy briefs are currently being translated into several European languages and will be available shortly.

For more information, please contact us at [email protected]

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They detail the scientific work carried out by teams at University College London/UCL Institute of Health Equity, the Department of Medical Sociology at Universität Düsseldorf, and the Centre for Health Equity Studies (CHESS) at Stockholms Universitet, on (respectively) early child development, employment & working conditions, and income & social protection.

While numerous academic papers have been - and continue to be - published in leading peer-reviewed journals, these reports bring together the expanded evidence base, explaining how the different pieces of work fit together and provide a solid foundation for the development of evidence-based recommendations. These recommendations are detailed in separately published recommendations document and three policy briefs.

The three reports are:

• Social Inequalities in early childhood health and development, evidence and policy implications, by Hynek Pikhart, Milagros Ruiz, Joana Morrison, Peter Goldblatt & Michael Marmot. Also see the Appendices.
• Working conditions and health inequalities, evidence and policy implications, by Johannes Siegrist, Diego Montano & Hanno Hoven.
• The role of income and social protection for inequalities in health, evidence and policy implications, by Olle Lundberg, Monica Åberg Yngwe, Kersti Bergqvist & Ola Sjöberg.

The project's final recommendations will be presented tomorrow, 3 February 2015, at a conference held at the Residence Palace in Brussels. The final recommendations document and policy briefs are available from the publications section of the website.

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DRIVERS participated in several pre-conference sessions, during which project partners presented some key findings of the project and discussed the role of effective advocacy in realising health equity goals.

A session titled “How to tackle health inequalities? Results from four EU-funded projects” saw Prof Olle Lundberg (CHESS) illustrate the limitations of a welfare regime approach to studying social protection and health inequalities. It also saw Dr Hynek Pikhart (UCL) underline methodological and conceptual challenges in the harmonisation of inequality-relevant indicators across Europe.

Dr Claudia Marinetti (EuroHealthNet) gave an overview of the role of advocacy in reducing health inequalities. She emphasised the value of different kinds of evidence in advocacy efforts, in contrast to the well-known ‘hierarchy of evidence’, and the use of different types of advocacy messages.

In a poster walk dedicated to evidence-informed policy, Linden Farrer (EuroHealthNet) presented results from DRIVERS on improving the effectiveness of advocacy for health equity. He stated that it is important for evidence to find its way into policy processes, but doing so requires specific methods of knowledge transfer and translation. As scientists are not always willing or able to advocate, knowledge brokering organisations such as EuroHealthNet can play an extremely important role in facilitating this process.

One of DRIVERS’ aims is to identify solutions to reducing health inequalities through policy and practice in early childhood development. Joana Morrison (UCL) presented a review of early childhood interventions in several European countries conducted over the last two decades with the aim of addressing health and early development. One of the findings is that interventions with better outcomes appear to combine educational activities for both parents and children beginning in early pregnancy and include home visits by specialised staff.

DRIVERS also featured in a packed plenary session on tackling health inequalities organised by EuroHealthNet. The session included a discussion on presenting policy recommendations to policy makers from four EU-funded projects (DEMETRIQ, DRIVERS, SILNE, SOPHIE), all aiming to generate new evidence on the best ways of tackling health inequalities.

On behalf of the DRIVERS team, Prof Johannes Siegrist emphasised that public spending should strengthen sustainable employment and address health-adverse working conditions, particularly among lower socio-economic groups. Indeed, he noted that “DRIVERS has demonstrated a social gradient in risk of suffering from work stress, with lower occupational groups facing the greatest risks of psycho-social stress”.

All in all, the EPH conference was an excellent opportunity to disseminate new evidence arising from the DRIVERS project to public health researchers, policy makers, practitioners and health professionals.

If you missed DRIVERS at the EPH conference then please visit our Storify page (see below), which summarises the key events through the tweets that were produced throughout the course of the Pre-conference.

You can find the joint DRIVERS and EuroHealthNet news release issued at the start of the EPH Pre-Conference here.

You can also find the DRIVERS presentations and poster here.

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The report also explores the importance of ECEC to reduce socio-economic inequalities and to foster the healthy development of children.

Other aspects:

• Affordability is a very important factor in ensuring that all children have access to ECEC, especially those in most need, i.e. children are at risk of poverty or social exclusion.
• The compulsory qualification levels for ECEC staff vary between countries. Educational staff working with older children is usually required to have a Bachelor's degree as a minimum qualification, while such requirement often does not exist for staff working with younger children.
• The participation in ECEC is low for the under three years old. In contrast, 93% of children attend ECEC before starting primary education.
• The involvement of parents and community representatives creates better conditions for children's learning.

The full study Key Data on Early Childhood Education and Care in Europe – 2014 can be found here.

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Claudia Marinetti presented on the project as a whole. Hynek Pikhart presented on the work on early childhood development on behalf of the UCL team. Next, Hanno Hoven presented the work on employment & working conditions for the University of Dusseldorf team. Then Olle Lundberg of CHESS presented an overview of what’s known and some of the findings of their research network. Finally, Linden Farrer presented on the advocacy work taking place within DRIVERS.

A lively question and answer session followed each presentation, and useful feedback will be incorporated into future work.

Furthermore, DRIVERS had the opportunity to present a rolling presentation of its work at the Third Annual Convention of the Platform against Poverty and Social Exclusion on 26-27 November 2013.

• European Public Health Conference - Introduction to DRIVERS (C. Marinetti)
• European Public Health Conference - Early Childhood Development (P. Pikhart)
• European Public Health Conference - Employment & Working Conditions (H. Hoven)
• European Public Health Conference - Income & Social Protection (O. Lundberg)
• European Public Health Conference - Advocacy for Health Equity (L. Farrer)
• Third Annual Poverty Convention - DRIVERS rolling presentation

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The review is divided into four main sections: 1) Context and background to the review with key principles underpinning the recommendations, 2) Summary of current evidence on the health divide between countries, 3) A focus on the life-course perspective, wider society, macro-level context, governance, delivery and monitoring systems, 4) Implementation, framework for action, reasons for failure, guidance on good practice.

Overall, the report calls for universal coverage of health care, a focus on health-adverse behaviours, and action on the conditions into which people are born, grow, live, work and age, and the inequalities in power, money and resources that give rise to them.

New themes in the report, compared with the CSDH, include:

• Emphasis on human rights as an approach to tackle the SDH and improve health but continued commitment to social justice.
• Emphasis on empowering communities and individuals to take action.
• Emphasis on the life-course approach, meaning that although early childhood is important every stage of life plays a subsequent part in determining health.
• Emphasis on protecting future generations from perpetuations of social and economic inequalities.

Click here to download.

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EAPN and Eurochild produced an Explainer on Child Poverty in the EU  in order to:

• Raise public awareness about what child poverty means in a European context, its causes, and how it impacts on the lives of children and their families.
• Highlight effective solutions that can help to fight child poverty and promote the well-being of all children and families, particularly in times of austerity and public spending cuts.

It is hoped to mobilise widespread public and political support for intensified action to reduce child poverty and to promote children’s well-being, at a timely moment to support the implementation of the European Commission’s Recommendation against child poverty. Open the publication here in English - French

EAPN has already issued a series of three Explainers on Poverty and Inequality in the EU (2009), on Adequacy of Minimum Income in the EU (2010) and on Wealth, Inequality and Social Polarisation in the EU (2011).

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• Push national governments to take the fight against child poverty seriously
• Launch the Child Poverty Explainer & Unicef Report Card

The facts are known: one in four children in the European Union is at risk of poverty or social exclusion, amounting to 25.3 million children. The crisis and austerity measures across the continent have had an enormous impact on the most vulnerable in society - among them children, who have been disproportionately affected.

You can follow this event on Twitter using #childpoverty2013

What is child poverty?

EAPN and Eurochild take the opportunity of this event to launch "Towards Children’s Well-Being in the EU", which aims to raise public awareness on child poverty in Europe and on the devastating effects it has on lives of children and families as well as on society as a whole. The explainer illustrates concrete solutions at EU, national, local and individual levels to support the implementation of the European Commission Recommendation. This will be available as from 10 April 2013 at www.eurochild.org

UNICEF Report Card  11 – Child well-being in rich countries. A comparative overview

UNICEF will launch its Report Card 11 at the Round Table. UNICEF Report Cards provide a mirror to industrialised countries on how children are faring in their societies, and present a wide range of measures of progress. Report Card 11 also includes an important section on how children see their own lives. The Report Card will be available from 10 April 2013.

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