The Role of Cohesion Policy Funds in Decreasing the Health Gaps Measured by the EURO-HEALTHY Population Health Index
Abstract
:1. Introduction
1.1. The EU Cohesion Policy and Health
1.2. The EURO-HEALTHY Population Health Index
- (1)
- Do the intervention fields with planned allocation of CP funds match the dimensions where regions are lagging behind, as identified in the population health index?
- (2)
- Are there any categories/intervention fields that are relevant for closing regional health gaps but appear to be currently underrepresented in CP planned investments?
2. Materials and Methods
2.1. Materials
2.1.1. Population Health Index
2.1.2. Cohesion Policy Funding for 2014–2020
2.2. Methods
3. Results
3.1. Population Health Index and Regional Level of Development
3.2. Cohesion Policy Funds Allocation by Intervention Field and Category of Region
3.3. Cohesion Policy Categories of Intervention and the Population Health Index Dimensions
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Area of Concern | Dimension | Indicators |
---|---|---|
Health Determinant Index | ||
Economic conditions, social protection, and security | Employment | Unemployment rate (%) |
Long-term unemployment rate—12 months and more (%) | ||
Income and living conditions | Disposable income of private households per capita (euros per inhabitant) | |
People at risk of poverty or social exclusion (%) | ||
Disposable income ratio—S80/S20 (ratio) | ||
Social protection | Expenditure on care for the elderly (% of gross domestic product (GDP)) | |
Security | Crimes recorded by the police (per 100,000 inhabitants) | |
Education | Education | Population aged 25–64 with upper secondary or tertiary education attainment (%) |
Early leavers from education and training (%) | ||
Demographic change | Aging | At risk of poverty rate of older people—aged 65 years and over (%) |
Aging index (ratio) | ||
Lifestyle and health behaviors | Lifestyle and health behaviors | Adults who are obese (%) |
Daily smokers—aged 15 and over (%) | ||
Pure alcohol consumption—aged 15 and over (liters per capita) | ||
Live births by mothers under age of 20 (%) | ||
Physical environment | Pollution | Annual mean of the daily fine particulate matter (PM2.5) concentrations (µg/m3) |
Annual mean of the daily PM10 concentrations (µg/m3) | ||
Greenhouse gas (total tons of CO2 equivalent emissions per capita) | ||
Population exposed to traffic noise—Lden55–59db, during day (%) * | ||
Extreme weather events * | Population affected by flooding (per 1,000,000 inhabitants) * | |
Built environment | Housing conditions | Average number of rooms per person |
Households without indoor flushing toilet (%) | ||
Households without central heating (%) | ||
Water and sanitation | Population connected to public water supply (%) | |
Population connected to wastewater treatment plants (%) | ||
Waste Management | Recycling rate of municipal waste (%) | |
Land use * | Population density (inhabitants/km2) * | |
Road safety | Road safety | Victims in road accidents—injured and killed (per 100,000 inhabitants) |
Fatality rate due to road traffic accidents (per 1000 victims) | ||
Healthcare resources and expenditure | Healthcare resources | Medical doctors (per 100,000 inhabitants) |
Health personnel—nurses and midwives, dentists, pharmacists, and physiotherapists (per 100,000 inhabitants) | ||
Healthcare expenditure | Total health expenditure (purchasing power standard per capita) | |
Private household out-of-pocket expenses on health (% of total health expenditure) | ||
Public expenditure on health ( purchasing power standard per capita) | ||
Healthcare performance | Healthcare performance | Hospital discharges due to diabetes, hypertension, and asthma (per 100,000 inhabitants) |
Amenable deaths due to healthcare (standardized death rate per 100,000 inhabitants) | ||
Health Outcome Index | ||
Health outcomes | Length of life (mortality) | Life expectancy at birth (years) |
Infant mortality (per 1000 live births) | ||
Preventable deaths (standardized death rate per 100,000 inhabitants) | ||
Quality of life(morbidity) | Self-perceived health less than good (%) | |
Age-standardized disability-adjusted life year (DALY) rate (per 100,000 inhabitants) | ||
Low birth weight (%) |
Categories and Intervention Field Dimension | Code | Intervention Field |
---|---|---|
A—Energy infrastructure | 009 | Renewable energy: wind |
010 | Renewable energy: solar | |
011 | Renewable energy: biomass | |
012 | Other renewable energy (including hydroelectric, geothermal, and marine energy) and renewable energy integration (including storage, power to gas, and renewable hydrogen infrastructure) | |
013 | Energy efficiency renovation of public infrastructure, demonstration projects and supporting measures | |
014 | Energy efficiency renovation of existing housing stock, demonstration projects, and supporting measures | |
015 | Intelligent Energy Distribution Systems at medium and low voltage levels (including smart grids and information and communication technology (ICT) systems) | |
016 | High-efficiency co-generation and district heating | |
A—Environmental infrastructure | 017 | Household waste management (including minimization, sorting, recycling measures) |
018 | Household waste management (including mechanical biological treatment, thermal treatment, incineration, and landfill measures) | |
019 | Commercial, industrial, or hazardous waste management | |
020 | Provision of water for human consumption (extraction, treatment, storage, and distribution infrastructure) | |
021 | Water management and drinking water conservation (including river basin management, water supply, specific climate change adaptation measures, district and consumer metering, charging systems, and leak reduction) | |
022 | Wastewater treatment | |
023 | Environmental measures aimed at reducing and/or avoiding greenhouse gas emissions (including treatment and storage of methane gas and composting) | |
A—Transport infrastructure | 028 | Trans-European Transport Network (TEN-T) motorways and roads—core network (new build) |
029 | Trans-European Transport Network (TEN-T) motorways and roads—comprehensive network (new build) | |
030 | Secondary road links to TEN-T road network and nodes (new build) | |
031 | Other national and regional roads (new build) | |
032 | Local access roads (new build) | |
033 | Trans-European Transport Network (TEN-T) reconstructed or improved road | |
034 | Other reconstructed or improved road (motorway, national, regional, or local) | |
A—Sustainable transport | 043 | Clean urban transport infrastructure and promotion (including equipment and rolling stock) |
044 | Intelligent transport systems (including the introduction of demand management, tolling systems, IT monitoring, control and information systems) | |
B—Public facilities | 049 | Education infrastructure for tertiary education |
050 | Education infrastructure for vocational education and training and adult learning | |
051 | Education infrastructure for school education (primary and general secondary education) | |
052 | Infrastructure for early childhood education and care | |
053 | Health infrastructure | |
054 | Housing infrastructure | |
055 | Other social infrastructure contributing to regional and local development | |
C—Business development | 068 | Energy efficiency and demonstration projects in Small and Medium-sized Enterprises (SMEs) and supporting measures |
069 | Support to environmentally friendly production processes and resource efficiency in SMEs | |
070 | Promotion of energy efficiency in large enterprises | |
071 | Development and promotion of enterprises specialized in providing services contributing to the low-carbon economy and to resilience to climate change (including support to such services) | |
C—ICT | 080 | E-inclusion, e-accessibility, e-learning, and e-education services and applications, digital literacy |
081 | ICT solutions addressing the healthy active aging challenge, and e-health services and applications (including e-care and ambient assisted living) | |
C—Environment | 083 | Air quality measures |
084 | Integrated pollution prevention and control (IPPC) | |
085 | Protection and enhancement of biodiversity, nature protection, and green infrastructure | |
089 | Rehabilitation of industrial sites and contaminated land | |
090 | Cycle tracks and footpaths | |
D—Employment | 102 | Access to employment for jobseekers and inactive people, including the long-term unemployed and people far from the labor market, also through local employment initiatives and support for labor mobility |
103 | Sustainable integration into the labor market of young people, those not in employment, education or training, including young people at risk of social exclusion and young people from marginalized communities, including through the implementation of the youth guarantee | |
104 | Self-employment, entrepreneurship and business creation including innovative micro, small- and medium-sized enterprises | |
105 | Equality between men and women in all areas, including in access to employment, career progression, reconciliation of work and private life, and promotion of equal pay for equal work | |
106 | Adaptation of workers, enterprises, and entrepreneurs to change | |
107 | Active and healthy aging | |
108 | Modernization of labor market institutions, such as public and private employment services, and improving the matching of labor market needs, including through actions that enhance transnational labor mobility, as well as through mobility schemes and better cooperation between institutions and relevant stakeholders | |
E—Inclusion | 109 | Active inclusion, including with a view to promoting equal opportunities and active participation, and improving employability |
110 | Socio-economic integration of marginalized communities such as Roma | |
111 | Combating all forms of discrimination and promoting equal opportunities | |
112 | Enhancing access to affordable, sustainable, and high-quality services, including healthcare and social services of general interest | |
113 | Promoting social entrepreneurship and vocational integration in social enterprises and the social and solidarity economy in order to facilitate access to employment | |
114 | Community-led local development strategies | |
F—Lifelong learning | 115 | Reducing and preventing early school-leaving and promoting equal access to good-quality early-childhood, primary, and secondary education including formal, non-formal, and informal learning pathways for reintegrating into education and training |
116 | Improving the quality and efficiency of, and access to, tertiary and equivalent education with a view to increasing participation and attainment levels, especially for disadvantaged groups | |
117 | Enhancing equal access to lifelong learning for all age groups in formal, non-formal, and informal settings, upgrading the knowledge, skills, and competences of the workforce, and promoting flexible learning pathways including through career guidance and validation of acquired competences | |
118 | Improving the labor market relevance of education and training systems, facilitating the transition from education to work, and strengthening vocational education and training systems and their quality, including through mechanisms for skills anticipation, adaptation of curricula, and the establishment and development of work-based learning systems, including dual learning systems and apprenticeship schemes |
Population Health Index Dimensions—Health Determinants | Welch’s t-Test | p-Value |
---|---|---|
Employment | 15.112 | 0.000 * |
Income and living conditions | 32.879 | 0.000 * |
Security | 22.979 | 0.000 * |
Education | 7.488 | 0.001 |
Aging | 0.899 | 0.410 |
Lifestyles and health behaviors | 28.000 | 0.000 * |
Pollution | 11.899 | 0.000 * |
Housing conditions | 57.107 | 0.000 * |
Water and sanitation | 27.124 | 0.000 * |
Waste management | 79.516 | 0.000 * |
Road safety | 0,186 | 0.831 |
Healthcare resources | 82.760 | 0.000 * |
Healthcare performance | 38.083 | 0.000 * |
Population Health Index Dimensions—Health Determinants | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Intervention Field Dimensions | Employment | Income, Living Conditions | Security | Education | Aging | Lifestyles | Pollution | Housing Conditions | Water and Sanitation | Waste Management | Road Safety | Healthcare Resources | Healthcare Performance |
Energy infrastructure | • | ||||||||||||
Environmental infrastructure | • | • | • | ||||||||||
Transport infrastructure | • | ||||||||||||
Sustainable transport | • | ||||||||||||
Public facilities | • | • | • | • | |||||||||
Business development | • | • | |||||||||||
ICT | • | • | • | • | • | ||||||||
Environment | • | • | |||||||||||
Employment | • | • | • | ||||||||||
Inclusion | • | • | • | • | • | • | • | • | • | ||||
Lifelong learning | • |
PHI Dimensional Health Sub-Indices | Number of Regions with Scores Below 50 | Number of Regions with the Lowest Scores and with Allocated Investment | ||||||
---|---|---|---|---|---|---|---|---|
LD | TR | MD | Total | LD | TR | MD | Total | |
Employment | 10 | 10 | 2 | 22 | 10 | 10 | 2 | 22 |
Income and living conditions | 17 | 4 | 1 | 22 | 17 | 4 | 1 | 22 |
Security | 5 | 12 | 14 | 31 | 5 | 12 | 14 | 31 |
Education | 8 | 7 | 4 | 19 | 8 | 7 | 4 | 19 |
Aging | 9 | 7 | 5 | 21 | 9 | 7 | 4 | 20 |
Lifestyles and health behaviors | 14 | 0 | 0 | 14 | 14 | - | - | 14 |
Pollution | 14 | 1 | 22 | 37 | 14 | 1 | 22 | 37 |
Housing conditions | 13 | 0 | 0 | 13 | 13 | - | - | 13 |
Water and sanitation | 10 | 0 | 2 | 12 | 10 | - | 2 | 12 |
Waste management | 46 | 8 | 9 | 63 | 46 | 8 | 9 | 63 |
Road safety | 2 | 0 | 3 | 5 | 2 | - | 0 | 2 |
Healthcare resources | 38 | 8 | 6 | 52 | 38 | 8 | 6 | 52 |
Healthcare performance | 24 | 0 | 3 | 27 | 0 | - | 0 | 0 |
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Santana, P.; Freitas, Â.; Costa, C.; Stefanik, I.; Santinha, G.; Krafft, T.; Pilot, E. The Role of Cohesion Policy Funds in Decreasing the Health Gaps Measured by the EURO-HEALTHY Population Health Index. Int. J. Environ. Res. Public Health 2020, 17, 1567. https://doi.org/10.3390/ijerph17051567
Santana P, Freitas Â, Costa C, Stefanik I, Santinha G, Krafft T, Pilot E. The Role of Cohesion Policy Funds in Decreasing the Health Gaps Measured by the EURO-HEALTHY Population Health Index. International Journal of Environmental Research and Public Health. 2020; 17(5):1567. https://doi.org/10.3390/ijerph17051567
Chicago/Turabian StyleSantana, Paula, Ângela Freitas, Cláudia Costa, Iwa Stefanik, Gonçalo Santinha, Thomas Krafft, and Eva Pilot. 2020. "The Role of Cohesion Policy Funds in Decreasing the Health Gaps Measured by the EURO-HEALTHY Population Health Index" International Journal of Environmental Research and Public Health 17, no. 5: 1567. https://doi.org/10.3390/ijerph17051567