Summary of cities’ discourses
| City | Knowledge on HI and their causes | Reducing HI as a priority for the city government | Information on health inequalities | Knowledge on policies and programmes | Intersectoral collaboration/participation of social agents | Barriers | Opportunities |
|---|---|---|---|---|---|---|---|
| Amsterdam | Economic, genetic, environmental, ethnic factors | It is a priority, through changing economic and political factors | Health survey, city memo, collaboration with academics | The city has a Health Plan | There is specific collaboration with other sectors | Funding and the administrative organisation | Health topics are placed in the agenda of organisations |
| Barcelona | Capitalist economic system, different life expectancy between neighbourhoods, structural poverty, traditional and emerging inequalities | HI is a priority but mostly for the health sector and at the local level | Annual city health report and health policy evaluation. Social observatory | Urban regeneration policies. Non-health policies with health outcomes, health in the neighbourhoods strategy to reduce HI | Not a formal intersectorality, council organisation still compartmentalised. Eighteen plans with community action, civil society | Financial restraints, factual powers | Proximity to the community and intersectorality |
| Brussels | Gradient in health, socioeconomic position, lack of redistribution mechanisms, segregation, personal traits, access to healthcare | Reducing HI is an absolute priority | Death certificates, census, national health survey, more data is needed on children | No specific policies aimed at health inequalities | Collaboration is transversal with 3 political structures. Social agents are advisory bodies and also participate in action plans | The liberal course of EU. Geographic proximity of actors | Migrant population contribute to healthy lifestyles |
| Cluj-Napoca | Health inequalities are not an issue | Reducing HI is not a priority, health is a right for all people | The city has the population health statistics | There are preventive measures for the whole population | There is close cooperation with municipalities | Funding and administrative restraints are a barrier | |
| Helsinki | Sex, education, unemployment, living conditions, social relations, exclusion of young people and ways of life | Strategy of city council 2009–2012. Resources directed at reducing HI | There is some information because it is a strategy of the city | Healthy Helsinki project to reduce HI. Non-smoking and responsible alcohol consumption programmes | There is not enough intersectorality. Steering committees include various social agents. Intersectorality might be slow | Difficulty to obtain funding. Administrative structures | Funding and good cooperation create opportunities |
| Lisbon | Socioeconomic, demographic, income and age inequalities. Housing conditions | Reducing HI is not explicitly a priority, but it should be. We have the Municipal master plan | There is no information or assessment | Policies and plan targeted at aging | Intersectorality is inherent in tackling health inequalities | Cultural, economic and legislative obstacles | Initiatives with multiple dimensions |
| London | Social determinants in a global context. Lack of evidence base of strategies. Policies directed at most deprived instead of all population | The informants did not answer explicitly that reducing HI was a priority | There is not a must on information data are pieced together | Primary care interventions, employment programmes, partnership approach, no knowledge on EU funds | There is intersectoral work with local partnerships not only health services | Little capacity to influence the upstream determinants of inequalities | Promoting local integration and pool resources |
| Madrid | Socioeconomic inequalities, housing, lifestyles, education, Income, cultural behaviours. Inequalities at the district level, access to healthcare services | A priority to be dealt with by healthcare systems | Yes, through research and the annual report | Plan Vallecas to change behaviours. Law for health, programme for the homeless with tuberculosis, for sexual trade workers, for women of Roma ethnicity, children at risk | Plan Vallecas which is multidisciplinary, communitary and participatory. The aim is to work transversally but it is difficult. Neighbours’ associations and participation at the micro level | Relations with other institutions, budget delimitation, lack of awareness of the population, little information on the impact of programmes | To integrate the actions on the groups affected by health inequalities |
| Paris | Access to healthcare | Health is not responsibility of the city government or a priority | Epidemiological information and on local health issues for specific municipalities | City policy: measures at the city level, preventive measures, public Health programmes in the neighbourhoods | City health workshops | The consideration of health in the context of urban policy | |
| Prague | Social status, poverty, chosen lifestyle, voluntarily socially excluded | Health inequalities are not a priority | National plan of social politics but no periodic support | Health 21, strategic plan of Prague | Complex a to work with different sectors, social agents make themselves heard | Legislative and coordination issues, financial barriers | NGO's are very close to the socially excluded |
| Rotterdam | Socioeconomic differences | Yes, with a broad view on health. Health is a precondition for the life of the city | Health is included in a general biannual survey | Directed at unhealthy behaviour of low SES, air quality and traffic, health plan | Work, participation, education. “Healthy in the city”: city health plan. “From complaint to strength”, depression and diabetes. Many joint projects but no collaboration with social actors | Long timeframe in cooperating with other networks. Different levels in institutions have trouble communicating | Benefits of cooperation |
| Stockholm | Structural differences: housing segregation, education level, age group, income, migration criminal acts/safety and living conditions. Health inequalities in Stockholm are very large | Based on healthcare services. Legislation is there but the educated are the ones who benefit. Accessibility to healthcare is the highest priority | Public health survey produced every four years, review of healthcare services, Karolinska Institute Public Health Academy reports | Wide range of choice of health providers, addressed at behavioural and cultural determinants, resources for prevention are too small | Action plan for health, hard for actors to cooperate voluntary organisations which strengthen the community but non-existent in participatory process | Lack of competence, knowledge and methods to change behaviours | Resources, Evidenced based health prevention, Engaged people working in health centres |
| Turin | Housing conditions, overcrowding, economic and employment crisis, deterioration of social conditions | The city has a direct and privileged approach to dealing with inequality but there are conflicts of interest | No use of effectiveness indicators for evaluation and modification of policies | Policies not addressed at specific groups, traffic calming and public transport development, security, social housing, local welfare strategies | Sentinel events arise interest but there is a conflict of interests in the political administration | Structural policies tend to be slow | Social cooperatives for housing by improving existing assets |
EU, European Union; HI, health inequalities; NGOs, non-governmental organisations; SES, socioeconomic status.