College of Commissioners Orientation Debate on Social Policy: An opportunity to address the social determinants of health and ensure a prosperous EU

02 June 2015

By Leonardo Palumbo and Linden Farrer

At the weekly meeting of College of Commissioners on 3 June, Vice-President Dombrovskis will lead an Orientation Debate on Social Policy. This is an important opportunity to highlight the Social Investment Package and future social policy objectives pursued by the European Commission because it could set the tone of developments to come for some time.

Taking place at a time when the Commission is verifying that all new initiatives meet Better Regulation requirements, and key pieces of social and employment policy are being evaluated for their impact on administrative burden, it is more critical than ever to remind the Commissioners that good health underpins European societal progress.

As argued in a letter EuroHealthNet recently sent to Vice-President and EU Health Commissioner Andriukaitis, health is a prerequisite to labour market participation, reduces expenditure on social protection and health, prevents social exclusion, reduces poverty and ensures a growing and prosperous European Union. In the letter, EuroHealthNet highlighted the recently completed FP7-funded DRIVERS project, which recommended taking a multifaceted and coordinated policy approach to improving quality of work and social protection based on four principles: 1) Universality, 2) Responding to disadvantage, 3) The need to respect rights and the importance of adapting interventions and policies to context, and 4) The necessity of using evidence to inform the design of policies[1].

The clear links between social protection and health inequalities

When social protection systems are well designed, they sustain health and well-being by reducing the economic consequences of illness or unemployment[2],[3]. Higher levels of social spending are generally linked to better health and smaller inequalities, and research shows that social protection is particularly beneficial for those with lower levels of education and smaller incomes[4]. DRIVERS’ results go further, showing that for unemployment insurance the coverage rate is crucial: the higher the coverage rate, the lower the risk that those with low education experience deteriorating health[5]. Once more than 90% of the workforce is covered, a higher replacement rate (the level of benefits received) becomes strongly associated with better health, particularly among lower educated people. This is not the case when coverage rates are below 90%[6].

Social protection consists of more than just unemployment insurance and there is a need to protect against different kinds of risks through, for instance, cash transfer programmes and high-quality welfare services. Particular attention should to be paid to those at risk of being marginalised. One way of doing this is to increase minimum income benefits[7]. Another is to ensure that meaningful active labour market policies (ALMPs) are put in place to support people (back) into the labour market[8]. Case studies carried out as part of DRIVERS suggested additional features of social protection that require attention. These included: 1) Enabling people to access and obtain their rights and entitlements, 2) Providing integrated support to help individuals with complex needs, and 3) Providing front line staff with the means necessary to treat their clients appropriately[9].

Take the social gradient into account

People with different backgrounds have different needs. Social protection systems therefore need to be designed so that they are appropriate, accessible and effective for all. Universal programmes are more likely to be high quality and accessible to all. But universal systems also tend to be used to potential by people from higher up the social gradient, who have the social networks, knowledge, time or even financial resources required to request, fight for and obtain the social protection rights they are entitled to[10]. Moreover, conditionalities in social protection systems, which easily run contrary to the principle of universality, are more likely to be imposed on those from lower down the social gradient[11], exacerbating already difficult conditions and reducing the effectiveness of social protection systems.

For this reason, universal protection needs to be supplemented by targeted programmes and interventions that respond to disadvantage; these should designed to help people facing specific and multiple adversities, and who may have particular needs and barriers vis-à-vis accessing social support and labour markets. Social protection should therefore be designed to respect the rights of the people concerned, and adapted to context. This means that interventions or ‘good practices’ that may be applicable in one context may not be suitable in another, and point to a weakness in European-level approaches that primarily aim to transfer identified ‘good practices’ from one context to another. Comparative qualitative and quantitative research can therefore play a self-evident role in supporting EU-level policy making based on evidence.

A multidimensional and multidisciplinary approach

Social protection is a good example of the multidimensionality of policy making. It shows how labour market, health system, taxation and other policies fit together and lead to outcomes across different dimensions. The approach to modernising social protection should take a similarly multidimensional and multidisciplinary approach.

EuroHealthNet works across sectors to try and find solutions to improving health equity and well-being and to support the goals of Europe 2020. EuroHealthNet is engaged with the debate about the future of EU social policy and encourages policy makers to apply DRIVERS’ four principles to future initiatives in the field of EU social policy to reduce health inequalities. These principles should be applied to policies and practices across the life course: from early childhood, through working life and into retirement.

 

[1] See here

[2] Ferrarini T, Sjöberg O. Social policy and health: transition countries in a comparative perspective. Int J Soc Welfare. 2010(19):60-88.

[3] Ferrarini T, Nelson K, Sjöberg O. Decomposing the effect of social policies on population health and inequalities: an empirical example of unemployment benefits. Scand J Public Health. 2014;42(7):635-42.

[4] Dahl E, van der Wel KA. Educational inequalities in health in European welfare states: a social expenditure approach. Soc Sci Med. 2013;81:60-9.

[5] Ferrarini T, Nelson K, and Sjöberg O. Unemployment insurance and deteriorating self-rated health in 23 European countries. JECH. 2014;Online First, published on March 10, 2014 as 10.1136/jech-2013-203721.

[6] Ferrarini T, Nelson K, Sjöberg O. Decomposing the effect of social policies on population health and inequalities: an empirical example of unemployment benefits. Scand J Public Health. 2014;42(7):635-42.

[7] Nelson K, Fritzell J. Welfare states and public health: The role of minimum income benefits for mortality. Soc Sci Med. 2014(112):63-71.

[8] Lunau T, Wahrendorf M, Dragano N, Siegrist J. Work stress and depressive symptoms in older employees: impact of national labour and social policies. BMC Public Health. 2013;13(1):1086.

[9] McHardy F, with Lundberg O. Report on Income and Social Protection for the EU DRIVERS project. Synthesis of case study evidence compiled by European Anti-Poverty Network. August 2014, EAPN and CHESS.

[10] See, for example, relating to health and health inequalities: Bambra C. Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’. J Epidemiol Community Health. 2011; 65:740e745. 2011; doi:10.1136/jech.2011.136333.

[11] See, for instance in relation to the UK’s welfare system: Etherington D & Daguerre A. Welfare reform, work first policies and benefit conditionality: Reinforcing poverty and social exclusion. January 2015, Centre for Enterprise and Economic Development  Research  Middlesex University in London. Available here