EUROSAT Seminar, Berlin 30 Sept - 1 Oct 2010

1. Health Inequalities, Long-Term Care and Gender issues EUROSAT Seminar, Berlin 30 Sept - 1 Oct 2010 Arnaud SENN, E4,Social Protection & Social Services DG Employment, Social Affairs & Equal Opportunities

2. Health inequalities, Long-Term Care, and Gender dimension on the EU agenda • Long-Term Care: reflection launched in 2008 • Ageing issues: Swedish Presidency Conference in September 2009 • Health Inequalities: EC Communication in October 2009 • EU 2020 Strategy: inclusive growth • Gender dimension: “Access to healthcare and long-term care: Equal for women and men?” DG EMPL report October 2009

3. Three Common objectives for health care and long-term care To promote accessible, high-quality and sustainable healthcare and long-term care by ensuring: • access (incl. financial and geo.) for all to adequate health and long-term care and that the need for care does not lead to poverty and financial dependency; • quality in health and long-term care and by adapting care, including developing preventive care, to the changing needs and preferences of society and individuals; • that adequate and high quality health and long-term care remains affordable and financially sustainable 13-Oct-14 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit 3

4. Extent of Health Inequalities EU Communication October 2009 « Solidarity in health: reducing health inequalities in the EU” 14-year difference in life expectancy for men and 8 year gap for women between EU Member States 13-Oct-14 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit 4

5. Causes of Health Inequalities Living conditionsbasic needs, warmth, food, water, housing, environmental quality Services healthcare, education, social protection Work and working conditions job quality, health and safety at work Health related behaviours life skills, smoking, alcohol, exercise 13-Oct-14 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit 5

6. Vulnerable groups clearly identified • Vulnerable groups:poor people, some migrants or ethnic minorities (eg:Roma), unemployed people. • Vulnerable age-groups: children, women, elderly people who are, in average, more subject to poverty in most of the EU Member States. Child health is also determining for (future) adult health. Elderly people are more likely to require long-term care. • Initiatives on improving access to health services for migrants, ethnic minorities and other vulnerable groups. • Initiatives on Healthy ageing, the 2010 Roma Summit and the European Year for Combating Poverty and Social Exclusion 2010 • Improving knowledge and data collection on the groups mentioned above is a prerequisite. 13-Oct-14 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit 6

7. Long term care and Gender-Dimension: which challenges? Long-Term care is very complex:wide range of providers to coordinate. Access problems: insurance coverage, lack of provision for certain types of care, financial obstacles, distribution of supply (esp. rural areas), waiting times, Gender-Dimension:women are overrepresented as care providers but also as care recipients (better average life-expectancy). Access problems and care supply must be considered accordingly. In the context of EES, indicator of “Care of dependent elderly”: “Dependent elderly men and women over 75 as a proportion of all men and women over 75. Breakdown by: living in specialised institutions, help at home (other than by the familiy) and looked after by the family”. 7 13-Oct-14 13-Oct-14 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit

8. Gender dimension: specific life cycle • Gender dimension in professional choices (traditions and stereotypes). Professional Integration often more difficult. • Careers are often shorter (maternity leave, parental leave), or hindered by reconciliation problems (greater investment in child care, household chores) • Gender pay gap remains noticeable in many fields and many countries. • Women of working age may devote time to family members (parents, family-in-law) in need of care (incl. non clinical dimension): important impact on carrier development. • As a whole: noticeable impact on the level of pensions. • When reaching retirement age, women standard of living is (in average) lower and women are more hit by poverty; possible financial obstacle for access to LTC .

9. Health Inequalities, Long-Term Care, and Gender dimension: key priorities . Defining a small set of EU indicators for monitoring progress on Health Inequalities (HI) – must be in place for 2012 progress report. . Working on HI indicators to support MS and to support EU policy in key areas such as: children and young people, older people, workforce, gender dimension of health, health care etc. . Launching a reflection on Long-Term Care and Active ageing issues, with a view to preparing for the 2012 EU Year on Active Ageing (see:access, quality, sustainability. . Focusing also on gender dimension, from gender perspective itself, but also for each of the topics mentioned above. . Keeping geographical dimension in mind especially urban Vs rural dimension, in terms of access to health care (poor distribution of health care supply is denounced in many Member States). 13-Oct-14 9 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit

10. Health Inequalities, Long-Term Care, and Gender dimension: our needs • Indicator A: Care of elderly people 65+ with limitations in daily activities and/or instrumental activities of daily living computed with questions PC.1, PC.2, HA.1, HA.2 and HA.3 of the EHIS questionnaire. • Having a breakdown for + 75 (since more likely to resort to LTC) • Having the coverage of persons in institutions • Indicator B: Care, only by the family (or other non-professionals), of elderly people 65+ with limitations in daily activities and/or instrumental activities of daily living computed with questions PC.1, PC.2 , HA.1, HA.2, HA.3 and HC.18 of the EHIS questionnaire. • Having a breakdown for + 75 (since more likely to resort to LTC) • Having improved information on the non professional carer: identity ( spouse, other family member, friend, relative) and gender 13-Oct-14 10 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit

11. Health Inequalities, Long-Term Care, and Gender dimension: our needs • Indicator C: Care, using at least partly home care services, of elderly people 65+ with limitations in daily activities and/or instrumental activities of daily living computed with questions PC.1, PC.2 , HA.1, HA.2, HA.3 and HC.18 of the EHIS questionnaire. • Having a breakdown for + 75 (since more likely to resort to LTC) • Having the coverage of persons in institutions 13-Oct-14 11 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit

12. Health Inequalities, Long-Term Care, and Gender dimension: our needs • HC7: What was the main reason for not being hospitalized? Could not afford to (too expensive or not covered by the insurance fund):sorted by gender  ? • Too far to travel / no means of transportation - Having improved information on the reason(s) for not resorting to hospital care: geographical obstacle (distance +/- a specific distance) ; waiting list - Having improved information on the reason(s) for not going to an institution: geographical obstacle (distance +/- a specific distance) ; waiting list and financial obstacle. • Self-Completion form “out-of-pocket expenses” • Will this question be applied to Long-Term Care ? 13-Oct-14 12 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit

13. Health Inequalities, Long-Term Care, and Gender dimension: our needs Thank you for your attention 13-Oct-14 13 Directorate-General for Employment, Social Affairs and Equal Opportunities ─ Unit