AAPRISS Program: health equity impact assessment of cancer prevention projects

Transcription

1 EIS 2013, Geneva, 2-4 October 2013 AAPRISS Program: health equity impact assessment of cancer prevention projects Apprendre et Agir Pour Réduire les Inégalités Sociales de Santé Elsa Bidault, Project manager - Mélanie Villeval, PhD student UMR 1027 INSERM Université Toulouse III, France For the AAPRISS Steering Committee: F ALIAS (IREPS Midi-Pyrénées), B GANDOUET (Oncopole Toulouse), P GROSCLAUDE (UMR 1027 INSERM-UPS, Institut Claudius Regaud), N HASCHAR-NOÉ (PRISSMH SOI, UPS), T LANG (UMR 1027 INSERM-UPS), M SERVAT (CHU Toulouse), Y THEIS (Mairie de Toulouse) 1

2 CONTEXT High level of Social Inequalities in Health (SIH) observed in France (Menvielle et al. 2010) SIH are now better described and recognised as a key public health concern. But still little is known about how to reduce them (Braveman, Egerter, et Williams 2011) SIH issue is seldom dealt with in public health interventions, which may contribute to their exacerbation (Lorenc et al. 2013) Need to assess the unintentional impact of those projects on SIH 2

3 OBJECTIVE AAPRISS is an umbrella progam aiming at undertacking health equity impact assessment of cancer prevention projects in Midi-Pyrenées. Objective = to assess and reorient cancer prevention projects in the field of nutrition, in order to increase their positive impact, and reduce the negative one, on equity in health 3

4 PROJECTS INCLUDED Community based program«atelier Santé Ville», northern neighborhoods of Toulouse (Municipality of Toulouse) Elementary school interventions «4 meals a day» (Municipality of Toulouse). Nursery school interventions «Eating Well and Being Active as Early as Nursery School» (CPAM de Haute- Garonne (Public Health Insurance)) Patient Education on obesity (Toulouse University Hospitals) Patient Education on type 2 diabetes (Toulouse University Hospitals) 4

5 PRINCIPLES AAPRISS HEIAs : Prevention projects In the field of health Concurrent (projects are currently going on) Comprehensive (several months of empirical research) Focused on equity (more general health impacts of projects are not assessed) 5

6 PRINCIPLES Focus on social inequalities in health Interdisciplinarity (sociologists, psychologists, epidemiologists, etc.) Use of scientific methods : qualitative (observations, interviews) and quantitative (ex Deprivation indicator ) Intersectorality (Health institutions, associations, local authorities, researchers, etc.) Co-construction of project assessment and reorientation between project leaders and researchers 6

7 PROCESS -Practitionners -Researchers The process of projects analysis and changes in AAPRISS program A priori analysis Phase 1: First meeting Phase 2: Plenary analysis Phase 3: Working group Phase 4: Shared findings Working group Evaluation Phase 5: Transformations Observations, data 7

8 PROCESS -Practitionners -Researchers Phase 1: First meeting A priori analysis Phase 2: Plenary analysis Phase 3: Working group Phase 4: Shared findings 1 2 Working group Evaluation Phase 5: Transformations Observations, data 8

9 PROCESS -Practitionners -Researchers Phase 1: First meeting Phase 2: Plenary analysis A priori analysis Phase 3: Working group Phase 4: Shared findings 1 2 Working group Evaluation Phase 5: Transformations Observations, data 9

10 PROCESS -Practitionners -Researchers A priori analysis Phase 1: First meeting Phase 2: Plenary analysis Phase 3: Working group Phase 4: Shared findings 1 2 Working group Evaluation Phase 5: Transformations Observations, data 10

11 PROCESS -Practitionners -Researchers A priori analysis Phase 1: First meeting Phase 2: Plenary analysis Phase 3: Working group Phase 4: Shared findings SIH taken into account but not explicitly Lack of equitable accessibility and acknowledgment of sociocultural features Socially distributed side effects Participation of population that could be reinforced, 1 Etc. 2 Working group Evaluation Phase 5: Transformations Observations, data 11

12 PROCESS -Practitionners -Researchers A priori analysis Phase 1: First meeting Phase 2: Plenary analysis Phase 3: Working group Phase 4: Shared findings Improvement of the choice of schools where to implement intervention, using a deprivation index Improvement of the involvement of associations through the formalisation of a frame of shared values 1 Etc. 2 Working group Evaluation Phase 5: Transformations Observations, data 12

13 PROCESS -Practitionners -Researchers A priori analysis Phase 1: First meeting Phase 2: Plenary analysis Phase 3: Working group Phase 4: Shared findings 1 2 Working group Evaluation Phase 5: Transformations Observations, data 13

14 STRENGTHS Beyond projects reorientations, raising awareness among actors and decision makers on the impact of their actions on equity in health Reconceptualising the issue of each project s evaluation Bringing together public health practitioners and interdisciplinary researchers to share experiences and skills: co-construction 14

15 DIFFICULTIES Differing temporalities among researchers and practitioners and social representations regarding each other Differing paradigms, methods, visions of the program, among researchers Social representation of public health and a fear of engagement in a normative evaluation or a rigid frame Precariousness of some projects : risk of endangerment Institutional constraints 15

16 PERSPECTIVES HEIA of prevention project is of interest : projects assessed are «downstream interventions» with high risk of generating inequities (Lorenc et al. 2013) SIH = multiplicity of interrelated determinants in health system, life and working conditions, and overarching macroeconomic, cultural and environmental conditions (Whitehead, 2007) AAPRISS perspective : Health Impact Assessment - on policies - beyond the health sector - prospective 16

17 Thank you Comments and suggestions are very welcome! To find out more: - AAPRISS website: - Lang T et al. Reducing social inequalities in health: acceptability anf feasability of an health equity impact assessment program (AAPRISS) submitted for publication. Financial support has been provided by: Institut National du Cancer (INCa), Agence Nationale de la Recherche (ANR), and Agence Régionale de Santé (ARS) Midi-Pyrénées. 17