Final recommendations of the European Symposium “Environmental health and social vulnerabilities”
Recommendations were presented by each workshop and approved during the final plenary session. Some recommendations still required additional work which was conducted after the symposium using an iterative electronic way (e-mail). with the members of the various concerned workshops.
The symposium’s recommendations have thus been finalized as follows:
Overall recommendations
1. Support and promote the development of a second European environment and health action plan integrating social vulnerabilities as a full dimension.
2. Include social health inequalities and their multiple determinantswhen designing, implementing and evaluating the various research, monitoring and intervention programs related to environmental health financed by the European Commission, Member States or their regions or sub-regions.
3. Establish and supportwithin each Member State a centralized watch system to check the effective inclusion of social vulnerability in all environmental health policies targeting the general population, specific groups (homeless people, elderly people in precarious situations, etc..) or specific settings (communities of old/ young people, or disabled people, schools, workplace, etc.)..
Specific recommendations
Understanding and tackling links between Environmental Health and Social Vulnerabilities - The role of Research
1.1. Develop research in Environmental Health, Social Inequalities in Health (SIH) and Social Vulnerabilities in Health (SVH) through a multidisciplinary and transnational approach by:
-Defining and disseminating a common conceptual framework which clearly includes Environment, Health and Social Inequalities and Vulnerability,
-Proposing appropriate methods to tackle these research questions
-Supporting the trans-disciplinary research (qualitative and quantitative) of networks working on the links between these three elements (environment, health and social vulnerabilities)
-Encouraging beneficiary participation in the research and sharing of knowledge and know-how between researchers, politicians, field workers and beneficiaries in fields beyond environment and health: e.g. social work, housing, education etc.
1.2. Ensure that social vulnerabilities / inequalities are considered in environmental health research by highlighting these aspects when conceiving the research, by including these in the lists of criteria used in allocating research budgets/grants and by controlling their effective inclusion in the evaluation of performed research.
Considering social vulnerabilities in Environmental Health policies, programs and projects
2.1. Consider the reduction of health inequalities as a crucial and necessary part of any Sustainable Development Strategy
2.2. Involve local actors (e.g. beneficiaries, NGOs, civil society) in a consultation process as an intrinsic part of the policy making process
2.3. Create opportunities for pooling of resources and insure accountability and ex-post evaluation of policies and programs.
Taking stock of social vulnerabilities in action - Training and sensitization of field stakeholders
3.1. Basic field staff curricula and in-service training contain the necessary topics which will enable each actor in the fields of health, social, environment, education and housing to be:
- Aware of the links between environmental health and social vulnerabilities,
- Able to identify and understand the needs of socially vulnerable groups,
- Able to clearly identify those actions that can be initiated at his level in line with his own professional skills,
- Prepared to work in an interdisciplinary manner.
3.2. Courses/training/modules will need to include, in addition to scientific and technical aspects:
- Acommunity and transversal dimension in order to raise the awareness of and the ability to use the existing local support structures (social welfare centers, first line comprehensive care centers, community houses etc..); as well as nongovernmental associations and the field actions the latter are running;
- A communication dimension in order to develop the field operators’ listening skills and capacity to promote the participation of socially vulnerable groups in order to enable these groups to actively contribute to the decision making process and to finding solutions to the issues they are confronted with. This communication should contribute to strengthening the self esteem of the most vulnerable people, to recognizing their own skills, and to enhancing their capacity to implement useful actions, acknowledging that behavior change process take time
3.3. Establishand support networks to share good practice and other processes that will facilitate the result dissemination and that will develop the professional and field worker expertise in a trans-disciplinary way (by building bridges between disciplines).
Taking stock of social vulnerabilities – Monitoring and observation of Environmental Health
4.1. Establish, develop and/or support a monitoring and observation system of the links between environmental health and social vulnerabilities that:
- analyzes the socioeconomic characteristics of individuals and their environment by considering them as explanatory variables, beyond their status as confounding variables.
- is long term and sustainable
- leads to action.
4.2. Ensure synergy without overlap between local and other levels of observations (national, European,...) by developing links / partnerships between institutions active on these different levels and assure consistency in the data they collect. Indicators are first developed to meet the needs of each geographic or administrative level, and then to allow comparisons at the national or even European levels.
4.3. Methods used in the current observation/monitoring mustbe adapted to include concerns about social vulnerabilities.
Taking stock of the non governmental sector in Environmental Health policies
5.1. Generate opportunities for dialogue / exchange between stakeholders and policy makers in order to support their training / information mission, and to include them in the decision making process as well asin implementation, follow up & evaluation of the decisions.
5.2. Member States should support the role of non governmental stakeholders and associations in tackling vulnerabilities in Environmental Health by:
- Structural funding with long term perspectives to enable organizations to plan and invest in the long term.
- Also financing collaborations between all stakeholders, the evaluation of their actions (financial support for the coordination of actions, writ-ups, sharing and analysis of results etc.) and their continuous training.
Taking stock of social vulnerable publics in action – Involvement in Environmental Health actions and in decision making
6.1. Knowledge of population:
- Maintain a continuous and active approach to reach a good understanding of beneficiaries of the interventions, especially if they are in a vulnerable situation by: on the one hand giving them the floor and listening to them and on the other hand, by listening to professionals in contact with these persons; ensuring that these professionals do not project their own representations of key issues as if these were the perception of vulnerable people themselves.
-Ensure that people representing the various perspectives in the processes related to the interventions are included..
6.2. Community involvement related to action (projects, programs, policies):
- recognizecollective and individual expertise of the socially vulnerable groups of people.in identifying problems and solutions:
- Check the level of awareness of individuals and groups about the problem (ability to recognize the problematic nature of a situation),and their level of understanding of the problem (understanding the causes and consequences); and starting from their daily lives, their knowledge, their skills and their perception of prioritiesgain their support and build the action..
-Select and promote appropriate participatory tools and methods; this includes the use of an appropriate language understood by all stakeholders (professionals, people, policy makers), especially during decision making processes, and when stimulating knowledge and know-how exchanges between all stakeholders, and especially between beneficiaries themselves.
6.3. Role of policy makers (local and others)
- Policy makers will be sensitized to the added value and the absolute need to share some decision-making power with the interventions’ beneficiaries.
Actions and policies in the field of Environmental Health - Transversality and Multi-disciplinarity
Objective: To obtain sufficient political commitment at every level to engage in an interdisciplinary approach using participatory methods
7.1. Designate a pilot among the various partners involved coming from different sectors o ensure consistency of joint efforts between environmental, health, welfare and other related disciplines/fields.
7.2. Build bridges between partnersactive in Environmental Public Health by:
- Identifying professionals who are not,a priori,traditional environmental health actors but who may play a role,
- mobilizing these people as partners in action and giving them support
- allowing them to understand,through training and collaboration,the perspective of the various other areas of concern they are not familiar with.
7.3. Improve the existing environmental impact assessment in order to include impacts on health and social vulnerabilities. This work requires transversality and trans-disciplinarity
Environmental health policies - Inclusion of a territorial dimension
8.1. A territorial dimension should be considered as:
- An integrated social, economic and environmental approach based on a territorial framework
- A means of defining a field of actions and the public they will address based on a defined spatial area and enabling an evaluation of these actions in terms of, for example, coverage and social coherence
8.2. A territory remains a dynamic concept reaching beyond administrative boundaries. It is a potentially useful tool in apprehending the reduction in social vulnerability in Environmental Health on condition that:
- it is combined with other aspects such has history and anthropology
- answers are tailored to the needs and requests of the population
- comparisons are made and trends are monitored
- it can fluctuate according to the problems addressed
- each geographical level (national, regional, local) specifically sets its responsibilities, functions, objectives, strategies, resources, and ensure that these definitions are disseminated.
8.3.Mutual understanding between the various population groups living in the same territory will need to be promoted in order to encourage population mix and social cohesion.
8.4. The territorial approach may become restrictive, for example when access by the population to some services is dependent on people residential/community status
How to enhance students’/garduates’ awareness of social vulnerabilities
9.1. Extend the concept of "social vulnerability" so that it can be included in every environmental health action
9.2. Encourage preventive actions as early as possible when engaging social vulnerability problems
9.3. Ensure that all stakeholders (scientists, practitioners, beneficiaries, etc.) are networking through relevant access to both qualitative as well as quantitative databases
9.4. Decompartmentalize the interventions/work of all actors
9.5. Regularly update the databases on the state of social health vulnerabilities of a defined population
9.6. Increase politicians’ awareness of the range of tools to be developed and of the information required to reach decisions regarding the social vulnerability of those populations they are responsible for
9.7. Ensure that strategic health services and institutions have a sound political base/support
9.8. Develop health programs over the long term and promote continuity of operations
9.9. Strengthen participatory democracy in health programs.