Tuulia Rotko

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country’s adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

Mental health is largely shaped by the daily environments in which people live their lives, with positive components of mental health emphasising the importance of feeling good and functioning effectively. Promoting mental health relies on broad-based actions over multiple sectors, which can be difficult to measure. Different types of Impact Assessment (IA) frameworks allow for a structured approach to evaluating policy actions on different levels. A systematic review was performed exploring existing IA frameworks relating to mental health and mental wellbeing and how they have been used. A total of 145 records were identified from the databases, from which 9 articles were included in the review, with a further 6 studies included via reference list and citation chaining. Five different mental-health-related IA frameworks were found to be implemented in a variety of settings, mostly in relation to evaluating community actions. A Narrative Synthesis summarised key themes from the 15 included articles. Findings highlight the need for participatory approaches in IA, which have the dual purpose of informing the IA evaluation and advocating for the need to include mental health in policy development. However, it is important to ensure that IA frameworks are user-friendly, designed to be used by laypeople in a variety of sectors and that IA frameworks are operational in terms of time and monetary resources.