Social inequalities in health are one of the main challenges in public health. Minimizing those inequalities in health which are considered unfair and avoidable or remediable has been recognized as a priority for public health interventions. Various studies have demonstrated that physical activity, which is an important determinant of health, is less prevalent among socially disadvantaged population groups. Moreover, there is evidence suggesting that population-based prevention strategies only reach socially advantaged groups and thus may contribute to an increase in health inequalities. These so-called “intervention-generated inequalities” (IGIs) may arise at several points of intervention implementation. For this reason, considering social inequalities during development and implementation of interventions aiming to increase physical activity as well as evaluating the equity impact of these interventions is essential. This requires advancement of innovative methods.
The primary objective of the subproject EQUAL is to extend the currently limited evidence regarding equity impacts of interventions to promote physical activity among older adults. With its work, EQUAL contributes to the overall goal of the research network AEQUIPA regarding developing new approaches for understanding and monitoring the impact of physical activity interventions on health equity.
Results of the first funding period
Within the first funding period (02/2015-01/2018), EQUAL provided advice for the other AEQUIPA subprojects regarding integrating sociodemographic and socioeconomic indicators into data collection, which is an important prerequisite for evaluating equity impacts of the interventions. Additionally, three methodological workshops were held to raise awareness among the other subprojects of AEQUIPA on equity impacts of intervention methods. Moreover, an evidence synthesis on methods to consider social inequalities in the development, implementation, and evaluation of interventions to promote physical activity among older adults was conducted using systematic review methods and expert interviews. Findings of the systematic review on universal interventions to promote physical activity among older adults (Lehne & Bolte 2017) suggest that many studies have not exploited the potential for assessing equity impacts so far. Expert interviews and workshops resulted in several key points of equity-sensitive practice such as setting orientation and participatory approaches.
Lehne, G. & Bolte, G. 2017. Impact of universal interventions on social inequalities in physical activity among older adults: an equity-focused systematic review. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 20.
Working programmeof the second funding period
Within the first funding phase, EQUAL started with the development of innovative methods for equity impact assessment of interventions, which will now be applied to the interventions implemented within the AEQUIPA prevention network. Moreover, an international cooperation is planned comprising a joint equity-specific (re-)analysis of previously conducted interventions aimed at promoting physical activity in the elderly. Another focus of the project is an analysis of the population-level prevention potential of physical activity interventions in the elderly in Germany, particularly accounting for the expected impact on social inequalities in health (comparable with 'health equity impact assessment' or 'health inequalities impact assessment' approaches). For this purpose, a simulation tool will be used to quantify health effects of interventions to promote physical activity for the older population in Germany (e.g., changes in life expectancy, chronic disease incidence and prevalence) as well as to assess changes in health inequalities among different social subgroups.
Prof. Dr. Gabriele Bolte, MPH, University of Bremen, Institute for Public Health and Nursing Research (IPP) (Head of project)
Gesa Lehne, M.A., University of Bremen, Institute for Public Health and Nursing Research (IPP)
Prof. Dr. Stefan Lhachimi, MPP, MSc, University of Bremen, Faculty 11 & Leibniz Institute for Prevention Research and Epidemiology - BIPS, Research Group for Evidence-Based Public Health
Phone: +49 421 218-68826