Norway Grants Support Capacity Building for Tackling Health Inequalities in Central and Eastern Europe

It is well documented that significant health differences exist among European countries. ¹ The most unfavourable situation is observed in Central and Eastern Europe. Therefore, Iceland, Liechtenstein, and Norway have initiated an EEA/Norway Grants program that aims to provide financial and expert support for tackling health inequalities by promoting physical and mental health in the beneficiary countries, and improving access to and quality of health care services. ² A EUR 184 million (USD 196 million) support package has been allocated to finance public health projects in Bulgaria, Cyprus, Czech Republic, Estonia, Hungary, Poland, Portugal, Romania, Slovenia, and Lithuania. This letter focuses on the case of Lithuania.

As mentioned, all Central and Eastern European countries face a problem with large socioeconomic inequalities in health; Lithuania is among those countries with the most unfavorable situation. The most recent data confirm that the main socioeconomic factors, (eg, education, occupational status, rural/urban place of residence) have a considerable impact on one's health status. ¹ This situation has caused tackling health inequalities to become the priority issue on the Lithuanian public health policy agenda. To achieve a reduction in inequalities, Lithuania implemented the Development of a Model for the Strengthening of the Capacities to Identify and Reduce Health Inequalities project in 2014–2017, which was financed by the Norwegian Financial Mechanism 2009–2014 Programme “Public Health Initiatives.” The project had 4 main actions: (1) analysis of the present situation in monitoring and reducing health inequalities; (2) development of a sustainable health inequalities monitoring system; (3) development of a set of recommendations for public health professionals to reduce health inequalities; and (4) capacity development of public health professionals and health policy makers in the area of health inequalities. The first 3 activities are described in a previous publication ³ ; therefore, this letter focuses on the capacity building component.

A pre-project survey identified the primary obstacle to tackling health inequalities in Lithuania to be lack of competencies in the field. ⁴ Therefore, 2 capacity-building programs for public health specialists and health policy makers were developed. Both programs covered issues including but not limited to the definition of health inequalities, monitoring of health inequalities, managing intersectoral collaboration, strategic planning, and evidence-based and best-practice interventions. Training effectiveness was measured by pre-training and post-training surveys of participants. Results showed that the training has changed participants' attitudes. More participants: emphasized the need to designate health inequalities as a top priority issue in Lithuania (64.1% pre training vs. 70.3% post training), agreed on the importance of effective intersectoral collaboration (58.6% vs. 65.5%), and agreed on the continuation of dissemination of information about health inequalities (14.5% vs. 39.3%). These results illustrate that capacity-building seminars had a considerable impact on the understanding of and preparedness for addressing health inequalities. It is expected that Norway Grants support will have a sustainable effect and will facilitate further reduction of health inequalities in Lithuania. Moreover, this practice could be a transferable example for other countries in Central and Eastern Europe that also are tackling health inequalities.