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Chapter 8: Conclusion

8.4. Recommendations for Policy and Practice

There are many observations or practical suggestions from civil society to improve health equity and environmental health but naming all of them would defeat this research’s purpose. Examples include apparent but crucial steps such as the expansion of public transportation in Europe (I11), health insurance reforms enabling everyone in society to access at least basic health care services (e.g. I1, I14), a stricter control of EU funding for green projects in Hungary (I12), or more EU funding for crucial civil society work on health equity in the EECA region (I4). Better working conditions for Northern Macedonian doctors who otherwise seek work abroad (I2) as well as a minimum standard for health personnel in German clinics (I1) would enable improved and more equal health care provision.

Principally, to strengthen the social justice paradigm (section 2.6.), governments should follow a rights-based approach to health instead of solely appropriating civil society’s language and rhetoric when acting simultaneously along neoliberal lines.

Top-down recommendations concern, as integral part of the findings, reforming European economic policy majorly determining health (sections 3.3.2. and 5.3). To (gradually) shift paradigms, it lies with the EU not to cut public spending (on health) in the post-covid period and to regulate private health care providers’ and pharmaceutical industry’s impact on the accessibility of health systems. Even though limited to directives and not responsible for ultimate national health policy, the EU can do much more to live up to their policy rhetoric including to pressures towards liberalization, to protect public health care from the EU’s trade and investment plans and to ensure that covid recovery funds are spend for the strengthening of public health care (cf. CEO, 2021, I6, I1).

75 Following the research recommendations, a consequently implemented HIAP approach is absolutely crucial when it comes to health equity and environmental health, including the evaluation of all other sectors’ regulations on their impacts on health in practice (I6). Hereby, a primary prevention approach stands out as the most needed agenda and mindset change (cf. I10). Concretely, national and supranational governance structures specifically for environmental health could coordinate research, policy and practice efforts to achieve these goals and to tackle the ‘epidemic of chronic diseases’ (cf.

ibid). Naturally, in general, efforts mitigating climate change and to end the current environmental crisis positively impact human health (ibid, I12).

From a bottom-up perspective, various alternative models of health care provision already exist and can be expanded such as outpatient clinics where everyone can access basic health services – as Naga (I14) reported about a system in Emilia-Romagna and VDÄÄ (I1) in parts of Germany. These alternatives are often provided and promoted by civil society confirmedly able to induce change and improve health equity and environmental health as well as shape public health governance. For civil society organizations themselves, better coordination among each other, thus upscaling and advocating as one voice is most necessary and promising to increase impacts.

Yet, most of the CSO work is done by volunteers with limited time and resources at their disposal. For more cross-sectoral research and action on environmental health and health equity, financial resources and political support are needed – only then, socially just and healthy societies in accordance with our environment are possible.

v

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