Gradually I arrived in my study on health inequalities at a final draft which I could discuss with faculty and research workers here. In April I gave a first presentation at the ‘Health of the nations’ study group at the Center of European Studies and more recently I presented the study and its conclusions at a ‘Work in Progress’ session at the Harvard Center for Development and Population Studies.

In general, the conclusions of the study refer to

– the existence in all countries studied of an important data source on health and its determinants in particular related to socio-economic variables and resulting from national health interview surveys (HIS)  and for some countries also a health examination survey (HES);

– the existing analysis and reporting of these national datasources by socio-economic variables but also the additional potential for further analysis of these national HIS/HES data sources and for pooling research data;

– a description of national actions on reducing health inequalities (with a potential of) using these HIS and HES data; these national actions are often scattered among different programmes; only half of the countries studied have (a proposal for) an overall action programme on health inequalities and even less countries have started a consistent monitoring of these actions through indicators, sometimes against targets set.

In addition the study includes recommendations for the future and analysis of the European HIS/European HES for monitoring health inequalities.


On 15 and 16 April all previous fellows of the Weatherhead Center for International Affairs (WCFIA) were invited to gather – together with the 2009-2010 fellows – at Harvard for an Alumni reunion and conference. More than 50 previous fellows came over to Cambridge and followed an intensive two-days’ programme.

During the morning of the first day we could follow lectures of faculty, in different series such as on ‘History of Art and architecture’, on ‘Culture and Belief’, on ‘The United States in the World’ or on ‘Government’.

The first day’s programme schedule also included a special seminar with a conversation with young scholars on trends in research.

The second day opened with presentations and a discussion on how we think about the international system. Furthermore the conference included  sessions on topics such as The Growing Power of China, The EU after Lisbon and The Global Economic and Financial Crisis, and ‘On the Frontlines of the ‘War on Terror’.

Concluding remarks were given by Steven Bloomfield, Executive Director of the WCFIA, and by Kathleen Molony, Director of the Fellows’program.

Yes we can !

March 22, 2010

At the end of last year it seemed that the Democrats would have an easy going for the adoption in the Senate of the health care bill, but finally they lost their so much wanted 61st vote with the appointment – in January – of the Republican Scott Brown instead of the Democrat Maria Coakley.

So another strategy was needed to have the bill passed: this time the way through the House would be tried where the Democrats have a clear majority, although it is well-known that not all ‘Dems’ are in favor of the bill.

After a hectic week with many personal discussions between President Obama and several reluctant House Democrats, the House has approved – yesterday 21 March – the Senate bill on health care reform. The vote was very close: finally 219 Democrats approved the bill with a ‘yea’ and 34 Democrats + all (178) Republicans  – so 212 in total – rejected it with a ‘nay’.

The bill passed only after some last hurdles were removed: earlier on a reconciliation procedure was proposed and agreed. And, yesterday afternoon, a deal was reached between the White House and the anti-abortion Democrats, lead by Democrat Bart Stupak, whereby President Obama gave his assurance that an executive order would be added so that no federal funding would be given to abortion.

It was a bitter struggle, both outside around Capitol Hill as well as inside Congress: the opponants argued that the bill would give them less freedom and it would cost too much, and they also feared it would give lead to too much government intervention. Those in favor of the bill argued that more people would now finally receive health care and they hailed the victory votes as a historic advance in social justice.

The vote in the House of Representatives was a crucial one but there is still more to come. Immediately after the approvement of the bill, the House approved also a reconciliation bill: a package of changes agreed among House and Senate Democrats and the White House and that package will go to the Senate for action as soon as this week in what would be the final step.

Last week Bernard Merkel (Minister Counselor and Head of Food Safety, Health and Consumer Affairs at the EU Delegation in Washington) and myself were in a 2 days meeting with faculty members and students from Harvard School of Public Health (HSPH).

The objective of the meeting was to find common grounds for EU-HSPH cooperation on issues such as research, distance learning and exchange of faculty and students between HSPH and European Universities,

For the EU Bernard and myself explained the rules for cooperation on research and exchange and we gave a presentation  – for faculty and students – on European Health Issues for the 21th century.

We had an interesting discussion with HSPH Dean Dr Julio Frenk and spoke directly with a number of HSPH faculty, who presented their research projects, going from environmental health to metabolic disorders, healthy eating and translating knowledge into good communication. Together we discussed the basis for possible cooperation.

Bernard and myself are very grateful to Monique Bertic, Associate Director for International Advancement of the HSPH Office for External Relations, who has perfectly organised these highly efficient and informative two days.

Time for the 2010 census

March 14, 2010

Yesterday, in the middle of Cambridge, close to Harvard Yard, the Census 2010 Promotion team organised an awareness raising campaign for the 2010 US census, which will officially start next week. They distributed lots of brochures in different languages with the aim of getting the American people ready to participate. I spoke with the campaign team and they were all very motivated and eager to get started for this huge undertaking…

The difference in this US 2010 census with previous censuses is that every household has to fill out only a short questionnaire of 10 questions, and more detailed socioeconomic information previously collected through the decennial census will be asked to a small percentage of the population via the annual American Community Survey.

Since July 2008, population and housing censuses in the EU are subject to a Regulation – approved by the Council and the European Parliament – which mentions 2011 as the first reference year under this Regulation.  So next year it will be our turn!

Sir Michael Marmot at Harvard

February 12, 2010

Yesterday, 11 February 2010, Sir Michael Marmot has published his final report “Fair societies, healthy lives”.

I was one of the lucky few to meet him personally at a seminar held mid January on ‘Social Determinants of Global Population Health’, hosted by the Harvard Center for Population and Development Studies and led by Director Lisa Berkman. At this seminar, Sir M.Marmot gave us already an insight into the findings of this now published report.

Professor  Sir  Michael  Marmot is Director  of  the  International  Institute  for  Society  and Health and MRC  Research Professor  of  Epidemiology  and  Public Health,  University  College,  London.

“We are dealing with these huge inequities within countries and the inequities between countries and they overlap. This is a problem for all of us…. No country has cause for complacency,” Marmot said in his lecture.

“The reason for taking action on the social determinants of health in order to promote health equity is one of social justice.”

Michael  Marmot  has  been  at  the  forefront  of  research  into health inequalities  for  the past  30  years.  He  was  a  member  of  the Royal  Commission  on  Environmental Pollution  for  six  years.  In 2000  he  was  knighted  by  Her  Majesty  The  Queen for services to  Epidemiology  and  understanding  health  inequalities.

It was in November 2008, that Professor Sir Michael Marmot was asked by the English Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy should include policies and interventions that address the social determinants of health inequalities.

In a few months Sir Michael Marmot and his team have come up with a remarkable piece of work, which not only focuses on health inequalities in England, but also leads the way on how to tackle the problem of health inequalities worldwide. The report is available at

With respect to the social situation in England, (not by coincidence  a country which has also the best data and documentation), the report gives 6 recommendations:

1. give every child  the best start possible

2. enable all children, young people and adults to maximise their capabilities and have control over their lives

3. create fair employment and decent work for all

4. ensure a healthy standard of living for all

5. create and develop sustainable places and communities, and

6. strengthen the role and impact of ill-health prevention.

So, quite a challenge, but not irrealistic; for each of the 6 recommendations, the report gives a practical example, situated in England, which has worked as is shown by quantitative and/or qualitative data.

During a short private discussion, Sir Michael Marmot and I spoke about the need to have solid and reliable statistical data base – in casu for Europe – on health and social determinants whereby health interview surveys harmonized across countries will play a major role.

The battle continues

January 18, 2010

Tomorrow, 19 January 2010, the people of Massachusetts will elect a new Senator, who will occupy the post left by the late Ted Kennedy who passed away last September. And the health care debate takes a front-and-center position in the race between the major-party candidates: Democrate Martha Coakley and Republican Scott Brown.

So what is now the situation on the US health care reform?

On Christmas eve, a majority of the US Senators has agreed on its version of the health reform bill, which has led President Obama to speak of “a historic vote” and to say “we are now incredibly close to making health insurance reform a reality in this country”.

The reform bill that passed the Senate includes, like the House bill, the toughest measures ever taken in the US to hold the insurance industry accountable.  Insurance companies will no longer be able to deny health coverage on the basis of a preexisting condition.  They will no longer be able to drop coverage when the assured get sick.  No longer will people have to pay unlimited amounts out of their own pockets for the treatments they need.  And people will be able to appeal unfair decisions by insurance companies to an independent party.

Now the two bills have to be merged into one text to be accepted by both the Senate and the House, before it can be submitted for signature to President Obama. An important difference between Republicans and Democrats is their respective proposals of how the reform will be financed.

The House bill proposes a taxation of the higher incomes, while the Senate bill includes a provision taxing high premium health plans provided by employers. The latter – the so-called Cadillac tax – was at first strongly opposed by the Unions, who said that it is unfair to workers who have traded larger paychecks for better insurance coverage.

However, last Friday 15 January 2010, at a the meeting with the White House administration, the Unions finally agreed after having obtained significant concessions such as an exemption for residents of States where the cost of health care is particularly high, as well as for employees in high-risk professions.

But Republican candidate Brown has now called for Congress to ‘go back to the drawing board’ and come up with a new plan, and polls show that he is closing the gap with his opponent, Democrat candidate Coakley. So the debate is far from finished and the battle continues…