Equality in cleft and craniofacial care

Abstract

This review examines the issue of equality of care amongst those with cleft lip and/or palate in the European Union (EU) and beyond. Issues of equality both between and within national populations are considered, and it is argued that those from countries with smaller healthcare expenditure and who are from marginalised groups are at the greatest risk of, and affected most severely by, healthcare inequalities. The socioeconomic impact of inequality is also discussed. Having reviewed these topics, the goals and activities of the European Cleft and Craniofacial Initiative for Equality in Care Action, formed pursuant to an award from the EU’s European Cooperation in Science and Technology, are introduced. Constituted of an open network of clinicians and researchers committed to exploring and reducing such inequalities, the ongoing Action is formed of multiple working groups examining these issues within the EU and has organised training schools, conferences and short-term scientific missions concerned with these issues. These activities are discussed along with the future directions of the Action, the impact it has had to date and the benefits of the European Cooperation in Science and Technology award.

Keywords

Cleft / craniofacial / equality / care / healthcare / Europe

References

[1] European Union. EU in figures: Living in the EU: 2020. Available from: https://europa.eu/european-union/about-eu/figures/living_en [Last accessed on 29 Apr 2020]

[2] Eurostat. Healthcare expenditure in the EU: 2018. Available from: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20181129-2 [Last accessed on 3 Jul 2020]

[3] European Cleft Organisation – 10 years in Bulgaria: 2019. Available from: http://europeancleft.org/wp-content/uploads/2020/04/ECO-in-Bulgaria-FINAL_1.pdf [Last accessed on 19 Jun 2020]

[4] The European Committee for Standardisation. CEN/TR 16824: 2015 Early care services for babies born with cleft lip and/or palate. Available from: https://standards.iteh.ai/catalog/tc/cen/d0bb9258-df47-411a-a9e1-cd383fcfb5b9/cen-tc-424 [Last accessed on 8 Jul 2020]

[5] Shaw WC,Nelson P,Mølsted K.The Eurocleft project 1996-2000: overview..J Craniomaxillofac Surg2001;29:131-40

[6] Han HH,Kim JM,Rhie JW.The importance of multidisciplinary management during prenatal care for cleft lip and palate..Arch Plast Surg2016;43:153-9 PMCID:PMC4807170

[7] European Parliament, Council of the European Union, and European Commission. European Pillar of Social Rights. Available from: https://ec.europa.eu/commission/sites/beta-political/files/social-summit-european-pillar-social-rights-booklet_en.pdf [Last accessed on 3 Jul 2020]

[8] Baeten R,Vanhercke B.Inequalities in access to healthcare. A study of national policies, European Social Policy Network (ESPN).2018;BrusselsEuropean Commission

[9] Eurostat. Archive: People at risk of poverty or social exclusion. 2017. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/People_at_risk_of_poverty_or_social_exclusion#Number_of_people_at_risk_of_poverty_or_social_exclusion [Last accessed on 6 Apr 2020]

[10] Eurostat. Children at risk of poverty or social exclusion. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Children_at_risk_of_poverty_or_social_exclusion#The_highest_risk_of_poverty_or_social_exclusion [Last accessed on 6 Apr 2020]

[11] Pickett KE.Income inequality and health: a causal review..Soc Sci Med2015;128:316-26

[12] Marmot M.Review of social determinants and the health divide in the WHO European Region: final report.2014;CopenhagenWHO Regional Office for Europe

[13] Keeley B.Human Capital: How what you know shapes your life.2007;ParisOECD Publishing

[14] U.S. Bureau of Labor Statistics. Unemployment rates and earnings by educational attainment. Available from: https://www.bls.gov/emp/chart-unemployment-earnings-education.htm [Last accessed on 8 Apr 2020]

[15] Eurostat. Unemployment statistics at regional level. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/Unemployment_statistics_at_regional_level#Regional_unemployment_rates_and_the_EU_average [Last accessed on 8 Apr 2020]

[16] Watkins SE,Aylsworth AS,Allori AC.Academic achievement among children with nonsyndromic orofacial clefts: a population-based study..Cleft Palate Craniofac J2018;55:12-20

[17] Fitzsimons KJ,Setakis E,Deacon SA.Early academic achievement in children with isolated clefts: a population-based study in England..Arch Dis Child2018;103:356-62 PMCID:PMC5890634

[18] Wehby GL,Barron S,Ansley TN.Academic achievement of children and adolescents with oral clefts..Pediatrics2014;133:785-92 PMCID:PMC4006437

[19] Persson M,Svensson H.Academic achievement in individuals with cleft: a population-based register study..Cleft Palate Craniofac J2012;49:153-9

[20] OECD“More than one in six people in EU countries have a mental health problem” in Health at a Glance: Europe 2018: State of Health in the EU Cycle.2018;ParisOECD Publishing

[21] Pedersen DA,Murray JC.Psychiatric diagnoses in individuals with non-syndromic oral clefts: a danish population-based cohort study..PLoS One2016;11:e0156261 PMCID:PMC4880322

[22] Tillman KK,Hoijer J,Ekselius L.Increased risk for neurodevelopmental disorders in children with orofacial clefts..J Am Acad Child Adolesc Psychiatry2018;57:876-83

[23] Nilsson S,Lyberg-Ahlander V.Psychotropic drug use in adolescents born with an orofacial cleft: a population-based study..BMJ Open2015;5:e005306 PMCID:PMC4390737

[24] Pedersen DA,Wehby GL.Use of psychotropic medications and visits to psychiatrists and psychologists among individuals with nonsyndromic oral clefts: a population-based cohort study..Birth Defects Res2017;109:824-35 PMCID:PMC5568049

[25] Eurostat. Archive: People at risk of poverty or social exclusion. 2017. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/People_at_risk_of_poverty_or_social_exclusion#Number_of_people_at_risk_of_poverty_or_social_exclusion [Last accessed on 06 April 2020]

[26] Kane M.Concept mapping for planning and evaluation.2007;Thousand OaksSage Publications, Inc

[27] Trochim WMK.An introduction to concept mapping for planning and evaluation..Eval Program Plann1989;12:1-16

[28] Hagell P,Hedin G,Hammarlund CS.Group concept mapping for evaluation and development in nursing education..Nurse Educ Pract2016;20:147-53

[29] Westergren A,Norberg E,Hedin G.Computer-based training in eating and nutrition facilitates person-centered hospital care: a group concept mapping study..Comput Inform Nurs2018;36:199-207

[30] European Commission Communication. EUROPE 2020 A strategy for smart, sustainable and inclusive growth. Brussels European Commission 2010. Available from: https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX%3A52010DC2020 [Last accessed on 8 Jul 2020]

[31] European Commission CommunicationEuropean Disability Strategy 2010-2020: A Renewed Commitment to a Barrier-Free Europe.2010;BrusselsEuropean Commission

[32] European Commission Communication. Early Childhood Education and Care: Providing all our children with the best start for the world of tomorrow. Brussels European Commission 2011. Available from: https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A52011DC0066 [Last accessed on 8 Jul 2020]

[33] European Commission Communication. The European Platform against Poverty and Social Exclusion: A European framework for social and territorial cohesion. Brussels European Commission 2010. Available from: https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=COM%3A2010%3A0758%3AFIN%3AEN%3APDF [Last accessed on 8 Jul 2020]

[34] ECCE. Training School Malta. The European Cleft and Craniofacial Initiative for Equality in Care 2019. Available from: https://ecce.nu/Malta-2019 [Last accessed on 8 Jul 2020]

[35] HI3. Health Innovation, Implementation and Impact - A functional training program on how to implement sustainable change in the healthcare system on a clinical level. Available from: http://health-innovation.nu/ [Last accessed 15 Jun 2020]