European Public Health News

In this European Public Health News, all authors address the need for and benefits of European collaboration. Both Azzopardi Muscat and Zeegers Paget reflect on the need for health policy leaders in Europe to step up and speak out for stronger collaboration at European level. Jakab addresses leaving no one behind, one of the main objectives of the UN sustainable development goals (SDG), by emphasizing the need for regional networking. Andriukaitis uses the example of falsified medicines to stress the need for European regulation and collaboration. All these good practice examples of European collaboration for health will be presented at the Marseille 2019 conference in November, as Charpak highlights. For nature, autumn heralds the period of quiet, stillness, hibernation and winding down of activity. On the contrary for many individuals, families with children and academic institutions, autumn signals a fresh start, a programme of activities and ambitions for a series of goals and tasks to be accomplished. This particular autumn marks the start of an important journey for the health of European citizens. Within the European region of the World Health organization (WHO), under the leadership of the newly elected regional director, the WHO has the opportunity to renew its vision for health in Europe beyond 2020. The European Union, under the leadership of a new Commission and with the enthusiasm of the recently elected European Parliament also has the opportunity to make its mark on what the EU can really do to improve the lives, health and well-being of European citizens and reengage with ordinary citizens through a most important facet of everyone’s life; health. Europe has made great strides in terms of improving life expectancy and several countries within the European Union top the charts when it comes to a series of health indicators. Yet taking a snapshot of the current situation, the prevailing health inequalities and the stagnating or declining health conditions of groups of people across Europe threaten the gains that have been achieved painstakingly over the years. Furthermore, appraising certain trends and forecasts, Europe may well start to be outstripped by others. That is, unless actions are taken to halt business as usual and exert leverage to change the slope and ultimately directionality of the negative trends. The agenda is a formidable one. Communicable diseases rear their head once more and issues such as anti-vaccination movements as well as anti-microbial resistance serve to remind us that we cannot file communicable diseases as past history. Whilst huge advances are being made in the prevention and treatment of cardiovascular diseases and cancer from a health services perspective, the classic commercial determinants of disease such as tobacco and alcohol remain huge contributors to burden of disease. Whilst significant advances have been made in environmental health policy, air pollution is still an important contributor to illness particularly in some countries and in persons from lower socio-economic groups. Europe is not on track when it comes to reducing health related inequalities. Indeed, the demographic changes that have taken place including migration, have served to further accentuate the differences in exposures and outcomes between different socio-economic groups. Living, which should be a joyful experience, has become increasingly tough for persons, groups, regions or whole populations that somehow feel they are marginalized and left behind. One of the manifestations is in terms of mental health issues. This is particularly worrisome amongst adolescents and young people, particularly when associated with lack of opportunities to build their own lives and a sense of despair. Health services are increasingly caught between the attractive opportunities to improve outcomes afforded by scientific discovery, the burgeoning burden of disease and the manifestly inadequate funds and workforce to deliver top notch care. Furthermore, a whole new world of technology is shaping population health and services, yet we seem reticent to embrace this fully also painfully aware of the potential for these systems to widen the gap between the haves and have nots. EUPHA has been preparing for the next 5 years with the launch of a new strategy to guide our activities and actions as well as two forthcoming supplements, one on digital health and the other on the SDGs. We recognize that our health policy leaders in Europe are going to have their work cut out in the coming 5 years to continue to advance health and well-being for European citizens in the midst of an increasingly unstable political, ecological and economic environment. We stand ready to continue to contribute in our mission of being the voice and convener of the scientific public health movement in Europe and augur the new leadership for health in Europe every success in their efforts. Recent political developments question the need for Europe to join forces. The Eurosceptics are gaining momentum, following the economic crisis, increase in populism and nationalism, mistrust in the existing political system, migration and the UK leaving the EU. Historically, international organizations, such as the EU, were set up to overcome a crisis (in the case of the EU, rebuilding Europe after WWII) and collaboration was in the best interest of all. But with the newest crisis of migration, collaboration seems more difficult and nationalism is taking over again. It seems that the EU needs to re-invent itself. But how? In March 2017, the European Commission published a White paper1 setting out five possible paths for the future of Europe: Carrying On: the focus is on delivering its positive reform agenda. Nothing but the Single Market: the focus is on gradually re-centering on the single market. Those Who Want More Do More: with a focus on allowing willing Member States to do more together in specific areas. Doing Less More Efficiently: the focus is on delivering more and faster in selected policy areas, while doing less elsewhere. Doing Much More Together: where Member States decide to do much more together across all policy areas. The idea was that the new European Parliament (elected this May) could use the White Paper to decide which direction is preferred for our European future. Even though the urge of people to have influence on the future of Europe drove more people to vote than we have seen in the last 20 years, the overall percentage of people voting for the European Parliament is only just over 50%, whereby Belgium and Luxembourg had over 84% of the population voting and Slovakia, Croatia, the Czech Republic and Slovenia under 30%.2 Overall there was an increase in right-wing representatives and the newly formed right-wing alliance (European Alliance of Peoples and Nations) will most likely increase the influence of nationalist groups in the European Parliament. This means that all actors at European level should make a clear call for European collaboration. In EUPHA’s statement on what European political parties are stating on health, the conclusion was that EU political parties do not see health as a priority,3 even when a recent Eurobarometer published that ‘70% of the European citizens want the EU to do more for health than they do now’.4 And the health of the people of Europe needs European collaboration, as there are still: Too many deaths from avoidable causes (e.g. alcohol- and tobacco-related). Resurgence of infectious diseases once controlled (e.g. measles). Increased environmental impacts on health (e.g. air and noise pollution). Together with our partner organizations, combining efforts in EU4Health,5 EUPHA is asking for: Furthermore, EUPHA calls for: Strong (public) health leadership at EU level, based on a directorate general on health. Stronger focus on health promotion and disease prevention, as this is always better than cure and prevention costs are lower than treatment costs. Every euro that is invested in health generates, on average, an economic return of 14 euros. Investing in health research and innovation, to identify health gaps, to understand what is needed for creating strategies and to set the agenda. Mainstreaming health in all policies via an inter-sectoral horizontal approach, as proposed in the All Policies for a Healthy Europe campaign. Health impact assessments are essential here. Placing health higher on the EU agenda to reach the SDGs, a cause the EU has committed to implement in both its internal and external policies. Ask 1–Dedicated health commissioner and the vice president for sustainable well-being. Ask 2–Adopt EU-level actions to prevent diseases and promote healthy lifestyles. Ask 3–Develop a framework for tackling non-communicable diseases. Ask 4–Support national health systems with expertise and evidence. Ask 5–Empower citizens and patients. Ask 6–Assess the impact on health of eu policies. Ask 7–Establish strong leadership with a european global health. In short, European action is needed for better (public) health action in Europe and health can and will enhance European solidarity. And by placing health higher on the EU agenda, the newly elected European Parliament can showcase its interest in the people in Europe. Leaving no one behind is the transformative promise of the 2030 Agenda and of our WHO General Programme of Work 2019–23. This implies reaching every single citizen by engaging with the Member States at all their levels of governance. As stated by the Ottawa charter as early as 1986: ‘Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love’. The subnational local and regional level are therefore especially important when trying to achieve good health and well-being for all. The WHO’s Regions for Health Network (RHN) was formally launched in 1993, as a response to a demand from subnational regions to work with WHO to improve health for their residents, with mutual interests and benefits recognized by WHO. Today RHN is a network of 41 regions within 28 countries in the WHO European Region, and its member regions represent 130 million people. RHN is a bridge between WHO and regions in Europe and between national policies within countries and more regional initiatives. It ensures that WHO’s vision, mission and strategic objectives are understood by the regional level within countries and facilitate implementation at that level. Recently RHN launched a new framework–the RHN IMPACThorama––in order to align and visualize the RHN framework within WHO’s three billion targets, and specifically the target of having one more billion enjoying better health and well-being. RHN engages in a variety of activities: annual meetings, thematic briefings, RHN case-study publications, study visits, webinars, summer schools, RHN newsletters, weekly updates, engaging interactions through website updates, RHN Facebook and Twitter. The RHN secretariat also facilitates tailored technical assistance to member regions and organizes workshops during the European Public Health Conferences and major public health national and international fora. RHN acts to help regions achieve healthier populations, leaving no one behind, through the RHN IMPACThorama: - I Inspire. - M Mobilize. - P Practice. - A Accelerate. - C Connect. - T Transform. Inspire. Through annual meetings, workshops, webinars and other capacity building opportunities, regions can share their best practices, have direct access to WHO expertise, become more familiar with WHO policies and are inspired to embed WHO core values into regional policies. Mobilize. Through RHN, member regions get to know each other, create joint-funding applications and have the possibility to benchmark their practices with those from other regions, which excel in a particular field. In order to engage and mobilize resources within regions, RHN organizes study visits exposing members to innovative solutions towards healthier populations implemented by host regions. Furthermore, the study visits also mobilize awareness and commitment from regional politicians in the host regions, and align different regional stakeholders towards a common, recognized goal. Practice. RHN focuses on achieving healthier populations mainly by inspiring, mobilizing and empowering people engaged in practice-related work and processes. Through peer-to-peer learning and sharing of practical know-how, the network creates dynamic movements towards effective implementation of change. RHN publishes a successful case-study series on outstanding examples of implementation of WHO policies and approaches. The series is characterized by a practical and inspirational perspective, is easy to read and aims at boosting the uptake of best practices in several subnational settings in the WHO European Region. Accelerate. An important pillar in order to accelerate processes toward healthier regions and Health in All Policies is the extensive communication activities carried out by RHN. RHN uses a variety of communication platforms and channels in order to make members aware of useful information and innovations that will accelerate and motivate change. RHN newsletters, RHN weekly updates and the RHN webpage on the euro.who.int website, as well as Facebook and Twitter accounts, keep members abreast with information on available WHO tools, policies, latest research and regional innovations. Connect. RHN connects 41 regions within 28 countries in WHO Europe. RHN acts as an important and direct channel for connecting WHO with regional policy makers in Europe. As many European countries have regions with a high degree of autonomy on health matters, it is vital that WHO has a possibility to inform the regional level of governance. Transform. RHN influences the alignment of regional plans with WHO policies, contributing to internal policy coherence across the several layers of governance within countries. As the RHN Secretariat is based in the WHO European Office for Investment for Health and Development, strong emphasis is given to principles of equity, promotion of investment for health and the safeguarding of human and gender rights. The 41 regions in the network represent a repository of practical know-how, a diversified portfolio of different health and welfare systems and a wide spectrum of stakeholders from the regional level, ranging from academia to policy makers, to regional managers and administrators. Through systematic and steady networking activities, long-term relationships and by applying a bottom-up approach, specific enabling factors developed within RHN are a strong sense of community, willingness to share, engagement and taking a participatory approach towards healthier and more prosperous lives for all. Through the RHN IMPACThorama, RHN strongly supports the role of the European regions in making change happen. I am proud that WHO Europe has increasingly strengthened its support to the subnational level of governance and I am confident this is a way to be closer to the citizens we serve, making sure no one is left behind. A cancer treatment drug travelling from Bulgaria to the Netherlands made history this month. It became the first falsified medicine detected through a new medicines authentication system designed to prevent such medicines from reaching patients in the EU. In order to grasp the full scope of the problem, we first need to define the term ‘falsified medicine’: this would be any medicine with a false representation of its identity, source or history. Falsified medicines pose a danger to patients since the safety and quality of the medicines coming from outside the legal supply chain cannot be guaranteed. They also lead to the gradual loss of confidence in medicines on an international level because they affect every region in the world. Between 2013 and 2017, around 400 falsification incidents were reported in the EU. Falsified medicines are not to be confused with counterfeit medicines. The latter term refers to medicines that do not comply with EU law on intellectual and industrial property rights, such as registered trademarks or patent rights. The Directive on ‘falsified medicines’ does not deal with this aspect. As Commissioner for Health and Food Safety, I am proud of what we have achieved so far. The threat posed to public health by falsified medicines has been a major problem for too long. The first medicine successfully detected through the new authentication system is a landmark moment in a journey, which began back in 2011 with the adoption of the Falsified Medicines Directive. We have come a long way since 2011. This landmark piece of aims to the legal supply chain of medicines through a of across including on the of for medicines. The Directive has also strengthened the supply chain with the of for It has created a to help citizens identify legal it the authentication of medicines two safety a and that be under years after its the implementation of the Falsified Medicines Directive was in this with the of safety and for medicines. each and in the the of those in and that have to their existing to to the EU system, making the of falsified medicines and more does the system the of the supply the of medicines are to place (in the of a and on each of medicines. 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