European Public Health News

This European public health news is looking at the future, and foremost at putting the health of our citizens first. Public health needs to move forward and the way forward includes support, collaboration, integration and an investment in the future public health professionals. Ricciardi emphasizes both the need for collaboration and the need for science, but especially the need for a change in the culture of the public health professionals. Our EUPHAnxt coordinators emphasize this change of culture and aim to prepare the next generations of public health professionals to be committed and engaged. Jakab reaffirms the need for participatory and intersectoral health systems and Borg commits to continuous support to European Union (EU) member states to invest in our future by investing in the health of our citizens. If we all work in the same direction, the future of public health is indeed looking bright. Twentieth century health systems were dominated by clinicians, effectiveness and efficiency. The two revolutions, the control of infectious disease and the battle against non-communicable disease, are both still ongoing, but the results of these revolutions are very different if we compare the situation in the developed world and in the developing countries. The infant mortality rate is 5.1 in Canada and 97.1 in Haiti, the rate of maternal deaths is 35 times higher in Latin America than in North America and the lifetime risk of death is 1 in 7.700 deliveries in Canada and 1 in 17 in Haiti. In Western industrialized countries, the success of public health has in many cases changed the nature of these societies, making them ‘health societies’, putting health as a main theme in social and political life, and as a major individual goal with a high life expectancy and ageing populations and an expansive health and medical care system. This situation is in contrast with the reality of the poorest countries where health is a matter of survival, neglected in the development policies, and there is still a lack of access to even the most basic services and a falling life expectancy. The developed world is still too lazy and ineffective to face these challenges. The health status of Europeans has been improving, but we still have risk factors that have never been addressed satisfactorily in our history, such as air pollution and gender inequalities; threats that we thought we had defeated but that are rearing their head again, like sexually transmitted diseases; and of course new threats we have to be prepared to deal with for the first time, like the far-reaching implications of climate change and the effect of economic crises like that we have been experiencing on socio-economic inequalities. It is therefore essential that public health moves forward, and such a progress can only be made by means of a collaborative effort—the challenges we have to face are transnational, and local or regional initiatives or efforts will never be as effective as international ones in dealing with them. We make it a point to create evidence, help translate it into practice and make this translation as effective as possible in terms of the final goal of fostering the health status. There is no point in supporting only one of these stages. Adding value can therefore mean ensuring the highest scientific rigor and severity when producing new evidence; bringing researchers and the results of their investigations into contact with practitioners and policy-makers, so that they can usefully orient each others’ priorities and activities; and finally using that information, those strategies or those tools where appropriate, when appropriate and in the appropriate manner. We cannot continue to do public health as we used to, but we need a third revolution that needs to be a global revolution helping to define the characteristics of the global society of the 21st century. These problems will not be solved only by more science but also by changing the culture of health professionals and in particular public health ones. We have to focus on people’s problems and the systems needed to solve them, not on institutions. We have to put people at the centre; share all the knowledge with them and make their responsibilities clear as well as our own and that of the health service. We have to manage knowledge at least as well as money. As EUPHA, we think that it is a priority today that both the general and the technical public realize that all policies, laws and behaviours by families and citizens have an impact on health. Health is not just a matter to be solved inside general practices and hospitals. Realizing that, becoming aware that we can greatly improve the general well-being by looking at the health consequences of all our personal and collective decisions is a step in the good direction for the future of all Europeans. For the proposed EUPHA strategy for the period 2014–2020, three main aims are presented in the draft version. After the first two parts of the mission being presented in earlier editions of this column, we, as EUPHAnxt coordinators, would now like to elaborate on the third and last part of the mission: In times of highly changing arenas, it is essential to continuously train and involve the new generations of public health professionals for their contribution to healthier societies. The moment they finish their education, particular taught skills are quickly outdated and more traditional approaches of more experienced generations may not be fitted to an ever changing society. In order to encourage engaged and connected public health professionals, EUPHA envisions to: To put this into practice, EUPHA established EUPHAnxt in 2011 as a unique network and platform within EUPHA for students, early career researchers, policymakers and professionals in the field of public health. In the light of these goals, EUPHAnxt will carry out the following activities: 3 To prepare the next generations of committed and engaged public health professionals for their leadership role in public health by facilitating networking and skills-building activities for students and early-career professionals in the field of public health. Sensitize and involve the next generation of public health professionals into the European and multidisciplinary network of public health associations. Prepare the next generations of public health professionals for their leadership role, by building their capacity and knowledge. Ensure that the training and education of the new public health professional is fitting their leadership role. EUPHAnxt, as representative of the next generation, will be officially included in the EUPHA governing structure and the next generation will be involved in all the work of EUPHA and related activities (Sections, EPH Conference, etc.). EUPHAnxt will encourage the member associations to do the same and set up national networks, which will then participate in a newly established EUPHAnxt General Assembly EUPHAnxt aims to organize two yearly skill-building workshops to train the early career professionals during the EPH Conference. In close collaboration with several partners, EUPHAnxt will also look into organizing events outside the conference, as summer schools, webinars or massive open online courses. EUPHAnxt aims to further its network together with its existing partners and organizations outside the field of public health. EUPHAnxt is committed to stimulate international exchange for job and internships programs throughout Europe. A system—‘Broaden your horizon’—will be set up to facilitate this by using both a bottom–up and top–down approach. Together with the EUPHA Education and Training Pillar, EUPHAnxt will continuously map gaps in existing public health education. It will take an active role to formulate future needs. However, EUPHAnxt is not able to reach these goals by itself. We can only achieve this in close collaboration with EUPHA member associations and other partners. An active role, as an investment in the future of public health, by all these parties is much needed. EUPHAnxt is dedicated to take a leading and a central role in this. Supplementary Data. This is the second in my series of articles for the European Journal of Public Health, in which I discuss the European health policy framework Health 2020 (Health 2020: a European policy framework supporting action across government and society for health and well-being. (Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/en/publications/abstracts/health-2020-a-european-policy-framework-supporting-action-across-government-and-society-for-health-and-well-being, accessed 28 May 2014)). In this article, I focus on the contribution of health systems. Health 2020 reaffirms the central tenets of the Tallinn Charter (Tallinn Charter: Health Systems for Health and Wealth. Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/__data/assets/pdf_file/0008/88613/E91438.pdf, accessed 28 May 2014)) by putting forward innovative approaches that strengthen core health system functions. Good health system governance and the development of national and subnational health policies, strategies and plans are vital. Health systems should be people-centred, evidence-informed, intersectoral and participatory. Universal coverage is a key principle of Health 2020. It aims to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. ‘The world health report 2010—Health systems financing: the path to universal coverage (The world health report 2010—Health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010 (http://www.who.int/whr/2010/en/index.html, accessed 28 May 2014)) provides a comprehensive overview. Access has suffered during the financial downturn, in spite of growing need, and Member States in the EU (e.g. Cyprus, Greece, Ireland, Malta and Portugal) increasingly rely on WHO to help them make effective policy decisions in times of austerity. There are powerful arguments for ‘going upstream’ to address the root causes of ill health, improving public health, health promotion and disease prevention. Health 2020 has therefore been developed alongside the European Action Plan for Strengthening Public Health Capacities and Services (European Action Plan for Strengthening Public Health Capacities and Services. Copenhagen: WHO Regional Office for Europe; 2012 (http://www.euro.who.int/__data/assets/pdf_file/0005/171770/RC62wd12rev1-Eng.pdf?ua=1, accessed 28 May 2014)). It is imperative that public health policies are based on solid and reliable health information, and credible evidence, which is still often lacking. Progress can be achieved through integrated national health information systems, which require investment and sustainability to monitor the success of national policies and the implementation of Health 2020. Both ‘The world health report 2008—Primary care—now more than ever’ (The world health report 2008—Primary health care—now more than ever. Geneva: World Health Organization; 2008 (http://www.who.int/whr/2008/en/index.html, accessed 28 May 2014)) and Health 2020 reaffirm the importance of primary health care in health systems and the central commitments of the 1978 Declaration of Alma-Ata (Declaration of Alma-Ata, 1978. Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/en/publications/policy-documents/declaration-of-alma-ata,-1978, accessed 28 May 2014)). Primary care acts as a hub to link other forms of care, and as a focus for coordinated and integrated care. Member States recommitted to the values of primary health care and a new vision of primary health care at the celebration of the 35th anniversary of the Declaration in November 2013 in Almaty, Kazakhstan. Integrated and coordinated health services (Roadmap. Strengthening people-centred health systems in the WHO European Region. A Framework for Action Towards Coordinated/Integrated Health Services Delivery. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/__data/assets/pdf_file/0005/231692/e96929.pdf?ua=1, accessed 28 May 2014) Good management and improved information technology are needed to support more integrated processes. Close coordination is needed between the levels and elements of service provision. Mechanisms are needed to support self-management where appropriate, and delivery of care as close to home as is safe and cost-effective. WHO is helping countries in the European Region to implement Health 2020 and strengthen their health systems. Achievement of all these goals will require much political, managerial, professional and public commitment and, above all, leadership and change management. Over the past decade, all EU health policy-makers have had to tackle similar challenges: an ageing population, the increasing burden of chronic diseases, a greater demand for health care and the high cost of technological progress. More recently still, the economic crisis has restrained health budgets. This aggravated Member States’ difficulties in providing quality health care to all their citizens in a sustainable manner. Such common challenges call for closer cooperation between the European Commission and the EU Member States. In 2006, Member States had already agreed upon a set of common values for Health systems in the EU: universality, access to good quality care, equity and solidarity. Subsequently, the Council of Health Ministers established an EU reflection process to help Member States provide modern, responsive and sustainable health systems. In 2013, Health Ministers reviewed progress achieved and called for further efforts in EU level cooperation in this area. Health system's reform aimed at improving cost-efficiency, resilience and sustainability is a part and parcel of on-going structural reforms across the EU. In this context, last year's recommendations for health system's reform were addressed to 11 Member States in the context of the European Semester (http://ec.europa.eu/europe2020/making-it-happen/country-specific-recommendations/2013/index_en.htm). This year, the Commission addressed recommendations to 16 Member States, emphasizing the need to ensure cost-effectiveness and sustainability of health systems and calling for concrete, targeted reforms to optimize the hospital sector, strengthen primary care and optimize pharmaceutical spending. To support Member States in this regard (COM(2014) 215: http://ec.europa.eu/health/healthcare/docs/com2014_215_final_en.pdf), the Commission has laid out an EU agenda to help make Europe’s health systems fit for facing current challenges and pressures, in a Communication adopted on 4 April 2014. The Communication highlights a number of initiatives the EU can develop and build upon to help Member States ensure that citizens’ aspirations to high-quality care can be met. The focus is on methods and tools to enable Member States achieve greater effectiveness, accessibility and resilience of their health systems, in line with the recommendations issued in the context of the European Semester. Better workforce planning, cost-effective use of medicines and an optimal implementation of the Directive on patients' rights in cross-border health care will contribute to greater accessibility of health care. In addition, integration of care and a greater use of health system performance assessment will help Member States make their health systems more effective. I further encourage Member States to share best practices on how to make health systems more resilient. They already do so through our network on Health Technology Assessment (http://ec.europa.eu/health/technology_assessment/policy/network/index_en.htm). Finally, I believe all Member States have much to gain from investing in health information systems and promoting the uptake of eHealth; and this is why the Commission is keen to enhance cooperation between Member States in this area. The Health of our citizens is a value in itself. Health is also a key asset and precondition for economic prosperity: to build a healthy economy, you need a healthy population. This is why investing—in a smart way—in the health of our citizens is investing in our future. And the European Commission is committed to supporting Member States in this important mission. This year’s European Public Health Conference will be held from 19 to 22 November at the Scottish Exhibition and Conference Centre in Glasgow, Scotland, UK. This year, we have received an absolute record of abstracts and workshops, in total 1086 from 68 countries. This meant an extra challenging task for our International Scientific Committee (ISC) scoring the abstracts. The ISC consisted of 58 experts from all over Europe. The ISC members scored between 80–205 abstracts following clear guidelines. We are, as always, highly appreciative of the excellent work of the ISC. Without the members of the ISC, the high scientific quality of the European Public Health Conference cannot be guaranteed. Single abstracts were scored by an average of 6.1 scorers. The average score was 3.351. The highest score was 4.800, the lowest 1.250. Workshops were scored by an average of 4.8 scorers. The average score was 3.567. The highest score was 4.750, the lowest 1.000. A decisional meeting mid-June has set the programme for Glasgow 2014, which consists of 73 oral sessions, 28 pitch session (short oral communication sessions), 18 poster walks and 16 pre-conferences. This full packed programme is already available on the conference website at www.ephconference.eu.

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