European Public Health News

In this European Public Health News, we continue to focus on collaboration to attain the best public health for Europe. Jakab presents the joint action for the protection of people from health emergencies, a clear field where European collaboration is essential. Bucher presents the work of the European Commission to tackle the spread of vaccine preventable diseases, again a clear field where European joint efforts are necessary. Azzopardi Muscat highlights the World Health Day theme of universal health coverage. It takes a joint effort to continue this as top priority to reach the ambitious target of one billion persons covered for care. Zeegers Paget discusses the need for the public health network to step out of its comfort zone and start working with all policies to reach the highest level of health and well being possible. Charpak highlights the ‘bridge’ theme of the upcoming Marseille 2019 conference. Bridging is necessary not just between regions (Southern Europe–Northern Africa), or between professions touching upon health, but also bridging between languages (the language of advocacy but also the different languages in Europe). Collaboration for health remains a priority for all of us. This year’s theme for World Health Day on 7 April 2019 was Universal Health Coverage. The World Health Organisation has made this a top priority for its work in the coming years with the ambitious target of 1 billion persons more covered.1 Often, I get the sense that in Europe there is a feeling that achieving Universal Health Coverage is a task for other regions and developing countries more than it is for Europe. I disagree, and will proceed to argue why Universal Health Coverage merits attention now more than ever in Europe. Although Europe has some of the best functioning healthcare systems in the world, as testified also by the findings from the HealthCare Access and Quality Index,2 where several countries feature in the top decile, it is equally true that in some of these highly functioning systems people are being left behind. Europe can achieve more along the three dimensions of Universal Health Coverage by paying attention to WHO is covered? WHAT is covered? HOW MUCH is covered? As mobility within Europe and globally has increased with migration becoming a new normal, it is quite easy for people to fall between the cracks. Whilst traditionally this has been studied mostly in relation to undocumented migrants and new forms of slavery, the fragility of access and coverage was also a key issue that was raised in the context of the Brexit negotiations particularly in the NO-DEAL scenario. It is sad to note that for many migrants working in semi-legitimate and precarious conditions, the first time that the issue of access to healthcare comes to the fore happens to be around an accident or an injury or possibly a mental health crisis. We cannot accept in line with our European ethos and values that we allow people to work in an exploited fashion, without giving them access to healthcare. Turning to address the issue of WHAT is covered we should start by looking at some very basic services such as dental care, coverage of which in Europe is highly variable and often incomplete. We can also consider the restricted access to more controversial services related to reproduction such as in vitro fertilization or Lesbian, Gay, Bisexual and Trans-sexual (LGBT) healthcare, including transgender health services. We cannot ignore the reality of access to expensive innovative medicines and the fact that many persons living in poorer European countries often remain without access to treatments and technologies that are proven to work merely because they are unaffordable. Third, there are many health systems which deliver quite well on covering their resident population and providing a comprehensive package of health services, yet a report issued by WHO to coincide with World Health Day 2019 clearly shows that some people face barriers to access and forego treatment due to the cost involved; some pay and experience financial hardship as a result; and some are affected in both ways, even in Europe’s richest countries.3 Achieving Universal Health Coverage requires attention to both demand side factors as well as supply side factors. Public health has a duty to work to improve the architecture and governance of health systems since the way in which they are designed can make an immense contribution to reducing health inequalities associated with barriers to access or limited supply. For several years now, EUPHA has been encouraging its members to step outside of the field of public health and find partners to further public health. At the Design and Health Symposium organised by the International Academy for Design and Health and supported by—among others—EUPHA and the Italian Society of Hygiene, Preventive Medicine and Public Health, our president—Natasha Azzopardi Muscat—put it clearly: ‘Public health needs to reach out and build bridges to create a stronger impact on citizens’ health’. The upcoming European Public Health conference in Marseille also has interdisciplinary collaboration as a main topic. In several plenaries at Marseille 2019, the interdisciplinary approach to health is addressed. The notion of intersectoral collaboration has existed for a long time. First mentioned in the WHO preamble where the definition of health as a human right includes physical, mental and social well-being and encompasses areas like food, clothing, housing, medical care and so on. Mentioned in the Alma Ata Declaration on Primary Health Care (1978) and later in the Ottawa Charter for Health Promotion (1986), intersectoral action and healthy public policy are central elements for the promotion of health, the achievement of health equity and the realization of health as a human right. The concept of Health in All Policies includes to improve the accountability of policymakers for health impacts at all levels of policy making. It includes an emphasis on the consequences of public policies on health systems, determinants of health and well-being and also contributes to sustainable development. In 2015, the UN adopted the Sustainable Development Goals (SDGs). The 2030 Agenda for Sustainable Development (last accessed 9 April 2019), adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. 17 SDG goals were formulated for a call for action by all. Even though only one goal (SDG3) specifically mentions health, all 17 goals touch upon health-related issues. The WHO—together with 11 other international organisations—developed a GLOBAL ACTION PLAN for healthy lives and well being for all [https://www.who.int/sdg/global-action-plan, last accessed 9 April 2019]. The plan builds on growing commitment among global actors to improve coordination on health, in a field that has long been a source of innovation and impact. Global health has set new standards for global solidarity, international cooperation and the centrality of human rights to sustainable development. This action plan—currently under consultation and planned to be presented at the UN General Assembly in September 2019—is exploring new ways of working together to accelerate progress towards the health-related SDG targets. A great initiative, but does it include a vision of health as the central human right to be protected? The Lancet Series on Health in Europe [https://www.thelancet.com/series/health-in-europe Published: 27 March 2013, last accessed 9 April 2019] provides a comprehensive examination of some of the most important issues affecting the health of people in Europe today. Seven Series papers, led by Professor Martin McKee of the London School of Hygiene & Tropical Medicine, cover a diverse range of subjects, from how the financial crisis is affecting health in Europe, to whether children’s health services are keeping pace with the changing landscape of child health. In recent years, several European countries have undergone turbulent political changes that have an impact on the health of their populations. We continue our quest for intersectoral collaboration. For instance, on 20 March 2019, EUPHA was a happy co-singer of the press statement on health and well-being key to unlocking Europe’s potential, initiated by the ‘All policies for a healthy Europe’ initiative. But it seems clear: if we do not put health in the middle of all our efforts, if we do not put health in all our policies, we will not reach our objectives for healthy lives and well-being for all. To achieve this, we, the public health professionals, need to step up our actions and step out of our comfort zone. The new public health professional needs to forge alliances, be inventive, think outside of the box, be creative and—above all—be brave and bold to be able to reach health in all policies for a healthier Europe. WHO Member States face increasing numbers of emergencies with health consequences from all hazards, including infectious disease outbreaks, conflicts, natural disasters, chemical or radio-nuclear spills and food contamination. Many emergencies can be complex, with more than one cause, and can have significant public health, social, economic and political impacts.1 Every year, the WHO Health Emergencies Programme in the Regional Office for Europe receives about 20 000 signals of public health threats. Approximately 2000 of these are analysed and between 40 and 60 are verified. Together with partners, WHO is also responding to ongoing protracted emergencies: in Eastern Ukraine and from Turkey, under the whole-of-Syria approach. The WHO Member States continue to be vulnerable to natural or human-induced disasters, including epidemics, radionuclear or chemical incidents and other hazards.1 This renewed recognition has compelled political leaders and policy makers to raise public health preparedness and response to a higher position on the policy agenda. This political commitment was embodied in the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region,2 whose resolution EUR/RC68/R7 was unanimously adopted by the 53 Member States of the European Region at the 68th session of the WHO Regional Committee for Europe in September 2018. The Action Plan reflects a joint commitment by Member States, key partners, and the Regional Office to the common vision of a WHO European Region where the impact of health emergencies is prevented or minimized.2 The regional Action Plan builds upon the 5-year Global Strategic Plan to Improve Public Health Preparedness and Response, 2018–23 and is aligned with the WHO Thirteenth General Programme of Work (GPW 13), 2019–23 and the European health policy framework, Health 2020. The regional Action Plan contributes particularly to the GPW13 target of 1 billion people better protected from health emergencies.3 The action plan adheres to the framework and principles of the IHR (2005). It strives to contribute to the achievement of the commitment in the Sustainable Development Goals to leave no one behind, through the promotion of universal health coverage, and complies with existing international health policy frameworks such as the Sendai Framework for Disaster Risk Reduction 2015–30. With the overarching aim of discussing how to ensure high-level sustained political commitment to strengthen joint action for the protection of people from health emergencies, the WHO Regional Office for Europe, with generous support from the Government of Germany, convened a High-level Technical Meeting and a Ministerial Consultation on the Implementation of the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region on 12–14 February 2019 in Istanbul, Turkey. Through facilitated panels and working groups, participants identified cross-cutting issues that posed a challenge for the implementation of the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region, such as insufficient mechanisms to enable and sustain intersectoral collaboration; lack of capacity to retain trained health workforce; insufficient communication and information sharing among sectors, levels of government, countries and partners; or effective modalities for community engagement in the context of health emergencies. Country experience and solutions were shared to overcome these challenges, such as the establishment of multisectoral task forces, special sub-committees and memoranda of understanding to enhance collaboration across sectors; or the use of voluntary IHR evaluation tools to assess capacity gaps and learn from previous actions and initiatives. In addition, experts from WHO and other UN agencies and international organizations provided a comprehensive overview of the tools available to support countries to better prepare for and respond to health emergencies. On the final day of the meeting, a ministerial consultation brought together Ministers, Deputy Ministers and high-level representatives from 32 countries to report on the deliberations of the previous days and discuss how to best ensure the high-level political commitment necessary for the implementation of the regional Action Plan. Participants wholeheartedly supported the leading role of WHO to coordinate international efforts for public health preparedness and response and the implementation of the IHR (2005). Participants reinforced the importance of both regional and sub-regional cooperation in this area and welcomed the opportunity to advance and sustain policy dialogue. The 3-day meeting resulted in the agreement of an outcome summary, which recognized the need to realize the vision of the regional Action Plan and move forward with its goal and actions, by: a. Ensuring high-level political commitment to sustain investment throughout the implementation of the regional action plan. b. Accelerating the implementation of the regional Action Plan by creating opportunities for dialogue and exchange of experiences. c. Monitoring progress on the implementation of the regional Action Plan regularly in accordance with the requirements of the IHR (2005), without additional reporting requirements. The WHO Regional Office for Europe stands ready to work with all countries in the European Region to fully implement the Action Plan through its role as the lead agency for international health, as convener and coordinator of partners in the international response to health emergencies and according to the specific needs of each country. Measles killed 72 children and adults in 2018 (World Health Organisation 2019, http://www.euro.who.int/en/media-centre/sections/press-releases/2019/measles-in-europe-record-number-of-both-sick-and-immunized. The WHO European Region includes 28 EU and 25 non-EU countries.) in Europe. More than 82 000 were infected—three times more than in 2017 and the highest number of cases in a decade. And all this is happening in a situation where a safe and effective vaccine exists! What is really worrying is not only that in several EU countries confidence in vaccination is decreasing (State of Vaccine Confidence in the EU 2018, https://ec.europa.eu/health/sites/health/files/vaccination/docs/2018_vaccine_confidence_en.pdf) but that Europe as a region has lower confidence in the safety of vaccines than other world regions. Unfortunately, younger adults seem to be less confident in the safety and importance of vaccines than older people. This is partly due is the spread of ‘disinformation’ on vaccination. Myths about vaccination have led to the fear of vaccinating, especially children, and more generally to a rising distrust in science. This has resulted in falling vaccination rates. Infectious diseases do not respect borders. A low level of vaccination in one country can have a severe impact on the health and security of citizens across the EU and the world. It is no surprise therefore that the WHO considers disinformation on vaccination one of the biggest public health threats in the world in 2019. President Juncker already pledged to launch an EU-wide action on vaccination back in 2017 (State of the Union Address 2017, http://europa.eu/rapid/press-release_SPEECH-17-3165_en.htm), and in April 2018, the Commission put forward a Communication and a Proposal for a Council Recommendation to tackle the spread of vaccine preventable diseases, further adopted by Health Ministers in December 2018. The Recommendation focuses on three main pillars: tackling vaccine hesitancy and improving vaccination coverage, sustainable vaccination policies in the EU, and EU coordination and contribution to global health. It insists on targeted outreach towards vulnerable groups, calls to strengthen vaccination training in medical curricula and aims to establish electronic vaccination records for all EU citizens. We are moving fast with its implementation: an EU Coalition of healthcare workers and relevant students’ associations started working early March. Its main purpose is to deliver accurate and transparent information on vaccination to patients and to the public and to increase confidence in vaccines and its uptake by citizens. In parallel, the European Centre for Disease Prevention and Control, with the support of the European Medicines Agency is preparing a ‘Vaccination Information Portal’ to provide objective, transparent and on the and safety of In September last the Commission started an Action on with 20 including 17 EU Member States and and with the aim to developing systems, stronger and and development. With a of the Health and the with the support of the of about EU countries and the Commission a for the of of the EU population will have access and for vaccines in the of an are ongoing in of a that will the vaccine coverage according to the specific needs of the We will also be to the of our citizens in several from the European between and April to a high-level in key health and other experts to discuss issues such as vaccination and of vaccines to all. 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