bluuebunny/crossref_metadata_2025 huggingface dataset:
Plenary 2 Benefits and challenges of the European Health Data Space
Authors:   Organised by: EUPHA, European Commission,   Moderators: Iveta Nagyova (EUPHA), Isabel de la Mata (European Commission)
Published: October 2022

The creation of a European Health Data Space (EHDS) is one of the key components of a strong European Health Union. The objectives of the EHDS are: i) Empower individuals through better digital access to their personal health data; support free movement by ensuring that health data follow people; ii) Unleash the data economy by fostering a genuine single market for digital health services and products; and iii) Set up strict rules for the use of individual’s non-identifiable health data for research, innovation, policy-making and regulatory activities. As such, the EHDS aims to improve and support healthcare delivery within Europe by allowing public health data to be accessible throughout Europe. The EHDS also aims to promote better access and exchange of different types of health data for research and policy purposes. The aim is to have the EHDS up and running in 2025.

The EHDS is expected to bring great benefit, but it also brings challenges related to technology, governance and privacy. The exchange of data at European level means that health data from different sources need to be able to talk to each other. Making the data Findable, Accessible, Interoperable, and Re-usable is key to the success of the EHDS. Moreover, the diversity of Europe’s health information systems need to be taken in account. The EHDS will also have to be transparent to ensure privacy of personal information included in the EHDS.

Speakers:

Fulvia Raffaelli

European Commission, Brussels, Belgium

Petronille Bogaert

Sciensano, Brussels, Belgium

Irene Schlünder

TMF, Germany

Emmanuel Bacry

Health Data Hub, France
1.B. Workshop: Adaptations in a time of crisis – public health practice in Sweden during the COVID-19 pandemic
Authors:   Organised by: The Public Health Agency of Sweden,   Chair persons: Anna Månsdotter (Sweden), Karin Guldbrandsson (Sweden)
Published: October 2022

Background

The Public Health Agency of Sweden has assessed the consequences of the COVID-19-pandemic in relation to the Swedish public health goals, aiming at good and equitable health. This assessment indicated 1) that preconditions for good and equitable health have changed during the pandemic, 2) that groups with higher risk of ill-health before the pandemic were more severely affected, 3) that the general health of the population remains good although some groups appear to have suffered from increased minor mental health problems, 4) that physical activity has decreased and sedentary behaviour has increased, and 5) that many activities of relevance for public health, such as prevention of alcohol, drugs, and tobacco (ADT) at the local and regional levels were paused or were replaced with other, often digital, alternatives.

Objectives

The objective of this workshop is to present and discuss the results of four projects studying the consequences of the COVID-19-pandemic for public health practice in Sweden. Special attention is paid to ADT-prevention at the local and regional levels, focusing on how such work has developed digitally during the pandemic. Potential implications will be discussed with the audience. The added value of organizing this workshop: This workshop will contribute to an improved understanding of how public health practice, particularly ADT prevention, has navigated through a time of a crisis (i.e. a pandemic) in order to provide important lessons for the future. The presentations in this workshop will lay the foundation for discussing with the audience what might happen within the arena of health promotion and disease prevention as a result of a pandemic as well as ways to cope with the consequences of such a pandemic at the local and regional levels. The coherence between the presentations and the topic of the workshop: There is an obvious logic between the main topic of the workshop and the four presentations. In different ways, they all discuss consequences of the COVID-19-pandemic on public health practice in Sweden.

The format of the workshop

The workshop will start with a brief introduction, aiming to give a short background and set the scene. Four presentations will then follow, with time allocated for questions after each presentation. The presentations will contain descriptions of each subproject, including the background, methods, results, and conclusions. Finally, the moderator will lead a discussion with the audience and the presenters.

Key messages

• The pandemic forced public health practice to adapt its ways of working.

• When challenged, public health practice can operate in new ways, although with some regional differences.
Public health in Sweden during the COVID-19 pandemic
Authors: Månsdotter A , Fochsen G
Published: October 2022

Background and objectives

The COVID 19 pandemic has highlighted how public health is dependent on many areas of society, and several aspects of public health can be affected. We have evaluated how the COVID-19 pandemic and the measures taken to reduce its spread have impacted public health in Sweden during 2020.

Methods

We systematically compiled international research on the pandemic's impact on public health, we examined living conditions of groups at a particularly increased risk of ill health, and we collected and analysed Swedish data on lifestyles, health, injury, and illness during the pandemic compared to previous years.

Results

Most people have, in one way or another, been affected by the pandemic and by societýs preventive measures. However, some groups have suffered more than others. Groups who were already at an increased risk of ill health before the pandemic have been most affected, e.g. in schools, on the labour market, and in society in general. There is a risk of increased health inequality, not only related to morbidity and mortality of COVID-19 during 2020, but also when it comes to the effects on living conditions.

Conclusions

The consequences of the COVID-19 pandemic pose major challenges for public health, and the measures taken to limit its spread inter-relate with social and economic conditions. In Sweden, health inequalities have remained the same or increased over the years. Our study suggests that the consequences of the pandemic will reinforce health inequalities. It is too early to determine what the pandemic's full impact on public health will be. Nevertheless, health promotion and preventive measures need to be strengthened and prioritized in order to maintain good public health and reduce inequalities.
The Transforming Health Care Systems Partnership – collaboration for improvement post-pandemic
Authors: Montante S
Published: October 2022

Building on the experience and results of important European initiatives like the TO-REACH Action, the new European Partnership on Transforming Health and Care Systems aims to accelerate the sustainable transformation of European health systems. By means of multidisciplinary research with a focus on improving the uptake of innovative solutions by health system actors, including organisational, service, and overarching policy innovations, the partnership plans to achieve access to high quality, sustainable and innovative health care for European populations. This presentation will explore current and upcoming plans for the Partnership, as well as discuss some of the lessons learnt from past initiatives and how these, combined with the experiences from the pandemic, have contributed to shaping the new Partnership's agenda. Inputs from stakeholders in the audience will be collected to inform the Partnership's ongoing learning process.

A country perspective from Slovenia

Vesna-Kestrin Petric

Slovenian Ministry of Health, Ljubljana, Slovenia

Health system strengthening and transformation – Current priorities of the European Commission

Isabel de La Mata

DG SANTE, European Commission, Brussels, Belgium
Air pollution and health – the importance of air monitoring and burden of disease for attaining SDGs
Authors: Martins C
Published: October 2022

Pollution is the worldwide largest environmental cause of disease and premature death, being also considered a risk for planetary health, a cause of ecosystems destruction and intimately linked to global climate change. Pollution is considered costly, with attributable diseases resulting in health-care costs that are responsible for 1.7% of annual health spending in high-income countries. Moreover, in utero and early childhood exposures are responsible for health effects in children. The importance of air pollution as a cause of disease is well reflected in the Sustainable Development Goals (SDG), mainly in the SDG 3, SDG 11, and SDG 15, but indirectly in all the SDGs. To tackle this issue, an integrative and holistic approach linking human and environmental health such as One Health is needed, to provide evidence-based data to support the establishment of reduced air pollutants’ maximum admissible levels. A case-study developed in Portugal in the scope of PMCardImpact project, regarding the exposure of population to particulate matter with a diameter of 2.5 μm or less (PM2.5) and the associated number of cases of cardiovascular diseases will be presented herewith. Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario. This assessment is the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal. With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies.

This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020).
Increase in Mental Disorders During the COVID-19 Pandemic - Role of Occupational & Financial Strains
Authors: Dragano N , Reuter M , Peters A , Schmidt B , Bohn B , Berger K
Published: October 2022

Background

Numerous studies reported an increase in mental disorders during the COVID-19 pandemic, but the specific causes for this increase are unclear. We therefore investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic.

Methods

We analyzed data from the German National Cohort Study (NAKO). Between May and November 2020, 161,849 participants answered questions on their mental state and social circumstances. Responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/financial changes (controlling for covariates).

Results

A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours without short-term working allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model.

Conclusions

Depressive symptoms and anxiety disorders increased in the study population during the first year of the COVID-19 pandemic and occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures. Results suggest that welfare state benefits such as short-time allowance in times of crises may reduce mental load in affected populations.
Risk factors for SARS-CoV-2 infection: a case-control study in college students after vaccination
Authors: Renzi E , Baccolini V , Covelli A , Migliara G , Massimi A , De Vito C , Marzuillo C , Villari P
Published: October 2022

Background

Within the SARS-CoV-2 screening campaign offered through RT-PCR test by Sapienza University of Rome, we conducted a case-control study to identify the risk factors for the acquisition of SARS-CoV-2 infection among university students.

Methods

Positive students identified through the SARS-CoV-2 screening campaign (September 2021 - February 2022) were enrolled as cases and matched to two randomly selected students who tested negative on the same day. The interview questionnaire consisted of 39 questions investigating exposure to modifiable and nonmodifiable risk factors for SARS-CoV-2 in the two weeks before testing. A multivariable conditional logistic regression model was constructed to identify predictors of SARS-CoV-2 infection. Adjusted odds ratio (aOR) and 95% CI were calculated.

Results

Out of 8.730 tests for SARS-CoV-2, 173 students tested positive (2.0%), of which 122 were included in the case-control study (response rate: 70.5%). Most students were female (73.2%), with a mean age of 23.3 years (SD ± 3.6), vaccinated for SARS-CoV-2 (97.8%) and enrolled in non-health faculty (56.8%). At the multivariable analysis, significant positive associations were found with having had contact with a person who tested positive for SARS-CoV-2 (aOR: 3.04, 95% CI: 1.59-5.82) or having been to a disco/nightclub (aOR: 5.37, 95% CI: 2.00-14.38). Instead, being vaccinated against SARS-CoV-2 (aOR: 0.13, 95% CI: 0.01-0.93), having a valid EU COVID digital certificate (aOR: 0.06, 95% CI: 0.01-0.30) and attending lectures in-person (aOR: 0.35, 95% CI: 0.17-0.70) were negatively predictors. No association was found for sex, age, health faculty students, use of public transportation, attendance at restaurants or gyms.

Conclusions

The results highlight how anti-COVID-19 vaccinations and the reasons for students to obtain an EU COVID digital certificate may prevent students from getting infected. In addition, university environment seems to be safe for students.

Key messages

• Promoting SARS-CoV-2 vaccination adherence in the college-age population is crucial to limiting the SARS-CoV-2 spread.

• Attending in-person educational activities in regulated settings (e.g., low occupancy, mask use) may not be a risk factor for COVID-19 infection.
Waning of SARS-CoV-2 IgG antibodies after vaccination: first results from the CoMoLo follow-up 2021
Authors: Kußmaul C , Schaffrath Rosario A , Allen J , Lange M , Koschollek C , Haller S , Schlaud M ,   RKI CoMoLo Study Team
Published: October 2022

Background

In 2020, the study “Corona-Monitoring Lokal” (CoMoLo) assessed seroprevalences of SARS-CoV-2 IgG antibodies in four study locations that were particularly affected by outbreaks in the early stages of the pandemic in Germany. One of the objectives of the 2021 follow-up was to examine the development of immunological parameters over time, including the extent of IgG antibody waning after vaccination.

Methods

Venous blood specimens were collected from a sample of initial study participants over a 2-week period between May and October 2021, with an oversampling of seropositive or previously infected individuals. Levels of IgG antibodies to the SARS-CoV-2 spike protein were measured from serum using Anti-SARS-CoV-2-QuantiVac-ELISA (IgG) tests by Euroimmun. Information on SARS-CoV-2 vaccinations or known infections was collected via online questionnaires or telephone interviews.

Results

A total of 3328 participants (74% response) gave blood specimens for this follow-up study, with questionnaire information available for 2843 (85%) of these. Preliminary analyses suggest that in participants who had received two doses of a vaccine more than 3 weeks before giving blood (n = 1583), IgG levels decreased exponentially by about 9.8% (95%CI 9.1% - 10.4%) with each additional week since the last dose, when controlling for age, sex, and type of vaccine. There was evidence of this waning effect differing by vaccine type. Antibody levels also appear to decline with increasing age, according to preliminary results. Final results of the linear model used to assess the dynamics and predictive factors of antibody levels will be reported.

Conclusions

This follow-up study will add evidence to an improved understanding of antibody waning after SARS-CoV-2 vaccination. Preliminary results are in line with international studies and may be helpful for discussions on potential benefits of further vaccinations in Germany.

Key messages

• Antibodies induced by COVID-19 vaccination wane over time. The magnitude of this effect differs by vaccine type. Antibodies also decreased with increasing age.

• Our results may be helpful for discussions on potential benefits of further COVID-19 vaccinations in Germany.
Long-term immunity after HBV vaccine: shall we consider a change? A 20-year-follow-up study
Authors: Fonzo M , Amoruso I , Baldovin T , Trevisan A , Bertoncello C
Published: October 2022

Introduction

Although vaccines against HBV have been available since the 1980s, the long-term immunity is still debated. When assessing immune persistence, a number of clearly defined variables must be taken into account. Often the expression ‘infant vaccination’ means the administration within the first year of life at any age, but a difference of a few months may imply a different antibody persistence over the years. This study assessed the anti-HBs titre 20 years after the primary vaccination course and estimated the effect of age at 1st dose and time interval between doses on long-term protection.

Methods

Data on age, sex and date of administration were collected. Inclusion criteria: born to negative mother, 3-dose schedule, no previous HBV infection, age at enrolment 18-24 years; age at 1st dose 2-12 months. Titres ≥10IU/l were considered protective. A logistic regression was performed, adjusting for sex, follow-up time and date of 1st dose and analysis.

Results

We included 5,485 participants (64% female). The mean anti-HBsAg increased from 46, 52, 85 to 193IU/l when the 1st dose was administered in the I, II, III or IV trimester of life, respectively. Similarly, the proportion of individuals with titre <10IU/l decreased from 51 to 18% between the two extreme quarters. The risk of a titre <10IU/l decreased with age at the 1st dose (AOR: 0.84; 95%CI: 0.78-0.91 per one-month increase) and time between the 2nd and 3rd doses (AOR: 0.89; 95%CI:0.85-0.94).

Conclusions

The mere presence of a titre <10IU/l does not equate lack of protection. However, antibody levels are very different depending on the actual age of vaccination. One-month delay within the first year is associated with a -18% chance of a titre <10IU/l 20 years later. Although this information needs to be combined with local epidemiology and surveillance to obtain an informed risk-benefit balance, the implications from a public health and economic perspective may be diverse and worth considering.

Key messages

• Still within the first year of life, a delay in the administration of the 1st dose of HBV vaccine and a longer time between the 2nd and 3rd dose imply a higher antibody persistence even 20 years later.

• Considering the local circulation of HBV and surveillance, this result could be taken into account to obtain an informed risk-benefit balance.
Looking for methodologies and data pathways used in research to assess the COVID-19 impact: a scientific literature review
Authors: Feteira-Santos R , Nogueira Dr
Published: October 2022

COVID-19 spread worldwide after the surge of a novel coronavirus infecting humans in late 2019, rapidly becoming a pandemic in early 2020. Then, the scientific community started studying SARS-CoV-2 infection to address the uncertainties around the impact of this new disease on the population health and sustain public health measures to mitigate it. As a result, the research on COVID-19 proliferated fast, and the number of related records also multiplied in research databases. By November 2020, one year after starting the outbreak, PubMed counted more than 80 thousand records, which had already tripled by April 2022. Facing that large body of research, the PHIRI WP5 team deployed a literature review to identify research methods and the research paths from the generation and collection of data used to assess the COVID-19 impact on the population's health and well-being. Consequently, this work aims to describe the evidence gathered according to the location where the research was conducted, its design and statistical methods used to analyse the COVID-19 impact. Therefore, the sample of COVID-19-related records indexed in the PubMed database until November 2020, which concomitantly matched the “data” search term, was considered. As a large sample was retrieved (19837 records), automated text analysis and text mining methods were considered to summarise the information. Then, titles and abstracts were screened for inclusion, and more than half of the initial sample was excluded. The main reasons to exclude were not using original data, not being related to the assessment of the impact of COVID-19 on the population's health or well-being, or not having complete information on the title and abstract. This work is intended to highlight gaps in the evidence on the COVID-19 impact on the population's health and well-being, leading to further research that could enhance the countries’ preparedness for future pandemics.
2.F. Skills building seminar: Health Data Pipelines: moving away from Excel to scalable, insightful and future-proof infostructure
Authors:   Organised by: EUPHA-DH,   Chair persons: Stefan Buttigieg (EUPHA-DH), Juan Rachadell (Portugal)
Published: October 2022

Public Health Data Pipelines are critical in the implementation of scalable Digital Public Health projects as part of the reporting, evaluation and monitoring aspects of any public health intervention. The WHO Europe Programme of Work covering the period 2020 to 2025 puts an emphasis on “developing big-data capacity in surveillance, modelling and policy monitoring”. This workshop will provide an initial insight into the world of Health Data Pipelines and will give you the necessary ingredients to get closer to establishing processes and systems that provide you the right information at the right time and context.

Key messages

• Data Linking is critical in the transition between legacy systems and data sets based on decades old technology to reliable and robust information infrastructure (infostructure).

• Kicking off the necessary internal discussions to consolidate data and processes into health data pipelines do not require advanced technical knowledge.
2.G. Workshop: The development of HTA collaboration in Europe: where we are and where we are going
Authors:   Organised by: EUPHA-HTA; EUPHAnxt,   Chair persons: Chiara de Waure (EUPHA-HTA), Elena Petelos (EUPHA-HTA)
Published: October 2022

Health decision-making should be always well-informed. This draws the attention on the need to make the best use of available evidence in respect to different clinical and non-clinical issues to make a value-based allocation of resources. Health Technology Assessment (HTA) is a method for supporting evidence-informed health policymaking as it is defined as a multidisciplinary process that uses explicit methods to determine the value of a health technology at different points in its lifecycle. The role of HTA is of utmost importance at European Union level considering that citizens have the right to access healthcare in any EU country with reimbursement by their home country. Therefore, Member States (MS) cooperation in the evaluation of health technologies is envisaged to ensure safe, high-quality, and efficient healthcare. Several efforts have been put in place at EU level to make this collaboration possible. The cross-border healthcare directive 2011/24/EU have led to the establishment of a voluntary network of MS to facilitate their cooperation and the exchange of scientific information. This network has been supported by another network, namely the European Health Technology Assessment Network (EUnetHTA) that was launched in 2006 with the aim to increase the contribution of HTA to decision-making in EU MS, strengthen the link between HTA and health policymaking, and reduce the overlap and duplication of HTA efforts by promoting a more effective use of resources. EUnetHTA has created a long-lasting Joint Action that has developed principles, methodological guidelines, as well as functional online tools for the sharing production of HTA. In the meantime, starting from 2018, a proposal for an EU regulation on HTA has been discussed within the European Commission first and the European Council and Parliament later. The discussion led to the approval of the Regulation (EU) 2021/2282 on health technology assessment (HTAR) that entered into force on 11 January 2022 and will apply from 12 January 2025 onwards. The HTAR calls for mandatory participation in and use of joint clinical assessments at MS level opening a new era for HTA at EU level. In order to make public health professionals ready for the challenge, this skill-building seminar will provide the audience with basic knowledge in respect to the objective, the application, the methods, and the history of HTA at European level. After two formal presentations on these issues, a case study will lead the following interactive discussion with the audience.

Key messages

• Health decisions should be informed by the determination of the value of health technologies through shared methods, such as Health Technology Assessment.

• Collaboration on Health Technology Assessment at European level has had a long-lasting story and is now looking out into a new challenging era that will be the EU regulation being implemented.
Why and how can HTA support evidence-informed health policymaking?
Authors: Gutiérrez-Ibarluzea I , Ibargoyen-Roteta N , Benguria-Arrate G , Galnares-Cordero L
Published: October 2022

Issue

Health care systems actors are in need to take decisions every day. The basis for a good decision is to consider all the factors, the value of the action, the values that support a “go” or “not go” decision and the intended and unintended consequences that those decisions could entail. Furthermore, understanding decisions implies knowing which the context and the circumstances that surround decisions are.

Description of the issue

HTA should cover all those aforementioned aspects and make it along the life cycle of health technologies. Thus, it should be the pivotal element that health systems should look at when making decisions. Nevertheless, this is not the case in all the countries/regions or health systems. Empirical research (facts) and normative inquiry (values) are not consistently considered and holistic approaches to the determination of value are lacking.

Results

Policymakers, health care systems and HTA bodies are differentially approaching to value determination, and, in most cases, this is not explicitly shared with the stakeholders concerned. The consideration of the implication of life cycle concept is not well addressed and decisions are mainly focused on introduction and implementation, meanwhile decisions on deletion or modification of use are lacking, although relevant for health systems sustainability. Mostly systems failed by individual determination of technologies’ value without considering that they are used on systems in combination to other technologies, by different professionals, applied to different patients and within different contexts.

Lessons

There is a need for a holistic approach of value determination. Likewise, the life cycle concept offers a unique opportunity to promote proactive actions in improving added value generation for technologies under development. Similarly, the assessment of value once solutions are introduced is substantially a way to improve systems’ outcomes and their efficiency.
Building a qualitative systems map: applying systems thinking to the commercial determinants of health and industry influence on health policy
Authors: Bertscher A , Nobles J , Zatonski M , Van Den Akker A , Dance S , Bondy K , Gilmore A , Bloomfield M
Published: October 2022

Background

Unhealthy commodities are major drivers of the global burden of noncommunicable diseases. Commercial actors attempt to influence policy to undermine regulation and existing literature draws attention to the underlying macro-level factors that enable this influence. Public health literature also suggests that industry adapts to regulation and such influence may thus be considered a complex adaptive system. Therefore, this study aimed to build a qualitative systems map to help communicate the complexity of industry influence and develop a tool to facilitate the identification of interventions in follow up research.

Methods

In-person group model grouping workshops were adapted for the online environment. A preliminary qualitative systems map was developed by synthesising two recent studies to facilitate workshop discussions and expedite the mapping process. Twenty-three small group system mapping workshops were conducted with a total of 52 stakeholders, representing researchers, civil society, and public officials from various geographical regions.

Results

The qualitative systems map identifies five pathways through which industry influences policy: a) direct access to public sector decisionmakers; b) creation of confusion and doubt about policy decisions; c) prioritisation of commercial growth; d) industry leveraging the legal and dispute settlement processes; and e) industry leveraging policymaking rules and processes. The pathways contribute to perpetuating macro-level factors that enable industry to deploy practices to influence policy.

Conclusions

A system thinking approach can be applied to industry influence on health policy to depict a complex adaptive system. Interventions need to take into consideration the system's complexity and adaptivity. Further research is needed to test, and improve the systems map and identify interventions to achieve systems change.
Corporate capture of public health by food industries in Europe
Authors: Royo Bordonada M
Published: October 2022

Corporate capture is the deliberately planned process whereby political decisions respond to a particular interest of a private nature, in detriment to the public interest. The result is an unjust regulation or the absence of regulation where this is necessary for the protection of the common good. Corporate capture of public health has to do with commercial determinants of health, such as alcohol, tobacco, sugar-sweetened beverages and ultra-processed foods. Capture-related actions are targeted at civil society, experts, public-health officials, civil servants and politicians. These actions range from material (corruption, revolving doors and donations to political parties) to intellectual (distortion of science and professional training), social (control of information and communication) and/or cultural (group identity, status and relationship of the regulator with the representatives of private corporations). The most common capture strategies are aimed at biasing scientific results, creating consumers from an early age, promoting a good image of corporations, questioning the legitimacy and appropriateness of governmental intervention aimed at regulating their activity, controlling professional education; and exerting pressure on governments and international bodies. To illustrate this phenomenon, we present findings from several examples of corporate capture of food policies in Europe. Preliminary results from publicly available information suggest that most of the mentioned tactics were used in Europe in order to block nutritional profiles, health warnings on food and effective food advertising regulations. We suggest implications for how European legislation can better protect European citizens, especially children, from vested interests aimed at promoting the consumption of unhealthy food and beverages.
2.Q. Workshop: Prepared for the unexpected: using foresight to address uncertainty
Authors:   Organised by: RIVM (Netherlands),   Chair persons: Henk Hilderink (EUPHA-FS), Ana Vieira (Netherlands)
Published: October 2022

All future trends carry uncertainty in them. For example, the COVID-19 pandemic showed great uncertainty about current and future health impacts and how the virus may directly impact our health. Foresight (as a systematic, participatory, future-intelligence-gathering and medium-to-long term vision-building process aimed at enabling present-day decisions and mobilising joint actions) explicitly addresses uncertainty. Doing a foresight study one has to deal with different sources of uncertainty. Next to commonly known statistical uncertainty, foresight studies have to deal with cognitive uncertainty, i.e. uncertainty related to the limited knowledge that we have regarding the complexity of the underlying system or limited knowledge of what future economic growth will be. A better understanding of the location, level, and nature of the cognitive uncertainties helps assess the robustness of future scenarios. In addition to cognitive uncertainty, normative uncertainty are distinguished. This refers to uncertainty related to differences in what we consider a desirable future. Especially in the field of public health people differ on what they consider to be “good health”. In this workshop, we will focus on the different aspects of uncertainty and how they are considered in existing foresight studies. The workshop will start with an interactive Mentimeter session to better understand how the audience is familiar with foresight and uncertainty. Then, a brief presentation is given as introduction to foresight and a systematic way of accounting for uncertainty, explaining the basic concepts to level understanding of the audience. This is followed by a presentation of a Foresight study (FRESHER) that addresses cognitive uncertainties consistently and systematically. The second foresight study (Dutch PHFS, RVIM) is a good example of how normative uncertainties are considered. Finally, the last presentation (CEG-IST) gives the policy perspective about how policy makers can incorporate uncertainty, as modelled through foresight, into policy evaluation. The workshop will be concluded by a discussion with the three presenters on the lessons learned regarding foresight and uncertainty.

Key messages

• Foresight studies addressing uncertainty are essential to be better prepared for the future.

• Acknowledging different types of uncertainty is needed to support foresight-informed policy making.
Health information system (HIS) assessments as the starting point for HIS strengthening
Authors: Ortiz David
Published: October 2022

One of main the HIS strengthening tools applied by WHO-Euro is the ‘Support tool to assess health information systems and develop and strengthen health information strategies’, which was first published in 2015 and updated in 2021. The support tool comprises two main parts: it provides guidance firstly for performing an overall assessment of the full HIS, and secondly, for the subsequent development of an HIS strategy. The common mode of application of this tool is an external HIS assessment by a WHO team and a subsequent country-led process of HIS strategy development. So far, experience in the field has been gained mainly with the assessment part of the tool, which has been applied in 15 MS. The assessment process starts with a preparatory desk review, followed by a country visit during which semi-structured interviews are held with key HIS stakeholders. The guidance for the interviews consists of a core module and several add-on modules. The aim of the core module is to provide an overview of the functioning of the entire national HIS, while the add-on modules shed more light on specific parts or functions of the HIS, such as noncommunicable diseases monitoring, human resources for health or health data governance. The core module forms the basis of the HIS assessments, and one or several add-on modules can be added to it, according to the needs of the assessed country. The country visit is finalised with a multi-stakeholder debriefing. After the visit, a report is written with a summary of the situation in the country including an HIS maturity score, an analysis of strengths, weaknesses, opportunities, and threats (SWOT), and recommendations for improvement for the short, medium, and long term. In this presentation, we will explain the methodology of the assessment tool, and reflect on its added value as well as challenges encountered when applying it in practice.
Long COVID and NCDs: the Elephant in the Room
Authors: Nagyova I
Published: October 2022

Issue/problem

COVID-19 has now emerged as a public health concern that not only disrupted healthcare services of people living with non-communicable diseases (NCDs) but likely also increase the burden of NCDs.

Description of the problem

Before the pandemic, SDG target 3.4, which calls for a reduction in premature mortality from NCDs by one third by 2030, was expected to be achieved by 17.5% of countries, and a further of 23% could achieve the target with a slight acceleration in decline. Currently, most countries are off track due to disruption of healthcare services for people with NCDs, overstretched health systems, and fewer resources than before the pandemic. In addition, only around one in four people who had COVID-19 reported feeling fully recovered within a year of being discharged from hospital. The adverse health effects from long COVID range from ‘invisible symptoms’ such as fatigue and difficulty concentrating, to neurological and neuropsychiatric symptoms, respiratory and cardiovascular problems, and metabolic disease.

Results

The COVID-19 pandemic has shown that siloed programmes are increasingly unfit, and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Cost-effective, feasible, and relevant interventions that target both physical and mental health impairments are urgently required.

Lessons

By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Protecting current investments and scaling up cost-effective public health interventions is especially crucial in the context of long haul COVID and NCDs. Policy makers and planners will need concrete guidance for making progress on SDG target 3.4, often with overburdened health systems and scarcer resources.
Making the case for the governance of (digital public) health futures
Authors: Wong B
Published: October 2022

Digital and data tools are fundamentally changing approaches to health and the design of health systems, but governance models have neither followed nor kept up with the pace of innovation. In response to this challenge, The Lancet & Financial Times Commission on Governing health futures 2030: Growing up in a digital world explores the convergence of digital health, artificial intelligence, and other frontier technologies with universal health coverage to support attaining the SDG 3. Children and young people are crucial groups requiring particular attention to ensure that no one is left behind in achieving universal health coverage and SDG 3 amidst the digital transformation in health. Today, there are 1.8 billion people between the ages of 10 and 24 - the largest youth population in history - 90 percent of whom live in developing countries. This cohort represents an unprecedented powerhouse of human potential and digital engagement that could transform health to reach sustainable development goals. This presentation introduces several key findings from the Commission's report which pertain to the governance of (digital public) health futures amidst digital transformations in health. It will highlight how human-centred approaches to health are vital to navigating the digital transformations and maximising their benefits for population health and well-being. Further, it will provide an action plan for meaningful youth engagement in the design, development, implementation, and evaluation of digital public health policies, programmes, and services.
Association between socio-economic deprivation and AHRQ composite indicator during pandemic
Authors: Cedrone F , Di Giovanni P , Di Martino G , Romano F , Staniscia T
Published: October 2022

Background

The Agency for Healthcare Research and Quality (AHRQ) identifies preventable hospitalizations as proxy of potentially low-quality of care. Previous studies showed as socio-economic status was associated to poor diseases outcomes and to the performance of health services. Recently a particular attention was focused on the effect of the pandemic on this context. The aim of this research is to analyze the association between poor quality of primary care and socio-economic status before and during the pandemic.

Methods

A retrospective observational study was conducted in Abruzzo Region, Italy. Hospital discharge records (HDR) of two different periods were selected: from April to December for 2019 and 2020. The aggregate Prevention Quality Indicator 90 (PQI-90) has been coded according to the indications of the AHRQ. The Italian socioeconomic deprivation index (DI), divided in quintiles (from 1st less deprived to the 5th most deprived) was attributed to all patient, based on the municipality of residence. A multivariate logistic regression model was performed to evaluate the association between PQI-90 and DI.

Results

Totally were analyzed 253,063 HDR, of which 14,845 attributable to the PQI-90. By correcting for gender, age and number of comorbidities, the DI was not associated with the PQI-90 during 2019. During 2020 the PQI-90 was associated to 4th DI quintile (aOR 1.19;95%CI 1.09-1.30) and 5th DI quintile (aOR 1.13; 95%CI 1.03-1.23), compared to the 1st quintile.

Conclusions

The impact of the pandemic on primary care has been substantial. Compared to the pre-pandemic era, during the pandemic, an association between potentially poor quality of care and the most disadvantaged socio-economic areas has been shown in Abruzzo. This evidence must be an interesting starting point for health planning in order to fight against inequalities in health services access.

Key messages

• The reduction in the primary care quality during pandemic caused potentially preventable hospitalizations and it was associated to socioeconomic deprivation.

• The analysis of hospital admission linked to context indicators such as the deprivation index, can be a useful tool for the policy maker in order to reduce healthcare inequalities.
Socio-economic inequalities in mental health: a new framework and analysis across 113 countries
Authors: Henking C
Published: October 2022

Background

Socio-economic inequalities in common mental health disorders (CMDs) cut across each step in the cascade of care: (1) Less affluent individuals have a higher prevalence of CMDs, (2) are less likely to utilise treatment and (3) might benefit less from treatment when they do receive it. Here, we propose a new framework for distinguishing between these three types of inequalities in CMDs and test if such ‘triple inequalities’ exist globally and how they vary across countries.

Methods

We use the Wellcome Global Monitor 2020 (N = 119,088 in 113 countries) to test if socio-economic factors, psychological factors (stigma and trust) and country-level factors (GDP, GINI and health expenditure) predict CMD lifetime prevalence, utilisation and perceived helpfulness of talking therapy and medication. Multi-level logistic regression models were used.

Results

As predicted, people with higher household income are less likely to experience anxiety or depression (OR = 0.90 for each income quintile, p < 0.01), more likely to talk to a mental health professional (OR = 1.05; OR = 1.34 for higher education, p < 0.01) and more likely rate this treatment as very helpful (OR = 1.06, p = 0.02) across countries. In contrast, income is not linked with utilisation (OR = 0.99, p = 0.18) and helpfulness of ‘taking medication’ for CMDs (OR = 1.02, p = 0.26). In LMICs, the highly educated take less medication (OR = 0.74, p < 0.01). Local stigma reduces utilisation (OR = 0.95) and helpfulness of talking therapy (OR = 0.77), while trust in health practitioners increases both (OR = 1.07 util. and OR = 1.31 helpf., p < 0.01 in all cases).

Conclusions

Three types of socio-economic inequalities for CMDs (in prevalence, talking therapy utilisation and helpfulness) deepen disadvantages for the less affluent across 113 countries. For pharmacological treatment, inequalities in utilisation and helpfulness are weaker and have a different social gradient in LMICs. Here, less educated people are more likely to take medication.

Key messages

• Three types of socio-economic inequalities in common mental health disorders (in prevalence, talking therapy utilisation and helpfulness) exacerbate disadvantages for less affluent individuals.

• These Inequalities in CMD treatment utilisation and helpfulness are stronger for talking therapies than for medication, and depend on country contexts, stigma and trust in health practitioners.
Diabetes Prevention Programme and socioeconomic inequalities in Type 2 Diabetes in England
Authors: Chatzi G , Whittaker W , Chandola T , Mason T , Soiland-Reyes C , Sutton M , Bower P
Published: October 2022

The National Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type 2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH, HbA1c 42-47 mmol/mol or 6.0-6.4%). How this programme affects inequalities by age, gender, disability, ethnicity, or deprivation is not known. We used multinomial logistic regression models to compare population characteristics at three stages along the prevention programme pathway: prevalence of NDH [using survey data from UK Household Longitudinal Study (N = 794) and Health Survey for England (N = 1,383)]; identification in primary care and offer of the programme [using administrative data from the National Diabetes Audit (N = 1,267,350)]; and programme participation [using programme provider records (N = 98,024)]). Younger adults (aged under 40) [4% of the NDH population (95% CIs 2%-6%)] and older adults (aged 80 and above) [12% (95%CIs 10%-14%] were both underrepresented amongst DPP participants [2% of DPP participants (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.7%-8.3%) respectively]. People with disabilities were underrepresented in the DPP [15% (95%CIs 14.9%-15.1%) vs 60% (95%CIs 58%-62%)] compared to the general population. People living in more deprived areas were under-represented [14% (95% CIs 13.7%-14.3%) vs 20% (95%CIs 16%-24%) in the general population]. Ethnic minorities were overrepresented [36% (95%CIs 35.8%-36.2%) vs 13% (95%CIs 9%-17%) in the general population] among DPP referrals, though the proportion dropped at programme completion stage [19% (95%CI 18.5%-19.5%)]. The DPP has the potential to reduce ethnic inequalities but may widen socioeconomic, age, and disability-related inequalities in T2DM. Whilst ethnic minority groups are overrepresented at identification and offer stage, efforts are required to support the completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM.

Key messages

• The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability.

• The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.