bluuebunny/crossref_metadata_2025 huggingface dataset:
The challenge of tackling weight stigma through the legal system in Germany
Authors: Schorb F
Published: October 2020

Weight stigma is a growing public health problem that has not yet received the attention it deserves. The UN and the WHO both identified discrimination as a crucial obstacle in solving health inequalities. The Lancet recently acknowledged the central role of discrimination in health inequality and specifically called to address weight stigma. Weight stigma is responsible for a vast array of health problems including but not limited to high cortisol, high blood pressure, mood and anxiety disorders, and depression. Weight stigma is correlated with eating disorders, the avoidance of exercise, and further weight gain. Weight stigma in healthcare affects the quality of services and leads to the avoidance of health consultations. Anti-discrimination laws are one way of dealing with the harmful effects of stigma. They have proven to be effective in rising awareness for discrimination, thereby directly and indirectly helping those most affected by unequal treatment.

Germany introduced the General Equal Treatment Act in 2006. More than ten years later the effects of the law were evaluated. With regard to weight stigma important obstacles were found. Since weight is not a protected characteristic in the law, people who experience weight stigma can only make their claims by referring to disability-related discrimination, leaving many who suffer from weight stigma but aren't classified or do not perceive themselves as disabled at the side lines.

If public health wants to successfully challenge the obesogenic environment without harming people of size meaningful measures to avoid discrimination have to be established. But in order to successfully implement laws tackling weight discrimination it is necessary to cover weight stigma explicitly. There is already a high level of support for these kinds of measures in a variety of countries, and there are examples of successfully implemented anti-discrimination laws that include weight as a protected characteristic.

Key messages

It is impossible to successfully tackle the obesity epidemic without confronting the parallel epidemic of weight stigma, thereby removing the burden of change from those experiencing mistreatments. Weight stigma is a crucial public health problem that can be tackled by anti-discrimination laws. In order to be efficient these laws have to explicitly include weight as a protected characteristic.
Population trends and burden of disease profile in Somalia from 1990 to 2017
Authors: Mehl T , Senkubuge F , Cronje T
Published: October 2020

Background

In Somalia, general health indicators and information on the health trends are lacking. Somalia and countries globally aim to attain the United Nations (UN) Sustainable Development Goals (SDGs) for health. This study aims to describe the trends in population health and disease burden in Somalia in the past 27 years and show the pattern of health transition across the country from 1990 to 2017.

Methods

This cross-sectional study retrieved secondary data from the Institute for Health Metrics and Evaluation (IHME) system. All health-related data were cleaned, captured, and descriptively analysed through SAS 9.4. We analysed Mortality rates, Disability-adjusted life years (DALYs), Years of Life Lost because of premature death (YLLs), Years lived with disability (YLDs), Health-Adjusted Life Expectancy (HALE), and Age-Standardised Death Rate (ASD). Causes and risks of mortality and morbidity were categorised in communicable diseases (CMNN), non-communicable diseases (NCD) and injuries.

Results

Life expectancy has improved from 52.5 to 60.7 years old for females and 48.0 to 56.6 years old for males. The total causes of DALYs declined by 52% (from 120 860,71 to 58 321,04); YLD declined by 8% (from 9 957,15 to 9 152,86); and the YLLs declined by 54% (110 903,56 to 49 168,18) for both sexes. The maternal mortality rate declined by 34% (522,99 to 343,86) and under 5 mortality rate by 64% (5 176,54 to 1 899,17). CMNNs was the main cause of DALYs, NCDs for YLDs and CMNNs for YLLs in 2017. HALE saw a steady increase. CMNNs was the main cause of ASD in 1990 then declined and NCDs became the main cause of ASD in 2017.

Conclusions

Somalia's health status has improved between 1990 and 2017, although certain geographically and societal factors still play an important role in rates not changing. Strengthened policies to address health and developmental challenges within Somalia is vital in achieving the SDG health goals.

Key messages

An analysis of the health system in Somalia was used to make recommendations and improvements in and for health outcomes. Information on health systems is an important topic and due to the challenges and changes in population demographics and patterns of disease, improving health care in a country like Somalia is vital.
Childhood bereavement and adult mortality: A 65-year follow-up of the Stockholm birth cohort
Authors: Hiyoshi A , Berg L , Grotta A , Almquist Y , Rostila M
Published: October 2020

About 3% of children in Sweden, 4-5% in the UK, and 5% in the US experience the death of a parent during childhood. The event is highly unexpected and stressful and could have long-term social and health consequences across the life course. To alleviate grief, bereaved children may engage in health-damaging behaviours such as smoking, alcohol or drug abuse, violence, delinquency and risky sexual behaviour. Few studies have been able to study health consequences by childhood parental loss and mechanisms explaining associations across the life course. Using the Stockholm Birth Cohort Study (SBC), including all children born in 1953 in the metropolitan Stockholm area, we examined whether childhood bereavement is associated with all-cause mortality until age 63 and whether various pathways (e.g. economic, behavioral and social circumstances) account for the association. 15,117 individuals were followed between 1953 and 2018 using survey data and national registry data. We used Cox proportional hazard regression and mediation analysis for survival analysis to decompose direct and indirect effects. The death of a parent was associated with 40 to 50% elevated risk of mortality in offspring, and the association was mediated through delinquent behaviour in adolescence and income in adulthood especially for male offspring. Our findings suggest that parental loss has a life long impact on the mortality risk of bereaved children and that interventions targeting delinquency and socio-economic circumstances in bereaved children could be successful in reducing their excess mortality risk.

Key messages

Bereavement in childhood has a life-long impact on health. Interventions targeting delinquency and socio-economic circumstances could be successful in reducing the excess mortality risk.
Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil
Authors: Ishitani L , Teixeira R , Abreu D , Paixão L , França E
Published: October 2020

Background

Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil.

Methods

Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence.

Results

In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9).

Conclusions

Analysis of GCs is essential to evaluate the quality of mortality information.

Key messages

Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.
Challenges and opportunities in promoting health equity for migrants
Authors: Nordström C , Ingleby D , Dias S , Magnus J , Eikemo T A , Kumar B
Published: October 2020

Issue

What has to be done to achieve health equity for migrants? International bodies have published many weighty declarations and recommendations to this end, but these need to be ordered and synthesised. A recurring theoretical problem is how to disentangle the health effects of socioeconomic position (SEP) and migrant status, in order to develop policies that effectively address both factors.

Description of the problem

As part of the Policy Framework for Analysis (PFA) for Work Package 7 of the Joint Action on Health Equity Europe (JAHEE), key policy documents between 2007 and 2018 were reviewed to form a ‘Road Map' from which a coherent synthesis was extracted. The PFA also developed a model for conceptualising the joint influence of SEP and migrant status. What is the relationship between these, and what policy approaches does it imply?

Results

The main recommendations of the ‘Road Map' were summarised in two categories: ‘upstream' measures (data collection and research, governance, and intersectoral action to tackle social determinants of health) and ‘downstream' ones (access to health services, responsiveness to migrants' needs, and attention for vulnerable groups). In the past, ‘upstream' measures have been unduly neglected. According to the proposed model, migrant status can have both direct effects on health and indirect ones that are mediated via SEP. Along the indirect pathways, migrants may suffer from increased exposure and/or increased vulnerability to health threats associated with low SEP.

Lessons

A high degree of consensus already exists about health inequities affecting migrants and the measures needed to tackle them. The urgent challenge at the moment is to put these conclusions into practice. To this end, there is little point in tackling socioeconomic inequities and those linked to migration and ethnicity as though they had nothing to do with each other.

Key messages

The recommendations of international bodies on migrant health from 2007-2018 can be summarized in three ‘upstream’ measures and three ‘downstream’ ones. Promoting health equity for migrants requires breaking down the silos in which work on migration and on SEP has hitherto been carried out.
Ensuring access to medicines at a fair price? Innovative contracting experiences in France
Authors: Alaoui I , Izambert C , Toullier A
Published: October 2020

Issue

Innovative contracting models are developed to ease price-setting negotiations in case an extremely expensive drug has not proven sufficient efficiency in clinical trials. As disruptive HIV treatments are expected in the near future, French patient organizations evaluated the ability of these innovative contracts to ensure accessible medicines at a fair price.

Description

Performance-based schemes condition prices paid by the State to the efficiency of the medicine observed through real-world data. In France, thirteen performance-based contracts have been concluded between 2008 and 2015. They are presented as a triple solution: innovative treatments are available to patients, manufacturers access markets, and states ensure healthcare within limited budgets. Establishing the added value of these models implies determining if they allow rapid access to treatments with substantial savings for payers, while ensuring rigorous price and cost transparency.

Results

Performance-based contracts indeed ensure patient access to treatments, but other mechanisms (such as temporary use authorizations) already serve this purpose. Regarding expenditure reduction however, these schemes have not proven their worth. The Court of Auditors' evaluation showed they do not generate substantial savings, as final prices correspond to those that would have applied with the European price guarantee. Lastly, as contracts are protected by business secrecy, the public cannot access neither to actual prices negotiated by payers, nor the amount of public investment that have been used for the research and development of the drug.

Lessons

The derogatory nature of performance contracts invites us to consider them on a case-by-case basis if ensuring access to a specific innovation is necessary. These contracts are certainly innovative, but they cannot be presented as technologies providing access at a fair price. Finally, their contractual and derogatory nature raises serious transparency issues.

Key messages

Performance-based contracts should be considered as alternatives to existing administrative channels provided that they lead to substantial savings and are drawn up in full transparency. Patient organizations need to assess innovative schemes such as performance-based contracting to ensure access to treatments without undermining historical struggles for fair and transparent pricing.
The economic impact of air pollution: a European assessment
Authors: Conti S , Ferrara P , D'Angiolella L S , Lorelli S C , Agazzi G , Fornari C , Cesana G , Mantovani L G
Published: October 2020

Background

In 2017, the Global Burden of Disease Study estimated that in Europe 0.42 million deaths and 8.9 million disability-adjusted life years were attributable to air pollution. Monetizing this burden is a key step for estimating benefits of exposure reduction strategies. However, robust and synthetic estimates of direct (e.g. due to hospitalizations or medications) and indirect (e.g. due to premature mortality or loss of productivity) health-related costs of air pollution seem to be still lacking. We carried out a systematic review, aimed at identifying evidence from research in Europe.

Methods

We searched 5 electronic databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web Of Science) in which we applied algorithms tracing keywords such as “cost of illness”, “health care costs”, “economics” and synonyms, together with “air pollution” and synonyms. We limited our search to articles written in English and Italian, without date restriction.

Results

The initial search retrieved 2420 records. 200 were classified as relevant, and 38 fulfilled inclusion criteria. Most of them (68%) were published after 2010. 26% were multi-country studies, while the remaining focused on a single country or city. Investigated pollutants were usually particulate matter (79% of the studies) and nitrogen oxides (37%). The approaches to the economic analysis were heterogeneous: estimates could include direct and/or indirect costs. Among the studies, the most comprehensive one (12 countries) estimated that complying with WHO guidelines would avert €31 billion yearly, of which €19 million due to hospitalizations.

Conclusions

Over the last decade, progress has been made in evaluating the economic burden of air pollution. However, estimates based on indirect costs are affected by high levels of uncertainty, while those based on direct costs are more robust and should be further investigated, since they are crucial information for healthcare policy makers.

Key messages

Air pollution poses a high economic burden on European countries, mainly due to social costs. More attention should be devoted to estimating direct healthcare costs of air pollution, in order to properly inform policy makers about the impact on healthcare systems.
Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries
Authors: Waitzberg R , Schmidt A E , Blümel M , Barbabella F
Published: October 2020

Background

Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). The objectives of this cross-country study is to highlight to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.

Methods

Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries.

Results

11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.

Conclusions

A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Key messages

A minority of LTC systems in OECD countries fully meet distributional equity in allocation of resources across payer agencies. Countries that value distributional equity should harmonize the eligibility criteria to LTC at the national level and allocate funds according to needs across regions.
What is the health-related burden of EU-Candidate Countries? A snapshot of public health indicators
Authors: Šantrić Milićević M , Boskovic N , Vasic M , Bjegovic-Mikanovic V , Stamenkovic Z , Todorovic J , Terzic-Supic Z
Published: October 2020

Background

Various studies have shown the ebb of the political spectrum when determining entry into the European Union. The objective of this study was to determine the key differences between the European Union (EU) and the current EU-candidate countries through the lens of the financial burden of the public healthcare system.

Methods

The most complete and available EUROSTAT data describing health-related burden (13 indicators) for current EU- candidate countries (Serbia, Turkey, the Republic of North Macedonia and Montenegro) were evaluated and compared.

Results

Total health expenditures (Purchasing Parity Power) per capita in EU candidate countries is almost one-third of that in the EU. General government health expenditure for all four countries was below the EU average with Montenegro spending the highest and North Macedonia spending the least. Turkey, with a significantly higher gross domestic product (GDP), allocated the smallest percentage of its GDP on health (4.31%), while Serbia the highest percentage (8.55%), both being below the EU average (10%). The private health expenditure for all of the countries was higher than the EU average, with Serbia's proportion being double that of the EU average. Assessing the burden of disease for these countries, Serbia has the highest disability-adjusted life years (DALY) rate per 100,000 (25,468.38), while the average DALY rate of the other three countries was 23,656.33 and the EU average was 16,390. Turkey and North Macedonia tying for the highest infant mortality rate, three times the EU average. Of the candidate countries, Serbia contains the highest density of physicians and nurses and Turkey, the lowest.

Conclusions

The process of entry to the EU is a varied experience for each country since attaining benchmark standards affects the time needed to achieve them. This study on a selected number of public health indicators contributes to the evidence on the current health-related burden of EU-candidate countries.

Key messages

All EU candidate countries have a much higher burden of disease and a much lower health workforce and health expenditure than the EU average. The challenge for countries in the accession process is to reach a level of quality and achievement in health care in the EU.
Do you Vape With Aloha?: How culture and place are used to spread misinformation on Instagram
Authors: Sentell T , Kearney M , Hazen A , Dela Cruz M R , Yamauchi J , McHenry L , Rodericks B , Massey P
Published: October 2020

Background

Forty-two percent of high school teens in Hawai'i have tried e-cigarettes, double the United States' national average. Native Hawaiians have higher use than other racial/ethnic groups. While Hawai'i state law prohibits tobacco sales to anyone under 21, many Hawai'i adolescents purchase e-cigarettes on the internet, often through social media.

Methods

We collected 717 public Instagram posts from April and December 2018 geotagged in Hawai'i that mentioned one or more hashtag search terms (e.g., #vape, #ecig). All relevant, working posts (n = 476) were manually coded for text and image characteristics.

Results

Over 80% of posts were from vape shops (n = 389 of 476;81.7%). Caption text commonly mentioned brand names (n = 409;85.9%), vape shop names (n = 379;79.6%), and flavors (n = 103;21.6%). The most frequent image elements were logos (n = 395;82.7%), e-cigarettes (n = 324;68.1%), and flavors (n = 110;23.1%). Less than one in 50 (n = 9;1.8%) included caption text warnings.

One in five posts (n = 94,19.7%%) featured content specific to Hawai'i including references to Native Hawaiian culture, flavors and foods, scenery, plants, animals, and language. For example, “Hawai'i Nei...Stay Blessed n Vape With Aloha” or “Ma'o Hau Hele” is the state flower of Hawaii, combined with a refreshing sweet raspberry it makes the perfect balance of flavor.” User engagement (i.e., likes) varied, with a median of 17 likes per post (range: 0-308). Posts with Hawaiian cultural elements received significantly more likes than other posts (median: 22 versus 16;p=0.0047).

Conclusions

Culture is a critical strength that can support positive health outcomes in many communities. Vape shops and product promoters explicitly misappropriated Native Hawaiian culture to sell e-cigarettes on Instagram, while downplaying known harms. Adolescents and young adults may be particularly vulnerable given social media's role as a powerful health behavior influence and an e-cigarette purchasing source.

Key messages

Health misinformation is contextualized within culture and place in a way that is compelling to users, may put youth at particular risk, and can perpetuate health disparities. Our study supports tailored health campaigns and interventions for local communities and cultures to combat such online misinformation.
Developing a core set of indicators for quality assessment of cancer genetic services
Authors: Unim B , Sindoni A , Pitini E , Vacchio M R , Marzuillo C , De Vito C , Villari P
Published: October 2020

Background

One of the major challenges of personalized medicine is how to assess the quality of genetic services offered both in public and private sectors. Although the quality of genetic services can be assessed and compared with structure, process or outcome measures, a consensus on the appropriate quality assessment measures is lacking worldwide. The aim of the study is to develop a core set of indicators for the quality assessment of genetic services providing testing for breast and ovarian cancer (BRCA1/2 testing).

Methods

In the first phase, a literature review was performed to identify genetic services providing BRCA1/2 genetic testing in Europe. In the second phase, structural, process and outcome measures retrieved from the literature records will be rated, with a 5-point Likert grading scale, by members of multinational genetic associations in a three-round Delphi survey. The survey will also accommodate quality assessment measures proposed by the participants. In the last phase, the feasibility of using a core set of indicators will be assessed across European countries.

Results

The literature search yielded 92 relevant records published 2000-2019, in English or Italian. The records reported outcome measures (92/92) and, to a lesser extent, process (80/92) and structure measures (71/92). An ad hoc data extraction form has been developed and the evaluation of the literature records is ongoing. Highly rated measures obtained through consensus among genetics professionals will form the core set of indicators for quality assessment of genetic services providing BRCA1/2 genetic testing.

Conclusions

The development of a standardized set of indicators for the assessment of genetics services is an essential step forward in defining common quality standards of the services in Europe. It will also facilitate direct comparisons across countries, highlighting examples of good practices and points of improvement for currently implemented genetic services.

Key messages

A minimum set of indicators for the assessment of genetics services is required to guarantee quality standards of the services across European countries. A core set of indicators will facilitate direct comparisons across European countries, underlining good practices and points of improvement for currently implemented genetic services.
The burden of cancer in Belgium, 2004-2017
Authors: Cornez A , Silversmit G , Gorasso V , Grant I , Wyper G M A , De Smedt D , Devleesschauwer B , Speybroeck N
Published: October 2020

Background

Monitoring the health status of a population requires consistent and comparable data on the morbidity and mortality impacts of a disease. The Disability-Adjusted Life Year (DALY) is an increasingly used disease burden indicator, combining healthy life years lost due to living with disease (Years Lived with Disability; YLDs) and due to dying prematurely (Years of Life Lost; YLLs). In Belgium, as in many other developed countries, cancer is a major contributor to the overall burden of disease. To date, however, local estimates of the burden of cancer are lacking.

Methods

We estimated the burden of 48 cancers in Belgium from 2004 to 2017 in terms of DALYs, using national population-based cancer registry data and international disease models. We developed a microsimulation model to translate incidence- into prevalence-based estimates, and used expert elicitation to integrate the long-term impact of surgical treatment.

Results

In 2017, in Belgium, breast cancer was the cancer with the highest disease burden among women, followed by lung cancer and colorectal cancer. Among men, lung cancer had the highest disease burden, followed by colorectal cancer and prostate cancer. Between 2004 and 2017, the burden of lung cancer increased by more than 50% in women, while in both sexes, significant increases were observed in melanoma and skin cancer burden. The majority of the cancer burden remained linked to premature mortality.

Conclusions

Cancer maintains a major impact on the health of the Belgian population. Current resources allocated for their prevention and treatment will need to be maintained to further reduce the cancer burden. Lung cancer remains a crucial challenge, among both men and women, calling for strengthened tobacco control policies. Integrating the current study in the Belgian national burden of disease study (BeBOD) will allow monitoring the burden of cancer over time, highlighting new trends and assessing the impact of public health policies.

Key messages

Burden of disease studies allow assessing and monitoring the impact of diseases and risk factors in a comparable way. Cancer maintains a major impact on the health of the Belgian population; lung cancer in particular remains a crucial challenge.
Raising the bar: Sex and Gender-Based Analysis and Reporting (SGBAR) in health research
Authors: James L , Menezes S , Lawrence S
Published: October 2020

Issue

For decades, research has been male dominated: research led by men with male participants. Two-thirds of heart disease and stroke clinical research is based on men. When research is led by women, sex and gender are more likely to be incorporated into the research itself, and the levels of sex reporting also increases. Unfortunately, the low involvement of women in research around the world - as both researchers and participants - has led to findings that are not always applicable to women, resulting in gaps in treatment, care and recovery. The results are worse health outcomes for women in most countries.

Background

Applying sex and gender methods and analysis in research leads to higher quality results. A review of the literature and research landscape showed that sex and gender analysis was more common in public health, but not in clinical, biomedical or health systems research.

Results

The Heart and Stroke Foundation (Heart & Stroke), as both a funder of research and advocate for systems change recognized the research system perpetuated the inequities in women's health. The solution was to restructure the organization's research funding enterprise and also push for change among the health community. H&S put SGBAR requirements into its research funding program. To build on the change, H&S is now working across all levels of government and research institutions to secure SGBAR as a standard of practice. To date, this advocacy pursuit has created substantial systems change.

Lessons

Due to the complex research landscape, making SGBAR a priority across all research institutions is a massive undertaking. There is a need for both top down and bottom up approaches to ensure wide scale change.

Key messages

Incorporating sex and gender-based analysis and reporting in health research will improve health equity. Health research Funding agencies have an opportunity to raise the bar and shift the research environment.
21.I. Round table: Comparing and designing the politics and policies for better economic and social welfare
Authors:   Organised by: EUPHA Public health policy and politics section,   Chair persons: Marleen Bekker - EUPHA-PHPP
Published: October 2020

While the political and social determinants of health have become accepted among academic researchers, health inequalities in the health policy and political arenas are still predominantly addressed as outcomes of citizens' lifestyle and behavioural choices. The rise of populist radical parties across Western countries brings renewed urgency to communicating with elected leaders and policy makers about the importance of tackling the social (as well as behavioral and medical) determinants of health. Recent publications such as 'Health in Hard Times. Austerity and Health Inequalities' (Clare Bambra, 2019) and 'Health Equity in England: The Marmot Review 10 Years On' (Marmot et al, 2020) find that financial and economic policies in large part contribute to stagnating and even reversing population health trends in the UK and across Western countries. The underlying political system of decision-making needs to be clarified in order to effectively engage and exert influence.

This workshop aims to strengthen countervailing power and competence in understanding the policy trajectories that effectively target the larger ambitions of economic and social welfare including reduced health inequalities. We provide participants with basic knowledge, methods and tools to carry out practice-based comparative analysis of public health politics and policies across different countries.

The workshop consists of: A 20-minute mini-lecture by Julia Lynch, who will present key findings and the underlying methodology of her recent book Regimes of inequality: The political economy of health and wealth. This book systematically used historical institutionalist-methods and process tracing to compare the policies and politics aimed at reducing health inequalities in Finland, France and the UK from the 1990s to the present.A 15-minute panel reflection: The panel, consisting of Clare Bambra, Karien Stronks, and Holly Jarman, will relate this to their own key research and impact.A 25-minute plenary discussion of examples, questions and contributions to tackling inequalities in political and social determinants of health. Examples are labour market participation policies, progressive fiscal policies or policies resolving illiteracy or household financial debt.

Key messages

Health inequalities are a political choice. Learning by comparison increases capacity to improve policies on the social determinants of health as well as capacity to increase political influence.
Monitoring health and well-being of children and adolescents in Germany since 2003
Authors: Goesswald A , Lange M , Hoffmann R , Houben R
Published: October 2020

Background

KiGGS - the German Health Interview and Examination Survey for Children and Adolescents is part of the German health monitoring framework providing data analyses and recommendations for politics based on own primary data collection and secondary data from other sources. In 1998, the Robert Koch Institute was commissioned by the Federal Ministry of Health to develop approaches and instruments for a health survey for children and adolescents aged 0 to 17 years.

Methods

KiGGS is conducted at regular intervals and acts as a central source of information that collects wide-ranging, reliable data on child and adolescent health. KiGGS comprises a cross-sectional and a longitudinal component. Until now, three nationally representative surveys have been performed: KiGGS baseline (2003-2006), Wave 1 (2009-2012) and Wave 2 (2014-2017). The baseline sample comprises 17,641 children and adolescents. The KiGGS cohort is the longitudinal component of the study. To date, two follow-ups have been accomplished.

Results

The repeated cross-sectional surveys have provided a profound data basis in order to calculate prevalences and conduct context analyses for each period and identifying changes over time in physical and mental health status, health behaviour, utilisation of health care services and prevention as well as social, family and environmental factors. Additionally, the longitudinal data enable to analyse developments in health and their influencing factors during the life course. Reports and recommendations based on KiGGS data have been useful to support the implementation of national health programs for children and adolescents, e.g. for the prevention of childhood obesity.

Conclusions

Regular health interview and examination surveys are necessary to provide reliable data to derive recommendations for health politics. Furthermore, they offer a robust method to evaluate actions taken to prevent illness and promote positive health behaviour on the population level.
21.L. Workshop: To what extent can we trust our data on trends in mental health among adolescents?
Authors:   Organised by: Nordic Collaboration on Positive Mental Health,   Chair persons: Charli Eriksson - Sweden, Katrine Madsen - Denmark
Published: October 2020

Mental health complaints have increased among school-aged children in the Nordic countries, especially among girls according to survey data in the Nordic countries. Moreover, the consumption of mental health services among adolescents has also increased. However, criticism from qualitative researchers have questioned the validity of the response to survey questions and the interpretation of the results. This controversy has been public in the media both in Denmark and Sweden.

The objectives of the workshop are to describe trends in mental health among adolescents in the Nordic countries, review criticism of mental health indicators, discuss measurement and analytical options, and consider consequences for policy making. Moreover, the workshop will discuss the situation in other parts of the worlds.

Researchers in five Nordic countries have collaborated in the Health Behaviour of School-aged Children (HBSC) study to mental health. School-aged children, 11-, 13- and 15-year olds (n = 112,000) have participated in HBSC surveys. Of key concern are psychosomatic complaints (1985-2018), but trends will also be presented for indicators of excellent self-rated health and high life satisfaction (2002-2018), with additional indicators of positive mental health (Warwick Edinburgh Mental Well-being Scale, General self-efficacy, Self-esteem) from the 2017/18 HBSC data collection.

There has been an increase in the psychosomatic complaints among girls and boys, in all age groups and in the five Nordic countries. Strengths and limitations of epidemiological surveys will be discussed. The impact of different frequency cut points will be presented as well as the heterogeneities regarding profiles of adolescents with different combination of negative and positive mental health indicators. Moreover, qualitative studies and registry-based analysis will be used as contrasting evidence. The qualitative studies on symptom perception indicate that the prevalence of problems may be overestimated, and data from psychiatric care and prescription of drugs show important increase.

After an introduction and two presentations the workshop will be a dialogue with the participants. First the core similarities and differences between countries will be explored. Then the policy implications will be discussed.

Key messages

The HBSC survey design give thousands of adolescents and children across dozens of nations the ability to be heard through a reliable and valid methodology. It is important to use indicators according to their intended use, monitoring of population trends, developing causal networks of determinants, screening of clinical cases or as diagnostic tools.
21.M. Workshop: How to learn from interventions for context-adapted solutions to improve migrants reproductive health
Authors:   Organised by: EUPHA Migrant and ethnic minority health section,   Chair persons: Sonia Dias – EUPHA-MIG, Sarah Fredsted Villadsen - Denmark
Published: October 2020

Although considerable research identifies the challenges that immigrant women experience in terms of inequitable access to and quality of reproductive care, less is known about models of care that can overcome such barriers. In recent years, a range of intervention projects has addressed this issue with a specific focus on the interactional dynamics between the women and the health system. Subsequently, diverse implementation and evaluation research is being conducted and it can provide valuable insights for knowledge exchange and transfer across contexts. Adapting interventions that have worked elsewhere can save resources and make progression faster. Decisions on when, to what extent, and how to adapt interventions are not straightforward, particularly when assuming that intervention effects depend on contextual interactions in complex systems. No guidance currently addresses these questions comprehensively. This workshop is intended to shed light on the developing work of country-specific implementation and evaluation studies and discuss strategies for good practice to improve reproductive health among immigrant women across contexts, digging into methods for adaption to the context when transferring interventions. The workshop will be structured in a first part with presentations and a second part with open discussion involving the audience. The short presentations of the first part will cover examples of initiatives to improve health outcomes for immigrant women based on implementation and evaluation studies conducted in diverse European countries with a common ground of having an increasingly ethnic diverse population, ethnic disparities in reproductive outcomes and suboptimal care. In the second part of the workshop, a presentation on methods and challenges for adaption of interventions to the context when transferring complex interventions will be the starting point for the interactive discussion with all workshop participants. The discussion will focus on how to acknowledge that context matter while still insisting on learning from each other experiences across settings. By learning from each other, using the current implementation and evaluation research as a starting point, this workshop will inform the development of an overarching guidance on adaptation of complex reproductive health interventions.

Key messages

Cross-country sharing of implementation researches on interventions to improve migrant women’s reproductive health, inform the context specific adaptation. Interactive session to discuss strategies for successful adaptations of complex reproductive health interventions across contexts.
Telemedicine and mental health: coming of age?
Authors: Ohannessian R , Scardoni A , Bellini L , Salvati S , Amerio A , Odone A
Published: October 2020

Telemedicine is the practice of medicine from distance using information technology and include mainly teleconsultation via video and/or chat, teleexpertise to request the opinion of a specialist, and remote patient monitoring to improve the follow-up of patients. The use of telemedicine in mental health and most specially psychiatry has been one of the first use case described in the scientific literature, via video teleconsultation, due to the absence of physical patient examination. One of the oldest telepsychiatry case from the literature was published in 1973 for patients assessed from 1968 with the Massachusetts General Hospital in Boston, USA.

Despite its medical and technical ease, telepsychiatry is still not widely spread and integrated into healthcare systems due to organisational and implementation challenges. More recently, telepsychology and other telemedicine interventions in mental health have been growing across the globe, including for mental wellbeing promotion and prevention of mental health conditions in specific environments. The rise of consumer digital healthcare directly through mobile app and dedicated websites is also to be considered in the wide opportunities of telemedicine opportunities to address mental health issues at a global scale. Various models needs thus to be considered between digital only care and blended approach mixing face-to-face and digital ways, as well as telemental health delivered only via the existing healthcare system or via new private digital players. The objective of the presentation is to describe the spectrum of existing telemedicine interventions in mental health, the digital features enabling its adoption and the assessment of its impact on clinical and public health outcomes.
Has the Netherlands created a healthy food environment for its citizens? Application of the Food Environment Policy Index (Food-EPI)
Authors: Djojosoeparto S K , Kamphuis C B M , van Lenthe F , Poelman M P
Published: October 2020

Background

Healthy food environments have the potential to improve population nutrition and decrease NCDs. The aim of the study was to assess the efforts of the National Government in the Netherlands towards creating healthier food environments using the Healthy Food Environment Policy Index (Food-EPI).

Methods

We compiled evidence on national food environment policies in the Netherlands for each of the 47 indicators. This document has been verified for completeness and accuracy by Dutch governmental officials. A panel of independent, nongovernment experts specialized in nutrition, obesity or chronic diseases, was provided with this evidence and rated the extent of implementation of Dutch policies by benchmarking these policies against international best practices during an online survey in May-July 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve food environment policies in the Netherlands.

Results

This is the first interdisciplinary study to assess food environment policies developed and set by the Netherlands. The overview of national level policies resulted in a evidence document, describing policies (or the lack thereof) for each of the 47 indicators. The evidence document shows that the Netherlands has mostly voluntary policies, mainly through the National Prevention Agreement (launched in 2018) and Agreement on Product Improvement (launched in 2014). Results from the online survey and the formulated actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to governmental officials and public health advocates in their efforts to improve the food environment policies in the Netherlands.
A study on implementation of food-related policies in Poland using the Healthy Food Environment Policy Index
Authors: Romaniuk P , Kaczmarek K , Brukało K , Grochowska-Niedworok E , Lobczowska K , Banik A
Published: October 2020

Background

Existing studies indicate obesity and diseases associated with diet and sedentary lifestyle as leading health problem in Poland that cannot be solved without explicit public intervention. The purpose of this study is to evaluate actions to create a healthy food environment, undertaken by public authorities in Poland.

Methods

We used the Food Environment Policy Index (Food-EPI) to describe the Polish national food environment policy. We analysed available government documents, studies, reports, legal acts and other relevant materials to compile a evidence document, which has been then validated with government officials. In the next stage (March 2020), national policies will be subject to assessment in reference to international best practices by independent experts through an online Delphi study. Results of the survey will be then used during a national workshop (April 2020) in order to formulate and prioritize actions.

Results

For 15 out of 47 indicators we found no evidence for government actions that would meet the criteria set out in the Food-EPI definition. In case of the other 6 indicators it was observed that the existing solutions are non-binding and result from government-independent policies. The lack or limits of government involvement was observed in particular in the domains related to food promotion, food provision, food in retail, and Health in All Policies. Results from the online study and the workshop will be presented during the conference.

Conclusions

The preliminary results obtained through the review of the evidence point to the need for intensified government activities in the area of shaping food policy in Poland. Full conclusions will be formulated after the study is completed. Preliminary findings of the Food-EPI project suggest the need for strengthening food environment policy in Poland.