bluuebunny/crossref_metadata_2025 huggingface dataset:
Busting the myth of the ‘greedy elderly’
Authors: Lynch J
Published: November 2019

Background

The politics of ageing are both personal, involving judgements about specific family members as well as broad social groups. This chapter evaluates the argument that governments implement packages of policies that are favorable to the elderly, but that are societally sub-optimal, because of political pressure from the elderly. It begins by laying out the core premises of the “greedy geezer” narrative: because pension transfers, high-cost medical care, and policies that protect transferable assets like housing are highly salient to the elderly and their advocates, intense preferences for these types of policies communicated to politicians and policy-makers will eventually crowd out other, more societally-optimal policies.

Methods

Looking at public opinion data on ageing, intergenerational transfers, and the welfare state this chapter wants to understand both how different publics understand and frame ageing and health as well as what priorities these publics identify, and why?

Results

The elderly and their organized representatives (e.g. pensioner parties, pensioner unions, and advocacy groups) in some contexts do push for policies that are “greedy” in the sense of being beneficial for the elderly or their own children, but not for society as a whole. However, this phenomenon is far from universal: It is especially pronounced in the US and the UK, but much less so in other national contexts. Moreover, the policy packages adopted by national governments are generally motivated by concerns other than appeasing the elderly.

Conclusions

Characterizing the elderly as uniformly “greedy” obscures the fact that inequality among the elderly means that many need more support than they actually receive.
Interactive activity and discussion
Authors: Mensah K
Published: November 2019

A representative of each group will be invited to share the outcomes and main points with the audience.
Current capacities and challenges for equity-oriented municipal health promotion in Europe
Authors: Plantz C , Quilling E
Published: November 2019

As a basis for implementing actions in the frame of Work package 6 - healthy living environments in the Joint Action Health Equity Europe, each of the 13 participating countries conducted a country assessment.

Methods

The country assessments were self-assessments conducted in the first quarter of 2019. Partners received templates that had been agreed upon beforehand. Most of them conducted the country assessments by themselves or with the help of colleagues from their institutions as a desk-based review, and validated results with external experts and stakeholders. The first part of the country assessment referred to how municipal health promotion capacities are currently developed in the countries. Through the second part of the country assessment, each of the 13 countries selected up to 4 promising practices.

Results

In most of the 13 countries, municipalities have a clear mandate to promote health. However, there is a big heterogeneity in resources, structures and capacities of municipal health promotion within and between countries. One key challenge is the self-government of municipalities and health promotion as a voluntary task. One of the main problems is a deficit in intersectoral working. It appears that poor municipalities are even more disadvantaged in terms of capacities for municipal health promotion. 33 promising practices were identified, covering programmes, strategies, tools and interventions mostly from the local level, with a big variety of topics and approaches for health equity.

Conclusions

There is a big fragmentation and heterogeneity in municipal health promotion between and within European countries. National and regional public health authorities are in the position to contribute a lot to support municipalities. This can include promoting quality development, providing data, integrating health equity in existing structures, plans and approaches or collaborating with the broad range of existing stakeholders and networks.
Strengthening health information systems in Europe through peer review assessments
Authors: Bogaert P , Abboud L A , Calleja N , Ziese T , Fehr A , Van Oyen H
Published: November 2019

Background

How does your Health Information System (HIS) measure up to others in the EU? How can you empower national HIS players with an objective peer-reviewed HIS assessment? Nine InfAct partners engaged in a capacity building exercise where experts in rotating groups of three countries performed peer assessments of each other’s national HIS. Using a WHO Europe adapted and refined tool, assessors analysed the HIS of a country (data collection, processing, analysis, dissemination and use) and exchanged practices in an intensive 2-day schedule of interviews with established key stakeholders.

Objectives

The aim of the peer assessment is three-fold: to test the feasibility of a peer-review HIS assessment, to map heath information inequalities across EU MSs, and to strengthen the knowledge of HIS players.

Results

Two cycles are now complete and the feedback is overwhelmingly positive - from assessors and hosts alike. So far, the HIS assessment has been a major success in its ability to systematically and concisely analyse a HIS. It identifies gaps in the HIS through desk review and interviews, and provides a SWOT analysis and SMART recommendations to address these gaps. Additionally, this exercise has shown the ability to increase stakeholders’ awareness of their role in their national HIS, and to build new networks within and between MSs. The exercise is also perceived as an opportunity for cross-fertilisation of ideas and exploration of methodologies on how to address specific challenges. This will stimulate actions to improve national HISs, and will lead to the identification of good practices which can then be used by other EU countries.

Conclusions

By bringing together key HIS stakeholders from different countries and stimulating the improvement of HIS and the exchange of good practices, InfAct contributes to capacity building in the EU, which in turn may lead to the reduction of health information inequalities between countries.
Development of composite indicators to monitor burden of disease across Member States
Authors: Haneef R , Gallay A , Hilderink H , Devleesschauwer B , Ziese T , Schmidt J , Newton J
Published: November 2019

Background

The burden of disease (BoD) methods are not part of routine public health activities and policy development process across all Member States (MSs). The main reasons for this are varying levels of knowledge, experience, and capability to apply and use BoD methods. Therefore, MSs need support, guidance and training to adopt and integrate BoD approaches in their public health systems. In this context, two workshops have been organised by InfAct. The main objectives of the workshops are to raise awareness, share knowledge and experience, and to provide mutual support to to integrate BoD indicators in the public health policies across Europe.

Methods

The workshops were about the BoD concept and methodologies, and the use of BoD data in public health policy. These workshops were supported by technical presentations describing methods and the use of BoD data in health policy with various case studies, followed by expert exchange with facilitated discussions and group work. The case studies included national BoD studies from Belgium, Germany, Netherland, and Scotland.

Results

Two workshops were held at Santé Publique France, and attended by 16 BoD experts and 40 participants from 25 MSs. The workshops were well received by the participants particularly with regards to the diversity of the group and the possibility to share knowledge and experience from various perspectives. Three areas of action were highlighted: 1. the need for methodological trainings to strengthen skills in interpreting and calculating BoD estimates; 2. the encouragement of more collaborations across MSs to share or exchange good practices on BoD; and 3. the importance of the implications of BoD data to guide policies across MSs.

Conclusions

The workshops highlighted the need for capacity building activities to implement BoD approaches across MSs in routine public health activities and to use BoD data to guide health policy. More collaborations among MSs on BoD activities are needed in the future.
Building a sustainable network of health examination surveys through training and mutual learning
Authors: Tolonen H
Published: November 2019

Background

Health information is a broad concept and can be obtained from variety of data sources such as administrative and disease specific registers, surveys, longitudinal studies etc. Health surveys comprise two main formats; questionnaire based health interview surveys (HIS) and more comprehensive health examination surveys (HES) which include also objective health measurements and collection of biological samples. At the European level, HISs are coordinated under European Health Interview Survey (EHIS) by Eurostat. For HESs, the European Health Examination Survey (EHES) initiative has been responsible for the coordination and capacity building.

Objective: The EHES initiative aims to establish a sustainable European network on nationally representative HESs, which use standardised methods and therefore, provide comparable information between and within countries.

Results

EHES has prepared standardised protocols for objective measurements and several guidelines for organisation of the survey. To enhance use of these protocols and guidelines, several capacity building activities took place during 2010-2019. These activities include hands-on training events, online training materials, person-to-person consultations, site visits and networking.

A survey among national HES organisers was conducted in 2017 to evaluate which of the capacity building activities were perceived as most important. Based on this survey, availability of standardised protocols and guidelines was seen very important as well as hand-on training events and person-to-person consultations.

Conclusions

National HES data is actively used for health monitoring and identification of public health problems, for development of health and prevention programmes and to support evidence-informed policies. EHES capacity building activities support establishment and development of national HESs across Europe and enhance benchmarking between countries.
Conceptual framework for intersectionality-based gender sensitivity in multivariable analysis
Authors: Mena E , Bolte G
Published: November 2019

Background

Intersectionality-based gender sensitivity in multivariable analysis might advance simultaneous consideration of intersecting social positions and identities. Identification and implementation of quantitative statistical approaches that adequately operationalise the concept of intersectionality are currently scarce.

Methods

An intersectionality-based framework for evaluation of gender sensitivity in multivariable analysis and for future study design was developed. The framework comprises operationalisation of sex/gender, definition of solution-linked variables from a gender mainstreaming perspective, definition and function of intersectional variables and consideration of central gender theoretical concepts. For evaluation of current practice regarding sex/gender sensitivity in intersectionality-informed analyses, a scoping review within selected thematic fields relevant for heath reporting has been conducted.

Findings

Based on 16 identified intersectionality-informed studies, sex/gender shows to be exclusively operationalised as binary. Solution-linked variables from a gender mainstreaming perspective are rarely taken into account. Sex/gender and race/ethnicity are the only intersectional variables considered in almost all studies, predominantly for stratification or as part of interaction terms. Income, education and employment status as proxies for social position as well as age are mainly used for adjustment in multivariable analyses.

Conclusions

The framework allows for comparison of gender sensitivity in intersectionality-based multivariable analysis. The project AdvanceDataAnalysis at the Institute of Public Health and Nursing Research, University of Bremen, Germany, will contribute to the detection and analysis of complex interactions from an intersectionality perspective, including the consideration of gender theoretical concepts in multivariable analyses.
Building institutional capacity for a future health workforce. The WHO Global HRH Strategy
Authors: Jacob G
Published: November 2019

Background

There is a growing recognition that the main population health challenges of sustaining universal healthcare coverage (UHC), and responding to the growing non-communicable diseases (NCDs) burden in all countries of the WHO European Region requires that each Member State has an effective, responsive and adaptive approach to human resources for health (HRH). However, there is a worldwide shortage of health workers and the situation is becoming more challenging globally and regionally. This presentation introduces the WHO Framework for Action, which builds on the Global Strategy on Human Resources for Health: Workforce 2030. The aim is to provide guidance to health policymakers, planners, analysts and others with a responsibility for health workforce issues.

Methods

The WHO Global Strategy was adopted in 2018 by the 69th World Health Assembly. It has identified four strategic objectives, which have been adapted to the regional context as follows: to transform education and performance, to align planning and investment, to build capacity, and to improve analysis and monitoring.

Results

The WHO Regional Office for Europe is working with Member States across the Region and supporting efforts to achieve sustainable health workforces. This includes promoting the use of the Labour Market Framework approach and maximising the utility of the National Health Workforce Accounts for national use and as a contributor to sustainable human resources for health planning.

Conclusions

Having a sustainable health workforce in place with the right skills and competencies is critical to making progress towards achieving UHC. Effective implementation of a labour market framework approach, including multisectoral workforce governance, can support effective, responsive and adaptive approaches to human resources for health.
Professionalisation of the public health workforce: why, what and how
Authors: Czabanowska K
Published: November 2019

Background

Member States of the WHO European Region are calling for guidance on how to build the capacity of the public health workforce to help strengthening health systems. The aim of this presentation is to stir the discussion about the professionalization of the public health workforce. Attention is paid to the why, what and how this should be done in countries of the European Region.

Methods

The European Competency Framework for the Public Health Workforce (Eco-FPHW) has been developed in the framework of the Coalition of Partners, led by WHO European Region, and is one of the pillars of the Roadmap to Professionalizing the public health workforce. The Eco-FPHW primarily relates to the core public health workforce, and that the definition of what constitutes the core public health workforce will differ from one country to the next.

Results

The Roadmap puts forward several possible levers and measures which include: public health education and training, competencies, formal organisation, credentialing and accreditation, codes of ethics and professional conduct as well as laws and regulations, enumeration and job profiles among others. These measures can be engaged with by a range of stakeholders who have important roles and insights into improving public health. Stakeholders include governments, ministries, national and regional/local health authorities, but also directors of public health training institutions, public health institutes, professional organisations, and employers of the public health workforce.

Conclusions

The Roadmap provides a guide for all those countries, institutions and organisations wishing to strengthen the delivery of the public health functions and to support the competencies of the public health workforce.
Internationalisation of health workforce education: the case of medicine in Romania
Authors: Ungureanu M
Published: November 2019

Background

Long recognised as a major source country for health professionals working in Western EU Member States, Romania has become increasingly attractive for international medical students in recent years. The current study explores the drivers of this trend, its opportunities and challenges, as well as its implications on the broader health system goals.

Methods

The study used secondary data analysis and interviews with key informants. Data originated in a study conducted for the OECD (grant no. EC-2017-5304 financed by the European Commission).

Results

Since 2011, 11 of the 13 Medical Schools in Romania have opened additional study lines in foreign languages (English and French) and gradually increased the number of places allocated to international students. Of all new-entrant student places available in the medical schools in 2018/19, nearly 30% (1740 out of 6121) are in the international study programmes - a 50% increase since 2011/12. Moreover, while the total annual number of places for new medical students have increased by nearly a fifth between 2011/12 and 2018/19 (from 5,250 to 6,121), the share of new study places in the Romanian division has decreased from 80% to 70% in the same period. For Medical Schools, internationalisation has been driven mainly by financial reasons and has had a positive impact on curriculum development and improvement. For many international medical students, in particular nationals of the EU countries, the main push factors are the numerus clausus policies limiting access to medical education in their home countries.

Conclusions

Internationalisation of medical education in Romania has taken place in the absence of a formal national internationalisation strategy and efforts have not translated into significant improvements in health workforce management in Romania. This suggests that potential benefits of internationalisation of health workforce education must be assessed in context of national health systems.
Workshop: Active participation of migrants, refugees, and ethnic minorities in public health research
Authors:   Organised by: University of Bern Chair persons: Thomas Abel - Switzerland, Annika Frahsa - Germany
Published: November 2019

To introduce the relevance, benefits and challenges of participatory approaches in public health research addressing issues of migrant and refugee health. Participation of stakeholders has a long tradition in fields of public health research, in particular in community-based research and health promotion. Today, increasing demands of grant agencies and policymakers in Europe challenge researchers to include stakeholders in all processes of health research. Active participation of migrants and refugees poses complex challenges for public health research including but, going beyond language problems and risks of stereotyping.

The specific objectives of this workshop are: (1) to introduce current approaches for participation and their adaptability for the context of health research with migrants and refugees, (2) to explore participation in three projects that deal with issues like improving quality health care among chronically ill women with immigration background, introducing a health mediator model for refugees as well as ethical issues in participatory research with refugees and ethnic minority groups and (3) to discuss benefits and challenges of participatory approaches intended to improve health and health care services of specific groups.

The workshop will start with an introduction providing a short overview of definitions and key concepts. Substantive presentations showcase three participatory projects in migrant health. A panel discussion, led by experienced moderators, with Prof Thomas Abel (PI of the MIWOCA project presented), Prof Antonio Chiarenza (WHO-HPH Task Force on Migration, Equity & Diversity, member of the Steering Committee of the EUPHA section on Migrant Health), Prof Luis Saboga-Nunes (EUPHA health promotion section) and Prof Sibel Sakarya (Department of Public Health Koç University) will address benefits and challenges of participation in migrant and refugee health research. The panel will open into a discussion to integrate audience’s experience and questions on participatory research. The workshop will be closed by the chair’s summary of lessons learnt and perspectives for future directions.

Key messages

Public health research for and with migrants and refugees poses basic and specific challenges. Experience with PR demonstrates the benefits of migrants’ and refugees’ active participation and the importance of adequate contextualizing of the problems and potential solutions.
Presentation of the European Journal of Public Health 2019 supplement on Digital Health
Authors: Azzopardi Muscat N , Ricciardi W , Odone A , Buttigieg S
Published: November 2019

EUPHA President, and EJPH Editor Natasha Azzopardi-Muscat will present the structure and content of the European Journal of Public Health 2019 supplement on Digital Health
Health in the 2018 Italian general election
Authors: Guicciardi S , Quargnolo M , Moser G , D’Avenia R , Toth F , Pia Fantini M
Published: November 2019

Background

General elections represent a peculiar moment in which clear positions on relevant topics are more likely to emerge. Therefore, they may serve as a reference point to monitor policy development and to verify decision makers’ accountability.

The aim of this study is to systematically examine the proposals on health issues in the manifestos of the 38 parties running in the 2018 Italian general election, comparing them with the contents shared on social media.

Methods

All the electoral manifestos published on the websites of each party and of the Italian Ministry of the Interior were collected and independently assessed by four evaluators.

A list of 48 health themes grouped into 13 main domains into was then consensually created and used to classify the reported proposals.

Parties’ official social media accounts (Facebook and Twitter) were subsequently screened for selected keywords to determine the frequency and the content of health-related posts.

Results

Thirty out of 38 parties included a specific section on health in their programmes or generally addressed healthcare topics. The most covered themes were health promotion and lifestyles, self-sufficiency of fragile populations, management of private healthcare and health workforce, although implementation strategies varied greatly and only in a few cases it was possible to compare them.

On social media, health related posts represented less than 1% of the contents shared by any party during the election campaign.

Conclusions

In the 2018 Italian election campaign the majority of the parties’ manifestos explicitly addressed health issues but, apart from a few exceptions, significant differences were present in the themes and in the proposed solutions, mostly generic. On social media health was almost neglected. Despite its social relevance, health played a marginal role in the 2018 Italian election campaign.
Do political parties matter to health?
Authors: Falkenbach M , Bekker M P M , Greer S L
Published: November 2019

Background

Do political parties matter to health? Do they affect population health either directly, or through welfare states’ social policies and the eligibility, affordability and quality of health systems? And if they do, how? These are crucial questions if we are to understand health politics or shape public health policy, particularly given the changing landscape of both political parties, party dominance in the executive, and the possibly mediating influence of the legislature.

Methods

This review using a systematic approach examines 107 peer-reviewed articles and books published after 1978 about high-income countries asking the overarching question: Do political parties matter to health and the welfare state?

Results

As the literature relating parties to health directly was surprisingly thin, the welfare state was used as a ‘proxy’ variable. An overwhelming majority of the literature sample suggests that Left parties are inclined to expand the welfare state and avoid cutting benefits if possible, while the Right does not expand and tends to reduce benefits. There is an inflection in the 1980s when Left parties shift from expansion to maintaining the status quo.

Conclusions

Considering current health trends in the form of measles outbreaks, the “Deaths of Despair”, the return of presumed eradicated infectious diseases and the declining health expectancy rates in some Western countries as well as the rise of PRR parties in office we question the current partisanship thesis that political parties matter less and less.
Steps forward for the SCIROCCO tool and its evaluation as part of SCIROCCO Exchange
Authors: Anderson S , Alexandru C , Alhambra-Borrás T
Published: November 2019

The ambition of the SCIROCCO Exchange project is to maximise the value and impact of the B3-Maturity Model and the SCIROCCO tool. To this aim, SCIROCCO Exchange will develop an enhanced tool including a Knowledge Management Hub. The first objective of this presentation will be describing the progress and plans towards this enhanced tool.

The SCIROCCO enhanced tool will support measures for scaling up integrated care, and an important part of it will involve building cross system community to facilitate transfer and scaling. Through its Knowledge Management Hub, the enhanced tool will include the capacity to integrate knowledge from highly relevant sources of information on integrated care practice and advice. To support and augment twinning and coaching activities, it will allow the searching for, combination of this knowledge and its adjustment to the maturity levels of health systems and the maturity requirements of good practices. The enhanced tool will also support the tracking of the evolution of the maturity of the health systems and the maturity requirements of good practices, which will allow the development of further functionality for improvement planning and monitoring.

The second objective of this presentation will be outlining progress and plans towards the evaluation of the enhanced SCIROCCO tool. This evaluation will focus on the assessment of the enhanced tool’s personalised knowledge transfer and capacity-building support. It will provide feedback on the processes of knowledge transfer and capacity-building support, and help conclude on the key mechanisms supporting these processes. Moreover, this evaluation will feed into the development of Improvement Plans in the 9 SCIROCCO Exchange regions. The ultimate goal of this evaluation is to optimise the potential of the enhanced SCIROCCO tool as a key facilitator and integrator of knowledge transfer and capacity-building support for integrated care.
Social cost-benefit analysis of regulatory policies to reduce alcohol use in The Netherlands
Authors: de Wit G A , van Gils P F , Over E A B , Suijkerbuijk A W M , Lokkerbol J , Smit F , Spit W J , Evers S M A A , de Kinderen R J A
Published: November 2019

Background

If all costs and all benefits of alcohol use are expressed in monetary terms, the net costs were 2,3 to 4,2 billion euro in 2013. Examples of the costs of alcohol are less productivity at work, costs of police and justice and traffic accidents.

Methods

In this study three regulatory policies have been modelled using the Social Cost-Benefit Analysis (SCBA) approach. Regulatory policies aimed at curbing alcohol consumption were (1) an increase in excise taxes, (2) a reduction of the number of sales venues, and (3) a total mediaban for advertising alcohol.

Results

In the long run, over a period of 50 years, an increase in excise taxes of 50% will result in societal benefits of 4.5 to 10.7 billion euro, an increase of excise taxes of 200% will result in societal benefits of 12.2 to 35.8 billion euro. The societal benefits of closure of 10% of sales venues are estimated at 1.8 to 4.3 billion euro after 50 years, and at 4.6 to 10.7 billion euro when 25% of sales venues would be closed. The societal benefits of a mediaban would amount to 3.5 to 7.8 billion euro after 50 years, but this estimate is surrounded by uncertainty.

Conclusions

Regulatory policies aimed at reducing the amount of alcohol consumed, such as a further increase of excise taxes, a reduction of the number of sales venues and a total mediaban, will result in savings for society at large. However, costs and benefits are spread unequally over the different stakeholders.
Psychological follow-up and its perception in civilians involved in the January 2015 terrorist attack in Paris, France
Authors: Vuillermoz C , Montreff Y , Pirard P , Lesieur S , Chauvin P , Baubet T , Vandentorren S
Published: November 2019

Background

A terrorist attack occurred in Paris in January 2015 against the staffs of the Charlie Hebdo magazine and a kosher grocery. This study examined the psychological follow-up and the non-satisfaction of the people civilians involved in the terrorist attacks.

Methods

The IMPACTS survey, an open cohort study of civilians involved in the terrorist attacks was conducted 6-10 (wave 1) and 18-22 months (wave 2) after the attacks. Psychologists interviewed in face-to-face 190 civilians in wave 1 and 123 of them participate to the wave 2. A questionnaire was used to collect data on socio-demographic characteristics, exposure level, social support, psychological support and perception, impact on work and social functioning, and mental health disorders.

Results

In wave 1 (N = 190), 24% of participants had initiated a regular follow-up with a psychologist or a psychiatrist. Reasons of non-follow-up were: they had refused because they did not feel the need or they did not want to talk about it (60%), it was not suggested to them (30%), or they have already had a follow-up before (12%). In wave 2 (N = 123), 25% had a regular follow-up with a psychologist/psychiatrist since the events, 22.0% had had a follow-up but not anymore in wave 2, 15% did not have a follow-up in wave 1 but they had in wave 2 and 38.2% never had. Psychological aid from professionals for resilience has not been appropriate for 32% of the participants at 6 months and for 39% at 18 months. In both waves, non-satisfaction of follow-up was more frequent among witnesses than with those who were directly exposed.

Conclusions

Six months after the January 2015 terrorist attacks in Paris, among the participants without psychological follow-up, it was not offered to nearly a third of participants. In order to enhance resilience, psychological aid should also be provided to those who have not been directly exposed.

Main message

Psychological follow-up should be provided to all civilians in short and long-term.
Research under Attack: A Framework for Prospective Cross-European Research in the Wake of Terrorism
Authors: Stene L
Published: November 2019

This presentation will propose a framework for prospective cross-European research study that may provide unique knowledge about the health effects of terror attacks and the challenges they impose to the health services. Terror attacks devastatingly affect individuals and societies worldwide. Unfortunately, unmet needs are frequently reported by those impacted. How to design and implement efficient psychosocial care, and reach affected individuals and communities, is a challenge for researchers, clinicians and policy makers alike. There is an urgent need for coordinated efforts to develop scientifically based guidelines for psychosocial support and health services after terrorism, and thus strengthen our public health preparedness to such events. Examples will be given on how accurate register-based and administrative claims data on primary and secondary health service utilization before and after attacks can be linked with terror-exposed individuals’ own reports of their perceived health, social support and other factors that are important to consider in the planning and implementation of post-attack healthcare. Cross-country comparisons may provide new insight about cultural, structural and organizational factors that may impede or promote coherent patient pathways in the wake of terror attacks. A long-term goal is to develop a sound research methodology that allows for international comparisons of healthcare delivery in the context of different types of trauma. During the presentation, methodological challenges in current trauma-focused studies and suggestions for strengthening future research concerning healthcare to trauma-exposed populations will be discussed.
Call for a European collaboration in the use of Real World Data in Health Technology Assessment
Authors: Daugbjerg S , Marchetti M
Published: November 2019

Issue/problem

Modern patient care requires a heavy investment in innovative health technologies while at the same time it is facing a fiscal sustainability challenge in the health care system. Evidence on effectiveness of health technologies informing Health Technology Assessments (HTA) have traditionally been based on randomized control trials (RCTs). However, RCTs are expensive and the external validity is relatively low which makes it difficult to assess effectiveness and long-term outcomes in clinical practice especially in diverse populations.

Description of the problem

Real-World Data (RWD) studies use observational data routinely collected to gather information on the delivery and outcome of care. RWD studies cost less than RCTs and are considered to have a high external validity. Results from RWD studies are therefore a good supplement to support evidence from RCT in HTA-reports. However, RWD are not still fully used in HTA. This is partially due to concerns about data quality and accessibility.

Effects/changes

In order to provide a deeper insight into how health technologies are working in real-world settings across Europe, it is time to systematically including RWD in HTA. A first step should be to call for a European collaboration to map relevant sources of RWD that can be used in HTA and define the quality and main format, in which they can be analysed and used. Common legislations and guidelines regarding which RWD should be accepted as sources of information for HTA should be elaborated.

Lessons

Through a European collaboration, the quality and accessibility of RWD should be secured in order to use evidence from RWD studies to inform HTA on effectiveness of health technologies.
Using behaviour change principles in the development and adoption of health policies
Authors: Bacon S
Published: November 2019

Issue/problem

We now live in world of ever-increasing amounts of evidence and information. Unfortunately, high quality evidence is not always incorporated into policy documents and can be ignored by policy makers when making decisions.

Description of the problem

Canada recently released its Healthy Eating Strategy, a comprehensive policy which covers a number of aspects, including Canada’s new Food Guide. The Food Guide is rooted in both nutritional and behavioural evidence. It is unique in the fact that it has taken a behaviour-oriented perspective, rather than a macro and micronutrient path. In addition, to incorporating a behavioural perspective into the policy there is a concerted effort to leverage basic behaviour change principles to get the healthcare community to increase their uptake and usage of the food guide. Furthermore, the same principles are being leveraged to ensure that policy makers and members of the government continually reinvest and push the food guide forward as new evidence is generated.

Results

Though the Healthy Eating Strategy is still relatively new, there has been substantial policy movement on a number of the areas it will tackle. For the Food Guide, this was only released at the start of 2019, so its uptake and impact is not currently measurable. However, there is a monitoring plan which will evaluate these aspects. That being said, there is some evidence that the Food Guide, and the messaging around it, has been well received.

Lessons

Taking a behaviour change perspective in the development and delivery of policy, especially health policy, has the potential to positively engage more stakeholders in the process. Ultimately, more evidence is needed to define the optimal way to do this.
Applying behavioural science to improve physicians’ ability to help people improve their own health behaviours
Authors: Lavoie K
Published: November 2019

Issue/problem

Poor health behaviours are at the centre of most non-communicable chronic diseases and account for a significant amount of morbidity and mortality. Healthcare professionals, and especially physicians, are in a unique position to be able to positively influence their patients and aid them in changing poor health behaviours. However, most physicians report having low confidence or a lack of skills to effectively achieve this.

Description of the problem

The main approach that physicians take to influence their patients’ poor health behaviours is to provide them with advice and evidence about the impact of the poor health behaviours. This strategy has been shown to have limited impact on changing patient behaviour. As such, there is a need to develop effective interventions that target changing physician health behaviour counselling behaviours, effectively, a behaviour change intervention for physicians so that they are better at helping patients change their behaviour.

Results

Using a structured stakeholder-oriented approach (the ORBIT model for developing behavioural interventions) we have systematically developed a robust behaviour change-based continuing medical education curriculum (leveraging motivational communication), and online assessment tool to improve physician competency. These were developed by a pan-Canadian team with notable international input through the IBTN.

Lessons

The use of a structured stakeholder-driven process, we have developed an intervention which seems to have greater relevancy to the target audience, lead to greater engagement, and a higher probability of implementation than a researcher led approach. Whilst the studies are still ongoing, it is anticipated that this intervention will be able to dramatically improve the health of individuals through effective health behaviour change interventions by healthcare professionals.
Generating knowledge on data collection methods and the availability of health information in Europe
Authors: Unim B , Mattei E , Carle F , Bernal-Delgado E , Achterberg P , Tolonen H , Zaletel M , Grisetti T , Oyen H Van , Palmieri L
Published: November 2019

Background

Data collection methods, metadata-reporting standards and usage of data for health monitoring (HM) and health system performance assessment (HSPA) are not uniform in Europe. Moreover, the evidence produced by research are not always available, comparable or usable for research purposes and policy making. The aim is to summarize health data collection methods, quality assessment, availability and accessibility procedures covering different data sources for HM and HSPA across EU countries.

Methods

The study is conducted through a multidimensional approach, which includes: i) a review of institutional websites (OECD, Eurostat, WHO-Europe); ii) a review of EU research networks; and iii) a multi-national survey addressing epidemiologists, health data managers and researchers that have played leading roles in EU projects. Currently, the survey instrument is being piloted. A qualitative data analysis to describe and compare the identified data sources for HM and HSPA will be performed.

Results

As part of the work within the Joint Action ‘Information for Action’ (InfAct), the study will generate knowledge on standardized health data collections and related metadata, used methods and procedures for HM and HSPA in EU. It will also facilitate the identification of national or sub-national health data collected through standardized procedures but not included in international databases or research networks.

Conclusions

The lack of infrastructures for health data sharing in EU limits data usage and comparability within and between countries. This study, as part of InfAct, will facilitate the assessment of health inequalities across EU countries in terms of quality, availability, accessibility and comparability of health data and information. It will also facilitate sharing and dissemination of standardized and comparable health data collections, which are essential for research and evidence-based policy-making.
Prioritizing Health Information in Europe – What do we want and need to know?
Authors: Fehr A , Ombrellaro K J , Achterberg P , Bogaert P , Carle F , Palmieri L , Tijhuis M J , Lyons R , Zelviene A , Ziese T
Published: November 2019

Background

Prioritization of Health information (HI) involves the establishment of methodological standards, and the development of political momentum to reliably track health status and health determinants. This is important in order to strengthen the evidence base for public health policies and facilitate effective delivery of healthcare services. In support of the establishment of a sustainable EU-wide Health information system, this consortium explores how HI is prioritized in EU and associated countries.

Methods

The Robert Koch Institute is conducting an online Policy Delphi survey among InfAct project partners, stakeholders from EU-Member States and associated countries. The Delphi methodology allows for rankings and priority-setting among a group of experts. The Policy Delphi facilitates the analysis of the impact and acceptability of a proposed policy option. The survey targets experts in national public health institutes and agencies, ministries of health and research. Participants are invited to provide information regarding their national HI prioritization processes, and to rank prioritization strategies and criteria, according to their degree of “desirability”, “feasibility”, “importance” and “confidence”.

Results

The Delphi survey will compile and assess processes and methods used to prioritize health information at national level in the EU and associated countries. The expected outcome is a list of good-practices in health information development and prioritization within countries, which could be further integrated to a health information prioritization strategy at the European level.

Conclusions

Prioritizing health information ensures that the right data is collected, is used to support ongoing public health policy action, and to capture emerging public health issues. This overview of prioritization strategies and methods aims to promote evidence-based public health by structuring exchanges about national HI prioritization in Europe.
Analysis of the free caesarean section initiative at the Nabil Choucair Health Center
Authors: Leye M M M , Mbengue E T , Tal Dia A
Published: November 2019

Introduction

The initiative for free caesareans was officially launched in December 2004. Our study, with The overall objective of contributing to an evaluation of the impact of this initiative on the operation of the Nabil Choucair Health Center (NCHC) will strengthen its implementation.

Methods

This is an analytical, cross-sectional, quantitative and qualitative study conducted from September 1 to October 31, 2017 at NCHC. It focused on four target populations: providers, beneficiaries, members of health and co-management committees, and those responsible for maternity and the laboratory. Data entry and analysis were performed with the Excel software and EPI Info version 3.3.2.

Results

The survey involved a total of 135 beneficiaries, 55 providers, 11 co-management committee members, 2 health committee members, the manager, the laboratory manager, and the chief medical officer of the community. maternity. The average age of the beneficiaries was 29.31 years. The media represented the main source of information with 52%. Despite the free cost of drug expenditure was 40039 FCFA. The average waiting time was 5 hours. The most frequently mentioned problems were: delay in repayment, influx, debt of the structure, abuse of benefits, breakage of reagents and / or drugs. At NCHC 33% of deliveries are by caesarean section. The rate of caesarean section in population has increased from 4% to 8% with free delivery.

Conclusions

It seems appropriate to make recommendations for the referral of providers on free caesarean section, for the management of cesarean section, for reorganization of services and for the improvement of the quality of reception.

Key messages

Caesarean. Universal health coverage.
Understanding place-based public health to reduce inequalities in the context of austerity
Authors: Lhussier M , Forster N
Published: November 2019

Background

Ageing populations and increased prevalence of long-term conditions, combined with reduced public funding following the financial crisis mean health needs often outstrip provision. Furthermore, austerity policies across Europe have been associated with a steep rise in health inequalities.

Methods

A comparative case study design, drawing on realist evaluation, examines the place-based strategies used by five UK Local Authorities (LAs) to maximise resources and reduce health inequalities. LAs were selected based on their implementation of innovative interventions and/or their experience of better or worse than expected trends in reducing health inequalities. Initial programme theories (IPTs) were developed through stakeholder consultation and literature searches, which will be tested and refined using case study data. Data collection methods are tailored to each case study context, but include: documentary analysis; system mapping exercises; and interviews with stakeholders and community members.

Preliminary Results

Initial programme theories were developed detailing the place-based strategies that are most effective in maximising resources and improving health outcomes, depending on contextual conditions. These theories cover strategies such as income generation schemes to supplement taxation; the introduction of ’disruptive’ voices into decision processes; outsourcing and widening skill-sets; reviewing and streamlining resources; and the development of tightly defined targets.

Conclusions

There is currently a lack of guidance on the optimal allocation of limited resources and effective delivery of services and interventions in contexts of reduced spending. Employing a realist approach has enabled us to move beyond the particularities of local contexts and strategies to produce pragmatic and transferable solutions which can inform the funding decisions of local government.

Key messages

LAs have to innovate to balance growing needs with shrinking resources. Pragmatic lessons are drawn to inform decision making applicable beyond local contextual specificities.