bluuebunny/crossref_metadata_2025 huggingface dataset:
The paradoxical surplus of healthcare workers in Africa: the need for research and policy engagement
Authors: Hutchinson E , Kiwanuk S , Muhindo R , Nimwesiga C , Balabanova D , McKee M , Kitutu F E
Published: October 2024

Background

In many countries in Africa, there is a paradoxical surplus of under and unemployed nurses, midwives, physicians and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million healthcare workers (HCWs) alongside 700,000 un- or underemployed health staff. This study aims to bring the nature and consequences of an existing paradoxical surplus of HCWs in low income countries into the HCW migration debate and to explore novel solutions.

Methods

The study draws on a rapid review of the literature and deeper insights from expert information, using examples from Uganda, Kenya and Niger.

Results

In Niger, between 2010-2014, 55% of health graduates were unable to find permanent work in the sector leaving 15 000 HCWs unemployed or in precarious jobs. In Sudan, an 8-fold increase of the number of places at medical colleges (between 1996-2012) was not accompanied by a commensurate investment in physician positions leading to increased unemployment and brain drain. In Kenya, in 2021, 27243 HCWs were un or under-employed. In Uganda, 20590 nurses and midwives were reported as unemployed in 2023. Despite this, the emphasis in policy debates about the healthcare workforce crisis in most national and global levels is on staff shortage and the need to train more HCWs. In contrast, an existing surplus HCWs and their association with patterns of migration are largely unknown. Little time is given over to understand the economic, political and social factors that have driven their emergence and the governance challenges and potential interventions to improve employment rates.

Conclusions

The results highlight the complexity of migration, labour market conditions and health systems, in particular in low income countries in Africa. Both qualitative and quantitative data is necessary for policy makers to find effective solutions to the problem.
Forced displacement and the healthcare workforce crisis: Venezuelan healthcare workers in Peru
Authors: Rees G
Published: October 2024

Background

The migration of healthcare workforces tends to be economically based benefiting high income countries, while draining lower-income countries of workers and skills. However, national instability or civil conflict may also have the effect of forcing out health workers. Few articles focus on the experiences of these types of migrants. This study aims to close a gap in the migration debate by exploring the capacity of integrating displaced healthcare workers in middle-to-low resourced health systems, using Peru as a case study.

Methods

The study draws on a policy analysis, statistical data and expert information from Peru.

Results

Peru has become the second largest Latin American destination for Venezuelan forced displaced migrants, a number of which are healthcare workers. While the exact numbers of these workers is unknown, it is estimated that 4,000 and 3,000 physicians and about 2,500 nurses and health technicians from Venezuela reside in Peru. These workers find entry into the heath system difficult due to bureaucratic and costly registration and qualification validation procedures. However, during Covid-19 the conditions were relaxed, and a large number of these workers entered the healthcare workforce. They were primarily physicians and worked in urban medical facilities, though there was some distribution across the country’s departments. This avenue to the healthcare workforce allowed the mobilisation of dormant health skills and assisted to lift density numbers.

Conclusions

Peru’s experiences bring into focus the potential benefits of mobilising new resources through integrating displaced healthcare worker migrants. It is too early to assess the sustainability of these policies on the country’s healthcare workforce and its Universal Health Coverage goals, yet there seem to be some positive experiences.

Speakers/Panelists

Tomas Zapata

WHO/Europe, Copenhagen, Denmark
Can we adapt fairly? Systematic review of health equity implications of climate change in coastal communities in the UK
Authors: Turner G , Kovats S , Brisley R , Landeg O , Brown S , Connor L O
Published: October 2024

As climate change becomes more apparent, it is important to evaluate the equity implications of adaptation interventions and policy measures. Many coastal populations experience high levels of social deprivation, which can be compounded by environmental factors. Coastal hazards, such as erosion and flooding can cause short and long term impacts on physical and mental health. To systematically review the published evidence on the differential impacts of coastal change on health inequalities and review the implications of adaptation responses for health inequality. We systemically reviewed the evidence for the UK only on a) inequalities in coastal flood impact or risk, and b) effectiveness and equity implications of current measures to manage the climate risks to an acceptable level of impact. Interventions included: plans and guidance, insurance, and infrastructure, including natural flood management. We found 8 papers quantifying differentials in current and future impacts of coastal flood risk and 6 papers assessing equity implications of adaptation measures. Coastal flood risk is unevenly distributed. Those owning their own home were more likely to experience flood impacts including increased stress and displacement. There is good evidence that policies for household insurance and property level protection measures have the potential to increase inequalities; other measures (community engagement; planning; defences) may reduce health inequalities, depending on implementation and local context. Adaptation to coastal change requires a range of approaches in the short and longer term, which potentially exacerbate current inequalities. Adaptation responses that rely on individual behaviour change, such as relocation, purchasing insurance, or retrofitting dwellings, may exacerbate inequalities within coastal communities. Climate change challenges organisations to deliver national and local policy responses ensuring that adaptation is effective and equitable.
Child-targeted foods in the Portuguese market 2024: Nutritional characteristics and claims
Authors: Brazão R , Fernandes P , Lopes A , Dias M G
Published: October 2024

Background

Excessive consumption of high-energy products with high saturated fats, sugars, and salt contents, contribute to the prevalence of overweight, obesity and other related diseases in Portugal, especially among children. Children represent a vulnerable group whose food choices are significantly influenced by advertisements and marketing methods that often promote highly palatable and less healthy foods. This study aimed to assess the nutritional characteristics of visually appealing products targeted at children in Portugal and analyse nutritional, health, and other mentions and claims, as well as icons present in the package. The goal is to contribute to the promotion of healthier food choices and inform public health policies.

Methods

Nutritional information and mentions/claims from child-targeted foods, featuring labels with cartoons and other appealing images, were collect. These were compared with the reference values (RV) of Integrated Strategy for the Promotion of Healthy Eating (EIPAS) and of Directorate-General of Health Label Decoder (RVLD), as well as the limit values (LV) defined by a Portuguese law related to restrictions on food advertising aimed at children.

Results

247 products from six categories were monitored. Only 1.2% met the EIPAS RV for sugar and salt evaluated together, while 10.1% complied with the law LV. According to the RVLD, 19.0%, 26.3%, 49.4%, and 0.4% of the products presented high levels of fat, saturates, sugars, and salt, respectively. The majority of the products (68.0%) had one or more types of mentions/claims, predominantly nutritional (64.3%) and all featured one or more icons, with 10.5% being licensed.

Conclusions

The majority of these pre-packed child-target foods do not have a healthy nutrient profile. In this context, public health actions, namely legislative measures to further regulate food marketing and labeling elements aimed at children along with literacy and product reformulation initiatives are essential.

Key messages

• The child-targeted food products in the Portuguese market present inadequate nutritional profiles.

• Public health actions are needed to promote healthier food choices and protect children from foodborne non-communicable diseases.
Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023
Authors: Lesa L , Longobardi G , Turello D
Published: October 2024

Issue

Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services).

Problem

Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area.

Results

In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported.

Lessons

Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions.

Key messages

• Mass gathering s events put under stress all the main areas of public health system.

• Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.
Prevalence and sociodemographic correlates of COVID-19 vaccine acceptance in 20 European countries
Authors: Pezzullo A M , Di Berardino F , Tricomi V , Boccia S
Published: October 2024

Our study aimed to analyze the prevalence and socio-economic factors associated with COVID-19 vaccine hesitancy using individual data from representative national samples of 20 European countries. Data from round 10 of the European Social Survey, collected from May 2021 to September 2022, were analyzed. Prevalence (with a 95% confidence interval (CI 95%)) of participants’ intention to get vaccinated against COVID-19 was calculated. Crude differences in vaccine hesitancy proportions across sociodemographic strata were assessed using the Chi-square test. There were 31,771 adult participants (46.0 % men). The percentage of those hesitant (i.e. those who were not already vaccinated and intended not to be) toward the COVID-19 vaccine was 18.0% (CI 95% 17.6 - 18.4). Men and women were equally hesitant (18.0% vs. 18.0%, p = 0.93). There were differences between those under 40 (22.9%), adults between 40 and 59 (18.1%), and those over 60 (14.3%, p < 0.001). The unemployed had a higher proportion of hesitancy (32.9%) compared to the employed (17.4%), retirees (14.8%), and students (21.1%, p < 0.001). People living in rural areas have higher levels of hesitancy compared to those in urban areas (19.3% vs. 17.3%, p < 0.001). The estimates indicate that the highest prevalence of vaccine hesitancy was in Bulgaria (61.6%), Slovenia (40.4%) and Slovakia (30.7%), while Iceland (2.3%), Portugal (3.6%) and Italy (4.0%) had the lowest. Our study confirms high prevalence and high variability of hesitancy towards COVID-19 vaccines in Europe and identify groups for potential targeted interventions.
Environmental and health databases used together for boosting a One Health approach
Authors: Viegas Susana
Published: October 2024

Publicly available European environment data, and specifically those collected and published by the European Environment Agency represent a great asset for environment and health researchers and practitioners. This presentation will summarize the use of such data for various environment and health projects and assessments at the National School of Public Health of NOVA University in Lisbon, Portugal.
EEA data streams of public health relevance: the examples of air pollution, environmental noise and industrial emissions
Authors: Djurhuus Sune
Published: October 2024

The knowledge work of the European Environment Agency relies on high-quality data from our network and other institutional partners across 38 European countries. We collect, quality-assure and quality-check data on the environment, climate and sustainability, many of which are of high public health relevance. This presentation will summarize the most importance EEA datasets of public health relevance, including on air pollution, noise, industrial emissions, and others.
Developing survey instruments for low back and neck pain to improve disease severity estimates for burden of disease assessment
Authors: Wyper G , de Pauw R , Porst M
Published: October 2024

Two people living with the same disease can have very different experiences; one has little consequence, whilst the other struggles with much more debilitating consequences that impacts how they live their lives day-to-day. A growing body of research highlights the need for better estimates of disease severity to facilitate better estimation of the non-fatal burden of disease (BOD). Routine data does not always offer solutions because it’s often not coded at a granular enough level to map to individual health states. Data offering solutions are scarce and therefore not available across time or space. Most commentators have quantified the problem of assuming the same proportional severity splits to fill data gaps; a problem common to the Global Burden of Disease (GBD) study and independent BOD studies. However, whilst the need for highlighting the problems associated with this assumption remains, there are other positive steps that can be taken to overcome it. We propose how reproducible approaches can be developed, and present how they can be used to develop disease severity estimates. This involves developing a survey instrument to estimate the overall and health state prevalence of back pain and neck pain, basing health state definitions from the GBD non-fatal disease models, where the classification of cases by severity is based on the combination of respondent’s answers. Furthermore, we discuss how self-assessed severity estimates allow for internal validity checks, but also more widely offer opportunities to appraise the appropriateness of GBD non-fatal disease models. The development, and publication, of survey instruments can assist both independent studies and the GBD study to improve estimates of disease severity, as well as retaining important opportunities for cross-country comparability. Understanding the spectrum of severity is important for understanding how disease impacts populations and can inform healthcare provision and expenditure strategies.
Exploring changes in the distribution of health status in type 2 diabetes over time - methodological aspects for estimating years lost due to disability for Germany
Authors: Porst M , Rommel A , Schüssel K
Published: October 2024

Knowledge of the severity distribution (SD) of certain diseases is crucial for calculating the years lost due to disability (YLD), as the time spent with a disease is explicitly weighted on the health state level. Depending on the disease, different severity levels are considered. In most cases, the SDs vary from mild, moderate, severe to most severe. This is different in the context of diabetes, where an explicit distinction is made according to the sequelae resulting from the disease progression. In general, these include diabetic neuropathy (with foot ulcers or amputations) and (mild or moderate) vision impairments including blindness due to diabetic retinopathy. These complications cause a considerable loss of quality of life for those affected and high costs for the healthcare system. However, the progression of many of the sequelae can be avoided through (secondary) preventive measures. Estimating the degree of severity is therefore an important indicator of the population affected and in need for care. Due to a lack of data, the Global Burden of Disease Study often uses time-invariant and regionally fixed SDs. Important insights as to the temporal variance of SDs thus remain unnoticed. As part of the BURDEN 2020 pilot project in Germany, SD for diabetes-related complications were estimated from routine health insurance data for the year 2017. In a follow-up project (BURDEN 2.0), these results will also be available for the years 2017 to 2022. If there are any changes in the proportion of individual health conditions, implications can be generated from routine healthcare data of those affected. The SDs overall and according to certain sequelae will be presented over time and discussed. Also, the resulting YLD over time for type 2 diabetes will be examined, including changes in the prevalence of the disease. This makes it possible to analyse and interpret the burden of disease due to diabetes during the years 2017 to 2022.
Digital health literacy of adults with low reading and writing skills: A mixed-methods study
Authors: Muellmann S , Wiersing R , Brand T
Published: October 2024

Background

Around 12% of the adult population living in Germany have low reading and writing skills. Little is known about their digital health literacy and use of digital health technologies. The objectives of the Liter@te study were to assess the digital health literacy of adults with low reading and writing skills and to explore which digital tools they used in everyday life.

Methods

A cross-sectional survey (n = 96) and five focus groups (n = 39) were conducted with adults aged 18-64 years with low reading and writing skills. Digital health literacy was measured using the eHEALS scale and compared with results from a nationwide sample. Focus group participants completed a task course on digital health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and logistic regression. Qualitative content analysis was applied to analyze the focus group data.

Results

Survey participants were on average 44 years old, 72% were female and 92% were not born in Germany. Compared to the nationwide survey, use of digital health technologies and digital health literacy were lower. In addition, use of digital health technologies was associated with higher digital health literacy. Lack of technical skills, language problems, and searching and finding health information online were most challenging for focus group participants (mean age 43 years, 87% female). Focus group participants reported that they prefer videos when searching for health information online and seek support from family members or local organizations if they cannot find a solution to their health issue.

Conclusions

Adults with low reading and writing skills search for health information online, but have difficulties to find the appropriate information. Interventions to promote digital health literacy are needed to ensure that persons with low reading and writing skills are not further left behind.

Key messages

• Adults with low language skills have a low digital health literacy.

• Reading and writing requirements and lack of technical skills make it difficult for them to search health information online.
7.C. Scientific session: Commercial determinants of health: impeding attainment of the Sustainable Development Goals
Authors:   Organised by: American University of Beirut (Lebanon), Global Commercial Determinants of Health Action Network,   Chair persons: Jihad Makhoul (Lebanon)
Published: October 2024

The commercial determinants of health (CDOH) and the adverse impacts they have on health equity globally, have recently emerged as an innovative growing field of research in public health. The corporate playbook comprises a myriad of strategies and tactics that aim to enhance profitability for the commercial actors, while harming health and posing grave risks to planetary health for current and future generations. The literature however, rarely explicitly makes the connection between commercial determinants and the impact they have on the attainment of the Sustainable Development Goals (SDGs) set out by the United Nations in 2015. This workshop aims to use the commercial determinants of health framework as a new approach to draw attention to, and make linkages between, commercial determinants and the challenges they pose to the attainment of several if not all the global SDGs. The four presentations showcase exemplars of the commercial determinants to include the firearms industry, fossil fuel industry, food industry and the tobacco industry focusing on impacts in low- and middle-income countries (LMICs). The workshop will start with a brief overview of the CDOH framework, their corporate playbook, and the progress in SDG attainment globally while presenting the first case on the firearms industry trade impacting armed conflicts that impede SDG 3 (good health and wellbeing), 10 (reduced inequalities), and 16 (peace, justice and strong institutions). The second presentation will discuss how the fossil fuel industry uses greenwashing tactics to conceal its harmful activities thereby compromising SDGs 7 (affordable and clean energy), 11 (sustainable cities and communities), and 13 (climate action). The third presentation will address how the tobacco industry impedes the advancement of SDG 3, 8 (decent work and economic growth), 13 (climate action) and 17 (partnerships for the goals) perpetuated by national system level attributes. The last presentation will showcase how the food industry challenges SDG 3 in its production of ultra-processed foods. The workshop will draw on evidence from LMICs, but is also eye opening for high-income countries of Europe which face industry interference in social and health policymaking progress in SGD attainment. The audience will be engaged in a short warm-up exercise at the start of the workshop through an app for real-time feedback accessed through a QR code on the screen, and will interact with the presenters at the end of the workshop if time permits.

Key messages

• All commercial actors pose a direct or indirect threat to progress in attaining the SDGs.

• The commercial determinants of health pose are in direct contradiction to the SDG 17 through their corporate playbook.
Digital divide in access and use of digital health technologies: what do we know from Germany?
Authors: Muellmann S
Published: October 2024

Even though Germany is an industrialised country, health inequalities exist between individuals or population groups due to unequal access to scarce social resources such as money or knowledge. This case study illustrates the extent of the digital divide in access and use of digital health technologies. Data from the Liter@te study, in which 96 adults aged 18-64 years with low reading and writing skills living in Germany were asked about their digital health technology use and their digital health literacy, were compared with two parallel conducted population surveys in Germany (i.e., nationwide telephone survey on digitalisation and health with 1020 internet users aged 18 years and above, online survey on digitalisation in health care with 1839 adults aged 18-80 years insured at a statutory health insurance company). Adults with low reading and writing skills used digital devices in the health context such as computers (23% vs. 71%) or activity trackers (21% vs. 35%) less frequently than the general population, whereas no differences were reported in the use of smartphones (79% vs. 70%). In addition, 18% of adults with low reading and writing skills and 4% of the general population stated that they do not use digital health technologies. Other digital health technologies such as online appointment scheduling (25% vs. 81%) or health websites (32% vs. 45%) were also used less frequently by adults with low reading and writing skills compared to the general population. Participants in the Liter@te study who do not use digital health technologies reported more frequent access problems (e.g., no suitable device, technical problems, poor internet connection) than participants in the population survey. 35% of participants in the Liter@te study have a low digital health literacy (eHEALS score between 8-19/40 points), compared to only 8% in the population survey.
Population health status and green urban areas: impact on health outcomes in two Italian regions
Authors: Congedo G , Perilli A , Filomeno A , Rodeschini M , Lombardi G S , Zjalic D , Di Russo M , Nachira L , Garda E , Bruno S
Published: October 2024

Background

Living in urban areas has been linked to a rise in noncommunicable diseases. Nevertheless, there is scarcity of evidence emphasizing the combined impacts of certain urban attributes (e.g. pollution, excessive soil sealing, urban temperatures) and the existence of green spaces on health outcomes. Further studies are imperative to evaluate the association between chronic illnesses such as dementia and ischemic heart disease, and the presence of urban green areas.

Methods

We conducted an ecological study in two Italian regions. Prevalence of chronic diseases in Tuscany and Latium were obtained at the municipality level from public health databases available online and Normalized Difference Vegetation Index (NDVI) was calculated for 2023. Descriptive analyses and Poisson regression models were run to assess the association between green space and chronic diseases prevalence, adjusting for age, sex, education, employment, foreign residents, income, urbanicity and spatial correlation.

Results

Preliminary analyses were conducted on 273 municipalities in Tuscany. Mean prevalence per 1000 inhabitants of dementia and ischemic heart disease were 15.75 (SD = 5.3) and 48.25 (SD = 11.06), respectively. Mean NDVI across municipalities was 0.37 (SD = 0.04). Higher green exposure is associated with lower prevalence of ischemic heart disease (β= -0.21; p < 0.05) and dementia (β=-0.3, p < 0.05). Analyses will be executed for the Latium region and complete results will be available by mid-June.

Conclusions

The presence of urban greenery appears to be associated with a reduction in chronic illnesses. While further studies are warranted, it is crucial to adopt urban policies focused on green spaces and citizens’ health outcomes. Generating evidence for decision-makers is essential for shaping urban environments in ways that promote both health and overall human wellbeing.

Key messages

• Living in green urban areas appears to positively impact human health, reducing chronic disease prevalence.

• Greenery serve as a tool for mitigating and adapting to the climate crisis, promoting health.
Does the way workplace canteens are managed influence users’ plate waste?
Authors: Menis D , Fiori F , Cautero P , Zago D , Driutti M , Lesa L , Conte A , Scarpis E , Brunelli L , Parpinel M
Published: October 2024

Background

Plate waste (PW) is part of the food waste and is defined as the amount of edible food served not eaten. There are few estimates of PW in the food services, mainly in school canteens, where PW appears to differ depending on the provider. Our aim was to analyse the role of different canteen management in determining PW in three hospital canteens in Italy.

Methods

On 5 working days between August and September 2022, healthcare workers’ trays were photographed before and after meal consumption. We compared two canteens managed by an external catering service (EC) with one internally managed (IC). The two canteens with similar sample size had different management. A modified visual Comstock scale was used to assess the PW. The Carbon Footprint (CF), Water Footprint (WF), energy and nutrient content were estimated using the SU-EATABLE LIFE database and the Italian Food Composition Database for Epidemiological Studies (www.bda-ieo.it). Significance was set at p < 0.05.

Results

1227 trays were analysed (1026 in EC; 201 in IC), most of which contained no waste. The percentage of trays with leftovers was higher in EC (34%) than in IC (21%), as was the mean amount of PW (104g EC vs 60g IC) (p < 0.001). The PW contained significantly more energy (125 kcal vs 73 kcal) and protein (6.0g vs 2.4g) and had higher CF (204 CO2eq EC vs 76 CO2eq IC) and WF (178 LH20 EC vs 75 LH20 IC) in CE than in IC. The significance was confirmed independently to the sample size of the canteens, and when the analysis was repeated and only the first access of each user was considered.

Conclusions

Results suggest that an internally managed canteen produces less leftovers than a canteen operated by an external provider. This could be because an internally managed canteen is more adaptable to users in terms of food offerings and portion sizes, despite a smaller number of food options. However, further studies are needed to confirm our findings and to identify the causes of PW in food service.

Key messages

• Internally managed canteens seem to reduce plate waste, probably due to certain flexibility according to users’ plate waste.

• Non-served food of the canteen should be estimated to confirm our data.
Screen time and social media exposure in children and adolescents - the landscape
Authors: Elias Cecília
Published: October 2024

Dr. Cecilia Elias is a Public Health Consultant, collaborating with the Infant, Youth, Sexual and Reproductive Health Division at the Health Directorate General, in Lisbon, Portugal. Following on from John’s introduction, Cecilia will dig deeper into the impacts of the omnipresence of social media and phones in modern society. She will provide an overview of the harms and benefits for today’s youth. She will highlight data for example on impaired development of language, cognitive and social skills from screen exposure at young ages, and increased rates of depression, anxiety, self-harm, and school refusal among adolescents with problematic social media usage, including examples of significant outcomes. Exposure to disturbing and harmful content on social media platforms like TikTok and Instagram will be covered also.
Social media use in children and young adults: the Malta experience
Authors: Calleja-Agius Jean
Published: October 2024

Prof. Jean Calleja Agius MD PhD is Professor at Faculty of Medicine and Surgery at the University of Malta. Jean will demonstrate further examples of interventions to make the internet safer for young people, drawing on her experience of collaborating with the Children and Youth Council within the Malta Foundation for the Wellbeing of Society (MFWS), which in turn is affiliated with EUROCHILD. She will share the outcomes of initiatives which have been carried out within MFWS and outline recommendations made directly by children and adolescents. More stringent regulation of social media companies will be addressed, as well as the need for other measures to engage children in other healthier activities and empower them to opt for the right choices.
Summary of presentations and urgent call to action
Authors: Kosola Silja
Published: October 2024

Dr. Silja Kosola MD PhD is Associate Professor of Adolescent Medicine and primary investigator with the University of Helsinki, Finland, and Research Director at the Western Uusimaa Wellbeing Services County in Southern Finland. As the concluding presentation, Silja will quiz the audience again with the online tool, this time to gauge the responses and support of the solutions that have been outlined. She will present a summary of the points raised, and this will then lead into the interactive discussion about the call to action.
7.O. Skills building seminar: Initiating change: Mainstreaming equity and diversity in public health
Authors:   Organised by: JACARDI, EUPHA-MIG,   Chair persons: Bernadette Kumar (EUPHA-MIG)
Published: October 2024

Background

Consideration of the increasing population cultural and ethnic diversity and the widening of social gaps is essential for narrowing health inequities. While tailored and targeted measures for populations at risk of social disadvantage are needed, mainstreaming and integration of diversity and inclusion perspectives in all public health measures are required. To our knowledge, the EU Joint Action for Cardiovascular diseases and diabetes (JACARDI) is the first large-scale program to apply a systematic and harmonized approach for integrating equity and diversity perspectives.

Objectives

The main objective of the workshop is skills building in integration of equity and diversity perspectives in practice through:

1) Introducing the key requirements for achieving EU-wide programme change, drawing from several decades of experience in projects conducted in over 30 countries, including those partnered with the World Health Organization, governments and industry.

2) Outlining a practical tool in the format of an equity and diversity matrix designed for integrating equity and diversity perspectives developed within the JACARDI project to support implementation of 142 sub-projects in 21 partner countries.

3) A practical participatory group work based on the JACARDI equity and diversity maturity matrix, followed by a moderated discussion.

The workshop acts as a valuable platform for sharing and building collaborative knowledge across European countries and empowering participants as initiators for sustainable, more equitable, and diversity inclusive public health actions. It provides practical and concrete skills on equity and diversity that participants can apply in their work and disseminate within their organizations. The presentations will build knowledge, while group work and the moderated discussion will build skills among participants on the workshop topic.

Format of the workshop

Two presentations followed by participatory group work and a moderated discussion among workshop participants and presenters.

Key messages

• Population diversity should be systematically mainstreamed in public health to effectively and sustainably narrow persisting health inequities.

• An equity and diversity maturity matrix can be used as a practical tool for systematic integration and monitoring of diversity perspectives in practice.
The future of screening and early detection in the Netherlands: a foresight study to support new screening policy strategies
Authors: De Vries M , Snijders B , Den Hertog F , Hilderink H , Dekker L
Published: October 2024

The Dutch government provides several population screening programmes intended for early detection of diseases so that prompt treatment can be provided. These include population screenings for various forms of cancer and screenings for specific diseases in unborn and newborn children. The future provision of these screenings is influenced by various developments, including the ageing population, economic fluctuations and technological advancements. To understand these developments and their potential impacts on the future of screening and early detection, RIVM has conducted a foresight study based upon a systematic six-step approach. Important steps in this process are building a conceptual framework, identifying important developments via horizon scanning, selecting scenario logics and making scenarios in order to select important challenges and opportunities for the future. The final output of the foresight study consists of a broad horizon scan, two simple future scenarios and four societal perspectives on screening and early detection. In this foresight study, there was special attention for the role of different societal perspectives and the variation in desirable futures that these perspectives entail. These perspectives were presented to the Ministry and other important stakeholders in the future strategy planning, by playing a serious role game. The results of the foresight study and the experience of looking to the future through various perspectives forms the input for the Dutch Ministry of Health, Welfare and Sport in formulating a strategy for the future of screening and early detection and making informed decisions about potential actions. The presentation will focus on how the foresight process was done and how this has informed the Ministry of Health in order for them to follow the next steps in setting future goals and ambitions and planning for a future policy strategy.
Digital interventions to prevent smoking habit among children. Is there evidence?
Authors: Gianfredi V , Traverso L , Sgueglia A C , Barbati C , Bertuccio P , Odone A
Published: October 2024

Smoking remains one of the foremost preventable causes of death and disease on a global scale, with its roots often traced back to early childhood. The habit typically begins at a young age, setting a pattern that becomes increasingly difficult to break over time. This enduring issue highlights the critical need for effective preventive measures. Traditional approaches to curbing smoking among the youth-such as public health campaigns, school-based education, and legislative measures like age restrictions on tobacco purchases-have had limited success. In this context, digital interventions (DIs) have begun to emerge as a promising new frontier for tobacco prevention. Leveraging the pervasive influence of technology in young people’s lives, these interventions include gamified educational programs, which transform learning about the dangers of smoking into interactive and engaging activities; social media campaigns, which can spread powerful anti-smoking messages quickly and broadly; and virtual reality experiences, which immerse users in scenarios that vividly illustrate the impact of smoking on health. These digital strategies not only offer fresh avenues for conveying important health information but also engage young audiences in a medium they find relatable and compelling. In this context, the presentation will discuss results of a systematic review aims to assess the efficacy of DI in preventing smoking, and improving knowledge and awareness about smoking damages, among children. This review is part of the PRIN project, titled: “Leo&Giulia standing for public health”, whose goal is to evaluate the effectiveness of a DI aimed at school-aged children, intended to increase knowledge about the negative effects of smoking and prevent its use. Grasping the impact of DI in smoking prevention can greatly benefit public health by offering practical alternatives.
Learnings from ‘Everyone In’ initiative in England for improving health of people facing homelessness
Authors: Jain N , Adams E A , Haddow K ,   Groundswell Research Team, Kesten J , Howells K , Sanders C , Adamson A , Kaner E , Ramsay S E
Published: October 2024

Issue

The COVID-19 pandemic presented an unprecedented health risk to people experiencing homelessness including risk of infection due to inability to self-isolate, and pandemic restrictions adding barriers to accessing health support. The English Government implemented the ‘Everyone In’ policy at the start of the COVID-19 pandemic, which offered accommodation to those who were (or at risk of) sleeping rough. This led to integration of support for health, care and housing.

Description of the problem

Between January-October 2023, a qualitative study was undertaken to understand what worked well and less well in implementing the ‘Everyone In’ initiative for improving physical and mental health outcomes for people experiencing homelessness. People who were provided accommodation and those involved in the planning or delivery of the initiative were interviewed.

Results

Flexibility in provision of funding and support, lack of red tape and joined-up working between partners across sectors were key positives of implementing the policy. ‘Everyone In’ also led to new ways of supporting and overcoming barriers to support, for example, provision for people with no recourse to public funds. Access to health services for people experiencing homelessness was improved by strengthened relationships with service providers, and outreach within the accommodation for wrap-around support. Challenges were faced in support for substance use. Data sharing practices, mental health support, and recognition of trauma were areas that could have worked better.

Lessons

Availability of flexible and earmarked funding is crucial in implementing strategies for improving outcomes in homelessness. Many short and long-term initiatives have been launched as a result of ‘Everyone In’. This study highlights the importance of partnership working, supported housing and maintaining flexible, responsive approaches to interventions to meet the health and social care needs of people experiencing homelessness.

Key messages

• Multi-sectoral partnerships and integrating housing with health and care support can improve access to services.

• Availability of flexible funding for homelessness strategies supports adaptable and responsive service provision.
The potential of EU policies for achieving wellbeing economies
Authors: Costongs C , Stegeman I , Putatti V , Godfrey A
Published: October 2024

The environmental crisis, growing levels of social inequalities and rising levels of non-communicable diseases are all symptoms of economic systems that are failing to generate wellbeing. There is increasing support for the notion that addressing these crises requires shifting the focus from economic growth to a broader range of measures that reflect wellbeing, through more comprehensive, consistent and integrated policy approaches to deliver this. This presentation explores to what extent the concept of the Wellbeing Economy is being applied at the EU level, by tracking changes in some of the EU’s key policies and strategies over the past 10 years and in the Semester process, as a mechanism to implement them. It concludes that while progress towards more integrated policy approaches have been made, it is limited by the continuing emphasis on economic, over other policy areas. Recommendations will be made for an even more comprehensive EU Strategy that enables policy sectors to deliver wellbeing objectives in a more coordinated manner and on how to ensure health and wellbeing remain on policy-making agendas.
Future patterns of health inequalities in the population of England to 2040: a microsimulation study
Authors: Raymond A , Watt T , Douglas H R , Rachet-Jacquet L , Head A , Kypridemos C
Published: October 2024

Introduction

The existence of wide inequalities in health across England is well-documented. Our research adds to this evidence on inequalities in self-reported health by describing current patterns and projecting future patterns of inequality in diagnosed illness across multiple conditions by deprivation.

Methods

We used the IMPACTNCD microsimulation model that simulates a close-to-reality synthetic population of adults in England from 2019 to 2040. This model combines individual-level data on demographics, health and mortality from linked administrative data for primary and secondary care with survey responses on individual-level risk factors and epidemiological evidence on the associations between risk factors and chronic illness. This model can be adapted for other countries based on data availability. We used the Cambridge Multimorbidity Score (CMS) as our multimorbidity measure. This assigns a weight to 20 common long-term conditions based on individuals’ healthcare use and their likelihood of death. We further focus on “major illness” which corresponds to a CMS greater than 1.5.

Results

In preliminary results, we project that health inequalities are not projected to improve between 2019 and 2040. In 2019, the difference in the average time spent without major illness between the most and least deprived 10% of areas in England was 10.4 years. This is projected to remain largely unchanged at 10.7 years (8.8, 11.7). We also find that in 2019, the share of working age people living with major illness in the most deprived 10% of areas in England (14.6%) was more than double the rate seen in the least deprived 10% of areas (6.3%). In 2040, we project these rates to remain largely unchanged at 15.2% (13.0%, 17.6%) and 6.8% (5.4%, 9.1%) respectively.

Discussion

On current trends, health inequalities are projected to persist into the future. This has significant implications not just for population health but for labour supply and wider economic growth.

Key messages

• If current trends in risk factors continue into the future, existing wide inequalities in diagnosed illness in England are projected to persist onto 2040.

• With significant disparities in major illness among the working-age population, this has implications not just for population health but for labour supply and wider economic growth.
Large scale OECD health valuation study to estimate the economic benefits of chemical regulation
Authors: Dussaux D , Hu I , Bystrom O , Leinala E
Published: October 2024

Chemical regulation aims at protecting human health and the environment from the risks of chemicals, while recognizing the economic importance of the use of chemicals. Assessment of the societal impacts of chemical regulation and different policy options requires information on both costs and benefits. So far, regulators assessing chemicals regulations has not had access to high quality and internationally comparable data on the full monetary benefit of reducing health and environmental risk. The OECD has implemented a multi-country stated preference valuation project that covers ten chemicals-related health conditions (e.g. asthma, kidney disease, infertility, etc.) with more than 80 surveys with large samples in 22 countries. The OECD Surveys on Willingness-to-Pay to Avoid Negative Chemicals-Related Health Impacts (SWACHE) project aims to establish internationally comparable values for the willingness-to-pay (WTP) to avoid negative health effects due to exposure to chemicals. The values can be used to demonstrate and measure the economic benefits of minimising the morbidity impacts of chemical regulations, environmental policies and public policies in general. The latest valuation results of the project will be presented, along with key aspects of the joint methodology used and the plans to further expand this work. In addition, the OECD is collaborating with other intergovernmental organisations via the Inter-Organization Programme for the Sound Management of Chemicals (IOMC) to update the cost of inaction estimates for chemicals as part of the Global Framework on Chemicals. An update on this initiative, that can benefit from the results of the SWACHE project, will be provided.