bluuebunny/crossref_metadata_2025 huggingface dataset:
How much of the unemployment effect on mental health is due to income? Mediation analysis in UK data
Authors: Thomson RM , Kopasker D , Leyland A , Pearce A , Katikireddi SV
Published: October 2022

Background

Employment and income are important determinants of mental health (MH), but the extent to which unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income.

Methods

We studied adults 25-64y from nine waves of the representative UK Household Longitudinal Study (n = 45,497/obs=202,297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as a General Health Questionnaire-12 score ≥4. We conducted causal mediation analysis using inverse probability of treatment weights to estimate odds ratios (OR) and absolute differences for the effects of unemployment on CMD as measured in the same sweep, before (TE) and after (CDE) blocking the income pathway. The percentage mediated by income was 100*(TE-CDE)/TE, with standard errors calculated via bootstrapping. Multiple imputation addressed missingness.

Results

The TE of unemployment on short-term CMD risk was OR: 1.66 (95% CI 1.57-1.76), with 7.09% (6.21-7.97) absolute difference in prevalence; equivalent CDEs were OR 1.55 (1.46-1.66) and 6.08% (5.13-7.03). Income mediated 14.22% (8.04-20.40) of the TE. Percentage mediation was higher for job losses (15.10% [6.81-23.39]) than job gains (8.77% [0.36-17.19]). Mediation by income was lowest for those aged 25-40y (7.99% [-2.57, 18.51]) and those in poverty (2.63% [-2.22, 7.49]).

Conclusions

In the UK, a high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for those who are younger or already living in poverty. Population attributable fractions suggested 16.5% of CMD burden was due to unemployment, with 13.9% directly attributable to job loss rather than resultant income changes. Further research is needed across different European countries to determine how different welfare regimes might moderate these effects, and to investigate longer-term effects.

Key messages

• Unemployment has a clear detrimental effect on MH in the short-term.

• Only a small proportion of this effect appears to be mediated by income.
A novel plot for the early alert of epidemic growth using regional targets: the doubling plot
Authors: Carinci F , Veltro G , Rocchi L , Mipatrini D , Mantoan D , Siccardi G
Published: October 2022

Background

During the pandemic, restrictions set by the Italian Government were primarily based on the regional level of key parameters including hospitalization and incidence rates. We aimed to build a specific plot to monitor trends and trigger early alerts, with daily updates publicly available on a National Portal.

Methods

A multidisciplinary team conceived and implemented a new composite plot, developing ad hoc R scripts on top of a specialised database, built in collaboration with the Ministry of Health. We calculated the doubling time Td as log(2)/log(1+r/100), where r is the daily change of target parameters and Td ranges between (0,+-infinity), and not determined for constant or missing values. We calculated Td daily, as either doubling (growth) or halving (decrease) time. To visualize trends, we assembled two different types of graphs: a bivariate plot showing the path of each point (Td, target parameter) over time, and a line plot of Td over time. The Y axis was inverted for doubling times, as lower Td indicate higher alert in this case. The two graphs were arranged in lines, using cutoffs for excessive high values for doubling times and low values for halving times. A third line was included to display trends of the target parameter over time.

Results

The plot was successfully realized and published on the Portal for all regions in February 2021 (https://www.agenas.gov.it/covid19/web/index.php?r=english%2Fdoubling&q=ITA&t=0). Since July 2021, we used the doubling plot to monitor the three main parameters adopted to set restrictions for Covid-19: a) occupancy rates in intensive care; b) occupancy rates in medical wards; c) weekly incidence rates. The plot highlighted growth trends and early alerts, particularly in the initial phases of growth.

Conclusions

The doubling plot can provide useful information to trigger early responses for pandemic control in decentralised governance. R code is available open source from AGENAS for free use.

Key messages

• The doubling plot was conceived and implemented on a National Portal to trigger early alerts of Covid-19 progression in Italian Regions and Autonomous Provinces.

• The plot could be rapidly adapted to legislative parameters and can be useful in different situations to monitor epidemic growth and support public health policies.
6.B. Round table: Insights from COVID-19: Preparing for and responding to the next health emergency
Authors:   Organised by: Institute for Health Metrics and Evaluation, Division of Country health Policies and Systems, WHO Europe,   Chair persons: Maja Pasovic (USA), Elizabeth Serieux (USA)
Published: October 2022

The COVID-19 pandemic has stretched national health care systems to its limits, underscoring the importance of advance planning for health emergencies and the role of health data and evidence for informed policy interventions and actionable strategies. The experience with the pandemic has demonstrated the constraints of existing health information systems and the negative impacts that the lack of actionable and timely data can have on the implementation of rapid response measures during emergencies. This workshop aims to assist participants to become better prepared to deal with future health threats, such as pandemics, by exploring the role of trust in pandemic preparedness and response, effective communication strategies during a pandemic, and the use of qualitative research for evaluation of pandemic response. The specific objectives are to share and discuss: (a) results and conclusions derived from an online qualitative survey of experiences and lessons learned by member states across the WHO European Region; b) results and conclusions derived from an IHME study exploring the factors that contribute to / predict pandemic preparedness, and (c) lessons learned in the process of developing and disseminating scientifically valid, timely evidence across the globe, to assist policymaking during a pandemic. Together, these topics present and explore what countries and populations can do to effectively mitigate the negative effects of a pandemic or other health emergencies. These strategies and lessons learned include building trust, communicating clearly and succinctly, and using qualitative methods and data to evaluate pandemic response. Collectively, these are all geared at improving the capacity to address such threats and unexpected emergencies in the future. The panelists will also reflect on successful tools and strategies developed to aid policymakers and country governments in their response to the COVID-19 emergency. The workshop will be in the form of a 60-minute round table discussion with three panelists. Each panelist will make a brief presentation on their specific area of research, followed by a discussion between the panel members and audience.

Key messages

• Trust, transparent communication, and reliable and timely data are critical aspects of both pandemic preparedness and response.

• The importance of qualitative evaluation for exploring what worked during the pandemic and what innovations should become part of an enhanced health information system in the future is essential.

Speakers/Panellists

Maja Pasovic

Institute for Health Metrics and Evaluation, Seattle, USA

Elizabeth Serieux

Institute of Health Metrics and Evaluation, Seattle, USA

David Novillo-Ortiz

WHO Regional Office for Europe, Copenhagen, Denmark
Precarious work, sickness absence and risk sharing between employers, employees and social insurance
Authors: Ose S
Published: October 2022

Background

The COVID-19 pandemic has revealed the importance of social protection systems including income security when health problems arise. Particularly the protection of those with precarious work felt short in some countries. For some time there has been an interest in the European variation in sick-pay schemes but still we still lack knowledge on country differences and similarities. This is particularly the case regarding precarious workers, while they have higher chances for sickness absence. Our aim is to understand, in the context of precarious work, the differences in risk sharing of sickness absence between employer, worker and social insurance.

Methods

Data had been collected in a study on sickness absence follow-up regimes in nine countries (the Nordic countries (Sweden, Denmark, Finland, Norway and Iceland) and in Germany, the Netherlands, Belgium and the UK). Comparative statistics were collected and scholars familiar with their countries system were invited to answer a list of 51 questions on system characteristics. Data were re-analysed from the perspective of precarious work, using actor-network theory and insider-outsider theory of employment.

Results

Countries with shorter employer periods of sick pay have stricter follow-up responsibility for employers as they are regarded gatekeeper except for The Netherlands. The tax-based systems that target all citizens offer more protection for precarious workers while the employee-focused systems define their target population more strictly, leaving precarious workers underserved. There is a large difference in how self-employed are supported or not.

Conclusions

Despite small economic differences in the nine countries studied, the systems for dealing with sickness absence in the context of precarious work vary largely. Even though, in all systems those with secure jobs seem insiders and those with precarious work outsiders. Social protection systems should be updated to avoid an increasing inequality.

Speakers/Panellists

Anita Tisch

Working time and Organization, Federal Institute for Occupational Safety and Health, Dortmund, Germany

Angelique De Rijk

Department of Social Medicine, Maastricht University, Maastricht, Netherlands
Strengthening the Swiss health system by improving organizational health literacy: a practice-approach
Authors: De Gani S , Bilgeri AS
Published: October 2022

Issue

Healthcare organizations represent vital points of contact and disseminators for people to find, understand, assess, and apply health information, and may thereby strengthen people's health literacy (HL). From a system perspective, healthcare organizations provide essential practices and structures to foster population health beyond their medical-based services.

Description of the problem

Despite increasing research on the promising role of organizational health literacy (OHL) the current Swiss healthcare system provides insufficient support for healthcare organizations to address HL. In response, the Careum Foundation in Zurich recently launched a Center for Health Literacy to promote OHL - among other HL initiatives. A first step was a practice-oriented collaboration project with the Department of Health of the canton of Zurich, which started in 2019 to assess, implement, and improve HL in primary care organizations. Therefore, a self-assessment tool for OHL is being developed, implemented, and evaluated. In addition, the center started to shed light on HL in Switzerland, on HL and necessary competencies of health professionals. Moreover, it is investing in communication and expertise on OHL, and developing first ideas regarding health literate hospitals.

Results

A first systematic evaluation of the self-assessment tool has demonstrated a significant potential to improve OHL, organizational development, and teambuilding processes in healthcare organizations. Connected through (inter)national networks, the Center for Health Literacy launches a practice approach to understand OHL as both medium and outcome of a health literate population.

Lessons

We have learned that practice-oriented OHL initiatives can provide promising approaches to strengthen both population health and organizational development processes.
COVID-19 impact on hospitalizations in older adults with chronic conditions: a real-world analysis from Lombardy, Italy
Authors: Bosetti C , Rognoni M , Ciampichini R , Scala M , Cavalieri d'Oro L , Zucchi A , Amerio A , Iacoviello L , Odone A , Gallus S
Published: October 2022

Background

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions.

Methods

We investigated such impact among all adults with chronic conditions aged ≥65 years, identified through the electronic health databases of two local health agencies - ATS Brianza and ATS Bergamo - from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs).

Results

Overall, in 2017-2019 there were a mean of 374,855 older adults with ≥1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases.

Conclusions

Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run.
The ultra-processed food content of school meals and packed lunches in the United Kingdom (2008-2017)
Authors: Parnham JC , Chang K , Rauber F , Levy RB , von Hinke S , Laverty AA , Millett C , Vamos EP
Published: October 2022

Background

British children have the highest ultra-processed food (UPF) intake in Europe, which is linked to adverse health outcomes. Schools are posited as a setting for dietary intervention, yet the level of UPFs consumed at schools is currently unknown. This study aimed to describe the UPF content of school food in the UK, explore the UPF content of school meals and packed lunches (food from home) and examine whether UPF differs by children's household income.

Methods

A pooled cross-sectional analysis of primary (4-11 years, n = 1,895) and secondary schoolchildren (11-18 years, n = 1,408) from the UK's National Diet and Nutrition Survey (2008-2017) was conducted. Food diaries recorded student's meal-type (school meal/packed lunch). UPF intake was defined using the NOVA food classification system. Quantile regression models assessed the association between meal-type and lunchtime UPF intake (%kcal and % grams). Models were stratified by school phase (primary/secondary) and interacted meal-type with income.

Results

Schoolchildren consumed most of their lunch as UPF, with higher median intakes in secondary schoolchildren than primary schoolchildren (77.8 %kcal vs 72.6 %kcal). School meals were associated with lower median UPF intake (%kcal) in both primary (-20 percentage-points[pp] [95% CI -22.2, -17.4]) and secondary schoolchildren (-11pp [-16.0,-7.0]) compared with packed lunches. Results were similar when UPF %g was analysed. Overall, income was inversely associated with UPF content. However, in primary schoolchildren there was no significant income gradient in the UPF(%g) content of school meals.

Conclusions

In the first nationally representative study, we showed that on average UPF intake was high in all UK schoolchildren. Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those with a lower income. Procurement policies must be revaluated to protect children from high UPF intake.

Funders: NIHR School for Public Health Research

Key messages

• In the first study of ultra-processed food content of UK school food, we show that children consumed around three quarters of their energy as ultra-processed food at lunch.

• Children who were older, took food from home or were from a low-income household were more likely to consume higher levels of ultra-processed food. Regulation is needed to protect these children.
Mobile phone filmmaking in health promotion. Addressing problematic social media use in Swedish youth
Authors: Dahlqvist H , Gillander Gådin K
Published: October 2022

Background

Digital media is an important part in the everyday lives of young people. However, hate, threats, and harassment on social media is becoming a global public mental health issue among youth. To promote mental health in this age group, this issue needs to be addressed, and community-based health promotion, in particular participatory interventions, are needed to make measures taken meaningful for youth. The aim of the study was twofold; to teach participatory mobile phone filmmaking to Youth Community Center (YCC) staff; and to investigate how they assess this method regarding feasibility, relevance, costs, resources needed, and time considerations.

Methods

YCC staff participated in a two-day mobile phone filmmaking training. Group interviews that were recorded and transcribed verbatim were conducted and field notes were taken. Data was deductively analyzed in accordance with Elo and Kyngäs (2008).

Results

YCC staff found the technology was easily accessible and the method needs limited extra resources. It has the potential to promote creativity and can be used as a means to involve young people in describing the issue in their own words, and to find a solution to the issue at hand. The method also has the potential to reach and engage the whole community as organizing a mobile phone film event is part of the process. Time consumption was not perceived as an issue, as staff is free to plan activities as they see fit.

Conclusions

According to YCC staff, participatory mobile phone filmmaking has the potential to promote positive interactions on social media among youth. This in turn has the potential to promote wellbeing of young people. Recommendations are that this method is tested among young people and investigate if it is a helpful intervention to promote mental health in this age group.

Key messages

• Participatory mobile phone filmmaking may be useful in youth mental health promotion.

• The method is cheap, easily accessible, and have the potential to involve the whole community.
Short introduction to JAHEE and Actions
Authors: Costa G
Published: October 2022

Reducing health inequalities is on the agenda of many countries. Despite an increasing concern and awareness on health inequalities a wide gap exists in Europe in terms of political response. The main objective of JAHEE was to strengthen a cooperative approach among participating countries and implement concrete actions to reduce health inequalities. The partnership was composed of 24 countries including many strategically most relevant public health institutions in the European Union, which contributed with different backgrounds, skills and know-how to the achievement of the project objectives. The main results will be presented.
Labor and social protection gaps impacting health of non-standard workers: An international study
Authors: Kvart S , Cuervo I , Gunn V , Baron S , Bodin T ,   PWR Consortium
Published: October 2022

Background

Labor regulations and social protection structures are intended to protect workers, but the needs of those in precarious and non-standard employment (NSE) are often missed, which may negatively impact health and well-being. The aim of this research is to document how workers in NSE in six countries - Belgium, Canada, Chile, Spain, Sweden, and the US - with varying policy contexts experience aspects of employment that are linked to health.

Methods

We employed a mixed methods approach for this study. To understand policy contexts, we analyzed country-level labor regulatory and social protection frameworks using 2019 Organization for Economic Cooperation and Development data. To understand the experiences of workers in NSE, we conducted 250 in-depth interviews with workers at different levels of employment precariousness between January and June 2021.

Results

Overall, European countries have the most social expenditures and North American countries have the weakest labor market regulations. In all these varying contexts, workers in NSE reported multiple unmet needs, e.g., inadequate paid sick and parental leave and unemployment compensation. These unmet needs occur due to various barriers, including poor enforcement, legal loopholes, or required minimum employment time. Workers’ living accommodations are also affected, as home financing or rental contracts are dependent on permanent employment. In response, they tended to rely disproportionately on individual or family resources for financial and social support rather than on government or employer resources.

Conclusions

Findings suggested that diverse labor regulatory and welfare regime contexts are unsupportive of workers in NSE due to multiple gaps in policies essential to public health. The shifting of responsibility for key employment and social supports to individuals and their families is likely to increase health inequities for workers in NSE.

Key messages

• Our study documents multiple policy gaps affecting key employment-related social determinants of health among workers in NSE.

• This occurred across diverse labor and social structure contexts in six countries.
The way from stakeholders’ needs research to the public health policy and practice
Authors: Lewtak K , Sugay L
Published: October 2022

The implementation of the project “ProfiBaza” was the unique opportunity to effectuate a data set with the possibility to showcase for the first time in Poland which public health (PH) interventions are taken and whether they cover population health needs. In order to be forethoughtful to this challenge, the needs of stakeholders within the health system were investigated. Particularly, considering the widely recognised knowledge-practice gap in the PH field. We would like to demonstrate the results of a needs analysis related to: the accessibility assessment of the information about PH interventions; the need of establishing a good practices database regarding health promotion and disease prevention; the possibility to use research findings in PH practice. All those would be presented from the perspective of researchers, politicians, decision makers and PH institutions. This research was conducted as a questionnaire-based survey and focus group interviews. Researchers were asked to assess the compatibility between the PH research and the population health needs. The group of health sector decision makers were questioned about the usage of the information available in the ProfiBaza for the process of evidence-based decision making; local government politicians - to assess their readiness to implement health programmes, use the good practices database and build partnerships for health while representatives of various sectors - to assess the need of initiating a knowledge translation platform via the launched ProfiBaza system. The results of the research demonstrate that there is a need for: solidified collaboration between different types of PH stakeholders, mobilization, coordination, sharing experiences, creating networks of cooperating institutions, which will enable the effective response to emerging challenges and opportunities and to counteract the phenomenon of dispersion of efforts in improving health and reducing social inequalities in health.
Promoting implementation of “Good and Best Practices” through Health Promotion and Prevention Registries
Authors: Rossmann C , van Dale D , Rados-Krnel S , Kylanen M , Lewtak K , Grasso M , Tortone C , Ragazzoni P , Costa L , Maassen A
Published: October 2022

Health promotion and disease prevention programme registries can play an important role in increasing transparency of “good/ best Practices” and promoting their implementation. In the EU, there are different approaches to how registries seek to support the implementation of practices. However, there is limited knowledge of the extent to which there are informative differences or overlaps in the mechanisms chosen for accreditation, capacity building and implementation. This presentation focuses on six national registries in the EU (Finland, Germany, Italy, Netherlands, Poland, Slovenia) and the European Public Health Best Practice Portal. Information was obtained through a working group on Good/ Best Practice Portals, established in 2019. Information on the process of adding good/best practices to the registry and on measures that promote implementation was gathered and evaluated through a descriptive case comparison. The comparison suggests that implementation can be promoted through different approaches for capacity building measures and incentives for implementation. The latter included funding resources, titling/awarding of practice and professional feedback in only a few registries. Registries may be useful not only for transparency of good and best Practices but also for implementation through capacity building and several incentives. The information provided in this presentation may be informative in guiding development of similar resources elsewhere and a starting point for discussion on how to support best the implementation of good/ best practices.
Central concepts in mental health promotion programs for children and adolescents: Evidence and examples from Switzerland
Authors: Wieber F , Zysset A , von Wyl A
Published: October 2022

Universal mental health promotion programs draw on a wide range of concepts to promote children's and adolescents’ mental health. This presentation aims to provide an overview of the central concepts from health, developmental and social psychology, psychiatry, and public health/health promotion and to illustrate their application using examples from Swiss mental health promotion programs for children and adolescents. Concepts on internal, biological, psychological and psychosocial factors such as the ten life skills that are recommended by the WHO, self-efficacy, (mental) health literacy, and the resilience literature are looked at as well as concepts on external risk and protective factors such as social support (quality of attachment and relationships, positive family climate and peer relations) and the quality of educational institutions. Evidence on their effectiveness is reported and conceptual similarities and differences as well as the underlying mechanisms of action are explored from a health behavior change perspective using the behavior change wheel. Finally, implications for the design and implementation of mental health promotion programs are discussed
The protective effect of reserves on mental health: a cohort study among undocumented migrants
Authors: Cullati S , Fakhoury J , Duvoisin A , Courvoisier D , Burton-Jeangros C , Jackson Y
Published: October 2022

Background

Resources are essential for mental health. In temporary stressful situations throughout life, people need to use a particular type of resources, their “reserves”, to handle the stress. We do not know whether “reserves” (economic, cognitive, and relational) are more protective of mental health than “conventional” resources. Using a cohort of undocumented migrants experiencing a stressful transition in their life course (in the process of regularisation with local authorities), we will determine which resources, or reserves, and which types, better protect their mental health.

Methods

A two-wave cohort study followed 362 undocumented migrants from 2017 to 2020, half of whom (48%) were involved in a regularisation process with the local authorities. Depressive symptoms were measured with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder. Economic reserves were measured at baseline and follow-up, cognitive and relational reserves at baseline only. Conventional economic and relational resources were assessed at both time points. The association between reserves and resources and mental health were examined using generalised estimated equations adjusted for age, sex and working hours per week, as well as the interactions between reserves/resources and regularisation status.

Results

The indicators of economic and relational reserves were consistently and strongly associated with lower levels of anxiety and depressive symptoms. On the other hand, we found that mental health outcomes were marginally associated with conventional economic resources but independent of the relational resources indicators. We did not find strong evidence of interactions between reserves/resources and regularisation status.

Conclusions

In a vulnerable population experiencing a stressful transition, reserves are more protective than resources. More research is needed in other vulnerable groups experiencing other stressful events.

Key messages

• Undocumented migrants’ economic and relational reserves protect their mental health.

• More research on the protective effect of reserves is needed in other vulnerable groups experiencing other stressful events.
Action recommendations to support people living in precarious conditions during a pandemic
Authors: Öcek Z , Volkmann AM , Klünder V , Basil A , Geise M , Coenen M
Published: October 2022

Background

The COVID-19 pandemic has deepened pre-existing health inequalities. As members of an EU-funded research consortium (SoNAR-Global) tasked with assessing vulnerabilities in five European countries, we explored the impacts of the pandemic on vulnerable populations and identified concrete actions that strengthen resilience. Here, we present our action recommendation development process for populations living in precarious conditions such as refugees, migrants and those living below the poverty line in Munich, Germany.

Methods

The process began by interviewing 82 people who were likely to face vulnerability mechanisms, followed by interviews with 19 community representatives. Based on this qualitative research data, we defined challenges and resilience factors, and matched these with a list of action recommendations. This list, named “Provision of social support to people living in precarious conditions in times of a pandemic”, was considered by a panel with ten experts on migration, health, poverty, social support, and inclusion.

Results

Through discussion, we eliminated one recommendation and re-defined three others and achieved consensus on six recommendations. They are: 1) work towards eliminating opportunity inequity in education, 2) streamline bureaucratic processes to improve access to care, 3) establish structures that allow for continuing social support even during a pandemic, 4) refrain from isolating socially vulnerable groups through blanket pandemic mitigation measures, 5) Hybrid (online and live) solutions for inclusion, 6) improving healthcare empowerment.

Conclusions

Through an inclusive process that involved citizens, vulnerable populations, and health- and government experts we identified a set of actions that should be taken now to ensure an equitable and just approach to pandemic preparedness. Our panel identified feasible and achievable goals within those recommended actions.

Key messages

• Vulnerability mechanisms are multi-layered. Therefore, policies that need to be developed should be based on comprehensive approaches, not selective interventions.

• Actions to mitigate vulnerabilities in pandemics must be ambitious in order to prevent further exacerbation of existing issues with potentially catastrophic long-term consequences.
Meeting the governance challenges of integrated health and social care
Authors: Exley J , Glover R , McCarey M , Reed S , Ahmed A , Vrijhoef H , Manacorda T , Stewart E , Mays N , Nolte E
Published: October 2022

Background

Many countries are experimenting with novel ways of organising and delivering more integrated health and social care. Governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration.

Methods

Cross-country case analysis involving document review and semi-structured interviews with 27 local, regional and national level stakeholders in Italy, the Netherlands and Scotland. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to structure our analytical enquiry to explore factors that influence the governance arrangements in each system.

Results

Governance arrangements ranged from informal agreements in the Netherlands to mandated integration in Scotland. Novel service models were generally participative involving a wide range of stakeholders, including the public, although integration was seen to be driven, largely, from a health perspective. In Italy and Scotland some reversion to ‘command & control’ was reported in response to the imperatives of the Covid-19 pandemic. Policies, budgets, auditing and reporting systems that are clearly aligned at all levels were seen to help with implementing innovations in service organisation. Where alignment was lacking, cooperation and integration was suboptimal, regardless of whether governance arrangements were statutory or not. There was wide recognition of the importance of buy-in. Enablers of greater engagement included visible leadership, time and long-standing working relationships. Lack of suitable indicators and openness to data sharing to measure integration hindered working relationships and thus the successful delivery of integrated services.

Conclusions

Our study provides important insights into how to more effectively and efficiently govern service delivery structures within care systems. We will discuss approaches to governance that help support more resilient integrated care systems.

Key messages

• Different governance arrangements face common challenges to greater integration of care. Enablers include strong leadership, inclusivity and openness to work across traditional boundaries.

• Meeting the governance challenges of integrated health and social care requires clear lines of accountability, aligned policies, budgets and reporting systems.
COVID-19 containment measures impact utilization and provision of healthcare in Europe
Authors: Dratva J , Klein A , Marti S , Wieber F
Published: October 2022

Background

The COVID-19 containment measures, implemented to curb the pandemic, impacted health of children and adolescents by numerous pathways. We present the impact on health care utilization and provision.

Methods

A systematic review on secondary health impact is ongoing (PubMed, PsychInfo, Embase). Literature is screened (title, abstract, full-text) by 2 researchers, and data of interest extracted systematically.. Inclusion criteria are age (0 - 25 yrs.), exposure: containment measures, outcome: secondary health outcome, and European data origin.

Results

Jan. 2020 - Aug. 2021 10112 studies were identified, 337 were included. n = 60 were on health care utilization and provision. Utilization studies relied on objective hospital or registry data, care provision studies more often on survey data (professionals, parents). Data yields a large but varying decrease in emergency department visits during the lockdown: Italy ∼75%, Spain ∼65%, France ∼60%, and Germany ∼64%, and a substantial change in case mix and severity compared to comparable pre-COVID. Specialized and primary pediatric practices report that elective interventions were postponed, state of the art diagnostics withheld, and rehabilitation services disrupted. Vaccinations in infants, children, and adolescents dropped during the lockdown inversely proportional to children's age. Studies repeatedly suggest patients’ health services avoidance out of fear of infection and stay-at-home rules.Results on catch-up utilization and provision to follow (ongoing study).

Conclusions

COVID-19 measures exerted a measurable impact on health utilization and provision in children and adolescents. The utilization was comparatively lower and service provision disrupted across Europe. So far little can be said about a potential recovery in terms of catch-up of visits, diagnostics, or treatments. Analyses of the long-term health impact of the observed effects is recommended and can serve to improve future pandemic preparedness.

Key messages

• COVID-19 confinement measures had measurable secondary health impact on children and adolescents.

• Data on catch-up healthcare is important to establish long term impact and learnings.
The Health and Quality of Life Development Plan as a policy advisory tool for municipalities
Authors: Sequeira R , Pita Ferreira P , Carmezim Pereira S , Quinaz Romana G , Campos Fernandes A , Sousa P
Published: October 2022

Issue

In 2019, the Portuguese government established the autonomy of local authorities and the decentralisation of public administration. Consequently, a process that includes the transfer of health competencies from the central government to the municipalities began. The newly acquired competencies enable local governments to play a crucial role in defining health policies and strategic partnerships with special focus on disease prevention, promotion of healthy lifestyles and active ageing. That said, several municipalities established a collaboration protocol with the National School of Public Health (NSPH) for the development of the Health and Quality of Life Development Plan (HQLDP) as a contribution to their strategic planning.

Results

NSPH has developed a solidified methodology for municipalities to substantiate their health planning and priorities, based on a deep health diagnosis, from existing demographic, economical, health and environmental data in a given timeline. HQLDP is a medium-term reference that will support strategic action in the area of health and social determinants. The general objective of the HQLDP is to contribute to the improvement of the health status, in the different stages of the life cycle, based on the evaluation of the health profile and social determinants and to define a set of strategic objectives that promote the reduction of inequalities, the promotion and protection of health and the prevention of disease. The developed plan also includes public and stakeholders’ scrutiny, to define key areas of action in the health sector.

Lessons

The HQLDP takes into account the vocation of local authorities to act on determinants through policies that intervene in the environmental, socio-economic, educational, urban planning and mobility contexts; assuming an active, influential and local role in health policies. Municipal intervention requires a strong and concerted local action and the definition of territorialized development strategies.

Key messages

• HQLDP has a crucial role on the situational diagnosis and set of priorities of the quality of life and health indicators to assess the priorities at council level.

• HQLDP provides the knowledge for the development of public policies and interventions that comply with the population characteristics by reducing health inequalities and inequities.
WHO RHN Network
Authors: Menne M , Forcellini A
Published: October 2022

The WHO European Office for Investment for Health and Development (Venice Office) works in the thematic areas of health equity, social and economic determinants of health, and investment for health in the context of the 2030 Agenda for Sustainable Development and the European Programme of Work. Within the WHO Venice Office, the the Regions for Health Network (RHN) works to place health and well-being high on the key political agendas, and advocates the needs of local and subnational authorities at the regional and international levels. RHN has been launched in 1993 to help regions to accelerate the delivery of improved population health, and currently has 34 members. It has developed over the decades into a forum that creates synergies between regions and stakeholders in the field of health (mutual learning); strengthens cooperation/collaboration between regional and local actors and international health institutions; increases understanding of the functioning of regional and local health systems; promotes the exchange of experience, and mutual learning. RHN positions itself at the forefront of innovative approaches and aims at becoming a cutting-edge network ready to capture and disseminate effective approaches, policies and strategies that improve population health at the regional level of governance. In past years, RHN has spearheaded collaborative efforts amongst cross-border regions, on different topics, and with technical guidance from WHO. These efforts have led to joint initiatives, publications, study trips, project collaboration and periodic and structured exchanges of experiences.
Healthacross initiative of Lower Austria
Authors: Winkler J
Published: October 2022

Lower Austria is by size the biggest province of Austria and located in the heart of Europe with a 414 km long border to the Czech Republic and Slovakia, and in close proximity to Hungary. Not only through its geographic location but also through its understanding to be a connected region as part of a strong European Union, cross-border health care plays an important issue at the provincial level. Led by the European spirit, all international and cross-border health activities are bundled under the umbrella of the ‘Healthacross initiative”. The initiative is part of the Health Agency of Lower Austria (NÖ Landesgesundheitsagentur), which operates and manages all 27 public hospitals and around 50 care/nursing homes in the region. Via the “Healthacross initiative”, Lower Austria is participating in four transnational networks and since 2008, conducted eight EU co-funded projects in cross-border healthcare, four of them currently running. Healthacross is the coordinator of this session, with support of WHO RHN network. Active networking in various European and international networks is part of the regional strategy of Lower Austria in order to gain excellence to improve the health and quality of life for citizens living in border regions. The premise is to enable equal access to health care services for citizens, regardless of their place of residence. The current epidemiological situation with the COVID-19 pandemic has not only impact on cross-border healthcare, but also on the life, health and well-being of citizens. With the closure of national borders, the exchange of healthcare services came to an interim halt; solely dialog remained - which was incredibly valuable for both commuters and citizens living in the border regions. Lower Austria will take care of the moderation of the session and will be represented by Julia Winkler.
Association of European Border Regions (AEBR)
Authors: Guillermo Ramirez M
Published: October 2022

AEBR is one of the oldest regional associations in Europe (founded in 1971), with a hundred members (border and cross-border regions) in more than thirty European countries. AEBR works for the interest of border regions towards EU and national authorities, developing capacities, increasing awareness, organizing events and implementing projects. AEBR currently implements IVY (Interreg Volunteer Youth) on behalf of the European Commission's DG Regio, within the framework of the European Solidarity Corps, which has deployed more than 700 young Europeans in Interreg programmes and projects during the last four years. It also manages b-solutions to tackle cross-border legal and administrative obstacles and test possible solutions, and takes part in other projects in Europe and other continents. It has recently finished a study for DG SANTE on cross-border patients’ flows in various EU cross-border areas. The association will be presented by it's Secretary General, Martin Guillermo-Ramírez.
8.G. Workshop: European Health Data Space: Dialogue on TEHDAS JA data quality & semantic interoperability proposals
Authors:   Organised by: TEHDAS JA WP6,   Chair persons: Enrique Bernal-Delgado (Spain), Persephone Doupi (Finland)
Published: October 2022

The EU Data Strategy foresees the development of shared European data infrastructures, enabling cross-border exchange and availability of comparable and high-quality data. The European Health Data Space (EHDS) is the first of these infrastructures to be launched, making use of the potential of health and social data for the purpose of advancing public health, research and innovation. Quality of digital health data has been the focus of research and debate for a long time and several proposals for improvement have been put forward. While these efforts are ongoing, secondary use or re-use of health data, combined with recent developments in data analytics, AI and real-world data (RWD), have raised new requirements on our understanding of data quality and the means for its assurance. Both the European Commission and Member States have underlined the need to support EU and national authorities, as well as the scientific community to agree on interoperability guidelines addressing data quality and semantic interoperability. The TEHDAS Joint Action has responded to these expectations through work undertaken in the context of WP6 - Excellence in data quality. With expected delivery deadline early 2023, the EUPHA conference offers an excellent platform to present the draft forthcoming proposals to the public health community and engage in meaningful dialogue with participants. Key members of the WP6 team will present the process through which the TEHDAS JA recommendations on data quality and semantic interoperability have been developed, the results achieved thus far and the remaining open questions. The workshop discussion section will allow the JA team to collect direct input and feedback for utilization in the production of the final version of the deliverables.

Key messages

• Increased awareness and understanding of background and rational of forthcoming proposals on data quality and semantic interoperability in the European Health Data Space.

• Opportunity to raise concerns and proposals for improvement and thus have a direct impact on the final TEHDAS JA output on data quality.
Review of data quality assessment frameworks experiences around Europe
Authors: Engsig-Karup T , Doupi P , Mäkinen M , Launa R , Estupiñán-Romero F , Bernal-Delgado E , Sahlertz Kristiansen N
Published: October 2022

In the first phase of its work, WP6 has explored and synthesized existing knowledge and experiences on data quality assurance frameworks (DQAFs) in the context of cross-border sharing of federated secondary use health data. Our aim was to identify good practices within this area and develop a first set of corresponding recommendations. The recommendations reflect the synthesis of results from three parallel lines of work, each utilizing a different methodology: a) thematic workshops and partner meetings, b) analysis of existing data-sharing initiatives, and c) a scoping literature review. Our analysis of literature and existing health data initiatives suggest that currently deployed DQAFs cannot as such serve as platforms or models for an EHDS-wide data quality solution. There is an agreement in principle, that reliability, relevance, timeliness, coherence, coverage and completeness should be incorporated in a DQAF as measurable dimensions of data quality. We aim towards a working definition of data quality, which will be able to reflect the reality of the data, as well as its fitness for purpose from the perspective of potential users.

• We recommend focusing efforts on transparency at the level of data holder institutions across Member States in relation to adoption of regular audits, a well-developed DQAF and clear procedures with regard to processing the data.

• In the medium to longer-term EHDS nodes could promote and support the development of a benchmarking process, which will assist data managers and data holder institutions with alignment against a Europe-wide approach to measuring data quality within and across Member States.