bluuebunny/crossref_metadata_2025 huggingface dataset:
Opportunities to increase the attractiveness of the German Public Health Service as an employer
Authors: Arnold L , Hommes F , Kellermann L , Fischer F , Jung L , Mohsenpour A , Stratil JM
Published: October 2022

For decades, the public health service in Germany (PHS) experienced shortages of young professionals and challenges in recruiting qualified personnel. To sustainably counteract this challenge, it is necessary to understand the reasons of the perceived low attractiveness of PHS as a potential employer among students and young professionals. Two cross-sectional online surveys were conducted to assess the attitudes of medical, public health, and health science students towards the PHS as a potential employer. Wave 1, conducted from 2019-12 to 2020-04, focused on factors associated with high and with low interest in working for the PHS. Wave 2 was conducted from 2020-06 to 2020-09 to capture changes that may have resulted from the newfound attention of the PHS during the SARS-CoV-2 pandemic. Participants in both waves were asked about opportunities to increase the attractiveness of the PHS, which were analyzed using qualitative content analysis. In total 3040 students participated. Low interest in the PHS was associated with limited knowledge about public health, primary interest in clinical medicine, and a negative image of the public service. The qualitative analysis indicated as major obstacles: low visibility of and low awareness about the PHS, a perception of hierarchical and bureaucratic workplaces, and perceptions of repetitive occupations, among others. The participants suggested: improving awareness about the PHS in the population, including PHS in curriculum, and reducing entry barriers for non-medical students. The results of the largest survey of students on the attractiveness of the ÖGD in Germany provide valuable insights for ongoing reform processes. In addition to approaches to increase external visibility, existing processes and procedures within the ÖGD should be considered.

Key messages

• To counteract the shortage of skilled workers, the PHS must become more attractive to young professionals. This requires both, greater external visibility and modernization of internal structures.

• Successful inclusion of the perspective of young professionals in the current modernization processes introduces opportunities to increase the attractiveness of the PHS in the long-term.
Workplace health promotion programs for employees in long-term care facilities - a systematic review
Authors: Herz M , Gebhard D
Published: October 2022

Background

Employees in long-term care facilities (LTC) are exposed to physically and mentally demanding workloads. Due to the specific working conditions and processes in LTC, recent literature recommends that care setting-specific health promotion is required. The objective was to systematically review the current evidence of workplace health promotion programs among employees in LTC.

Methods

A systematic review was conducted in accordance with the PRISMA 2020 Statement. The literature search was applied in the online databases PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and APA PsycArticles (Jan 2000 - Feb 2022). Studies were included if (1) participants worked in any occupational setting in LTC, (2) personal health and outcomes related to occupational health were measured as primary outcome, and (3) studies were randomized controlled trials. Methodological quality was assessed using the Cochrane risk of bias assessment tool (RoB 2).

Results

The literature search yielded 23.007 articles, resulting in 24 included studies and 21 unique interventions with a total of 6.625 participants at baseline. Most participants were female (85.2% to 100%). Interventions were grouped into person-directed (n = 4), person/work interface-directed (n = 10), work-directed (n = 0), and combined approaches (n = 7). Of these studies, two studies (2/4) using a person-directed approach, four studies (4/10) using a person/work interface-directed approach, and four studies (4/7) using a combined approach demonstrated significant improvements in personal health-related outcomes and occupational health-related outcomes. Methodological quality can be rated as some concerns.

Conclusions

Interventions that incorporate a combination of intervention approaches appear promising for improving health and work-related outcomes among employees in LTC. There is a lack of evidence for only work-directed approaches to health promotion in LTC. High-level quality studies are still needed.

Key messages

• Combined intervention approaches to workplace health promotion in long-term care facility settings appear to be beneficial.

• High-level quality studies on workplace health promotion in long-term care facilities are still needed.
Health system barriers to vaccination among Ukrainian economic migrants in Poland
Authors: Gańczak M , Kalinowski P , Kowalska M
Published: October 2022

Background

Before Russia's aggression, Ukrainians were the largest migrant group in Poland. However, data on health system barriers to vaccination in this vulnerable group were not collected. The study aimed to explore barriers to child MMR/HPV vaccination and related access to Polish healthcare services.

Methods

Between December 2021-January 2022, a qualitative study of Ukrainian migrants (UM) living in Poland, recruited through a snowball sampling method, was conducted as a part of RIVER-EU project. 8 focus groups were held with 49 UM aged 16-44 years, followed by interviews with 12 health care providers (HCP).

Results

UM and HCP experienced communication barriers despite language similarities. HCP reported that since a UM is not willing to register at a GP practice he cannot be reached by the Polish vaccination system. UM experienced challenges in navigating the system and accessing credible information in Ukrainian, no official local health authority vaccination material existed either. UM complained that there are no translated versions of vaccination materials accessible at the PHC facilities and they are not adequately informed about the possible side effects of vaccines; HCP reported the lack of time provided by the system for health promotion. UM were not familiar and rather hesitant regarding self-paid vaccines, such as HPV vaccine. In Poland and Ukraine this topic is not targeted at school curriculum neither by information campaigns. UM reported that HPV vaccine is not of interest for them due to the high cost, however they might consider it for their daughters, if the cost was fully refunded.

Conclusions

The study identified main health system barriers to child vaccination regarding economic UM in Poland, seen from the perspective of migrants and HCP and pinpointed issues for improvement. This can serve as a starting point to confront vaccination related challenges in the context of Ukrainian refugee crisis Poland is currently dealing with.
Health system barriers to HPV and MMR vaccination in recent migrants/refugees in Greece
Authors: Karnaki P , Dalma A , Papaevgeniou N , Katsas K , Linos A
Published: October 2022

Background

Migrants have lower vaccination rates compared to the general population and report multiple barriers in accessing related services. We explored practices and perceptions regarding MMR & HPV vaccinations in migrant children & adolescents from third countries to inform the development of tailored interventions to increase vaccination coverage. Third country nationals for the RIVER-EU project are migrants arriving to the EU from countries beyond Europe (the Middle East, Asia & Africa) escaping civil conflict, war, and poverty.

Methods

A qualitative study was conducted in the wider Athens area as part of the RIVER-EU project. Four Focus Groups and 23 semi-structured interviews were conducted with health care professionals, children and parents with a migrant background. Data were analysed using thematic content analysis. Findings: Identified barriers relate to the lack of standard operational procedures at system level that would define a schedule of vaccinations for migrants. Migrant vaccinations are subject to availability of vaccines (MMR as opposed to HPV) and potential threat of outbreaks (MMR vs HPV). There is no consistent, unified recording system of vaccinations while at system level there is a lack of trained cultural mediators. Targeted health promotion campaigns are rare while the few related activities that do exist are not systematically evaluated.

Conclusions

MMR vaccination is more frequent compared to HPV which is not prioritised by the target group or health professionals. Nevertheless, the target group is open to learning more about HPV while the important role of mothers concerning vaccinations emerged as crucial. Health professionals focus more on MMR due to the availability of the vaccine and the threat of outbreaks. The vaccination system has flaws and inconsistencies with a lack of vaccination related data. There is urgent need for culturally appropriate vaccination and appropriately evaluated vaccination campaigns.
The impact of country-level structural stigma on loneliness and social capital in older and younger LGB individuals in 113 countries
Authors: Doyle DM , Qualter P , Victor C , Barreto M
Published: October 2022

Background

The mental health gap between sexual minorities and heterosexuals remains a pressing issue for policy makers and scholars. In past years, numerous studies from the US found support for the vast impact structural stigma on a state level can have on the lives of LGB individuals. However, most research has been conducted within a US context and research capturing structural stigma on a country level remains scarce. In the current study we aim to close this gap by examining whether country-level structural stigma can explain loneliness and social capital among sexual minorities across the world and testing whether these relationships are different for LGB individuals from different age groups.

Methods

The current study analysed a sample of over 7000 LGB people from across 113 European and non-European countries to examine the influence of country-level structural stigma on individual level loneliness and social capital.

Results

Multilevel models showed that the greater structural stigma present in a country, the lower social capital was experienced by LGB respondents (b = -0.05, 95% CI: -0.07, -0.02, p < 0.001). This relationship was unaffected by respondent age. Further, multilevel models showed the following for loneliness as an outcome: The greater structural stigma present in a country, the more loneliness was experienced by LGB individuals (b = .01, 95% CI: .01, .21, p = .048). Furthermore, this relationship was moderated by respondent age (b = -.03, 95% CI: -.06, -.01, p = .01), in the sense that younger LGB people showed significantly higher levels of loneliness than older LGB people in countries with greater, but not lesser, levels of structural stigma. These effects remained robust to adjustment for demographics as well as adding country-level covariates.

Conclusions

The findings of this study demonstrate the impact structural stigma on a country level can have on LGB individuals’ loneliness and social capital, differing for older and younger individuals.
3.Q. Workshop: Using foresight to anticipate future public health challenges
Authors:   Organised by: RIVM (Netherlands), Sciensano (Belgium), PHIRI, EUPHA-PHMR, EUPHA-FS,   Chair persons: Henk Hilderink (EUPHA-FS), Petronille Bogaert (EUPHA-PHMR)
Published: October 2022

The COVID-19 pandemic brought great uncertainty about current and future health impacts. Uncertainty about how the virus would directly impact our health. And uncertainty about indirect impacts of COVID-19 on long-term health and wellbeing, including consequences due to delayed prevention, diagnosis, and medical treatment. At this point in time, we know a lot more about the immediate mortality and morbidity aspects. How we fare on the wider impacts on the longer term is more difficult to say. A structured tool for gaining in sight in this, is foresight. We use this tool within the Population Health Information Research Infrastructure (PHIRI). PHIRI supports research across Europe through the identification, access, assessment and reuse of population health and non-health data to underpin public health policy decisions. PHIRI is a practical use case and lays the foundation for ultimately developing a Distributed Infrastructure on Population Health (DIPoH). The joint workshop aims to show ways to better understand the complexity of the wider impacts of the SARS-COV-2 virus on population health across Europe; show how a research infrastructure might help researchers in Europe build capacity and helping each other to achieve higher goals. The workshop will begin with a presentation providing a brief overview of the PHIRI foresight work. This will be followed by two researchers who participated in the PHIRI foresight training program and undertook their own Public Health Foresight study. In the last presentation of the session foresight will be reflected on from a policy perspective. How can researchers and health policy makers better interact to have better foresight-informed policy making. Interaction with the audience will be guaranteed using Mentimeter questions. With this interactive element, insights art obtained what people find the most important trends to act upon, what they consider most important future challenges and how researchers and policymakers can better interact.

Key messages

• Foresight studies are essential to be better prepared for and to anticipate to future challenges.

• With foresight-informed policy making direct and indirect health impacts of COVID-19 are addressed.
Using foresight methodologies to tackle SARS-COV-2 related health impacts
Authors: Tijhuis M , Moye Holz D , Rodriguez M , Peyroteo M , Hilderink H
Published: October 2022

Background

A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity.

Methods

PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues.

Results

The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. A PHFS capacity building course was developed, including videos posted on the PHIRI website and a template structuring the different foresight elements. Around 15 researchers undertook their own PHFS, covering a wide range of public health topics, using the material provided during the course. In addition, a compact guide was developed and provided, explaining the different foresight elements. Based on these studies, common challenges and promising policies are identified.

Conclusions

Foresight in public health is gaining more and more interest, especially now in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-CoV-2 pandemic and in translating this into policy options.
Foresight for policy – addressing the challenges for policy impact
Authors: Bontoux L
Published: October 2022

Background

The role of policymaking is to create the future that we want. In its communication on Better Regulation, the European Commission recognises the need for strategic foresight to play a key role in helping to ‘future-proof’ EU policymaking. The aim is to ensure that decisions are grounded in a longer-term perspective. In times of rapid change, EU policymaking needs to have impact assessments, fitness checks and major regulatory evaluations informed by foresight. Strategic foresight is also a powerful way to engage with stakeholders and not only capture their perspectives, but also generate collective intelligence in the areas of policy interest.

Lessons from EU policy making

This fits within a broader effort at the Commission to be at the forefront of excellence in policymaking in Europe and worldwide. This is why the EU Policymaking Hub was launched 2020. It offers a platform for policymakers to learn, collaborate and share knowledge in EU policymaking, introducing new capacity building offers. It aims at strengthening the Commission's policymaking capacity through anticipating, developing, implementing, monitoring, and evaluating policies in an evidence-informed, transparent, and collaborative way with stakeholders, citizens and experts. Providing the policymaking community with a framework for long-term competence development will strengthen the profession, make it fit for the future, contribute to colleagues’ motivation and help the Commission to achieve its goals.

Conclusions

Being futures literate covers a range of skills from anticipation to the ability to run in-depth foresight processes. It spans a range of abilities from having an anticipatory mindset to scanning for change, understanding change and being able to influence change. Since its inception, this competence framework is at the base of an effort to train European civil servants in foresight and to increase foresight literacy for application in policymaking.
High level review of configuration and reform of Public Health systems in selected countries
Authors: Cardwell K , Broderick N , Tyner B , Masukume G , Harrington P , Connolly M , Larkin L , Clyne B , Ryan M , O'Neill M
Published: October 2022

Background

The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2).

Methods

Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations’ websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and.

Results

Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public health interventions; public participation, public messaging and communication; continuation of healthcare services; and workforce capacity and resilience.

Conclusions

When structuring Public Health systems, there is a need to identify which functions, and or which elements of a function, should be delivered at a national, regional or local level to ensure a sustainable and comprehensive Public Health system. Appropriate IT infrastructure, strong communication and an established evidence synthesis function are key to timely and informed decision making. Ideally, these functions should be established during periods of relative stability to permit a faster response during a pandemic or emergency situation.
Organisational perspectives on Public Health delivery in Ireland: Lessons learned from COVID-19
Authors: Norris M , Carty P , McDowell C , O’Loughlin M , Comaskey F , Jingjing J , Harrington P , Ryan M , O'Neill M
Published: October 2022

Background

The COVID-19 pandemic has placed healthcare systems worldwide under unprecedented pressure, with the Irish Public Health system no different. To strengthen delivery of Essential Public Health Functions (EPHFs) and increase future pandemic preparedness, Public Health leaders are now focused on identifying learnings from the pandemic. Within Ireland, given their experience, organisations situated within the Public Health system may be in a unique position to provide valuable information around the delivery of EPHFs, both prior to and in light of the COVID-19 pandemic, and how this can be improved in the future.

Methods

An online survey was distributed by the Department of Health, from 2 March 2022 to 25 March 2022, amongst organisations situated within the Public Health domain in Ireland. The survey consisted of six open-ended questions around the delivery of EPHFs prior to and in light of the pandemic, success stories that could provide scalable solutions to EPHF delivery and current health system barriers, key areas in the public health system that require strengthening, and barriers to achieving these actions. Thematic analysis to identify key themes was conducted on survey responses.

Results

Twenty-eight organisational responses were received. Themes around the workforce were apparent throughout, with staff training, staff diversity and staff morale, identified as areas for strengthening EPHF delivery. Themes around ICT, data collection and research were frequently identified with a lack of adequate ICT identified as a key lesson from the pandemic, while the Public Health ICT strategy was identified as key to strengthening future EPHF delivery.

Conclusions

In general, themes around the workforce; leadership, management and governance and ICT, data collection and research were reoccurring across organisational responses and therefore may be key areas for consideration when strengthening delivery of the EPHFs in Ireland.

Speakers/Panelist

Louise Hendricks

Department of Health, Ireland

Sohel Saikat

WHO, Geneva, Switzerland
4.C. Workshop: Promoting health without borders: cross-border public health policy in the Euregio Meuse-Rhine
Authors:   Organised by: EUPHA-PHPP, Gesundheitsamt Düren (Germany), Foundation euPrevent (Netherlands),   Chair persons: Sofia Ribeiro (EUPHA-PHPP)
Published: October 2022

For more than 20 years, different public health institutions in the German-Belgian-Dutch border triangle have been involved in cross-border public health activities. The partners in the Euregio Meuse-Rhine (EMR), as this area is called, have jointly implemented studies on COVID-19 and on adolescent risk behaviour. They have established joint health reporting for various purposes and implemented prevention measures together. The special problems in the border regions during the Corona pandemic have once again impressively shown how important cross-border cooperation is - also for cross-border public health policy. In the health sector, orientation towards municipal, state and federal borders does not lead to the desired results. The results of the Euregional COVID 19 study of 2021 show that in this way a ‘borderless’ life - and partly also cross-border health care - cannot be adequately served. In fact, in the everyday life of a border community, there is hardly any difference between a district border and a national border. In the EMR, this is exemplary for the entire European Union, with its many national or local responsibilities. For infectious diseases, lifestyle risks, environmental toxins or climate risks, borders have no meaning. For health, however, they do. Cross-border policy and politics is the appropriate response to real European conditions. The workshop will show the possibilities and results of cross-border policy on the basis of 3 examples from the long-standing cooperation of public health actors from the Euregio Meuse-Rhine. Finally, we will present these factors and put them up for discussion. From these and other activities, the factors that enable or hinder policy along borders can be deduced. We will present these factors, classify their significance and present the possibility of generalisation for cross-border work for discussion.

Key messages

• Cross-border policy and coordination are the appropriate responses to the current realities in the European Union.

• National differences in culture, administration and policy can be obstacles to cooperation; but are usually inspiration for new approaches and input for best practice.
The Euregional policy impact of COVID 19 on the border region between the Netherlands, North-Rhine Westphalia and Belgium
Authors: Hoebe C
Published: October 2022

During the Coronavirus pandemic, internal European borders were temporarily re-established with the argument to mitigate the outbreak. Also in the border region between the Netherlands, North-Rhine Westphalia and Belgium (EMR). Existing evidence on the effectiveness of border control for infectious disease control (IDC) has been dominated by studies that focused on scenarios within countries with limited attention to border regions. To address this gap, we analysed the experiences of public health professionals working in European border regions. We conducted three studies: 1. seroprevalence and questionnaire study among 10.001 Dutch persons with and without cross border mobility, 2. analyses of incidence data in municipalities in 4 cross border regions to analyse cross border differences, and 3. we conducted 27 semi-structured interviews with public health professionals in the EMR. Participants were asked about their perspectives on border controls and the spread of Covid-19.

Four key-results: First, border regions are characterised by dynamic social life and cross-border movements. Incidence was mainly determined by country policy, Second, the impact of border control and closing on local infectious disease epidemics is likely marginal. Third, due to the dynamic social life, border control measures cannot be fully implemented in border regions, and thus their effectiveness is even more questionable. Fourth, border control measures may harm the social fabric of border regions more than they do in in-countries territories. Our study results highlighted the ineffective role of border control measures for regional infectious disease control. Sustainable cross-border collaboration is crucial to ensure effective pandemic management in border regions. The results of our study impacted on policy makers, to be much more reluctant with closing borders.
Food Production as a challenge for One Health Approach and Public Health
Authors: Jevtic M , Bouland C
Published: October 2022

A sustainable food production is essential for human sustainability. According to available data, the world's diets and food habits must evolve and change intensely. Nowadays, more than 800 million people suffer from deficient food. On the other hand, more consumers have an unhealthy diet contributing to premature death, obesity, food related non-communicable diseases. Diets must provide an appropriate calorie intake, different of plant-based food, low amounts of animal-based food, unsaturated fats, vitamins and minerals (rather than saturated, refined grains, highly processed foods, and added sugars). It is needed adjustment to various agro-systems, cultural traditions, and individual dietary preferences. However, production must also be sustainably adjusted to meet the global population's growing food demands, as well as using the doughnut economy principle. A sustainable food production requires a One Health approach, and also evolving towards a decarbonized agricultural production by eliminating the use of fossil fuels and land use change losses of CO2 in agriculture. Policies to encourage people to choose healthy diets are needed. Those should include the improvement of the availability and accessibility to healthy food through improved logistics and storage, increased food security, policies that promote buying from sustainable sources, as well as reducing food waste. The mindset change regarding to the agro-system, food production and food usage in a healthy way at individual level, community level, national level and global level are essential for sustainable human population. Healthy eating should be the highest priority of food consumers, as well as its mindset shift from ‘live to eat’ to ‘eat to live’. Consumers should feel safe and healthy, but also think about future generations, respecting agriculture and food production. Sustainable, equitable, healthier, and more inclusive food systems have the power to catalyze the achievement of all 17 SDGs by 2030.
Rethink cities to promote an active lifestyle and tackle climate change: best practices from the OECD
Authors: Cecchini M , Piatrova A , Aldea A , Lerouge A , Cheatley J
Published: October 2022

Background

City design can have major health and environmental implications. The overall layout of cities influences air quality, as urban sprawl can encourage the use of motorised vehicles and decrease active travelling. Furthermore, lack of trees has a negative impact on particulate matter levels and contributes to the urban heat island effect. There is a growing interest for creating an urban environment conducive of healthier lifestyles.

Methods

The analysis uses the five OECD criteria to assess best practices in public health - Effectiveness, Efficiency, Equity, Evidence-base, and Extent of coverage - to carry out a systematic assessment of selected candidate best practices to improve the public health potential of cities. The impact of scaling up these interventions within and across countries is evaluated by using the OECD SPHeP-NCD microsimulation model.

Results

Interventions such as Superblocks in Barcelona, which reshapes the city layout to make them more people centric and less vehicles reliant, or Cycle Superhighways from Denmark, which develops cycling networks, have a the potential to avoid a significant number of chronic diseases by promoting an active lifestyle and decreasing transport-related pollution. Such interventions can also decrease healthcare expenditure and, if well designed, health disparities.

Discussion

While many urban design interventions are a good investment for countries and, in general, there is good support, a number of implementation hurdles exist. First, extent of coverage is still relatively limited across European countries. Second, changes take time to be implemented and some of the health impact materializes in the longer-term. Third, the implementation of such interventions is generally competence of other authorities, other than the health authorities. Building strong multi-stakeholder approaches and making a strong case for such investments can promote change.
Strengthening resilience to address climate change and chronic diseases: evidence from small states
Authors: Moncada S , Spiteri M
Published: October 2022

Background

Climate & environmental change are disproportionally impacting small states, given higher costs per capita associated with coping with the immediate risks of environmental & climatic events. Climate change has been identified as a serious public health threat. This is especially true for heatwaves in the Mediterranean Basin, with poor air quality worsening the health impacts during periods of extreme heat, often affecting already high levels of chronic diseases. Promoting climate change adaptation measures is crucial to address the negative socio-economic impacts brought by heatwaves, & its interactions with poor air quality. While awareness about the link between poor air quality & heat-waves is gaining momentum, there is still a gap in policy responses, especially in small states. This research assesses the level of preparedness of the European Union, with a focus on adaptation to heat-waves since the extreme European heat-wave of 2003. A case study on Malta is also presented, aiming at discovering what measures the island is adopting to tackle the problems arising from the interaction between poor air quality & heatwaves.

Methods

A systematic literature review is conducted, investigating the links between heat-waves & air pollution post 2003, followed by a qualitative content analysis to assess the preparedness of climate change adaptation measures in this regard.

Results and conclusions

The findings of this research show that the link between heat waves & poor air quality has not been sufficiently acknowledged by academia, with evident gaps in applied small states research. Also, a closer look at key adaptation policies & measures in Malta finds that heat waves & poor air quality are hardly been linked, leaving much scope to introduce policy & economic instruments to tackle both public health risks to address growing chronic diseases, & not to compromise current & future socioeconomic wellbeing.
How RIVM is responding to the challenge of protecting human health from the effects of climate change – now and in the future
Authors: Hall L , Zwartkruis J , Velders G
Published: October 2022

In 2020 the Dutch National Institute for Public Health and the Environment (RIVM) published its vision on climate change and health. This vision reflects the position of RIVM in society and highlights the transdisciplinary and collaborative nature of our work on this topic. We define this societal challenge as: protecting and promoting the health of people throughout society with regard to climate change and climate measures. The purpose of our work on this challenge is to support all levels of Dutch government with policy development and implementation and to forge links with both national and international organisations to further knowledge and expertise.

The focus of our work, in collaboration with the aforementioned actors, is as follows:

1. Knowledge translation of the health impacts of climate change for the public and government.

2. Developing instruments to promote health in relation to climate change and mitigation and adaptation measures.

3. Implementation research on solutions to mitigate and adapt to climate change.

4. Strengthening national and international cooperation to enhance synergies in our work.

In the workshop we will present examples of our work:

• Quantifying the health impacts of climate change, now and in the future under different global warming scenarios.

• Developing a set of indicators to monitor the health impacts of climate change and mitigation and adaptation plans and actions.

• Collating and disseminating easily digestible information for public health services on evidence-based, effective adaptation measures.

• Developing tools and instruments to ensure health benefits and limit unintended consequences of adaptation measures, such as green and blue spaces.

• Prioritising research on climate change and health through a research agenda.

Workshop participants will be encouraged to provide feedback to inform RIVM's future work and that of other national public health institutes, and to ensure we are fully supporting our stakeholders.
4.G. Workshop: Economic evaluations of public health interventions: from case studies to next methodological steps
Authors:   Organised by: EUPHA-ECO, EUPHA-HTA,   Chair persons: João Vasco Santos (EUPHA-ECO), Vanessa Gorasso (EUPHA-ECO)
Published: October 2022

For establishing evidence-based or evidence-informed decision making in health systems, it is essential to determine which public health interventions and health policies are worth investing in, considering that public budgets are always limited. For that purpose, we can use well-established economic evaluation methods based on marginal analysis as cost-benefit and cost-effectiveness analyses. While the use of economic evaluations is a common practice in health technology assessment of drug and medical device in many high-income countries, the systematic assessment of public health interventions is marginal and non-compulsory. In fact, if conducted at all, many economic evaluations of public health interventions are performed internally without dissemination outside organisations. In general, there is already some guidance on how to perform and report economic evaluations that can also be used for public health interventions, as the recent update version of Consolidated Health Economic Evaluation Reporting Standards (CHEERS) check list. However, some methodological and implementation difficulties still persist, including insufficient or low-quality data on costs and outcomes (e.g. absence of experimental studies), complexities related to the need of measuring outcomes in the very long term an on aspects beyond the healthcare sector, or high relevance of contextual factors that are difficult to measure. This workshop will take on some examples of economic evaluations of public health interventions and explore how analyses, methods and implementation can be improved in order to allow a more evidence-based or evidence-informed decision making process.

Key messages

• Economic evaluations of public health interventions could be performed more frequently when it comes to the decision making. Planning and implementation difficulties are highlighted in this workshop.

• Methods used in current economic evaluations of public health interventions can still be improved with a correct estimation of costs and outcomes, based on good quality data.
A perspective on the assessment of the broad value of vaccinations
Authors: de Waure C , Calabrò GE , Ricciardi W
Published: October 2022

Vaccinations are considered a cost-effective public health intervention to control vaccine-preventable diseases and are commonly evaluated in respect to several domains, including efficacy, safety and cost-effectiveness, before being implemented nationwide. There are plenty of evidence of economic evaluations performed on single vaccines or vaccinations. They commonly relies on static or dynamic models and considers both direct and indirect costs, i.e., those linked to productivity loss, of vaccine-preventable diseases. Nevertheless, vaccinations are expected to provide also societal benefits that call to the development and implementation of methods to value them, also from an economic point of view. The scientific debate on the assessment of the broad value of vaccinations has pinpointed several relevant aspects that need to be paid attention in future evaluations. They include the antibiotic sparing effect of vaccination, their impact on antimicrobial resistance - which is a challenge of our days -, their effect on social cohesion, their role in avoiding the loss of school days and in ameliorating educational attainment. The economic evaluation of vaccinations need to be further developed in order to allow a quantitative exploitation of their broad value according to the aspects described above. As the experience is still scant, we need to work on several fronts, including capacity building, data production and sharing and new methods development.
Challenges in economic evaluation of public health interventions: the example of surveillance of high risk pancreatic tumour patients
Authors: Cortesi P
Published: October 2022

Evaluation of public health interventions raises a number of potential challenges in applying and performing economic analyses. The impact of interventions may extend beyond the health sector, and even within the health sector, the value may be difficult to estimate and extended beyond the health improvement of individuals. Screening and surveillance cancer programmes give the possibility to detect patients in a curable and treatable stage. Increasing number of expert recommendations and guidelines of cancer screening and surveillance have been recorded in the last decades. This scenario has increased the uncertainty on the most valuable and affordable approach to adopt. A case study can be provided by the premalignant pancreatic primarily cystic tumours surveillance. American, European and International guidelines for surveillance of asymptomatic cysts are available with significant differences in patients stratification, surveillance intensity (frequency of visits-exams), and duration. Further, real-world data suggest a significant variability in the surveillance approach even within Europe. However, no comparative data on different programmes efficacy are available, neither reliable medium-long term data on cancer risk. The lack of evidence must be considered with methodological issue associated to the inclusion of method to estimate inequalities created by the different programs and the indirect effect of healthcare resources consumption (e.g. CT and MRI) to access and allocation of these resources to other subjects (cancer and no cancer patients). Economic evaluations of surveillance or screening cancer program raise significant challenges, as data availability and methodological approach to apply. This scenario highlight the need of specific recommendation on data quality and type required to assess the programmes value and on methodological approach required (e.g. type of decision analytical models) to provide useful information for public health decision makers.
Methodological advancements in costing methods for (public) health economic evaluations: results from the European PECUNIA project
Authors: Simon J
Published: October 2022

(Public) health economic evaluations face significant problems regarding the standardization and comparability of their methods. In addition, at least a quarter of the total direct cost impact of healthcare interventions affects other economic sectors. International methods and tools are lacking for the rigorous and comparable assessment of the costs and outcomes of (public) health care from a societal perspective. The H2020 PECUNIA project (grant No 779292) brought together ten partners from six countries (AT/DE/ES/HU/NL/UK) between 2018 and 2021 aiming to improve the comparability and feasibility of multi-sectoral, multi-national health economic evaluations in Europe. A multi-step, mixed methods approach was used following a new harmonized costing concept to develop new methods and tools for the standardised identification, definition, measurement and valuation of costs in multiple sectors (health care, social care, (criminal) justice, education, employment and productivity, and patient, family and informal care), and for the broader, harmonised, supra-national assessment of outcomes using selected mental disorders as illustrative examples. This presentation will summarise the relevant advances in costing methods, give an overview of the developed tools that are now publicly available (www.pecunia-project.eu/tools), and discuss the lessons learned regarding how far it is possible to harmonize costing evidence with standardised tools in Europe, and what the necessary future research directions may be.
4.J. Workshop: Health system performance assessment in Europe – recent developments, evidence, and challenges
Authors:   Organised by: Berlin University of Technology,   Chair persons: Reinhard Busse (Germany), Carine Van de Voorde (Belgium)
Published: October 2022

Assessing the performance of health systems is essential to initiate policy processes that further strengthen health systems to improve population health. Starting with WHO's World Health Report of 2000, Health System Performance Assessments (HSPA) gained increasing attention in research and policy. By now, several comparative HSPA initiatives of international organisations (e.g., OECD's Health at a Glance) and country specific HSPA (e.g., Sweden, Netherlands, Austria, Belgium) were implemented in Europe. Further countries are currently in the process of developing or piloting an HSPA (e.g., Germany). The objective of the workshop is to foster and strengthen the interchange of different HSPA initiatives in Europe and beyond. While each health system has its specifics, initiatives likely face similar challenges in the implementation and ongoing development, which holds a lot of potential for learning from each other. The workshop is supposed to be a platform for the exchange of and about HSPA initiatives and related topics by bringing together stakeholders of different countries and professions. Participants are supposed to gain new insights into recent activities in Europe and will be able to discuss challenges and lessons learned. The presentations give insights into recent activities of selected HSPA initiatives in Europe. One presentation originates from the Belgian HSPA which is well established. This presentation will focus on the transversal dimension of equity, on which a separate report was recently published. The second presentation is about the German HSPA which is still in development and currently tested in a pilot study. Both presentations represent HSPA initiatives at different stages, which provides a good basis for the following panel and discussion with all workshop participants. The two presentations of about 20 minutes each will be combined with a panel discussion. Afterwards, there will be room for exchange and discussions between all participants and presenters.

Key messages

• Recent developments of HSPA initiatives in Europe will be presented along two examples from Belgium and Germany and lessons learned and challenges will be discussed.

• The workshop provides a platform for the exchange of and about HSPA initiatives and related topics by bringing together stakeholders of different countries and professions.
Piloting the first health system performance assessment for Germany: key results and learnings
Authors: Blümel M , Achstetter M , Hengel P , Schwarzbach M , Busse R
Published: October 2022

Background

Health System Performance Assessment (HSPA) is a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a country specific HSPA is currently being piloted for Germany.

Methods

The HSPA is based on a newly developed conceptual framework including nine dimensions (e.g., access, quality, efficiency, population health). Indicators were selected based on a systematic search of (inter)national studies and HSPA initiatives. Where possible, indicators were analysed in their development over time (2000-2020), in comparison to eight European countries (e.g., Austria, Denmark, France), and along up to seven equity dimensions (e.g., sex, age, income, education, region).

Results

Overall, 90 indicators were included in the HSPA. Trend and equity analyses were possible for almost all and country comparisons for most indicators. A few indicators could not be analysed at all due to missing data. The overall HSPA provides an in-detail picture of Germany's health system. Access, for example, can be rated as good in Germany compared to the other countries, as insurance coverage and physician density are high, and unmet needs and waiting times for elective surgery are low. Results for quality are not as good, e.g., cancer survival rates, but most indicators show a positive trend. While population health outcomes are average in country comparison (e.g., fetal and infant mortality), resource input is comparatively high. Consequently, overall efficiency can still be improved (e.g., amenable mortality per total health expenditure).

Conclusions

This first HSPA for Germany allows new insights to the performance of the German health system which are important for policy and research. While the pilot benefitted a lot from previous HSPA initiatives, data availability remains one of the biggest challenges.