bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tackling Health Inequalities in Times of Crisis
Authors:   Organised by: EuroHealthNet
Published: October 2024

Abstract

Across Europe, people are grappling with a multitude of challenges, spanning from the cost of living to housing, food insecurity, climate change, conflicts, and social unrest. These adversities significantly impact individuals’ health and wellbeing, and create the conditions for persisting health inequalities. At the root of these crises are unjust economic systems, in which the privileged few benefit while the majority face difficulties on a daily basis.
Societies across Europe are witnessing rising polarisation and discrimination. Competitiveness and security are emerging as key priorities in the new European political landscape, with health and wellbeing pushed to the sidelines.
Tackling health inequalities in times of crisis requires urgent, targeted action across societal sectors and levels. Education emerges as a crucial equaliser, alongside income and social safety nets. Moreover, effective climate strategies must prioritise the needs of the most vulnerable population groups.
This plenary session lays the groundwork for understanding our contemporary, rapidly evolving landscape and its implications for addressing health inequalities. What lessons can we draw from new approaches across sectors that meet social and health needs, and how can we navigate these challenges – and sail those waves of innovation – to ensure equitable health and social justice for all?

Moderators
Caroline Costongs
Director EuroHealthNet
Cristina Abreu Santos
Vice-President Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Portugal

Keynote speakers
Fran Baum
The Stretton Institute, The University of Adelaide, Australia (by video message)
Katarina Ivanković Knežević
Director for Social Rights and Inclusion, Directorate-General Employment, Social Affairs and Inclusion, European Commission

Panellists
Didier Jourdan
UNESCO Chair and WHO Collaborating Centre ‘Global Health and Education’, University of Clermont-Auvergne, France
Jill Litt
Professor of Environmental Health in the Environmental Studies Programme, University of Colorado, USA and Senior researcher, Barcelona Institute of Global Health (ISGlobal), Spain
Reducing obesity and overweight: Subregional Policy Dialogues in the WHO European Region
Authors: Williams J , Spiroski I , Heinen M , Whiting S , Rakovac I , Wickramasinghe K 
Published: October 2024

Abstract
In the WHO European Region, obesity and overweight stand as leading causes of disability and premature mortality. They contribute significantly to the burden of noncommunicable diseases, hindering efforts to achieve sustainable development goals related to health, including SDG goal 3.4, aiming to reduce premature mortality from NCDs by one-third by 2030. Despite some policy successes such as sugary drinks taxes, restrictions on marketing unhealthy products to children, and physical activity promotion campaigns, no country has managed to halt the rising levels of obesity. Addressing obesity requires a comprehensive approach, and WHO endeavors to support countries in implementing a wide range of policy actions across various settings. The WHO Special Initiative for NCDs and Innovation has recently adopted a subregional approach to promote evidence-based, data-informed policy action. In June 2022, it organized a series of obesity dialogues, including sessions for the Western Balkans. This session will outline the methods and outcomes of these dialogues, including stakeholder engagement, presentation of the latest obesity data, evidence-based policy recommendations, and the process of prioritizing policy options with decision-makers. It will consider the lessons learned from this process, offering insights not only for the health agenda but also for addressing other complex public health, environmental, or social challenges, which require multisectoral collaboration and comprehensive, policy actions on many levels.
Diet Impact Assessment model: an interactive tool for analysing the health, environmental and affordability implications of diets
Authors: Springmann M 
Published: October 2024

Abstract
Global diets, environmental factors, and health require a holistic approach in public health discourse that takes into account the well-being of both humans and planetary health. Modeling tools have demonstrated being useful to estimate priorities and differences between countries and gain insight into future paths that depend on predetermined priorities. Modeling efforts that include environmental goals indicate the possibility of reducing environmental impacts while both improving food quality and overall health outcomes, especially in high-income settings. The aforementioned forecasts highlight the effectiveness of giving priority to dietary recommendations that lead to better, balanced patterns as the most effective approach to reducing mortality risks and environmental implications. The presentation will introduce the Diet Impact Assessment (DIA) model - a new interactive modelling tool for analysing the health, environmental and affordability implications of diets and dietary change. The tool enables countries to analyse user-specific scenarios of dietary change, and to estimate the health, environmental and cost burden of each scenario in terms of diet costs, avoidable deaths, changes in resource use and compatibility with global environmental targets, including those associated with food-related greenhouse gas emissions, land use, water use and fertilizer application. The tool was commissioned by the WHO Regional Office for Europe and is based on analytical frameworks developed by Marco Springmann and colleagues.
Maternal near-miss and mortality associated with being referred: a case control study in Luanda
Authors: Castelo M , Campos P , Magalhães P , Teixeira C 
Published: October 2024

Abstract

Background
Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola.

Methods
A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value &lt;0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI).

Results
Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89).

Conclusions
According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting.

Key messages
• Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola.
• Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.
Home and leisure accidents among children and young people up to 19 years old as an event observed in the EU-IDB surveillance system: 2012-2021 data
Authors: Alves T , Giustini M , Papadakaki M , Nijmans S , Valkenberg H , Silva S , Braz P , Matias-Dias C 
Published: October 2024

Abstract
Paediatric injuries are widely acknowledged as a major public health issue among different medical disciplines. In the context of injuries and accidents, the surrounding environment of children and young people remains a major health concern. The present study was developed to extend current knowledge on the characteristics and magnitude of home and leisure accidents in this population. A descriptive, observational, cross-sectional study was developed under the EU-IDB (European Injury Database) collaborative network comprising up to 25 European countries and ten years of data collection (2012 to 2021). The methodology of the EU-IDB is a well consolidated standard for collecting injury data in Emergency departments, in compliance with the Eurostat methodological requirements for European health statistics. During the ten years of data collection in emergency departments, through EU-IDB surveillance 3 603 975 episodes of home and leisure accidents (HLA) were recorded at European level, involving people aged 0-19 years, constituting 34.5 % of hospital ED attendances due to HLA. Children and young people between 10 and 14 years old represented the major age group proportion of HLA(33.0%), the proportion of HLA increased across age groups until fourteen years old, being these differences statistically significant(p &lt; 0,001). Falls were the most common cause of injuries among all age-groups, in the youngest group up to 4-years(54.4%), the 5-9years old (52.2%), the 10-14years old (46.1%) and in the oldest group between 15-19 years(37.5%), representing 47.2% of the total HLA mechanism. As regards to the treatment/follow-up, the vast majority of the HLA episodes were not admitted to hospital (92.9%). Hospital ED Injury data represent very useful information on the health burden of non-fatal injuries in this population of interest. These data could be used for the design of injury prevention policies and regulations for accidents that occur at home, school and outdoor spaces.
2.B. Scientific session: Learning from intercountry comparisons in digital healthcare transition monitoring
Authors:   Organised by: NIVEL, Università Cattolica del Sacro Cuore (Italy), University of Copenhagen (Denmark),   Chair persons: Gemma Williams (UK)
Published: October 2024

Abstract

In many countries, healthcare is facing several challenges, including increasing healthcare demand, healthcare workforce shortages, rising healthcare costs, and keeping healthcare accessible. It is thought that the use of digital health might help to tackle these challenges. However, digital health programs and interventions are often not (systematically) monitored or evaluated. Monitoring of the digital healthcare transition in countries over time helps policymakers and healthcare professionals to investigate which digital services work well, and which do not, to (partly) solve the experienced challenges. In Europe, several countries monitor the digital healthcare transition within the primary and secondary care in their country. Comparing and sharing the monitoring methodologies between countries and describing the current state of the digital healthcare transition in primary and secondary care, will help to learn from other countries about how digital health could help to tackle the frequently experienced healthcare challenges. During this workshop, three countries throughout Europe (the Netherlands, Italy and Denmark) will briefly share their methodologies used for monitoring the digital healthcare transition in their country and will provide an up-to-date overview of the current state of the digital healthcare transition in primary and secondary care in their country. Challenges, achievements and future plans for the monitoring of this transition will also be shortly discussed in 10-minute presentations. Further, there will be 25 minutes for audience interaction which will be moderated by the chairperson. During this discussion, there is time to hear experiences from other countries and explore best practices in monitoring the digital healthcare transition.

Key messages
• The digital healthcare transition can be monitored in different ways. Experiences from three European countries may inspire others to organize national monitoring programs.
• The speed and nature of the digital healthcare transition differs between European countries. Experiences from three European countries provide insight into state of the art of national transitions.
Monitoring the digital healthcare transition in Denmark: Challenges, achievements and future
Authors: Vrangbaek K 
Published: October 2024

Abstract
Denmark is often mentioned as one of the countries that have introduced digital solutions early and extensively within the health care sector, including the launch of health portal sundhed.dk in 2003, the introduction of the e-record system ‘e-Journalen’ in 2007, and the establishment of a national infrastructure for telemedicine in 2012. Denmark is well advanced in digital health measurement, providing opportunities for researching the digital transition and its effects for healthcare organizations and Danish citizens. Most digital health data is collected through national population-based databases and registries. Additionally, annual surveys of health professionals and biennial surveys of citizens’ use of health IT are conducted. Recent data show that all general practitioners use electronic health records, mainly for receiving laboratory test results from hospitals, ordering prescriptions at pharmacies, exchanging records, and sending referrals to hospitals. This workshop provides an overview of developments in Denmark and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care. Issues about implementation and evaluation of digital infrastructure will be discussed with examples from Danish health care. A key question is whether digital solutions can fulfill their promise of supporting integrated and home based health care in an era of changing demographics.
Did social inequalities in child development change during the COVID-19 pandemic in Germany?
Authors: Hoffmann S , Tschorn M , Spallek J 
Published: October 2024

Abstract

Background
Early childhood development (aged &lt;6 years) is dependent on the social conditions in which children live and strongly affect their life course trajectory. This study describes changes in social inequalities in language development during the COVID-19 pandemic based on data from the legally prescribed school entry examination in the German federal state of Brandenburg. The aim is to inform public health interventions for individuals at risk of long-term health inequalities.

Methods
Secondary data from three cohorts of 5-7-year-olds were used [n = 19,2992018|19; n = 19,9162019|20; n = 19,6982020|21]. Language development was assessed as delayed compared to peers [LD yes/no], measured by public health services using validated instruments. Descriptive bivariate and multivariate analyses [OR, 95%CI] examined language delay [%] with social inequalities defined by (1) an index composed of parents’ reported education and occupation [SEP low|high], (2) ‘German native language’ [yes|no] and (3) ‘years of kindergarten attendance’ [&lt;4|≥4].

Results
Overall, the proportion of LD decreased over the years (21.1%2018|19; 19.2%2019|20; 18.8%2020|21), both among children from families with high SEP (14.3%2018|19; 13.0%2020|21) and from German-speaking families (20.2%2018|19; 17.8%2020|21). LD rates among children increased with low SEP (42.4%2018|19; 43.4%2020|21) and remained constant with a non-German native language (36.0%2018|19; 35.5%2020|21). The probability for LD differed only for SEP (2018|19: ORlow|high=4.4, 3.93-4.94; 2020|21: ORlow|high=5.12, 4.54-5.77) and for native language (2018|19: ORnon-German|German=2.22, 1.86-2.66; 2020|21: ORnon-German|German=2.54, 2.19-2.95).

Conclusions
Social inequalities in language development based on SEP and native language increased slightly during the pandemic compared to the pre-pandemic period. Research should examine the effects of the pandemic on early development as well as protective and risk factors on a longitudinal basis.

Key messages
• Social inequality in early development increased in Germany during the COVID-19 pandemic.
• To reduce health inequality in the life course, longitudinal research should assess the impact of the pandemic on child development.
Issues of social justice in the development of personalised therapy for paediatric SIRS patients
Authors: Yankulovska S , Thiemicke P , Stolte F , Orzechowski M , Steger F 
Published: October 2024

Abstract

Background
Systemic Inflammatory Response Syndrome (SIRS) is an often-emergent condition, which lacks specific diagnostic tools. Personalised therapy could fill this gap but as every new technology, it raises issues of social justice. Our report aims at identification and analysis of social justice implications within the bigger ERA PerMed funded project of development of tailored immunotherapy for paediatric SIRS patients (TIPS) coordinated by Prof. Catharina Schütz from Technic University Dresden.

Methods
Qualitative research methodology thought 10 semi-structured interviews. Systematic literature review grounded the interview questionnaire. Transcripts were subjected to thematic analysis by two independent researchers.

Results
Social justice was seen as equal chances of inclusion of different population groups in research. Socioeconomic differences were perceived as a challenge to ensure justice across various populations (N = 7). Two interviewees saw discrimination as inherent to precision medicine, which is focused on personalised treatment. Two experts viewed the exclusion of specific patients’ groups as an unsolvable problem, that only advocates for the inclusion of as many patients as possible. On the opinion of six experts individual and ethnocultural factors may influence outcomes in personalised treatment, especially considering the small sample size and the diverse populations. One medical expert, on the contrary, perceived no significant challenges associated with the heterogeneity of patients. Whether socioeconomic injustices should be addressed by guidelines and how these correspond to the rights of the patient were further discussed.

Conclusions
The issues of social justice accompany research in personalised medicine, including SIRS. In general, there is sensitivity to this issue, but current guidelines are too vague. As with other ethical problems, so with social justice we seem to have a rethinking of the concept, that needs further study.

Key messages
• In the context of SIRS personalised therapy research, there is a sensitivity to the issue of social justice, but no consensus how to ensure it.
• Issues of social justice are often boiled down to equal chances of inclusion in research and equal access to treatment. In the case of personalised therapy, there seems to be more to it.
The evolution of vaccine mandates: from historical perspectives to contemporary applications
Authors: Vigezzi G P , Vecchio R , Barbati C , Gentile L , Dallagiacoma G , Odone A 
Published: October 2024

Abstract

Luigi Sacco pioneered efforts in 19th-century Italian vaccination campaigns when mandatory vaccination practices began as a public health strategy. We bridge past and present through a systematic review of both historical and contemporary vaccine mandate policies. While Sacco’s early initiatives, characterised by compulsory vaccination and effective communication strategies, set foundational principles for vaccine mandates, the modern era, especially during the COVID-19 pandemic, has seen a significant shift in the nature and application of vaccine mandates. Recent legislative changes across various countries have introduced stricter mandates aimed at managing public health crises. For instance, Italy and France, deeply impacted by reduced vaccine uptake and subsequent measles outbreaks, responded by reinforcing vaccine mandates. These countries aimed to mitigate the dual challenges of achieving high vaccination coverage and combating growing vaccine hesitancy. Comparative analysis of recent legislative changes reveals a trend towards increasing coerciveness in vaccine mandates, reflecting a blend of functional and political pressures driving government decisions. This trend is evident in the legislative adjustments made in California, Australia, France, and Italy, where heightened penalties and reduced exemptions were introduced to counteract declining public compliance. The synthesis of these experiences highlights the critical role of robust, credible communication and the nuanced application of mandates that consider societal and cultural contexts. Contemporary strategies are characterised by targeted interventions aimed at specific populations, reflecting the complex interplay of social, political, and health dynamics in vaccine policy. The enduring relevance of vaccine mandates underscores the necessity of flexible, responsive public health strategies that effectively address both long-standing and emergent vaccine hesitancy and coverage challenges.

Speakers/Panelists
Carlo Signorelli
HSR, Milan, Italy
Maria Gańczak
Department of Infectious Diseases, University of Zielona Góra, Zielona Góra, Poland