bluuebunny/crossref_metadata_2025_split huggingface dataset:
6.C. Workshop: Monitoring progress towards the SDGs: are we leaving someone behind?
Authors:   Organised by: WHO/ Europe, EMCDDA, EUPHA-PHPP, EUPHA-IDC,   Chair persons: Lara Tavoschi (Italy), Sofia Ribeiro (EUPHA-PHPP)
Published: October 2023

Abstract

People in vulnerable situations such as people in contact with the justice system and people living in prison (PLP) are characterized by exclusionary processes such as stigma and discrimination; restrictions on basic freedoms or rights (e.g., voting, privacy, and liberty); or barriers to accessing public services (e.g., health care). Exposure to incarceration is associated with higher rates of ill health and premature death compared with unaffected peers, even after accounting for the socioeconomic position. Evidence suggests that experience of detention frequently co-occur with other well-known vulnerabilities, such as social marginalisation and substance use disorders, although the extent of this overlap varies by context. These experiences and their co-occurrence might influence health through multiple and complex pathways. For instance, their harmful effects might combine or even synergise. An accurate understanding of the burden of ill health in people living in prison is essential to inform the development and implementation of services and policies that meet their needs and tackle inequities in health. Unfortunately, the information richness resulting from the data science revolution is not equally distributed within and across human populations. Vulnerable populations, including PLP, remain both under-studied and under-consulted on the use of data derived from their communities. Strategies to improve the use and integration of data designed for the general population may not be accessible to or as effective in disadvantaged groups and may lead to an exacerbation of health inequities. In the analysis of social science and health data, the global consequences of social exclusion are costly, including exacerbating poverty and reducing human capital. It also hampers the design of culturally coherent solutions which could be more easily adopted in specific communities. This is not only relevant at local/national level, but it has implications at regional and global level. Inclusion of health data on PLP into routine public health monitoring processes is scarce due to poor data availability, parallel and often unlinked data collection tools, as well as organizational and political reasons. Efforts have been made in Europe through dedicated monitoring initiatives led by EMCDDA and WHO, however large scope for improvement and scale-up do exist. This workshop aims at exploring the current landscape and deriving implications of prison health monitoring in Europe and beyond.

Key messages
• Despite efforts, availability of comparable and comprehensive information on prison health in Europe is scarce/suboptimal.
• Integration of prison health into current and future developments in public health monitoring is essential to achieve equity in health.
Gaps in monitoring global progress toward universal health coverage among disadvantaged populations: the case of people living in prison
Authors: Winkelman TNA , Kinner S 
Published: October 2023

Abstract
The United Nations’ Sustainable Development Goals (SDGs) represent a sweeping initiative to create a sustainable and equitable global future. SDG 3 focuses on the health and wellbeing of the world. Expanding universal health coverage is a central component of SDG 3 and has been a focus area of the World Health Organization (WHO), which aims to expand universal health coverage to an additional 1 billion people by this year (2023). The WHO developed an index (indicator 3.8.1) intended to monitor coverage of essential health services across the globe. However, this indicator fails to incorporate health coverage for people in prisons. People incarcerated in prisons across the globe have high rates of physical health, mental health, and substance use conditions compared with the general population, and they are frequently excluded from policies and services available in the general population. For example, in some countries, like Australia and the United States, people in prison are legislatively excluded from the public health insurance programs available to the general population. Exclusion of prison health coverage from the WHO's universal health coverage indicator likely results in overestimation of health coverage in most countries and fails to identify gaps in care during and after periods of incarceration. We believe prison health coverage should be incorporated into the WHO's 3.8.1 indicator, which would more accurately capture a country's health coverage among its most disadvantaged populations. Monitoring of prison health coverage will require improved measurement of quality and service availability in prisons, which is sorely lacking in most countries.
Monitoring health status of people living in prison in Europe: insights from HIPED
Authors: Alves da Costa F 
Published: October 2023

Abstract
Aiming to improve the information available about the health status of people living in prisons in the WHO European region, a survey was sent to Member States (MS) in the Region whose Ministry of Health nominated a focal point. The survey used was derived from the operationalization of the WHO Prison Health Framework which contains 8 domains that characterize the population, the health system, the healthcare services available and the health outcomes at the individual level, in addition to influencing factors and cross-cutting principles. Data from 613 497 people living in prison establishments in 2020 was obtained from 36 MS and suggested the most common way of delivery of prison health care to be shared between the Ministry of Health and the Ministry of Justice. Many MS (⅔) experienced difficulties reporting individual data that would allow the quality of primary care to be characterized. Only 4-10 MS (11.1-27.8%) could provide data on health behaviours and 14- 28 figures on the number of individuals with diagnoses on record (except for oral health status; only 4). The most prevalent condition was mental health disorders (32.8%) and 2.6% of individuals were reported to be living with HIV; in both cases suggesting severe underreporting. Weak links with community care were obvious (e.g. 47.2% of MS had a support service to register people with community health services upon release; and 11.1% did not provide any medication upon release), and possibly aggravated by poor health information systems, where most countries still keep paper-based records and among those with electronic records, most did not have interoperable systems. Even death data was poorly linked with national surveillance systems and only 18 MS had a formal data transfer system in place. Investments are needed so that prison health may be fully integrated into public health to be able to monitor progress in SDGs.
Subnational inequalities in YLLs and associated socioeconomic factors: a disease burden study
Authors: Baravelli C M , Chen-Xu J , Varga O , Grad D A , Mahrouseh N , Charalampous P , Unim B , Economou M , Badache A C , Haneef R 
Published: October 2023

Abstract

Background
Health inequalities are an unjust and avoidable problem. This study examines subnational geographical inequalities in all-cause years of life lost (YLLs) and the association of socioeconomic factors in pre-coronavirus European Economic Area (EEA) countries.

Methods
In this ecological study complimented with a longitudinal analysis, demographic and socioeconomic data for 1390 small regions and 285 basic regions of 32 EEA countries were extracted from Eurostat. Age-standardised YLL rates per 100,000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease Study. Inequalities were assessed using the Gini coefficient (GC) and slope index of inequality (SII). The association between socioeconomic factors by YLLs were assessed using negative binomial mixed models in 2019.

Findings
Over the period 2009-2019, YLLs have decreased in almost all subnational regions. The GC of YLLs across EEA regions was 14% for females (95% CI = 13·5 to 14·6%) and 17% for males (CI = 16·1 to 17·5%). Greece (GC = 10·1%, CI = 7·8 to 2·5%) and Belgium (GC = 10·8%, CI = 9·5 to 12·0%) had the highest relative inequalities in YLLs for women and men, respectively. Subnational regions with the lowest income (incident rate ratio (IRR)=1·39, CI = 1·23 to 1·58) and levels of educational attainment (IRRfemales=1·19, CI = 1·13 to 1·26; IRRmales=1·22, CI = 1·16 to 1·28), and highest poverty risk (IRR=1·18, CI = 1·12 to 1·25) were associated with increased YLLs, with stronger associations observed in Central and Eastern Europe.

Interpretation
Differences in YLLs remain within and between EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing specific health inequities to improve overall disease burden within the EEA.

Key messages
• The study highlights the need for public health policies targeted at the subnational level to reduce health inequalities in the EEA.
• The study describes the effect of existing public health policies targeting socioeconomic factors.
Longitudinal clustering of risk behaviours and their association with multimorbidity in older adults
Authors: Suhag A , Webb T L , Holmes J 
Published: October 2023

Abstract

Smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (SNAP risk behaviours) are leading risk factors for multimorbidity and tend to cluster within specific subpopulations. Little is known about how these clusters change with age in older adults and their association with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess eight body system disorders, multimorbidity, and complex multimorbidity. Logistic regressions examined how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11·4%), Abstainer yet inactive (20%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10·9%). There was little evidence these clusters changed with age. Clusters characterised by physical inactivity (in combination with other risky behaviours) were associated with lower levels of education and wealth. The heavy drinking clusters were predominantly male. Compared to other clusters, Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all diseases studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and ought to be addressed early. By identifying seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics, and disease prevalence, our study provides valuable information for identifying high-risk subpopulations and tailoring interventions to their behaviour patterns and socio-demographic profiles.

Key messages
• We identified seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics and disease prevalence.
• Health-risk behaviours tend to be stable as people age and ought to be addressed early.
Cost-benefit assessment of health benefits of local climate action: scoping review
Authors: Kovats S , Turner G , Connor L O , Connell E O , Hajat S , Cairns J 
Published: October 2023

Abstract

Background
Local climate strategies are often linked to current priorities for transport, housing and planning but the health benefits of these strategies are often neglected in decision making. Economic information on the health benefits of climate action, including return on investment (RoI), would help support adaptation in Local Government.

Aim
To review methods for economic evaluation of the health benefits of local climate action (adaptation and mitigation) in high income countries.

Methods
We undertook a scoping review of full economic assessments that considered the health impacts of local climate action. We first reviewed climate actions and strategy documents to identify climate policies, practices and measures. We searched four electronic databases (Global Health, Web of Science, ECONLIT, and MEDLINE via OVID) for studies published from 2000 to 2022.

Results
26 studies were identified. The economic assessments covered a range of interventions, mostly for mitigation objectives: active travel (n = 10); housing (n = 6), green infrastructure (n = 4), heatwave warning systems (n = 3), transport (n = 1), and food waste (n = 1). A limited range of economic methods were used, with most using benefit-cost ratios (BCR) as a measure of cost effectiveness (n = 14). The range of health outcomes that were monetised was even more limited, either benefits from reduction in indoor or ambient heat and/or air pollutants (PM) on mortality or increased physical activity.

Conclusions
Currently there is limited economic evidence to support decision-making for local climate action that takes health into consideration. Climate actions may also incorporate nature-based solutions but these have specific challenges for evaluation and valuation. There is a need to develop standard methods to allow decision makers to evaluate the most appropriate strategies.
Digital Public Health in Slovenia
Authors: Hrzic R 
Published: October 2023

Abstract
The digitalisation of the Slovene healthcare system began in the mid-2000s with the publication of the eHealth 2010 strategy. However, it was not until 2016 that the digitalisation process gained significant momentum with the adoption of the Resolution on the National Health Care Plan 2016-2025 and the conclusion of the pilot phase of the eHealth project. These resulted in a unified health data infrastructure that links various health databases and telemedicine services, including the central registry of patient data, ePrescriptions, eReferrals, eConsultations, and the electronic registry of vaccinations (eRCO). Slovenia's eHealth capacity proved critical in enabling continuity of care during the pandemic, with more than 60% of the population consulting their physician or receiving a prescription remotely. This was enabled by the national patient portal, zVEM, which created a one-stop- shop for health services and information and the changes in the reimbursement rules of the national health insurance institute during the pandemic, which enabled the reimbursement of teleconsultations. Crucial for public health and health research, the current health data infrastructure links various national databases, including national cancer and central population registries. However, gaps remain in the health information system. For example, data from long-term healthcare services are inadequately captured, and there is currently no scope for linkage between health and the social welfare system datasets. In November 2022, the government unveiled a new healthcare digitalisation strategy for 2022-27. Its key objectives include streamlining the governance of eHealth services, infrastructures, and health data, implementing a standardised electronic patient record supporting medical imaging, and creating a national framework for telemedicine. The strategy also aims to enable the secondary use of health data in preparation for participating in the European Health Data Space.
Assessing resilience though a health system performance lens
Authors: Zimmermann J , Karanikolos M , Haywood P , Levy N , Cylus J 
Published: October 2023

Abstract
Health system resilience testing has generated keen interest since the COVID-19 pandemic but so far no methodology for this complex exercise exists. Our concept of resilience testing is inspired by the experience of stress tests in the banking sector. The novel approach is a mixed-method country-led exercise, which applies a health system lens to a particular shock scenario, and identifies vulnerabilities using the Health System Performance Assessment Framework for Universal Health and the Shock Cycle. In the first part of the presentation we describe the resilience testing methodology, based on the two conceptual frameworks. We share lessons from the required preparatory work: shock scenario selection, scope of background research, formation of a resilience testing group, resilience test day structure and process, and the facilitator's role. We also discuss the outcomes of the resilience testing process, which includes a formal assessment of the resilience of the health system. This will provide workshop participants with an overview of key concepts to conduct a country-led resilience testing exercise. The second part of the presentation focuses on the overarching results from the country-led pilots. These show that the resilience testing method can identify specific health system weaknesses at different stages of the shock cycle. Given the appropriate selection of resilience test facilitator and participants, the method can also detect system-wide challenges, shock implications and spill-overs. The participant interaction on the test day may identify key priorities for action and strengthen relevant national multiprofessional networks. Overall, the resilience testing approach is an important new tool to identify strengths and weaknesses of the current health system and in scenario-specific preparedness planning.
Strengthening health system resilience at the European level
Authors: de La Mata I 
Published: October 2023

Abstract
The resilience testing project builds on the work carried out by the ‘Expert Panel on effective ways of investing in health’ in its ‘opinion on the organisation of resilient health and social care following the COVID-19 pandemic’, adopted on 25 November 2020 as well as the December 2020 report by the EU Expert Group on Health Systems Performance Assessment (HSPA) titled ‘Assessing the resilience of health systems in Europe: an overview of the theory, current practice and strategies for improvement’. Resilience testing may contribute to the European Semester, which addresses health system effectiveness, accessibility and resilience. The encompassing resilience assessment framework (‘the testing framework’) will serve to detect critical health system weaknesses against specific shocks as well as long-term structural challenges. This will help to develop recommendations for remedial action. The heath system resilience testing methodology will support the implementation of the Regulation on serious cross-border threats to health which envisages stress tests and simulation exercises to help the development of health system functions and preparation of prevention, preparedness and response plans. It could also support the European Centre for Disease Prevention and Control (ECDC) in their assessment activities of the prevention, preparedness and response plans. By establishing a resilience testing methodology, Member States will be able to regularly and independently review their preparedness for health crisis and check their healthcare systems’ resilience against specific high-pressure scenarios and long-term structural challenges. This action will generate insight and evidence through resilience tests and will reinforce the ability of Member States and regions to become more resilient to future shocks.
Self-perceived barriers to healthcare access for patients with post COVID-19 condition
Authors: Brus I , Spronk I , Heemskerk SCM , Biere-Rafi S , Tieleman P , Polinder S , Haagsma J A 
Published: October 2023

Abstract

Background
Many patients with post COVID-19 condition (PCC) require healthcare services. However, qualitative studies indicate that patients with PCC encounter many barriers to healthcare access. This cross-sectional study aimed to identify which barriers to healthcare access patients report, and to determine differences between subgroups based on sociodemographic characteristics, medical characteristics, and PCC symptoms (fatigue, dyspnoea, cognitive problems, anxiety and depression).

Methods
Data were collected via an online survey from 10,462 adult patients with a confirmed or suspected COVID-19 infection in the Netherlands, who experienced persisting symptoms ≥3 months after the initial infection. To measure self-perceived barriers, a list of eleven possible barriers was used, covering multiple aspects of healthcare access.

Results
Respondents reported a median of 2.0 (IQR=3.0) barriers; “I didn’t know who to turn to for help” (50.9%) and “No one with the right knowledge/skills was available” (36.8%) were most frequently reported. Multivariate logistic regression analyses showed that those with lower age, higher educational level, longer disease duration, not hospitalized, and who had more severe PCC symptoms, had significantly higher odds of reporting ≥1 barrier to healthcare access. Analyses per barrier showed that women had higher odds of reporting financial barriers as well as feeling uncomfortable asking for help, while men had higher odds of reporting barriers related to availability of care. Hospitalized respondents had lower odds of reporting barriers related to availability of care, but not financial barriers.

Conclusions
This study shows that the majority of patients with PCC experiences barriers to healthcare access and that the type of barriers patients experience differs depending on sociodemographic and medical characteristics. Differences by educational level might be due to underrepresentation of low educated patients who experience barriers.

Key messages
• Many patients with post COVID-19 condition experience barriers to healthcare access, including barriers related to availability of care, finances, and feeling uncomfortable asking for help.
• The number and type of barriers patients with post COVID-19 condition report differs depending on sociodemographic characteristics, medical characteristics and the presence of core symptoms.