In this European public health news, Azzopardi Muscat and Jakab are talking about the control of NCDs. Even though progress has been made, we need to act now, we need co-ordinated efforts and bold public health measures. The need for co-ordinated efforts is also addressed by Andriukaitis who is presenting the newly adopted Commission proposal to cooperate on health technology assessments in order to bring innovative health solutions faster to patients. The necessity of a strong voice and a multi-disciplinary, co-ordinated approach also applies to violence, as described by Zeegers. All these contributions ask for public health professionals to be innovate, collaborative and ready to learn from each other. Our new EUPHAnxt team is doing just that and the upcoming Ljubljana 2018 conference (Erzen) will showcase our successes as well as our ‘successful failures’. President’s column Natasha Azzopardi Muscat Natasha Azzopardi Muscat EUPHA President 2016–20 EUPHA President 2016–20 The commitment to reduce premature mortality from non-communicable disease globally by 30% until 2030 will not be met unless action is accelerated. ‘Business as usual is insufficient’ was the conclusion from the technical report of the WHO Independent High Level Commission on NCDs.1 Obesity is a major risk factor for non-communicable diseases, such as cardiovascular disease, diabetes and several cancers. Three hundred and fourty million children and adolescents are obese. Obesity is preventable but it shows no signs of declining. Many European countries are also struggling with obesity. Obesity is differentially distributed with the lower socio economic groups bearing the brunt of the effects. Solely relying on public health messages about calorie intake, diet, and physical activity is insufficient.2 A co-ordinated series of actions is needed if we want to get serious about tackling obesity and about not allowing a new generation of growing children to have to content with obesity throughout their lifetime. Policy advocates are calling for challenging the status quo through bold initiatives such as framework conventions. Although the battle over tobacco is far from over, there is no denying the benefit of a global convention such as the Framework Convention for Tobacco Control. The European Union is a key political institution at the global level with a strong potential to engage in supporting such initiatives. Yet all indicates that the European Union is adopting a retrenchment attitude when it comes to bold public health measures. This is a pity since the world needs a strong European Union which is active on health issues at a global level. The year 2018 is a key year to chart a way forward for tackling NCDs which are preventable with the convening of the UN meeting in September 2018. The window of opportunity is fast closing. Tackling NCDs successfully requires a plethora of concerted actions and activities. More than that, it requires the political will and decisive leadership of those who are no longer willing to accept this state of affairs and understand that transformational approaches are necessary. The time for incrementalism is over. We are already overwhelmed and further postponement will only make the problem so large that we give up on ever managing to tackle it. Whilst, social engineering is no longer a politically popular choice, we must recognize that a new kind of implicit social engineering is being fabricated. This is the social engineering of data sharing through social networks. Unfortunately, at the present moment this tool is being used to support digital marketing that further contributes to exacerbate problems such as obesity and mental health in children and adolescents. Public health needs to move firmly into the 21 century. Our armaments must necessarily become more innovative. We must find ways to reach out to individuals who are most at risk. Waiting for political appetite for regulation and fiscal measures to materialize is not enough. Whilst we must keep up our advocacy efforts to steer our societies away from obesogenic promoters towards environments where living healthily is not a costly effort but an easy choice, we must also discover new ways of reaching out and influencing the next generation using data and social media. Obesity has become an almost insurmountable problem in a number of small island states worldwide. These small populations may not hit the headlines when it comes to measuring burden of disease but we need to better understand what has caused this rapid phenomenon in these countries and how we can start to reverse it before a similar wave hits larger countries where millions will be affected and reversing the process will be far more arduous. References 1 Report of the Technical Consultation WHO Independent High Level Commission on NCDs Geneva march 2018. Available at: http://www.who.int/ncds/governance/high-level-commission/HLC_Final_report_of_the_Technical_Consultation_21-22_March_2018-CORR1.pdf?ua=1 (4 May 2018, date last accessed). 2 Tackling Obesity Seriously: The Time has Come. The Lancet Public Health, Vol 3. Available at: www.thelancet.com/public-health (April 2018, date last accessed). EUPHA Office Column Dineke Zeegers Paget Dineke Zeegers Paget Executive Director EUPHA Executive Director EUPHA In the past year, there have been numerous incidents of violence [gun violence, especially in the US, violence in public places (whether or not on religious grounds) to kill many especially in Europe]. These outbursts of violence lead to feelings of increased anxiety, anger and helplessness. The cry to do more against violence and to fully understand the impact of violence is becoming louder. So what is preventing us from acting? The first obstacle is the lack of systematic data. The Global status report (no ‘s’) on violence prevention 20141 is the first report to assess what countries are doing to address interpersonal violence. This report was published jointly by WHO, the United Nationals Development Programme and the UN office on drugs and crime and covers data from 133 countries. But data is lacking. For instance, in the field of gang-related and armed violence, only few countries have gathered systematic data on this. A lack of data on the why, how and prevention of violence is missing, and this is a first step in fully understanding the presence, incidence and consequences of interpersonal violence. The second obstacle is the lack of collaboration. Violence and prevention of violence fall under the responsibility of the judiciary system and collaboration e.g. with public health is not an automatic given. The American Public Health Association (APHA)2 recently called for a comprehensive public health approach to address the growing crisis of gun violence. And overall: better surveillance of violence and violence related injuries; more research to expand the collection of data and research related to gun violence and other violent crime deaths in order to better understand the causes and develop appropriate solutions and better access to mental health services. The third obstacle is the lack of political will. In recent months, we have seen calls in the press that (gun) violence should be seen as a public health problem,3,4 but how do we change the system to move toward a multi-disciplinary proactive approach to violence? In March 2018, hundreds of thousands of students marched the street in over 800 locations worldwide, asking for less violence and more gun control. Carrying signs like ‘we are the change’ and ‘no more silence’, this next generation is standing up and demanding a change in politics. And this very visual protest and call for action was even taken up by President Trump, albeit very shortly as he quickly changed his mind back to arming teachers as the best solution to prevent violence in schools. To come to a multi-disciplinary proactive approach to stop violence and the effects of violence on the whole population, we need data, we need to collaborate and we need to work on political willingness to do something about this violence. And here, there is a role for the public health professionals. We can gather and analyze the data, we are successful in collaboration with the widest array of fields and—if we stand up and raise our voices—we can change political unwillingness to act. References 1 Available at: http://www.who.int/violence_injury_prevention/violence/status_report/2014/en/ (2 April 2018, date last accessed). 2 Available at: https://www.apha.org/topics-and-issues/gun-violence (6 April 2018, date last accessed). 3 Available at: https://www.theguardian.com/us-news/2018/mar/24/washington-march-for-our-lives-gun-violence (6 April 2018, date last accessed). 4 Available at: http://www.sciencespo.fr/liepp/en/content/violences-en-france-un-probleme-de-sante-publique (6 April 2018, date last accessed). 5 Available at: https://www.nytimes.com/2018/03/12/us/politics/trump-gun-control-national-rifle-association.html (7 April 2018, date last accessed). EUPHAnxt Introduction The EUPHA family has expanded once again with the new EUPHAnxt arrivals. EUPHAnxt, the next generation network, is a unique network within EUPHA for students and young professionals, including early career researchers and policymakers, in the field of public health. The new team includes four young enthusiastic and public health-passionate individuals whom strive to continue the fantastic work of EUPHAnxt, further expand the network, build more partnerships and strengthen the presence of students and young professionals in the European public health community. Sara McQuinn is the new EUPHAnxt Co-ordinator. She is a SPHeRE (Structured Population and Health-services Research Education) Programme Ph.D. scholar at Dublin City University, Ireland. She loves to meet new people, travel and keep active. She has a B.Sc. in Public Health, and a M.Sc. by Research in European Child Health. Sara completed an internship at the World Health Organization European Office, and has been a member of EUPHAnxt since her first EPH conference in 2015. Pasquale Cacciatore is the new EUPHAnxt Communication Manager. He is a medical Doctor living in Rome and is currently attending his residency program in Public Health at Università Cattolica del Sacro Cuore. Within his areas of interest he is currently focusing on health services research, technology assessment and epidemiology. He loves keeping busy with plenty of activities, including being an official football referee and tinkering with tech devices. Keitly Mensah is the new EUPHAnxt Conference Manager. She is a Public Health physician and works as a Research Associate in Princeton, USA. She was involved in different junior doctor associations during her residency in Lyon, France, where she discovered EUPHAnxt. She loves traveling, trying new sports and new cocktails. Anton Hasselgren is the new EUPHAnxt Partnership Manager. He is from Sweden and currently lives in Norway where he is enrolled in a Master program in Global Health at NTNU, Trondheim. His bachelors are in exercise physiology and public health. Anton’s main interests in public health are NCD prevention and e-health. During his spare time he loves to go ski-ing, climbing and running in the mountains. EUPHAnxt current projects and initiatives include: A fun and informative periodic newsletter addressed to students and young professionals interested in public health. To organize skill-building workshops at the annual EPH conference to promote training and education. The abstract mentoring programme, which provides an opportunity for young and/or less experienced abstract submitters to receive feedback from expert reviewers on abstracts that are to be submitted to the EPH Conference. An Informal Internship Programme, where our goal is to put students and young professionals interested in doing an internship at the EUPHA office or within one of the EUPHA sections, in contact with the relevant public health professional. If you have any queries, or would like more information regarding EUPHAnxt, please email: firstname.lastname@example.org. We also have Facebook, Twitter, Instagram and LinkedIn accounts where we share our latest activities and interesting public health news! Lastly, with a new team, comes a new logo! Take care, The EUPHAnxt Team Health systems respond to non-communicable diseases: time for ambition Zsuzsanna Jakab Zsuzsanna Jakab WHO Regional Director for Europe WHO Regional Director for Europe Zsuzsanna Jakab, Regional Director for Europe, World Health Organization The good news is that the rates of premature mortality from non-communicable diseases (NCDs) are declining across the whole of the WHO European Region and that the health inequity gap between countries is narrowing. The bad news is that this is not happening fast enough. If current rates are projected, it may take another six decades for countries in Eastern Europe and central Asia to reach today’s premature mortality levels in Western Europe. Given our current knowledge and experience of what works in addressing NCDs, these deaths are needless and avoidable. It is time to set more ambitious goals now, for the benefit of our children. We know what to do to improve NCD outcomes. Global and European NCD action plans propose a set of core population interventions and individual services, also referred to as NCD ‘best buys’. They have a great population health impact, are proven to be cost effective in many settings and can be implemented in a wide range of health systems. However, there is strong evidence that many countries in the WHO European Region have not taken advantage of these core interventions and services, and so there is scope to be more ambitious in walking the talk on our commitments. We are excited to be able to present soon a new report by the WHO Regional Office for Europe, Health systems respond to NCDs: time for ambition. In this report, we make the case that health systems are critical for a more ambitious response to NCDs and for scaling up core NCD interventions and services. A more comprehensive and better aligned health system response to NCDs can accelerate improvement in NCD outcomes and improve the lives of millions of people living with often multiple conditions. A well-designed, equity-oriented health system response can also reduce within-country health inequalities. Our report examines the changing nature of health system stewardship to ignite action on the determinants of health. For this, we need to rethink governance arrangements in order to ensure coherence across different sectors and settings where NCD policies are developed, and sustainably embed intersectoral action with stronger mandates and financial support. We highlight the fact that strong national policies are essential for creating a framework for action. However, contextualized solutions to complex problems often originate at the regional and local levels (e.g. how to adjust community services to the growing number of elderly people with dementia, or how to stop the growth in childhood obesity with an emphasis on lower-income groups), providing opportunities for shared learning. In order to scale up core NCD interventions and services in a people-centred manner, there is a need for ambitious transformation in how we deliver public health, primary care and specialist services, with a sharpened focus on outcomes, co-ordination, continuity and comprehensiveness. For example, the increasing shift towards larger, multi-profile primary care teams connected to other community resources (such as social services and public health services) can enable better population health management at the community level and provide more proactive, dynamic and tailored services than the solo practices of the past. Prioritized health financing strategies, competency-based health workforce strategies, multi-pronged medicines policies and information solutions must be aligned with this desired service delivery transformation. An important way to accelerate improvement in NCD outcomes is by strengthening the equity orientation of health system policies––to leave no one behind and to break the harmful cycles of health inequalities. This can be achieved through balancing the implementation of universal strategies with scale and intensity proportionate to the level of disadvantage in a population. For example, universal smoking bans in public places is a best buy, but an equity oriented approach would also focus on prioritizing smoking cessation workplace interventions in low-income and less-secure areas of employment with the provision of heavily subsidized or free nicotine replacement therapy and counselling. Embedding equity and gender-sensitivity into health system policies and public health action are critical areas of leapfrogging in health systems, particularly for NCDs that can accelerate the decline in inequalities of NCD outcomes. This is an important year for celebrating health systems, with three major regional and global events putting the spotlight on successful examples and inspirational action. The first high-level regional meeting, ‘Health systems respond to NCDs: the European experience’, is just weeks away (16–18 April in Sitges, Spain). Soon after that we will celebrate the 10th anniversary of the Tallinn Charter, at the meeting on ‘Health systems for prosperity and solidarity: leaving no one behind’ (13–14 June in Tallinn, Estonia). Finally, we all look forward to the global conference in Almaty, Kazakhstan, in November at which we will celebrate the 40th anniversary of the Declaration of Alma-Ata on primary health care. EU co-operation on HTA: newly adopted Commission proposal can bring innovative health solutions to patients faster Vytenis Andriukaitis Vytenis Andriukaitis EU Commissioner for Health and Food Safety EU Commissioner for Health and Food Safety At the beginning of 2016, I informed readers that the Commission was exploring options for sustainable EU-level cooperation on Health Technology Assessment (HTA)––an area where we have been working together with Member States on a voluntary basis for many years. Now, I am back with an update: on 31 January 2018, the Commission adopted a proposal to boost co-operation amongst EU countries for assessing health technologies. This is a triple win–for patients, national authorities and industry. We have set out a framework for joint clinical assessments in two areas: for new medicines and for some new medical devices including certain in vitro diagnostics. Such joint assessments are limited to the most innovative technologies and should focus on the clinical benefits these new technologies can offer to patients as compared with existing ones. The new framework enables the common use of HTA tools, methodologies and procedures across the EU. Joint work would also include joint scientific consultations to advise health technology developers on evidence requirements, and identification of emerging health technologies. Voluntary cooperation on health technologies other than medicines and medical devices will also be supported, for example surgical procedures or vaccination programmes. Individual EU countries will continue to be responsible for assessing non-clinical aspects of health technology–for example: economic, social and ethical, in order to take well informed decisions on access, pricing and reimbursement. Patients will gain from faster uptake of promising innovative technologies, to the extent that Member States decide to incorporate highly rated technologies in national healthcare systems. National authorities will be able to pool their expertise and avoid duplication of efforts on clinical assessments, making better use of human and financial resources. Industry, including SMEs, will benefit from clearer rules and greater predictability for their business planning and cost savings. All three of these groups will benefit from greater transparency, for example through the publication of joint clinical assessments. Our proposal is ambitious, but it is also balanced. For example, it takes account of the specific characteristics of the pharmaceutical and medical device sectors, keeps different processes and remits well separated and does not add any unnecessary administrative burden. It also entails a phase-in approach (3 years between entry into force and becoming applicable in Member States, plus a further 3-year transition period) to give national authorities and industry adequate time to adapt to the new procedures and to ensure that the new system gradually builds up its capacity and delivers the timely output of high quality, which is a key requirement for the co-operation. In order to discuss HTA co-operation and to make sure that all actors involved (HTA bodies, patient organizations, industry, healthcare providers and payers, academia) are perfectly aware of the adjustments they will need to make to comply with the new rules, we will organize a stakeholder conference in Brussels on 9 July 2018. For more information see: https://ec.europa.eu/health/technology_assessment/eu_cooperation_en 11th European public health conference 28 November–1 December 2018 Cankarjev Dom, Ljubljana, Slovenia Ivan Eržen Ivan Eržen Chair Ljubljana 2018 Chair Ljubljana 2018 The preparation activities for our 11th European Public Health Conference, which will be held in Ljubljana from 28th November to 1st December this year, are very intense. Abstract submission for the parallel programme has opened on 1 February 2018. There is not much time left to send your abstract since the abstract acceptance is like every year, possible only until 1 May 2018. I would like to encourage experts from cross over the Europe to come and present to the fellow peers your work and your achievements. The programme of the plenary sessions is already shaped. Our partners: EuroHealthNet, ASPHER, European Observatory on Health Systems and Policies, ECDC, European Commission and WHO Regional Office for Europe have prepared very interesting and actual programme which will be covered by distinguished key note speakers. The programme of the opening and closing sessions is also almost finished. We will give the floor also to the young generation. For example, an awarded programme, which was developed by Slovenian students to promote immunization will be presented. In November 2017, European Commission awarded this programme with first prize given to non-governmental organizations working in the field of Health Promotion on behalf of NGOs promoting vaccination. The parallel sessions are not defined yet. They will be organized according to your interest, suggestions and needs. There are certain fields like communicable diseases, environmental health, health systems performance, discussion on essential public health operations and its evaluation that will certainly find place in one of the many parallel sessions and discussions. But there are also other themes, very important and relevant for better health of the population. We are very open and we are waiting for your active participation. All details on how to send the abstract are given at our web page: https://ephconference.eu/. The abstracts will be peer-reviewed by the International Scientific Committee with public health experts from across Europe. Applicants will be notified of the acceptance of their abstract by mid-June 2017. Certain activities are going on to enable colleagues from Western Balkan to attend the conference and we do hope w will be successful in this. We are striving to prepare very interesting and useful conference. This is possible only by your active participation. We are looking forward meeting you in Ljubljana later this year. © The Author 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
The European Journal of Public Health – Oxford University Press
Published: May 21, 2018
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