Teaching public health: an innovative method using computer-based project work

Restructuring of training in public health in the Hungarian medical schools is being undertaken in the context of a major European Union tempus Joint European Project. Under the aegis of this project a common core curriculum of public health has been developed. As part of the implementation of the curriculum, new approaches to learning are being explored that should enable students to appreciate the nature and magnitude of the major challenges to public health in Hungary and promote the development of their analytic, interpretative and presentational skills. One of the approaches is based on the individual preparation of reports on important public health issues, making use of secondary data from electronic databases (WHO HFA/PC and OECD Health Data) and traditional printed sources (annuals). This method called 'computer-based project work' was introduced in Debrecen in 1992–1993 with a secondary objective to develop basic computing skills. The initial experiences of introducing computer-based project work to the curriculum have been positive. This paper describes a practical example of the implementation of innovative approaches to teaching in a highly traditional setting in Central Europe, and one that provides ideas and encouragement to those facing similar problems in the countries of Central and Eastern Europe and the former Soviet Union.     

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM: Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that. METHODS: This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts. RESULTS: Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden. CONCLUSIONS: Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.     

Unity or diversity?: Task profiles of general practitioners in Central and Eastern Europe

Background: The countries of Central and Eastern Europe, where- until the end of the 1980s - the Semashko health care systemprevailed, are often perceived as a homogeneous group. If thishighly centralized system, with its tight state control, togetherwith the ‘equalizing’ influence of communism, hasled to a uniformity in the provision of health services, thiscould be reflected in the service profiles of general practitioners(GPs). The aim of this paper was to find out whether this pictureis justified and investigate differences between the formercommunist countries. Methods: In 1993 and 1994, standardizedquestionnaires were sent to (mostly random) samples of GPs (7,233in total) in 30 European countries. Four areas of service provisionwere measured: the GPs' position in first contact with healthproblems and their involvement in the application of medicaltechniques, disease management and preventive medicine. Variationpatterns and mean scores were analyzed by way of multilevelanalysis. Results: There is no more uniformity in Central andEastern Europe than in Western Europe. In Eastern Europe thereare in fact considerable differences: GPs in former Yugoslaviahave the most comprehensive service profile, whereas the lowestscores were found among doctors in the former Soviet Union.The countries which had a social insurance system before theSecond World War, such as the Czech republic and Hungary, aresituated in between. Conclusions: There are distinctive nationaldifferences in GPs' task profiles in Central and Eastern Europe,which provide clues for the country-specific design and implementationof primary care-oriented reforms.     

Gesundheitssurveys in Europa

In almost every European country health surveys are conducted in order to describe the health status of the population and to use these data for planning health services and preventive activities. In the last 10-15 years the availability and quality of data from population-based health surveys in Europe have greatly improved, particularly in the countries of Central and Eastern Europe. Nevertheless the design, quality of data and the comparability across countries, nations and cultures remain a challenge. Therefore WHO and EU have started various activities to harmonize the methods and instruments in health surveys. These activities are described in this contribution.     

Social care and changes in occupational accidents and diseases - the situation in Eastern Europe in general and for skin diseases in particular

Background  

As a consequence of the disintegration of the state systems and the expansion of the European Union, there have been marked changes in the political and social affiliations of the countries of Eastern Europe. Of the 22 countries in Northeastern, Centraleastern, Southeastern and Eastern Europe, 12 are now members and 10 are "new" neighbours of the European Union. The accident insurance systems and changes in occupational accidents and occupational diseases in eastern European countries are described. Changes since EU and visible differences from non-EU countries are analysed. Special emphasis is given to occupational skin diseases.     

Strategic orientation of public health in transition: an overview of South Eastern Europe

Two recent developments have redirected the course of Public Health in Europe - the Public Health Mandate of the European Commission and the conceptualization of a New Public Health. For the transition, countries in South Eastern Europe, particularly Serbia, provide support to essential public health reforms in four areas: strategic management, public health information, public health legislation, and public health training and research. The roles of the Dubrovnik Pledge (2001) and the Stability Pact, which has international support, have been central.     

The development of health technology assessment

The field of health technology assessment (HTA) is still relatively new, but it has shown remarkable growth over the last decade, having spread first from the United States to Europe, and now to the entire world. HTA seeks to couple evidence with decision-making, and thus has similarities to evidence-based health care and evidence-based policy-making. The early history of HTA, beginning around 1975, reveals a first period of synthesising available evidence-principally that dealing with efficacy and cost-effectiveness of health care interventions-so as to put it in a format helpful to health policy-makers, especially those in national governments. From 1985 or so, the focus of the second period was on seeking more effective links with these policy-makers, particularly in Europe. The most recent period, beginning in the late 1990s, has been increasingly devoted to more effective dissemination and implementation in order to influence administrators and clinicians. While early assessments tended to focus on large, expensive, machine-based technologies, the scope has gradually widened to include smaller technologies, 'softer' technologies (such as counselling), and health care needs. Actual assessments have also taken on broader issues, such as organisational, social, and ethical implications. In the Member States of the European Union (EU), HTA activities are increasingly visible, and almost all now have a national focus for HTA associated with the Ministry of Health or its equivalent. Central and Eastern European countries are also developing HTA activities. Most recently, HTA has been highlighted by health policy documents from the European Commission. It seems likely that HTA will in the future be institutionalised in some form as part of EU activities.     

Creating a Knowledge Translation Platform: nine lessons from the Zambia Forum for Health Research

Background

Public health research provides evidence for practice across fields including health care, health promotion and health surveillance. Levels of public health research vary markedly across European Union (EU) countries, and are lowest in the EU's new member states (in Central and Eastern Europe and the Mediterranean). However, these countries now receive most of the EU's Structural Funds, some of which are allocated to research.

Methods

STEPS, an EU-funded study, sought to assess support for public health research at national and European levels. To identify support through the Structural funds, STEPS drew information from country respondents and internet searches for all twelve EU new member states.

Results

The EU allocates annually around ?7 billion through the Structural Funds for member states' own use on research. These funds can cover infrastructure, academic employment, and direct research grants. The programmes emphasise links to business. Support for health research includes major projects in biosciences, but direct support for public health research was found in only three countries - Cyprus, Latvia and Lithuania.

Conclusions

Public health research is not prioritised in the EU's Structural Funds programme in comparison with biomedicine. For the research dimension of the new European programme for Structural Funds 2014-2002, ministries of health should propose public health research to strengthen the evidence-base for European public health policy and practice.     

Transnational migration of health professionals in the European Union

The establishment of the European Common Market has involved the free movement not only of capital and goods, but also of persons and services. The principles of free movement also apply to the health care sector, i.e. they allow for the free incorporation of health care providers and the cross-border delivery of services. Since the 1970s, the European Union (EU) has passed numerous regulations to enforce the mutual recognition of qualifications of physicians, nurses, and other health professionals by the Member States, considered an indispensable precondition for the free movement of services. Thus far, the establishment of a European job market for the health care professions has not led to extensive migration among the EU Member States. Likewise, the accession of Central and Eastern European countries to the EU in 2004 did not cause a "brain drain" to the better-off countries of Western and Northern Europe. However, the mobility among health care professions is expected to increase in the coming years.     

The importance of father’s and own education for self‐assessed health across Europe: an East–West divide?

How are one’s own education, father’s education, and especially the combination of the two, related to self‐assessed health across European societies? In this study, we test hypotheses about differences in self‐assessed health between 16 post‐socialist countries in Central and Eastern Europe and 17 Western European countries. We find substantial cross‐national variation in the (relative) importance of own and father’s education for self‐assessed health. Over 65 per cent of this cross‐national variation is accounted for by the East–West divide. This simple dichotomy explains cross‐national differences better than gross domestic product or income inequality. An individual’s father’s education is more important, both in absolute and relative terms, for self‐assessed heath in Eastern Europe than in Western Europe. Intergenerational mobility moderates the relative effects of one’s own and one’s father’s education. In Eastern Europe the relative importance of one’s father’s education is greater than it is in Western Europe – particularly for those who are downwardly mobile and have a father with tertiary education. The results are sometimes contradictory to initial expectations; the theoretical implications are discussed.     

Investigación en salud pública: ¿hay diferencias entre los países del norte,el sur y el este de Europa? Una perspectiva desde las asociaciones nacionales de salud pública

IntroductionResearch provides the important evidence base for public health practice. We sought to compare the current support for public health research within European countries.MethodsWithin a collaborative study SPHERE (Strengthening Public Health Research in Europe), we developed an e-mail questionnaire and sent it to 93 representatives of national member associations of the European Public Health Association. We compared the answers with reference to tree macro-areas: Northern, Southern and Eastern Europe.ResultsWe gained responses for 22 of 39 European countries (56% country response rate). Current priorities at national level were: health service and patient safety for Northern Europe; infectious disease, health service and cardiovascular disease for Southern Europe; and food safety and nutrition, environmental and occupational health for Eastern Europe. Respondents gave fewer priorities for international research. In the North Europe the priorities empathized were health promotion, prevention and education (26.3%) together the injuries and alcohol habits (26.3%).ConclusionSupport for public-health research differs across Europe, and barriers to undertaking better research include structures and sufficient personnel. National public health associations and public authorities should cooperate in order to find effective answers to common problems.     

Changing trends of diseases in Eastern Europe: closing the gap

One of the greatest challenges in Europe at the beginning of the 21st Century is the wide east-west health gap. In 2008, the difference in life expectancy between men in some Western European countries and Russia was 20 years. Whilst trends for life expectancy at birth have improved in many areas around the world, those for Russia, as well as those for some other former Soviet Union countries, have fluctuated greatly and have not shown signs of growth since the middle of the 20th Century. This problem is most acute in Russia and former Soviet Union countries, but is also far from being solved in the states that have made significant progress since 1990 and joined the European Union in the 21st Century. One of the priorities of the Polish presidency of the European Union, which began in July 2011, is the call for a European solidarity for health that could help to close the health gap dividing Europe.     

Gesundheitswissenschaften in Europa

Background

Research provides an important evidence base for public health practice. This was the basis for a comparison of current support for public health research within European countries.

Methods

Within a collaborative study SPHERE (Strengthening Public Health Research in Europe) an e-mail questionnaire concerning current priorities in public health research was developed, which was sent to 93 representatives of national member associations of the European Public Health Association (EUPHA). The answers were compared with reference to three macro-areas: Northern, Southern and Eastern Europe.

Results

Responses were received from 22 out of 39 European countries (56% country response rate). Current priorities at national level were health services and patient safety for Northern Europe, infectious diseases, health services and cardiovascular diseases for Southern Europe and food safety and nutrition, environmental and occupational health for Eastern Europe. Respondents reported fewer priorities in international research. In Northern Europe the priorities emphasized were health promotion, prevention and education (26.3%), injuries and alcohol habits (26.3%), in Southern and Eastern Europe health economics, health impact assessment and evaluations of services and programmes were prioritized by 30% and 41.7%, respectively.

Conclusions

Support for public health research differs across Europe, and barriers to undertaking better research include structural obstacles and insufficient personnel. National public health associations and public authorities should cooperate in order to find effective answers to common problems.     

The Hebrew University--Hadassah Braun School of Public Health and Community Medicine: its international role and experience

For more than 40 years the Hebrew University-Hadassah Braun School of Public Health and Community Medicine has been involved in the training of public health professionals from Israel and around the world. The Israeli MPH course has graduated more than 600 professionals who occupy senior posts in the Israeli health service system. The parallel International MPH (IMPH) course (in English) has produced almost 600 graduates from some 80 countries, especially in the developing world. They have returned home to make a major contribution to public health and the public's health is their countries. In recent years there has been a growing number of graduates from countries in Eastern Europe and those of the former Soviet Union. The School has defined its mission as improving the health of the population of Israel and internationally through training, research, and service. Recently a special PhD program for outstanding graduates of the IMPH has been instituted. This international experience has laid the foundation for growing collaboration and support for newly developing Schools of Public Health in Europe and elsewhere.     

Eastern Europe and the former Union of Soviet Socialist Republics: animal health systems in transition

The economic transition in Eastern Europe and the former Union of Soviet Socialist Republics (USSR) during the last decade has profoundly changed the agricultural sector and the well-being of people in rural areas. Farm ownership changed; selected farm assets, including livestock, were transferred to farm workers or others, and the social and service structures of rural society are in a state of uncertainty. The transition has, in general, led to the deterioration of rural services. Animal health services have also deteriorated. This decline is associated with the contraction of the livestock inventory, the fragmentation of farms, higher transaction costs for service providers, and the overall decline of the rural economy which has, so far, lowered the demand for animal health services. There are considerable differences in the way that these countries are coping with the economic transition and its aftermath. Among the determining factors in the former USSR are, as follows: the speed of recovery from the legacies of large State-controlled farming and a centrally planned animal health system, the efforts made to address poverty reduction, the choice on whether to become a Member of the World Trade Organization and the requirements of such membership, the ability to provide low-cost services to a fragmented and unskilled livestock production sector. In Eastern Europe, the requirements for joining the European Union (EU) are an additional and important determining factor. In the short term, the choice of a veterinary system to serve the livestock sector may differ from country to country, depending on the legacies of the past, the status of reforms and the proximity of Western markets. Lower-income countries with an oversupply of veterinarians may support labour-intensive, low-cost systems which focus on food security and public health. The better-endowed EU accession countries may focus rather on improved disease surveillance, production enhancement, quality assurance and increased food safety. Such choices may also determine the investment made by these countries in upgrading their State system, laboratories and veterinary education facilities.     

Environmental pollution and child health in central and Eastern Europe.

For the last 50 years, the economic and industrial development of the nations of Central and Eastern Europe has been achieved at the cost of environmental degradation. The health risks posed by this pollution to children and the steps necessary to ameliorate such risks are only beginning to be investigated. At a recent conference in Poland, sponsored in part by the National Institute of Environmental Health Sciences, participants from 11 countries in the region, together with scientists from Western Europe and the United States, met to share information regarding pediatric environmental health in Central and Eastern Europe, to consider methodologic issues in the design and conduct of such studies, and to discuss preventive strategies. This report summarizes the deliberations, outlines problem areas such as heavy metals and air pollution, delineates research and training needs to help Central and Eastern Europeans deal more effectively with such problems, and recommends specific future actions and collaborative efforts.     

Differences in Subjective Well-being Between Older Migrants and Natives in Europe

This study examines disparities in subjective well-being (SWB) among older migrants and natives across several European countries using data from the Survey of Health, Aging and Retirement in Europe (SHARE). Our results show a significant SWB gap between migrants and non-migrants that diminishes with increasing age. While migrants from Northern and Central Europe have similar SWB levels as natives, Southern European, Eastern European, and Non-European migrants have significantly lower levels of SWB than the native population. The immigrant-native gap becomes smaller but remains significant after controlling for sociodemographic characteristics and health, the financial situation, citizenship, age at migration, and length of residence. Additionally, we find that the size of the SWB gap varies largely across countries. Current family reunion policies as measured by the Migrant Integration Policy Index (MIPEX) correlate with these country differences. The immigrant-native gap is bigger in countries with restrictive and smaller in countries with open policies.     

The impact of the financial crisis on human resources for health policies in three southern-Europe countries

The public health sector has been the target of austerity measures since the global financial crisis started in 2008, while health workforce costs have been a source of rapid savings in most European Union countries. This article aims to explore how health workforce policies have evolved in three southern European countries under external constraints imposed by emergency financial programmes agreed with the International Monetary Fund, Central European Bank and European Commission. The selected countries, Greece, Portugal and Cyprus, show similarities with regard to corporatist systems of social protection and comprehensive welfare mechanisms only recently institutionalized. Based on document analysis of the Memoranda of Understanding agreed with the Troika, our results reveal broadly similar policy responses to the crisis but also important differences. In Cyprus, General Practitioners have a key position in reducing public expenditure through gatekeeping and control of users’ access, while Portugal and Greece seeks to achieve cost containment by constraining the decision-making powers of professionals. All three countries lack innovation as well as monitoring and assessment of the effects of the financial crisis in relation to the health workforce. Consequently, there is a need for health policy development to use human resources more efficiently in healthcare.     

Drinking water, mortality, and life expectancy: an assessment of the east-west mortality gap in Europe

The role of the drinking water in public health has been recognised for many years. Recent ecological studies of mortality rates in Slovakia when compared to indicators of environmental pollution have shown surprising results--areas with greater air pollution seem to have lower total mortality rates. This paradox may be explained by a number of other factors, including urban/rural occupational conditions, socio-economic status, access to health care, and perhaps drinking water. Overall population access to safe drinking water is about the same between East and West Europe, but more careful evaluation suggest at least one important difference. About 35.7% of the people in Central and Eastern European countries do not have 100% access to safe drinking water in their rural areas, compared to only 18.7% of the rural populations in Western Europe who do not have full access to safe drinking water. This study examines access to safe drinking water, assesses overall drinking water quality, and utilises an index of drinking water quality to perform correlation with total mortality, selected chronic diseases which have been associated with drinking water contamination, and life expectancy at birth. These methods are applied to data for East-West Europe, Slovakia, and detailed urban-rural comparisons for three areas of Slovakia (Trnava, Banská Bystrica, and Kosice).