Public health in the central and eastern European countries

During the last two decades, the countries of Central and Eastern Europe have been transforming their health systems and built an intermediate model between market and socialised economies. At the same time, they have been trying to establish a system of observed in public health between the countries of the European Union and those of Central and Eastern Europe widened in the last decade. In view of accessing the European Union, this article develops the different points in a context where public health represents a topic of extreme importance for the European Commission.     

Public health training in Europe. Development of European masters degrees in public health.

BACKGROUND: Changing political and economic relations in Europe mean that there are new challenges for public health and public health training. There have been several attempts to develop training at the master's level in public health which is focused on meeting the new needs. These have failed due to being too inflexible to allow participation by schools of public health. METHODS: A project funded by the European Union involving public health trainers has developed a new approach which allows participating schools to retain their national differences and work within local rules and traditions, but which aims to introduce the European dimension into public health training. This paper reports the conclusions of this project. CONCLUSIONS: A network of schools wishing to develop European Master's degrees is being established and other schools offering good quality programmes will be able to join.     

Education for management in the new public health

The new public health movement has developed over the last decade and is emerging as an alternative to traditional concepts in Europe, Canada, and Australia, but not in the U.S.A. Fundamental principles, evolved mainly by the World Health Organization under the banner of the "Health for All by the Year 2000" Strategy, include community participation in health policy development and implementation of programs, emphases on primary health care and health promotion, and inter-sectoral cooperation involving agencies whose influence impinges on health. Little attention has been given to organizational and management activities. Decentralized organization of public health activities appears to be an absolute requirement, along with firm political commitment to new public health concepts. Typically, however, health authorities have tended to develop separate bureaus for new public health activities rather than integrate the latter with traditional administrative structures. It is evident that a new style of management is needed with emphases on flexibility and interactional skills. Formal attempts to incorporate new public health principles in graduate educational programs are currently underway in Europe, where all nations are committed to the concepts. The European M.P.H., which includes an as-yet-undefined component of management education, will have a core curriculum based on the new public health. Although there has been considerable activity in Australia, uncertainty remains over the viability of the new movement due to the creation of separate bureaus operating parallel to traditional health departments and their reliance mainly on a single source of funding from the federal government.     

Development and Implementation of A European Guideline and Training Standards for Diabetes Prevention-The IMAGE project

Background The dramatic increase of type 2 diabetes, particularly in younger people, has developed into a major public health concern of the European Union (EU). Several studies have demonstrated that prevention programmes can significantly reduce the risk of developing diabetes. At the EU level, there is a clear consensus that action is needed now to develop targeted prevention management programmes for type 2 diabetes. Currently several prevention management concepts exist in various European countries which can be implemented in clinical practice. Nevertheless, EU-wide strategies are still lacking. Therefore, initiated by the Technical University Dresden, the IMAGE project was submitted to the European Commission under the call for proposals 2006 for the programme of community action in the field of public health (2003–2008) and recommended for co-funding as one of the largest in the public health sector. Methods IMAGE stands for “Development and Implementation of A European Guideline and Training Standards for Diabetes Prevention”. Its general objective is to improve the ability of EU countries to prevent type 2 diabetes in Europe. Within the project, four specific objectives will be developed and implemented into clinical practice: (1) joint European guidelines, (2) a European curriculum for the training of prevention managers, (3) European standards for quality control of diabetes prevention programmes, and (4) a European e-health training portal for prevention managers. Results By now, 32 partners from 13 EU member states plus partners from Serbia-Montenegro, the Ukraine and Israel are involved in the project. The project duration is 3 years, starting in May 2007. The partners who are involved in the IMAGE project, building a consortium of expertise, will work in seven work packages to achieve the project’s objectives. Conclusion The development of competent education programmes, as well as the establishment of quality standards for the primary prevention of type 2 diabetes, will significantly enhance the ability of healthcare professionals to respond swiftly to the drastic increase of type 2 diabetes and its burden to society. Implementing the project achievements will be of major importance in both the prevention of diabetes and the promotion of health through addressing health determinants across all policies and activities in Europe.     

The importance of harmonizing food composition data across Europe

OBJECTIVE: To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment. RESULTS: The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations. CONCLUSIONS: Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.     

Preparing currently employed public health nurses for changes in the health system

OBJECTIVES: This article describes a core public health nursing curriculum, part of a larger project designed to identify the skills needed by practicing public health workers if they are to successfully fill roles in the current and emerging public health system. METHODS: Two focus groups of key informants, representing state and local public health nursing practice, public health nursing education, organizations interested in public health and nursing education, federal agencies, and academia, synthesized material from multiple sources and outlined the key content for a continuing education curriculum appropriate to the current public health nursing workforce. RESULTS: The skills identified as most needed were those required for analyzing data, practicing epidemiology, measuring health status and organizational change, connecting people to organizations, bringing about change in organizations, building strength in diversity, conducting population-based intervention, building coalitions, strengthening environmental health, developing interdisciplinary teams, developing and advocating policy, evaluating programs, and devising approaches to quality improvement. CONCLUSIONS: Collaboration between public health nursing practice and education and partnerships with other public health agencies will be essential for public health nurses to achieve the required skills to enhance public health infrastructure.     

Introduction: health technology assessment and the European Union

Health technology assessment (HTA) has become increasingly important in the European Union as an aid to decision making. As agencies and programs have been established, there is increasing attention to coordination of HTA at the European level, especially considering the growing role of the European Union in public health in Europe. This series of papers describes and analyzes the situation with regard to HTA in the 15 members of the European Union, plus Switzerland. The final paper draws some conclusions, especially concerning the future involvement of the European Commission in HTA.     

Enhancing the Role of Health Communication in the Prevention of Infectious Diseases

Despite the recognized importance of health communication for disease prevention, a gap in knowledge was becoming apparent as regards the extent and nature of its use at the European level to support prevention and control of infectious diseases. To address this gap, the European Centre for Disease Prevention and Control (ECDC) commissioned in 2009 a consortium of universities to undertake a 3-year research project called “Translating Health Communications.” The outcomes of this project comprise 2 major areas: (a) primary information gathering to provide insights into how health communication activities are currently being used for communicable disease prevention in the European Union and European Economic Area and (b) synthesis of knowledge on the evidence of use and application of health communication approaches. The overview of main findings of the project presented in this article highlights the many challenges that remain and the various areas of opportunity in order to raise the profile of health communication in the prevention of infectious diseases in the European context.     

Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws

Background  

With the emergence of influenza H1N1v the world is facing its first 21^st century global pandemic. Severe Acute Respiratory Syndrome (SARS) and avian influenza H5N1 prompted development of pandemic preparedness plans. National systems of public health law are essential for public health stewardship and for the implementation of public health policy[1]. International coherence will contribute to effective regional and global responses. However little research has been undertaken on how law works as a tool for disease control in Europe. With co-funding from the European Union, we investigated the extent to which laws across Europe support or constrain pandemic preparedness planning, and whether national differences are likely to constrain control efforts.     

lessons learned in a European Latin American collaboration for developing postgraduate education in public health

Background: New funding from the European Union (EU) allowedthe collaborative development of postgraduate education in publichealth between five countries in South America and Europe. Methods:A planning meeting, two workshops, a final meeting and the useof e-mail and faxes for discussing curricula were employed.Results: One new master of public health in Argentina has begun,plans for new masters in Chile have been developed. A new collaborativemodule using the Internet was started and is now in its thirdyear, new European plans for distance learning are being developed.Possibilities for collaborative research have been identifiedand those involved developed a broader horizon and internationalcontacts. The planned grant from the EU was 72,040 Euros. Stafftime spent administering the project was much greater than timespent discussing curricula. This is the only publication. Conclusion:Although the aims were achieved, the opportunity costs weregreat, as methods of assessing European research do not valuesuch work highly and the administrative burden of small EU grantsis high. Once a network is established greater efforts shouldbe put into electronic communication, but European programmescurrently do not fund such ‘remote’ support.     

Health claims in Europe: new legislation and PASSCLAIM for substantiation

A regulation on nutrition and health claims made on foods was introduced in the European Union in 2007. This Regulation provides opportunities for the use of health claims on foods in Europe, including reduction of disease risk claims. The Regulation will be fully implemented by January 2010. A community list of permitted and rejected claims will be established and made available to the public. Some European countries have applied voluntary codes of practice on health claims for foods, awaiting the Regulation. Experience with scientific evaluation and use of health claims has been gained using these codes with regard to both generic claims that are closely related to official nutrition recommendations and to product-specific claims based on human intervention studies with the product. The European Commission supported a concerted action project, "Process for the Assessment of Scientific Support for Claims on Foods" (PASSCLAIM). This project reviewed the scientific state of the art in diet and health areas regarded most likely for health claims. The main purpose of the PASSCLAIM project was to define a set of generally applicable criteria for the scientific substantiation of health claims. These criteria were considered to be a scientifically robust tool for evaluating the quality of the data submitted in support of health claims on foods. PASSCLAIM is useful in assisting applicants for a health claim to prepare their supporting dossiers as well as in aiding agencies responsible for evaluating the scientific evidence for the claim.     

Restoring the Tower of Babel: building a multilingual thesaurus on health promotion

In 1994 the International Union for Health Promotion and Health Education, Regional Office for Europe (IUHPE/EURO), began a thesaurus project in the field of health promotion and health education, in collaboration with terminologists and health promotion specialists from various European countries. This article describes the different phases of the international project. Special attention is paid to the origin of the project and the international cooperative imperative needed to bring such a project to fruition.     

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.     

European public health professionals express ten priorities for the European Union...to be followed

Even if the European Union acquired explicit competencies in public health with the Maastricht and Amsterdam Treaties (articles 129 and 152), public health professionals still have not had their word in the definition of public health priorities. Yet it is they, whatever their mission, who must take into consideration the new constraints imposed by Community directives. The French Society for Public Health (FSPH) took the initiative of running a project, financed by the European Commission, aiming to shed light on some of the public health problems considered priority in the 15 member states, and to provide suggestions for facing them. The FSPH adopted a resolutely participative and pragmatic process. At each step (definition of priorities and compiling arguments), the intention of the SFPH was more to allow different, even diverging, points of view to be expressed, than to aim for a hypothetical representativeness. The undertaken themes are the social gradients in health, alcohol, illicit drugs, tobacco, surveillance of health issues, quality of care, older persons, mental health, the environment, nutrition and food security. This work marks the wish of the FSPH for international openness toward Europe. The FSPH hopes that this work becomes a platform for the development of a reinforced dialogue between public health professionals and European decision makers.     

Developing preschoolers' social skills through cross-cultural physical education intervention

The purpose of this study was to investigate the changes in children's social skills after their participation in a physical education programme named ESPEC (‘Early Steps’ Physical Education Curriculum). The evaluators of the children's social skills were the trained educators who implemented the curriculum as well as parents of the participating children. This study was conducted in three European countries and was part of a European transnational project. The participants were 286 preschoolers from Cyprus, Greece and Italy. Twelve educators and 286 parents completed the ‘Social Behaviour Instrument’ (SBI) before and after the implementation of the ESPEC. This four months’ physical education curriculum was designed for preschool-aged children and it included 24 lesson units. The results showed an improvement in children's social skills after ESPEC implementation in all three countries. It can be concluded that the implementation of physical education activities for preschool-aged children can be a way to improve preschoolers' social skills.     

European training in public health: A practical experience

Development of public health in Europe requires the human resourcesnecessary for planning and managing programmes with a European,intersectoral and multidisciplinary approach, based on the ‘healthfor all’ strategy. In this paper the European TrainingConsortium in Public Health (ETC-PH) presents the experienceof 4 years of developing educational activities and materialwith these approaches. Participants from different countriesand 5 institutions concerned with training in public healthhave been involved. Evaluation is positive both for studentsand teachers and an ETC network and project register have beencreated as a way for communication to continue and for the consortiumto offer ongoing support to all participants.     

Financing and planning of public and private not-for-profit hospitals in the European Union

While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.     

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.     

Healthy cities -- WHO's New Public Health initiative

The World Health Organization's European Office has initiateda major new project known as "Healthy Cities". As a laboratoryfor the lifestyle targets agreed for Europe, the time seemsright to support integrated approaches to health promotion atthe city level. The city is often the lowest administrativelevel which can marshal the resources and has the politicalmandate and authority to develop and implement intersectoralapproaches to health; because it is a place with which its citizensidentify, there are good prospects for participation harnessedto neighbourhood or civic pride. Throughout the European Regionat present there is evidence of a general renaissance of publichealth activity at this level and it seems appropriate for WHOto support and facilitate processes which are already underway. The project will initially bring together ten or twelve Europeancities to collaborate in the implementation of intersectoralcity health plans. In turn, these cities will take responsibilityfor supporting the development of further networks of citieswhich wish to participate in the project. WHO will provide technicalexpertise and generate a range of resource materials of valueto the cities involved. In addition there will be a major collaborativeEuropean television series on the healthy city. By concentrating on concrete examples of health promotion whichinclude a commitment to community participation and intersectoralcollaboration, it is expected that the Healthy Cities projectwill mark the point at which WHO philosophies and frameworksare taken off the shelves and into the streets of European cities