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Conference Report

Crisis and opportunityHealth in an age of austerity

2012European

Health Forum gastEin

Supported by the European Commission

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Video summary of the 15th European Health Forum gasteinis available at www.ehfg.org/1014.html

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European Health Forum gastein

Conference Report 2012

issn 2307-0854

© EHFg 2012

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günther Leiner and Helmut Brand 1

gastein Health Declaration 2012 2

Health and well-being in times of austerity 4

Communicating health 7

global health governance 10

Health systems sustainability 12

Public health challenges by 2050 15

Personalised medicine 18

non-communicable diseases 22

Health in an age of austerity 26

Financial crisis 29

Evidence of the effectiveness of eHealth: focus on telehealth 32

improving nutrition in Europe with flour fortification 34

Be aware of your kidneys 36

Disease prevention 37

Vaccines 39

active and healthy ageing 41

new science and future healthcare 43

Health and wealth 45

Healthcare financing 47

Public-Private Partnership 49

governance 51

Vaccination and the role of social media 53

innovation and sustainability 55

Dialogue, transparency, trust. What part do they play in 57aligning the pharmaceutical industry with social needs?

Wake up to the real solutions! 58

Health literacy – the cornerstone in future health 59

new ideas, enthusiasm and new European contacts 60

European Health Literacy Project 61

CONTENTSEuropean Health Forum

gasteinConference Report 2012

Forewords |

Health Declaration |

Opening Plenary |

Forum 1 |

Forum 2 |

Forum 3 |

Forum 4 |

Forum 5 |

Forum 6 |

Closing Plenary |

Workshop 1 |

Workshop 2 |

Workshop 3 |

Workshop 4 |

Workshop 5 |

Workshop 6 |

Workshop 7 |

Workshop 8 |

Workshop 9 |

Workshop 10 |

Workshop 11 |

Lunch Workshop 1 |

Lunch Workshop 2 |

Lunch Workshop 3 |

Lunch Workshop 4 |

Breakfast Workshop 1 |

Breakfast Workshop 2 |

Young Forum gastein |

European Health award |

this year’s conference was entitled “Crisis andOpportunity. Health in an age of austerity” andthe parallel forums, workshops and plenarysessions all focussed on a range ofcomplementary specific issues related to thisoverarching theme.

in 2012 we were fortunate to bring together over600 health experts and decision-makers from 50countries. together we discussed policies,actions and tools to improve health acrossEurope and beyond. i hope we can now worktogether to put these ideas into action andimprove health for all.

i would like to take this opportunity to thank allparticipants, speakers, sponsors and friends ofthe gastein Forum for the wonderfulcollaboration i have enjoyed over the past 15years. i am very pleased that we were able toestablish such a successful and importantplatform to exchange views and discuss currentand future public health issues. i wish the newpresident of the EHFg, Professor Helmut Brand,all the very best in continuing the Forum’sdevelopmental journey – here’s to the next 15years!

i hope you will join us again in 2013.

the 15th European Heath Forum gastein, whichtook place in October 2012, was yet again animportant platform for experts, practitioners andstakeholder representatives to exchange viewsand debate the current and forthcominghealthcare issues, challenges and opportunitieswhich Europe is facing.

this publication provides an overview of themain topics of the Forum. in this edition you willfind reports from the plenary sessions, parallelforum sessions and for the first time we are alsopresenting the reports from all seventeenworkshop sessions. if you require any additionalinformation on a specific session or speaker,these can be found on the EHFg website.

Health communication and the futuredevelopment of healthcare were two of the keytopics at the 2012 Forum. We also looked at theperformance of European health systems intimes of economic crisis and both the challengesand new possibilities that such conditions createfor healthcare. the global governance forumhighlighted the interdependencies betweenhealth and other sectors and panellists assertedthat globalisation and other factors mean aninnovative approach is required for global healthgovernance, which should be led by the EU andWHO championing health as a human right. achallenging non-communicable diseases session

pitted industry against academia and considereda range of policy options to tackle the problemfrom nudge to regulation. Personalised medicinewas once more high on the agenda withparticipants considering whether Europe couldlead the way in this innovative field, and how wecan prepare for the main challenges ahead.

i would like to draw your attention to one of lastyear’s EHFg outcomes – the gastein HealthDeclaration, which has been prepared by a groupof Young gasteiners. it not only highlights themain findings and discussion points from theForum, but also gives suggestions on solutionsfor European healthcare, which i recommend tobe considered.

Over the past fifteen years the EHFg has been agreat success and evolved to become one of themost important public health events in Europe. iwould like to thank you for your support of theForum over the years and for welcoming me asthe new president of the EHFg. i intend to followthe well-trodden path that the Forum is alreadyon, but i am also going to introduce somechanges with the guiding principle in mind:“Evolution not Revolution” – changes which i amsure you will welcome as well.

i hope you will join us for the “old-new” 16thEuropean Health Forum gastein in October 2013!

FOREWORD

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Conference Report 2012Günther LeinerHonorary President of the European Health Forum Gastein

Helmut BrandPresident of the European Health Forum Gastein

it is clear that the sustainability of our healthcareis at stake: there are higher patient expectations,new and often expensive treatments are beingmade available, and living with the realities ofdecreased budgets is inevitable.

Over the years there have been keyimprovements made in life expectancy and childmortality but the economic crises are threateningthis work. We know that societal problems linkedto the financial crisis, such as unemployment,have high impacts on health: there is double therisk of illness and 60% less likelihood of recoveryfrom illness associated with unemployment.

Health systems are an integral aspect of theeconomy and a crisis in the economy can causea crisis for healthcare. However, perhaps there isno need to be overly pessimistic - in times ofcrisis the ‘system’ may be able to respond andadapt faster than when no crisis is upon us, andthe healthcare system is more experienced atthis than most. the case must be made for anintegrated whole-government, indeed whole-society, approach to health.

The only way forward is to increaseefficiencyin this time of austerity, many countries arefacing an enormous challenge in securingfinancial sustainability in keeping with thefounding values of EU health systems such asuniversal coverage, solidarity, equity of access,and the provision of high quality health care.

During the 15th European Health Forum gastein,it was advocated that health care has becomeincreasingly expensive and we cannot continueto deliver care in the same ways. However, ifausterity can be used as an opportunity anddriver for change then we must grasp this andrenew commitments to health to secure it for thefuture.

there were no easy answers to this majorchallenge that Europe is facing, however sometrends have emerged:

Healthcare to HumancareHealthcare today is becoming more patient-centred and our systems must take advantage ofthis. Patient empowerment is a crucial aspectnot for only the better management of chronicconditions but also to enable patients todecrease the cost of healthcare: early screeningand detection must come hand in hand withbetter lifestyle choices. through empoweringpatients to know their rights, to know how toaccess information, and working with them tomake the right decisions about their own health,we can enable savings to be made throughcompliance and system wide efficiency gains.

Innovation and Health Technology Assessment

a new approach to manage health rather thansickness is required, and eHealth may allow us tolive longer and healthier by creating mechanismscontributing to the prevention of disease byhelping people making healthier choices,improved management of conditions, and patientflow, which might ultimately contribute toefficiency gains for the health system. Moreover,continuity of care is a major challenge for healthsystems, and one that we may not be able toovercome this unless we adopt electronicmedical records.

However, with technological advances incomputing and data storage, legal regulationsand ethical norms are imperative to safeguardthe use of personal data. Questions like whoowns the data, and who uses it, must beconsidered.

in conclusion, to improve efficiency in healthsystems we need more innovation and we needto maximise the use of technology to improveefficiency – the effective use of health technologyassessment is fundamental. Policy-makers mustmake sure that choices made in deploying newtechnologies respond to demonstrated costeffectiveness. it is not just about deployingtechnology but also understanding the benefits.

HEALTH DECLARATION

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Conference Report 2012Gastein Health Declaration 2012By Tania Lourenco, Laura Otero Garcia, Sofia Ribeiro, Iva Rincic and Rosalind Way

Health research

Research is needed not only in diseaseprevention, but also in translational research.Efforts will be made to make sure that the healthsystem is able to cope, and therefore, we willneed to bridge the gap between knowing anddoing.

Efficiency

Fiscal sustainability – the ability of a governmentto finance its expenditure programme – must beregarded as a constraint, and not a policyobjective. Cost containment is different toefficiency. short-term cuts that are aimed at onlysecuring fiscal sustainability may fail to addressthe underlying efficiency problems, but it mayalso aggravate them by potentially cutting cost-effective interventions resulting in the reductionof financial protection and health gain.

governments should therefore avoidimplementing policy tools that risk undermininghealth system goals such as: reducing coverage,reducing the scope of essential services,increased waiting times for essential services,and attrition of health workers due to reductionsin salaries. if short-term cuts in health areunavoidable at this present time, governmentsshould consider adopting policies that willminimise adverse effects on the health system,where any extra spending should demonstratevalue, be transparent and explicit abouttradeoffs, increasing in performance andreducing costs through efficiency, for example,hospital reconfiguration, improve purchasing, usehealth technology assessment and evidencebased medicine as tools to support decision-making.

Health is an investment, not a cost!the state of the economy is not just related tomoney. to work against the financial crisis theremust be healthy, active and productive citizens.Healthcare has a direct implication to all of us,and it must be considered as an investment andnot a cost. the health system makes a largecontribution to the economy, accounting for 10%of gDP, and being the largest employer in theEU. During EHFg 2012, an appeal came out forFinance Ministers and Health Ministers tocommunicate more and better in the making ofhealth policy decisions. this calls for theestablishment of institutional dialogue,clarification of roles and the realization that we allshare in the same objectives.

Is it time for a new ‘big conversation’about health?EHFg 2012 demonstrated that in this time ofausterity, there is a need for an open attituderegarding how to sustain healthcare today andfor the future, and that this crisis presents anopportunity for change. there must be arenewed focus on how to improve efficienciesacross the whole system in order to continuework in improving health and reducinginequalities.

We must all work together to rethink healthcare.Expectations must change and this must bedone through empowering individuals, andsociety as a whole, to be accountable for theirlifestyles and health. Reducing the burden ofillness will not only improve health outcomes butwill also help to overcome the economic crisis.

HEALTH DECLARATION

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the opening plenary of the 2012 EuropeanHealth Forum gastein showed its keynotespeakers were keen to explore the opportunitiespresented by the financial crisis rather than dwellunduly on crisis issues. Moderated by arminFidler, World Bank Lead advisor for Health Policyand strategy, speakers included EstonianPresident toomas Hendrik ilves, WHO EuropeRegional Director Zsusanna Jakab and Memberof the European Parliament antonyia Parvanovawho presided over the presentation of the 2012European Health award.

EHFg President günther Leiner opened thesession on Wednesday afternoon and gave ashort introductory message on behalf of thePresident of the Republic of austria, HeinzFischer.

in his own speech Leiner stressed that crisis isan opportunity. He concentrated on one of theconsequences of the financial crisis, namely itsimpact on our mental health. the ongoing race tobe better, faster, more efficient, such cruelcompetition, he said, puts a lot of pressure on allof us, we no longer take time-off to relax anymore. that, combined with long working hours,stress and other unhealthy lifestyle factorsaffects us in many ways, and now morefrequently than ever has fatal consequences.Leiner took as an example part of the healthworkforce – german and austrian doctors. theyare at greater risk of suffering from a heart attackor being more suicidal than many of theirwestern colleagues. Over 30% of them evenregret their choice of profession! Leiner’s keypoint was that even (or especially) at a time offinancial crisis, we should not forget that thewell-being of humans is of the utmostimportance.

the second speaker was the Mayor of BadHofgastein, Friedrich Zettinig, who alsowelcomed all guests to gastein. in his opinion,the financial situation required savings andreorganisation of services, which have to beapproached carefully in such a fragile area ashealthcare. He expressed the hope thatpoliticians will use the results of this conferenceto improve the situation in their states.

the organisers of this year’s Forum were alsoglad to host toomas Hendrik ilves, President ofthe Republic of Estonia.

During his speech ilves briefly presented theoutcomes of the report Redesigning Health inEurope for 2020(www.president.ee/images/stories/pdf/ehtf-report2012.pdf) prepared by a task Force set upin 2011 by a number of Member states and theEuropean Commission. today, healthcare costsin Europe are climbing. Within the EU, theworking population in 2012 was 67%, in 2060projections show that this number will decreaseto 56%. at the same time the percentage of thepopulation who are 65+ will increase from 17%to 30%.

a radical redesign of the healthcare system istherefore needed. technology can help healthsystems to respond to these challenges, bydelivering greater efficiency, lower costs andbetter health outcomes. Up until now medicinehas dealt with people who are already sick.

Our current challenge should be a transition tofocus on preventing individuals from becomingsick in the first place. at the same time the issueof data is becoming more important. individualsare the owners and controllers of their ownhealth data, with the right to make decisions overaccess to the data and to be informed abouthow it will be used.

giuseppe Ruocco, Director general of theDirectorate general for Prevention in the italian

OPENING PLENARYHealth and well-being in times of austerityBy Natalia Zylinska-Puta

Toomas Hendrik Ilves, President of the Republic ofEstonia

http://www.president.ee/images/stories/pdf/ehtf-report2012.pdf

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Conference Report 2012Ministry of Health gave a very interesting speech,where he reminded everyone that the right tohealth is an essential and traditional notion withcomplex and multifaceted connotations, whichshould not be forgotten. On the one hand, it isconsidered as a right to freedom and on theother as a right to receive a service.

today, the true challenge is to reconcile thepublic health service with dwindling resources,and the protection of rights and planning musthave a reforming role. not long ago, the right tohealth was deemed to be compatible with publicexpenditure. today this no longer seems to bethe case: its costs must be reduced as much aspossible and they may even be adjusted to theindividual income level. He advocated stronglythat we do not want to give up this universalservice, the protection of this right and thereduction of inequalities.

it is absolutely necessary to avoid the slowerosion of welfare, because the weakestsegments of the population would suffer themost.

Paola testori Coggi, Director general in theDirectorate-general for Health and Consumers ofthe European Commission admitted that the titleof the Forum captured the mood of the day.

Healthcare costs are rising, people are sick andtreatments are more expensive, but at the sametime there is less money in the system. Usually ina time of crisis, systems adapt faster to workunder new terms. in a time of austerity we needto involve all stakeholders to make wiserdecisions and to support healthcare progress.

Patients should be empowered, so they canbecome more active and better follow treatment.By making healthier choices in their lives,patients influence the resulting increase ordecrease in healthcare costs (for example an

obese patient generates 20% more costs peryear than a non-obese one).

During the transformation of healthcare systemslong term sustainability should be treated as amain requirement. greater increases in costs arestimulated by an ageing population and theavailability of new and more advancedtechnology, which at the same time is muchmore expensive.

therefore, first of all we have to make sure thatthe choices which we made on medicalequipment and technical innovations were reallycost effective and helped our citizens. nowadayswe are all partners, who need to think how wecan ensure that the structural funds are effectiveand successfully used, how to better integratehealthcare with the focus on hospitalmanagement and how we can measure ifspending on healthcare is effective, becausehealthcare expenditures grow 2% more than oureconomy.

Zsuzsanna Jakab, WHO Regional Director forEurope assured the audience that health in theage of austerity is central to WHO work.

the financial and economic crisis is threateningthe gains made across Europe in recent decades,and exacerbating the longer term challengesfacing our health systems. Countries in Europediffer greatly in the extent to which their publicfinances have been affected by the financialcrisis. Health promotion and disease preventionprogrammes may help to avoid greater costs.Health prevention should be treated as aninvestment not a cost. an increase of 1% in lifeexpectancy results in a growth of 6% gDP(OECD), meanwhile absenteeism due to illness isestimated at 4.2 days/worker level (EU, 2009)generating an average cost of 2.5% of gDP.

summarising, she said that the crisis should benavigated by avoiding across the board budgetcuts, targeting public expenditure more tightly onthe poor and vulnerable and thinking long-termand implementing counter-cyclical publicspending.

Barbara Kerstiëns, head of the Public Healthsection within the unit of infectious Diseases andPublic Health in the Health Directorate of theDirectorate-general for Research and innovationat the European Commission stated that smartinvestments in research and innovation are vitalto create jobs and put Europe back on the pathto growth.

OPENING PLENARY

Paola Testori Coggi, Director General, DG SANCO,European Commission

she cited this as the reason why the current 7thFramework programme will be replaced in 2014with a new funding framework: Horizon 2020(http://ec.europa.eu/research/horizon2020/index_en.cfm?pg=home&video=none), with aproposed budget of eight billion Euros overseven years.

through Horizon 2020 the EC will also look intoways of how to achieve a stronger impact fromtheir funding through achieving more innovation– a smarter way to support researchers andinnovators in Europe – so as to further boostexcellence and to help ensure that good ideasthat centre on addressing societal challengesreach the market.

in the future, disease prediction and prevention,and better management of chronic diseases, willbecome even more important. Ways must befound to ensure that healthcare providers andother partners involved in innovation give thesethemes the necessary attention they deserve. allthese developments require a new mind-set andopen attitude – the will and skill to strike the rightbalance between knowledge sharing and theprotection of intellectual property, and the searchfor new business models by all those involved.

OPENING PLENARY

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Find out more about this session atwww.ehfg.org/923.html?eid=23i

http://ec.europa.eu/research/horizon2020/index_en.cfm?pg=home&video=none

http://www.ehfg.org/923.html?eid=23

this forum looked at the challenges ofcommunicating health to both citizens andpolicy-makers. Communicating health is a timelysubject for discussion as health systems urgentlyrequire a paradigm shift towards promotion andprevention orientated services in response to thefinancial crisis and the need to ensuresustainability of services. in order to achieve this,effective communication to citizens (on healthybehaviours) and to policy-makers outside thehealth circle (advocating for investment in healthand a health in all policies approach) is essential.

Are EU citizens health literate and aware ofhealthy lifestyles?the first session of this forum dealt primarily withthe strategies that health actors need to employwhen communicating to both citizens and policy-makers. Paola testori Coggi, Director general ofDg sanCO, opened the session by setting thesocial, political and scientific context for thedebate.

testori Coggi pinpointed the growing nCDburden in European populations as the case foraction. the health community has to engage withcitizens, using modern techniques, to encouragebehavioural change that will lead to short andlong-term benefits for health. Moreover,economic policy-makers have to be made awareof the value of investing in health. to do this, thehealth community must use accurate, reliableand coherent data in a uniform manner, in orderto be credible and convincing.

antonyia Parvanova, MEP, emphasised theimportance of health literacy as understood in itsbroadest sense, addressing the environmental,social and political factors that determine health.Parvanova noted that in Bulgaria 70% of citizensexpress difficulties with health literacy, which isclearly a barrier to supporting the behaviouralchanges that will lead to healthier populations.Parvanova stated that health actors have tocommunicate health to the entire population (toavoid distortions of health inequalities) but not allin the same way.

Olivier Ouiller from the French strategic analysisCentre gave a challenging presentation whichqueried the evidence base underpinning currentapproaches to communicating health. Ouillerstated that information is not sufficient, asdemonstrated by the fact that individuals oftenperform to the contrary of what is beneficial forthem. Environmental influences on behaviour areoverlooked in current approaches. this isimportant as individuals display a tendency toresonate with the behaviour of others, looking athow the majority behave. this method impliesthat a more positive message should bedelivered, which is more likely to be effective withboth individuals and policy-makers.

a practical example of this approach was givenby Jordi Mones Carilla, a member of the Board ofFC Barcelona, who presented the adoption of theEx-Smokers are Unstoppable campaign by FCBarcelona (http://quitsmokingwithbarca.eu/uk-en#.UMWrJVH6Dm4). this campaign and theapproach used by FC Barcelona demonstrate

FORUM 1

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Conference Report 2012Communicating health By David Ritchie and Edwin Maarserveen

Anotnyia Parvanova,MEP, Bulgaria

Jose Moes Carilla,Director of Medical

Services, FC Barcelona

http://quitsmokingwithbarca.eu/uk-en#.UMWrJVH6Dm4

how positive messages and group dynamics canexert lasting behavioural change that promotes ahealthier lifestyle.

Finally, Mariana Dyakova reminded the audienceof the importance of ethics in communicatinghealth and the close proximity between effectivecommunication and art (as communication is notsimply conveying information), whilst Cliveneedle from EuroHealthnet concluded bypresenting the case for effective communicationwith policy-makers, stressing the importance ofunderstanding what factors influence them.

Key discussion points related to the level of self-reflexivity in the health community. Both needleand Ouiller challenged the degree to whichhealth actors are aware of the effectiveness andappropriateness of their health communicationstrategies to both individuals and policy-makers.it is vital to acknowledge and understand howunhealthy actors communicate their messages tocitizens and policy-makers, as withoutinterrogating the reach and reception of currenthealth communication approaches, effectivecommunication of health will not be achieved.

the main outcomes from the debate were:

n the need for double evidence-based policy-making

– gathering the scientific evidence for thecontent of the communication; plus

– understanding what channels work in orderto influence the form of communication.

n Realise that one size does not fit all

– therefore information must be tailored to theaudience.

n Understand the influences on the behaviourof individuals and policy-makers

– acknowledge the environmental factors andgroup dynamics influencing individualbehaviour, and orientate messages with apositive aspect.

n Understand the pressures and influencingfactors on policy-makers, and be self-reflexive and do your homework if yourmessage is not getting through.

n Be creative and courageous – be aware ofconflicting messages from unhealthy actorsand be prepared to adapt to this challenginglandscape. Health actors need to beimaginative with existing resources, but alsocourageous enough to use all availablelevers for communicating health.

How can we best use ICT as a tool forcommunicating health?the leading theme in the second session’sdiscussion was how can we communicate healthin a better way and what can we learn from othersectors about health communication. themoderator of this meeting, Robert Madelin,Director general of the Dg COnnECtchallenged the panellists and the audience to putforward questions which weren't answered in theprevious session and also to consider whatpeople could do within their own domain tofacilitate the better communication of healthissues.

a significant controversy discussed in thissession was that the health sector is not in thedriver's seat any more. We cannot lead socialmedia and the development of “apps” and norshould we try to. instead, we should focus ontrying to make sense of the new opportunitiesprovided by technology. We need to createplatforms for positive engagement andempowerment, whilst maintaining high levels ofquality and safety.

FORUM 1

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Conference Report 2012Panellists:

Clive Needle, Director,EuroHelathNet; AnonyiaParvanova; Paola Testori Coggi;Jose Mones Carilla; MarianaDyakova, University of Warwick,Oliver Oullier, Adviser at theFrench Centre d’AnalyseStrategique and moderator; andDelia Meth-Cohn, EditorialDirector CEMEA, The EconomistGroup

nowadays, google is an important health actor.the health sector is changing, we can no longerthink in the role of traditional actors, the worldhas moved on. not everybody is acommunicator, but we should realise that thereare new actors and welcome their ideas.

One of the panellists posed the question: “Whyare communication experts not here in gastein?”the bottom line is, we know what works, weknow the power of network and dialogue, we justneed to ensure the health sector is fully engagedin the development of communications.

it follows that in the future society and patientswill be leading the development of health policycommunications. the former roles of healthactors, as “gatekeepers” guarding safety,providing information and addressing problemswill no longer work. nowadays people andpatients are underestimated when it comes tohealth communication and health information.the current stakeholders will try to protect theirinterest. this is the same in all domains: healthcare provision, health financing, health law andpublic health. it is all about the business modelsof these stakeholders. We should find a way tobreak open these interests.

Disruptive innovation is the keyword. With newtechnologies – and new policies – old ways ofthinking become obsolete. in our own domainswe have to train ourselves to change and beopen for change.

During the panel session it became very clearthat there is a lot to be gained from

communicating health in a better way. there is aworld of opportunity, but we should shift thediscussion from public budgets and introducenew partners, seeking new opportunities forcollaboration. We should avoid sticking withinour box of health policies and look instead atsystem architecture and the system as a whole,not only health policy.

ConclusionCommunicating health can be viewed as theopportunity of the financial crisis.

the current political and economic situation issuch that key policy-makers outside the healthcircle are more susceptible than ever to thepossibilities offered by positive behaviouralchange at the citizen level and renewedinvestment in health at the policy level.

Especially in the second session the crisis wasnot represented by budgetary austerity, butthrough the manner in which the health policyfield continues to look at health. there are hugeopportunities to be seized by bettercommunicating health, especially when we areopen to learning and prepared to change theconservative way in which we think aboutcommunicating health.

there are also huge profits to be made when wereally start interacting with other domains andstart tapping into their ideas aboutcommunication. For too long the healthcaresector has been focused on the traditionalpatient-doctor relationship to communicatehealth. now is the time to start doing thingsdifferently. the crisis of national budgets bringswith it new opportunities that technical andsocial innovations are ready and able to adopt.the healthcare sector must also be ready andable to collaborate with technological innovatorsand seize the upcoming opportunities.

FORUM1

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Ulrich Schulze-Althoff, Medisana SpaceTechnologies



in a globalised world health has become a globalpublic good. Understanding that thedeterminants of health go beyond nationalborders suggests that state and non-state actorswill need to cooperate to confront the globalhealth challenges of today. global governance ofhealth issues among interdependent statespresents challenges as well as opportunities.

this two-session parallel forum discussed howhealth can be governed at the global level andhow common goals can be achieved.

Zsuzsanna Jakab from the WHO Regional Officefor Europe highlighted that in a globalised world,countries need to act together to ensure thehealth of their populations and to drive progress.Managing interdependence has moved up thepolicy agenda of global policy-makers. Healthhas become a global economic and securityissue where collective action is needed.

Jakab sees the WHO as the legitimate agency forcoordinating efforts between the many globalhealth actors. the WHO/Europe has alreadybegun to adapt to these situations; one exampleis the Health 2020 (http://www.euro.who.int/en/what-we-do/health-topics/health-policy/health-2020) initiative, which involves many partnersand can be understood as an instrument tostrengthen collective efforts to influence factorsthat impact on global health.

ilona Kickbusch challenged the notion that healthcan continue to operate on a charity model andillustrated how new partnerships and modes ofgovernance need to be developed for healthissues. Key developments over the last decadehave shown that global health is about more thanricher countries helping dependent, “poor”countries. a refined global model should providea mechanism for partners to share commongoals and to collaborate with each other at alllevels of government.

Global governance for health in practice Latter sessions reviewed examples of globalhealth governance by addressing environmental

and demographic determinants of health.

Regarding environmental determinants, there isevidence that reduction in the unnatural increasein CO2 in the atmosphere would not only tackleclimate change but produce health co-benefits:preventing premature deaths, ischaemic heartdisease and cerebrovascular disease. However,such changes are contingent on cooperationbetween public, private, bilateral and multilateralactors. However governments can take an activerole to integrate efforts from science andadvocacy communities to build holistic healthstrategies and promote changes thatsimultaneously benefit both society’s health andthe environment. One example is active travellingat local or global levels.

Demographic change driven by travel, tourismand globalisation indicates that protecting the EUpopulation against communicable diseases alsorequires a global approach. it was stressed thatdue to global social and environmentaldevelopments, the drivers for infectious diseasesare changing as well. this requires renewedefforts to effectively tackle pandemics in thefuture, and here the European Centre for DiseasePrevention and Control (ECDC) is a key actor.

The future of global health the EU, WHO and Member states are alsoworking towards a common approach to globalhealth. in the EU, health has been an important

FORUM2

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Conference Report 2012Global health governance By Lillian Li Chi Yan, Katharina Bauer, Michaela Told andChristoph Aluttis

Ilona Kickbusch, Director, Global Health Programme

http://www.euro.who.int/en/what-we-do/health-topics/health-policy/health-2020



part of foreign policy since the Oslo Declarationin 2006. Europe has also recognised the need towork in a joint manner and to collaborate withpartners outside and in particular, with BRiCcountries (Brazil, Russia, india and China).

gong Huan Yang from China and K srinathReddy from india both reiterated the role ofEurope as a “good” actor and partner for healthat the global level, as also expressed by themany international agreements and frameworks,which include health, passed across sectors.

at the core of the discussion in this forum wasthe understanding that health has lost much ofits national sovereignty. globalisation and acomplex network of actors and determinantsrequire a different and novel approach to globalhealth governance. However, bureaucraticchallenges stemming from fragmented activitiesoften hinder developments in health and in theministries of health. WHO and the EU must takeresponsibility to address this challenge byleading collaborations to promote health as ahuman right. this also requires partnerships withthe private sector, which is also influenced by thechanges and power shifts in the globalarchitecture.

One example was given by David Boyd from gEHealthcare. He showed that healthcare no longersolely originates in the “wealthy” north.innovations are nowadays produced everywherein the world and it will require a substantial

paradigm shift in business culture to understandthis phenomenon and to benefit from itcommercially. Collaborations between privateand public sectors were widely regarded asbeneficial, if guided by a set of rules andregulations.

the forum concluded with the general consensusthat agreed goals constitute the basis forcooperation. the next step is to clarify leadersfor health governance. in order to do so,coordination among actors and a cleardistribution of responsibilities and tasks arenecessary. Furthermore, the accountability of allparties involved has to be defined and newfinancing mechanisms developed.

Policy recommendationsn Recognise that, in particular at the global

level, health has determinants outside theheath sector: environmental, demographic,and economic determinants amongst others.thus, managing health cannot only beconcentrated in the health sector.

n specific global health challenges of thefuture are climate change, ageing andunequal access to public health resources,financial pressure and lifestyle changes dueto globalisation.

n global health governance is about findingcommon policies and politics on the basis ofshared agendas for health.

n Managing global health requires thecollaboration of countries, organisations andinstitutions at local, national, regional andglobal levels. therefore, it is essential toraise political and social awareness thatmultilateral organisations with conveningpower are needed.

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K Sirnath Reddy,President of thePublic HealthFoundation of India



Policy-makers, professionals and patients aredelivering and using healthcare in a time ofsevere austerity, unprecedented in living memoryfor many. Financial austerity, however, is not theonly challenge facing stakeholders.

at the same time, most European countries areundergoing a transition to a more elderlydemographic. By most estimates, at least fourfifths of the elderly population suffer from a longterm condition such as diabetes or hypertension,in many cases, multiple long term conditions arepresent in the same individual. Even if livinghealthily, this demographic shift inevitably impliesincreased contact with, and support from, thehealthcare system.

Patient expectations are, rightly, also increasing,particularly around coordinated care for longterm conditions and around the quality andsafety of healthcare.

Finally, technological advances in drugs andother therapeutic or diagnostic modalities canfrequently (although not always) imply increasedhealthcare expenditure; most often, the truecost/benefit remains unclear until after severalyears of system-wide implementation.

to examine how to respond to these challenges,the first session looked at protecting andexpanding the fiscal space for high qualityhealthcare, and the second session looked atreforming the healthcare model.

Protecting and expanding the fiscal spacefor high quality healthcarethe first session began with Philipa Mladovsky,Research Fellow, European Observatory onHealth systems/ LsE Health, reporting on theresults of a 2011 survey of responses to thefinancial crisis in 45 European countries.

Reassuringly, the breadth and scope of statutoryhealth insurance was unaffected in mostcountries. Using specific country experiences,Mladovsky demonstrated that the financial crisiscan, and should, be taken both as an opportunityto increase efficiency, as well as an opportunity

to increase access and equity for low incomegroups.

Michael Borowitz, OECD senior Policy analyst,emphasised the need for closer working betweenMinistries of Health and Ministries of Finance tocreate a stable environment within which torealise efficiency gains. He reported on a meetingof senior budget officials in tallinn in June 2012where the absence of a common languagebetween Ministries to address the challenges ofsustainability, let alone explicitly sharedobjectives or time frames, was striking.

illustrating the need for closer working, triinHabicht, Head of Department of Health Care,Estonian Health insurance Fund, outlined thelessons learned from the Estonian healthsystem’s experience of the global economicdownturn, including avoiding over-reliance onpayroll taxes during rising unemployment and ashrinking working age population; the value of amix of provider payment methods (DRg, FFs,capitation, and P4P) to balance the pros andcons of each; and, reiterating both Mladovsky’sand Borowitz’s observation, the need for a longterm perspective.

as an example of this, anita Charlesworth,senior Economist, the nuffield trust, discussedthe likely long term fiscal scenarios for UKhealthcare. Charleswoth’s main point was toemphasise that the historically generous fundinglevels which the UK and many other healthsystems enjoyed prior to the global economic

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Conference Report 2012Health systems sustainability By Ian Forde, Charlotte Hosbond and Diana Beglaryan

Anita Charlesworth, Chief Economist, Nuffield Trust

downturn will not return. several implicationsarise: health systems may need to reducecoverage or generosity of the benefit package,taxes and other sources of revenue may need tobe increased, or other public services may needto be cut to protect health system spending.given that none of these are likely to bepolitically feasible in the current climate, the onlyremaining option is for health systems toincrease productivity.

the same set of fiscal trade-offs was identifiedby Patrick Jeurissen, special advisor, Ministry ofHealth of the netherlands, in his discussion ofHolland’s new health system of managedcompetition between insurers. although it is stilltoo early to assess all the effects of the reform,the following lessons are already apparent:

- the fact that “real” monetary risk seems to be acrucial condition for combining fiscalsustainability.

- the need for technical competence andimproved governance at every level of thehealthcare system.

- the need to support competing insurers tocoordinate activity where beneficial (in blockpurchasing, for example) and the need for allstakeholders (patients, providers, payers andworkforce) to realise that fiscally constrainedcircumstances are likely to continue and mayimply the need for increased risk-bearing acrossall actors.

Reforming the healthcare modelin the second session speakers explored otherfacets of the sustainability challenge by arguingfor reforms of the health care model.

Eric de Roodenbeke, CEO of the internationalHospital Federation, argued that market-orientedhospital payment systems have often failed to

show the positive results expected in terms ofhealth outcomes and patient satisfaction, relativeto cost. De Roodenbeke argued that hospitalsshould move from organ- or disease-basedorganisational models to matrix- or patient-centred models, which might better servepatients. However, he also pointed out thechallenges implied by such a transition, includingthe education of doctors, the challenge ofdelivering highly complex treatments andmaintaining quality for low-volume treatments.

along similar lines, thomas Plochg, assistantProfessor at the University of amsterdam andsenior Policy advisor at the netherlands PublicHealth Federation, argued for reconfiguration ofhealthcare professionals. specifically, medicalspecialisation as currently organised forceshealth professionals to think and act disease-by-disease. in the future, multi-morbidity generalistsmay be a more appropriate workforce.

Beth Lilja, Head of the Danish society for Patientsafety, argued that poor quality and safety isinefficient, as well as damaging to patients. shepresented results showing that the number andseverity of bed ulcers created annually (andwholly avoidably) in European hospitals isenough to occupy the entire Danish andnorwegian hospital systems put together. Hence,it is possible to ensure higher quality and safetyand reduce waste resources at the same time.

along the line of other speakers, RobertJohnstone, Patient advocate, also underlined theneed for a new matrix based health care model(integrating both primary and secondary care andhealth and social care) as well as new attitudesand new skills amongst healthcare professionals.Johnstone stated that patients are part of thesolution and not the problem: improving healthliteracy, access to high quality information andimplementation of shared decisions are all vitalelements in making health systems sustainable.

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Patrick Jeurissen,Special Advisor,Ministry of Health ofthe Netherlands

Thomas Plochg,Researcher,

Academic MedicalCentre, University of

Amsterdam

Issues arising during discussionseveral issues were raised from the floor duringopen discussion at each session. One themewas the extent of public willingness to pay forhealth (that is, bear increased taxes). there weredivided opinions on this, but overall it wasagreed that this was a political economydecision, rather than a technical one, and in duecourse increased taxes to support publiclyfunded healthcare are not implausible.

another theme centred on whether increasingprivately funded healthcare (through out-of-pocket co-payments, for example) was asensible solution to austerity. in general, it wasfelt that this was likely to lead to a fragmentedhealth system, with less solidarity and, indeed,less efficiency. it is known, for example, that co-payments tend to reduce consumption ofnecessary (as well as discretionary) healthcare,leading to an overall reduction in systemefficiency.

a third theme of discussion focussed on thebarriers to the implementation of health sectorreform. some of those identified included poorgovernance and/or lack of leadership and/or ofpolitical will, particularly around the issue of jointfinance and health ministry working, as earlierdiscussed; similarly, a lack of conceptualcoherence and aligned incentives within thehealthcare sector (across primary and secondarycare, for example); and a lack of technicalcapacity, at every level, whether institutional orcentral government, were identified asfundamental – but not insoluble – barriers.

Conclusions and policy recommendationsthe healthcare model of today is unlikely to beable to withstand the challenges of fiscalconstraint on the one hand and increasinghealthcare demand and costs on the other.nevertheless, austerity can, and should, be takenas an opportunity to increase value for money, aswell as to increase access, quality and equity inhealth systems. Most vital is the need to keephealth system objectives clearly in mind duringtimes of fiscal constraint, that is, the goals toprotect and improve health, to protect individualsand families from financial catastrophe and topreserve equity and build social well-being. ifthese objectives are not kept in mind, fiscalconsolidation can be achieved simply by makingcuts with no thought as to the consequences.

thereafter,

n at system level: Ministries of health and offinance need to work more closely togetherto create a stable environment within whichto realise efficiency gains, keeping a longterm perspective which does not sacrificelonger term structural reforms at the expenseof short term financial gains.

n at institutional level: Hospitals and otherproviders must look for ways to increaseproductivity, recognising that it is possible toensure higher quality and safety and reduceinefficiency at the same time. Barriers torapid adoption of good practices whichachieve both of these goals must beidentified and overcome.

n at clinical level: all stakeholders must seepatients as part of the solution to thechallenge of health system sustainability andseek to improve health literacy, expandaccess to high quality information andencourage shared decision making.

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Beth Lilja, CEO,Danish Society forPatient Safety



the parallel forum session on Public HealthChallenges 2050 focused on the anticipatedhealth challenges as well as on projections offuture developments in healthcare and theirimplications for the European research agendaHorizon 2020 (http://ec.europa.eu/research/horizon2020/index_en.cfm?pg=home&video=none),the future EU Framework Programme forresearch and innovation.

What will be the main challenges andopportunities by 2050? Future environmental changes will bringchallenges such as rising temperatures andextreme events like floods and droughts and mayaffect health outcomes such as air pollution andwater related diseases, and emergence of foodand vector borne diseases that have not beencommon in Europe so far. there is a need tobetter foresee these effects and to developstrategies for health systems that can anticipateand respond in a flexible way to changingpatterns of diseases in an integrated way.

as mentioned during the discussion, theenvironmental footprint of the healthcare sectormust also be addressed. the demographic andsocietal challenges include an increased ageingpopulation, the need for effective preventivemeasures that are adopted in an early stage oflife, rising healthcare costs and a persistentsocial gradient in health. However, a healthyaged population will also be a huge valuable

resource that should be turned into anopportunity for society.

additionally, it was discussed that in the absenceof effective policies, current lifestyles will furtherboost unhealthy behaviour: lifestyle relatedhealth threats will continue to be a strong driverof health conditions. the realisation of healthychoices being the default choices of thepopulation is an area of future research whichgenerates a struggle between science,practitioners, and policy making: how can theimplementation of effective preventive measuresbe assured?

these changes in environmental, societal andlifestyle factors as well as possible economicdecline, urbanisation, migration andtechnological innovations will influence the set-up and financing of our health systems. thethree major driving forces of healthcare costs willbe a continuing increase in life expectancy, theavailability of technological advances, and a risein public expectations of healthcare.

accordingly, we must tackle one of theconsequences of ageing, namely the increase innon-communicable diseases and multi-morbidity, alongside an increasing healthcaredemand and a decrease in the health workforce.it is estimated that by 2020 the EU will have ashortfall of one million healthcare workers.Moreover, the financing typology of healthsystems must be adapted and new models mustbe developed among others redefining the shareof public and private health spending. at thesame time policies to reduce greenhouse gasemissions can also have major impacts on publichealth particularly by reducing risks of non-communicable diseases. increasing physicalactivities in urban areas should reduce the risk ofdiseases related to sedentary lifestyles.

the pharmaceutical industry is considering futurescenarios in which the exact pathways ofdiseases are known and new diseaseclassifications are used. advanced technologieswill lead to the convergence of engineering andmedicine, targeted treatments and preventiveoptions will be available. these scenarios will

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Conference Report 2012Public health challenges by 2050 By Nicole Rosenkötter and Annamaria Szalay

Line Matthiessen, Head of Unit, DG RTD, EuropeanCommission



require new collaborative mechanisms betweenhealthcare providers, industry, the governmentalsector and potential new players like itcompanies, to put the individual at the centreand to take into account the possibilities of a“Digital age”.

the scenario of future information andcommunication technologies in healthcare willalso be person-centred. these technologies willoffer potential for predictive and preventivehealth information that is pervasive and peerconnected. the “information age” will shifthealthcare roles so that the individual, friends,families and self-help networks are positioned atthe forefront; the healthcare experts having amore facilitating and cooperative role.

the transformation of the health services andrevitalization of public health requires a multi-skilled heath workforce whose skills andknowledge must be adapted to tackle the healthchallenges of the 21st century, with a focus oncommunication and collaboration amongproviders but also between providers andpatients.

What was controversially debated duringthe forum?the challenges identified led to lively discussionsbetween the experts on the panel and theaudience. the main focus of the discussion wason the discrepancy between available knowledgeand the knowledge uptake by the individual,practitioners and policy-makers. How to movefrom knowing to doing? How can pro-healthchoices be rewarded?

another major focus of the discussion was theneed for radical health system changes, thepotential catalytic role of information andcommunication technologies and the related fearof loss of privacy and concerns regarding thecapability to integrate sufficient security and

integrity measures. some argued that futuregenerations will not share these fears, thatinformation and communication technologies willbe a normal part of their lives. nowadays, societyshould be more open and brave regardingtechnologies in order to enable change. societyshould start the discussion about thetransformation and modernisation of healthsystems to address the long term needs, thesocietal models on which future health systemsin Europe could be based, and the realisation ofintersectoral governance for health.

a strong emphasis in the discussions was givento the values of universal access to healthcare,solidarity, equity, and the empowerment ofcitizens for active participation in health.

What are the emerging topics for aEuropean research agenda?Based on the challenges identified, the followingset of research needs was compiled:

n Modelling and projection of future scenarios(for example, demographic, environmental,technological and economic) and theirinteractions and potential impact on health.

n Linking of environmental and health datasets and surveillance systems that identifyenvironmental health threats.

n adaptation procedures/strategies of thepopulation and of healthcare systems in achanging environmental setting.

n approaches to reduce the healthcaresystems environmental footprint.

n Development of comparable epidemiologicaldata and health information systems acrossEurope to model, monitor and evaluate thehealth situation including identifying diseasepatterns and health behaviour trends.

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Dipak Kalra,Professor at UCLCentre for HealthInformatics andMultiprofessionalEducation, UK

Petra Keil, HeadGlobal Public Policy,

Novartis

n Developing new or improved preventionmeasures (population or personalised) for lifestyle related diseases and disorders. theseshould, among others, include the evaluationof policies and technologies to reducegreenhouse gas emissions.

n Comparative effectiveness research in theareas of health promotion, diseaseprevention and health services, while takingadvantage of both the commonalities andthe diversity across the EU.

n Development of comprehensive individualhealth information systems that combine allrelevant health information (includinginformation about genomics, proteomics,metabolomics), and make individualisedrecommendations that fit the personal lifecourse.

n address how to translate theories andinterventions into “everyday practice” at the

level of the individual, practitioner and policymaker.

n Understanding of the biological processes ofageing instead of disease-centred research.

n Reforming of the existing diseaseclassification by focusing rather onmolecular pathway characteristics than onthe classification by organs.

n identification of ways to integrate and applyinformation and communication technologiesin health care.

n Development of new health financingmechanisms including cost-effectivenessand cost saving approaches for healthcare.

n addressing health inequalities, especially ina changing healthcare system that might bebased on individual responsibilities andempowered citizens.

n Health systems research dealing with topicslike the balancing of preventive and curativecare, innovative transformation of healthsystems, provision of intervention packagesinstead of single interventions, and timelyknowledge implementation by policy-makersand practitioners.

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Anders Olauson, Chairman, AGRENSKA



the aim of this forum on personalised medicinewas to present progress since 2011, to discusshow we can prepare for the new challengesahead, and to debate whether Europe can leadthe global way in this innovative field.

Stakeholders’ perspectivesstephane Berghmans, Director, Centred’innovation Médicale, and former Head,Biomedical sciences Unit, European scienceFoundation, gave an overview of the 80recommendations contained in the Europeanscience Foundation (EsF) report ESF ForwardLook. Personalised medicine for the Europeancitizen (http://www.esf.org/uploads/media/Personalised_Medicine.pdf).

EsF’s vision calls for revised models anddecision-making processes which reflect a focuson the individual citizen at all levels, fromassessment of the safety and efficacy ofinterventions, through Hta and reimbursement,to diagnosis, treatment and prevention.Moreover, the EsF recommends that emphasis isplaced on stakeholder participation,interdisciplinary interaction, public-private andpre-competitive partnerships, and translationalresearch in order to develop the frameworks thatsupport the vision of personalised medicine andhealthcare. all this will not be achieved withoutthe necessary infrastructure and resources.Dedicated funding and governmental supportmust be provided to ensure the availability ofcore infrastructure, including access to coretechnology and frameworks for education andtraining of professionals and the widercommunity.

Kurt Zatloukal, Professor, Medical Universitygraz, austria, discussed ways of addressingglobal health challenges through researchcollaboration by focussing on the examples ofthe EU Flagship proposal information technologyFuture of Medicine (http://www.itfom.eu/) (itFoM)and the Biobanking and Biomolecular ResourcesResearch infrastructure (http://www.bbmri.eu/)(BBMRi).

in an attempt to find new collaboration models,innovative solutions such as public-privatepartnerships implemented in a pre-competitiveenvironment represent a possible win-winsolution for both sectors. the public sectorcontributes with medical data, biologicalsamples and knowledge while the industrycontributes with data, funds and expertise. suchmodels are envisaged to improve innovationthrough collaborative research, lead to betterusage of finite resources, and create the basis fordata sharing.

Focusing on biomarker-driven treatmentapproaches, andreas Penk, Regional PresidentOncology Europe, Pfizer, emphasised how policyand legislative changes are needed to foster aconducive environment for personalisedmedicine in Europe.

More specifically what is needed is adaptingauthorisation procedures for medicines to takeinto account innovative clinical trial designs thatpersonalised medicines will depend on, closerregulatory links between diagnostics andtreatment, and rules on data protection thatsafeguard privacy while permitting scientificsharing of data as required.

in addition, wider coordination on research inEurope through Horizon 2020 is necessary, betteraccess to information for researchers, doctors,pharmacists and patients as an essential pre-requisite to promote research, new approachesto assess the value of personalised medicines,high-quality molecular testing facilities in Europe,multi-disciplinary training of healthcareprofessionals, and increased awareness ofpatients. in this process, the European alliancefor Personalised Medicine (EaPM) is a keyadvocate for change.

Robert Wells, former Head Biotechnology Unit,Directorate for science, technology and industry,OECD, discussed the need for a global approachto personalised medicine and the recent OECDefforts relevant in the area.

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Conference Report 2012Personalised medicine By Alessandra Ferrario and Michael Eder

http://www.esf.org/uploads/media/Personalised_Medicine.pdf

http://www.esf.org/uploads/media/Personalised_Medicine.pdf

http://www.itfom.eu/

http://www.bbmri.eu/

Wells identified the following areas whereincreased effort would be beneficial: greatercoordination among national bioeconomy andstratified medicine strategies, greatercoordination among regulatory bodies, thedevelopment of new models for clinical trials toreduce costs and speed time to market/patients,better use of large employers especially the self-insured companies, better use of iCts, morepatient and stakeholder advocacy groups,greater international discussion of ethical, legaland social issues, faster turn-around in the policyenvironment.

the future paradigm of medicine will be the four“Ps”: Predictive, Personalised, Pre-emptive, andParticipatory according to Werner Christie,Chairman of World Health Connection, norway.

However, because the market pull ispathogenesis (factors that cause disease) whilesalutogenesis (factors that support human healthand well-being) is affected by market failure, thefour “Ps” will not be enough to move from asystem characterised by curative medicinetowards a system based on preventive publichealth.

Christie’s conclusions were that:

n Personalised curative and pre-emptivemedicine have come to stay.

n the four “Ps” will be important, butinsufficient as a public health strategy.

n Commercial pressure will place the priorityon personalised medicine.

n Political pressure and funding must also aimat developing preventive populationstrategies based on evolutionary systemsbiology.

n Public-private partnerships are needed.

n a Public Health genomics Europeannetwork iii with preventive focus and relatedresearch funds for basic science is muchneeded and should be welcomed.

n Political and personal health literacy mustbecome part of cultural competence.

John Bowis, Co-chair, European alliance forPersonalised Medicine, talked about the EAPMManifesto (http://img.euapm.eu/resources/eapmmanifesto.pdf) which defines therequirements to take advantage of theopportunities offered by personalised medicine.

these include adapting the regulatoryenvironment to allow early patient access tonovel and efficacious personalised medicine,increasing research and development intopersonalised medicine and providing theincentives for translating laboratory innovationinto medicines and other innovations, adjustingeducation and training of healthcareprofessionals, the development of newapproaches to reimbursement and public healthassessment tools including health technologyassessment, health needs assessment andhealth impact, developing health literacyincluding awareness.

stephen Friend, President, sage Bionetworks,Usa, presented a new community based visionof open access innovation in personalisedmedicine.

in his opinion, access innovation in personalisedmedicine is going to be harder than we think butinevitable, it will be unaffordable without deepcitizen activation, and will need to fundamentallychange sharing data and models betweenresearchers especially between and withinuniversities.

sage Bionetworks aims to create a “commons”where integrative bionetworks are evolved bycontributor scientists and citizens. Usingnetworked team approaches, it is trying toaddress challenges regarding usable data,privacy barriers, tasks distribution, rewards forsharing, education and bioinformatics. this willbe achieved through a computer space forcollaborative research (synapse platform),introduction of portable legal consent(weconsent.us), and the use of ‘co-opetitions’(cooperative competition) like thesage/Bionetworks/DREaM breast cancerprognosis competition which aims to build bettermodels for disease prediction.

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Werner Christie, Chairman, World Health Connections

http://img.euapm.eu/resources/eapmmanifesto.pdf

http://img.euapm.eu/resources/eapmmanifesto.pdf

Wolfgang Boch, Head of Unit, Dg COnnECt,European Commission, presented the EUFlagship initiative of Dg COnnECt.

FEt (Future & Emerging technologies) Flagships(http://cordis.europa.eu/fp7/ict/ programme/fet/flagship/home_en.html) were requested by thescientific community, and by the Council of theEU to enable the targeting of outstandingchallenges via a structured effort, to open newhorizons by the creation of pioneering iCtfoundations in other s/t domains, and to reducefragmentation and avoid duplication of efforts byeffectively coordinating long-term researchactivities at national and EU level.

there were six initial pilot projects ending in 2012of which at least two will be selected for funding(2013 –2015). these pilots include the it Future ofMedicine FEt Flagship for personalisedhealthcare (itFoM), which will help develop thenecessary technologies to help process the verylarge amount of biological data currentlyavailable and translate it into more reliable, faster,and successful healthcare to deliver trulypersonalised medicine. Using computer healthsimulations (virtual patients), it will be possible topredict health, disease, therapy and its effectsfor individual patients. through clinicalapplication, this will ultimately help to change thefuture of medicine.

tom Lillie, Head Oncology internationaltherapeutic area, aMgEn, discussedpersonalised medicine from the perspective of itbeing a panacea or rather representing aPandora’s Box.

Currently, personalised medicine is likely to lookmore like a Pandora’s Box and Lillie suggestedthe following elements as key in making thetransition process towards a successfulpanacea. these include the continuousinvestment in innovation, the availability of

flexible regulatory and reimbursement pathways,and incentives for collaboration with particularemphasis on bio-banking for biomarkers andpublic-private partnerships for drugdevelopment.

Lillie concluded that faster progress in thedevelopment of personalised therapies anddiagnostics will require new clinical trials,regulatory and reimbursement approaches andthe need for collaborative approaches anddiscussions between academia, industry,regulators and payers.

Min-Huei Hsu, Director of Bureau of internationalCooperation, Department of Health, taiwan,showcased how taiwan successfully moved fromelectronic medical records (EMR) to personallycontrolled electronic health records whichinclude EMR, public health data, genomic dataand self-collected health data.

telehealth is also used in the country and linkscommunity care, home care and residential careto a central telehealth station which telemonitorsphysiological parameters (blood pressure and/orblood sugar), provides relevant healthinformation and medication instructions througha home gateway to the television, and offersconsultations with healthcare professionals byvideoconferences. Hsu concluded that taiwanneeds it because like every other country it haslimited resources and suggested the country’ssingle payer system and its modest populationas success factors in this process from EMR toelectronic health records.

nicolay Ferrari, assistant Director, institute ofCancer Research, Canadian institutes of HealthResearch, Canada, presented some of the latestdevelopments in PM in Canada.

to date four of the ten Canadian provinces haveidentified personalised medicine as a priority(British Columbia, alberta, Ontario, and Quebec).in the first wave of initiatives, together withpartners from the public and private sector, overC$200 million were committed over five years tospeed up the development of better and safermedicines for patients in Canada and across theworld.

in terms of future directions, Canada is interestedin engaging in a novel public-private sectorpartnership for the development of a newresearch models that would better addresscurrent needs and in liaising with similarinitiatives across the world.

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Wolfgang Boch,Head of Unit, DG CONNECT,European Union

http://cordis.europa.eu/fp7/ict/programme/fet/flagship/home_en.html

http://cordis.europa.eu/fp7/ict/programme/fet/flagship/home_en.html

stephen spielberg, Deputy Commissioner, UsFood and Drug administration, Usa, gave a Us-view on PM by discussing perspectives on thefuture of precision diagnosis; some examples ofsuccessful applications of genomic science todrug development, evaluation, and clinical use;shortcomings of technology validation and thecomplexity of multi-factorial clinical conditions.

Marisa Papaluca, section Head of scientificsupport and Projects, European Medicinesagency (EMa), discussed evidence for the needfor personalised medicine and the need for amulti-stakeholder approach (four “Ps”) todecision making, including payer, prescriber,patient, public health, to achieve this.

Various initiatives of the EMa are going to haveimportant implications in the field including theEMa innovation taskforce and qualificationprocess, the pilot multi-stakeholders consultationearly stage drug development, the EMa andEUnetHta joint action start collaboration onEuropean public assessment report contributionto relative effectiveness assessment, andadaptive licensing.

Papaluca concluded that personalised medicineoffers an opportunity to streamline developmentand promote efficient and integrated regulatoryoversight. to achieve this, partnerships,transparency and collaboration are key for facingthe challenges ahead.

angela Brand, Director of the European Centrefor Public Health genomics, summarised themain public health challenges currently facinghealthcare systems in the move from stratifiedmedicine to truly individualised medicine andconcluded with an overview of the EuropeanBest Practice Guidelines for Quality Assurance,Provision and Use of Genome-based Informationand Technologies (http://www.degruyter.com/dg/viewarticle/j$002fdmdi.2012.27.issue-3$002fdmdi-2012-0026$002fdmdi-2012-0026.xml;jsessionid=72D0EF51F57FB9EB5193a8aD7aE7F49F),which have been developed by the Public Healthgenomics European network (PHgEn) over thepast three years and have recently beenendorsed by all EU Member states and relevantEuropean organisations and institutions such asEMa or health technology assessment agencies(Declaration of Rome from 19.04.2012). thesebest practice guidelines will be implemented inthe next few years in EU Member states.

Key challenges and open questionsthe key challenges included the need for iCtsolutions, funding for infrastructure andeducation, the need for evidence-based qualitycriteria for samples and pre-analytics, the needto address current fragmentation of clinicalresearch, consent and privacy surroundingpatient data use and biobanks, the challenge ofsuccessfully establishing multidisciplinary,international and intrasectoral collaborations.

Open questions include whether personalisedmedicine will actually reduce health expenditure,how to achieve cross-disciplinary consensus,how to overcome challenges of biomarker-drivencancer treatment and the challenges in addingroutine diagnostic testing to clinical practice.How to overcome challenges of open scienceregulatory issues and bottlenecks and privacyand consent issues for use of genomic data, andhow to adapt reimbursement systems to the newhealthcare environment, were further issuesdiscussed..

to summarise the key question is probably howto ensure that all the positive expected effects ofpersonalised medicine (for example, fewer sideeffects, savings for treating only people who willbenefit) are actually going to happen in practice.

Future trendsOne of the key messages in this area was thatresearch will deliver. this is a given. What thediscussions in the coming years will be about areissues and questions around data use,knowledge translation, regulatory framework(s),reimbursement, and use of resources.

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Stephen Spielberg,Deputy

Commissioner, US Food and Drug

Administration


http://www.degruyter.com/dg/viewarticle/j$002fdmdi.2012.27.issue-3$002fdmdi-2012-0026$002fdmdi-2012-0026.xml




these parallel forum sessions had two distinctthemes. the first session debated the regulatoryroles and potential partnerships betweengovernment and industry in the prevention ofnon-communicable diseases. the secondsession highlighted evidence on recent healthsystem financing reforms to introduce nCDprevention and treatment schemes.

NCDs: what works? From nudge toregulationthe debates in the first session highlighted thepotential roles of government and industry in theprevention of nCDs and questioned the benefitsof collaboration between the two actors. ChairMartin McKee, Professor of European PublicHealth at London school of Hygiene and tropicalMedicine, set the scene for presentations byasking the audience the following key questions:

n should the public health community engagewith industries that make and market theproducts that drive the nCD epidemic?

n is nudging industry more efficient andacceptable than regulating them?

David stuckler, Lecturer in sociology atCambridge University, enthusiastically began thesession by urging the audience to lobbygovernments for better investment in preventionmeasures rather than budget cutting in the nameof austerity. He encouraged a focus on economicevidence suggesting that investment returns onhealth are 11, which is significant relative toreturns gained on military (0.6–0.9) or foreigninvestment (1.6–1.7) expenditure, for example.Overall, his premise was that “investing in healthmakes money” in the long-term, and this isevidence that cannot be ignored.

Industry: “We have a role to play and wetake it very seriously”the biggest controversy of the session was theparticipation of Clare Leonard, the Director ofscientific affairs at Mondelez international(formerly Kraft Foods inc). Leonard suggestedthat Big Food could contribute to governments’

prevention efforts via three sustained actions:

1. Products: making small changes to bigbrands sold around the world, such asmaking high calorie foods more wholesome,rather than making big changes to smallproducts that would not be consumed by thewider population because of the assumedcompromise on taste.

2. Partnerships: creating partnerships withinitiatives to educate young people abouteating less and exercising more.

3. Policies: creating policies that supporteducation around food contents, portionsizes and upper calorie levels, andresponsible advertising, such as notadvertising in primary and secondaryschools.

When the audience began asking questions itbecame apparent that Mondelez, which pridesitself as a leader in the industry, sells its productsin 75 countries but has some form of a regulatorypartnership with only 19 national governments.When queried on this Leonard replied that manycountries simply had not initiated discussionsyet. But if Big Food takes its role so seriouslythen why wait for the other side to initiate thedialogue?

Is nudging the answer? Apparently not…Chris Bonell, Professor of sociology and socialintervention, Oxford University, was asked tocomment on whether nudging companies would

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Conference Report 2012Non-communicable diseases By Louise Boyle and Stephanie Kumpunen

Claire Leonard,Director of ScientificAffairs, Regulatory

Affairs and Nutrition,Kraft Foods Europe

suffice in guiding self-regulated industries. Hedescribed nudging as premised on Thaler andSunstein’s theory (http://www.youtube.com/watch?v=xoa8n6nJMRs&feature=relmfu) thateveryday decisions made by individuals are notconscious or rational, but are instead guided byperceived norms and rely on poor information.through the use of choice architecture it istherefore possible to influence individuals’behaviours in non-coercive ways.

Bonell purported that the UK’s Conservativegovernment had taken the stance of “rather thannannying people we will nudge them by workingwith industry to make healthier lifestyles easier.”By establishing the UK Public HealthResponsibility Deal, the UK government had aframework in which they could work withindustry, thinking it might be faster, cheaper andmore effective to get them to voluntarily self-regulate. Bonell was very critical of this initiative,citing that there had been patchy sign-up topledges, which in many cases didn’t break newground, but just reflected existing standards.

He also described companies signing up toagreements that did not reflect their product line,such as the UK tea manufacturer typhoo thatcommitted to reducing transfats in their teaproducts (within which there are only traceamounts). Furthermore many companiesinvolved in the responsibility deal had opposedearlier public health initiatives such as traffic lightwarnings on food, one of the few measures forwhich there is strong evidence that consumersfind this the easiest way to gauge how healthy afood is.

Bonell’s conclusion… nudge and voluntaryregulation does not work or at best currentlylacks any evidence base. therefore, individualsmay have the freedom to be foolish, but industrymust be regulated.

If not nudging, can political championsstrengthen public health efforts? the presentation from shu-ti Chiou, Directorgeneral of taiwan’s Bureau of Health Promotion,showed that where there is a will there is a way.

Chiou described a huge “whole society”campaign to raise public awareness and gainsupport for healthy public policy and movestowards stronger regulation, to counteract theencroaching obesogenic environment in thecountry. the campaign, ultimately involving 3%of the total population, mobilised 600,000 peopleto collectively lose 600,000kg of body weight.there was strong political leadership and supportfor the campaign, as the Prime Minister pledgedto lose 10kg and has publicly tracked hisprogress.

Corporations as a determinant of healthand the growth of “industrial epidemics”Conversations also turned to Big tobacco andBig Booze, where anna gilmore, Professor ofPublic Health and Director of the tobaccoControl Research group at the University of Bathand Judith Watt, Director of the nCD alliance,suggested that the products of major industriesare responsible for a significant and growingproportion of the global burden of disease. theyargued strongly for greater regulation of industryand protested against partnerships betweengovernment and industry.

gilmore’s thesis was that “corporations haveresponsibilities to maximise profits” regardless ofconsequences to health, society or theenvironment, and to oppose policies that couldreduce their profits.

Likely out of respect for the courage of Big Foodto step into the lion’s den at EHFg 2012, neithergilmore nor Watt explicitly attacked the food andbeverage industry; yet they argued that the

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ST Chiou, DirectorGeneral, Bureau ofHealth Promotion,Department ofHealth, Taiwan

Anne Gilmore,Professor, Director of

Tobacco ControlResearch Group,University of Bath

http://www.youtube.com/watch?v=xoa8n6nJMRs&feature=relmfu

http://www.youtube.com/watch?v=xoa8n6nJMRs&feature=relmfu

rhetoric of Big Booze and Big tobacco aresimilar in that they both describe consumption oftheir products as a personal choice andresponsibility, advocate for self-regulation (overlegislation), influence the evidence base andcriticise the “nanny state”, for example. theypointed out the irony that Big tobacco isregarded as the root of all evil while the WHOrecognises Big Food and Big Booze as validparticipants of civil society.

in closing Watt listed the expected challenges inmoving forward, which included, among others:establishing time limited goals and ensuringgood leadership both inside and outside thehealth sector (as in the example demonstratedby taiwan).

the second session asked governmentrepresentatives and researchers to comment onthe strategies recently introduced to incentiviseclinical management of nCDs across manycountries.

Taiwan: Early detection and diseasemanagement programmesin taiwan the national health insurance nCDprevention and treatment strategy is organisedinto two facets:

1. integrated clinic-based and outreach “earlydetection” services (i.e. various types ofcancer screening, hepatitis, flu vaccinations)integrated into one general wellbeingappointment.

2. Disease management programmes withquality excellence targets and bonussystems developed to encourage adherenceto clinical guidelines.

shu-ti Chiou reported that success has beenachieved in some areas; for example, there hasbeen a 15% reduction in diabetes-relatedmortality rates in the last ten years. Furthermore,the quality of services has risen at treatmentcentres enrolled in the payment-for-performance(P4P) policies. Chiou said that the next step is toinvolve more institutions and patients in P4P-funded disease management programmes.

The Netherlands: Disease-specificbundled paymentsin the netherlands, the 2006 reform of the caredelivery and financial reimbursement systems setoff a priority to focus on care for people withchronic, rather than acute, illnesses.

Bert Vrijhoef, Professor of Chronic Care at tilburgUniversity described the cornerstones of theapproach:

1. Care groups: the providers (or contractorsfor other providers).

2. Disease-specific care standards: documentsstipulating the minimal required patientservices to be covered and authorised bycaregiver organisations.

3. Bundled payments: single fees for specificchronic diseases, paid to care groups byinsurers to provide primary and specialistoutpatient care as detailed in the carestandards.

Results from an evaluation of bundled paymentsdemonstrated that the management of somechronic diseases like diabetes and COPD werebetter organised, but only saw moderate effectson quality of care (e.g. better adherence toguidelines). there was also a 3% increase in theoverall cost of care, which has been attributed tothe employment of new practice assistants at theprimary care level and hospitals billing twice forthe same treatment. the implementationchallenges were expected, yet Vrijhoef warnedthat the introduction of any reform takes moretime than anticipated. the next step for theDutch is to move towards a system of regionalbundled payments.

France and Estonia: incentive schemes fordisease management and qualityisabelle Durand-Zaleski, Chief of Public Health atHenri Mondor Hospital in Paris, described the2009 introduction of a new contractualagreement for physicians to incentivise quality;yet the focus of her discussion were thechallenges faced when all of the French national-level stakeholders resisted its introduction.

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Bert Vrijhoef,Professor, Tilburg

University

starting from its inception, Durand-Zaleski toldthe audience that all stakeholders were invited toreview the guidelines and targets, and mostthought they were poor. as a result of the review,the physicians’ unions opposed the scheme, butmany physicians signed up to the schemeanyway – aware that targets were not difficult toachieve and that they would stand to gain atminimum €3000 extra per year. a few years in tothe scheme and unions have now yielded seeingevidence of the success of similar schemes inthe UK and the netherlands.

an alternative perspective showed that thechallenges faced in France were not mirrored inEstonia. taavi Lai, senior Health Policy analyst atthe Estonian Ministry of social affairs, describeda different situation whereby physiciansassociations worked with insurers to developand implement a voluntary quality bonusscheme. However the contention is now thatphysicians believe that targets are too high andinsurers want them to remain high so that activitydoes not become effortless. Moving forward,Estonia will try to introduce an extra bonus tophysicians who achieve all targets, andearmarked funds have been reallocated to allowphysicians to follow up with patients moreeffectively.

Researchers reviewing innovations across13 European countriesEllen nolte, Director of Health and Healthcare,RanD Europe, then reviewed the evidence forthe introduction of nCD treatment strategies(most often related to diabetes), and argued thatnearly 50% of all studies report positive healthoutcomes, yet evidence for cost savings islimited.

in attempts to add to the literature, nolte andcolleague Cecile Knai, Lecturer in EuropeanHealth Policy at London school of Hygiene andtropical Medicine, worked with key informants

across 13 European countries to ask a number ofquestions on the context of the development ofthese programmes.

nolte found that there are generally threeapproaches to disease managementprogrammes:

1. Efforts to encourage one principalcoordinator for care (usually gPs – especiallyin countries where gPs work in solopractices).

2. Multidisciplinary team working (frequently ledby gPs).

3. nurse-led approaches including manageddischarge and case management.

nolte argued that most of the programmes arefunded through quality improvement initiatives,and the use of clinical information systems tendsto be the least developed strategy in mostapproaches. she presented mixed results, forexample, improved survival of german diabetespatients, and increased re-admissions anddecreased patient satisfaction with theirexperience in England. Knai stepped in tosuggest that the barriers to success may belinked to a lack of culture of evaluation in somecountries (and lack of resources to undertakeevaluations), feelings of reluctance to collect data– especially in countries where solo gP practicesare common, and a lack of sustained funding forpatient education.

Knai closed the session citing the key criteria forsuccess of chronic disease managementprogrammes: strong primary health caresystems, buy-in from patients (as well as otherkey stakeholders), strong leadership, theemphasis within medical training on theimportance of an evidence base (and thereforeevaluation), and coherent it systems.

ConclusionOverall, across the two sessions, researchers,industry and government shared their successes.While no decisions were made on how to worktogether collectively, the forum identified futurechallenges for the global eradication of nCDs –which is a necessary first step in the rightdirection.

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Cecile Knai, Lecturerin European HealthPolicy, LSHTM



as the financial and debt crisis has endured, thisyear’s forum focussed once again on the healthand health systems affected by economicdownturn and reactive austerity policies. incontrast to EHFg 2009 on Financial Crisis andHealth, where the potential damaging impactwas anticipated and measures to protect healthbudgets were advocated, we witness now thefirst measurable effects on health and healthsystems and are able to take stock of envisagedand already implemented health systemresponses to the crisis. Moreover, we haverealised that the financial crisis is not a shortterm event but is still persistent.

in this regard the Closing Plenary addressedthree basic questions:

1. What do we know now?

2. What are strategies so far?

3. What are future directions?

the Closing Plenary involved two keynotepresentations outlining the austrian and EUresponse, a comparative analysis of healthimpacts, a video reflection and finally a paneldiscussion involving representatives of EU,OECD, WHO and civil society as well asacademics.

What do we know now?in order to set the scene Philipa Mladowsky,Research Fellow, LsE Health/EuropeanObservatory, presented work on the impact ofthe financial crisis on health and health systemsand the health policy responses that Europeancountries are engaged in. although she stressedthat the impact and responses differ very muchbetween countries, the key findings were asfollows:

n there were significant negative impacts onsome types of mortality and morbidity incountries with weak social protection.

n there have been reductions in the rate ofgrowth of public expenditure on health.

n there have been increases in cost sharingand increases in unmet need.

she concluded by highlighting that fiscalsustainability should not become a health policyobjective in itself. Rather resources need to beallocated more efficiently and proven to be ofadditional value to health. general cutbacksacross the sector are not efficient. if cuts areinevitable they have to be transparent and trade-offs need to be explained. Lastly, we have tomake the case for health better and emphasiseits positive contribution to economic growth.

What are the strategies so far?Beyond the comparative overview given byMladowsky, alois stöger, austrian Minister ofHealth and John Dalli, EU Commissioner forHealth and Consumer Policy, elaborated on theaustrian and EU answers to the healthchallenges caused by the financial crisis.

Health Minister stöger exemplified the austrianway of investing in their health system in times ofcrisis as the background to his hypothesis thatthe current crisis is a “trust crisis”. He regardedinvestments as the means to build trust andsecurity by ensuring a social security net for itscitizens. at the same time health investmentsoffer economic growth and act as “stabilisers” ina generally unfavourable economic climate.

the way forward outlined by Commissioner Dalliwas based on the assumption that in times ofeconomic decline and lower levels of

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Conference Report 2012Health in an age of austerity By Timo Clemens and Angelika Le Beau

Alois Stöger, Minister of Health, Austria

government revenues “health, of course, is notimmune”. “Delivering more healthcare with fewerresources” is possible according to Dalli due toexisting inefficiencies in the system and is verymuch needed to ensure that future generationscan benefit from affordable health care. Ensuringinter-generational equity is a long-termendeavour that requires structural reforms to beundertaken now.

although both differed in their analysis of andbroad approach to the crisis, and despite thedifferent levels their measures operate on(national versus EU), their envisaged objectivesand instruments for reforms resembled eachother quite well. Both strived to use investmentsin health for the realisation of efficiency gains inthe health sector. Both regarded coordinationand cooperation among actors in the healthsector and among member states as key toachieving better functioning systems. Bothstöger and Dalli saw a vital role for technologysuch as eHealth applications like the ElectronicPatient File or prescriptions to ensure patientsafety and increase efficiency. Moreover, bothembraced additional efforts and investments inhealth promotion and disease prevention.

Prevention was regarded as a “key investmentfor the future” because it avoids suffering in thefirst place and pays off in the long run. inaddition, both addressed governance issuessuch as health targets, the role of regulation andthe stimulation of innovation to achieve thesereform objectives.

the contributions of stöger and Dalli resonatedvery much with his year’s EHFg in two aspects.Firstly, the two basic positions stöger and Dallirepresented in dealing with the crisis, oneadvocating that health budgets need to bepreserved and shielded from cuts, the other

acknowledging that cuts are inevitable and thatwe have to deal with fewer resources: bothpositions have been inherent in manydiscussions throughout the days of the EHFg.secondly, the instruments and objectives theyaddressed in their speeches mirrored at large thethemes discussed in this year’s parallel forumsand workshops.

Future directionsthe video reflection and panel discussions raisedmore questions and aspects that need closeattention, and highlighted persistentcontroversies as the crisis goes on, rather thanproviding fully-fledged answers. some of thesepainstaking aspects of dealing with the crisis arepresented here without claiming that this is acomplete representation of the discussions.

Is austerity the new normal?

so far the recession is enduring. is there an endin sight or do we have to accept austerity as thenew norm? assuming that the crisis situation willfurther persist, preparations are needed topreserve access to health services for the“worse-off” in society. in addition, what effectscan be anticipated if temporary cuts becomepermanent? so far, countries have been able tocatch up quite fast after the economic upturnbegan. Lastly, if tight budgets and reducedservices are the new norm, should there be asocietal conversation on our expectations forhealth?

Is austerity working in terms of economicdevelopment and what are its health effects?

in terms of economic development and thesuccess of austerity, it has been recorded thatthe financial crisis is not solved yet.nevertheless, austerity was regarded by some towork, for example in ireland, but it is painful!However, austerity is certainly not the soleanswer to the problem. as the discussionsdemonstrated inter alia macroeconomicimbalances between countries need to beaddressed and wise investments have to bemade.

as to the health effects of austerity, it was notedthat Member states were trying to preserve thesame quality and scope of services with fewerresources and that there has been a stimulus inmany Member states advancing needed healthsystem reforms in the right direction. However,the health effects of austerity are still unknown.

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John Dalli, former EU Commissioner for Health andConsumer Policy, European Comission

therefore, there has been a call for a Healthimpact assessment of austerity measures ingeneral and especially for those measures thetroika is imposing for the worst affectedcountries in the framework of the economicadjustment programmes.

When cuts are decided… by whom? Who isaccountable?

Contributions indicated that those regarded asthe obvious advocates for cuts such asrepresentatives of Dg ECFin and the iMF earlierthis year rejected that they campaign for healthcuts. Who is endorsing cuts then? Moreover,political stewardship was generally stated to belacking in visibility. a civil society that is on thestreets and the rise of right wing parties and civilriots have been regarded as symptoms ofmissing leadership. in answer to an apparentlyinsufficient political leadership in the crisis, therewere calls that we as health advocates would

have to present our case in a way that involvesarguments and issues beyond our own field. indoing so we would need to be increasinglyproactive but would rather stay reactive as therecipients of boundaries and limitations given tous.

Finally, the EHFg 2012 and the closing session inparticular showed that the goals of maintainingthe resilience of our health systems anddemonstrating leadership in this financial crisis –already discussed in 2009 – are still valid.attaining both goals needs our ongoingcommitment and joint efforts!

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Panellists: Judith Watt, Director, NCD Alliance; Constantino Sakellarides, Professor Emeritus, National School of PublicHealth, Portugal; Mark Pearson, Head of Health Division, OECD; Monika Kosinska, Secretary General, EPHA; John Dalli,former EU Commissioner for Health and Consumer Policy, European Commission and Hans Kluge, Director of HealthSystems and Public Health Division, WHO/Europe



this workshop session explored the range ofresponses to the challenges that the financialcrisis brought to the health systems of countriesof the Commonwealth of independent states(Cis).

The effects of the financial crisis on healthsystems in Russia and other CIS countriesthe crisis impacted the Cis countries differentlydepending on a number of factors. indicators likegross national income (gni) show that somecountries have not been as severely affected bythe financial crisis as others: gni is continuing togrow in all Cis countries except for Belarus andazerbaijan, where the crisis had a strongerimpact.

Other indicators, such as the total PrimaryEnergy Production, also explain the differentialimpact of the crisis in the region: for instance theRussian Federation, as the biggest producer ofoil and gas in the region, is dealing better withthe crisis compared to other Member states.

those countries that already faced severeresource constraints had fewer options formaintaining equitable access to health servicesof a reasonable quality. But even resource-richcountries such as the Russian Federation havesought to contain or reduce health spending in anumber of ways.

there are various options available to policy-makers for building resilience to and dealing witheconomic shocks to the health system whenthey arise in both resource constrained andresource rich economies. the most commoninterventions to address the effects of thefinancial crisis are containing or reducing healthspending, improving technical efficiency andimproving allocative efficiency.

in particular in the Cis, cost containment isassociated with interventions like cutting budgetexpenditure, redefining the benefit package byintroducing user charges, extending or limitingcover, and/or reducing public health spending,which in some countries was considered toohigh.

Introducing user charges: this intervention wasimplemented in a few countries for services likehospital care, primary care consultations,diagnostic procedures etc. However even in thisarea the Cis countries are not homogeneous: inthe last five years some countries have seen anincrease in private households´ out-of-pocketpayments (for instance in armenia and theRussian Federation), while in others these havefallen (Uzbekistan and Kyrgyzstan).

Prevention: some countries have decided tointroduce sin taxes in the form of duties ontobacco and alcohol, allocating more money tohealth promotion and in some cases cuttingexpenditure and investments in health services.

Cost containment: Measures like price controlsfor pharmaceuticals, medical goods and equip-ment have been implemented to contain costs.

Common challenges in CIS countriesPresentations from high level representativesfrom the Cis countries highlighted some of thechallenges that their countries are facing:

n in many Cis countries, like Kyrgyzstan, theeconomy has been in transition since thedissolution of the soviet Union and this hashad an impact on the health care sector.also more recent crises (like the one of theyear 2000 in tajikistan) have impacted ontheir economic growth.

n Common obstacles in the Cis countries arethe insufficient quality of medical care, lowbudgets, a lack of good infrastructure and alack of human resources (both nurses andmedical doctors).

n several health systems are undergoingsignificant changes: for instance inKyrgyzstan two programmes have beencreated to undertake health sector reforms,one including compulsory health insurance.the concept of family medicine has beenrecently established and has been workingquite successfully and serious reforms havebeen conducted in the field of public health.in tajikistan upcoming reforms are trying to

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Conference Report 2012Financial crisis By Gabriele Pastorino

push forward the implementation of apayment system based on performance. inthe Russian Federation importantprogrammes have been designed to improvepopulation health and fight againstcommunicable diseases.

n Many countries like the Russian Federationand armenia are investing in programmes totackle noncommunicable diseases (nCDs)which cause 90% of all deaths in armenia.the Russian Federation has also increasedinvestments in cancer care by tenfold.

n Many countries face severe problems infinancing their health systems (in tajikistan,for instance, especially for primary care andprevention) and several ministries areworking to maintain universal access to carebut trying to maintain also the principle ofsolidarity. Even in richer countries like theRussian Federation the federal budget isnow allocated by taking into account theinternational economic situation andconsidering the average price of oil.

n it is difficult to measure how the economicdownturn affects health in the Cis countries.However looking at the data on differentcauses of mortality there is a worryingincrease in circulatory disease-related deathsin the region.

n Access to care: there are issues in severalcountries in this area but current data relateto the pre-crisis period. national surveyshave been carried out in several countriesand they suggest that there are hugedifferences in access across the region.

n there are general challenges most countriesface when trying to balance quality,accessibility and efficiency of the healthsystem: it is difficult, for instance, to offermore services without increasing co-payments.

What can Europe learn from theexperiences of the CIS countries?the crisis Western European countries are facingis not comparable to the fall in gDP experiencedby the Cis countries in the post soviet Uniontransition period. However, it is extremely helpfulto review their experiences in light of what isgoing on now in Europe.

in an economic crisis there are different ways thehealth system can react: one of these is to try to

bring more resources into the system (it isdifficult to ask for more taxes but despite this theexperience of the Cis countries shows that theymanaged to bring fresh money into the system).

in Europe we see an increasing tendencytowards co-sharing payments and reducingaccess while the Cis countries worked to reduceinformal payments. One of the main commonconcerns is how to protect the most vulnerablesegments of the population.

a good lesson from the Cis countries is to lookat how they managed to restructure healthservices by reducing the number of beds andintroducing payment for performance.

it is important to stress the important role ofpublic health at a time of financial crisis.

the role of the government is key and the healthministry has to be able to persuade the ministryof finance and the government to allocate moremoney to the health system.

intersectoral governance and health in allpolicies (the importance of protecting theweakest part of the population by protectingthem from unemployment etc.) play a key role.

Controversial issuesthe use of sin taxes on alcohol and tobaccogenerated significant discussion in theworkshop.

sin taxes were considered to be very importanttools but these measures were thought to beoften difficult to implement because of the role ofindustry lobbies. it is also difficult to measurehow much progress the countries thatimplemented the sin taxes have made.

Earmarking funds for health on revenues fromtaxation on tobacco and alcohol might make thestate dependent on certain industries. Measuresimplemented should be a way to tackle thehealth issue and not as revenue, and states thatuse this leverage have to bear this in mind. somequestioned whether sin taxes should be used tosupport the transformation of the health system.

alcohol has a huge impact on gDP growth incountries like Russia and it has very strong socialimplications and goes beyond being a healthissue (the important role of social determinantsof health and intersectional governance).

Other controversial questions also arose duringthe discussion:

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n How to predict and regulate pharmaceuticalexpenditure in a time of financial crisis?

n How is it possible to build a democraticmovement to support health involving civilsociety?

n How can we measure the scale and impactof health reforms in the Cis countries?

Conclusionsn the Cis countries have made amazing

progress in reforming their health systemsover the last 20 years.

n solidarity has a central role in shaping thepolicies.

n the reaction to the financial crisis across Ciscountries was not homogeneous: countrieshave implemented different reformprogrammes and have actually taken quitedifferent directions.

n Evidence shows that in some countries evenwhen the financial crisis had an impact onthe economy this didn’t necessarily lead toactual changes in policy making and tohealth systems. this was the case for

countries like azerbaijan and Ukraine.

n in other countries, like georgia, Kyrgyzstanand the Russian Federation, even whenchanges have occurred these were notnecessarily direct responses to the financialcrisis but rather part of programmes alreadyplanned and initiated by the governments.

n Only Belarus and Moldova implementedsome substantial policy changes in responseto the financial crisis.

n in some cases the financial crisis has beenused to implement reforms that would havebeen otherwise politically difficult toimplement. this is the case for countries likearmenia where some positive programmeswere implemented during the economicdownturn, and other decisions were takenfor political reasons and not because ofactual budget constraints.

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Josep Figueras, Director, European Observatory on Health Systems and Policies; Willy Palm, DisseminationDevelopment Officer, European Observatory on Health Systems and Policies; Varduhi Petrosyan, Assistant Professor,College of Health Sciences, American University of Armenia; Oleg Chestnov, Assistant Director-General, Non-communicable Diseases and Mental Health, WHO; Tatyana Chubarova, Academy of Sciences Institute ofEconomics, Russian Federation; Bernd Rechel, Senior Researcher, European Observatory on Health Systems andPolicies; N Grigorieva, Head of the Center for Comparative Social Research MSU, Russian Federation; Elena Tkacheva,Head of Planning and Economices, Ministry of Health, Belarus; and Erica Richardson, Senior Researcher, EuropeanObservatory on Health Systems and Policies



eHealth has the potential to help Europeanhealthcare systems by improving accessibility tohealthcare in remote locations, overcomingshortages of health professionals, bringingpatients closer to managing their health, andhaving a positive influence on attitudes and thebehaviour of patients resulting in better clinicaloutcomes. although policy-makers doacknowledge this potential, large scaledeployment of eHealth solutions in Europe stilllags behind. Whether it is so due to remainingdoubts about the evidence of the cost-effectiveness of eHealth or also because of otherbarriers such as organisational and financiallimitations, are important questions.

the workshop focused on sharing the results ofdifferent research projects at EU and nationallevels, while stimulating a discussion amongexperts around the existence of real informedevidence on the effectiveness of eHealth. thelevel of evidence but also the use of evidencewas discussed in the context of possibilities ofeHealth supporting our health systems.

Different kinds of evidence neededall the presentations showed that there isevidence that eHealth and telehealth can beeffective, but the evidence is still coming mostlyfrom research settings. there is a lack ofevidence at the provision level and this meansthat more collaboration is needed amongstakeholders.

Furthermore, cost-effectiveness measurementsshould take a more holistic view. the impact onthe labour market and social system should betaken into account and both direct and indirectcosts evaluated. it was also pointed out thatmaybe there is too much attention given to costsand the debate should be more focused onquality and outcomes.

Mostly the problem is not the amount ofevidence, but the quality of evidence and itsapplicability to other settings. this can be seenas a barrier for wider use, although other aspectsare also important. there is also a belief that the

focus of the evidence does not have to be oncost-effectiveness any more, but rather ondecision making.

Communication is a key problem inimplementation and involving stakeholders.Evidence building is difficult and contactbetween researchers and patients in needed.there should be on-going engagement ofpatients in the processes and this assumesskilled project management.

if all relevant stakeholders are involved, then thefinalised evidence can be more easily put straightinto practice. the evidence has to be built in thecare settings, because specificity is high and itcan be very hard to transfer the evidence toother regions. Evidence should not be overgeneralised and should focus more on localisedmethodologies. it could be useful practice forevidence building to be connected directly toprovision – the same stakeholders who wereinvolved in research should also continue toprovide the service.

there is the question to what extent futureresearch should focus on randomised controlledtrials and to what extent on organisationalissues. Maybe we must re-use the evidence wealready have and focus on implementation andstakeholder involvement?

What should support the evidence?Proving cost-effectiveness has to becomplemented by new ways of providing care,whether it is modifying the care processes orpatients playing a bigger role in their care.

the latter has some important preconditionsregarding data use. technology can play a role inpersonalising data more, but a vital component isalso trust. Patients’ access to health records isimportant and easy access to data should not beunderestimated.

it should be noted, that eHealth on its own is notenough and it is problematic that organisationalaspects cannot keep up with existing technology.

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Conference Report 2012Evidence of the effectiveness of eHealth: focus on telehealth By Priit Kruus

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Heelen Riper, Professor, VU University Amsterdam, Claus Duedal Pedersen, Renewing Health Project


innovation emerges from new processes andnew provision models. Patients can see benefitsin technology, but industry might perceivetechnology as disruption and thus theexpectations of industry have to be managedappropriately. the key is developing processeswhich do not disrupt the existing organisationalstructure but enhance it and improve existingday-to-day processes.

this means giving the care providers an incentiveto change their organisational design, whichmeans sustainable investment assurance by notonly the private sector but also the public sector.

as a supporting solution, a new type of healthcare professional could help to make better useof eHealth and the evidence built about itseffectiveness.

eHealth in the age of austerityausterity can be both a burden but also achance. eHealth could be a contributor to healthsystem sustainability, but this means findingfunds for investments. Furthermore it meanscutting across the traditional levels of care andreducing the pressure of cost-containment witheHealth.

Political will is needed to get momentum intotelehealth, but it is unrealistic to expect privateinvestors to invest if they do not know that theywill have a market to whom they can providetheir solutions.

at both political and organisational levels thereshould be a change in attitude or even aconstant attitude of change. Health systemshave high inertia and there is a lack ofunderstanding that the reimbursement systemshould be altered. Changes won’t emerge unlessthe ones who carry the burden of change arerewarded for their work.

Conclusionto conclude, the session highlighted the mostimportant aspects of using evidence in healthcare. as eHealth is very connected to differentaspects of health systems and there is suchvariety in health systems between countries andregions, it is hard to transfer evidence. We shouldmove towards more integrated approaches.

all levels of the systems have to be incorporatedinto the building and using of evidence ineHealth. the industry has an important role inchanging the way care is provided, but thenational and EU level incentives have to also bethere. the reimbursement system has to supportorganisational change in health care in order torealise the full benefits of eHealth.


Food fortification, the addition of essentialvitamins and minerals to food staples, isimplemented by countries throughout the worldto prevent micronutrient deficiencies and reducethe incidence of neural tube defects, such asspina Bifida. Fortification of at least one type ofcommonly consumed wheat flour is currentlymandated by 74 countries. Despite the fact thatflour fortification has been practiced in somecountries for more than 60 years and that it hasbeen a topic of discussion in European countriesfor a number of years, few have embraced thiscost effective public health strategy.

the workshop outlined and addressed commonconcerns related to flour fortification as well asthe nutritional and economic benefits of fortifyingflour. Because foods made with wheat flour arecommonly consumed throughout Europe,fortification has the potential to benefit millions ofpeople in the region. the workshop alsohighlighted the evidence for fortifying flour withfolic acid to prevent neural tube defects.EUROCat, a network of population-basedregistries covering 1.7 million births in 21European countries, reported between 1,130 and1,344 neural tube defects each year from 2006through 2009. none of the included countrieshas a mandate to fortify flour with folic acid, andonly one fortifies with iron.

The Flour Fortification Initiative (FFI)the Director of the Flour Fortification initiative,scott Montgomery, outlined the wheat industry inEurope and potential benefits of flour fortificationthere. More than 600 types of flour are producedin Europe to meet consumer demands,according to the European Flour Millingassociation. Foods made with wheat provide23% of the population's protein supply and 22%of the total calorie intake, according to the Foodand agriculture Organization of the Unitednations. Because wheat consumption across theregion is at least 150 grams per capita per day,flour could be fortified with minimum levels ofvitamins and minerals and still be expected tohave a significant public health impact.

the FFi is an international network of individualsand organisations working together to make flourfortification standard industrial milling practice.among the partners are flour millers, scientists,government ministries, and non-governmentalorganisations. an Executive Management teamrepresenting global leaders in the public, private,and civic sectors provides strategic direction tothe network.

the FFi global secretariat is at Emory Universityin atlanta, georgia, where students collect dataon global flour fortification practices. Mostcountries fortifying flour include both iron andfolic acid, a B vitamin, in their standards. Manycountries include zinc plus other B vitamins;some countries include vitamins a and D as well.

Countries determine the type and quantity ofnutrients to include in flour fortification based ontheir population’s typical consumption patterns,diet and any specific health concerns.international meetings in 2004 and 2008 led toglobal guidelines to help countries make thesedecisions. some regional guidelines are alsoavailable, but ultimately flour fortification is mostsuccessful when national leaders drive theprocess. From its beginning, the FFi network ofpartners has offered technical expertise to millersin countries initiating flour fortification. thistechnical support is expanding to include qualityassurance and quality control training forindustry leaders as well as government foodsafety authorities. FFi’s partners are encouragingcountries which have been fortifying flour fordecades to update their fortification standardsbased on the newest scientific evidence.technical support is available for countrieswanting to monitor flour fortification programmesfor their health impact.

FFi has historically focused on wheat flour. Plansare underway for the emphasis to expand toinclude maize and rice fortification. these threecereal crops are the most commonly consumedgrains worldwide, and the fortification of eachrepresents tremendous opportunities to improveglobal health.

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Conference Report 2012Improving nutrition in Europe with flourfortification By Sabrina Montante

Common concerns related to flourfortificationCommon concerns about negativeconsequences of flour fortification areunfounded, said William Dietz, former director ofthe Us Centers for Disease Control andPrevention (CDC), Division of Physical activityand Obesity. He presented evidence that:

n Fortification does not cause people toconsume more than the tolerable upperlevels of folic acid and iron.

n Fortifying with folic acid does not causecancer or mask B12 deficiency.

n Fortifying with iron does not increase the riskof iron overload in people with betathalassemia.

n an approach that targets women to take folicacid supplements before conception is lesseffective than fortifying flour with folic acid.

n Unfortified flour has many ingredients addedand is not really 100% “pure”.

n Mandatory flour fortification preservesconsumer choice.

Federation for Spina Bifida andHydrocephalus (IF)Margo Whiteford, Vice President of theinternational Federation for spina Bifida and

Hydrocephalus and a Consultant Clinicalgeneticist, presented a photo description andscientific explanation of the different types ofneural tube defects.

according to research findings, almost 75% ofpregnancies affected by a neural tube defect areaborted. However most neural tube defects,such as spina Bifida, can be prevented if themother has at least 400 micrograms of folic aciddaily at least a month prior to conception and inthe early weeks of pregnancy. Children withspina Bifida very often develop hydrocephalus,some paralysis, pressure sores and incontinency.

Whiteford was born with spina Bifida and shedescribed spina Bifida’s physical challenges, aswell as the impact on family life, from herprofessional and personal experience.

in the age of global austerity, flour fortification isa wise investment. Children born with spinaBifida require a lifetime of medical treatment. inspain, the annual medical costs per spina Bifidapatient per year are €3,500. in contrast, fortifyingflour with iron, folic acid and other B vitaminscould cost €0.16 per person per year.

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Liven Bauwens, Secretary General, IFSBH; Francesco Branca, Director of Nutrition for Health and DevelopmentDepartment, WHO; Scott Montgomery, Director, FFI; William Dietz, former Director of Division, Centers for DiseaseControl and Prevention; Margo Whiteford, Vice-President, IFSBH; and Susan Horton, Chair in Global Health Economics,Centre for International Governance Innovation



the key topics of this workshop session duringthe European Health Forum gastein 2012 were:

1. Problems for the healthcare system incalculating the costs of treatment andrelated expenditure of diseases like diabetes.

2 Decision-making between patients anddoctors concerning dialysis or kidneytransplantation.

3 Ethical issues and the balance between theinterests of the donor and the recipient of theorgan.

it is very important to increase the population’sawareness of frequent diseases. Because manypeople do not know that they have kidneyproblems, they learn about the disease too late,when they must decide between dialysis or akidney transplantation. When they begintreatment they should be extensively educatedon the therapeutic options. this is necessary tofind the optimal therapy, based on personalpreference and on medical prerequisites. Healthauthorities should be encouraged to facilitatepatient education.

We do not know how many patients exist whoare unaware that they have renal disease. thisawareness is important not only for patients butalso because the health care system can’tpredict the potential costs of treatment.

Renal disease has many controversies, whichbecome apparent when the health of one persondepends on that of another. to find the rightbalance between the donor and recipient iscrucial. We must always remember that post-transplantation the donor is left with only onekidney – does this then mean this person is stillhealthy or is now also vulnerable? We mustconsider the potential health implications of this.

another problem is with the recipient, whoreceives a kidney, but the kidney does not lastforever, a successfully transplanted kidney lasts“only” about 15 years. after this time, the patientmust decide again between transplantation or

dialysis. thus post-transplantation, do we havetwo healthy people or two sick people, or maybetwo healthy people for a limited period of time?We should also take into account that finding adonor takes time.

When we consider the different methods of renaldisease treatment, we must also consider thedifferent costs. a study has shown thattransplantation of the organ is much more costeffective than dialysis. Costs of transplantationare around a quarter of the costs of getting adialysis, however dialysis is more accessible forpatients.

to summarise and conclude, people need to bemore conscious that they are suffering from arenal disease and efforts should be made toensure they start treatment earlier. the financialcrisis is a problem but also an opportunity. it is atime when we must pay attention to the best andmost cost-effective methods of treatment forpatients. it is a good time to analyse once moreall available treatments, and decide which ofthem are really beneficial. thus the crisis alsopresents possibilities to discover new ways oftreating diseases without redundant costs.

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Conference Report 2012Be aware of your kidneys By Joanna Smolinska

Erich Pohanka, Head of Medical Department, AKH Linz,Austria and Franz Vranitzky, former President of theRepublic of Austria



this workshop presented the very interestingtopic of disease prevention and the value of lifespan immunisation. the four speakers,representing different institutions and havingcompletely different backgrounds and education,spoke about the huge benefits of vaccination tochildren, adults and wider society; anycontroversial debate was missing. the sessionwas moderated by Karin Kadenbach, MEPaustria.

the issues of vaccination and immunisation ofindividuals are today more relevant than ever,one reason being because of growing migration.the question of costs in comparison to benefitsresonates strongly with the theme of this year’scongress: Crisis and Opportunity – Health in anage of austerity.

The debatethe main statement of the debate was: “We needvaccination and life span immunisation; we needeasier and cheaper access to vaccination in oursocieties around the world. immunisationextends the life of people and has a high valuefor society and protects communities againstcommunicable diseases. the informed behaviourof individuals and their position in relation toimmunisation is important.”

the debate centred, firstly, on the introduction ofand investment in vaccination in developingcountries. armin Fidler, Lead advisor HealthPolicy and strategy, World Bank, pointed out theproblems of the vaccination market: lowcompetition between producers, limited vaccine

supply (which leads to relatively high prices), veryhigh costs for vaccine development, and theavailability of cheaper vaccines for the wholeworld.

a second important question was also asked byFidler: how to achieve acceptance ofimmunisation as a prevention measure in Europe;and, further, if it should be fully paid as aprevention measure from a benefit basket.

David taylor, Professor of Pharmaceutical andPublic Health Policy, University College Londonschool of Pharmacy, underlined that vaccinationshould also be seen as a cost and optimallyeffective public health strategy. “immunisationconfers collective benefits within and betweenage groups, over and above individualprotection”.

Further key questions included: is drugresistance increasing the need for adultimmunisation? What value has vaccination forolder adults?

taylor pointed out the value of and opportunitiesfor immunisation:

n interventions that extend immune-system lifeexpectancy.

n Vaccines for use in treating different types ofcancer.

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Conference Report 2012Disease prevention By Alena Ottichova

Armin Fidler, Lead Advisor of Health Policy and Strategy,World Bank; Karin Kadenbach, MEP, Austria; andStephen McMahon, International Alliance of Patients’Organisations

David Taylor,Professor, UniversityCollege LondonSchool of Pharmacy

n Development of vaccines against infectiousdiseases, such as malaria.

stephen McMahon, international alliance ofPatients’ Organizations, said: “Vaccinationprevents diseases, saves lives and means socialand economical opportunity.” His perspectivewas that broad immunisation coverage was anecessary public health measure to protect allcitizens, and that the focus should not only be onchild immunisation.

Conclusions and recommendationsn Due to freedom of movement, we need more

coordination of vaccinations to reduceinconsistencies in vaccination policiesacross Europe.

n We need more protection and immunisationprogrammes and guidelines; and morecommitment from national governments andthe EU.

n We need more screening in vaccinations (inorder to provide a high security ofimmunisation).

n We need more information about vaccinationand more interest in promoting globalapproaches.

n Easier and cheaper access to immunisationis necessary all over the world.

n Common standards within the EU should bedefinitively guaranteed.

n We need coherent adult immunisation.

n We need continued development ofvaccinations.

n Local conditions need to be understood inorder to define optimal local policies.

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this vaccines workshop session was moderatedby Karen Kadenbach, MEP, who highlighted, thatdespite vaccines being a success story, theyoften seem to be a victim of their own success.she emphasised that nowadays people are oftenafraid to be vaccinated, due to social media andthe rapid flow of negative information.

the first presenter was Hildrun sundseth, BoardMember of the European institute of Women’sHealth (EiWH).

sundseth noted that this year three workshopswere held concerning vaccines and vaccination,which reflect the importance of the topic. in herpresentation sundseth emphasised theimportance of vaccination, which is the best toolto prevent infectious diseases.

Despite prior success – for example diseases likepolio nearly disappeared thanks to vaccination –the public is still sceptical and afraid ofvaccination. the main reason for society’s lack oftrust in vaccinations is because of the media.People are becoming increasingly hesitant toembrace vaccination, resulting in the potential foreradicated diseases to return. Having said this,sundseth noted that distrust in vaccination is nota new issue and has been present throughouthistory.

the main public health objective should berestoring public trust in vaccination. in order toachieve this objective, concerns should beaddressed early, accurate scientific evidence onbenefits and risks should be presented, and aclear strategy is needed. she also highlighted theproblem of the lack of leadership in vaccinationby the public health community. it is crucial toinvest in health literacy and EU action and acommon strategy is necessary.

the second presentation of the workshop wasgiven by gitte Lee Mortensen, an independentanthropologist, who provided an anthropologicalperspective on health related decision-making.

in her presentation Lee Mortensen underlinedthat the rational choice theory doesn’t alwaysseem to work in the health sector, because thereare many other factors which determine ourbehaviour. in the field of health people do notalways act rationally, for example lots of peopledon’t get vaccinated, despite vaccination beingeffective. she highlighted that rationality is oftensocio-culturally defined, and communicationtakes understanding. Using HPV (humanpapillomavirus) vaccination as the main casestudy, the approach to vaccination in Denmarkwas discussed in the presentation.

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Conference Report 2012Vaccines By Andras Borsi

Hildrun Sundseth, European Institute of Women's Health; Suzanne Suggs, Head, BeCHANGE Research Group,University of Lugano (USI), Switzerland; Karin Kadenbach, MEP, Austria; Gitte Lee Mortensen, Medical anthropologistand Research Consultant; and Boleslaw Samolinski, Professor, National Consultant in Public Health, Poland

the main message of Lee Mortensen’spresentation was that information campaignsand advocacy could have a large impact on thethinking of the public, and that HPV should notbe treated any more as a “girls only issue”.

the third presenter of the session was suzannesuggs, assistant Professor at Università dellasvizzera italiana.

the main topic of her presentation was therelationship between social media and trust invaccination: how can we use social media as aninstrument to restore trust in vaccination?

Urgent action is important, because of thecurrent situation: for example currently, morethan 250,000 people worldwide die annually fromcervical cancer, despite the fact that there is avaccination available against HPV, the leadingcause of cervical cancer. in the European Union,the HPV vaccination rate is higher than 80% inonly two countries, the UK and Portugal.

suggs emphasised that commercial media doesnot work on its own (but could be used for socialmarketing), but that social marketing with anecological approach is needed. she underlined,that social marketing is not equal toadvertisement, and a one size fits all approach isnot an appropriate strategy. social marketingoffers a coordinated approach, but it demands asophisticated understanding of the targetaudience(s).

the final speaker was Boleslaw samolinski,Professor, national Consultant in Public Health.

in his presentation samolinski summarised themeasures which have been introduced in Polandregarding HPV vaccination. in Poland, 1800people die of cervical cancer every year, which isa high number compared to other WesternEuropean countries. the main problems are lackof awareness and education, and the lack ofpopulation programmes on HPV vaccinations.the aim of an organisation called the PolishCoalition against Cervical Cancer is to improvethe current situation in Poland. the keyconclusion of the presentation was that strategiccooperation is needed between professionalsfrom different fields.

the main findings of the session were thatproviding information, setting up a clearmessage/strategy and improving health literacyis crucial in order to restore trust regardingvaccination. the presenters agreed that HPVvaccination should not be handled as a genderissue in the future.

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With its innovation Union strategy, the EuropeanCommission aims to enhance Europeancompetitiveness and tackle societal challengesthrough research and innovation.

the European Commission has identified activeand healthy ageing as a major societal challengecommon to all European countries, and an areawhich presents considerable potential for Europeto lead the world in providing innovativeresponses to this challenge. the pilot Europeaninnovation Partnership on active and Healthyageing aims to tackle this challenge throughthree areas: prevention and health promotion,care and cure, and active and independent livingof elderly people.

the overarching target of this pilot partnershipwill be to increase the average healthy lifespanby two years by 2020. this will foster innovationsin products, processes and services, and inparallel facilitate the innovation chain and reducethe time to market for innovative solutions.Ultimately this will produce benefits forinnovation’s final users – the older people andcare providers. in a time of austerity the need forinnovative solutions to healthcare challengesbecomes ever more important.

the objective of the workshop was to use theEuropean Health Forum gastein 2012 as anopportunity to showcase a number of projectscommitted to running activities contributingtowards the target deliverables of each specificaction.

Action plan on finding innovative ways toensure that patients follow theirprescriptions and treatmentsstefano Vettorazzi, aPss trento, italy

Hospital care systems, primary care systems andpersonal health record systems integrated into athree stage eHealth system. all patient recordsare freely accessible to all citizens upon request.this system can be used to monitor chronicconditions such as diabetes remotely in olderpatients. the creators of the (fully operational)software are offering to give it away for free to

those countries within the partnership through asystem of mutual sharing of experiences.

Action plan on finding innovative solutionsto better manage our own health andprevent fallsteresa Moreno-Casbas, nursing and HealthcareResearch Unit, institute of Health Carlos iii,spain

Falls are the main cause of injury amongst olderpeople leading to physical disability and fatalinjury. this action plan aims to bring together theworld of research, iCt and health care providersand thus get promising solutions implemented.

the three groups of activity in this action plan arethe collection of data on risk factors, incidenceand costs of falls. the plan details models andtools such as implementation of guidelines, iCtand education and the outlining of service carepath models and offering iCt and technologicalsupport. at present eight care centres haveimplemented best practice guidelines related tofall prevention and the monitoring and evaluationof health outcomes. these models and toolshave proved transferable as the project is part ofan international collaboration using mobile apps,guidelines and outcome indicators.

Action plan on helping to prevent functiondecline and frailty Miriam Vollenbroek-Hutten, Roessingh Researchand Development BV, the netherlands

Old people who remain healthy liveindependently and incur fewer health and socialcare related costs. Frailty and functional declineare a problem in all areas of physical, cognitiveand mental functioning. the action plan hasreceived the commitment of thirty differentinstitutes focusing on extramural diagnosis,monitoring, coaching and treatment of frailty. thedraft action objectives focus on the developmentand implementation of sustainable multimodalinterventions for the prevention andcomprehensive management of frailty andfunctional decline.

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Conference Report 2012Active and healthy ageing By Dorothy Gauci

Action plan on promoting integrated caremodels for chronic diseases, including theuse of remote monitoring george Crooks, Director of the scottish Centrefor telehealth & telecare, scotland, UK

this action plan was pushed by the desire forsafe, effective, person-centred care. the actiongroup are determined to continue deliveryagainst real targets. the long-term focus is tosecure commitment and encourage newparticipants – scaling up across Europe. theaction group applies key tests to all collaborativeactivities and will lead to the development of arepository of best practice to help dissemination.the aim is to provide incentives to industry toinvest in the EiP agenda – as true partners. thefocus is on the implementation of electronic caserecords and teleservices. there is a need forchange management, workforce training andstratification of risk factors.

Action plan on deploying ICT solutions tohelp older people stay independent andmore active for longer andy Hull, Director of stakeholder Engagement,Liverpool Primary Care trust, UK

Use empowerment to support people at home tolead active, healthy and independent lives bydeploying interoperable independent living

solutions. improve knowledge, confidence anduse of life enhancing technology to put people incontrol of their care and health. For exampleLiverpool One is a smart house where one cantry equipment with health trainers on hand whocan show how it works. standards, guidelinesand reference platforms developed between5000+ users in 5+ countries focused on creatinga practical and sharable tool kit.

Action plan on promoting innovation forage-friendly and accessible buildings,cities and environmentsJoan Martin, Louth County Council, ireland

a cross-cutting action plan involving regions andcities implementing age-friendly practices. it isbuilt on research and evidence for spatial contextand smart environments encompassing buildingsand outdoor spaces, transport, housing,healthcare, social participation, communicationand social inclusion. the focus of similarstrategies should be on the importance ofengaging older persons – asking them what theywant and need.

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George Crooks, Director, Scottish Centre for Telehealth and Telecare; Teresa Moreno-Casbas, Institute of Health, CarlosIII, Spain; Marjon Vollenbroek-Hutten, Roessingh Research and Development BV, The Netherlands; John Dalli, former EUCommissioner for Health and Consumer Policy, European Commission; Joan Martin, Louth County Council, Ireland;Stefano Vettorazzi, APSS, Trento, Italy; Andy Hull, Director of Stakeholder Engagement, Liverpool Primary Care Trust;and Robert Madelin, Director General, DG CONNECT, European Commission



the main topic of this workshop session was thelink between new science, current healthcaresystems and patient benefits, in order tounderline the way science is changing. newways of collaborating in scientific research arerevolutionising results and outcomes. newfindings are leading to a reclassification ofdiseases, which is consequently changing theway patients are treated and healthcare isdelivered.

the workshop was moderated by trevor Jones,Director of allgeran inc., who opened the debateby asking how scientific progress could actuallylead to patient benefits.

Is the contract between society and thepharmaceutical industry up for renewal?Michel goldman, Executive Director at theinnovative Medicines initiative (iMi) showed therationale behind the creation of iMi: public-private partnerships like a solution for theconnection between new science and healthsystems. it allows “non-competitive”collaborative research for European Federationof Pharmaceutical industries and associations(EFPia) companies, with data sharing and widedissemination of results. the principal objectiveis to better involve patients and facilitate growth,in order to create concrete patient benefits fromscience.

the role of the UK national institute for Healthand Clinical Excellence (niCE), was presented byCarole Longson, Director of the Centre for Healthtechnology Evaluation, niCE, describing its aimin sharing good practice as well as evaluatingcost-effectiveness for medicines that haverecently been or will soon be authorised in theUK. she stressed the debate about the definitionof “value”, based on a consultation processbetween academics, patients and industries. theniCE challenge is to achieve a cost-effectiveapproach, assuring systems sustainability andmaintaining an environment friendly towardsindustry.

Jim attridge, Research Fellow at imperialCollege, UK highlighted the issue related to

European weaknesses to incentivise industrialinnovation, showing some concrete examples.innovation is a long-term incremental processwhile, especially in the current economic andhealth systems funding crisis, European marketsfavour short-term results. He underlined threeaspects that could improve the situation inEurope and promote innovation: increaseresearch findings, reduce development expensesand adapt 27 Member states regulationstowards innovation.

sascha Marschang, Policy Coordinator forHealth systems, introduced the European PublicHealth alliance (EPHa), a network representingthe public health community with the vision of“…a Europe whose policies and practicescontribute to health, both within and beyond itsborders.” He stated that innovation is driven byprofit for pharmaceuticals, including public-private partnerships, but it is necessary todevelop a more sustainable, socially responsibleand innovative model that allows for the concreteinvolvement of patients and an increasing publicinterest. He proposed that an initiative likeHorizon 2020 could help in achieving theobjective. there was a very interesting debate onproblems related to innovation and possibleways to improve its sustainability, with activeaudience involvement. it was noted that in thecontext of the transparency directive, allpharmaceutical data will have to be accessible topatients and industry needs to continue workingtowards the increased involvement of patients.

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Conference Report 2012New science and future healthcare By Maria Chiara Orlandi

Sascha Marschang, Policy Coordinator for HealthSystems, EPHA

Discussion and conclusionthe necessity of a new global research agendawas underlined, together with collaborativeefforts at a global level to develop more cost-effective medicines and healthcare systems.goldman pointed out that the iMi allows closecooperation and shared experience betweeninstitutions and stakeholders.

the debate moved to pharmaceutical costs anda member of the audience argued that ifmedicines were cheaper, volumes wouldincrease and the pharmaceutical industry wouldnot see its revenue decreased, nor wouldmanufacturing plants be relocated to india andChina. attridge answered that a lot of money andjobs moved to generic industry since 80% ofdrug consumption comes from generics withindian and Chinese manufacturers.

Other topics discussed related to the length oftime patients were required to wait to receive thebenefits from innovation and the need for risksharing and data sharing as a means ofimproving capacity for innovation.

the session was eventually closed by Jones whopointed out that in order to improve innovation inthe pharmaceutical sector we need to establishpriorities. in the current age of austerity the focusshould not be addressing the value of innovation,and the way it can be assessed, the key topic israther to allow society to fund and affordinnovation.

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the current financial, economic and social criseshave resulted in substantial cuts to someEuropean healthcare budgets. these remarkablebudget constraints are likely to impact oninnovation in healthcare as well as increasinghealth inequalities and threatening well-being.new models and new business approaches forinvesting in health are required to supporteconomic growth and Europe-based research.

the aim of this workshop session was to reflecton the current situation and to sketch outconcrete future perspectives which will helpimprove citizens’ health, ensure equity andprotect Europe’s innovation and competitioncapacity. the workshop focused on how newbusiness models can stimulate investment andgrowth and how equity, patients’ rights andresponsibilities can be balanced.

Investing in health, increasing equity andwealththe experienced panel was chaired by tamsinRose, an independent EU Health advocate. aftera short introduction round Josep Figueras,Director of the European Observatory on Health

systems and Policies, set the scene by definingand contrasting the terms sustainability,innovation and equity in relation to healthsystems. He pointed out that following the recentwork of Paul Krugman, Professor at PrincetonUniversity, larger welfare states (for example,sweden or germany) might be better performersin times of economic crisis which means thatinvestments in particular in health strengthen theeconomic power of countries. Moreover cuttinghealth expenditure may lead to increasing healthinequalities and can be a source ofdissatisfaction and precipitate a deterioration inthe social climate.

Health systems undoubtedly create wealth. thisbecomes apparent by the economic size of thehealth sector (10% of gDP within EU) or labourmarket effects of healthcare (6% of all workers inthe EU). additionally the R&D and innovationdriven pharmaceutical and medical technologysector is constantly growing in the EU (~1.2million jobs). However innovations in bothsectors have to show their cost-effectivenessand should be accessible for all social classes.Otherwise the acceptance of the need forinnovations decreases. additionally new

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Conference Report 2012Health and wealth By Alexander Geissler

John F Ryan, Head of Unit, DG SANCO, European Commission; Tamsin Rose, Independent Health Activist; Nicola Bedlington, Director, EPF; Anders Olauson, President, EPF; and Claude Perol, Sanofi

business models have to be established toensure that pharmaceutical R&D also generatessolutions for rare diseases which are oftenconsidered as less profitable from amanufacturer’s perspective.

Panos Kanavos, Reader at the London school ofEconomics, discussed some reflections on thesustainability of health systems financing. Heshowed results from a survey in which therespondents (n=366) would prefer morerestrictive purchasing of medical technology andan increase in sin taxes in order to achieve moresustainable healthcare financing.

Representing the European Commission, John FRyan summarised that times of crisis oftenpresent a good opportunity for breaking upexisting patterns. Crisis should therefore not onlybe seen as negative. When discussing new waysof providing healthcare, patient needs should beincorporated more than ever. this means that theempowerment of patients including initiatives toincrease patient literacy should be strengthened.

Moreover prevention (for example, early cancerscreening, vaccination campaigns) should play amore important role. Currently in Europe just 3%of gDP is spent on prevention and 10% onhealthcare. in order to avoid hospital stays andphysician visits, budgets might be rebalancedfrom healthcare to prevention taking also otherpolicies (for example, education, environment)into account.

Ryan announced that in the future the EuropeanCommission will make use of the Europeansemester in order to review national health

policies and budgets. By doing this, theCommission wants to sensitise member states toconsider upgrading their health systems insteadof investing in e.g. infrastructure projects.

Claude Perol, sanOFi Vice President for Centraland Eastern Europe, advocated a change ofmindset, arguing industry is part of the solutionand should be more incorporated in decisionsand discussions. as health is not a cost butrather an investment in the community, nationalgovernments and the European Commissionmight think about an industry policy for the lifescience sector. For example internationalreference prices can help to face the priceproblems which lead to inequalities andinefficient cross border circulation of drugs withinthe EU.

the discussion at the end of the workshopshowed that health expenditures should not beseen as costs but as investments and whenconsidering decreasing, restricting or at leaststabilising budgets for health we have toredesign our thinking, taking into account shiftingbudgets towards prevention and other sectorslike education. Furthermore new businessmodels have to be invented in order to makerelatively cheap solutions profitable and toincentivise industry to develop products for rarediseases.

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While the discipline of health economicsprovides a growing body of evidence on whatshould be done in health policy, it sometimestakes decades for a country’s healthcare systemto adopt these findings. numerous obstacles lieon the road from science to practice, and manyof these can be found in the political processes.

the aim of this workshop session was toexchange experiences gained in variouscountries that have undergone major reform orare in the process of doing so. Presentationsfocused on examples and lessons learned in thisfield. Participants from austria, the netherlands,norway and Poland presented examples fromtheir home countries and analysed the relevantfactors, with the OECD providing an outline ofthe bigger picture.

Getting health reform donethe workshop started with an introduction to thecommon challenges for healthcare systemsacross Europe. in contrast to former years, whenreforms proposed by stakeholders mainlyaddressed only changes in the “other side’s”jurisdiction, empty coffers and continuous effortsby health economists seem to have broughtabout a change towards more holistic reformapproaches. the chance for profound healthcarereform has probably never been better thantoday. nevertheless, the stakeholder landscapeis problematic.

Austria

Peter Brosch, Head of Department, FederalMinistry of Health: Despite its small size of onlyeight million people, austria has numerousplayers in its healthcare system with both federaland provincial levels holding legislative powers inthis area.

the para-fiscal bodies mirror the federalisticorganisation of the country, with 19 sicknessfunds and their federal association. Professionalbodies, first and foremost the Chamber ofPhysicians, have a strong influence on politics aswell. Only by understanding all these factors

does it become obvious why it is hard to gethealth reform done in austria.

Health economists in austria have for a long timedemanded considerable structural change inorder to make the country’s healthcare system fitfor the imminent demographic changes. Despitescientific evidence, most money is spent onhospital care that is poorly integrated with otherareas. specialist care is provided dually inhospital departments and in the outpatientsector, with fragmentation in financing.

The Netherlands

ilaria Mosca, Professor at the institute of HealthPolicy and Management, Erasmus UniversityRotterdam: the netherlands on the other handhas introduced a new system of healthcareinsurance based on risk equalisation through arisk equalisation pool. in this way, a compulsoryinsurance package is available to all citizens ataffordable cost without the need for the insuredto be assessed for risk by the insurancecompany. Furthermore, health insurers are nowwilling to take on high risk individuals becausethey receive compensation for the higher risks.

the 2006 Dutch healthcare reforms were theproduct of nearly two decades of discussion inresponse to a number of problems that manyhealthcare systems in Europe are very familiarwith: a two-tier system of private healthinsurance for the rich and state coverage for therest; inefficient and complex bureaucracy;lengthy waiting lists and a lack of patient-focus.

the health insurance reform in the netherlandsis a rather fascinating example of cross-countrypolicy learning. some key features of the Dutchreform such as the introduction of a universalhealth insurance system, mandatory coveragefor the entire population, tax-financed premiumsubsidies for low-income consumers andvoluntary deductibles can also be found in theswiss health insurance system. Evidence of theimpact of the Dutch healthcare reforms is still notclear, although the introduction of a single healthinsurance system has certainly provided

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Conference Report 2012Healthcare financing By Sabrina Montante

consumers with more transparency. the ratherarbitrary past separation between social healthinsurance and private health insurance has beenabolished. the distinction between public healthinsurers and private health insurers hasdisappeared. as a consequence, all consumersare able to choose between all insurancecompanies on the market. the new healthinsurance scheme is compulsory for allinhabitants of the netherlands although there isno control mechanism to seek out individualswho fail to take out health insurance.

Norway

tor am, Director general, Ministry of Health andCare services: integration policy has been highon the agenda for norwegian health authoritiesduring the last decade and despite the numerouschallenges major national policy initiativesconcerning cooperation have been promoted.

in June 2009 the Coordination Reform waspassed by the norwegian Parliament. this reformrepresents a shift in perspective away from theoperational to the administrative level andappeals for the need for economic ororganisational reforms. it pointed at theconsequences of demographic changes forhealth care utilisation and proposed majorstructural reforms to reduce the demand forhospital services.

Key features of the Coordination Reform are twowell-known strategies put forward in many healthsystems: (1) more patients should be taken careof in primary health and long-term care insteadof being referred to hospital for treatment; and (2)discharge from acute hospitals should take placeearlier.

Poland

Cezary Wlodarczyk, Head of Health Policy andManagement Department, Jagiellonian Universitydiscussed the recent healthcare reforms inPoland. On 14 October 2010 the Polishgovernment approved two key pieces of itshealthcare reform package: the HealthcareProvision act and the Reimbursement act. theformer is among other things intended to

strengthen incentives for the commercialisationof public healthcare entities, while the lattercontroversially introduces fixed mark-ups andprices for reimbursed medicines.

International perspective

the last presentation from the OECD Head ofHealth Division, Mark Pearson provided thebigger picture and summarised the factors thatcommonly lead to healthcare reforms. theprocess of reform design and implementation ina health system should start with an evaluationof the performance of the health system, tryingto identify the gaps and needs for structuralchange. Data are often lacking at all levels ofgovernment and political discontinuity does nothelp the reform process which is normallyslowed by political turnovers. incentives play amassive role in getting reforms agreed. Despitethe financial constraints health reforms don’thappen in recessions.

in line with factors highlighted by Pearson at theend of the workshop an attempt was madetogether with the audience to draw conclusionsfrom these experiences that might be relevantand transferable to other countries.

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Cezary Wlodarczyk, Head of Department, JagiellonianUniversity, Poland


this session of the European Health Forumgastein 2012 summed up topics we have heardabout in other workshops: public procurementfrom the private sector and austerity and healthservice innovation. Public-private partnership(PPP) is a new topic that can bring solutions tothe problems discussed.

The economic crisis, the health sector andwhy you should be worriedin the future, funding by governments, includingfor health systems, will be restricted. austerity isarguably not the answer, but few seem to have abetter idea of how to best respond. We need todefine “the economic crisis” and estimate howlong it is going to last, so that the health sectorcan respond to measures of austerity. the crisisin 2009 has gone deeper than the crisis of 1929.at a global level the situation is improving but ifyou look at the West it endures and there havebeen huge costs associated with it. there is noconsensus from economists about the roots ofthe crisis, but there are some common themes:

Inbalances: some countries (eastern countriesand emerging countries) had big surpluses. theyexport more than they import. this capital wasnot used productively, but went into housing, forexample in the importing countries. at thismoment in time the imbalances still remain.

High public and private debt: public debt is greatand is still increasing. Private debts have riseneven higher and have gone into bad investmentsand income. Countries with public and privatedebts have lower economic growth.

The retirement of the baby-boomers.

We should probably look at a mixture of reasons.

What do new generation PPP-modelsneed to deliver?all definitions have in common that they includerisk-sharing between public and private partners.Features include: private finance, bundling, payfor performance and long term contracts (25–50years). new models of PPP need to be: flexible,able to embrace and stimulate innovation,

efficiently allocate risk between private and publicorganisations, have contract completeness.

We can conclude that:

n PPP is here to stay, because there is a needfor investment in healthcare infrastructure.insurance companies, pension funds andsovereign wealth funds need stable andlong-term investment and PPP can bringgovernments desirable public policyoutcomes.

n there has been limited evaluation of PPPmodels. More analysis is needed.

n Decision-makers need better understandingof elements of effective PPP design.

n it is possible to expand PPP frominfrastructure to healthcare services.

Financing future health infrastructuresthe European need for infrastructure investmentwill be €1.5–2.0 trillion from now to 2020. thefinancing of infrastructure projects has beendone with long-term bank loans. the ‘Basel iiiframework’ outlines that banks need to havemore capital. to reach that, banks need to sellassets. the concepts of long-term financing andlong-term lending have almost vanished.

in the Europe 2020 project bonds initiative,bonds are launched for the financing ofinfrastructure projects in the transportation, iCtand energy sectors. the European Commissionwill be sharing the risk. insurance and pensionfunds have €8.73 trillion to invest and need toinvest in stable and long-term bonds. thisinitiative will be operational in 2014. the EUproject bonds initiative does not include thehealthcare sector. if €50 million were invested, itwould be able to realise new investments ofabout €800 million. it could be of interest to theEU and its citizens to get the healthcare sectorinto the EU Project Bonds initiative.

the European Directive solvency ii frameworkwill start in 2013. the aim of the framework is toensure financial stability by insuring transactions,and it will allocate capital to each risk activity.

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Conference Report 2012Public-Private Partnership By Andras Borsi

Modern health service delivery andinnovationEverywhere in Europe hospitals are moving intoprivate forms of management in order to improveperformance, confront patient demands, reducecosts and respond to demographic pressures,improve technology, and in response to pressurefrom different stakeholders.

if we can find a way to combine robust financingwith the efficiency we see in the private sector,gains will be bigger. there is space for theprivate sector, if European governments providethe right regulation. the public sector shouldcontinue to provide personal care and populationservices but should not be the only one to do so.

there are theoretical problems inherent in PPPbut there are bigger problems in the public sectorbecause of a lack of incentives, outdated modelsof care and irrational ways of working. it is as yetunknown how to resolve these problems.

Conclusionsthere has been a certain chain of reasoningpresented in this session. it does not need to bea shared one. it gives an insight into the futureand possible solutions.

the crisis is going to last for a long time and theMember states are not going to be able to fundnormal operations in the health sector. PPPmodels are used to get private sectors to deliverservices. it appears that wider models thatbundle more services seem to be more efficient.Before we are able to make widespread use ofthem, we need to realise new payment modelsand move from banks to institutional investorsthat can support capital investment.

Health services across Europe can be moreefficient. in the state controlled sector ofhealthcare we need to look at an appropriate anddesirable use of the private sector. We do needstewardship and governance procedures.

Questions and remarksDo we need private financing and private deliveryof care? Public financing should be preferentialand/or in the majority to guarantee solidarity,equity and be social. But there is no reason for itto be exclusively public. the private sectorknows how to solve problems.

What is private? it can be for profit or not forprofit. Both seem to work. Depending on theobjectives, issues at stake and the values of the

society you should look at the range of options.

When PPP goes wrong, public money pulls outof the project not private money. there areunacceptable examples. though private sectortools may be able to do more with less there isno reason why the health sector should not usethis knowledge.

PPP is a tool not a target in itself.

PPPs are automatically linked to financing butshould be linked to efficiency. to be able torealise the gains needed you need to linkfinancing to efficiency.

PPP is discussed from a public not private view.

We have 30 years of experience of PPP, why dowe still not know what works? Public sectorshave not been monitoring what goes in and whatcomes out. We do know what mechanisms havean impact but not always how or exactly in whichway. We need more robust evaluation.

In many countries PPP is used as hiddenprivatisation.

Some areas of the health care sector havealready been monopolised by private companies.

Final remarksn We need to have more discussions on PPP

so we understand the different aspects of it.

n We should be looking for the opportunities ofPPP.

n the health sector needs to get out more! it istoo self-focused. When talking about thefuture it is done only from a health sectorperspective.

n We need to understand the limits of oursystem and look at other systems like theamerican system.

n We need to talk more about the privatesector financing the healthcare sector fromwithin.

n External driving factors bring about changesto public health. Over the last 20 years therewas no crisis or catastrophe, so there hasbeen no change. now we have a crisis andchange can happen.

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all presenters and stakeholders agreed that goodgovernance is essential for ensuring a highquality and efficient health system, especiallyduring a time of financial crisis, the main topic ofthe conference. the conundrum betweensustainability, innovation, quality and solidaritycannot be solved unless elements of goodgovernance are in place, as simply cutting costswithout a vision may have disastrousconsequences. accountability and transparencyalso came high on the agenda thanks to thefinancial crisis so it can and should be seen asan opportunity.

But what exactly does governance mean? is itthe same as stewardship?

the chair of the session, Hans Kluge, Director,Health systems and Public Health Division, WHORegional Office for Europe suggested thatinstead of focusing on the terms only, it is moreimportant to discuss the elements and specificsof effective steering and governing.

Does governance contribute to asustainable health system?speakers from the World Health Organization –Juan tello, Programme Manager, Health systemgovernance, Health systems and Public HealthDivision; alejandra gonzalez Rossetti, senioradvisor, Health system governance, Healthsystems and Public Health Division and JosepFigueras, Director of the European Observatory

on Health systems and Policies, presented theircurrent work on health system governance with afocus on health system strengthening.

they argued that only by strengtheninggovernance will it be possible for those in chargeto deal with the increasing pressures to sustaindepth, breadth and width of coverage withintighter fiscal boundaries and the increasingdemands and needs of the population. at thesame time, there is an opportunity to seekefficiency gains through innovation andhealthcare reorganisation as cutting costs witheasy to implement measures (for example, costsharing through user fees, limiting benefits) is notsustainable.

aligning the proposed three functions of healthsystem governance – priority setting and policydevelopment, organisation and management,accountability and performance monitoring andevaluation – is essential for success. Each ofthese three functions consists of a number ofprocesses that lead to concrete outcomes.

speakers also stressed the importance of strongstewards (i.e. Ministries of Health) and a levelplaying field. Findings from a number of countrycase studies looking at governance for patientsafety were also presented. Health safety shouldbe considered a system issue, not only theproblem of an individual provider – we shouldlearn lessons from other sectors (for example,the aviation industry).

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Conference Report 2012Governance By Lucia Kossarova

Alejandra Gonzalez Rossetti, Senior Advisor, Health Systems and Public Health Division, WHO/Europe

the case studies provided usefulrecommendations for countries on how to bestalign existing institutions, skill sets and functionsto ensure better coordination, implementationand overall governance of health safety. thestudies also showed that countries have differentcultural and institutional set ups which providefor different tools and mechanisms ofgovernance. While comparability is limited, allcountries have a range of old and newinstruments to carry out effective governance.

Ludovica Banfi, Programme Manager from theEuropean Union agency for Fundamental Rights,presented the results of a patient survey on“equality in quality” where users and patientsbelonging to a minority group (for example,ethnicity, disability etc.) were interviewed aboutaccess to and quality of healthcare services.

the study identified a range of barriers to access(for example, unequal entitlements, language andcommunication, financial, lack of informationabout entitlements, organisational andaccessibility, supply side barriers, cultural andpsychological barriers) as well as forms of unfairtreatment and direct discrimination (delay intreatment, refusal of treatment, lack of dignityand stereotyping, malpractice and poor quality ofcare, lack of informed consent and harassment).

Finally, the study looked at the causes ofunderreporting including lack of knowledge, lackof belief in the effectiveness of the system, fearof victimisation, complicated systems, lack ofaccess, negative attitudes towards complaints,time and effort involved. actions needs to betaken to improve access and quality of careprovided to these minority groups.

ConclusionFirstly, the importance of an appropriate skillsetand institutional capacity to achieve effectivegovernance was discussed. it was noted by oneof the speakers that skills are becoming less andless generic and much more is needed thanparticular qualifications to carry out a jobeffectively. it is essential that highly qualified

people are hired but also retained in the publicsector. Continued integration of qualifications,diplomas and other standards at the EU level areimportant to help countries move towardseffective governance.

trust in Ministries of Health was also the subjectof a heated debate, especially as we live in ageneral climate where there is a lack of trust inthe democratic process and governments. Howdo you make governments part of the solutionagain, not part of the problem? How do weconvince people that governments matter? asministries are the impersonation of a mandate bytheir voters, there is no shortcut and we mustinvest in institutional capacity to allow them tooperate to their best potential. it is essential thata culture of integrity and transparency is builtwhere the public is listened to and also feels thattheir voices are heard.

Finally, the patient should be part of the solutionand not the problem. He or she should be thesteward of the system, not the victim. Patientsand citizens should be put in the centre of thedebate. But how can we best achieve that? Weneed agents for the patient such as improvedinvolvement of patient organisations. Whenprioritising, cutting costs or implementing otherimportant changes, we need to ask for theopinions of those who are affected. thenperhaps the right changes can be made andthose services are cut that the patient canhappily live without.

the session ended on a positive note. We shouldlearn from the many excellent country examplesthat exist. investment in institutions does have atangible impact on efficiency gains andsustainability and should therefore be high on theagenda. and last but not least, let’s allowpatients to make the best policy choices.

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Childhood vaccination is the basis of publichealth medicine. However, last year there were30.,000 cases of measles, which is a vaccinepreventable disease. For example, the HPVvaccine is a very safe vaccine for girls but its rateof uptake is still low and we need to investigatewhy this is the case. Complacency, convenienceand confidence are three barriers to vaccination.the first two can be dealt with by using socialmedia.

Pros of using social median social media can play a role in reaching

vulnerable populations and influencing thepublic.

n the capabilities of social media includedistribution and re-distribution ofinformation, peer-to-peer contact, speed ofdistribution of information and a wide rangeof coverage. it offers an immediate means ofcommunication rather than the lengthyprocesses involved when using traditionalmeans of communication, such as issuing apress release.

n Posting and blogging on social media ischeap and therefore ideal for use during atime of financial crisis.

Cons of using social median People trust the information they find on the

internet and they don’t differentiate betweeninformation that is evidence-based andinformation that is not.

n there are limited ways as to how one canretract and control the information that isreleased.

n For publishers, posting research findings onsocial media does not create much directincome, therefore their interest in this areamight be limited.

What needs to be done?Training of public officers to enable them to bemore proactive and engage in debates on social

media, rather than hiding behind previouslyreleased official statements.

Training of the team that is using social media, toenable understanding and participation on socialplatforms. Employees should be given thefreedom to try these social platforms and interactwith the target group, using a no-blame policyduring a formal training period.

Creating accounts with the different socialnetworks and updating them regularly to make itinteresting for the target population to sign-inand visit these accounts often.

Points to bear in mind when using socialmedia to promote vaccinationn Understand the dynamics of social networks

and social behaviour. Remember thatscientific facts mean nothing whenperception rules.

n Map all influencers - find out who are thepeople delivering the wrong messages toyour target audience. Know who is behindthese messages to understand how to dealwith them and be willing to agree todisagree. Carry out communication anddialogue profiling of the target audience tofind out where the gate keepers and agentsof change lie within the target community.

n Use analytic tools to do real time monitoringof all the vaccination campaign relatedmessages which are being featured on socialmedia. this will enable you to do yourresearch and know the facts before thepublic starts approaching you with queries.

n When blogging, enter and engage into aconversation, don’t just provide informationif you want to gain the user’s trust.

n take advantage of the fact that mainstreammedia pick-up messages from social mediato create the peer-to-peer effect, therefore,ask people who have been vaccinated toreact to messages in the media and sharetheir experience.

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Conference Report 2012Vaccination and the role of social media By Amanda Saliba

n Understand the language being used by yourtarget audience.

Future projectsVaccination tracker – plug-in gender, age andlocation and the user will have an immunisationcalendar on his smart phone or tablet, to keeprecords of his/her children’s immunisation.

Online Vaccine Rumours by country – an ongoingproject. a programme that traces online rumoursrelated to vaccines according to the country oforigin. Results so far show that the Usa and UKare the leading sources of these rumours.

Conclusion30% of the EU population don’t have access tosocial media. therefore, a mix of tools is neededto reach everyone. social media shouldcompliment not replace traditional media. Weneed a good business case to ask policy makersto invest more money in social media at theregional and national level, during a time ofausterity. this could be done by presentingpolicy makers with the advantages and benefitsof using social media and with examples thathave worked, such as the use of social media topromote HPV vaccination in the netherlands.

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Marc Sprenger, Director, ECDC, opening the lunch workshop session



the key topic of this lunch workshop sessionwas to highlight the way healthcare systemscould ensure access to financially sustainableinnovations. such access could be improvedthrough the adoption of a mechanism likedifferential pricing. the issue has been discussedfrom the point of view of different stakeholders,including academics, regulatory authorities andpatient organisations in order to provide acomplete overview.

Pavos Kanavos from London school ofEconomics showed the theoretical and empiricalimplications of differential pricing for prescriptionmedicines, underlining the point that the keychallenge is to balance different needs withinEurope, including:

Governments to control pharmaceuticalexpenditure.

Patients to get an equitable and rapid access tomedicines throughout the EU.

Industry to be rewarded for innovation and tofoster R&D, in order to have a competitive anddynamic market in Europe.

the economic principle is the third degree (multi-market) price discrimination, linked directly toconsumers’ willingness and ability to pay for agood or service. it means that the prices chargedmay bear little or no relation to the cost ofproduction. Ramsey-Boiteux pricing consists ofmaximising the total welfare under the conditionof non-negative profit, that is, zero profit.

as per policy implications, the issue for Europe isa balance between static efficiency, which seeksto maximise welfare by attaining the highesthealth gain from today’s expenditure at thelowest possible cost, and dynamic efficiency,that stands for incentivising R&D throughreasonable returns with a view to seekingtreatments and eradicating disease in the future.Currently greater attention is given to static thandynamic efficiency and re-balancing that focusmeans exploring further price differentiationoptions.

Reconciling innovation and sustainablehealthcare systems – what next forEurope?Differential pricing, generated from the dualismbetween innovation and sustainability, wasdiscussed by David taylor, University College,London school of Pharmacy, with a presentationabout the case for Ramsey-Boiteux pricing in thecontext of intellectual property (iP) protectedpharmaceutical products, taking intoconsideration medicines’ costs, values andprices.

Medicines are considered to be unique hightechnology products, difficult and risky todevelop and easy to copy; they normally havehigh fixed development costs and low marginalproduction costs and can be regarded asspecialised global “public utility goods”. For suchproducts, iP law grants temporary monopolies toprotect public interests in research investment,taking into account the amount temporarymonopolies should charge for new medicines.

in this context, Ramsey-Boiteux pricing theoryprovides a logical case for differential pricing,with poor markets being supplied at marginalproduction costs while the affluent are chargedat the maximum level they will bear. theunderlying objective is therefore to maximisepresent collective welfare while incentivisinginnovation for the future. Differential pricing has apotentially important part to play in the twenty-first century global pharmaceutical market,nevertheless optimising its contribution willrequire a more mature and better natured publicpolicy debate than has to date been achieved.

innovation sustainability was illustrated from thepoint of view of a patient organisation by nicolaBedlington from the European Patients Forum(EPF), which is the umbrella organisation of pan-European patient organisations active in the fieldof European public health and health advocacy,acting in the interest of over 150 patients withchronic diseases.

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Conference Report 2012Innovation and sustainability By Maria Chiara Orlandi

among other EPF initiatives, Bedlingtonhighlighted a recent conference on healthinequalities in the new EU member states,entitled “Policy makers and patients – creatingthe change”, that took place on the 20–21september 2012 in sofia, with representativesfrom Eastern European countries in attendance.

the objective of this conference was to create anopportunity for patients and policy makers todiscuss needs and gaps in national healthcaresystems, through patient experience andexchange of best practice.

in order to curb health inequalities in the EU,innovation should go hand in hand with solidarity.the application of External Reference Pricingshould be objective and transparent, in order toprovide opportunities for assessing its effects,make decision-makers accountable, reduceuncertainty for the pharmaceutical industry anddiminish the risk of discrimination and corruption(as also reported in the WHO-Hai Report 2011).

Pricing pharmaceuticals by gDP/capita couldencourage fairer and swifter access toinnovations across Europe and bring forward areduction in significant and growing healthinequalities. to achieve the objective an essentialrequirement is a commitment to transparency;there is indeed a requirement for both a cultureof solidarity and trust across countries and

among stakeholders.

Differential pricing issues were eventuallyanalysed from a Competent authorityperspective by stanislav Primožič, representativeof the agency for Medicinal Products andMedical Devices of the Republic of slovenia.

there are some weaknesses to take intoconsideration since it is a model not yet tested inan EU pharmacy environment with an unclearlevel of political consensus. Moreover, there is awide diversity of EU pricing and reimbursementregulation and practices, in addition to theadoption of the Hta model still underdevelopment.

Making the differential pricing idea fullyfunctional requires removing loopholes ofExternal Reference Pricing, ensuringtransparency of price determination, establishinga scientific theoretical basis and approachinghealth technology products in a selective way.the expected benefits are many, from enablingaccess to innovation to increasing the absolutesize and volume of the market.

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Nicola Bedlington, Director, European Patients’ Forum



the key topic in this session was the role ofCorporate social Responsibility (CsR) in thecurrent context of financial crisis and constrainedhealthcare budgets.

is CsR an opportunity or an additional cost? ingeneral, CsR can be defined as a corporateinitiative to assess and take responsibility for thecompany's effects on the environment and itsimpact on social welfare. the term generallyapplies to company efforts that go beyond whatmay be required by regulators or environmentalprotection groups.

Key challengesLack of transparency and trust – “The lack oftransparency and trust is a never ending story inhealth care”

this is true between all kind of stakeholders, butespecially between public authorities and theindustry. therefore, the European Commissionlaunched special work on CsR in 2010. Differentworkstreams cover for instance ethics andtransparency. Participating stakeholders are theindustry, health care professionals and Memberstates (e.g. Belgium, netherlands, and UnitedKingdom). the aim is to exchange informationand potentially achieve a common understandingin terms of best practice when it comes toaccess to medicines. a lack of trust is currentlyhampering innovation to a large extent.

Polypharmacy and co-morbidity – “The end ofblockbusters”

the current dynamics of the healthcare industrycan be summarised as a one size fits allapproach, since developing more medicines for asmaller audience seems to be less profitable. inthe future, diagnoses and treatment will bebased on biology. Patients will play a moredominant role, therefore they will need tounderstand the concepts of: healthy lifestyle,genetic predisposition, lifelong management of

risk, self-monitoring. But how should we workwith patients to ensure they become betterinformed? it must be understood that aninformed patient is a very cost effective patient.the key challenge is how to communicatescientific ideas to a non-scientific audience.Finally, the EFPia code of practice should beutilised more by patients. the pharmaceuticalindustry will be shaped by the extent to which itcan be a part of the data flows; however its roleis limited by trust issues.

The quality of information

new infrastructure needs to be built to navigatethe significant amount of information available.Further, the relationship between the industryand health care professionals needs to beimproved; standards need to be set, togetherwith all stakeholders. On the one hand qualitydata should be available, on the other hand thisraises concerns that raw data is presentedwithout any further adaptation or explanation.the information is therefore open tointerpretation, which can lead to confusion,uncertainty and fear.

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Conference Report 2012Dialogue, transparency, trust.What part do they play in aligning thepharmaceutical industry with social needs?By Claudia Fischer

John Bowis, President, Health First Europe



On the second day of the conference we wokeup to an optimistic early morning breakfastsession presenting real solutions.

Karen Kovach, Chief scientific Officer of WeightWatchers international, presented evidence thattackling obesity in a proper and systematic waycan reduce the burden of chronic diseases anddeliver substantial cost savings to strugglingEuropean healthcare systems. she highlightedcertain facts and threats supported by the resultsof a range of different studies and research:

n More than half of the EU population isoverweight or obese.

n 40% of the European population above theage of 15 have a chronic disease.

n Chronic diseases currently account for over86% of deaths in the EU.

n 70–80% of European healthcare costs arefor chronic care (€700 billion in the EU).

there is now good evidence to show that adultobesity is associated with a wide range of healthproblems. it is estimated that adult obesity andoverweight are responsible for up to 6% ofhealthcare expenditure in the European regionand costs spent on chronic diseases in EUcountries appear to be out of control.

there is a growing need for effective solutionsthat prevent and treat chronic diseases, whichare affordable and scalable. Weight losstreatment is one solution. Lifestyle interventionsthat deliver medically significant weight loss havebeen shown to lead to multiple clinical benefits.the population don’t have to achieve an “ideal”weight to realise significant benefits. as anexample, Kovach presented the results of theDiabetes Prevention Programme, (DPP)(www.cdc.gov/diabetes/news/docs/dpp.htm) amajor multicentre clinical research study. itindicates that millions of high-risk people candelay or avoid developing type 2 diabetes bylosing weight through regular physical activityand a diet low in fat and calories. in addition tohealth benefits, preventing or delaying the onsetof type 2 diabetes also brings the positive impactof cost savings to healthcare systems.

some solutions presented by Kovach were:

n to focus on the major recognised risk factorsfor chronic diseases by using specific“weight management” solutions, i.e.surgeries, medical devices, medications,lifestyle modifications.

n tackling obesity through lifestyle modificationprogrammes that meet best practice.

new and innovative partnerships betweenhealthcare and industry have been proven to bescalable, effective and affordable.

gillian Merron, former UK Minister of state forPublic Health, underlined the importance ofcommunity based programmes such as WeightWatchers, a unique programme whichsuccessfully tackles obesity, based on up-to-date science and tried and tested over the yearsby real people with many success stories. shecalled for more binding actions to be developedby policy-makers to change legislation andprepare regulations. Policies to support theprevention of chronic diseases need to changequickly – but there is no need to “re-invent thewheel”, she said. there are already scalable,effective and affordable solutions available.Cooperation and dialogue with the private sectorare very important as well.

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Conference Report 2012Wake up to the real solutions! By Edita Nagyova

Gilian Merron, former Minister of State for Public Health,UK and Karin Miller-Kovach, Chief Scientist Officer,Weight Watchers International, Inc.


http://www.cdc.gov/diabetes/news/docs/dpp.htm


in times of demographic change, with the rise ofchronic diseases and increasing competitionfrom other markets, health has become a keyasset for Europe in meeting its objectives for the2020 strategy. in addition, new healthtechnologies such as personalised medicines,eHealth and increased knowledge of healthylifestyles are promising developments thatcontribute towards reaching the ambitious 2020goals. a lot of resources have already beeninvested in community empowerment, howeverthe “right people”, have not yet been reached.

Healthy ageing is one of the key challenges, thesuccess lies also in the literacy skills of doctors.

Vaccinations: communicating scientifically validinformation to patients is challenging. it also asksfor communication on a national level (not justinternationally through the EuropeanCommission), because patients and the publicsearch for information nationally.

Tobacco: misleading labelling needs to beworked on. terms like “light”, “low” can bemisleading to the public.

How can national policies make adifference?take the example of austria, who defined healthliteracy as a health target in the Health Ministry.Political commitment and leadership needs to beembedded in the action plan Health 2020.

Further, more research is needed, for example,Patient University (Barcelona/spain).

the results of the first European Health LiteracySurvey led by the University of Maastricht andsupported by the European Commission,unveiled inconvenient facts:

n Europe moves at different speeds.

n Health literacy levels vary considerablybetween different Member states (austriashows high rates of health literacy, whereasfor instance in the netherlands the rates arelower and age is not a determining factor.Perhaps the Dutch health care system ismore easily accessible?).

Health literacy needs to be tackled in theeducation system– so far no educational bookexists. What shall we do then? Health literacyseems to be a key concept and a critical elementfor fostering healthy choices, supporting healthylifestyles or – in case of illness – improving healthoutcomes and healthcare efficiency.

Eventually, improving health literacy meansempowering citizens to take control over theirown lives – the latter being a critical element forbetter health. in this context employers can alsoplay a role.

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Conference Report 2012Health literacy – the cornerstone in future health By Claudia Fischer

Speakers and panellists: Jürgen Pelikan, Ludwig Boltzmann Institute for Health Promotion, Austria; Helmut Brand,Professor, Head of Department, Maastricht University; Kristine Sorensen, The European Health Literacy Project,Maastricht University; David Boyd, Director European Government and Public Policy, GE Healthcare; Judith delle Grazie,Head of Unit, Ministry of Health, Austria; Christine Neumann, CSR Europe; Nicola Bedlington, Director, EuropeanPatients’ Forum; Karin Kadenbach, MEP, Austria; Birgit Beger, Secretary General, Standing Committee of EuropeanDoctors; and John F Ryan, Head of Unit, DG SANCO, European Commission



For me the Young Forum gastein initiative meansnew ideas, enthusiasm and new Europeancontacts. it is quite special to have aninternational group of bright young researchersand young policy-makers together in a beautifulsetting like gastein. this setting providesexcellent opportunities for Young gasteiners toget introduced to the topics that senior-leveldecision-makers are working on. and, vice versa,it’s a good opportunity for these senior decision-makers to get in touch with a younger generationand discuss their ideas and opinions. the informal meetings in 2011 with, amongothers, former EU Commissioner John Dalli,Paola testori Coggi (Dg sanCO), RobertMadelin (Dg COnnECt) and Zsuzsanna Jakab(WHO Regional Director for Europe), are greatexamples of how easy it is for young gasteinersto interact with high level decision-makers. ibelieve that the Young Forum gastein initiativehas the potential to become a strong network ofEU health policy advocates, also outside of thegastein congress week.

the Young Forum gastein scholarship wasestablished by the EHFg with the support of theEuropean Commission, Dg Health and

Consumers and Dg Research and innovation, onthe occasion of the EHFg’s 10th anniversary. theproject aims to bring promising youngresearchers and policy-makers to the conferencein gastein for learning and networking towardsfuture activities in the sphere of health.

in 2012, young researchers and officials workingin the field of health from EU Member stateswere once again invited to attend the 15th EHFgconference. in addition, the WHO Regional Officefor Europe contributed to the initiative,supporting several Young gastein scholars fromEastern Europe and Central asia.

apart from actively participating in the generalprogramme, specific Young Forum gasteinmeetings and working groups took place, withmeetings between the scholars and former EUCommissioner John Dalli, Director general Paolatestori Coggi, Director general Robert Madelinand WHO Regional Director for EuropeZsuzsanna Jakab.

the EHFg and the European Commission arepleased to have created this important initiativeand are looking forward to the continuation anddevelopment of the Young Forum gasteinproject.

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Young Gasteiners: Michael West, Edwin Maarserveen, Ana Raquel Nunes and Daniela Negri

The Young Forum Gastein Initiative – new ideas,enthusiasm and new European contacts By EW Maarseveen, Ministry of Health, Welfare andSports, The Netherlands, Alumni 2011

Health literacy is identified as a criticalempowerment strategy which constitutes theability to make sound health decisions in thecontext of everyday life. With the globalemergence of the health literacy field, it becameclear that the European region was lacking anevidence base on health literacy.

the European Health Literacy Project (HLs-EU)was established from 2009–2012 with financialsupport from the European Commission. itsobjective was to demonstrate the manifestationof health literacy in various European countries,to address its overall cultural, social and politicalimpact, and to ensure the implementation ofworking structures and the formulation of policymeasures. accordingly a consortium of nineEuropean partners coordinated the EuropeanHealth Literacy survey in eight countries, andestablished the international network ‘HealthLiteracy Europe’ and national advisory boards onhealth literacy in eight countries.

the European Health award is awarded annuallyin connection with the European Health Forumgastein. the prize honours projects and

initiatives that contribute towards improvinghealth care systems in Europe. important criteriaare that several countries have to participate in agiven project; the project concept has to betransferable to additional countries; and asignificant portion of the population must benefitfrom it.

the short list of projects nominated for theEuropean Health award 2012 were as follows:

n Breast Health Day – Prevention and earlydetection of Breast Cancer

n EB-CLinEt of EB centres and EB experts(EB = Epidermolysis bullosa)

n EUBiROD – European Best informationthrough Regional Outcomes in Diabetes

n HLs-EU – the European Health LiteracyProject

n Paediatric nutrition in Practice – Extensive e-learning programme

n tob taxy – Making tobacco tax trendy

EUROPEAN HEALTH AWARD 2012

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The European Health Award 2012 goes to theEuropean Health Literacy Project

Antonyia Parvanova, MEP, Moderation; Wolfgang Tüchler, Representative FOPI, Sponsor; Gerardine Doyle and Kristine Sorensen, EHA Winner 2012, HLS-EU Project; and Günther Leiner, Honorary President of the EHFG

Organiser international Forum gastein

Coorganiser Federal Ministry for Health, austria

supported by and in collaboration withEuropean Commission, COnnECt DgEuropean Commission, Health and Consumers DgEuropean Commission, Research and innovation DgFederal Ministry of Health, austriaLand salzburgOECDWorld Bank

supporting OrganisationsaMgEnBureau of Health Promotion, Department of Health, taiwanEuropean science FoundationFEt Flagship Pilot Project it Future of MedicineForum der forschenden pharmazeutischen industrie (FOPi)glaxosmithKlineglobal Health EuropeHoffman-La RocheMaastricht UniversityMax Planck institute for Molecular geneticsMsDOECDÖsterreichische ÄrztekammerParacelsus Medical UniversityPfizer



european health forum gastein 2012 · publisher international forum gastein (ifg) tauernplatz 1...

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