public health capacities in europe · public health capacities in europe (preliminary results)...

Public Health Capacities in Europe (preliminary results) European National Public Health Institutes Directors’ Meeting 5th - 6th November 2011, Poznań Helmut Brand, Professor of European Public Health, President elect ASPHER

Public Health capacities in Europe are…

1 …the level of organisational, human, financial and

other resources that enable actions to be taken by responsible authorities to improve health and reduce health inequalities (working definition; EAHC, 2009).

2 …the combination of available infrastructures, resources and people’s competencies to achieve the desired public health goals (PAHO, 2007).

3 …the activities or interventions which aim to change a system’s ability to address health issues by creating new structures, approaches and/or values (Bagley and Lin, 2009).

Department of International Health 3

Relevance to EU

The “Third Public Health Revolution” has confronted the European public health communities with changing goals, approaches and actors. Respective public health capacities need to be adapted and strengthened accordingly.

Need for greater capacity in public health delivery recognized in the EU Health Strategy 2008-2013

Sustainability of public health capacities threatened across Europe in times of economic crisis


Health effects of financial crisis: omens of a Greek tragedy

www.thelancet.com Published online October 10, 2011 DOI:10.1016/S0140-6736(11)61556-0

Alexander Kentikelenis, Marina Karanikolos, Irene Papanicolas, Sanjay Basu, Martin McKee, *David Stuckler [email protected] *Department of Sociology, University of Cambridge, Cambridge CB2 3RQ, UK (AK, DS); European Observatory on Health Systems and Policies (MK, MM) and Department of Public Health and Policy (SB, MM, DS), London School of Hygiene and Tropical Medicine, London, UK; Department of Social Policy, LSE Health, London School of Economics and Political Science, London, UK (IP); and Department of Medicine, University of California San Francisco, San Francisco, CA, USA (SB)


Kentikelenis A, et al. www.thelancet.com Published online October 10, 2011 DOI:10.1016/S0140-6736(11)61556-0

Greece compared 2007 – 2009 Cuts in hospital budgets - 40% - admissions public hospitals +24% - admissions private hospitals - 25%

Suicide-rates - 2007 – 2009 + 17% - 2009 – 2010 (inofficial) + 25% - 2010 – 2011 (inoff., 1. quarter) + 40% - “financial difficulties” mentioned

in call to national suicide helpdesk 25%

Homicide and theft + 100% HIV infections (2010 -2011) + 52 % NGO street clinic visits was 3%, now 30% Alcohol consumption down Drink-driving down


65

70

75

80

85

1970 1980 1990 2000 2010 2020

LatviaSweden

Life expectancy at birth, in years

WHO HFA Database


Healthy Life Years at birth male 2009 (IT, UK 2008)

Eurostat 2011


Healthy Life Years at birth female 2009 (IT, UK 2008)

Eurostat 2011


Jagger C et al. Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 2008;372:2124-31


Life Expectancy in Germany: 1952 - 1990

55

60

65

70

75

80

851950

1955

1960

1965

1970

1975

1980

1985

1990

1995

Jahr

Lebenserw

art

ung b

ei G

eburt

Männer

Frauen

E

W

WE

E. Nolte 2000


Life Expectancy in Germany: 1956 - 2007

55

60

65

70

75

80

85

1956 1961 1966 1971 1976 1981 1986 1991 1996 2004

year

life e

xpecta

ncy a

t birth

males

females

E

E

W

W

Aims and objectives of the assessment

1. Carry out a detailed review of the capacity in the EU Member States to develop and implement public health policies and interventions;

2. Identify the main strengths, weaknesses, opportunities and threats (SWOT) for public health in the EU;

3. Make recommendations for action;

4. Identify key gaps in knowledge.

Department of International Health

Mixed methodology

Literature review to develop a conceptual model and a questionnaire for the assessment;

Assessment at country level with closed and open questions answered by national experts and validated by focus groups;

Quantitative and qualitative analysis of the national assessment;

Case studies to provide more in depth information of the capacity to develop and implement a certain policy or intervention addressing emerging or new issue for public health;

Appreciative inquiries and policy dialogues with national experts to develop recommendations for EU Member States and the EU.

Country specific context with relevance for public health

Capacity for public

health

Workforce Availability and distribution

of workforce

Training and development

Public health competencies

Professional associations

Leadership &

Governance Responsibilities for public

health

Policy making for public

health

Expertise within MoH

Leadership qualities in the

health sector

Strategic visioning and

systems thinking

Financial resources Financial resource

generation

Financial resource

allocation

Partnerships • Formal partnerships

• Joined up government

• Informal partnerships

Organizational Structures Institutional capacity for

public health

Program delivery structures

Public health aspects of

health care services

Capacity to respond to

emergencies

Knowledge Development • Health information and

monitoring systems

• Public health reporting

• Research and knowledge

infrastructures

(Very) general results

Across Member States (MS) there is a need for:

1. More “good governance” including political commitment and effective public health policy formulation, implementation and evaluation;

2. A stronger focus on “new” public health measures;

3. More financial resources and sustainability of systems (in the light of the financial crisis);

Notably:

4. „Traditional‟ country-clusters did not emerge from assessment (e.g. “old” vs. “new” MS, rich vs. poor MS, tax based vs. social insurance based MS)

National context & Leadership and Governance

+ Formal recognition that PH is important

+ National strategies formally exist

+ Many professional organisations and associations exist to advocate for PH issues

- PH Priorities often politically rather than evidence-based

- Instability over political cycles / dependence on political will

- Public health as a „soft‟ political topic

- Health care often dominates political debate

- Monitoring and evaluation of policies weak

Organizational structures

+ Infrastructures for communicable disease control, hygiene and health protection widely exist

+ Many public health related programmes and projects in MS

+ Need for collaboration between public health and health care has been recognized and some collaborations and distributions of tasks have been established

+ Well functioning PH emergency response systems

- Capacities of local institutions often weak to face population needs

- Large differences in capacities of organizations across regions and municipalities

- Health care and public health linkages still underdeveloped

- Weak collaborations between organisation

- Limited sensitivity for differences in population groups and minorities

Workforce

+ Many people (indirectly) involved in public health activities

+ Generally good training and education capacities

+ Growing number of university graduates with PH degrees

+ High quality research capacities

- No idea of size and nature of „public health‟ workforce

- Weak capacity in rural areas

- Career pathways poorly developed and few plans for PH workforce development

- Many people focused on traditional health protection measures rather than on Social Determinants (SD) or Health Inequalities (HI)

- No agreed competency framework for PH workforce

Financial resources

- Difficult to precisely identify and enumerate the financial resources for public health

- Limited financial resources for PH programmes and projects (and in some countries shrinking, although demand is likely to increase)

- Financial crisis

- Strong imbalance in favor of

curative health services is reflected in funding

+ Various public sectors make financial contributions to public health issues (and are not labelled as such; e.g. road safety campaigns)

Partnerships

- Weak links between academia and policy makers

- Intersectoral action weak

- „Public health‟ has not gained much prominence in other sectors (little acknowledge-ments of health impacts)

- Skepticism regarding partnerships for public health between the private and

public sector

+ Collaborations exist at EU and international level

+ Various public institutions are involved on specific PH issues and Ministry of health is not the only Ministry that initiates public health activities

+ Partnerships with other

sectors at local level to deliver public health

Knowledge Development

+ Good knowledge of health status (in most countries)

+ Available expertise and capacity to carry out research about effectiveness of PH policies and practice

+ Some information sharing across institutions and countries

- Funding for public health research is inadequate and research is often medically dominated

- Weak mechanisms to monitor and evaluate public health and health promotion programme implementation

- Weak links between policy makers and academia

Scoring system1

1 2 3 4 5 6

Not developed Not developed but need for

capacity recognized

In early stage of development

Partially developed

Fully developed

Fully developed

and functioning

well

There is no capacity in place in this area or it has

not been considered

There is awareness that

capacity needs to be developed in this area but no steps have been

taken

Objectives for capacity development in this area

have been set and there have been

some steps taken to develop capacity

There has been partial development of capacity

in this area

Capacity in this area is fully

developed but it is too early to

assess impact or outcomes

Capacity in this area is fully

developed and results show that it is achieving its

objectives

[1] This scoring system is adopted from Fawkes S. & Lin V. (2005), Rapid Assessment of National Health Promotion Capacity: A Dialogue-Based Tool And Manual For Use In Countries In The Western Pacific Region. WHO Regional Office of the Western Pacific Region. It is also used by Spence K. (2007). Health

Communication/Promotion Capacity Mapping Questionnaire for the UNICEF CEE/CIS Region.

Green line: capacities fully developed and functioning well Red line: EU-average

EU-average

1

2

3

4

5

6

Leadership & Governance

Organisational Structures

Workforce

Financial Resources

Partnerships

Knowledge Development

Green line: capacities fully developed and functioning well Red line: national scores

Leadership &Governance


Workforce

FinancialResources

Partnerships

KnowledgeDevelopment

Germany Leadership &Governance


Workforce

FinancialResources

Partnerships


Greece Leadership &Governance


Workforce

FinancialResources

Partnerships


Hungary Leadership &Governance


Workforce

FinancialResources

Partnerships


Ireland

Leadership &Governance


Workforce

FinancialResources

Partnerships


Italy

Spidergrams were built on the basis of standardized scores. The scores indicate relative strengths and weaknesses in each particular country, regardless of the country‟s absolute level of capacities

Recommendations to the EU

Final report:

“The findings of this report reiterate the importance of on going EU / DG SANCO activities, which contribute to strengthening public health capacities in the Member States.

In the light of the economic crisis the EU activities form an important pillar of continuity.

To further strengthen and support Member States in building additional capacities for public health, the EU should maintain the current activities and, if necessary ensure their sustainability and effectiveness.”

Recommendations to the EU (selection)

Facilitation of EU Structural Funds for investments in public health infrastructures;

Creation of an integrated European strategy for public health research and innovation, with appropriate expert advisory structure and levels of funding;

Identification and development of tools and mechanisms to support translation of research into policy;

Support of the development of core competencies and definitions of roles and responsibilities for the public health and health promotion workforce;

Utilization of the existing consortium of European health organisations and key experts that responded to this study to take forward the recommendations as a dedicated public health capacities network and platform for exchange of information.

Public Health Capacities in Europe The team: Christoph Aluttis (Maastricht University), Britta Baer (EHMA), Floris Barnhoorn (EUPHA), Helmut Brand (Maastricht University), Stephan van den Broucke (Université Catholique de Louvain), Cristina Chiotan (EuroHealthNet), Caroline Costongs (EuroHealthNet), Elisabeth Jelfs (EHMA), Diane Levin-Zamir (IUHPE), Kai Michelsen (Maastricht University,) Robert Otok (ASPHER), Bernd Rechel (European Observatory on Health Systems and Policies)

The Key Experts: Roza Adany (Hungary), Tit Albreht (Slovenia), Colette Andrée (Luxembourg), Dace Beināre (Latvia), Miriam Camilleri (Malta), Teresa Contreiras (Portugal), Antonio Daponte Codina (Spain), Antonio G. de Belvis (Italy), Lieven de Raedt (Belgium), Antoine Flahault (France), Florentina Furtunescu (Romania), Anita Gębska-Kuczerowska (Poland), Ramune Kalediene (Lithuania), Zuzana Katreniakova (Slovakia), Ilmo Keskimäki (Finland), Niek Klazinga (The Netherlands), Heli Laarmann (Estonia), Tina Lesnik (Slovenia), Cristina Mattsson Lundberg (Sweden), Terese Otte-Trojel (Denmark), Constantinos Phellas (Cyprus), Anastas Philalithis (Greece), Petko Salchev (Bulgaria), Norbert Schmacke (Germany), Eva Schwarz (Austria), Martin Sprenger (Austria), Liina-Kaisa Tynkkynen (Finland), Jaroslav Volf (Czech Republic), Jenny Wright (England/UK)

The report will soon be available at: www. inthealth.eu or contact: [email protected]


Summary of all EU recommendations • Build capacity for strategic planning, development and implementation of public health measures at national, regional and

local level and use the existing consortium of European health organisations and key experts that responded to this study to take forward the recommendations as a dedicated public health capacities network and platform for exchange of information;

• Create an integrated European strategy for public health research and innovation, with appropriate expert advisory structure and levels of funding; give relative more emphasis to public health research, compared to pharmaceutical, biomedical and biological research, and at the same time close the existing research capacity gap on public health between EU countries;

• Develop long term EU strategies for public health capacities and support Member States to follow up long term strategy planning and ensure sustainability of resources needed for design and implementation of public health policies;

• Facilitate EU Structural Funds for investments in public health infrastructures, public health capacity building efforts and measures supporting “good governance”‟; public health issues are currently still underrepresented within the EU Structural Funds process;

• Communicate better the different initiatives and outcomes from EU funded projects, networks or partnership programmes that facilitate knowledge and information exchange, in particular about those public health capacities that are required for needs oriented, effective and sustainable health systems;

• Develop, improve and disseminate use of Health Impact Assessment Tools; increase awareness and knowledge for Health in All Policies approaches to address the socio-economic determinants of health and support capacity building for partnership development

• Encourage stronger collaborations between public health and health care services to increase the role of health care services for health promotion and diseases prevention and maximise other potential benefits;

• Build leadership capacities for advancing the public health agenda among policy makers, making the economic case for public health and health promotion and to develop collaborations and partnerships with other sectors;

• Develop tools and methodologies for monitoring and evaluation of policies and programmes, including distributional impacts across the gradient, and support capacity building at Member State level for harmonized health information systems;

• Support the development of core competencies and definitions of roles and responsibilities for the public health and health promotion workforce in light of the current social, economic, demographic and health challenges; encourage the development of public health training for officials or professionals working in other policy sectors;

• Support the development of guidelines for quality assurance in public health services; • Develop research on how to balance foreseen shortages in the public health workforce e.g. by societal innovations like

home based services and community development approaches; • Support identification and development of tools and mechanisms to support translation of research into policy; promote

good practices and develop capacities for data analysis and knowledge transfer into policy recommendations and actions.


References

• Bagley P, Lin V. The development and pilot testing of a rapid assessment tool to improve local public health system capacity in Australia. BMC Public Health 2009;9:413.

• Executive Agency for Health and Consumers (EAHC) Call for tender n° EAHC/2009/Health/05 concerning developing public health capacity. [Online] 2009.

• Pan American Health Organization (PAHO). Public Health Capacity in Latin America and the Caribbean: assessment and strengthening. Washington DC: PAHO, 2007.

• World Health Organisation Regional Office for Europe. Strengthening Public Health Capacities in Europe. A framework for action. Copenhagen:WHO, 2011.

Thank you for your attention! ... and see you in Europe

public health capacities in europe · public health capacities in europe (preliminary results)...

Documents