European Public Health Association |
President's column: The future of public health in Europe: towards a more active partnership with WHO/EURO
R. Horst NoackPresident of EUPHA
WHO's Eleventh General Programme of Work 2006–2015 to be decided in May 2006 concludes that ‘public health can no longer be considered separately from that of economics, trade, security, domestic and international policy-making, or any other field. Governments can no longer make domestic policies, bilateral or multilateral agreements on trade, agriculture, environment, or labour without considering the impact on the health and livelihood of their own people—and all people’.1 The programme identifies several major challenges: to close the gaps in social justice, responsibility and synergies, implementation, and knowledge. It proposes joint action among actors within and outside the conventional health sector, and in making the commitment to resolving those issues.
The programme of work outlines a global health agenda which includes the following 10 priority areas that follow up previous efforts2:
- — Ensure universal coverage and promote equity in health.
- — Build individual and global health security.
- — Promote health-related human rights and gender equality.
- — Reduce poverty and its effects on health.
- — Tackle the social determinants of health.
- — Promote a healthier environment.
- — Build fully functioning and equitable health systems.
- — Ensure an adequate health workforce.
- — Harness knowledge, science, and technology.
- — Strengthen governance and leadership.
- — Build individual and global health security.
EUPHA representatives were invited to participate as observers in an international consultation on the Programme on 10–11 January 2006. This meeting was attended by representatives of over 30 Member Countries and WHO staff. Both EUPHA President Horst Noack and EUPHA Manager Dineke Zeegers Paget participated in the discussion. In a short presentation on EUPHA's ‘10 Statements on the Future of Public Health in Europe’, Horst Noack briefly referred to the commonalities in aims and commitment of both organizations. He emphasized the potential gains to be expected from joining efforts in a number of fields. A closer look at EUPHA's statements suggests much common ground for future collaboration (see below for the summary of the 10 statements).
In a meeting of the EUPHA president and manager and former president Walter Ricciardi on 6–7 December 2005 with WHO/EURO Regional Director Marc Danzon and senior staff members Anca Dumitrescu, Roberto Bertollini, and Alicia Granados, a first step had already been taken to agree on a concrete EUPHA/WHO work package for the next years. It includes collaboration with the European Journal of Public Health (EJPH), with WHO's Health Evidence Network (HEN), with EUPHA conferences, on efforts at capacity building, with regard to the future of public health in Europe, on specific projects (e.g. obesity reduction) and technical issues.
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Footnotes |
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1 WHO Eleventh General Programme of Work 2006–2015. Together towards a healthier future, November 2005, p. 31.
2 WHO Eleventh General Programme of Work 2006–2015. Together towards a healthier future, November 2005, p. 16.
EUPHA'S 10 STATEMENTS ON THE FUTURE OF PUBLIC HEALTH IN EUROPE: SUMMARY
Dineke Zeegers PagetEUPHA manager
From November 2002 to November 2003, EUPHA organized a series of five workshops to discuss the future of public health in Europe. Each of the workshops addressed a specific issue (from a historical point of view, public health research, public health policy, public health practice, and overall discussion). The outcome of these workshops were summarized by a group of experts and—after approval of the EUPHA Governing Council in October 2004—published for a wider audience.
At the moment, EUPHA has started a dissemination strategy that involves not only free access to the full document online (available at www.eupha.org), but also the translation of the document in some of the European languages (e.g. Slovak) as well as publication of the document in national journals of public health.
The 10 statements are published below with a shortened explanation. For the full text, please download the document from www.eupha.org or contact the EUPHA office (d.zeegers{at}nivel.nl).
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1. Future public health can only be achieved if the whole society invests in it: building partnerships is essential here |
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Public health is and should be seen as an integrated challenge as it touches all aspects of society. An unhealthy population has a serious impact on the economy of a country. To effectively deal with this integrated problem, integrated solutions should be sought. This means that public health should be included in all levels, settings, and sectors of a society. New public health goes far beyond the health profession and health settings and therefore requires a new way of mobilization. Bridges are necessary not only between policy, practice, and research, but especially between different disciplines.
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2. The long-term benefits of public health should be taken seriously by policy-makers |
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Public health has been on the agenda of policy-makers for a long time, but is not seen as a priority. This is mainly due to the long-term focus of public health: the benefits of any intervention/policy cannot be measured in the near future. For instance, the effects of an active anti-smoking campaign will only be visible as a decrease of mortality due to lung cancer decades after the intervention was started. Furthermore, the public health intervention may not even be recognized as the cause of the decrease. New public health should therefore encourage researchers to examine the long-term benefits of public health interventions.
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3. Public health should form an integral part of the political agenda in all sectors |
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Public health should be included and form an integral part in all policy decisions. Population health should be presented as human capital, which is the basis for a solid economy and a happy population. Public health is subjective and long-term and it is important not to focus on short-term economic costs in the planning of public health initiatives. The burden of disease could be an important factor in the decision-making process, as it will show the cost-effectiveness of public health policy (e.g. Health as human resource).
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4. Public health policy should be based on assets rather than disease |
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In future public health, we should not base actions only on deficiencies (= illness or pathogenesis), but on assets (= good health or salutogenesis). Communities rarely develop on the basis of their deficiencies; they develop on the basis of their assets. One important factor to develop is the creation of a positive environment for individuals (e.g. sport facilities, green recreation areas, and also self-development possibilities).
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5. Research remains a solid basis for the development of public health practice and policy |
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As in the past, good research is the basis of successful public health interventions. Especially epidemiological research helps to identify risk factors for disease as well the impact of health promotion measures. As a supplement qualitative research and intervention studies can give useful information. In future, some fields of research will remain important or become more important:
- — Long-term morbidity and mortality studies will show the impact of prevention measures and the general development of public health and at the same time identify risk factors.
- — Comparative studies between countries will increase in importance. In order to create a common public health policy, it is necessary to have a clear picture of public health research, practice, and policy in the different European countries.
- — Research on differences in health, both inequalities in access as between ethnic groups is also a field of research that will further develop.
- — Studies on the burden of disease on a population (including not only attributable risks but also avoidable risks) need to be implemented.
- — The impact of gene technology on individual behaviour needs to be researched as well as the connection between our genes and the environment.
- — Comparative studies between countries will increase in importance. In order to create a common public health policy, it is necessary to have a clear picture of public health research, practice, and policy in the different European countries.
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6. Research should focus on the needs of policy and practice |
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There exists a significant gap between research on the one side and policy and practice on the other. A better interaction between policy/practice and research should be organized. This not only means that researchers should be open to policy/practice important aspects of research, but also that practitioners and researchers should learn to translate their research findings into recommendations for the solution of practical or policy problems.
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7. Researchers should learn how to interact with politicians and practitioners |
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It is generally stated that research on public health is at a good quality and quantity level, but the translation from research results to policy and practice is lacking. Future public health research should take the following points into consideration:
- — Researchers should interact continuously with policy-makers and practitioners. Research may be too late if presenting the results is only done when final results are present.
- — Ongoing interaction—preferable in person—should take place between the research community and policy-makers and practitioners. This should include the possible adaptation of the research questions, following questions from policy/practice.
- — Research should be presented not only short and concise, but also in a format which is attractive to policy-makers and practitioners.
- — Policy-makers and practitioners should be trained in how to interpret research results and how to translate policy problems into research questions.
- — Ongoing interaction—preferable in person—should take place between the research community and policy-makers and practitioners. This should include the possible adaptation of the research questions, following questions from policy/practice.
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8. Innovative ways to promote health should be encouraged |
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One important aspect of developing public health is to be innovative. What has been effective in the past (e.g. HIV prevention promoting condom use) may not be taken seriously by a new generation (increase in unsafe sex and HIV infections). New ways of either sending the same message or sending a new message need to be developed continuously.
In future, we should further develop these innovative ways:
- — Public health should not just implement measures to kick a bad habit (e.g. smoking), but should take into account the situation (when does a person smoke and how can we change this situation). This means that we should develop management of conditions and assets (= integrated approach).
- — Public health should go beyond the focus on human behaviour and changing that behaviour, but should also create a supportive environment.
- — Public health should go beyond the focus on human behaviour and changing that behaviour, but should also create a supportive environment.
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9. The future public health practice: think globally, act locally |
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Public health practice should be based on flexibility and pragmatism. Policies are set up at a national or international level, the implementation is at the local level and should be adaptable to different situations. In order to follow the principle of think globally, act locally:
- — Public health practitioners should be offered specific training.
- — The exchange of experiences of local implementation/practice should be facilitated. At the moment, this exchange does not exist; there are no adequate descriptive studies.
- — Public health practice should not be limited to specific diseases or specific settings, as is done now: public health encompasses all aspects and should be seen as such.
- — Criteria for good public health practice should be set up.
- — The exchange of experiences of local implementation/practice should be facilitated. At the moment, this exchange does not exist; there are no adequate descriptive studies.
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10. What can EUPHA do? |
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The European Public Health Association has two major assets to become active in the development of the new public health:
- — It is an European non-governmental association of public health experts.
- — It consists of researchers, policy-makers, and practitioners.
- — It consists of researchers, policy-makers, and practitioners.
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NEWS FROM EUPHA OFFICE |
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EUPHA office currently has the following priorities:
- — Updating the EUPHA database. At the moment, the information on EUPHA membership in the database is checked with the updated membership lists from our national associations. We invite you to check and complete your data and contact EUPHA or your national association in case some information is incorrect.
- — Expanding the interactive information exchange for the EUPHA sections. A new email exchange system has been created. This allows section members to more actively exchange information by sending the news to one email address only. The new system will distribute that email automatically to all section members.
- — Following the success of the 2004 EUPHA statement: 10 statements on the future of public health, EUPHA is currently developing two statements:
The public health consequences of man-made disasters. This statement is set up in close collaboration with Dr Joris Yzermans of the Netherlands Institute of Health Services Research (NIVEL).
The public health impact of obesity in Europe. This statement is a joint effort of:
- Dr Enni Mertanen, EUPHA section on food and nutrition.
- Dr Gerd Holmboe-Otesen, Norwegian Public Health Association.
- Dr Annette Matzke, section on nutrition of the Swiss Society for Public Health.
- — Expanding the interactive information exchange for the EUPHA sections. A new email exchange system has been created. This allows section members to more actively exchange information by sending the news to one email address only. The new system will distribute that email automatically to all section members.
UPDATE ON THE 2006 EUPHA CONFERENCE
Dineke Zeegers PagetEUPHA manager
The main theme of the conference is ‘Politics, policies, and/or the public's health’, which is organized in Montreux, Switzerland, from 16 to 18 November. The information on the conference is regularly updated on www.eupha.org by clicking on the Montreux banner.
The abstract submission is an online system and can be done via the EUPHA website. Please read the abstract and workshop/seminar instructions carefully before submitting your abstract.
Please note that the deadline for submission is: 1 May 2006
WHO/EURO COLUMN: WORLD HEALTH DAY 2006: THE CRISIS FACING THE GLOBAL HEALTH WORKFORCE
Galina PerfilievaRegional Adviser, Health Sector Human Resources, Nata Menabde Director, Division of Country Support, WHO Regional Office for Europe
The WHO Regional Office's Country Strategy, ‘Matching services to new needs’, approved in 2000, recognized human resources as a critical component of health and development strategies. The World Health Assembly identified human resources for health as the focus of World Health Day 2006 and of the year's world health report. Its theme—working together for health—highlights the challenging and often inspiring work carried out by health workers, who are crucial in providing better health services to the people.
For too long, the health workforce has been ignored, traditionally ranked low on the health policy agenda. The human resources that provide health services are often seen as a burden rather than as a capital asset. As a result, the global health workforce is in chronic crisis, suffering from severe skills shortages, supply–demand imbalances, poor distribution of health workers, poor knowledge about the effectiveness of interventions, and poor working environments, reflecting poor human resource management and regulation.
Health workforce issues are among the most complex and difficult areas to modify. But clearly a health workforce must be sufficient in numbers, well educated and trained, adequately deployed, managed, and motivated to provide services of good quality. Such a functional workforce will allow financial resources to be translated into more and better health services that meet the health needs of the population, and be a further step towards achieving the Millennium Development Goals.
Tackling the issue requires recognition both of the health workforce crisis and of its implications at all levels. Governments, non-governmental organizations, international agencies, academic institutions, and the private sector all share responsibility for the impact of their policies and priorities on the workforce. Many are already considering a set of actions and examining new ideas and methods for addressing health workforce issues. They know that solutions exist and are actively seeking new ones.
We hope that World Health Day 2006 will focus the attention of governments and communities on these issues, and persuade them to build partnerships to improve human resources for health.
For more information on World Health Day 2006 visit the WHO Regional Office for Europe's website (http://www.euro.who.int).
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