Underlying Differences in Health Spending Within the World Health Organisation Europe Region—Comparing EU15, EU Post-2004, CIS, EU Candidate, and CARINFONET Countries

The foreign trade deficit is an important problematic area for all countries, and it is the main cause of the current account deficit and the economic crises. It is useful to frequently analyze the level of these deficits. In this study, the presence of convergence among the EU member and candidate countries in terms of the foreign trade balance was analyzed with second-generation panel data analysis methods, operating under cross-sectional dependence, by using data from the 2000-2019 period. In the study, firstly the existence of cross-sectional dependence among the countries was analyzed and it was found that there was cross-sectional dependence among the countries included in the panel. In this study, firstly, CADF and HK panel unit root tests were carried out in order to test the existence of each country group's convergence to their group average; then in the country groups other than EU candidate countries, i.e., in the 36-country panel, in the EU28, EU15, and EU13 countries, it was determined that there was a convergence towards their own group means in terms of the foreign trade balance. Furthermore, the convergence of the country groups to the group average of the EU15 was tested by CADF and HK methods; and it was determined that the 36-country panel, the EU28, EU13 countries, and the EU candidate countries tend to converge towards the foreign trade balance of the EU15. Finally, the convergence of EU candidate countries to the EU13's foreign trade balance average was tested by CADF and HK methods, and according to the CADF tests, the EU candidate countries were unable to converge to the EU15 countries were also not able to converge to the EU13 countries. However, according to the HK test results, it was determined that the foreign trade balance of the 8 EU candidate countries converged to the foreign trade balance of the 13 countries that became members of the EU later. The robustness check was performed by using Fisher ADF, Fisher PP, LLC, and IPS panel unit root tests, and the results obtained were found to be consistent.

Financial Stability Challenges for EU Acceding and Candidate Countries: Making Financial Systems More Resilient in a Challenging Environment

Context: The World Health Organization (WHO) European Region’s political attention shifted to the COVID-19 pandemic from the start of 2020 onwards. A consequence of this shift has been decreased political attention towards combating tuberculosis (TB) in the WHO European Region. As a result, decreasing TB data reporting, rising death rates, and increasing antimicrobial resistance (AMR) have prevented the WHO European Region from remaining on track to reach the United Nations Sustainable Development Goal 3 (SDG3) to eliminate TB epidemics by 2030. Furthermore, the WHO tuberculosis action plan for the WHO European Region 2016-2020 has missed opportunities to mitigate TB in this region, thus exacerbating the issue and preventing the achievement of SDG3. Policy Options: The WHO’s Roadmap to implement the tuberculosis action plan for the WHO European Region 2016-2020 provided guidance for TB management in the member states (MS), but did not sufficiently address AMR, lacking promotion of new TB vaccine rollout, nor describe national TB implementation strategies. The WHO 2016-2020 TB action plan is now overdue and WHO policymakers should consider the following recommendations when creating the new TB action plan. Recommendations: This policy brief addresses the urgent need for a new WHO TB action plan to integrate a national level implementation commitment, AMR programming, and WHO support in creating a vaccine strategy with aims for the WHO European Region to achieve SDG3 and eliminate TB epidemics by 2030.

Despite increasing income per capita, the EU candidate and potential candidate countries remain confronted with high levels of income inequality. The purpose of our paper is to identify the main determinants of income inequality among the EU candidate countries. In addition to macroeconomic factors, we also analyze the impact of demographic variables to provide more reliable estimates. Using panel data analysis with fixed effects in the period 2005-2017 for three EU candidate countries (North Macedonia, Serbia and Turkey) we find that the unemployment rate, the level of economic development and the investment rate are the main determinants whose increase leads to a bigger income differentiation in the analyzed countries. The government indebtedness has also a statistically significant, but a negative impact on income inequality. The other two macroeconomic variables in the model – the terms of trade and inflation are statistically insignificant. Among the demographic factors, population growth and education significantly affect income inequality among the EU candidate countries. The obtained results suggest that a sustainable economic growth combined with active measures in the labor market and the improvement of education level of the population could lead to more equal income distribution.

This paper summarizes the findings for the European Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. The article presents a description of the region, an overview of mental health policies and legislation, a summary of relevant research in the region, a precis of community mental health services, a discussion of the key lessons learned, and some recommendations for the future.

Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region. Objectives and design: a comparative analysis of TB notification rates during 2014–2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration. Results: in the WHO European Region, incident TB rates in inmates were 4–24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was −7.0% in the civilian sector and −10.9% in the penitentiary sector. A total of 15 countries achieved treatment success rates of over 85% for new penitentiary sector TB patients, the target for the WHO European Region. In 10 countries, there were no significant differences in treatment outcomes between civilian and penitentiary sectors. Conclusion: 42 out of 53 (79%) WHO European Region countries reported TB data for the selected time periods. Most countries in the region achieved a substantial decline in TB burden in prisons, which indicates the effectiveness of recent interventions in correctional institutions. Nevertheless, people who experience incarceration remain an at-risk population for acquiring infection, developing active disease and unfavourable treatment outcomes. Therefore, TB prevention and care practices in inmates need to be improved.

Flexicurity and Employee Participation in Workplaces during the Crisis: Turkey Compared to the European Union

Background: The Global Action Plan for the Prevention and Control of Noncommunicable Diseases set the target of an “at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context”. This study investigated progress in the World Health Organization (WHO) European Region towards this target based on two indicators: (a) alcohol per capita consumption (APC) and (b) the age-standardized prevalence of heavy episodic drinking (HED). Methods: Alcohol exposure data for the years 2010–2017 were based on country-validated data and statistical models. Results: Between 2010 and 2017, the reduction target for APC has been met with a decline by −12.4% (95% confidence interval (CI) −17.2, −7.0%) in the region. This progress differed greatly across the region with no decline for the EU-28 grouping (−2.4%; 95% CI −12.0, 7.8%) but large declines for the Eastern WHO EUR grouping (−26.2%; 95% CI −42.2, −8.1%). Little to no progress was made concerning HED, with an overall change of −1.7% (−13.7% to 10.2%) in the WHO European Region. Conclusions: The findings indicate a divergence in alcohol consumption reduction in Europe, with substantial progress in the Eastern part of the region and very modest or no progress in EU countries.

To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region. In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals. Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001). There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals.

Forcibly displaced children and adolescents in the World Health Organization (WHO) European Region have high mental health needs, yet few manage to access mental health services, and those who do may encounter inadequate care. This scoping review aimed to identify and synthesize the available evidence on barriers and facilitators to quality mental health care for forcibly displaced children and adolescents in the WHO European Region.We applied the PRISMA guideline extension for scoping reviews, searching five scholarly databases and grey literature published between 2004 and 2025. A total of 7,327 records were screened, with 18 articles included. We used the WHO Quality Standards for Child and Youth Mental Health Services as an analytical framework to map the evidence.The identified studies represented only 7 out of 53 countries in the WHO European Region. Most studies employed qualitative research designs, with a lack of quantitative evidence using quality indicators. Available evidence revealed multiple, intersecting barriers to quality mental health care, including restrictive health care policies, service constraints and a lack of provider competence. Facilitators included the presence of community-based support, networks of interconnected services, task shifting and evidence-based scalable interventions.Major gaps remain in both the data and in the methods used to generate evidence for improving quality of mental health care for forcibly displaced children and adolescents in the WHO European Region. Our review highlighted the discrepancy between the care provided and the recommended WHO Quality Standards for Child and Youth Mental Health Services. There is a need for more targeted efforts to assess and improve the quality of mental health care for forcibly displaced children and adolescents.

Residential green and blue spaces and their potential health benefits have received increasing attention in the context of environmental health inequalities, because an unequal social distribution of these resources may contribute to inequalities in health outcomes. This systematic review synthesised evidence of environmental inequalities, focusing on availability and accessibility measures of green and blue spaces. Studies in the World Health Organisation (WHO) European Region published between 2010 and 2017 were considered for the review. In total, 14 studies were identified, where most of them (n = 12) analysed inequalities of green spaces. The majority had an ecological study design that mostly applied deprivation indices on the small area level, whereas cross-sectional studies on the individual level mostly applied single social measures. Ecological studies consistently showed that deprived areas had lower green space availability than more affluent areas, whereas mixed associations were found for single social dimensions in cross-sectional studies on the individual level. In order to gain more insights into how various social dimensions are linked to the distribution of environmental resources within the WHO European Region, more studies are needed that apply comparable methods and study designs for analysing social inequalities in environmental resources.

&#x0D; Background: Evaluation of the state of play of the 2003 Council Recommendation on the prevention and reduction of health-related harms, associated with drug dependence, in the EU and candidate countries and elaboration of proposals for new recommendations.&#x0D; Methods: Analysis of epidemiological data available at the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) using statistical modeling, a general literature review on harm reduction measures, four systematic literature reviews (one on peer naloxone pro-grams) and surveys among decision makers in the field of drug policy and among harm reduc-tion providers (“stakeholders”) using online questionnaires and a gap survey among the na-tional focal points of EMCDDA in EU-countries and candidate countries.&#x0D; Results: It was possible to decrease the number of HIV-infections among drug users substan-tially in most EU countries and candidate countries during the last decade; unfortunately for the numbers of deaths due to overdoses this effect could not be reached. Stakeholders (harm reduction providers) name improvement of needle and syringe exchange and harm reduction in prison as main priorities in order to reduce drug related infectious diseases. Concerning re-duction of mortality they prioritise peer naloxone programs, drug consumption rooms and first aid training of drug users.&#x0D; Conclusions : The increase of coverage of substitution treatment and of the availability of nee-dle exchange programs in most countries can be seen as successes of harm reduction policy although the coverage especially of the latter still needs improvement. Peer naloxone pro-grams and improvement of harm reduction in (and after) prison are two of 13 recommended actions to improve the situation concerning mortality of opioid users. Continuous political strengthening of harm reduction is necessary.&#x0D;

As is well known, institutional factors play a significant role in achieving sustainable development goals. The aim of this research is to conduct a comparative analysis of the current outcomes of policies implemented to achieve sustainable development goals in EU candidate countries, highlighting existing trends and challenges. The comparative analysis focuses on three dimensions of sustainable development: social development, economic development, and environmental sustainability. Using a comparative analysis approach, the study examines the status of EU member and candidate countries across all three dimensions, identifies current difficulties, and outlines forecasts for future development trajectories. Overall, the research analyzes over 15 variables (approximately 600 indicators) for nine candidate countries and 27 EU member states. The study is particularly relevant as the comparison is based on the most recent full data available for 2022, reflecting the starting point for new candidate countries. This will allow us to analyze future developments dynamically, assess the progress in overcoming identified challenges, and evaluate the effectiveness of implemented policies. The research is illustrated with factual numerical data and graphical material.

Since September 2012, over 90 cases of respiratory disease caused by a novel coronavirus, now named Middle East respiratory syndrome coronavirus (MERSCoV), have been reported in the Middle East and Europe. To ascertain the capabilities and testing experience of national reference laboratories across the World Health Organization (WHO) European Region to detect this virus, the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe conducted a joint survey in November 2012 and a follow-up survey in June 2013. In 2013, 29 of 52 responding WHO European Region countries and 24 of 31 countries of the European Union/European Economic Area (EU/EEA) had laboratory capabilities to detect and confirm MERS-CoV cases, compared with 22 of 46 and 18 of 30 countries, respectively, in 2012. By June 2013, more than 2,300 patients had been tested in 23 countries in the WHO European Region with nine laboratory-confirmed MERS-CoV cases. These data indicate that the Region has developed significant capability to detect this emerging virus in accordance with WHO and ECDC guidance. However, not all countries had developed capabilities, and the needs to do so should be addressed. This includes enhancing collaborations between countries to ensure diagnostic capabilities for surveillance of MERS-CoV infections across the European Region.

Following the licensure of two rotavirus vaccines in Europe, we aimed to assess factors, such as surveillance, disease burden and laboratory capacity, which will be relevant for making decisions about rotavirus vaccine introduction in the different countries. We conducted an email-based survey of the national public health bodies in the World Health Organization (WHO) European Region in 2006 and report here the results from the 23 countries in the eastern part of the region. The survey included questions on rotavirus surveillance, laboratory capacity, burden (in children under the age of five years) and intention to introduce rotavirus vaccination. Countries were grouped into the four per-capita income categories defined by the World Bank. Fourteen of the 23 countries responded to the survey. All except one country reported that less than a quarter of their laboratories had rotavirus diagnostic capacity. Four countries had some form of specific rotavirus surveillance, but half were of very limited coverage. Ten countries did not report data on the incidence of rotavirus hospital admissions, although nine were able to report some data on rotavirus burden. Six of the responding countries said they were likely to introduce universal rotavirus vaccination. Rotavirus surveillance and laboratory capacity in the eastern part of the WHO European Region is limited but most countries had some estimate of rotavirus burden, often from special studies. The reported mortality rates were lower than those from a WHO mortality data source. Many countries in the eastern part of WHO European Region face a number of challenges before vaccine implementation, including strengthening surveillance, improving laboratory capacity and addressing financial barriers.