Essential Public Health Operations Research Articles

Strengthening public health professionals in policymaking in the Eastern WHO European region

Abstract Background The collaborative research between EUPHA and WHO aimed to explore factors impacting public health professionals’ (PHP) involvement in health policy processes in the Eastern WHO European Region, addressing barriers, enablers, and capacity-building needs. Methods Utilizing a mixed methodology, the study employed document analysis, scoping review, and interviews to triangulate data, with the document analysis focusing on 4 published Essential Public Health Operations Self-Assessment Reports, the scoping review analysing 15 key articles, and 5 semi-structured interviews providing additional insight from key country stakeholders. Results Core findings revealed significant barriers impeding PHPs' participation in policy processes. Among others, these included limited intersectoral collaboration, shortage of skilled public health (PH) personnel, financial resource constraints and inadequate governance structures. Conversely, several enablers were identified, such as a positive trend in increased intersectoral collaboration and innovative governance structures during Covid-19, the development of more trained PHPs and the utilization of International Health Organisations. The two main capacity building needs reported were the importance of modernizing PH education and promoting intersectoral collaboration. Conclusions This study offers a preliminary overview of how PHPs' involvement in health policy processes in these countries can be enhanced: More intersectoral collaboration, updated PH education curricula and trainings, and governance re-design building on positive trends seen during the pandemic. Following actions are recommended: Creation of an international platform for cross-sectoral PH communication & exchange, direct support for universities and PH researchers, development of comprehensive PH trainings, assistance in forming or strengthening national public health associations and identification & sharing of effective local governance practices. Key messages • This research identifies barriers to PHPs’ participation in Eastern WHO European Region's health policy processes, while highlighting enablers like increased collaboration during Covid-19 to build on. • Recommendations to harness the enablers include clear actions such as creating an international public health platform for interaction and exchange or build-up of national public health associations.

Competencies needed for public health workforce in the programs of Iran's health transformation plan: A descriptive study based on programs, operations, and competencies chain.

The public health workforce faces a wide range of challenges related to people's health. Thus, they need a combination of different professional skills and competencies to perform essential public health operations and provide services to people. The present study was conducted to determine the competencies needed for the public health workforce to implement health transformation plan programs at Ahvaz University of Medical Sciences in the capital of Khuzestan province in Iran. This research was a descriptive cross-sectional study that was conducted in 2020 among 51 managers and experts of the health deputy and faculty members of the public health school. STROBE guideline was used for the present study. The research tools were two researcher-made questionnaires based on the chain of Programs, Operations, and Competencies (POC). Additionally, the validity and reliability of the questionnaires were checked. Cronbach's alpha coefficient was equal to 0.87 for the first questionnaire (programs-operations) and 0.85 for the second questionnaire (operations-competencies). The operations of surveillance of population health and well-being, monitoring and responding to health hazards and emergencies, and disease prevention, including early detection of illness, obtained the highest mean total score (3.9 (95% CI: 3.6 to 4.2)). Respect for and adherence to ethical principles and confidentiality in any professional activity obtained the highest mean total score (4.0 (95% CI: 3.7 to 4.3)) among the needed competencies. To properly implement public health programs, managers must plan and take necessary measures to improve such operations as surveillance of population health and well-being, monitoring and responding to health hazards and emergencies, disease prevention (including early detection of illness), and promotion of the workforce competencies in the field of respect for and adherence to ethical principles and confidentiality in any professional activity.

Mapping activities on climate and health to the essential public health operations (EPHO)

Abstract Issue/problem Variation exists in the degree to which public health organisations are taking action on climate change and health. However, all countries must effectively and rapidly operationalise climate and health strategy in order to protect national and global population health. Among the challenges, public health systems can have difficulty in conceiving practical ways of taking action. Description of the problem Our objective was to develop a resource to support public health organisations in identifying how they can begin to address the issue of climate change and health. It was important for the resource to be balanced in terms of providing tangible examples whilst being sufficiently high level so as to enable translation to different contexts. The method involved using the World Health Organization's essential public health operations (EPHOs) as a framework upon which to describe suggested actions on climate change and health. A collection of expert reports on climate and health were selected and each of the ten EPHOs were cross-referenced against these. Results The results are illustrated in a spider diagram in which examples of public health activities are written around the ten standard icons of the EPHOs, and shown connected to these by adjoining and interconnected lines. The visual nature of the diagram is planned to assist the user in more readily appreciating the relevance of climate and health activities in the wider context of the conventional public health agenda. Lessons To our knowledge, potential climate change and health activities have not been mapped to the EPHOs before. Users are encouraged to adapt the diagram as a living document in their own organisations and to update it iteratively, as well as in the light of new published expert recommendations on climate and health. Since the model is based on the WHO EPHOs and contains only high level examples, it is hoped it could prove relevant across settings and countries. Key messages • Based on published recommendations, we mapped high level activities on climate change and health to the World Health Organization’s essential public health operations (EPHO). • Since the model is based on the EPHOs, it is hoped it could prove relevant across settings and countries, and help to address barriers to public health action on climate and health.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Analysis

Abstract Background The COVID-19 pandemic has reinforced the critical needs for a well-qualified and proficient workforce to provide comprehensive, high-quality health services, reach minorities, reduce health inequalities, and confront emerging health challenges. We aimed to generate insights on how best to enhance the compatibility between Public Health (PH) training program competencies and the implementation of competencies required by employers in addressing emerging public health needs. Methods We conducted an online survey, adapted from the WHO-ASPHER Competency Framework for the PH Workforce, among Israeli PH managers from August to November 2021. The survey was pretested using a modified Delphi method process. The final survey comprised 44 PH competencies divided into ten categories and was formulated to mirror Essential Public Health Operations (EPHOs). Reliability of items ranged from Cronbach's α = 0.56 to α = 0.86. Forty-nine managers participated (37.6% response rate) in the assessment of PH competencies and the core organizational PH health operations. Participants were employed at regional health departments or governmental offices (51%), followed by Ministry of Health headquarters and other governmental offices (29%). Results Analysis of the EPHOs revealed a high deficiency in Advocacy Communication and Social Mobilization for health competencies. Collaborations & Partnership and, Leadership & System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy & Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusions There is an urgent need for PH professionals to acquire versatile and innovative competencies in response to ever-changing health threats. Using a validated survey backed by an expert consensus, our analyses profiled the work needs of many PH workforce employers. Key messages • Leaders of PH services and PH higher education programs should discuss actionable ways to collaborate, redesign and better adapt educational programs to the evolving and demanding field needs. • Continuous evaluation of PH competencies can prepare a competent PH workforce ready to confront new health challenges and adapt to the changing population health.

Self-assessment of essential public health operations in Kosovo

Aim: The National Institute of Public Health of Kosovo (NIPHK) considered the challenge of assessing the availability and performance of critical public health services in Kosovo. To this end, support was requested from the World Health Organization (WHO) European Regional Office, through the WHO office in Pristina, for an action-oriented process. The systematic process of the self-assessment of public health operations aimed to generate sufficient empirical evidence to identify the strengths and weaknesses of the country’s health services and functions to provide recommendations for future public health actions in Kosovo.Methods: The NIPHK team followed the systematic self-assessment methodology of the Essential Public Health Operations (EPHO) model that the WHO’s regional office for Europe developed. The appraisal was conducted throughout 2018 and the first quarter of 2019 and involved a broad spectrum of public health actors. It also followed a participatory, interdisciplinary, and inter-sectoral approach. It was developed in three phases: preparation and collection of information, analysis and interpretation of the data, and critical recommendations for the Kosovo health authorities’ consideration. Results: The assessment resulted in an overall score of 48% sufficiency for the set of public health operations (core and enablers). The most in need of development were EPHO 6, which is related to governance (only 20% of what is needed in this dimension as a whole), followed by EPHO 3, which considers vital aspects of health protection (35%), and EPHO 10, which is related to research capacities (40%). Based on the EPHO assessment results, the specialized teams developed a set of priority recommendations to strengthen the implementation of the EPHOs in Kosovo.Conclusion: The self-assessment revealed that, despite ongoing initiatives and measures to strengthen public health, the application of EPHOs has much room for improvement. We believe that decision-makers can use this method and the findings that it reveals to implement the most effective interventions to protect and promote the population’s health. In addition, the methodology and experience can be used for educational and training purposes.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis.

Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.

Together for better health in Germany. Towards a public health strategy

Abstract In Germany, the responsibility for public health is divided both between federal levels and between sectors, and there is no national or general strategy for public health. However, a strategy is essential for achieving the overarching goal of ensuring the best possible health for all people, including preventing and addressing significant health challenges such as pandemics and climate change. In 2016, Zukunftsforum Public Health (Future Forum Public Health) was established with the primary goal to enhance coherence and collaboration between public health stakeholders from academia, policy and practice. According to the principle of health in all policies, it also aims to promote collaboration across federal levels and political sectors. Within the platform provided by Future Forum, the public health community agreed that a strategy was necessary for strengthening and uniting the disparate field of German public health even though no official mandate for developing a strategy existed. Thus, Future Forum launched a grassroots process to identify key elements for a strong and resilient public health system, based on the essential public health operations (EPHOs), as defined by WHO Europe. For each of the ten EPHOs, the key issues paper “Towards a Public Health Strategy - Together for Better Health in Germany” presents a description of the current situation and challenges, an introduction to the key players, a definition of the aims and objectives, and concrete proposals on how to achieve these. Through its participative nature, the process of developing the key issues itself was an important factor for strengthening the public health community. This process highlights that even where national public health strategies and structures are missing, grassroots public health movements can be effective in strengthening the public health community as well as producing a visible set of recommendations for a resilient public health system. Key messages • Based on WHO’s essential public health operations, Future Forum Public Health developed a key issues paper with guidelines for a resilient public health system. • The participative process leading to the key issues paper was itself an important factor for networking and strengthening Germany’s public health community.

Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study.

Context:The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice.Objective:To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned.Design:A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis.Setting:This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems.Participants:Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58).Results:We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted.Conclusions:The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.

Overview of the implemented in Moscow state programs in the public health field

Introduction. Public health measures are implemented in accordance with the essential public health operations (EPHO). The EPHO tool can be used not only as a guide for assessing the potential of public health, but also to identify actions needed to strengthen and improve public health. As part of the self-assessment of the performance of operational functions of public health in Moscow, strategic documents in the interests of health and well-being implemented in Moscow (EPHO 6) were studied and a review of state programs implemented by executive authorities was conducted. Materials and methods. The study is based on the analysis of legal sources, regulatory legal acts, projects implemented by the executive authorities of Moscow, which are co-executors of the Regional Program for Strengthening Public Health. Results. State programs implemented by co-executors are an important tool that allows to combine the resources of stakeholders in addressing health promotion issues. It is possible to use the development and implementation of state programs as a search for new methods of solving tasks in the field of health promotion; coordination of goals, development of mechanisms of interdepartmental interaction for the formation of a public health system in Moscow.

List of essential public healthcare functions as a basis for analysis and evaluation of the public health system in a city

Introduction. The World Health Assembly in resolution WHA69.1 defined the essential public health operations (EPHO) as the most cost-effective, comprehensive and sustainable ways of improving population health and reducing the burden of disease. In recent years Russia has been actively working to introduce a system for motivating people to lead healthy lifestyles into the medical prevention system. A special place is given to the regions. Moscow as an independent region of the Russian Federation has a great potential in this field. However, for the effectiveness of health system planning and public health promotion measures at the national, regional and municipal levels, more clarity is needed on the issue of EPHOs. Objectives. To study the main characteristics of EPHO list and results of its application in the countries of the world as a tool of public health system construction on the level of a city. Materials and methods. A content analysis of World Health Organization documents, scientific publications of foreign and domestic authors, country reports on the development of EPHOs lists and evaluation of POPs implementation was performed. Results. The list of EPHOs varies from country to country because of different national priorities, demographics, financial resources, etc. The European Region's list of ten EPHOs describes elements inside and outside the public health system. The list of EPHOs is used as a tool for analyzing public health systems or organizations at the national and local level. Discussion. More conceptual clarity is needed for public health systems planning and public health advocacy, as well as adaptation of the EPHO assessment tool to the context of Moscow. Conclusion. The structure of the EPHOs list included in the instrument of WHO Regional Office for Europe can reflect the public health landscape in Moscow and be used as a tool for investigation of public health systems or organizations at the city level and can contribute to the elaboration of the unified city public health policy and establishment of integrated public health services.

8.M. Round table: The Why, the How, and the Tensions in the response of European SPHs to the 2020 COVID-19 pandemic

With its repeated waves of infection and a high death toll in countries all over the world, the COVID-19 pandemic places the public health (PH) discipline at the centre of public attention. Thus, it is a crucial ethical requirement to activate all available resources of PH knowledge and skills, nationally as well as internationally, in response to the pandemic. Universities, Schools and Departments of Public Health (SPHs) hold important resources in terms of theoretical and practical competences. In order that PH professionals will have the necessary competences to deliver the Essential Public Health Operations (EPHOs) to combat health threats, e.g. pandemics, the Association of Schools of Public Health in the European Region (ASPHER) has developed competency systems and lists for the PH workforce as well as for the academic knowledge and skills foundation of PH in its broadest sense. The membership of ASPHER thus represents a substantial resource of PH knowledge and skills, enabling the SPHs to play a critical role also in the COVID-19 pandemic. To develop the knowledge and skills resources further, ASPHER however set up a COVID-19 Task Force to describe and analyse the many-sided dynamic challenges, which the pandemic presents to society and thus to the role of PH institutions and professionals. Under normal circumstances, the central roles of the SPHs are teaching and research and, to a more limited extent, health communication to the public and giving advice to society's decision makers. The question however is, whether and to what extent these crucial resources actually are activated across the walls of the schools during the present pandemic. To throw light on this, the Task Force performed a survey on the actual, concrete role of ASPHER's members in the pandemic during 2020. Half (59) of the member SPHs responded. Eight out ten had engaged in both COVID-19 related teaching and communication to the public, and in COVID-19 related research as well as giving advice to national, regional and local decision makers. The target groups of teaching were PH students as well as students within other health disciplines. Health communication to the public was performed by use of a series of classic and modern media techniques. Both planned and published anti-COVID-19 research was reported. A large variation of subthemes was considered and employed within each of the four main themes, so that all ten Essential Public Health Operation (EPHO) main categories were represented. Consultancy was practiced in various international, national and local contexts and with effect on decision making. The main objective of the present panel discussion is to show and discuss, how European SPHs responded concretely to the COVID-19 pandemic through 2020, as shown in all main parts of their activities. Examples will be contact tracing (Dublin SPH), testing (Olomouc SPH), vaccination (Milan SR-SPH), training (Granada SPH), and development of mathematical simulation models (Copenhagen SPH).Speakers/Panelists Mary Codd University College Dublin, Dublin, Ireland Alena Petráková Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czechia Carlo Signorelli University Vita-Salute San Raffaele, Milan, Italy Alberto Fernández Ajuria Escuela Andaluza de Salud Pública, Granada, Spain Theis Lange Department of Public Health, University of Copenhagen, Copenhagen, Denmark Key messages Thinking out of the box: SPHs adjusted quickly to the demand shaped by the pandemic.This counts for education/training, communication with the public, research, and providing consultancy/advice to national, regional and local society leaders.

7.M. Round table: The role of European schools of public health in the 2020 COVID-19 response

Abstract With its repeated waves of infection and a high death toll in countries all over the world, the COVID-19 pandemic places the public health (PH) discipline at the centre of public attention. The pandemic threatens the health of individual citizens, higher-risk population groups and society as a whole. It threatens national and global economies. Thus, it is a crucial ethical requirement to activate all available resources of PH knowledge and skills, nationally as well as internationally, in response to the pandemic. Universities, Schools and Departments of Public Health (SPHs) hold important resources in terms of theoretical and practical competences. In order that PH professionals will have the competency profile necessary to deliver the Essential Public Health Operations (EPHOs) to combat health threats, including pandemics, the Association of Schools of Public Health in the European Region (ASPHER) has developed competency systems and lists for the PH workforce as well as for the academic knowledge and skills foundation of PH in its broadest sense. Consequently, the membership of ASPHER represents a substantial resource of PH knowledge and skills, enabling the SPHs to play a critical role also in the COVID-19 pandemic. To develop the knowledge and skills competency resource further, ASPHER however set up a COVID-19 Task Force to describe and analyse the many-sided dynamic challenges, which the pandemic presents to society and thus to the role of PH institutions and professionals. Under normal circumstances, the central roles of the SPHs are teaching and research and, to a more limited extent, health communication to the public and giving advice to society's decision-makers. The question is, however, whether and to what extent these crucial resources actually are activated across the walls of the schools during the present pandemic. To throw light on this, the Task Force performed a survey on the actual, concrete role of ASPHER's members in the pandemic during 2020. Half of the members (59 SPHs) completed the survey questionnaire. Among respondents, eight out ten had been involved in consultancy and giving advice to national, regional and/or local decision-makers. A similar proportion was involved both in COVID-19 related teaching and health communication to the public and in COVID-19 related research. Thus, the study demonstrated an outstanding potential to deliver crucial knowledge and skills to support the governance and the PH systems necessary to combat COVID-19 now and in the future. Accordingly, the main objective of the present panel discussion is to illustrate, how SPHs in four countries - France, Israel, Lithuania, Portugal - responded concretely to the COVID-19 pandemic through 2020, scrutinising the schools' interaction with national, regional and local decision-makers during the pandemic's development within the countries and across borders. Speakers/Panelists Laurent Chambaud École des Hautes Études en Santé Publique, Rennes, France Nadav Davidovitch Israeli Association of Public Health Physicians, Beer Sheva, Israel Ramune Kalediene Lithuanian University of Health Sciences, Kaunas, Lithuania Henrique Barros Faculdade de Medicina da Universidade do Porto, Porto, Portugal Key messages SPHs have got concrete potential to deliver crucial knowledge and skills to support both national governance and the public health systems necessary to combat COVID-19. The SPHs followed basic ethical rules and engaged in concrete anti-COVID-19 activities.

Schools of public health in Europe: common mission—different progress

Background: European Essential Public Health Operations (EPHOs) supposedly drive improvements in public health outcomes, including Schools and Departments of Public Health (SPHs). Overall, SPHs did not progress significantly in delivering outcomes related to the EPHOs between 2011 (Survey I) and 2015/16 (Survey II). This analysis attempts to identify the positive or negative development of individual SPHs.

31.D. Workshop: Sustainable public health: better individual and professional choices

Abstract The Sustainable Development Goals (SDGs) call for urgent action and global partnership in order to solve the worlds' most complex problems, arguing that we cannot have good health and wellbeing or reduce inequalities without solving the consequences that come with climate change, the necessity of need for quality education and the importance of responsible consumption and production. The public health (PH) arena touches all of these problems. According to the 10 Essential Public Health Operations (EPHO) defined by the World Health Organization (WHO), PH services are meant to deliver health protection, health promotion and disease prevention to populations. In order to do that, these EPHO, and particularly EPHO3, include climate change, green health services and sustainable development as important issues to take into account when identifying current and future weaknesses in health services and PH interventions, and inform the development of new policies, programs or projects to address them. This workshop aims to provide useful insight on the current climate change situation and its impact on the populations' health across the globe; the importance of the contribution of PH in the creation of green health services; what we can do on an individual level to contribute to the achievement of the SDG; and how PH policies, programs and projects can contribute to EPHO3 and the achievement of better and sustainable population health states. This workshop provides up-to-date knowledge on what is happening in the world regarding sustainability, green health services and climate change's health impacts, which practical measures every PH professional can implement in their daily lives to improve their individual carbon footprint and contribute to the achievement of the SDG, as well as examples of actual PH policies, programs and projects that are evidence-based and which health professionals can apply to their work in order to be more sustainable and contribute to the achievement of EPHO3. The workshop has a 'regular workshop' format with 90 minutes total. It is separated into 3 parts, each with a different speaker (15 minutes each, with a regular presentation type format): What is happening? World overview (Teresa Garcia)What can everyone do about it? The science behind creating a habit and sustainable individual choices that contribute to the SDG (Raquel Vareda)What can Public Health do about it? Relevant PH policies, programs and projects that are evidence-based and contribute to better PH and sustainable health systems (Juan Rachadell) Between presentations there will be a 5-minute break for Q&A. In the last 30 minutes, the participants will work in small groups to discuss PH projects in which they're currently/have been involved, and they'll be asked to choose or imagine a project and present a more sustainable way of creating and applying it. All projects will be shared and commented on by every group and by the trainers of the workshop. Key messages As an individual, you will learn practical actions that you can take in order to contribute to EPHO3 and the SDGs. As a PH professional, you will learn which projects, programs and policies are currently aiming for a more sustainable world.

Medical certificate of disability: a descriptive analysis of Aveiro region, from 2010 to 2016

Abstract Background In Portugal, Public Health Physicians attribute the medical certificate of disability (MCD). This document is mainly used for fiscal benefits or from other kind, as priority parking card and non-medical public services are increasing its requirement. The threshold to determine benefits is 60% of incapacity by law. Oncological, musculoskeletal and psychiatric diseases account for most of the cases. This activity is highly time-consuming and is not part of the Essential Public Health Operations or the competences of Public Health Physicians according to the Medical Professional Order. The aim of this study is to characterize the evolution of this procedure and the obtained incapacity values from 2010 to 2016 in the Public Health Unit of Baixo Vouga Primary Healthcare Cluster. Methods A descriptive analysis was made with the registers of production of MCD in four municipalities of the Aveiro Region from 2010 to 2016. Results An increase in the number of MCD was verified, going from 274 in 2010 to 550 in 2016, in a total of 3087. Two thousand and fifteen was the year with the greatest frequencies, with 632 certificates. The median value of incapacity was 60% (64% of total MCDs), with an interquartile amplitude of 12, varying from 6% to 99%. Incapacity values have an increasing tendency over the years, showing a cohort effect. Conclusions The increase of MCD reflects an enormous burden for the Public Health Services that consequently have fewer resources to deal with Essential Public Health Operations. Human resources or task distribution should be rethought in order to respond to population's needs. Cohort effects might be explained by the law-fixed re-evaluation, required every 5 years for oncological cases. In fact, this incapacity is the main cause of requirement of the MCD. Further studies should address this problematic in order to better organize the health services and understand the effectiveness of this procedure. Key messages The number of issued MCD is growing, overloading Health Services. The median incapacity is 60%, which is the threshold to attribute benefits. Further investigation is needed to address this issue.

The application of the complexity theory to public health interventions: a review of the literature

Abstract Background There is a growing recognition of the limitations of a linear cause-and-effect rationality in planning and evaluating public health interventions. Although this perspective is amenable to programme planning and evaluation, it leaves aside a whole array of mechanisms of change triggered by interactions taking place in complex social systems. Generative causality is one and recognized under a number of works referring to the complexity paradigm. Here we review the state of knowledge on what is often referred to as the complexity theory (CT), and present the results of a review of the literature on its application in public health. Methods We searched PubMed for articles, commentaries, editorials published in English, French and Italian, using the keywords 'Complexity Theory' (also plural). We categorized the fields of application of the CT according to the three core WHO's Essential Public Health Operations, i.e., Health Promotion, Prevention and Protection. All papers addressing issues related to health care services (but not prevention) were included in the category “health care services” while others were tagged as “others”. Results We found 203 papers meeting our inclusion criteria. The largest share of the research output applying the CT was in health care services (n = 167), followed by Health Promotion (5), Prevention (3) and Protection (2). 26 papers were labelled others. In health promotion/ prevention, applications of the CT have yet to integrate most of its concepts. Most authors tap into both the linear and generative rationality perspectives. Conclusions Although regularly deemed as promising in uncovering mechanisms for change triggered by public health intervention, applications of the complexity theory remain uncommon and has made little inroads in the public health domain. This is particularly the case for health promotion where one would assume that participatory community-based interventions would be an incentive to integrate this perspective. Key messages Although deemed promising the complexity theory has made little inroads in public health. Health promotion with its participatory community-based interventions can benefit from its application.

Local health contracts as instruments of cross-sectoral collaboration: the French CLoterreS study

Abstract Background Although recognised as essential, the role of local governments in promoting health remains under investigated. Yet their mandate directly impacts living conditions and promotes SDGs. In France, 'local health contracts' (LHCs) mobilise local decision-makers in 4 areas: health promotion, prevention, health care and social care. The CLoterreS study assesses the extent to which LHCs foster health-promoting actions through cross-sectoral collaboration. Methods We conducted 49 semi-structured interviews with staff from all Regional health agencies (RHAs) and local stakeholders. We analysed the action plans of a stratified random sample of 53 LHCs from the 165 signed between 2015 and March 2018. We used a validated multidimensional coding tool based on WHO's Essential Public Health Operations and other consensus documents. Results LHC's contribution to health promotion through cross-sectoral collaboration depends on a mix of factors. Among barriers, the improvement of access to health care is often a primary driver for local elected officials. However, political will and past experience in establishing 'win-win' relationships with other sectors is an advantage, as well as the fact that RHAs generally make LHCs an instrument to coordinate health promotion efforts instead of ad hoc funding of isolated actions. Overall, 73% of LHCs' actions address living conditions, health promotion or primary prevention. LHCs frequently target behavioural determinants such as physical activity or diet (44 out of 53) with an emphasis on individual or interpersonal targets. A few innovative actions situated at the intersection of urban planning, transportation, recreational or food environments illustrate the potential for further cross-sectoral action on living conditions. Conclusions LHCs are vehicles for health promotion. Reinforcing cross-sectoral action implies leadership, resource mobilisation, training and coordination of sectors whose health is not a core priority. Key messages In France, Local health contracts (LHCs) are significantly used for health promotion. Cross-sectoral collaboration in this area implies further capacity building beyond the health care sector at the regional and local levels.

The European Schools of Public Health: From theory to practice - two sides of a broken coin

Abstract Introduction Disease prevention and health promotion are closely related through the lifestyle concept and should be part of the postgraduate curriculum of every School of Public Health (SPH) in the European Region and beyond, especially concerning the modifiable behaviors of physical activity and healthy nutrition. Methods The Association of Schools of Public Health in the European Region (ASPHER) executed 2 surveys on the activities of its members between 2011 and 2015/16. A group of 48 SPH responded in both surveys. The performance of graduates was measured by a Likert scale of 1-5, applied to the 10 Essential Public Health Operations (EPHOs). Furthermore, we determined the delay in full implementation for the target year 2030. The target to offer both modules in 2030 has been set at 100% of all SPHs. Results For disease prevention as for health promotion, the 2nd Survey in 2015/16 shows slightly less positive results offering these two modules (72.9 vs. 77.1 and 81.3 v. 87.5%) as compared to the 1st Survey in 2011. The only exception is the use of social media which - as a method of teaching and training - increased for disease prevention from 20.8 to 37.5% of all SPH and for health promotion from 22.9 to 39.6%. Referring to the set target of 100% for running these two modules, considerable delays between 4 and 13.5 years accumulate for the target year 2030. Conclusions Except for the use of social media, progress towards 2030 is slow or even negative. Serious efforts have to be made by ASPHER to reverse this lack of progress.

Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district

Abstract Background Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019. Methods An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables. Results In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12). Conclusions Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016. Key messages Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.

Education and training in public health: is there progress in the European region?

The Association of Schools of Public Health in the European Region (ASPHER) is confronted with challenges to improve education for public health professionals. In this article, we attempt to answer the question: Did ASPHER members improve their organization and programmes to enable their graduates to acquire the competences to tackle the diverse areas of public health defined in the Ten Essential Public Health Operations (EPHOs)? ASPHER run two surveys among its membership: In 2011, 66 Schools and Departments of Public Health (SDPHs) took part (82.5%), while in 2015-16, 78 SDPHs (81.3%). The performance of graduates was estimated using a Likert scale. In 2015-16, the SDPHs delivered 169 academic programmes (2.2 on average per SDPH). Among the SDPHs participating in both surveys, significant differences could not be determined, neither for the organization (except increasingly using social media) nor for teaching areas. The performance of graduates did not show significant differences except for the deterioration of EPHO-8 ('assuring sustainable organizational structures and financing'). However, the qualitative data revealed progressive dynamics regarding innovations in the organizational set-up, digitalization, teaching/training, introduction of new modules and research. The results generated do not allow us to state that the innovative elements introduced after the first survey in 2011 have had a clear impact reflected in the second survey carried out in 2015-16, but perhaps this is due to the need for a broader follow-up in order to objectify the potential consequences derived from the boost generated by the changes introduced.