EU Health Research Articles

Fast lane for decision making: The PHIRI Rapid Exchange Forum

Abstract Issue & Problem The COVID-19 pandemic demanded swift, yet structured exchange of knowledge, data and good practices between experts and institutions supporting national governments in decision making for crisis response. Thus, in March 2020 population health experts from several European countries started to meet online, complementing the more formal EU Health Security Committee meetings. The European Commission understood the high need of Member States for evidence-based, and structured cross-country exchange and supported it as part of the Population Health Research Infrastructure (www.PHIRI.eu) project. Since then, the PHIRI Rapid Exchange Forum (REF) is a knowledge-sharing platform that brings together public health researchers, practitioners, policymakers, and other stakeholders to share information, experiences, and best practices in public health implementation research even if the EU co-funded PHIRI project has ended. The forum aims to promote collaboration and networking, facilitate the dissemination of research findings, and accelerate the translation of evidence into policy and practice. Lessons Through the PHIRI REF, participants can engage in interactive discussions, workshops, and presentations on various public health topics, including infectious diseases, digitalisation, health emergency simulations, health systems strengthening, and community health interventions. The platform is designed to be user-friendly and accessible to all, with a particular focus on European countries. By May 2024, the REF-Secretariat at the Austrian National Public Health Institute GÖG had organised 60 REF meetings, with in average 20 attendees from 12-15 countries. The monthly 1-hour online meetings cover in a moderated, structured format pre-agreed topics that are proposed by the participating countries. All findings and topics are documented and publicly available at the EU Health Information Portal (https://www.healthinformationportal.eu/rapid-exchange-forum). Key messages • The success of the Rapid Exchange Forum highlights the importance of collaboration and information exchange between population health experts in addressing global health challenges. • Having a pre-established information exchange network on urgent public health issues is of utmost importance as it enables rapid and trustworthy communication among relevant stakeholders.

The Network of Expertise on Long COVID as a means to synthesise intelligence and improve our response to long COVID at EU level

Abstract To promote international collaboration and strengthen EU and national-level responses to Long COVID, the Commission set up the Network of Expertise on Long COVID (NELC) in 2023. It brings together national institutions involved in Long COVID work, nominated by the Public Health Expert Group (PHEG) representatives of each Member State. The network provides a platform for exchanges of national experiences on diagnosis, treatment, and management of long COVID. The Commission and the NELC agreed on eight specific actions to be implemented to manage Long COVID. The development of a Long COVID definition is complex due to the diverse range of symptoms experienced by patients, and so working towards a unified EU case definition is the first action proposal. This will allow the development and implementation of a surveillance system on national and EU level to foster the knowledge on the actual scale and the symptomatology of Long COVID across the EU leading to a better comparability of health data at Union level. The proposal to develop and implement a training programme for healthcare professionals at EU level will allow for the exchange of expertise/training on Long COVID across Member States. The provision of clinical guidelines based on evidence to Member States will help manage Long COVID, and international collaboration will allow for the sharing of valuable information and data with third countries that have experience with Long COVID. The Commission will use the EU Health Policy Platform to create an open stakeholder group. This group will allow stakeholders and patient groups to express their point of view, and to share experiences. Assessing the far-reaching social and economic consequences of Long COVID across the EU will allow for more targeted social and economic policy responses from Member States. It is important that priority is given to research responding to the most urgent needs of health care systems, which is why the Commission aims to identify research needs.

Deployment of in-body wearable devices in healthcare and at work: closing the EU regulatory gap

Abstract Background In-body wearable devices can protect workers’ health and safety. Moreover, they might provide data that could be capitalized on in the context of the European Health Data Space (EHDS), which aims at fostering a single market for medical devices and high-risk AI systems. Yet, neither EU legislation nor national law regulates the use of in-body wearables at the workplace and the related data protection and safety issues. This regulatory gap impacts on workers’ rights. Methods The study explores whether the EU regulatory framework used in the healthcare sector for medical devices could fit the in-body wearables’ application in employment. The legal and policy analysis takes the perspective of workers’ rights and discusses the application of a key GDPR principle: lawfulness. The research discusses the potential transformations in the EU health data protection framework that could close the regulatory gap. Results The EU regulatory framework for medical devices (focused on product safety, performance, and quality) is not equipped to address the data protection challenges linked to the use of in-body wearables for occupational health and safety purposes. The GDPR’s principle of lawfulness and the related guidance by EU and national data protection authorities lack clarity on employers’ possibilities to apply in-body wearables for occupational health purposes. Filling the regulatory gap is conducive to appropriate qualification and risk-based classification of in-body wearables, which affect pre- and post-market requirements and impact on data protection. Conclusions a. The EU legislator could use its social policy competence to regulate the use of in-body wearables to protect workers’ health while safeguarding their data. b. EU authorities should clarify whether and how the data collected by in-body wearables at the workplace could be shared and (re)used within the EHDS. c. Further input by data protection authorities is needed to close the regulatory gap. Key messages • The EU should regulate the use of in-body wearables to protect workers’ health and safety. • Health data gathered through the application of in-body wearables at the workplace may be an asset for the EHDS.

3.Y.1. Genomics in EU Health Systems: Navigating the Opportunities and Challenges for Personalized Health

Abstract The rapid advancements in genomics research offer significant promise for revolutionizing healthcare, potentially reshaping how we approach disease prevention, diagnosis, and treatment. However, unlocking the full potential of genomics requires more than just scientific breakthroughs-it necessitates translating these discoveries into clinical practice. This involves bridging the gap between research and healthcare implementation, addressing challenges such as technical infrastructure, ethical and legal frameworks, healthcare professional competencies, and citizen engagement. As we navigate the evolving landscape of individualized patient care, it becomes increasingly crucial to implement effective risk stratification methodologies and personalized preventive measures. Among these methodologies, polygenic risk scores are gaining prominence. However, the adoption of these innovations necessitates careful consideration of their clinical utility, including their feasibility, cost-effectiveness, and acceptability in diverse healthcare settings. Validating these approaches from multiple perspectives is essential to ensure their effectiveness in real-world clinical practice. Integrating genomic sequencing data with health records presents an invaluable resource that can enhance patient outcomes and drive further research. The creation of infrastructures and initiatives such as those carried out by projects like the European Health Data Space and Genomic Data Infrastructure are fundamental to unleash the enormous potential of data-driven innovation. To date, the implementation of genomics in medical practice varies across European countries, with discrepancies in adoption levels across different aspects of healthcare, including prevention, diagnosis, and personalized treatment. Addressing these disparities and promoting standardized approaches to genomic medicine implementation are crucial steps toward ensuring equitable access and maximizing the benefits of genomics for all individuals across Europe. This workshop aims to provide decision-makers, healthcare professionals and researchers with a comprehensive overview of the state-of-the-art for the adoption of personalized approaches, and of the maturity of genomic medicine practices within different healthcare systems as well outlining the benefits of data accessibility for research. The speakers are coordinators and partners of EU projects as B1MG (Beyond One Million Genomes), Prophet (A PeRsOnalized Prevention roadmap for the future Healthcare), EHDS (European Health Data Space), GDI (European Genomic Data Infrastructure), GoE (Genome of Europe) and CanHeal. Key messages • Genomics has the potential to improve health outcomes. • Equal access to genomic medicine critical for personalized health. Ensuring equity, while considering feasibility.

11.L. Round table: Fiscal measures for building resilient European health systems

Abstract Currently, over 100 million European citizens are affected by obesity and non-communicable diseases. These health conditions impact individuals and society economically as well as socially. Therefore, an increasing number of Member States has introduced taxes on foods high in fat, sugar, or salt. However, divergent national fiscal health measures can lead to market distortion or fraudulent activities, revealing that, although the responsibility for implementing fiscal measures lies with national governments, health systems of different Member States are much interlinked. The increasing health risks for European citizens and its broader impact underline the importance of resilience in European health systems more than ever before, calling for early response and effective concrete actions from both EU institutions and national governments. Additionally, the topic of resilient health systems currently ranks high on the European agenda, with the Belgian Presidency promoting health system preparedness and early response and health care strengthening as one of their six priorities. The European Commission will also continue its work on this issue for the next five years. The EU has already taken steps in this matter, such as the launch of the European Health Union and the creation of HERA. However, in order to preserve a healthy society, the EU must further develop in this regard. Therefore, this round table discussion will focus on the question of how fiscal measures in Member States can contribute to resilient health systems. It aims to generate ideas on how Ministries of Health can contribute to resilient health systems via fiscal measures compatible with European Community law that promote health and prevent disease. Panellists from the WHO Regional Office for Europe, the Hungarian Ministry of Health and Ecorys, a research-based consultancy, will provide diverse perspectives on the topic. The added value of the round table is laying out possible ways of how both the EU and Member States can contribute to enhancing the resilience of European health systems. In the discussion, knowledge is derived from various research projects, such as Ecorys’ study for DG TAXUD on health taxes, their study for the Dutch Ministry of Finance on sugar taxes, and their literature study on sugar taxation and VAT reduction on fruits and vegetables. Furthermore, as an example of alternative funding mechanisms for resilient health systems, the Hungarian approach to health taxes will be reviewed, since a portion of the tax revenue from their public health tax is used to finance public health initiatives. From a policy perspective, the round table will aid in formulating recommendations for improving the resilience of EU health systems for the next five years. Key messages • Unhealthy foods and drinks consumption poses significant health risks, impacting economy and society, and requiring evidence-based fiscal measures as part of comprehensive measures. • The round table provides public health stakeholders the opportunity to generate recommendations for improving the resilience of EU health systems for the next five years. Speakers/Panelists Kremlin Wickramasinghe Division of Country Health Programs, WHO/Europe, Denmark Krisztina Biró Ministry of Interior, State Secretariat for Health, Budapest, Hungary Soila Karreinen Tampere University, Tampere, Finland Rana Orhan Pees Ecorys, Rotterdam, Netherlands Sara Cerdas Former Member of the European Parliament, Brussels, Belgium

Promoting vaccination for newly arrived migrants: a multistakeholder collaboration pilot

Abstract Access to vaccinations for Newly Arrived Migrants (NAMs) is a critical public health issue. In the context of the project ‘Increased Access for Newly Arrived Migrants-AcToVax4NAM’ (Grant No. 101018349, 3rd EU Health Program), DPHID-SAP and GLOB-ISS conducted a pilot aimed at developing and testing a system pathway to promote and vaccinate NAMs. The pilot began with the creation of a team between researchers from DPHID-SAP and GLOB-ISS, professionals from two services of the Local Health Authority and from a first reception centre (CAS) in Rome area. An integrated knowledge translation approach was used, which facilitated the collaborative development of strategies and actions of the pilot. The team then reached out to other ‘professionals FOR health’ involved in the vaccination process of NAMs, i.e. physicians from Temporarily Present Foreigners (STP) outpatient clinics, General Practitioners and Pediatricians. Between July 2023 and April 2024, four actions were developed. 1) analysis of the current access of NAMs to vaccination services and the subsequent development of a contextualized pathway to facilitate vaccinations for NAMs, including catch-up strategies; 2) identification of informed consent and other materials needed to be included in the pathway; subsequently, translated in 10 languages; 3) implementation of vaccine literacy session for CAS staff and NAMs; 4) improvement of immunization information flows to enable assessment of vaccination coverage of NAMs. To evaluate the pilot, the vaccination rate observed during the pilot (January-April 2024) was compared to that occurring in 2023, showing a 36.5-fold increase in the vaccination rate (4 x 100 person-year in 2023 and 155 x 100 p/y in 2024; RR = 36.5 (95%CI 14.6-117.6). The pilot highlighted that a research collaborative approach among various actors facilitated the access to vaccination for NAMs and was an opportunity to turn knowledge into action. Key messages • It is essential to ensure equitable vaccination coverage to reduce under-immunized groups. • Access to vaccination is a key element of the right to health and for collective health protection and it should be a shared responsibility.

Hospital satisfaction among older adults by European Union health system clusters

Abstract Background Health systems are influenced by political, historical, cultural and socio-economic factors and differ across countries. Classification of EU health systems into 5 clusters has allowed for international comparison and policy recommendations. This study is based on the Andersen’s Behavior Model, that predicts that a sequence of predisposing, enabling and need factors influence satisfaction and utilization of healthcare services. Aim Examine the nature and relationship of predisposing, enabling and need factors associated with hospital satisfaction of older adults across EU nations by health system classification clusters. Methods Data from Wave 9, of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of older adults from 10 EU countries. Analysis: Non-parametric one-way ANOVA (Kruskal- Wallis test) and Multinominal Logistics regression were performed to test the null hypothesis that (1) hospital satisfaction is equal across all clusters, and (2) predisposing, enabling, and need factors, are not predictors of hospital satisfaction. Findings There was a statistically significant difference in hospital satisfaction by cluster [Chi Square= 231.44, df = 21; p< .001]. Age, mental health, technology and chronic disease are predictors of healthcare facilities satisfaction. [Chi Square 50.94, df = 3, p< .001], Among those that reported to be highly unsatisfied with healthcare facilities, [chronic disease (Beta = -2.64) and mental health (Beta = -4.41) df = 1 p< .001] significantly predicted hospital satisfaction. Implications for Policy and Practice: Initiatives for the care of older adults should not only aim to increase access to care but also provide targeted services for sub populations such as older adults with mental health and chronic diseases. Further, significant investment is required in technology infrastructure within hospitals and technological assistance or training should be provided to older adults. Key messages • Older adults satisfaction with hospitals varies by health system clusters and is predicted by age, mental health, use of technology and chronic disease. • Chronic disease and mental health are strong predictors of hospital dissatisfaction among older adults.

Scoping the EU’s health impact in the Southern Neighbourhood: Building resilience and trust

Abstract Background The European Neighborhood Policy (ENP) focuses on security, migration, and economic stability. Strengthening health systems can contribute to these aims by building local resilience and institutions; however, little is known about the EU’s health policy and impacts in the Southern Neighborhood (Syria, Lebanon, Jordan, Palestine, Egypt, Libya, Tunisia, Algeria, Morocco). This paper examines the role of health in the ENP and what is known about the health-related impacts of EU actions in this region. Methods This is a qualitative case study of the EU’s ENP commitments, outcomes, and impacts (2004-2024) in nine middle-income Southern Neighborhood countries. A scoping review of empirical evidence included 5 scholarly databases and grey literature published. Retrieved publications and the ENP documents were thematically analysed with WHO’s health systems building blocks and the alignment between the ENP and practice was assessed. Results ENP health actions have evolved from public health and selected communicable diseases (2004), to health service delivery, vaccine supply, and occupational health (2021). The review included 19 publications (2004-2024). Publications most often addressed the financing (n = 14 papers) and service delivery (n = 9) aspects of health systems (not mutually exclusive), and only once addressed workforce and health information. Publications addressed mostly intentional EU health actions in the region; 4 papers reported unintentional effects. Conclusions The limited scope of health actions in the ENPs suggests health may be instrumentalised to pursue the EU’s security and stability goals. The type of EU health actions reported most often in the literature were consistent with the ENP health priorities. There is no systematic evaluation of the impacts of the EU’s health-related commitments in the ENPs. To build resilience and trust in the region, future EU action should support a range of WHO building blocks and mitigate potential negative effects. Key messages • The EU’s health commitments in the European Neighborhood Policy evolved from public health & communicable diseases (2004), to health service delivery, vaccine supply, & occupational health (2021). • There is no systematic empirical evaluation of the impacts of the EU’s health-related commitments in the European Neighborhood Policy.

Analysis of the mpox outbreak in Europe in 2022: vaccination rollout in the most affected countries

Abstract Background The mpox virus spreads through contact with infected material and causes flu-like symptoms and skin lesions. Common in Central and West Africa, a global rise in mpox cases in 2022 was observed, affecting mainly men who have sex with men. Methods The study analysed vaccination policies in the most affected WHO-EURO countries during the mpox outbreak, including the Netherlands, France, UK, Spain, Germany, Belgium, Portugal, and Switzerland. Epidemiological data from May to October 2022 (first wave) were compared. Additionally, the role of EU health institutions in assisting member states in controlling virus spread across the region was examined. Results By the end of May 2022, three countries (The Netherlands, France, and UK) initiated post-exposure vaccination shortly after the first case identification. Portugal, one of the most affected countries, implemented pre-exposure prophylaxis for high-risk groups by September, followed by Switzerland in November. Vaccination access for non-exposed priority groups varied, with France not requiring a medical prescription. EU cooperation in health was pivotal during the outbreak, with vaccines distributed through the EU4Health program budget via HERA to ensure preparedness. However, detailed information remains limited. Conclusions Countries’ responses to the mpox virus outbreak varied significantly, with discrepancies not always aligning with epidemiological data. These differences could stem from various factors, such as behavioural patterns, prior immunisation rates, and neighbouring countries’ policies. However, the unequal access to vaccines across the region underscores existing health disparities, particularly affecting stigmatised populations. Data on immunisation records were notably scarce in most countries, hindering thorough analysis of policy implementation and effectiveness. Additionally, further exploration is warranted into the role of LGBT associations and evidence of stigma surrounding the outbreak. Key messages • The mpox 2022 outbreak in Europe provides an important picture of cross-border health policies and public health responses for future emergences in a European cooperative environment. • Most national authorities provided limited information during the mpox 2022 outbreak; data on immunisation records and vaccine access is pivotal to assess countries’ health policies.

The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action

Abstract Background The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action aims to advance health workforce planning across the EU, addressing the pressing need for a resilient, sustainable, and accessible health service systems. Given the evident strain on health systems demonstrated during the COVID-19 pandemic, this initiative seeks to address the critical need for strategic HWF planning. Building on previous projects, HEROES will foster the capacity of EU states in workforce planning, preparing the health systems to meet future challenges. Methods The study adopts a collaborative framework involving 19 EU countries, segmented into clusters based on health system characteristics. A stepwise approach (‘AS IS,’ ‘TO BE,’ ‘TO DO’) characterizes the methodology, incorporating extensive data collection, stakeholder engagement, and scenario forecasting. Country-level information on HWF Data and Planning will be compared both across countries in clusters and across clusters. Results Initial findings indicate significant disparities in health workforce data quality, availability, and planning methodologies among the states. Identified methodologies also involve real-world data applications and predictive analytics to refine health workforce planning. Efforts are underway to define an Advanced Minimum Dataset (AMDS) to synchronize health workforce data and define planning tools across the clusters, as country-level AS IS reports have been finalized and cross-country comparisons are ongoing. Conclusions Collaborative, data-driven health workforce planning can significantly enhance health system resilience and responsiveness. Recommended public health actions include enhancing HWF data integration, forecasting capabilities, and stakeholder participation, with the aim of shaping national health policies and practices. The public health impact is profound, as it allows to improve health service delivery and workforce adaptability in response to dynamic health demands. Key messages • The HEROES Joint Action advances EU health workforce planning, with the aim of enhancing the resilience and responsiveness of health systems. • Strategic data-driven approaches in health workforce planning are pivotal for resilient, accessible and sustainable healthcare systems.

2.E. Round table: Building climate resilient health systems in the EU

Abstract Climate change is one of the biggest challenges for modern society. The health effects of climate change lead to negative impacts on European health systems, and conversely, European health systems contribute significantly to climate change. To overcome challenges posed by the climate crisis, European cooperation is essential. The interdependencies between climate change and public health and its broader impact underline the importance of resilience in European health systems, calling for concrete actions from both EU institutions and national governments. Additionally, the topic of resilient health systems currently ranks high on the European agenda, with the Belgian Presidency promoting health care strengthening as one of its six priorities. The European Commission will also continue its work on this issue for the next five years. The EU has already taken steps in this matter, such as the launch of the European Health Union and the adoption of the EU4Health Programme. However, in order to better prepare for climate resilient health systems, the EU must further develop in this regard. To explore this pressing issue, the round table discussion will focus on how EU actions in climate adaptation can synergistically contribute to the resilience of health systems. Resilience, often associated with adaptation, embodies the capacity to anticipate, withstand, and recover from shocks and stresses related to climate change. By delving into this question, the workshop seeks to uncover ways in which EU and Member State climate initiatives can reinforce health system resilience, thereby fostering a more adaptive and responsive health workforce and infrastructure. Featuring 4 panellists from Erasmus University Rotterdam, the Austrian National Public Health Institute, the Dutch Green Healthcare Alliance and the European Environment Agency, the round table will bring together diverse perspectives on this issue. The added value of the round table is laying out possible ways of how both the EU and Member States can contribute to enhancing the resilience of European health systems. After establishing the necessity for action, the round table discussion will focus on generating ideas to address climate change. Specifically, this discussion will cover examples of national policies, such as from the Netherlands, Austria, and other Member States. Also discussed will be the importance of monitoring and surveillance, and conducting a health and vulnerability assessment. This ensures better understanding of the relevant current and future health impacts, which will inform resilience measures. This will be followed by a discussion with the audience to formulate recommendations for improving the resilience of EU health systems for the next five years. Key messages • Climate change challenges European health systems, emphasising the need for European cooperation in resilience efforts. • Synergising climate adaptation with health system strengthening enhances EU’s capacity for resilience. Speakers/Panelists Chiara Cadeddu Erasmus University Rotterdam, Rotterdam, Netherlands Aleksandra Kazmierczak European Environment Agency, Copenhagen, Denmark Andrea Schmidt Austrian Public Health Institute, Vienna, Austria Juliette Mattijsen Groene Zorg Alliantie, Rotterdam, Netherlands

How to measure Organizational Vaccine Literacy: an exploratory cross-country survey

Abstract Background The project AcToVax4NAM (Grant No. 101018349-3° EU Health Programme) aims to ensure equal and guaranteed access to vaccination services for Newly Arrived Migrants (NAMs). The working group developed a tool that measured the level of Organizational Vaccine Literacy (OVL), defined as an organizational effort to make the Health System easier to access and navigate, thereby facilitating informed decision-making regarding vaccinations for individuals, families and communities. Methods A systematic literature review was undertaken to identify validated tools for measuring OVL, but none was found. Consequently, the review was broadened to include tools for assessing Organizational Health Literacy, which were then adapted to define OVL. A questionnaire consisting of 22 questions divided into 7 sections was developed, utilizing a scale of 1 to 5 to gauge OVL. The survey was then distributed among healthcare services in 8 countries of the AcToVax4NAM consortium. Results We received 88 responses, mainly from Italy (26%), Spain (23%) and Greece (12%), encompassing 17 facilities, primarily vaccination centers and health prevention departments. Questions about the clarity and easy access to vaccination information provided by organizations had high mean scores, except the questions on the navigability of websites for foreign patients (mean scores < 3). Notably, responses related to the issue of cross-sectoral collaboration between health services and other partners (e.g., patient associations, NGOs), had a mean score of 2.56. Low scores were observed in the area related to the perception of possible individual contribution to systemic organizational efforts. Conclusions Shifting to an approach in which organizations prioritize equity and address complex needs, rather than leaving it to individuals to navigate the complex world of healthcare providers, could bring benefits to population groups, particularly those at risk of not accessing prevention services, such as NAMs. Key messages • After conducting a systematic review to identify validated instruments for the measure of Organizational Vaccine Literacy (OVL), a tool consisting of 22 questions was developed to measure OVL. • Shifting to an approach where organizations prioritize equity and address complex needs, rather than leaving it to individual responsibility, could significantly benefit vulnerable population.

Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer. Methods Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective. Results 20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences. Conclusions Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services. Key messages • Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services. • Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.

Administering a Chill Pill? Better Regulation and the Potential for Regulatory Chill in European Union Health Policy

The European Union's “good governance” program, known as Better Regulation, seeks to improve the quality of EU legislation by controlling the policy-making process. Despite its importance, it is rarely accounted for in the EU health policy literature. Seeking to address this gap, this article introduces Better Regulation in the context of health policy making. It conceptualizes a model of regulatory chill, drawn from the literature on international trade, to interrogate the impact of Better Regulation on EU policy-making processes. Using examples from the literature and data from a series of interviews with EU officials, it explores potential pathways of response and anticipatory chill, identifying direct enforcement of Better Regulation, its utilization by corporate actors, interpretation of its provision by officials, and feedback loops as possible routes of influence. The article argues that such an approach not only presents methodological challenges but also offers a valuable way of conceptualizing the relevance of political institutions in general, and Better Regulation specifically, for health. As part of broader calls for attention to the political determinants of health, the article's findings highlight the particular, and often overlooked, importance of metaregulatory policy frameworks.

Cardiomyopathies matter: a multistakeholder european initiative to improve patient outcomes through effective health policies

Abstract Background/Introduction Cardiomyopathies are common and affect up to 1:250 of the population. Despite conferring a risk for sudden cardiac death and substantial disease burdens that could be reduced through better awareness, detection and care, cardiomyopathy care is rarely incorporated in European and national health policies. New European Society of Cardiology cardiomyopathy guidelines (1) could substantially benefit care but need to be supported by effective policies. Cardiomyopathies Matter is a Europe-wide, multistakeholder initiative aiming to raise awareness about cardiomyopathies and to ensure they receive the policy attention they warrant from EU and national decision-makers. Methods Cardiomyopathies Matters participants include experts from the fields of cardiology, cardiac nursing, economics, and patient advocacy, coordinated by a Secretariat, representing 36 countries and 6 patient advocacy groups (PAGs). A Policy Roadmap and other publications were co-created based on i) reviews of published and grey literature, and ii) input from topic experts and PAGs through 2 group workshops, individual consultation meetings, and a modified nominal group technique reviewing successive drafts toward consensus approval. Results The Roadmap (2) identifies unmet needs and challenges throughout the patient care pathway and offers holistic EU and national policy recommendations to address these and improve patient outcomes (Figure 1). These include policy measures to support early and accurate diagnosis, access to expert multidisciplinary care, guidelines-informed disease investigation and management, holistic support and empowerment of patients and carers, and research and innovation. Key aspects for nurses and allied health professionals include the need for 1)improved knowledge and awareness to promote early diagnosis; 2)rapid referral systems to multidisciplinary care and access to specialist cardiomyopathy or heart failure nurses care coordination, 3)genetic counselling (index cases and cascade/family screening), and 4)support of patients and families. Building on existing examples of good practice at national expert centre networks (e.g. France, Spain, UK),Cardiomyopathies Matter published updated policy recommendations for the European Union mandate (3), which are now being adopted more widely. National initiatives are underway or in development in Belgium, Hungary, Italy, Netherlands, Poland, and Spain. Local actions include multistakeholder roundtables and events, national Roadmap publications, events, educational activities, and media outreach. Conclusions EU and national Cardiovascular Health Action Plans are needed, with specific attention to cardiomyopathies and other inherited CVDs. Cardiomyopathies Matter fosters collaboration between healthcare professionals, PAGs and policymakers to promote policies that ensure all patients and families have access to guidelines-informed care.Figure 1Cardiomyopathy Priorities

Can EU Law Be Used to Challenge Better Regulation Practices That Do Not Lead to Better Health?

Legislation produced under the EU Commission's Better Regulation Agenda sometimes fails to achieve the Treaty obligation to ensure a high level of health protection in all EU policies and activities. Public health advocates have raised the question of whether EU law can be employed to challenge this apparent breach of Treaty obligations at the proposal preparation stage, compelling the Commission to amend prospective EU legislation so that it better protects health. This article will demonstrate that unfortunately this is not possible due to the justiciability of both Article 168 TFEU and the Better Regulation Agenda. However, this awareness can help public health advocates to re-focus their efforts on strategies that will likely have a greater impact in swaying the direction of EU health policy.

Landscape analysis of available European data sources amenable for machine learning and recommendations on usability for rare diseases screening

BackgroundPatient registries and databases are essential tools for advancing clinical research in the area of rare diseases, as well as for enhancing patient care and healthcare planning. The primary aim of this study is a landscape analysis of available European data sources amenable to machine learning (ML) and their usability for Rare Diseases screening, in terms of findable, accessible, interoperable, reusable(FAIR), legal, and business considerations. Second, recommendations will be proposed to provide a better understanding of the health data ecosystem.MethodsIn the period of March 2022 to December 2022, a cross-sectional study using a semi-structured questionnaire was conducted among potential respondents, identified as main contact person of a health-related databases. The design of the self-completed questionnaire survey instrument was based on information drawn from relevant scientific publications, quantitative and qualitative research, and scoping review on challenges in mapping European rare disease (RD) databases. To determine database characteristics associated with the adherence to the FAIR principles, legal and business aspects of database management Bayesian models were fitted.ResultsIn total, 330 unique replies were processed and analyzed, reflecting the same number of distinct databases (no duplicates included). In terms of geographical scope, we observed 24.2% (n = 80) national, 10.0% (n = 33) regional, 8.8% (n = 29) European, and 5.5% (n = 18) international registries coordinated in Europe. Over 80.0% (n = 269) of the databases were still active, with approximately 60.0% (n = 191) established after the year 2000 and 71.0% last collected new data in 2022. Regarding their geographical scope, European registries were associated with the highest overall FAIR adherence, while registries with regional and “other” geographical scope were ranked at the bottom of the list with the lowest proportion. Responders’ willingness to share data as a contribution to the goals of the Screen4Care project was evaluated at the end of the survey. This question was completed by 108 respondents; however, only 18 of them (16.7%) expressed a direct willingness to contribute to the project by sharing their databases. Among them, an equal split between pro-bono and paid services was observed.ConclusionsThe most important results of our study demonstrate not enough sufficient FAIR principles adherence and low willingness of the EU health databases to share patient information, combined with some legislation incapacities, resulting in barriers to the secondary use of data.

EU Health Policy and the Healthcare Labour Market in Latvia: The Out-Migration of Healthcare Practitioners

Healthcare systems in Europe are facing increasingly complex challenges that demand innovative solutions. Furthermore, public health is increasingly recognised as a productive factor which impacts the healthcare sector’s contribution to national economies. The out-migration of healthcare practitioners from Latvia is one of the most pressing problems in the health sector, which, in turn, negatively impacts the country’s economy. The outflow of healthcare practitioners to other EU countries has increased since 2004, the year which saw Latvia’s accession to the EU. This trend is a consequence of labour accumulation efficiency in the single market, and this article aims at conducting analyses of the main push factors governing healthcare practitioners’ emigration from Latvia and the impact of these factors on the healthcare sector. The complexity of this migration determines the use of an interdisciplinary as a methodological approach in the analysis of the main trends in the healthcare labour market. This approach can assist one in carrying out an assessment of the healthcare system’s losses as a result of the out-migration which has occurred thus far. Particular attention is paid to the training of resident doctors as a perspective trend in keeping healthcare professionals in the country. The legal mechanism for recovering public funding dedicated to residency programs has also been assessed. In conclusion, the article states that the mass emigration of healthcare practitioners from Latvia may jeopardise the efficient functioning of the country’s healthcare system.

NMR Analysis of Extra Virgin Olive Oil of the Epirus Region of Greece with Emphasis on Selected Phenolic Compounds.

Extra virgin olive oil (EVOO) is recognized for its numerous health benefits, attributed to its rich phenolic components. NMR has emerged as a prevalent technique for precisely identifying these compounds. Among Mediterranean countries, Greece stands as the third-largest producer of olives, with the Epirus region notably advancing in olive cultivation, contributing significantly to the dynamic growth of the region. In this study, an NMR method was employed based on the acquisition of a 1H NMR spectrum along with multiple resonant suppression in order to increase the sensitivity. Using the above method, 198 samples of extra virgin olive oil, primarily sourced from the Epirus region, were analyzed, and both the qualitative and quantitative aspects of the phenolic compounds were obtained. In addition, we examined the effects of various factors such as variety, harvest month, and region origin on the phenolic compounds' concentration. The results revealed an average total phenolic content of 246 mg/kg, closely approaching the EU health claim limit of 250 mg/kg. Approximately 15% of the samples were confidently characterized as high-phenolic olive oil. The highest concentrations were observed in the Thesprotia samples, with several Lianolia varieties exceeding the total phenolic content of 400 mg/kg. Statistical tests demonstrated a significant influence of the olive variety and the month of fruit harvest on phenolic component concentration, followed by the region of origin. A very strong correlation was noted between the total phenolics content and the levels of oleocanthal and oleacein, with a correlation coefficient (r) of 0.924. Upon optimization of all factors affecting olive oil quality, the majority of the EVOOs from the Epirus region have the potential to be characterized as high in phenolic content.

EU Health Union: Legal Aspects and Digital Health

Abstract Recurrent health crises and outbreaks of infectious diseases of international concern have created a specific EU public health policy. Its role was further strengthened by the COVID-19 pandemic, which triggered the next stage in the integration process of the Member States: the European Health Union. The research is carried out using a literature review method (a review of literature and documents in the field of public health policy and the European Health Union) and a comparative-legal method for comparing EU legal acts on which the Health Union is based (endogenous comparison) and the legal acts of EU and the Republic of Slovenia (exogenous comparison). The findings are examined using a qualitative content analysis method, which allows for meaningful aggregation and use of the data under study to answer the research questions. The European Health Union builds on and extends existing areas of public health and requires greater integration between Member States. One of its most essential pillars is a single information system with a single database to improve the health of individuals, resilience to cross-border health crises, patient mobility, and joint research on the most severe diseases. Member States, including Slovenia, must follow EU public health commitments. As the Slovenian legislative proposal analysis on the digitalization of healthcare shows, this challenging task will also require respect for the institute (safeguards) of other areas of law.