EU Health Research Articles

Public Health Innovation and Research in Europe: introduction to the supplement

PHIRE (Public Health Innovation and Research in Europe) was developed for the national member associations and individual researchers of the European Public Health Association (EUPHA) to engage collectively with the health research agenda in Europe. It was co-funded by the European Commission's Directorate for Health and Consumers within the EU Health Programme. It was coordinated by EUPHA in a partnership of eight organizations. This article introduces the Supplement in the European Journal of Public Health presenting the results of PHIRE. PHIRE used mixed methods to collect data across 30 European countries (European Union 27 plus Iceland, Norway and Switzerland). Seven thematic Sections of EUPHA identified eight cross-national public health innovation projects, and Country Informants to report on national uptake and impact of these innovations. Public health was considered broadly--health determinants and interventions, health services and practice. Through EUPHA's member national public health associations, and by direct country contacts, PHIRE described country public health research strategies and structures, reviewed calls and programmes for research in 1 year and organized stakeholder workshops. PHIRE was reported to the European Commission, and the component reports placed on the EUPHA web page. A draft of the Final Summary Report was sent by email for commentary by selected experts. PHIRE data from the work packages were organized into eight themes for the Supplement. Through the EUPHA thematic Sections, experts described the uptake and impact of eight innovation projects from the EU Health Programme. National reports indicated a positive impact of the innovations in public health 'markets'. Through national public health associations, 75 programmes and calls for public health research were found for 2010, but systems are not comparable and nor is information exchanged or coordinated. Only a few countries have public health research strategies. Having competitive research funding through Ministries of Health is potentially beneficial. There is limited contact between national and European public health research programmes and calls. Experts who were sent the draft PHIRE Summary Report gave generally positive responses on the validity and usefulness of the results. Dissemination has been achieved through meetings during the study and by electronic means thereafter. PHIRE has increased knowledge about public health innovation at national and European levels. Strengthening the public health research system, and demonstrating innovation in public health markets will maximize benefits to Europe's citizens.

Act programme: Breaking the barriers for care coordination and telehealth

Introduction: Chronic illness poses a huge individual, social and economic burden to the European health care systems. Care coordination (CC) and telehealth (TH) solutions can help, but are not widely deployed. Description of the program: Philips is leading ACT-Advancing Care Coordination and Telehealth deployment, an EU co-funded program to overcome structural and organizational barriers. This will: gather data and best practices from five European regions (Scotland, Groningen, Lombardy, Catalonia and Basque Country), determine a baseline for how CC & TH work in these regions, conduct an iterative evaluation of care structures and procedures and finally create a best practices “cookbook” to ensure that the findings can be replicated in other EU health regions. By developing key outcome/performance indicators and key drivers that cover the areas of patient stratification, adherence and engagement, efficacy and efficiency and organizational structures, we will be able to assess longitudinally capture the impact of integrated care in the healthcare services.

B.1. Skills building seminar: Everything you always wanted to know about EU health policy but were afraid to ask

B.1. Skills building seminar: Everything you always wanted to know about EU health policy but were afraid to ask

Health professional mobility and ethical recruitment: What are the options?

This presentation will explore the policy options available for ethical recruitment and professional mobility policies in the context of the challenges faced by EU health systems. Health professional shortages, an ageing population and the rise of non-communicable diseases highlight the urgent need to build a qualified health workforce. From a public health perspective, professional imbalances mean diminished patient safety and declining health outcomes. Migrating health professionals also run the risk of being viewed as replaceable …

Forming EU Health Strategy: An Ethnographical Study of Stakeholder Positions and Governance in European Policy Making 2012-2014

Background European health strategies cover a range of “wicked issues” such as smoking, alcohol consumption, physical activity, and (unhealthy) food products, thereby having a direct impact on the everyday lives of citizens. Health involves everyone, but who has a say in determining how and which interests are prioritised? The European Commission Directorate General for health and Consumers (DG SANCO) and WHO Europe have both …

B.1. Skills building seminar: Everything you always wanted to know about EU health policy but were afraid to ask

B.1. Skills building seminar: Everything you always wanted to know about EU health policy but were afraid to ask

Understanding the tobacco industry’s interests in smokeless tobacco and harm reduction in order to inform EU health policy

Background The EU Tobacco Products Directive, including a sales ban on snus, is currently under review. Transnational tobacco companies (TTCs) have been lobbying to lift this ban, arguing that switching smokers to snus could be an effective harm reduction approach. While many in public health support such approach, others have concerns that this may ultimately be detrimental to public health. To inform this complex debate, we explored TTCs’ European interests in smokeless tobacco (SLT) and TTCs’ use of the …

Methodological aspects of estimating rare cancer prevalence in Europe: The experience of the RARECARE project

This paper describes the usage and the performance evaluation of the completeness index method in the ‘Surveillance of Rare Cancers in Europe project’ (RARECARE) for estimating rare cancer prevalence in Europe. The 15-year prevalence at 1st January 2003 for 255 cancers is obtained from a pool of 22 RARECARE cancer registries (CRs). Incidence and survival models are applied to the RARECARE database to estimate the parameters from which the completeness indices are calculated. Complete prevalence is obtained adjusting the observed 15-year prevalence by the completeness index, to account for those cancer survivors diagnosed before the CR activity started. Main factors influencing the performance of the completeness index method for rare cancers are the same as for common cancers: age distribution of incidence and lethality of the cancer. For cancers occurring in the elderly, with low survival rates and consequently a restricted number of long-term survivors we obtained completeness indices higher than 0.9. Values lower than 0.7 correspond to those cancers with good prognosis and/or incidence more concentrated at the younger ages, indicating that 15 years of follow up are insufficient to detect all prevalent cases. Validation analysis shows that for a restricted subgroup of rare cancers with very low incidence and low survival, the completeness indices were not able to adequately correct the observed prevalence even considering a registration period of 20 years. On average, sensitivity analyses show a slight overestimation of complete prevalence for rare and common cancers whose increasing incidence is known in literature. RARECARE is the largest project on rare cancers conducted to date. Improving health care programs for cancer survivors is a public health priority and prevalence data which provides important information in this field should be regularly asked to Member States and included in the EU health statistics.

Supporting health systems in Europe: added value of EU actions?

Since the start of the economic crisis, the European Union's (EU's) predominant discourse has been austerity and fiscal consolidation. The detrimental effects on Europe's health systems and the health status of its citizens are well described. However, little is known about the emerging EU-level initiatives to support national health systems handle the challenges of efficient care provision and system reorganisation aimed to meet their future needs. This review analyses the manner, conditions and prospects of such EU support. First, health system objectives are increasingly entering the EU health policy agenda. Second, professional and patient mobility provisions may support member states (MS) in copying with crisis related health challenges but can potentially acerbate them at the same time. Third, in recent initiatives health system goals are more closely tied to the EU's economic growth narrative. And fourth, health system issues are taken up in existing EU-level structures for debate and exchange between MS. In addition, the design of some policies may have the potential to intensify socioeconomic and health inequalities rather than ameliorate them.

Editorial

Editorial

The EU Health Strategy—Investing in Health

The European Union has gradually developed a consistent and integrated policy framework to respond to common challenges in the field of health that combines legislation, cooperation and financing: the EU Health Strategy “Together for Health”. The economic crisis compounded the existing challenges stemming from changes in demographics and patterns of disease, technological change, as well as major threats to health. It put an additional strain on the sustainability of health systems and raised the urgency to channel EU efforts towards economic recovery and growth as outlined in the Europe 2020 strategy. Acknowledging this new environment, on 20 February 2013 the European Commission adopted a policy framework more closely linking EU social and health policies to Europe 2020: the Social Investment Package (SIP) including a document dedicated to ”Investing in Health”. This paper extends the EU Health Strategy by reinforcing its key objectives, firmly anchors health in the Europe 2020 policy framework and reaffirms that health is a value in itself and health spending is a growth friendly expenditure. A healthy population and sustainable health systems are decisive for economic growth. Investing in sustainable health systems means that cost-effective spending, structural reforms and sound innovation can bring efficiency gains and secure better health outcomes. Investing in people’s health also boosts economic growth by enabling individuals to remain active longer and in better health. Finally, investing in health requires reducing health inequalities to break the vicious spiral of poor health contributing to, and resulting from, poverty and exclusion.

Expert Services for Rare Anaemias across Europe

New challenges and priorities are given in the EU Health programme 2007–2013 [...]

Avoiding another directive: the unstable politics of European Union cross-border health care law

The European Union’s (EU) 2011 Directive on cross-border patient mobility codifies the right of any EU citizen to travel abroad for treatment and be reimbursed on the same terms as they would be at home. Governments hoped it would end the string of court cases that had reshaped EU health law but this article argues that it is likely to produce yet more judicial challenges. Patient mobility is an attractive idea with unclear definitions and divergent implementation. In many cases, providers, insurers and governments will not communicate and leave the patient with a bill – almost daring the patient to sue, and the courts to make more policy. Governments should try to prevent this by investing in coordination and alternative redress for patients who might otherwise sue.

Food and health research in Europe: Structures, gaps and futures

BackgroundFood and health research is concerned with production, marketing, choice, regulation and policy for food as it affects health, and the mechanisms and control of diet-related diseases, nutrition and obesity. It covers positive and negative impacts of food on health, as well as issues related to under and over consumption of food. The European Union-funded study FAHRE (Food and Health Research in Europe) has described structures and identified gaps and needs for food and health research across Europe. MethodsFAHRE was conducted by a consortium of partners in 7 European countries, including private and public research organisations, university-based researchers and civil society organisations. National advisers in 32 European countries made reports on the structures of food and health research, and nine experts made reports on food and health research themes. At the end of this phase, a stakeholder conference was held to review and discuss the findings, and from this a Strategic Document was developed and distributed electronically for wider consultation at national level. This report presents the findings of the Strategic Document. ResultsFAHRE proposed that future research using public funding should address the global issue of unhealthy eating, including obesity, which causes preventable disability and disease, reduced working life and increased healthcare costs. FAHRE suggests a move of the focus of research from healthy food to healthy eating, and to overcome the existing separation between food research and health research through a shift of research towards food for health.EU member states have widely differing national systems for research management, and information is poorly standardised for comparisons. There are many research programmes in both food and health, usually managed by ministries of science, but rarely in collaboration with ministries of health. Industry mainly contributes ‘near product’ research: few industry small and medium enterprises are engaged with food and health research, nor are civil society organisations. EU food and health research has been focused within the agriculture research theme, and not sufficiently linked to health research.FAHRE recommends coordination of food and health research through an EU-level Coordinating Agency, with budget and representation from the three EU directorates Agriculture, Health and Research, the member states, and wider stakeholders including civil society and industry. There should be corresponding ‘food and health research agencies’ in the member states bringing together national policy-makers and stakeholders, and directing research funding. Food safety agencies may provide a model for this joint approach. Further proposals include strengthening social and policy research, accessing Structural Funds for research programmes, and more strategic approaches to determining research programmes and funding. ConclusionFood and health research in Europe should move from ‘healthy food’, which concentrates on food as a product, to research for ‘healthy eating’ which is concerned with appropriate intake and reducing disease. Coordination of research on this theme, at European level, and between member states, could deliver major economic and social returns.

Reforming the EU Clinical Trials Directive: Streamlining Processes or a Radical “New” Agenda?

From its conception the EU Clinical Trials Directive met with controversy. Some saw it as an unnecessary inhibitor to scientific research, introducing bureaucracy which was unduly expensive, slowing down the clinical trial approval system. The Directive however also enshrined respect for fundamental rights in relation to clinical trials decision-making and impacted upon the domestic law of member states facilitating the alignment of trial review processes. Nearly a decade after its implementation the EU is moving towards implementation of further reform in this area, from a Directive to a Regulation, from a system placing the research ethics system at the heart of the clinical trials approval committee to one which does not and which represents a see change in international and domestic approaches to research ethics. This article critically examines the proposed reform of the regulation of clinical trials on medicinal product through the introduction of a new EU Regulation and asks whether this can be seen as a natural streamlining of processes or a radical new agenda in EU health law and regulation.

Patients’ rights in cross-border healthcare within the EU: Towards a common health area

The paper explores European patients’ rights to cross-border healthcare. It discusses limited competences of the EU in the field of public health, which is predominantly reserved for the Member States and explains how the EU Court nevertheless managed to interpret economic freedoms of the EU internal market so as to guarantee rights for the European patients. A significant event that was considered a great advance in the field was the judgment of the EU Court in the case of Decker and Kohll in 1998, where it established an alternative procedure by which patients who have received treatment in another member state without previous authorization can demand a reimbursement from the social security system of their country of origin. On this basis, the paper analyses recently adopted Directive 2011/24/EU, which entitles patients to obtain healthcare in any other EU Member State and to have these healthcare costs reimbursed by thehealthcare system in their home country. The directive establishes a compromise between the historic compartmentalisation of the national health systems and the increasing rights of EU citizens deriving from the free movement of services. The paper concludes that by way of the EU Court’s case law and the Directive 2011/24/ EU we are approaching the vision of the founding fathers of the EU regarding the common EU health area. Nevertheless, because of the differences among the social systems of the EU Member States full implementation of this vision is not plausible.

EU Health Claims Regulation and the Marketing of Functional Foods: A Regulatory Void?

This report evaluates the current regulatory regime for health claims in the EU on the basis of a case study of the marketing of Optimel Control, a yoghurt drink which was marketed in several EU member states as a functional food aimed at suppressing appetite and maintaining weight control. Our case study of the marketing of Optimel Control in the Netherlands reveals that the use of non-textual marketing claims was much more important than the use of textual health claims. Because the current EU regulatory regime emphasizes the evaluation of the wording of health claims, but lacks an evaluation of non-textual claims we conclude that there is a regulatory void that producers can use to market their products in ways that suggest more health effects than scientifi cally warranted. As a result the protective effect of the current EU regulatory regime on health claims is less strong than what legislators may have intended. While it might seem most logical to simply expand EFSA's remit by also letting it look at non-textual claims, we argue that a better solution to close this gap is through a stricter monitoring of unfair commercial practices at national level.

Public health science systems and policies: the UK in a European context

BackgroundIn bibliography studies, the UK shows a high output of medical research compared with other European countries. But less is known of public health research. With the European Public Health Association (EUPHA), we have created an EU-funded project PHIRE (Public Health Innovation and Research in Europe) to determine national structures for commissioning public health research, identify calls and programmes in 2010, and assess national uptake of European collaborative public health projects. The data were collated for each EUPHA member association to hold a national review workshop. MethodsWe identified public health research structures, calls and programmes, and uptake of European projects through informants and web sources. We held the UK PHIRE workshop at the Royal College of Physicians, London, in May, 2012, tabling papers with the UK position. There were 20 representatives from the UK health departments, funding agencies, charities, and researchers. We made a report of the meeting discussion and conclusions. FindingsAlthough the UK biomedical bench-to-bedside research approach is strong, the position of public health population and organisational research—despite previous high-level reports—is less clear. The research councils fund biological, medical, and social research separately; they emphasise cohort studies, methods for analysis of population data, and centres of excellence. The National Institute for Health Research includes calls for public health research on interventions outside the National Health Service. With a wider definition of public health research, we identified 15 different calls and programmes in 2010. Some medical charities support health behaviour and policy research, but usually not health systems or services research. UK public health researchers have participated in both EU collaborative research and the EU Health Directorate's Public Health Programme, but there has been little knowledge or effect centrally. In France, the Institut de Recherche en Santé Publique (within INSERM) has created a database of public health research calls and projects, drawing from 28 national and regional agencies. Scandinavian countries have had national programme reviews with external experts. Germany is developing public health research networks. Some EU new member states have used the structural funds for public health research. Uptake of research varies across countries. In the coming EU research programme Horizon 2020, the small existing EU public health research programme might be fragmented across 15 health research strands. Further strategic issues within a European context include careers (European mobility, including transfers of research funds within a European Research Area), access to European infrastructure funds for trans-European cohorts and health-care databases, and maximisation of exchange and use of knowledge for innovation. InterpretationImportant issues include taxonomies, methods, and databases for recording and reviewing public health studies; funding, sustainability, comparative effectiveness, and cost-benefit of public health interventions; comparison of outputs and benefits from investigator-led, institute-based, and thematic research calls; and assessment of effects of research on policy and practice. As European researchers increasingly use English for research and communication, UK research organisations can enter and compete in the wider public health research market of Europe. FundingThe UK Faculty of Public Health is a partner in PHIRE, with co-funding from the European Commission Health Programme (2009–1214).

Implementation of joint health indicators in Europe - Joint Action for ECHIM. Arpo Aromaa on behalf of the ECHIM core group

The story of the implementation of the joint EU health indicators (ECHI indicators) began in the 1990s after the Amsterdam Treaty. The first concrete step in establishing a health monitoring capacity for EU was the Commission working group set up in 1997. Several consecutive and parallel projects, notably the health indicator projects ECHI-1 and ECHI-2 between the years 2000 and 2005 led to a preparedness to implement the jointly agreed health indicators (ECHI shortlist) in all European countries. ECHIM (2005 – 2008) and the Joint Action for ECHIM (2009 - ) laid the foundation for the implementation of health indicators, and initiated Europe wide implementation proper. After the European recession of 2008 the circumstances in different countries were not optimal. Also the collaboration with the Commission could have been better. Nevertheless, the implementation process of the ECHI indicators is now well underway in most countries. By June 2012 half of the Member States had incorporated the ECHI indicators into their national health information system, and, if work can continue, by 2014 most countries are likely to have done so. Unfortunately, a gap may occur between the current programme and the next public health programme. The current momentum must not be lost. Therefore, all those responsible need to urge that the Commission (DG SANCO) together with the Member States helps to bridge the gap from June 2012 to January 2014. The new Public Health Programme provides the necessary financial instruments for setting up a permanent EU health information and reporting system.

Could co-payments on drugs help to make EU health care systems less open to political influence?

Could co-payments on drugs help to make EU health care systems less open to political influence?