EU Countries Research Articles

Exploring knowledge, attitudes and practices towards sustainable food aid programmes across Europe

Abstract Background Food insecurity has increased following the COVID-19 pandemic and the Ukraine conflict. In some EU high-income countries, more than 70% of food aid users experience food insecurity, highlighting the need for food aid programmes to provide good quality and sustainable services and maximise the social inclusion of food aid users. The aim of this study was to identify areas that can promote sustainability in food aid programmes. Methods Knowledge, attitudes and practices towards sustainable food aid were assessed via a quantitative questionnaire. Socio-demographic data were also collected. The survey was translated and disseminated online across 5 EU countries (Austria, Cyprus, Greece, Poland, Portugal), targeting staff and volunteers involved in food aid programmes (20 per country, total N = 100). Descriptive statistics were used for data analysis. Results Most participants were female (68%), 18-49 years old (87%) and occupied in a NGO (89%) as employee (55%). The mean total knowledge score was 11.8 out of 19 (SD 3.2) with low knowledge (% of correct answers) on household food waste (18%) and environmental impact of cooking appliances (29%). In all countries (except Austria) more than 70% of participants agreed that they can apply sustainability through their work; however, more than 50% agreed that sustainability is not always feasible in food aid programmes. Food loss/waste, access to local food and the economic crisis were the main parameters reported to impact sustainability in food aid (≥70% of N). The most frequently applied practices were storing food according to expiration date, monitoring quantities in food distribution, considering beneficiaries’ needs and reading food labels. The least frequently applied practices were composting food leftovers and using energy-efficient methods to distribute food. Conclusions Sustainability is considered important; however, more effort is needed to promote and embed sustainability parameters in food aid programmes. Key messages • Sustainability is considered important in food aid programmes; however, more effort is needed to promote and embed sustainability parameters in practice. • Identifying sustainability areas in food aid programmes can lead to successful educational and training initiatives.

Introducing innovative policy instrument to reduce antibiotics use. Relevant evidence from Bulgaria

Abstract Background of the public health challenge Excessive individual consumption of antibiotics (ABs) increases global antimicrobial resistance (AMR). Therefore, shaping consumers’ behaviors towards responsible ABs use is an essential strategy in the battle with the silent pandemic of AMR. The EU One Health (OH) Action Plan against AMR targets making Europe a best-practice region. Overall consumption of ABs in the EU decreased significantly, especially during the COVID-19 pandemic. Bulgaria is the only EU country that has reported an annual increase in ABs use during this period (ECDC data). A growing part of Bulgarians, believe that ‘ABs kill viruses’ and is unaware that ‘unnecessary use of ABs makes them ineffective’ (Eurobarometer 2022). This limited understanding of adequate ABs use resulted in counterproductive behaviors that demand change. Introducing innovative policy instrument as a tool for behavioral change: Undeniably, drug prescription monitoring has the potential to change consumers’ behaviors. In October 2023 mandatory electronic prescribing (e-Rx) for ABs was introduced in Bulgaria at a primary healthcare level. Consequently, there was an observed decline exceeding 30% in ABs sales (IQVIA Bulgaria data), evidencing a reduction in ABs consumption. However, there were negative reactions by the stakeholders, due to time-consuming procedures, nonoptimal IT infrastructure, etc., and that led to e-Rx-moratorium. Finally, in April 2024, the e-Rx is sustainably introduced. Conclusions Legislative measures, like e-Rx, can hinder the chaotic use of ABs. Moreover, Bulgarians need to reflect on their behaviors and values of solidarity which OH offers. Herewith, a multidisciplinary team of academic educators unite their OH efforts in raising awareness related to AMR and the rational use of ABs. Years of national endeavors toward healthcare digitalisation led to the introduction of e-Rx for ABs in Bulgaria. Research will prove its relevance for the rest of Europe. Key messages • To the European community: The introduction of the innovative policy tool (e-Rx for antibiotics) in Bulgaria is a significant national effort in making Europe a best-practice region regarding AMR. • To the Bulgarian society: Antibiotics are not bonbons! Responsible ABs use of every one of us can contribute to the EU efforts to manage AMR. In the context of AMR, every person is a stakeholder.

Analysing the European Defence Fund’s financing distribution across EU countries: what drives national participation in defence-industrial integration projects?

The establishment of the European Defence Fund (EDF) marks a significant shift in how EU Member States approach the integration of the defence industry as it aims to systematically promote inter-European defence-industrial cooperation across national defence sectors. However, there is a lack of empirical evidence of the actual dynamics regarding EDF implementation. While there are accounts of EU countries’ varying political positions on defence integration, including its industrial aspect, it remains unclear whether Member States’ actual participation in integration projects aligns with these positions. Are national motives consistent once effective defenceindustrial integration is underway? The findings, based on Masson’s (2024) data on by-country distribution of EDF project financing (2021–2022), present a more nuanced picture of EU countries’ effective engagement with defence-industrial integration than anticipated by the political perspective. While there is a positive relationship between participation in the EDF and defence market size, strategic culture does not influence EU members’ involvement in the Fund. Furthermore, while liberal economicindustrial governance is negatively associated with national participation in EDF projects, a country’s institutional quality has a significant positive relationship with it. This article reveals more complex dynamics of EDF implementation than suggested by the political perspective on defence-industrial integration pre-EDF.

Empowering Professionals For Health to promote Newly Arrived Migrant vaccination uptake

Abstract Issue/Problem The imperative task of making access to vaccinations equitable and guaranteed for Newly Arrived Migrants (NAM) in Europe not only highlights a public health challenge but also offers a chance to tackle barriers within health systems. NAMs frequently encounter hurdles in accessing healthcare services, with vaccinations often ranking lower on their list of health priorities. The AcToVax4NAM project developed and implemented tailored interventions for Professionals FOR Health (PFH) working with NAMs in 8 EU countries. Description of the problem NAM often overlook vaccinations due to more immediate concerns, and health systems lack a comprehensive approach to vaccinations. Thus, piloted interventions were developed in consortium countries, working with PFH to tackle vaccination barriers. Over 3 months, each country implemented context-specific interventions to enhance health systems’ responsiveness using culturally appropriate tools. Key objectives included developing procedures, improving PFH cultural sensitivity communication skills, and assessing NAM vaccination intentions. Results Initial findings vary depending on the country’s context but generally show notable enhancements in PFH cultural competencies and increased willingness among NAM to get vaccinated. The pilots underscored the importance of tailoring strategies to specific contexts and fostering collaboration among stakeholders for a successful intervention. Lessons The results highlight the pivotal role of tailored interventions in addressing vaccination disparities among NAM. As PFH working with diverse populations, their role in implementing similar training programs in other settings facing similar challenges is invaluable to achieving equitable vaccination processes. Recommendations encompassing the lessons learned and challenges encountered throughout the pilot implementation will further facilitate the dissemination of this knowledge amongst relevant stakeholders.

1.X.2. Reducing inequalities in access to care in Europe: achieving universal health coverage and more

Abstract Accessibility is multi-dimensional. Universal Health Coverage emphasises the role of population coverage, the scope of services covered, and the depth of financial protection. However, there are other major barriers for patients that can inhibit universal access to health services: geographical inequalities, organisational barriers, and care denial. Health systems can provide extensive cover in some dimensions such as financial coverage or the range of services covered, but gaps in other dimensions can still act as a major barrier to care. Some groups are excluded from population coverage, other patients must navigate waiting times, medical deserts or cultural barriers in order to access care. In this session we will use an innovative filter framework outline common obstacles that patients in the European Union must overcome before they can access the care they need. We will then highlight policy responses to meet the dual goals of reducing inequalities in access to care and ensuring Universal Health Coverage. This workshop will provide a platform for sharing knowledge on reducing inequalities in access to care in EU countries. The objectives of the workshop are to i) highlight cross-cutting themes and approaches, and ii) establish opportunities for cross-country research and learning. The workshop will consist of four short presentations, followed by a broad discussion with audience interventions to bring in the experience of other Member States. Each panel member will make a short presentation in Pecha Kucha format: firstly outlining the filter framework for understanding access to health services then moving to descriptions of a policy journey to strengthening UHC in Cyprus, Estonia and Spain respectively. Bold reforms in Cyprus have expanded coverage under a new universal system; changes in Estonia have improved access to medicines; and policy-makers in Spain have sought to expand coverage of dental care. The moderated discussion will emphasise the potential for cross-country learning - identifying those policy choices of relevance for the rest of Europe. Presentations about specific policy initiatives draw on the latest Health Systems Reviews for Cyprus, Estonia and Spain. Health System Reviews underpin the Health Systems in Transition (HiT) series, a core part of country monitoring undertaken by the European Observatory on Health Systems and Policies. These Reviews are routinely updated and provide a systematic description of the functioning of health systems in countries as well as reform and policy initiatives in progress or under development. As these are in-depth descriptions which detail the intricacies of health systems and an assessment of their performance, they provide the ideal basis for understanding the true multidimensionality of accessibility. Key messages • Even health systems in high-income countries need to address inequalities in access to care to ensure universal health coverage. • The workshop will identify themes and approaches to improving access to care from a cross-country perspective through a multidimensional understanding of accessibility. Speakers/Panelists Erica Richardson European Observatory on Health Systems and Policies, London, UK Cristina Hernandez Quevedo European Observatory on Health Systems and Policies, London, UK Yulia Litvinova European Observatory on Health Systems and Policies, Berlin Hub, Berlin, Germany Gemma Williams European Observatory on Health Systems and Policies, London, UK

Observed carbon decoupling of subnational production insufficient for net-zero goal by 2050

Historically, economic growth has been closely coupled to carbon emissions responsible for climate change, but to stabilize global mean temperature, net-zero carbon emissions are necessary. Some economies have begun to reduce emissions while continuing to grow, but this decoupling is not fast enough to achieve global climate targets. Subnational climate actions seem to be crucial for the achievement of these targets. Here, we uncover the effectiveness of subnational efforts by estimating decoupling rates and CO2 emission intensities over the last three decades for over 1,500 subnational regions, encompassing 85% of global emissions, using global data on reported economic output and gridded production-based emissions. Thirty percent of regions with available data have fully decoupled, with higher-income and historically carbon-intensive regions exhibiting higher rates of decoupling and declining emission intensity. Countries of the Organization for Economic Co-operation and Development with greater spending on subnational climate actions show higher decoupling rates, as do subnational regions in EU countries where climate policies have been implemented, highlighting the effectiveness of subnational policies. Moreover, subnational analysis reveals greater variance of decoupling rates within national boundaries than between them and that countries with weaker governance typically show higher variance of decoupling within their borders. If recent rates of production-based carbon decoupling continue, less than half of subnational regions would reach net-zero before 2050, even when accounting for observed acceleration via socioeconomic development and assuming no interregional carbon leakage.

2.C. Round table: A Pandemic Treaty to deliver global health equity: negotiating under a ticking clock

Abstract Access to medical countermeasures (vaccines, therapeutics, diagnostics), fair resource allocation and a global health framework to counter future pandemics are to be provided for by the Pandemic Treaty, intensely debated in the Intergovernmental Negotiating Body (INB) over the past two years. The final negotiations round began under tremendous pressure (Apr 29, 2024), with dissonance on structural treaty elements and a ticking clock to finalise the text at the World Health Assembly (end of May 2024). At a time of shifting geopolitical powers, in a year of elections across the world, war in Europe and rising defence expenditure, countries are reluctant to commit; the draft postpones key decisions, proposing to establish two intergovernmental working groups for instruments on One Health and prevention, and on a Pathogen Access and Benefits (PABS), with technology transfer and capacity-building remain largely unaddressed, despite COVID-19 lessons. With EU and G7 countries holding to their positions on surveillance, financing, and intellectual property (IP), negotiations will continue. A more critical question remains: will the Treaty’s be adequate and timely enough to meet the challenges of inevitable future pandemics? Will it deliver the global framework of its foundational purpose of equity and justice? This RT aims to inform and involve the European public health community, continuing the series of activities embarked upon at the beginning of the pandemic, empowering its members for evidence-informed advocacy and concerted action. Following a brief presentation on the Treaty’s key provisions, each panel member will deliver a brief (2-3 min) intervention based on core expertise, with two rounds of panel questions/statements to follow, and with an interactive element to prioritise and submit questions. The first elaborating on the current provisions, linking them to the key expertise of panel members, i.e., international and EU law, public health law, One Health and infectious disease control, global health policies, technology transfer, fair pricing and access to countermeasures. The second examining what can be achieved via evidence-informed advocacy, and with a special focus on the role of the European public health community. Has it been well represented so far in negotiations? Should it be more involved? Is it well equipped to provide expert advice to Europe’s policymakers? Is there complementarity in relation to Europe’s Global Health Strategy (GHS) and national global health plans? Finally, the role of WHO will be briefly debated. How can sovereignty be safeguarded without compromising implementation? What is the role of transparency and sound governance to remain in line with national and EU laws and priorities? The last five minutes of this RT will be used to consolidate messages and share plans to inform future formal EUPHA positioning in negotiations. Key messages • Pandemic accord deliberation has have taken place under extreme urgency and geopolitical pressure. The European public health community must be informed and engaged for EU and country-level advocacy. • At a time of permacrisis, the adoption of a global framework for fair resouce allocation, access to medical countermeasures,and to strengthen health systems for future pandemics is urgently needed. Speakers/Panelists Sujitha Subramanian University of Liverpool, Liverpool, UK Dimitra Lingri European Healthcare Fraud and Corruption Network, Brussels, Belgium Debjani Muller HTAi, Edmonton, Canada Ricardo Mexia National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal Bettina Borisch WFPHA, Geneva, Switzerland

5.C. Scientific session: Strengthen resilience against emerging vector-borne diseases through the ECDC Fellowship Programmes

Abstract Over the past decade, climate change has impacted the transmission of a wide range of vector-borne diseases (VBDs) in Europe, where locally transmitted outbreaks have occurred. It has been implicated in the observed expansion of competent disease vectors in Europe such as Aedes albopictus, which transmits diseases such as Zika, Dengue and Chikungunya. Climate may influence the life cycle of vectors, and the reproduction rate of viral particles inside vectors and human hosts, which means that upsurges in temperature can reduce the incubation period of these pathogens and the life cycle of vectors, thus boosting transmission risk through elevated vector populations. Moreover, globalization and international air travel contribute to pathogen and vector dispersion internationally. Risk mapping suggests further expansion of the species in northern Europe due to climate change. The above underscores the necessity for more proactive measures, such as developing an effective vector control program by monitoring the density and distribution of hosts and pathogens at urban, national, and cross-border levels. Additionally, establishing early warning systems based on integrated human and zoonotic and entomological surveillance is crucial to detect alerts promptly and comprehend where and when infections may emerge or spread. Furthermore, cross-border collaboration and harmonization of vector-borne surveillance systems across European countries may improve preparedness, control and response to mosquito-borne diseases. Preparedness and response require significant efforts from EU Member States and neighbouring countries. Only through a multidisciplinary approach, involving multiple sectors, can we truly prepare to address public health threats. To contribute to strengthening resilience against cross-border public health and emerging health threats in EU Member States and neighbouring countries, the European Centre of Disease Prevention and Control (ECDC) has established three fellowship training programmes. These programmes aim to create and maintain a network of highly qualified epidemiologists, microbiologists and public health professionals and strengthen the public health epidemiology workforce at EU and neighbor countries. This workshop will offer attendees a comprehensive overview of the ECDC’s fellowship programmes, describe how they function and explain their role in preparing for health threats. It will provide examples of three projects carried out by fellows on the implementation of preparedness, response and control measures for emerging vector-borne diseases in European countries at local, national and multinational levels. Those will set the scene for an in-depth analysis of the key challenges faced and can help promote awareness that integrated, multidisciplinary interventions are both feasible and effective in reducing the threat of vector-borne infectious diseases spreading in Europe and neighboring countries. Key messages • ECDC fellowship programmes aim to strengthen resilience against emerging public health threats in EU Member States and neighboring countries. • Fellows are engaged in national and cross-border integrated and multidisciplinary interventions to strengthen preparedness and mitigate the spread of emerging vector-borne diseases.

Increasing trends in hypertension-related mortality in European Union 27 countries from 2011 to 2019

Abstract Background Arterial Hypertension (HT) is one of the most common chronic cardiovascular disease in adults and a leading cause of disability and mortality worldwide. However, update data regarding the HT-related mortality trends in Europe are lacking. Therefore, we assess the age- and sex- specific trends in HT-related mortality in the 27 European Union Member States (EU-27) between years 2011 and 2029. Methods Data were retrieved from the free publicly available EUROSTAT death certificate database to examine age-adjusted HT-related mortality rates (AAMR) (per 100.000 people) and relative average annual percentage change (AAPC) across all European Union 27 countries (EU27) from 2011 to 2019 using the International Classification of diseases, Tenth Revision (ICD-10) codes I10-I13 and I15. To calculate annual trends in HT-related mortality, we assessed the average annual percent change (AAPC) and relative 95% confidence intervals (CIs) using Joinpoint regression analysis. Results Over the study period, 254.540 HT-related deaths (157,081 males) were listed in EU27. Age-adjusted HT-related death increased from 9.12 to 10.7 per 100,000 people [AAPC: +1.5% (95% CI: 0.8-2.0), p<0.001]. Specifically, the HT-related mortality increased in males [AAPC: +1.8 (95% CI: 0.9-2.6) while decreased in women [AAPC: -1.1 (95% CI: -2.0 to 0.2), p=0.001]. Additionally, the HT-related mortality rates increased in northern [+1.5 (95% CI: 0.7 to 2.3), p<0.001] and eastern [AAPC: +3.9 (95% CI: 2.3 to 5.4), p<0.001] EU-27 states. Conversely, the AAMR plateaued in southern [AAPC: -0.1 (95% ci: 0.6 to 0.7), p=0.96)] and western EU-27 countries [AAPC: 1.0 (95% CI: -0.1 to 2.1, p=0.07] over the same period. Conclusions In EU27, HT-related mortality increased from 2011 to 2019, especially in men. However, significant disparities in HT-related mortality rates still exist between different European regions.

2.L. Round table: Monitoring health reforms to inform policy innovation: the Health Systems and Policies Monitor

Abstract Background The European Observatory on Health Systems and Policies’ (Observatory) Health Systems and Policy Monitor (HSPM) network convenes an international group of around 50 national health systems researchers from over 40 institutions across 31 high-income countries, including all EU countries, Canada, Israel, the UK and the US. In advance of the HSPM annual meeting, experts share the current year’s “top-three” health reforms in their countries via a standardized survey, soliciting details on content and general implementation processes. Reforms are iteratively organized into to 2 of 11 clusters, derived from the WHO health system building blocks. Experts then discuss background, status and content of national reforms in the year’s main clusters and initiate cross-country collaborations. A repository of over 650 reforms since 2018 has been created and is available online, showcasing reform patterns in HSPM countries. The collected data have informed studies on reform trends in HSPM countries from 2018-2019 and between 2020-2022, with work ongoing. Data are also consulted by researchers and policymakers wishing to learn about and from reforms in other countries. This workshop specifically aims to: • Inform participants about the methodologies used by the HSPM network to track reforms • Highlight common trends in major health reforms across countries since 2018 • Discuss national health reforms and the value of understanding and tracking these across countries • Identify research gaps in reform monitoring relevant to policy makers • Discuss how the health system research community can generate more relevant and actionable evidence Added-value The comparative analysis of reform trends provides insights into how systems operate and the types of reforms more likely to be implemented. The sharing of these insights also serves as a source of inspiration, allowing countries to learn from each other’s successes and failures and adopt proven best practices. This is relevant for policymakers and researchers striving to support health systems strengthening. Therefore, the workshop will support knowledge exchange between researchers and policymakers by (1) informing researchers and policymakers about similar ongoing reforms in other countries and (2) identifying areas where researchers can contribute to country reform agendas, and (3) stimulating interest in cross-country collaborative research on similar and topical reforms in different countries. Format This is a roundtable workshop chaired and moderated by the Observatory. An overview of reform trends and patterns since 2018 will set the scene, followed by an interactive discussion with policymakers and HSPM network members to (1) delve into trend dynamics and implications for health policy and research and (2) identify major (missing) research areas relevant to policymakers. In addition, we will leverage the geographic scope and expertise of the audience to reflect on the value of monitoring reforms. Key messages • Cross-country exchange of information on reform trends and implementation patterns can inspire future reforms and help policymakers identify promising policy approaches abroad. • Knowledge exchange between researchers and policymakers helps to determine evidence gaps and to generate relevant and actionable evidence that can drive policy innovation. Speakers/Panelists Reinhard Busse Berlin University of Technology, Berlin, Germany Ines Fronteira National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal Iwona Kowalska-Bobko Jagiellonian University Medical College, Institute of Public Health, Cracow, Poland Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg Vesna-Kestrin Petric Ministry of Health, Ljubljana, Slovenia

A monitoring framework for reinforcing policies against antimicrobial resistance in Europe

Abstract In an attempt to overcome barriers to the effective implementation of policies against antimicrobial resistance (AMR) in the EU Member States, Norway and Iceland, One Health national action plans (NAPs) need to show improvements in both their formulation and their implementation. Research conducted by Tetra Tech, funded by the EU4Health Programme, has identified shortcomings to One Health national policies across all countries, such as limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; and lack of harmonised indicators and inadequate information systems for monitoring the implementation of plans. On this last issue, subsequent reseach by Tetra Tech has supported the design and development of monitoring indicators for reinforcing the expected improvements of NAPs and the implementation of policies aimed at EU Member States in the 2023 “Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach”. While drawing on existing data sources at EU and global level, the study has also worked with Member States representatives in identifying indicators for the monitoring framework and proposed new data collection activities at the national level. Key messages • EU countries face common barriers to the effective implementation of One health policies against AMR, and need to reinforce their national action plans. • Stepping up the fight against AMR in the EU requires a strong monitoring framework for following up on EU recommendations.

The spatial dimension of ageing and growth in European regions

AbstractThis study aims to tackle the potential effects of population ageing on regional growth dynamics in the EU. We collected information at a NUTS2 level for EU countries from the years 2000 to 2020 to understand the extent to which the ageing of EU society might impact the EU convergence process. Our results emphasize that the ageing of EU society does not seem to harm the possibility of regional economic growth if we think that immigrants can fill openings in local labour markets (left by retired persons), as well as new jobs stemming from new services needed by retired persons (mostly in health and daily care). Our outcomes also stress the relevance of considering the spatial dimension of the analysis to detect the place-based dimension of this dynamic and, hence, the need for tailored policies.

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.

Needs assessment to design a multidisciplinary training programme within the EU-PROMENS project

Abstract Background Mental health as a public health issue warrants a comprehensive prevention-oriented approach whereby capacity building as well as a multisectoral and life-course approach are crucial. The ‘Capacity-building on mental health: multidisciplinary training programme and exchange programme for health professionals,’ project enhances and improves the capacity of professionals across Europe in the field of mental health. Various professionals are targeted 1) health professionals working in the mental health sector, 2) teachers and educators working in the educational setting, 3) social workers working in various community settings and 4) prison staff. Objectives To understand the needs, gaps, obstacles in capacities, competencies, and to build upon existing programmes a mixed methods study, adopting a convergent parallel design is conducted to design and develop the programme. First, a literature review is conducted complemented with interviews, focus group discussions and a survey among various stakeholders to enrich the data. The training will be piloted in The Netherlands, Spain, Czech Republic, Croatia, Finland and Austria. Thereafter it will be rolled out in the 21 remaining EU countries as well as in Norway, Iceland and Ukraine. Results Various gaps and competencies identified from different perspectives build a solid fundament for a comprehensive multidisciplinary training programme tailored to the needs of various professionals within the mental health arena. Preliminary results show that 98 multidisciplinary training programmes exist, with about half containing training materials and limited reports on evaluation. Conclusions The comprehensive needs assessment will assure a multidisciplinary training programme is suitable and relevant for various professionals to ensure a well-designed capacity-building programme. Key messages • Various gaps and needs among various professionals exist. • A comprehensive study strengthens alignment of training to needs and gaps among various professionals.

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.

School canteens healthier for children and the planet in the Valencian Region

Abstract Issue SchoolFood4Change (SF4C), an EU Horizon 2020 project in 12 EU countries, aims at making school meals healthier for children and the planet through innovative and sustainable food procurement, promotion of planetary health diets and cooking, and a Whole School Food Approach. In the Valencian Region two subsequent market dialogues (MDs) were organised to explore a new school food procurement and feeding model. Description In our context, most children have lunch at school daily. SF4C sees schools as catalysts for a systemic change. Two intersectoral MDs were conducted with the participation of public authorities, food procurers, cooks and schools. The first one MD1, 23 attendees, used a gamification dynamic through building blocks. MD2, 58 participants, used a World Cafe methodology to analyse nutritional, environmental, educational, social and economic determinants. Results MD1 highlighted the need to increase food education in the curricula, value regional products and cuisine, improve culinary training and reduce food waste. It suggested establishing percentages of local and organic products in tenders and improving communication between the public administration and the educational community. MD2 emphasised the objective of promoting the Mediterranean diet and sustainability in canteens. To that end, participants identified the importance of establishing requirements in public tenders, annual planning of procurement, optimising logistics and integrating the canteen into the educational project. This would enhance predictability, economic sustainability, and social support for a new innovative model. Lessons Structured interaction between stakeholders was essential to devise innovative and sustainable solutions. The creation and dynamization of intersectoral working groups is an effective public health strategy to build networks for the co-creation of viable alternatives to achieve a healthier and more environmentally sustainable school feeding. Key messages • Structured interaction in intersectoral working groups is an effective public health strategy for the co-creation of viable alternatives to make school feeding healthier for children and the planet. • Tailored innovative and sustainable solutions entail a framework for structured discussions, specific context analysis, negotiations between stakeholders and locally adaptation of good practices.

Scaling up joint efforts to tackle cardiovascular diseases and diabetes in Europe

Abstract JACARDI, a Joint Action on cardiovascular diseases (CVD) and diabetes (DM), aims to support EU countries in reducing the burden of CVD and DM and related risk factors, both at individual and societal levels, while ensuring health systems sustainability and equity. In particular, JACARDI aims to implement best practices and pilot testing of innovative practices throughout the entire patient journey. Commencing by improving health literacy and raising awareness among general and target populations, moving through primary prevention and screening of CVD and DM among high-risk populations, and then address people living with CVD and DM and their health service providers, through the improvement of service paths and (self) management, including through digital tools, and completing the path by supporting and encouraging the labour participation of people living with these diseases. With 21 European countries and 76 partners engaged, JACARDI undertakes 142 pilot projects, promising to advance CVD and DM care for millions across Europe. In particular, through an innovative Work Package on methodology, JACARDI will develop and implement a methodological framework to guide all the pilot projects in the design, preparation, implementation, monitoring, reporting, and assessment processes. This framework will encompass transversal and intersectional aspects, ensuring a harmonized and efficient approach for all JA activities. Through rigorous and multidimensional evaluation, JACARDI aims to uncover new approaches to enhance healthcare systems, grounded in evidence-based practices and current needs, while adopting the lens of equity and sustainability throughout the entire methodological and implementation process.

Preventing unintentional injuries in children: the parents’ beliefs matters (CHILD Vigilance)

Abstract The CHILD Vigilance project is a European study supported by the Injury Prevention & Safety Promotion Section of the European Public Health Association (EUPHA INJ) and aims at assessing parenting knowledge and attitudes that are relevant to supervision and risk taking in children. For children the majority of these injuries occur in or around the home when their safety is the responsibility of a parent or other caregiver. The study aims contribute to the epidemiological knowledge of injuries through the study of the perceptions of parents and caregivers of children and adolescents. A descriptive, observational, cross-sectional study was developed under the CHILD Vigilance project, developed at European level within the scope of the Injury Prevention & Safety Promotion Section of the European Public Health Association. The information was collected by survey, from parents’ associations and schools in the EU countries represented in the EUPHA INJ Section. A total of 916 valid responses were obtained, involving 1229 children (51,4% male; mean age 7,8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). However it was found differences in these countries as to the most common type of injury in adolescents, pointing out road traffic crashes (41.2% in Greece vs 39.5% in Portugal) and poisonings in Lithuania (38,1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported the main cause in the pre-schoolers (62,5%; 35,1%) and in primary education (55,1%; 29,7%), being injuries pointed as the most frequent cause only in the oldest. The study emphasizes the need to invest in the identification of appropriate determinants of child unintentional injuries and harmonised injury outcomes across global initiatives. Key messages • The lack of data regarding to parents’ knowledge on injury prevention involving children highlight the need to conduct this type of studies. • The need for adequate epidemiological data on the burden of child injuries and validated tools to accurately measure injuries.

Benefits of cross-border access to human genomes at scale for research and healthcare

Abstract Genomics data will soon be routinely generated and integrated into national healthcare systems. To maximise the potential of genomic medicine, data should be accessible for research where possible. This is the remit of ELIXIR, an intergovernmental organisation that brings together life science resources from across Europe. Innovative solutions are needed to ensure the validated research findings for disease or preventative medicine are then integrated into healthcare. To tackle this, the 1+MG initiative, a joint initiative of 25 EU countries, the UK, and Norway, aims to enable secure access to genomics and the corresponding clinical data across Europe for better research, personalised healthcare and health policy making. In the design and scale-up phase (B1MG project), recommendations and guidelines to advance towards the deployment of personalised medicine at a European scale have been produced, adopted by 1+MG and developed into a 1+MG framework. This includes guidance on data governance, standards, quality and infrastructure, recommendations on how to approach citizen engagement and a tool for countries to self-assess implementation into healthcare. The European Genomic Data Infrastructure (GDI) project supports the scale-up and sustainability phase of the 1+MG initiative, to deploy infrastructure across 24 countries to support the overall ambition. Recommendations are being used to promote governance and technical interoperability across European initiatives including the European Health Data Space (EHDS), and European Cancer Image Initiative (EUCAIM). The 1+MG will be established as a European Data Infrastructure Consortia in 2025 and will act as an Authorised Participant in the EHDS providing access to a permanent high-quality federated data collection of genomic and health data that will accelerate research, innovation and policymaking facilitating the deployment of genomic medicine across Europe.

How did slovak students perceive the COVID-19 pandemic: Insights from one of the least vaccinated EU countries.

The COVID-19 pandemic brought different challenges to different populations. A less explored group was university students who generally suffered low mortality rates compared to other populations. Yet, they were affected by the psychological impact of lockdowns and limited access to education and socialization. This paper focuses on Slovakia, one of the least vaccinated EU countries. In November 2021 we conducted eight focus groups with 51 university students (45 women; 6 men; M = 23.67; SD = 3.43) and analyzed the data using reflexive thematic analysis. Our results identified the development of prevailing themes associated with COVID-19. Initially, COVID-19 was perceived as unreal but brought certain secondary benefits. We also identified themes of exaggerated disease, conspiracy, resignation, frustration, or adaptation to the disease. We divided the students into three groups based on their COVID-19 vaccine stance: accepting, hesitant, and rejecting. Insights from these groups could guide better communication strategies in the future.