EUPHA Office Research Articles

European Public Health NewsMartin McKee colomn9th EPH Conference—‘All for Health, Health for All’50 Years of Medicine Safety in the EU By Vytenis Andriukaitis, EU Commissioner for Health and Food SafetyMessage from the World Health Organization (WHO) Regional Director for Europe

European non-governmental organizations very often struggle with their sustainability. This sustainability is focused on two levels: financial and organizational. Financial sustainability—in times of economic crisis—is at the forefront. Next to own income, such as membership fees, most European NGOs have to find extra sources of income. Projects and grants from the European Commission are a good source of extra income, but with limited resources available and a high number of excellent quality projects, you might just miss the opportunity. The best option, which has worked really well for EUPHA, is to increase the own income and increase the number of financial sources. The reorganization of the European Journal of Public Health and the successful management of the EJPH by Peter Allebeck and his team at Karolinska Institutet have provided EUPHA with a solid second source of own income. And the collaboration with the European Public Health Conference Foundation has even provided a third source of (nearly) own income. With this financial structure, EUPHA is reasonably secure in covering the core activities, but for all extra activities, EUPHA, like most other European NGOs, is looking for other financial sources. For instance, the EJPH editorial office has been supported by the Swedish Research Foundation for numerous years. The other level for sustainability is organizational. Keeping in mind the financial situation, most of the European NGOs work with a small team of committed professionals, which does make them vulnerable. And this vulnerability can be clearly seen if one of the staff leaves the organization. At EUPHA Office, nobody has left the organization, but I have had to take a leave of absence due to illness, and this has certainly had an impact on our organizational sustainability. And even here, we see that EUPHA is up for the challenge. The small team of dedicated …

European Public Health News * President's Column * EUPHA office column * Message from the Who Regional Director for Europe: Preparedness and Response to Health Threats * 8th European Public Health Conference--'Health in Europe--from global to local policies, methods and practices'

In this European public health news, all authors reflect on potential threats and an unstable Europe (McKee, Jakab) and the impact this has on public health. All agree that a comprehensive (Jakab), collaborative (Zeegers) and global (McKee) approach is necessary to make sure that public health in Europe and in the world remains a strong partner to combat the potential threats and overcome the crisis. # President's Column {#article-title-2} As I write my first column as the newly appointed President of EUPHA, I am reflecting on several things. The first is the exceptionally high standard that my predecessor, Walter Ricciardi, has set. Elsewhere in this edition I pay tribute to his enormous contribution to public health and beyond. I commit to doing everything possible to live up to his standards. The second is the worrying state of Europe today. Once more we see armed conflict breaking out in our continent, in Eastern Ukraine, and in our neighbouring countries in the Middle East. We have yet to recover from a prolonged economic crisis and seem to have done nothing to address the problems in the financial sector that created it. The recent elections to the European Parliament saw a frightening increase in support for racist and neo-fascist parties. In the global arena, we face threats from international agreements that place trade above health. And we search in vain for the political leaders, at regional, national and European levels, who have the vision, charisma and ability to lead us out of this situation. Even if our political leaders lack a vision, we in EUPHA have one, set out in our recently adopted strategy for the years 2014–20. Our vision is one of improved health and reduced health inequalities for all Europeans. Our contribution to achieving this vision will be to add value to the efforts of …

European Public Health News

In this European public health news, the focus is in the first place on EUPHA itself. In his last column as EUPHA President, Ricciardi reiterates EUPHA’s commitment in working for European public health and bringing together public health professionals at its annual conference. Zeegers shows light on what it is to work for EUPHA Office. On a European perspective, Jakab explains what remains to be done to intensify the control of communicable diseases. Finally, Testori Coggi writes about measures by the European Commission to improve the patient safety situation in Europe. # President’s Column—Working for European Public Health {#article-title-2} Alas, my last column as EUPHA president. It has been an absolute privilege and honour to be EUPHA president for two consecutive terms (and not forgetting one term before that). In my last column, I would like to highlight the two most important features of EUPHA. The first one is working for European public health. EUPHA is at the heart of European public health in all its activities. The conference is the meeting place for public health professionals in Europe and beyond. It is where we meet the researchers, policymakers, practitioners and trainers that can make a difference. It is where EUPHA meets its national public health associations, institutional members and partners. This is where European public health is created, encouraged and further developed. The European Journal of Public Health is the European publication where public health research is presented, where viewpoints are defended and commentaries discussed. The EUPHA sections are the active theme-specific networks that put European public health in general and EUPHA in particular on the agenda. The second one is the EUPHA family feeling. Created by dedicated and renowned public health professionals, EUPHA is the home of European public health and—as the saying goes—home is where the heart is. The interaction in our network has always …

European Public Health News * President's column: the future of vaccines in Europe * EUPHA office column * Message from the Regional Director: public health aspects of migration * Message from the EU Commissioner: doctors and pharmacists remain our best allies in the fight against antimicrobial resistance * Seventh European Public Health Conference--'Mind the Gap: reducing inequalities in health and

In this European public health news, we are looking at some current public health topics. Ricciardi looks at the future of vaccines and calls for researchers to develop new universal criteria against which to evaluate new vaccines. Jakab writes about the public health aspects of migration, which has become a structural phenomenon creating specific challenges to health systems. Borg describes the ongoing fight against antimicrobial resistance. As he points out, this poses a challenge not only to the patient’s individual health but also to the society as a whole. The three articles show the need for European collaboration, not only among governments both foremost among researchers and professionals. EUPHA is in the centre of this: working together, exchanging best practices and letting the researchers’ and practitioners’ voice be heard. # President’s column: the future of vaccines in Europe {#article-title-2} ‘Vaccination’ was the word that Jenner invented for his treatment against smallpox (from the Latin vacca , a cow), and so successful did his innovation prove that by 1840, the British government had banned alternative preventive treatments and the word was adopted by Pasteur for immunization against any disease. After clean water, vaccination is the most effective public health intervention in the world for saving lives and promoting good health, but vaccines and vaccination are at a turning point. A number of new vaccines with major potential for controlling infectious diseases have just been licensed or are at advanced stages of development. Among the illnesses targeted are rotavirus diarrhoea, pneumococcal disease and cervical cancer (as caused by human papillomavirus), which together kill more than a million people each year, most of them in developing countries. Recent advances in genetics and in immunology have increased our understanding of microbial pathogenesis and of host defence mechanisms. As a result, within the next 20 years, a whole set of new vaccines should become available. …

European Public Health News * President's Column * EUPHA office column * Message from the WHO Regional Director for Europe: Vienna Declaration--a milestone in the fight against non-communicable diseases * Message from the European Director General for Health and Consumers: How can we best tackle all serious cross border health threats? * 6th European Public Health Conference--"Health in Europe: are

In this European public health news, we are looking at the future. Ricciardi looks at nine challenges for health care and calls for a new overarching paradigm. Jakab describes the newly adopted Vienna declaration as a milestone in the fight against non-communicable diseases and Testori Coggi explains the positive impact on European public health of the EU decision on serious cross-border health threats. This makes it even more important to build the capacity and knowledge of public health professionals, and EUPHA and the EPH Conference are two tools to ensure this—now and in the future! # President’s Column {#article-title-2} Just as it is impossible for the citizen of today to go out into their garden and dig a well for clean clear water, so it is impossible for them to create the health service they need when and where they need it. Like water supply, the supply of a health service requires the organized efforts of society and is therefore a public health service. The most important paradigm of the 20th century in Europe was the idea that health care was a right and not a privilege, but during the second half of the 20th century, there were a number of paradigm shifts, and each new paradigm embraced the previous one and has not rendered it invalid. First came the effectiveness paradigm; this developed after the publication of Archie Cochrane’s book on Effectiveness and Efficiency, which emphasized that the evidence of effectiveness derived from the study of groups, or samples, of patients was more reliable than that derived from experience. Nowadays every European country is committed to ensuring that its citizens receive a health service of assured quality, just as they are committed to ensuring that its citizens receive water or education of assured quality, although the task of providing quality-assured health care is …

European Public Health News * President's Column * EUPHA office column * Message from the WHO Regional Director for Europe: no public health without mental health * Investing in Health * 6th European Public Health Conference--'Health in Europe: are we there yet? Learning from the past, building the future'

The current European recession is well reflected in this issue of European Public Health News. The financial crisis is having an impact on the well-being and health of our citizens (Jakab). The cutting of budgets impacts our health systems and health research (Ricciardi). It is now even more important to look at sustainability, to invest in health (Giraud) and to use the evidence-base in policy. Working together, exchanging best practices and letting your voice be heard is what we all aim to achieve. # President’s Column {#article-title-2} Healthcare systems in Europe are facing an unprecedented challenge. While social and demographic pressures remain relentless in their effects on the demand for healthcare, and technological and scientific advances continue to drive costs upwards, the financial crisis in Europe is placing huge pressures on governments to control costs, limit demand and reduce spending. Public healthcare budgets are being cut in real terms, and costs are being transferred to individuals and families through out of pocket payments, with the greatest health impact falling on the least well-off. Equally seriously, the wider health effects of the worst European recession in living memory are likely to be profound and long-lasting, not just in those European countries which are subject to financial intervention and health system reform from the ‘troika’ of the European Commission, International Monetary Fund and European Central Bank but throughout Europe. Yet the European Commission invests largely only in biomedical research—just 4% of the €642 million co-operation programme for health research in 2011 was on health systems, public health or health policy research. The European Commission has recently set out its research priorities for Horizon 2020—its new €80 billion research programme, which will run from 2014 to 2020, and those proposals are on the table for negotiation and adoption by the European Parliament and member states. But once …

European Public Health News * EUPHA President's column * EUPHA office news * Message from the Regional Director (January 2013)--A Historical Turning Point to Fight Antibiotic Resistance * Increasing Efforts on Vaccine Preventable Diseases in the EU * Three Priorities of the 2013 Work Plan of ECDC * 6TH European Public Health Conference--Health in Europe: Are we there Yet? Learning

In this European Public Health News, we have a newcomer: the European Centre for Disease Prevention and Control has joined our efforts with a column on sustainable European collaboration. The Regional Director of World Health Organization (WHO) Europe announces the setting up of collaboration on antibiotic resistance. The European Commission emphasizes the need for a continuous commitment (on vaccine preventable diseases). The two EUPHA columns not only fully support the European collaboration, continuous commitment and use of networks but also look more critically at the sustainability of these initiatives. Of course the 6th European Public Health Conference offers an excellent opportunity to address continuous European commitment towards public health in Europe. # EUPHA President's column {#article-title-2} On 5 December 2012, Marieke Verschuuren, President of the EUPHA section on Public Health Monitoring and Reporting, and I sent a letter to European Union (EU) Health Commissioner Borg on behalf of EUPHA. In this letter, EUPHA expressed its concerns related to the lack of sustainability of health information activities at the EU level. The main messages in this letter are in line with the letter that was sent to former Commissioner Dalli by 13 Directors of national public health institutes in EU Member States in April 2012. It is widely acknowledged that public health monitoring and reporting are essential elements of an evidence-based public health policy cycle. At EU level, the European Commission has been actively engaged in stimulating the development of a public health monitoring and reporting system since the 1990s, when the Health Monitoring Programme was launched. Since then, a multitude of EU-funded projects, networks and Joint Actions have been and are working on specific elements of that monitoring and reporting system, such as indicators, data and measuring instruments. Many of these projects have made a real difference to the development of health policy and understanding …

European Public Health News * President's column * EUPHA office column * Message from the Regional Director * Patient safety and health care-associated infections * 6th European Public Health Conference, 13-16 November 2013, Brussels, Belgium

This first European Public Health News of 2013 is closely related to the theme of the 2013 European Public Health Conference: ‘Health in Europe: are we there yet? Learning from the past, building the future’. Chaze and Adam show that more needs to be done in patient safety; Jakab shows how WHO Europe helps build the future with the Health 2020 initiative; Zeegers Paget explains that building the future of EUPHA is based on the successes from the past; and Ricciardi reflects on the importance of European Public Health Conferences by summarizing the Malta 2012 conference. Ms Jakab describes the new year of European public health wonderfully in her column: ‘I believe that Health 2020 can add significant value to all our work and serve as unique resource to renew, enhance and enrich our efforts to work together for the benefit of the people of our Region, even in these difficult economic times’. # President’s column {#article-title-2} Taking advantage of the notes of our dear colleague and friend Natasha Muscat Azzopardi, Chief Medical Officer of Malta, I would like to underline the importance and success of the 5th European Public Health Conference. This conference was an important landmark, and it marked the 20th anniversary of EUPHA, a small project starting out from a noble idea of public health researchers who believed they had to go beyond the mere confines of the traditional researcher role and do something for public health at a European level. It was also the 5th anniversary of the European Public Health Conference, which has brought together the leading organizations in public health in Europe and has taken this conference altogether to a different scope and dimension. The conference got off to a fantastic start with Louise Gunning-Schepers putting forward the challenge that we do reasonably well on knowledge generation but …

European Public Health News * President's column * EUPHA office column * Message from the Regional Director * Information sources * Health literacy in the EU * Mark your agendas: 6th European Public Health Conference 13-16 November 2013 The Square, Brussels, Belgium

This European public health news summarizes some of the successes achieved this year and some of the challenges remaining. Ricciardi celebrates the adoption of the new health policy framework of the WHO’s Regional Office for Europe—Health 2020; Barnhoorn describes the promising progress of the Public Health Innovation and Research in Europe (PHIRE) project, where the impact of European projects and the organization of public health research are the main topics. Jakab goes back to childhood immunization and the hope that rubella and measles will be eradicated by 2015; Ryś stresses the importance now and in the future of health literacy and being in this ‘together for health’. The theme of the 6th European Public Health Conference in Brussels next year nicely completes this news: ‘Health in Europe: are we there yet? Learning from the past, building the future’. 2013 will be an interesting year. # President’s column {#article-title-2} Last September in Malta, 53 Member States of the WHO European Regional Committee endorsed ‘Health 2020’, the new health policy framework of European Region. The policy aims at significantly improving the health and well-being of populations, reducing health inequalities, strengthening public health and ensuring sustainable people-centred health systems. Progress towards its goals will be achieved by policy action in four areas: investing in health through a life course approach and empowering citizens; tackling Europe’s major disease burdens of non-communicable and communicable diseases; strengthening people-centred health systems and public health capacities, including preparedness and response capacity for dealing with emergencies and creating supportive environments and resilient communities. A key element in achieving progress towards the goals of Health 2020 is to further the development of the evidence base on what works to promote better health and well-being, in differing contexts and at what cost. European health systems face considerable challenges in promoting and protecting health at a …

European Public Health News * President's Column--Public involvement and public health * EUPHA office column * Message From the Regional Director * Twenty-Five Years of EU Cancer Policy * All Inclusive Public Health Malta, 7-10 November 2012

This European public health news mainly focuses on partnerships and the importance of including the public. Ricciardi addresses the need to involve the public in decisions in health care; Jakab focuses on patient empowerment and the importance to work in partnership; Thayer describes the success of partnership of the 25 years of European Union (EU) cancer policy. # President’s Column—Public involvement and public health {#article-title-2} Public involvement at the highest levels of decision-making and health prioritization is still not common in Europe. Recent data show that patients are represented in decisions pertaining to the licensing of pharmaceuticals only in the Czech Republic, Denmark and Sweden, whereas they are represented in decisions relating to the coverage of health services in the Czech Republic, Denmark, The Netherlands and Switzerland (OECD 2010). In all other countries, they have no involvement or only a marginal one, with no significant responsibility in decision-making. If we leave the field of principles and go on to consider the practical factors that appear to influence the actual scope of benefits guaranteed, it becomes plain that the evolution of the former has been heavily affected by the development of the latter. Since the definition of the structures of most European health systems after the Second World War, health costs have been increasing steadily. With regard to high-income countries (which all European countries are), the main factors on which responsibility for this trend is blamed are demographic changes leading to population ageing (with increased co-morbidity), advances in technology with introduction of increasingly expensive equipment and growing expectations on the part of the population on the efficiency and the quality of care. It is therefore not surprising that cost containment figures prominently in the agenda of health care policymakers. The first consequence of cost pressures is the increase in health care institutions’ deficits; other common consequences are also purely …

European Public Health News * President's column * EUPHA office column * Message from the WHO Regional Director for Europe * 'Ex-Smokers are Unstoppable': a new campaign to solve an old problem * European Public Health Conference

In this European public health news, the focus is on capacity building, within and beyond our network of public health professionals using old and new communication methods. Communication on health financing (Jakab), tobacco (Spanou) or communication in itself (Zeegers) is an essential part of European public health. Communication should be tailored to the audience you are trying to reach, keeping in mind that the pragmatic and creative solutions should reach beyond your usual network. In addition, there are some excellent pragmatic and creative examples in the contributions below. # President’s column {#article-title-2} EUPHA has two big events in a year. The most important is—of course—the European Public Health Conference, this year in Malta. This is where we meet our members, present our annual report and decide on the activities in the year to come. This is where public health in Europe is presented in research, practice, policy and training. This is where European public health is created, encouraged and further developed. The conference creates a positive boost for EUPHA, a sense of belonging together and a general European public health feeling. The second event is smaller, but also very important. It is the June meeting, where we combine the planning of the conference, the Executive Council meeting and the Section Council meeting. The nice thing about the June meeting is that it has a relaxed and cosy atmosphere. In fact, it is the perfect opportunity to spend several days together with key people in our organization, without everybody being busy with conference activities. This year, our June meeting was co-organized with the Maltese Association of Public Health Medicine. The weather in Malta was beautiful, the location as well, and this all created the EUPHA feeling. In this setting, we managed to organize an intense brainstorming on our activities and on our future. The Maltese …

European Public Health News * President's column * EUPHA office column * WHO Regional Director for Europe: The European health report 2012 is being prepared, breaking new ground in measuring well-being in close alignment with Health 2020--the new European policy for health * Editor's note * The European Innovation Partnership that champions Active and Healthy Ageing * Malta 2012 5th

In the president’s column, Ricciardi presents the impact of the financial and economic crisis on public health. Jakab updates us in the WHO/EURO column on the European health report and health 2020, combining health and well-being. In the DG Sanco column, Gomez presents the holistic approach of the European Innovation Partnership; and Zeegers reflects on the strengths of partnership. All these contributions are related to two words: Finances and Collaboration. The economic crisis forces us even more to reflect on efficient ways of implementing innovative strategies such as Health 2020 and the European Innovation Partnership. And is further encouraging synergies and using each other’s strengths not the most efficient way forward? # President’s column {#article-title-2} As reported by Martin McKee,1 the impact on population health of a financial and economic crisis, such as the current global crisis, may lead to an increase in suicides and deaths. Many European countries seem to confirm this hypothesis: the last available data from Italy show a sudden increase of 5.3% in suicides in 2008 (3.799, compared with 3.607 suicides in 2006, which represented the lowest value in a decreasing trend in the past 20 years). Although these numbers are less striking than data from other countries (in Greece, Latvia and Ireland, countries where the financial crisis severely affected the real economy, suicides increased by 17, 17 and 13%, respectively2), this is a remarkable finding. Although the economic downturn directly affects health and increases poverty, it also has indirect consequences for well-being through its effects on public policies. In particular, the public finance crisis of the past 2 years has forced governments to reduce public funding and to increase co-payments (which, in turn, reduce disposable income) and to reduce the overall actual supply of health services. If reducing public funding is not compensated by efficiency gains, providers …

European Public Health News * President's column * EUPHA office column--EUPHA 1992-2012 * Message from the World Health Organization Regional Director for Europe Healthy Ageing in Europe: Empowering More People to Remain Active and Healthy at Higher Ages * European Commission Proposes Measures to Better Protect Europeans from Serious Cross-border Threats to Health * Malta 2012 5th Annual European Public

In this European public health news, the main themes are management and leadership. Ricciardi starts with concluding that management is of vital importance, but leadership even more so. Zeegers Paget follows with discussing leadership of and within EUPHA. Jakab presents the leadership of WHO EURO in this year of healthy ageing, followed by Takki and Ryan who describe the proactive management by the EU to protect Europeans from serious cross-border health threats. It all shows that leadership and management are basic necessary skills to further European public health. # President’s column {#article-title-2} Some people, use and have used the word manager and leader as synonyms. However there is increasing agreement of the fact that leadership and management are different activities although many managers also are leaders. Perhaps one way to describe it now is to say that all leaders also have to manage but not all managers are leaders. So what is leadership and how does it differ from management? This is not an easy question to answer because, as always happens, the more widely a term is used the more meanings it acquires. One approach is to define management as primarily concerned with the running of an operation. In the excellent book called Trying Hardest Is Not Good Enough, a very important book for everyone involved in healthcare although it is primarily about education, Mark Friedman says that management is ‘the day to day a month to month running of operations’. Leadership is more than management and John Kotter, another very influential writer, distinguishes the two clearly. There are probably two features of the work of the leader that are crucial. One is that the leader has to help people adapt to bad news, to reframe their view of the world and to help them overcome significant problems. The other is that the …

European Public Health News * President's column * EUPHA office column--EUPHA 1992-2012--Time to expand the family! * Message from the Who Regional Director for Europe: HIV Cases Continue to Rise in Europe--Who European Region Launches New Action Plan to Bring the Epidemic Under Control * 5th Annual European Public Health Conference 2012: All Inclusive Public Health, Portomaso, St Julian's, Malta,

In this first European public health news of 2012, the need for European concerted action remains a top priority. Both for ongoing diseases such as HIV where immediate action in Europe is called for (Jakab) and for rare diseases, where European action will benefit the knowledge and treatment of these diseases (Montserrat Moliner). The role for EUPHA here is clear: support for our members and via our members; we are going in the right direction (Ricciardi) and we are planning the future (Zeegers Paget). # President's column {#article-title-2} The year 2011 has been a successful, packed year of further developing activities for our three strategic objectives: capacity building, knowledge building and policy building. It is not possible to list all our achievements over the year, so I would like to highlight some of them. The first achievement was our active involvement in the European ministerial meeting on health during the Polish presidency of the EU. The ministerial meeting was organized in Poznan, Poland, on 7–8 November and EUPHA organized a workshop on Health in all Policies. The workshop was organized together with the Polish presidency, the Polish Association of Public Health and the European Observatory on health systems and health policies. Background information included a draft policy brief on Health impact assessment from the European Observatory and EUPHA as well as an EUPHActs on Health impact assessment. Stan Tarkowski, past president of EUPHA, took the lead in organizing this workshop. It was the first time that EUPHA was this proactive at policy building level and the positive experience in Poznan will be continued in the coming years. The second achievement was the production of two new instruments for dissemination, capacity and knowledge building and support for our members. Two EUPHActs were produced (Environment and health; Health impact assessment) to provide a short (two pages) …

European Public Health News * President's column * EUPHA office--Active ageing and rejuvenating * Message from the Regional Director--'Scaling up activities for Roma health' * Evaluation and follow-up of the response to pandemic influenza A (H1N1) 2009 by the European Commission * Obituary Barbara Starfield * European Public Health Conference

In this last European public health news of 2011, we inform you on the quality of health care in the century of the patient (President's column), EUPHA's active ageing and rejuvenating (office), WHO/EURO's scaling up activities for Roma Health and the EU evaluation of the flu pandemic in 2009. We have also included an obituary for Barbara Stanfield and of course, we are updating you on the 2012 EPH conference (Malta 2012). # President's column {#article-title-2} While no policy-maker or health professional would ever refrain from confirming their support to initiatives aimed to ensure and increase quality in health care, a shared definition of what we actually mean by quality does not exist. Different European countries and, within them, different institutions and interventions confer on this word a variety of meanings, which need to be carefully taken into account as we consider what quality assurance policies are currently adopted. The most widely accepted definition of ‘quality’ is the one given by the Institute of Medicine in the USA in 1990, which reads as follows: ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’) (IOM, 1990). It is remarkable that this definition mentions both individuals and populations as the addressees of health services, and, above all, that their ‘desires’ are mentioned, which reflect acknowledgement of the central role played by the values and the expectations of those interested and involved in the performance of the health system. While this definition is carefully designed, attempts to implement and pursue the notion of quality in practice require it to be broken down into components more liable to be referred to visible actors and activities—the so-called dimensions of quality. Quality is variably considered to include effectiveness , the ability of a certain care …

European Public Health News * President's column * EUPHA office--EUPHA Sections * EUPHA Members 2011 * MARK YOUR CALENDARS!

In this section of the EJPH , we are pleased to report on European public health. The regular contributions of WHO/EURO and the European Commission are unfortunately missing, as we forgot to communicate the deadline to them. We apologize for this. This section focuses on EUPHA (president's column, EUPHA office column and our 2011 list of members) and the European Public Health Conference. # President's column {#article-title-2} Since the definition of the structures of most European health systems after the Second World War, health costs have been increasing steadily. With regard to European countries, the main factors on which responsibility for this trend is blamed are demographic changes leading to population ageing (with increased co-morbidity), advances in technology with introduction of increasingly expensive equipment, and growing expectations on the part of the population on the efficiency and the quality of care. It is therefore not surprising that cost containment figures prominently in the agenda of health care policymakers. The first consequence of cost pressures is indeed the increase in health care institutions’ deficits; other common consequences are also purely financial, with no significant impact on health-care delivery itself, e.g. partial refunds from health-care providers and/or the pharmaceutical industry to health insurance funds or the government, or reductions in physician fees. However, increase of out-of-pocket payments has today become the most widely employed measure to address increased costs, which has been considered one of the most worrying trends in European health-care policy of the last two decades, because of its impact on access to health care. Out-of-pocket payments increase the exposure of households to financial losses associated with health care, preventing which should be one of the main goals of health systems. Lastly, direct effects on the level of care are reported increasingly often: in recent years, waiting times for a number of services increased …

European Public Health News * Health in Europe 2020 * EUPHA President's Column * EUPHA office--Public health needs you! * Message from the Regional Director--'Governance for Health in the 21st Century' * Commission Reports on Voluntary and Unpaid Donation of Blood and Blood Components, and Tissues and Cells * Public Health and Welfare--Welfare Development and Health, 10-12 November 2011, The

In this section of the EJPH, we are pleased to report on European public health. This time, the emphasis is on communication: from research to practice and policy; from European level to national, regional level; from public health to the whole society; and from our network to every individual public health professional. We are very honoured that, exceptionally, we have the Directorate-General for Health and Consumers of DG Sanco, Dr Paola Testori Coggi, contribute to this section on the topic of Health in Europe 2020. Of course, we also provide you with the latest information on the 4th European Public Health Conference—Copenhagen 2011 and help you reserve the dates for the 5th European Public Health Conference—Malta 2012. # Health in Europe 2020 {#article-title-2} Putting the European Union back on the road to a healthy economy is the overarching objective of the ‘Europe 2020’ Strategy. It is an ambitious strategy that aims to create more and better jobs, boost productivity and social cohesion through smart, sustainable and inclusive growth. This should be achieved through specific EU-wide targets focusing on employment, innovation, education, reducing poverty and promoting a greener and more resource-efficient Europe. The 27 EU Member States have set their own national targets and have drawn up national plans (National Reform Programmes) to achieve them. Health can play a more prominent part in the national plans. I, therefore, appeal to Member States to recognize health not just as a cost, but as an investment in the drawing up of their respective National Reform Programmes. By investing now in health and health systems, we can reap the benefits, not just today, but in 10, 20, 30 years’ time. This certainly merits further attention and I acknowledge that more evidence is needed to demonstrate the important dual role that health plays both as a driver and as a prerequisite …

European Public Health News * EUPHA President's Column--EUPHA and WHO together in developing the new European policy for health * EUPHA office news * Message from the Regional Director--'Strengthening Public Health in Europe' * TB Prevention and Control in the EU: The Need for Further Efforts * Public Health and Welfare - Welfare Development and Health, 10-12 November 2011 the

We are pleased to provide you with an update on European public health. In this issue, we look at the future (Health 2020), at new challenges and trends as well as re-emerging diseases (TB). It is evident that continued action is necessary, together in public health and combining old and new. Of course, we are providing you with the latest information on the 4th European Public Health Conference—Copenhagen 2011. # EUPHA President’s Column—EUPHA and WHO together in developing the new European policy for health {#article-title-2} The Regional Director for Europe confirmed in this issue of the European Journal of Public Health her vision for better health in Europe and identified several strategic priorities for its implementation. For most of them public health is of crucial importance. Actually the way in which health is considered is changing rapidly. Health is now seen in a much more complex way than it was when it meant only health care services. It is seen today with its many determinants spread across the whole of society and it is also viewed as one of the key drivers, as well as one of the most important outcomes, of societal development. Health 2020, the paper produced by WHO European Regional Office in collaboration with an external advisory group where EUPHA has been represented by its current President comes in response to the need to re-examine the kind of governance mechanisms and instruments that can improve health policy and deliver health outcomes in an equitable and sustainable manner and to consider how priorities are set and strategic goals are implemented. Health 2020 is intended to be inspiring, challenging and practical. It should achieve three things.

European Public Health News * EUPHA President's Column * EUPHA office news * Message from the Who Regional Director for Europe: Non-Communicable Diseases, Inequalities and Development * Health at a Glance: Europe 2010 * Public Health and Welfare - Welfare Development and Health, 10-12 November 2011, the Bella Centre, Copenhagen, Denmark

In this section of the EJPH , we provide you with updates from EUPHA, WHO/EURO and DG Sanco. All three contributions look at the state-of-the-art of European public health as well as presenting thoughts on future public health issues. News from EUPHA office looks at our objectives of capacity, knowledge and policy building and EUPHApedia. Of course, we are providing you with the latest information on the fourth European Public Health Conference, Copenhagen 2011. # EUPHA President's Column {#article-title-2} Twentieth century health systems were dominated by clinicians, effectiveness and efficiency. The two revolutions: the control of infectious disease and the battle against non-communicable disease are both still ongoing but the results of these revolutions are very different if we compare the situation in the developed world and in the developing countries. The infant mortality rate is 5.1 in Canada and 97.1 in Haiti, the rate of maternal deaths is 35 times higher in Latin America than in North America, the life time risk of death is 1 in 7.700 deliveries in Canada and 1 in 17 in Haiti. In Western industrialized countries, the success of public health has in many cases changed the nature of these societies making them ‘health societies’, putting health as a main theme in social and political life and as a major individual goal with a high life expectancy and ageing populations and an expansive health and medical care system. This situation is in contrast with the reality of the poorest countries where health is a matter of survival, neglected in the development policies and there is still a lack of access to even the most basic services and a falling life expectancy. To face these challenges the developed world is still too lazy and ineffective. We cannot continue to do public health as we used to but we need a …

European Public Health News * EUPHA president's column * EUPHA office news * Message from the WHO Regional Director for Europe: Embarking on Developing the New European Health Policy--Health 2020 * European Commission, DG Health and Consumers * Public Health and Welfare - Welfare Development and Health, 10-12 November 2011, the Bella Centre, Copenhagen, Denmark

This first European public health news of 2011 provides information on networking, capacity and knowledge building and the future of European public health. All contributors, EUPHA, WHO/EURO and DG Sanco, present new activities aimed at encouraging an ‘European public health movement’ where governmental organizations, non-governmental organizations and individual public health professionals work together to further public health in Europe. As Ghandi already said: ‘you must be the change you wish to see’. Wishing you all a good start to a collaborative year. # EUPHA president’s column {#article-title-2} 2011 will be an important year for Public Health and for EUPHA. For Public Health because although the human race has been always subjected to global forces throughout its existence, many of the global forces that are now shaping our destiny, such as climate change, the emergence of new infectious agents or the consequences of financial crisis, are different as they are to a considerable extent of our own making. The implication of this is that we have it in our power to do something about them. For EUPHA, if we are to respond to these threats, then we must develop effective global responses. The most important of these is knowledge. Knowledge allows us to understand the often complex pathways by which health or disease arises, looking beyond the immediate causes to underlying factors, such as the reasons why some people live in poverty or are exposed to conflict. It also enables us to understand what can be done to counteract these threats. I hope that EUPHA will play a crucial role in calling upon the governments of Europe to place a higher priority on the global threats to the future health of humanity, investing in the global public goods for health that will enable us to respond effectively to them. In particular, we should focus on the …