Euro Region Research Articles

Navigating the housing channel of monetary policy across euro area regions

This paper assesses the role of the housing market in the transmission of monetary policy across euro area regions. By exploiting a novel regional dataset on housing-related variables, a structural panel VAR analysis shows that conventional and unconventional monetary policy shocks propagate effectively to the economy, particularly to the housing sector, albeit in a heterogeneous fashion across regions. A formal econometric analysis relates this heterogeneous impact of monetary policy to housing-related long-run regional economic and institutional characteristics. The analysis indicates a prominent role for the housing channel in the transmission of monetary policy to the economy, via both housing wealth and balance sheet effects. Moreover, heterogeneity in institutional features (share of fixed-rate mortgages) and labour income help explain the transmission of monetary policy across regions.

An international survey on the knowledge, aTtitudes and clinical pAtternS of use of medical cannabis for caNcer care: the TASMAN study

BackgroundMedical cannabis (MC) has gained traction in oncology for managing cancer-related symptoms, but its integration faces challenges due to limited evidence, inconsistent guidelines, and varied legal frameworks. MethodsThe TASMAN study aimed to assess the knowledge, attitudes, and practices of oncologists and palliative care providers globally regarding MC use in cancer care. A survey of healthcare providers from diverse regions and income levels was conducted. Resultswe study included 179 participants (response rate: 51.1%), with an equal gender distribution (49.4% female) and a median age of 37 years. Participants were primarily oncologists (71.5%), practicing in university hospitals (40.2%) or cancer centres (32.4%), with over half from low- and middle-income countries. Most respondents (92.7%) were unaware of clinical guidelines for MC. A proportion of 44.1% were familiar with MC use, 78.8% recognized its role in cancer pain, and 34% identified its role in managing cachexia. Awareness of specific products was low, with only 10% familiar with specific cannabis products. Three-quarters of respondents (84.4%) did not prescribe MC routinely. Legal status and regulations were unclear for most participants; 40% noted cannabis as illegal. MC use and patient requests were more common in high-income countries and the EURO region, with palliative care providers demonstrating the highest awareness and prescription rates. ConclusionClearer regulations, standardized guidelines, and targeted education are essential to support the safe integration of MC into oncology and palliative care, ultimately improving the quality of life for cancer patients.

How did European countries set health priorities in response to the COVID-19 threat? A comparative document analysis of 24 pandemic preparedness plans across the EURO region

The COVID-19 pandemic has forced governments across the world to consider how to prioritise the allocation of scarce resources. There are many tools and frameworks that have been designed to assist with the challenges of priority setting in health care. The purpose of this study was to examine the extent to which formal priority setting was evident in the pandemic plans produced by countries in the World Health Organisation's EURO region, during the first wave of the COVID-19 pandemic. This compliments analysis of similar plans produced in other regions of the world. Twenty four pandemic preparedness plans were obtained that had been published between March and September 2020. For data extraction, we applied a framework for identifying and assessing the elements of good priority setting to each plan, before conducting comparative analysis across the sample. Our findings suggest that while some pre-requisites for effective priority setting were present in many cases – including political commitment and a recognition of the need for allocation decisions – many other hallmarks were less evident, such as explicit ethical criteria, decision making frameworks, and engagement processes. This study provides a unique insight into the role of priority setting in the European response to the onset of the COVID-19 pandemic.

Integration of prison health care into national disease surveillance and health informatic systems: opportunities and challenges for Europe and beyond

Abstract Approximately six million people are incarcerated annually in the WHO EURO region. The majority of these people spend only a minority of their lives in prison. Many people living in prison (PLP) experience significant health & social care inequalities/inequities and have higher levels of health & care needs than their peers in the community. Imprisonment can represent a public health opportunity to identify and address such needs. Programmes delivered in prisons targeting infectious diseases like HBV, HCV, HIV and tuberculosis (TB) can improve active case finding specifically in prison settings but can also impact on elimination and control targets for whole populations by addressing high risk transmission networks centred in and around prison associated populations. But too often prisons represent a ‘black hole’ for health & care data flows, neither receiving health information from community-based health systems nor providing, in an accessible way, details of health interventions delivered in prisons. The result is discontinuity of care and inefficiencies (economic&clinical) in treatment and care programmes. For example, people being screened multiple times for an infection (e.g. HCV) but not receiving treatment, or starting and stopping multiple courses of treatment in a chaotic way which could add to public health risks, e.g. multi-drug resistant TB. National disease surveillance systems missing data on prison populations also risk health security given the ability of prisons to amplify infectious diseases which could pose health threats to wider communities. Significant efforts are required to ensure that national disease surveillance and health information systems routinely include PLP to improve health intelligence, health security and continuity of care. This can support delivery of screening, diagnostic and therapeutic services. But can also enable health service evaluation, health & care needs assessment, and quality improvement programmes.

The Correlation between Hofstede's Cultural Dimensions and COVID-19 Data in the Early Stage of the COVID-19 Pandemic Period.

COVID-19 (coronavirus disease 2019) has become the deadliest virus to affect the international community in recent history, with more than 760 million people infected and more than 6.87 million deaths as of March 2023; therefore, based on Hofstede's national cultural theory, this study collected Hofstede's six national cultural dimensions on a global scale, namely, power distance (PDI), individualism/collectivism (IDV), masculinity/femininity (MAS), uncertainty avoidance (UAI), long-term/short-term orientation (LTO), and indulgence/restraint (IVR) scores, and COVID-19 data from the World Health Organization (WHO) from 22 February 2020 to 30 February 2021. Then, based on eight items of global COVID-19 data, this study analyzed the correlation between Hofstede's six dimensions and the COVID-19 data from six regions (Africa (AFRO), Europe (EURO), the Americas (AMRO), the Western Pacific (WPRO), South East Asia (SEARO), and the Eastern Mediterranean (EMRO)) divided by the WHO. This study found the following: (1) Hofstede's six cultural dimensions indeed have a significant correlation with the COVID-19 data of different WHO regions in different ways. (2) Except for IDV and UAI, PDI is a highly critical factor and has a significant correlation with the COVID-19 data from AFRO and EMRO. MAS also is an important factor and has a significant correlation with COVID-19 data from WPRO and SEARO. Meanwhile, LTO has a significant correlation with some COVID-19 data from the AMRO region, and IVR has a significant correlation with some COVID-19 data from the EURO region. Finally, the new insights from this study are worthy of further study by scholars, and they will be of great help to global governments and medical institutions in formulating policies to suppress infectious diseases in the future.

Cost Analysis of Magnetic Resonance Imaging and Computed Tomography in Cardiology: A Case Study of a University Hospital Complex in the Euro Region.

In recent years, several hospitals have incorporated MRI equipment managed directly by their cardiology departments. The aim of our work is to determine the total cost per test of both CT and MRI in the setting of a Cardiology Department of a tertiary hospital. The process followed for estimating the costs of CT and MRI tests consists of three phases: (1) Identification of the phases of the testing process; (2) Identification of the resources consumed in carrying out the tests; (3) Quantification and assessment of inputs. MRI involves higher personnel (EUR 66.03 vs. EUR 49.17) and equipment (EUR 89.98 vs. EUR 33.73) costs, while CT consumes higher expenditures in consumables (EUR 93.28 vs. EUR 22.95) and overheads (EUR 1.64 vs. EUR 1.55). The total cost of performing each test is higher in MRI (EUR 180.60 vs. EUR 177.73). We can conclude that the unit cost of each CT and MRI performed in that unit are EUR 177.73 and EUR 180.60, respectively, attributable to consumables in the case of CT and to amortization of equipment and staff time in the case of MRI.

Implementation of the Pareto principle in focus group generation based on global coronavirus disease morbidity and mortality rates

The recent pandemic that has hit the world has affected humanity in all aspects of life. Since the outbreak of this worldwide epidemic, a huge amount of data has been generated. In this article, we have provided a new simplified insight into the 2019 coronavirus disease (COVID-19) using the Pareto principle to highlight the main contributors to morbidity and mortality. A time series database of confirmed cumulative cases and deaths for all countries was processed from the Humanitarian Data Exchange website provided by the United Nations Office for the Coordination of Humanitarian Affairs. More than 85% of the incidents recorded worldwide were from the AMRO, EURO, and SEARO WHO regions, and the United States, Russia, and India were found to account for the largest proportion of cases and deaths in these affected areas. The application of Pareto analysis is useful in finding focus groups for further study and modeling

Research prioritization in migrant health in Ireland: toward a participatory arts-based paradigm for academic primary care.

Context: People are experts in their own health and need to be involved in health-related decisions, including decisions about what issues should be researched. Underserved communities, such as refugees and migrants, are often excluded from having a voice in relation to their priorities for health research. To avoid tokenistic participation, it is important to develop and test innovative methodologies that are culturally attuned and that can offer 'whole person' (affective, creative and cognitive) engagement. The Participatory Irish World Music Café, first developed in the context of the Irish Refugee Protection Programme in 2015, uses music and singing to develop inclusive, social and creative spaces to support social integration. It has been adapted during COVID-19 as an on-line café. While the café has sustained a strong community presence for five years, its potential adaptation and use to support research health prioritisation processes is unknown. Objective: Explore the use of an on-line, participatory Irish World Music Café to generate research priorities about migrant health in Ireland. Study Design: Participatory health research study co-designed with community partners, using a qualitative ethnographic and arts-based framework. Data from six 1.5 hour on-line cafes includes interviews, focus groups and arts-based documentation generated during the cafes. Analysis follows principles of thematic analysis. Setting or Dataset: Community-based participatory study in Ireland Population studied: Refugees, migrants, primary care providers, national health service planners, artists and academics working in the field of migrant health (n=25) Intervention/Instrument (for interventional studies): n/a Outcome Measures: n/a. Results: Analysis is underway and will describe participants' shared and differential experiences of (i) the research prioritisation sessions with particular attention to their experience of using music and other artistic practices (ii) cultural attunement and whole person engagement and (iii) generating identified research priorities. Conclusions: Findings will inform the evidence base about music as an arts-based method to support a new, inclusive participatory arts-based paradigm for migrants' involvement in research prioritisation. The work will be disseminated in Ireland and in the 53 Member States of the WHO Euro region.

Asymmetric responses to shocks: the role of structural change on resilience of the Euro area regions

ABSTRACT Building on the notion of adaptive resilience, and sourcing from the Eurostat regional database on 150 NUTS 2 EURO regions over the period 1998–2019, we show that both industrial mix and regional specialization played a key role in the asymmetric reaction of European regional labor markets to the 2008 crisis and the following 2011–12 sovereign debt crisis. Standard and spatial econometric analyses confirm that the pre-crisis structural composition of regional labor markets resulted in the speed of the post-crisis recovery. Recovery was further affected by the kind of structural change each region experienced after the crisis, depending on their different capacity to host knowledge intensive and hi-tech activities. Based on this evidence, national austerity policies may have exacerbated regional divergence within and between EU countries.

Standard Survey Data: Insights Into Private Sector Utilization.

Universal Health Coverage in Low- and Middle-Income Countries is increasingly expanding through incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or part through government-managed health insurance. This underscores the importance of policies on health provision which apply across the whole delivery system regardless of ownership status. To advance understanding of private-sector policies, and to facilitate sharing of lessons across countries with similar public-private distributions, we have analyzed data on the source of inpatient and outpatient care from 65 countries. While past studies have conducted similar analysis, ours advances the field in two ways. First, we limit our analysis to data sets from 2010 through 2019, making our study more up-to-date than past studies, while changing health seeking patterns for maternal health since 2010 means that our data set is more representative of overall inpatient care. Second, while past multi-country analysis of public-private ownership have been based on the Demographic Health Surveys, we have added to this data from the Multiple Indicator Cluster Surveys, significantly increasing the countries in our analysis. We have aggregated our analysis by WHO's regions. Outside of the EURO region, where the private sector delivers just 4% of all healthcare services, the private sector remains significant, and in many countries represents more than half of all care. The private sector provides nearly 40% of all healthcare in PAHO, AFRO, and WPRO regions, 57% in SEARO, and 62% in EMRO. While specific countries with two recent surveys show variation in the scale of both inpatient and outpatient private provision, we did not find regional or global trends toward or away from private care within LMICs. Private inpatient care is most important for the wealthy in many countries; public vs. private care varies less, by wealth, for outpatient services.

Global health-related quality of life in schizophrenia: systematic review and meta-analysis

Background and aimSigns and symptoms of schizophrenia may have serious impacts on patients’ quality of life leading to concern about different aspects of their lives. This study presents a systematic...

Monetary Measures by European Central Bank under Covid Periods

To run the euro-region economy easily (saving from the awful impacts of crown), the European Central Bank (ECB) has reported countless measures since the start of the COVID-19 emergency. This reaction has set off apprehensions of a future expansion in swelling. We presume that the measures presented by the ECB during the emergency and the subsequent expansion in the size of its asset report, regardless of whether it were to be lasting, may prompt inflation. Central banks have found a way to keep their economies above water during the COVID-19 lockdowns. In the euro region, the European Central Bank (ECB) has facilitated essentially the states of its renegotiating activities and has reported another resource buy program to guarantee that its financial approach keeps on being very much communicated to all nations of the money related association. The European Central Bank worked by making cash and proficiently supplanting the credit framework by subbing cash for credit which may get terrible impacts the since quite a while ago run.

Multilateral action to harmonise migrant health data in the WHO European region

Abstract Member states in the WHO European region have made significant progress towards the implementation of the Regional Strategy and Action plan. The presentation includes the regional situation analysis on migration health data collection and results of the second survey on implementation of the Strategy WHO EURO Member States. It will also cover the policy landscape vis a vis migration health data in WHO EURO region and current gaps in migrant health data collection. Challenges and barriers for migrant health data collection and sharing will also be explored. Country examples for possible way forward including strengthening of national systems and coordination; harmonization of markers and definitions; mutual exchange between states & relevant stakeholders; strengthen data linkages in health information systems and provision of technical guidance will be presented.

4.E. Workshop: Health literacy in Policies: European and National Perspectives

Abstract Health literacy is a key dimension of public and global health policy. In the wake of Health in all Polices (HiAP), the Sustainable Development Goals (SDGs), and health equity discussions, health literacy plays an important role in empowering citizens by increasing their capacities to deal with health information and make informed decision. In recent years, digitalization and digital transformation of societies and everyday environments have contributed to the increasing awareness of the role of health literacy for navigation of these new and often complex environments. Together, these developments have facilitated the establishment of health literacy as a critical policy item on agendas across the world. In Europe, a lively policy discussion has emerged within the last decade with countries developing their own national and local strategies addressing health literacy in public health and healthcare policies, directives on health promotion and prevention and even in educational policies to include health literacy to school practices. The WHO EURO Region with 53 Member States has been particularly active, launching the WHO “Solid Facts” report on health literacy and two “Action Networks on Health Literacy” - one on measurement and one NCD interventions. Politically, these initiatives were followed up strategically by the Health Literacy Roadmap and by a resolution to develop a European health literacy action plan. While the policy movement is steadily increasing, research on health literacy policies and policy making is still a developing field. This is concerned with policies both on children`s as well as on adult`s health literacy. In this context, the aim of this workshop is to: present research findings from recent health literacy policy initiatives, such as the WHO European health literacy roadmap and action plan and European national policies and initiate a critical discussion regarding future health literacy policy development in the European region and beyond. The 1st presentation will provide an overview on health literacy policy initiatives at WHO Europe with a focus on the development of a new European Action Plan. The 2nd presentation will focus on the WHO health literacy policy initiative focusing on school-aged children. The 3rd presentation will share policy recommendation by experts for promoting health literacy in children and adolescents. The 4th presentation offers a national policy and field application focusing on health literacy and cultural appropriateness. The 5th presentation provides an example of a national position paper on health literacy from a structural perspective presenting a possible path to equity in health. This workshop offers a forum for researchers, practitioners, policy-makers and public stakeholders interested in public health policy-making with a specific focus on health literacy, and will promote discussion of results, facilitate knowledge exchange, and support further synergies. Key messages Health literacy policy is an important cornerstone of the WHO European Region Public Health and Policy strategy and the UN Sustainable Developmental Goals. This workshop will address health literacy policy development on national, European and global levels in different populations.

Monitoring the implementation of national climate action plans (NDCs) using the WHO CaRBonH tool

Abstract One crucial area of work of the WHO European Centre for Environment and Health has been the assessment of the health effects associated with the use of fossil fuels, both directly through the generation of local air pollution and indirectly by contributing to global environmental and climate change. The WHO European Centre for Environmental Health in Bonn has developed various decision support tools to calculate both the health burdens of local pollutants and the benefits of selected interventions. A key outcome has been the recent development of a simplified calculation tool, Carbon Reduction Benefits on Health (CaRBonH), capable of estimating the health, carbon and economic benefits of selected mitigation interventions. CaRBonH allows quantification of the physical and economic consequences on human health achieved through improvements in country-level air quality from domestic carbon reductions, specifically the policy mitigation actions and measures as reported in the NDCs submitted by the Conference of the Parties to the UNFCCC in support of the objectives as set out in Article 2 of the Convention. The work of improving and updating the CaRBonH tool, based on feedback from users, and the process of extending the geographical scope of the tool to account for countries outside the WHO EURO region, will be discussed in this session.

Global growth will pick up modestly

Growth in the global economy decelerated sharply in 2019 as a result of unexpected slowdowns in countries such as Germany, Brazil, and India, according to researchers at the investment bank Goldman Sachs. Ever the optimists, the researchers are calling for increased growth this year, despite slowing in continental Europe, the UK, China, and Japan. World: 3.4% (+0.3%) US: 2.3% (unchanged) Brazil: 2.2% (+1.2%) UK: 1.1% (-0.2%) Euro region: 1.1% (-0.1%) India: 6.4% (+1.3%) China: 5.8% (-0.3%) Japan: 0.4% (-0.5%) Note: GDP means gross domestic product. Numbers in parentheses are the changes from forecasts for 2019. Source: Goldman Sachs.

Workshop: Health literacy: an asset to public health policy

Abstract Health in all Polices (HiAP), the Sustainable Development Goals (SDGs), the social determinants of health, and health equity all have been recently linked with health literacy. Therefore, it comes as no surprise that health literacy has taken a place in many policy documents in the European Union`s member states. Several national, regional and local health literacy strategies are proof that many governments consider health literacy to be important for their national public health goals. The policy interest in health literacy is also well-documented within countries of the WHO Euro Region, where the political commitment to address health literacy is currently rapidly increasing. Accelerated by the WHO and several of its departments, the uptake of health literacy on policy agendas led to various new activities, such as two policy-related “Action Networks” and a “European Roadmap”. In the light of those recent events, the relevance of health literacy for public health, health promotion and digital health has attracted further NGOs and cross European networks to include health literacy to their working programmes and policy agendas. In this context, our aim is to: (1) present empirical findings from health literacy policy research projects conducted on European and national levels in the WHO Euro Region and (2) initiate a critical discussion among the audience and the presenters. The 1st presentation will provide a general overview on health literacy policy initiatives in the EU and the WHO Euro Region, showing interesting results on how most policies focus on health care rather other important arenas of everyday life. The 2nd presentation will compare data from two different European health literacy studies and share in-depth knowledge on the specific policy strategies European countries use, such as national, regional and local level policies, or if countries don`t use health literacy in their health policy frameworks. The 3rd presentation will build upon these presentations and provide results from a health literacy policy analysis regarding children. This is to see if and how health literacy policies address children and what kind of policies and policy instruments are used. The 4th presentation will explore how health literacy is applied in context of cancer. The study will discuss results of systematic analysis of National Cancer Control Plans (NCCPs), which is a public health strategy, regarding cancer literacy and the improvement of quality of life of cancer patients. The 5th presentation will introduce the WHO action network for measuring population and organizational health literacy (M-POHL) and its health literacy survey 2019 (HLS19), an initiative that emerged in context of European health literacy policy making and already comprises 24 European countries. This workshop offers a forum for people interested in public health policy making with a specific focus on health literacy and will allow discussing results, facilitate exchange, and support further synergies. Key messages Health literacy policy is an important brick in the Health in All Policies strategy. This workshop will address health literacy policy development on national, European and global levels in different populations.

The social and economic benefit of health literacy interventions in the WHO EURO region

Abstract Background Health literacy (HL) allows people to make informed decisions regarding their health, enabling them to understand health promotion activities and to self-manage their disease or complication without requiring support from healthcare services. HL has the potential to support sustainability in health systems by decreasing healthcare spendings stemming from lowered disease occurrence and progression, it can also impact on the rest of peoples’ lives and their surroundings by allowing them to be more independent. This study researched the evidence for return on investment and the social return on investment for health literacy interventions within the WHO EURO region. Methods A narrative literature review on published peer-reviewed reviews and grey literature was conducted by use of keywords and MeSH terms. Google, Google Scholar and PubMed were used find literature. The search on PubMed was restricted to reviews, published within the last 10 years (2009-2019), in English. Results In total, 450 publications were screened 12 publications that analysed the economic or social aspect of HL interventions were identified. Five discussed the cost-effectiveness of health literacy, three the return on investment (ROI) and the remaining three the social return on investment (SROI) of HL. Types of HL interventions ranged from health promotion campaigns, web-based HL programs, prevention systems to education-based interventions. Cost-effectiveness differed between studies and fields. Evidence for ROI was found, the return ratios ranged from 0.62 to 27.4. Findings show SROI between 4.41 and 7.25, indicating additional value of social benefit next to improved health. Conclusions A link between cost-effectiveness and HL interventions was established and ROI and SROI showed positive ratios. Further research is required in order to investigate whether HL interventions consistently achieve a positive returns. Key messages A link between health literacy interventions and positive investment returns has been established. Health literacy interventions show potential for sustainable development of health systems.

The WHO support tool: how is it used and what kind of adaptations are needed?

Abstract Issue and method In December 2013, the Standing Committee of the Regional Committee for Europe asked the WHO Regional Office for Europe (WHO EURO) to develop a practical tool for Member States that provides assistance in developing and improving national health information systems (HIS) through the development of a national health information strategy. The developed tool, the Support Tool, was informed by existing tools developed earlier by WHO’s Health Metrics Network and was adapted for the planned assessments in the WHO EURO region. The Support Tool was published in 2015 and was used until now for nine national HIS assessment missions. Results By using the Support tool all dimensions of a HIS are assessed: the general resources needed, the indicators used, the data sources available, the applied data management procedures, data quality, and the dissemination process and use of the HIS outputs. The Support Tool structures the assessment process and supports the identification of strength, weaknesses, opportunities, and challenges that inform HIS strategy development in the second stage. Lessons So far, the application of the Support Tool had a strong focus on the assessment stage. It turned out that it is necessary to develop a joint understanding of what a HIS entails. The Support Tool offers great potential to start a structured dialogue with all actors linked to the HIS including policy makers. The assessment provides an opportunity for HIS strengthening and the development of a joint understanding. However, it turned also out that further adaptations of the assessment content are needed to better cover topics prevalent in European HISs, like electronic health records, modern IT-resources, modern reporting approaches, and knowledge translation.

Prevalence of BRAF gene mutation in samples of primary and metastatic colorectal cancer: A meta-analysis.

Understanding the prevalence and biology of BRAF gene can improve the treatment methods of cancerous patients. This study aims to estimate the prevalence of BRAF gene mutation in samples of primary and metastatic colorectal cancer using meta-analysis method. We searched PubMed, Scopus, ScienceDirect, Ovid and Google Scholar motor engine using MeSH terms of relevant keywords. During the screening phase, titles, abstracts and full texts were reviewed and risk of bias was assessed for all selected papers based on Newcastle-Ottawa Scale (NOS) checklist. The results of the primary studies were combined using meta-analysis. Of 95 eligible studies entered into the meta-analysis, prevalence of BRAF gene mutation had been assessed among 19,484 primary tumour samples as well as 12,256 metastatic samples. The total prevalence of BRAF gene mutation among primary tumour samples was estimated as of 10.16% (8.09-12.22) in the world, 0.41% (0-1.89) in EMRO region, 10.06% (7.54-12.59) in EURO region, 10.33% (7.24-13.43) in SEARO region and 11.33% (7.29-15.37) in WPRO region. The pooled estimates for BRAF gene mutation in metastatic samples were 6.53% (5.09-7.96), 8.07% (5.57-10.56), 5.38% (3.75-7.02) and 5.55% (1.72-9.38) for all regions, EURO, WPRO and PAHO regions respectively. Our results showed evidences of BRAF gene mutation in one-tenth of primary colorectal tumour samples in EURO, PAHO, SEARO and WPRO regions which was considerably higher than that of the EMRO region.