European Public Research Articles

The COVID-19 Pandemic: Collective Action and European Public Policy under Stress

The European continent faces an apocalyptic pandemic that poses mortal danger to millions of citizens. This paper seeks to address the role played by European public policy in addressing the COVID-19 pandemic. Currently, each Member State across Europe is applying its own measures to deal with the coronavirus; namely, decentralised decision-making that could trigger political tensions among the states. The paper argues that European public policy must change rapidly and fundamentally if these tensions are to be successfully managed; otherwise, such policy might simply cease to exist. Moreover, the known and notorious problem of collective action, information asymmetries, irrationality, negative externalities and the related free-riding phenomenon persistently are distorting the Member States’ combined efforts, resulting in deficient attempts to contain the spread of COVID-19. The paper also argues that the current unprecedented outbreak of this superspreading virus calls for a bigger EU-wide coordinated response. We argue that the COVID-19 pandemic is a good example of an area in which the central EU level holds a comparative advantage over lower levels of government. In addition, the paper offers several substantive insights into ways to improve the public policy response in the “war” against COVID-19.

OLAF – 20 Years of Protecting the Financial Interests of the EU

In 2019, the European Anti-Fraud Office (OLAF) celebrated 20 years of existence. From today’s perspective, the Office could be qualified as one of the most recognisable Directorates-General of the European Commission. This is due to its unique powers, experience and the results achieved over the past twenty years. OLAF’s main mission is to investigate fraud against the EU budget, as well as serious misconduct within the European institutions, and to develop anti-fraud policy for the European Commission. For the time being, OLAF has concluded more than 5000 cases and recommended several billion euro be returned to the EU budget. In 2018 alone, OLAF opened 219 investigations after analysing incoming information in 1259 selections. It concluded 167 investigations, which led to OLAF issuing 256 recommendations to competent authorities at EU and national level. This article focuses on the processes that led to the establishment of OLAF, the results that the Office has achieved so far and the new challenges the Office will face in the near future, such as cooperation with the European Public Prosecutor’s Office and new priorities for its investigative activities.

Twenty Years since Tampere : The Development of Mutual Recognition in Criminal Matters

Twenty years having passed since the Conclusions of the European Council in Tampere, which proposed the principle of mutual recognition as the “cornerstone” of judicial cooperation within the Union, the author takes the opportunity to reflect on the main achievements in this sector before and after the entry into force of the Treaty of Lisbon. From the enthusiasm following the adoption of the European Arrest Warrant to the recently achieved European Investigation Order and the Regulation on freezing and confiscation orders, the panorama of mutual recognition still seems to be characterized by excessive fragmentation. After Tampere and following the adoption of the consecutive programmes of action of 2004 (The Hague) and 2009 (Stockholm), no really new strategic guidelines have been adopted by the heads of state and governments, notwithstanding the clear mandate assigned to them by Art. 68 TFEU. Looking forward to the new Strategic Guidelines to be adopted in March 2020, the European Council indeed seems to have for a long while abdicated from its leading role in streamlining objectives in the sector of criminal justice, an area that would enormously benefit from clear orientation guidelines for future initiatives of the new European Commission. As examples, the article proposes fostering the rationalization and simplification of the disparate instruments of cooperation and forging the future relationship between the European Public Prosecutor’s Office (EPPO) and Eurojust, in particular concerning the possible expansion of their respective competences and scope

The European Public Prosecutor’s Office : Protecting the Union’s Financial Interests through Criminal Law

The protection of the financial interests of the European Union and the defence of the European financial system are two aspirations that have accompanied the European Union since its foundation. They are part of the nature of the Union, which was born to overcome the economic crisis installed in Europe after the Second World War. Today, such objectives have been recognized in the Treaty on the European Union (TEU) and the Treaty on the Functioning of the European Union (TFEU). The undeniable economic imprint of the Union is shown in the different areas in which its legislative activity is carried out. The ambitious financial policy only makes sense on a solid economic and financial context, which requires the protection of the budget and the prevention and sanction of conducts undermining the economic pillars. The European Public Prosecutor´s Office (EPPO) marks the turning point in criminal policy that seeks to strengthen the fight against fraud. In this legal context, it is interesting to highlight two aspects. First, the European legislator understands that criminal law is the most effective instrument to combat fraudulent activities affecting the financial interests of the Union; as a consequence, criminal law becomes a prima ratio barrier against crime. Second, the EPPO will be the only body to investigate and prosecute such crimes. The objective of this article is to analyse these aspects and reflect on the limits on the material competence attributed to the EPPO.

The campaign "This Is Public Health" in Italy, set up by a team of Public Health Schools in Northern Italy.

Despite the great effort to raise awareness among health promotion, nowadays Public Health policies are not often recognized as important tools. For this reason, the Health in All Policies (HiAP) approach is instrumental in tackling this information gap. In 2018, the US Association of Schools & Programs of Public Health (ASPPH) launched an international campaign called “This is Public Health” (TIPH), whose aim was “to brand public health and raise awareness of how it affects individuals, communities and populations”. The Association of Schools of Public Health in the European Region (ASPHER), in coordination with ASPPH, decided to create a European campaign to support and to reproduce the American one, by opening a challenge among the European Public Health Schools. The Schools and Programs of PH of Vita-Salute “San Raffaele” University, Milan, University of Parma, University of Pavia and Politecnico of Milan won this bid. In this “briefing on” we present a report on the Italian project for raising awareness of Public Health among general population and health care personell.

The evidence base for psychotropic drugs approved by the European Medicines Agency: a meta-assessment of all European Public Assessment Reports.

To systematically assess the level of evidence for psychotropic drugs approved by the European Medicines Agency (EMA). Cross-sectional analysis of all European Public Assessment Reports (EPARs) and meta-analyses of the many studies reported in these EPARs. Eligible EPARs were identified from the EMA's website and individual study reports were requested from the Agency when necessary. All marketing authorisation applications (defined by the drug, the route of administration and given indications) for psychotropic medications for adults (including drugs used in psychiatry and addictology) were considered. EPARs solely based on bioequivalence studies were excluded. Our primary outcome measure was the presence of robust evidence of comparative effectiveness, defined as at least two 'positive' superiority studies against an active comparator. Various other features of the approvals were assessed, such as evidence of non-inferiority v. active comparator and superiority v. placebo. For studies with available data, effect sizes were computed and pooled using a random effect meta-analysis for each dose of each drug in each indication. Twenty-seven marketing authorisations were identified. For one, comparative effectiveness was explicitly considered as not needed in the EPAR. Of those remaining, 21/26 (81%) did not provide any evidence of superiority against an active comparator, 2/26 (8%) were based on at least two trials showing superiority against active comparator and three (11%) were based on one positive trial; 1/26 provided evidence for two positive non-inferiority analyses v. active comparator and seven (26%) provided evidence for one. In total, 20/27 (74%) evaluations reported evidence of superiority v. placebo with two or more trials. Among the meta-analyses of initiation studies against active comparator (57 available comparisons), the median effect size was 0.051 (range -0.503; 0.318). Twenty approved evaluations (74%) reported evidence of superiority v. placebo on the basis of two or more initiation trials and seven based on a single trial. Among meta-analyses of initiation studies against placebo (125 available comparisons), the median effect size was -0.283 (range -0.820; 0.091). Importantly, among the 89 study reports requested on the EMA website, only 19 were made available 1 year after our requests. The evidence for psychiatric drug approved by the EMA was in general poor. Small to modest effects v. placebo were considered sufficient in indications where an earlier drug exists. Data retrieval was incomplete after 1 year despite EMA's commitment to transparency. Improvements are needed.

Harmonisation, a road to the public sector accounting modernisation

In the last decades, the globalisation had a substantial influence on the accounting field. Thus, the accounting harmonisation has gained more and more ground, including in the public sector. In this context, the purpose of the paper is to identify the steps taken for public sector accounting modernisation, through the accounting harmonisation process, analysed both at the European and international level. The investigation leads to the conclusion that the European Public Sector Accounting Standards (EPSAS) represent just a project for the moment, but, at the international level, there are some countries that apply International Public Sector Accounting Standards (IPSAS) to a different extent.

The EU’s Trifecta Mechanisms: Analysis of EU’s Response to the Challenges to the Rule of Law and Corruption

The following paper examines the envisaged framework and effectiveness of the triangulation of mechanisms currently planned at the EU level: the establishment of the European Public Prosecutor’s Office (EPPO), proceedings under Article 7 of the Treaty on European Union (TEU) against Poland and Hungary, and the mechanism to protect EU’s budget in deficiencies withregards to the rule of law in Member States. This research focuses on the overall structure and powers of the EPPO with special attention on its role in investigating and prosecuting offences affecting to the EU’s financial interests. This includes active and passive corruption among others with particular emphasis on the expected interaction between the EPPO and the national authorities. However, not all EU Member States have joined the EPPO framework. Here the role of the EU institutions is analyzed in light of the recent developments in Article 7 TEU proceedings. A third possible mechanism to react to the growth of executive powers in some states and the corresponding imbalances is the EU Commission’s proposal for a mechanism on the protection of the EU’s budget in case of generalized deficiencies as regards the rule of law. This may include corruption or other breaches to the implementation of the Union budget.

Европейската прокуратура и необходимите промени в българското законодателство. Налагат ли се и конституционни промени?

The article named “The European Public Prosecutor’s Office and the necessary amendments in the Bulgarian legislation. Are constitutional changes necessary too?” tries to trace the changes in legislation of Republic of Bulgaria that are necessary in connection with the activities of the European Public Prosecutor’s Office (EPPO). First the author analyzes the mechanism for transposition of Directive (EU) 2017/1371 of the European Parliament and of the Council of 5 July 2017 on the fight against fraud to the Union’s financial interests by means of criminal law in the Bulgarian Penal Code. Specific proposals have been made on the wording of the crime sections in order to comply with the standards of the Directive. In the second part of the article, the author recommends specific amendments to the Code of Criminal Procedure to ensure the proper functioning of the European Public Prosecutor’s Office in order to ensure the successful completion of cases before the Bulgarian Criminal Court. The third part of the article is devoted to the changes in the Judicial System Law, which should guarantee the interaction of the Public Prosecutor’s Office of the Republic of Bulgaria with the European Public Prosecutor’s Office. Finally, in connection with the necessary legislative changes caused by the activity of the European Public Prosecutor’s Office, the author has devoted a special place in the article to the possible contradictions with the Constitution of the Republic of Bulgaria and has proposed specific solutions to this problem.

IPSAS for European Union member states as starting points for EPSAS

PurposeThe European Commission is pursuing an initiative to establish European Public Sector Accounting Standards (EPSAS) as a common mandatory set of rules for financial reporting of all member states of the European Union (EU). As a basis for developing EPSAS, the International Public Sector Accounting Standards (IPSAS) are being used. The purpose of this paper is to structure and analyze the discussion around EPSAS, with particular emphasis on the arguments that were brought forward by governments and other stakeholders of various EU countries regarding the suitability of IPSAS.Design/methodology/approachDrawing on several schools of thought in new institutional theory, how the prevailing institutional contexts in countries influence the debates is explored. Empirically, this research investigates the responses to a consultation on the suitability of IPSAS for EU member states and takes a closer look, via document analysis, at France and Germany as two critical cases.FindingsIt is found that, first, the majority of arguments from respondents are framed in a rational choice way. Second, skeptics of IPSAS tend to make arguments rather from positions closer to historical and/or sociological institutionalism.Research limitations/implicationsThe paper illustrates that while technical matters around EPSAS seem solvable, political, historical and cultural differences go deeper, and need to be addressed by change agents. Regarding limitations of the research, first, the analysis concentrates on financial reporting and does not deal with the implications for more reliable and comparable national accounts in the context of the European System of Accounts (ESA, 2010). Second, it is focused on debates in the context of the EPSAS proposal, and there is a need for an evaluation after the changes have gone live.Originality/valueThe study looks at a text genre that has so far received less attention in public sector accounting research: responses to consultations. The paper contributes to the literature by showing how institutional contexts matter in settings characterized by contestation of reform contents.

European Public Health News.

European Public Health News.

Anticancer drug prices and clinical outcomes: a cross-sectional study in Italy

ObjectiveTo investigate whether the prices of new anticancer drugs correlated with their relative benefit despite negotiation.DesignRetrospective cross-sectional study correlating new anticancer drugs prices with clinical outcomes.SettingWe did a retrospective cross-sectional...

Break or Bend in Case of Emergency?: Rule of Law and State of Emergency in European Public Health Administration

In this article, we ask what the impact is of the role of the EU administration in responding to emergencies in terms of (changes to) the rule of law. A response to an emergency in some cases creates exceptions to rule of law guarantees that bind the authorities to procedural rules and fundamental rights. These exceptions can become more permanent and even change the constitutional order of the EU. We articulate the legal framework for health emergencies, and discuss how the EU court has interpreted and developed this framework in two key decisions. We then ask whether this framework offers adequate safeguards for upholding the rule of law in cases of major health emergencies. We conclude that public health emergencies can bend and even break rule of law requirements for the EU administration, and advocate for more legal guidance on proportionality, which may offer better safeguards suited for protecting the rights of affected parties.

RESPONSIBLE ALCOHOL CONSUMPTION AND EUROPEAN PUBLIC POLICY

The detrimental effects of alcohol consumption have been the subject of numerous research works from various fields, particularly due to its social impact. As part of public policy, alcohol consumption has frequently been included in national and supranational agendas and eliciting many research studies, reports and consumption reduction strategies. World Health Organization statistics-based reports name European countries as having among the highest levels of alcohol consumption and, while the reduction of it is a stated European Union policy-making objective, the conclusions of the studies are not easily discernible, and the practical results achieved so far, not that effective. In a world of abundance, excessive alcohol consumption remains a rather elusive problem of public policy, due to the complexity of its interactions with all of the biological, psychological and social environments. Many studies so far suggest that the right policy may not be complete abstinence, but rather an approach based on a responsible level of consumption.

Úřad evropského veřejného žalobce a mezinárodní justiční spolupráce ve věcech trestních

This article explores the possible impact of the establishment of the European Public Prosecutor’s Office (EPPO) on international judicial cooperation in criminal matters. The starting point is the clarification that the EPPO is the authority that does not exercise the criminal jurisdiction of the EU, but the criminal jurisdictions of the EU member states bound by Regulation (EU) 2017/1939. It means that not only the relations between the EPPO and the criminal jurisdictions of the EU member states not bound by Regulation (EU) 2017/1939 and between the EPPO and the criminal jurisdictions of non-member states of the EU have the character of international judicial cooperation in criminal matters, but also the internal relations within the EPPO between the criminal jurisdictions exercised by the EPPO. Each of the three different areas of international judicial cooperation in criminal matters is then separately analysed and the analyses are followed by concluding remarks. While the international judicial cooperation in criminal matters between the EPPO and the EU member states not bound by Regulation (EU) 2017/1939 will probably at least remain on the current level of judicial cooperation between the EU member states, the international judicial cooperation in criminal matters between the EPPO and non-member states of the EU is at risk of worsening (compared to the current level of judicial cooperation between the EU member states and non-member states of the EU), depending on the willingness of non-member states of the EU to cooperate with the EPPO as a new actor on the stage. On the other hand, the international judicial cooperation between the EU member states bound by Regulation (EU) 2017/1939, i. e. within the EPPO, might be better than the current level of judicial cooperation between the EU member states, partly due to the provisions of Regulation (EU) 2017/1939 (although they are not too innovative) and partly due to the fact that higher level of willingness to cooperate is expected “under one roof” of the EPPO than between the authorities of various EU member states.

Medical students’ involvement in health policy: current focus and trend

Abstract Background European Medical Students’ Association (EMSA) and International Federation of Medical Students’ Associations (IFMSA) are two leading student organizations advocating for better health in Europe and the World. How student organizations support global public health policy and particularly which topics students place greater emphasis on are not documented, although it is crucial to understand their involvement and areas of interest. Methods Data on the valid policy documents of the last three years until April 2019 were retrieved from the official websites of EMSA and IFMSA. These documents were categorized using abstract submission tracks of the 12th European Public Health Conference. Results Twenty-nine policy documents were retrieved, ten of which were from EMSA and 19 from IFMSA. Fourteen of all 22 abstract submission tracks (63.6%) were covered by these policy documents. Of all policy documents, 20.7% fell under the track of ’infectious diseases, preparedness and vaccines’. Most commonly advocated topic in policy documents of IFMSA was infectious diseases and vaccines, whereas that of EMSA was healthy living and health promotion. Conclusions Medical students often take part in health policy by conveying their perspectives and calling other stakeholders to action via their policy documents. Policy documents of IFMSA were more related to global health challenges such as infectious diseases while special concerns in Europe such as healthy living and health promotion dominated EMSA’s policies. In the near future, more student advocacy work on climate change, noncommunicable diseases and primary health care would be expected in accordance with ’ten threats to global health in 2019’ announced by the World Health Organization. Key messages Medical student organizations, EMSA and IFMSA, are important stakeholders in health policy. The focus of their policy documents differs, and this trend is influenced by changing public health challenges in Europe and the World.

Workshop: Bridging the Gap in Digital Public Health in Europe

Abstract Europe is facing several health challenges and public health plays an important role in it. However, to address the increasing demand for public health services, public health institutions need to tackle digitalization in a proper and evidence-based way. Digital health comprises both an organizational and a technological component. While the technological one has been widely addressed, the organizational one got little attention so far. This is due to a lack of knowledge regarding the understanding of the new role of organizations that provide digital health services. Public health is a field deeply dependent on data and with an important opportunity to leverage information technology. Digital health could, within 10 years establish a new paradigm in public health. The public health professionals need urgently to tackle digital health to bridge the gap with others areas of healthcare. Moreover, since public health is a multi-disciplinary activity we want to take the opportunity to debate digital public health with European experts from different fields of knowledge. Three presentations from the point of view of People, Technology and Services. Digital health should be addressed as an evidenced-based approach towards both improving health professionals performance and quality of life of patients. This workshop aims at: To create the momentum towards the proper use of digital technologies in public health by discussing the main challenges and opportunities for European Public Health.To establish a forum to discuss digital public health solutions based on evidence to better improve the adoption of these tools in the public health profession;To have a serious discussion after 3 presentations that will clarify the main challenges and opportunities;After de presentations, a debate will be guide to help identify the main challenges for digital public health in Europe; Key messages Public Health Digitalization is essential to address health inequalities in Europe. The workshop identifies what are the main priorities for a sustainable EU public Health digitalization. Mutual learning, knowledge and good practice exchange in using digital technology can be organised in various ways – we show practical current examples on how it has been done.

Workshop: EUPHA and Europe-wide action on digital public health

Abstract The World Health Assembly Resolution on Digital Health unanimously approved by WHO Member States in May 2018 demonstrated a collective recognition of the value of digital technologies to contribute to advancing universal health coverage (UHC) and other health aims of the Sustainable Development Goals (SDGs). The World Health Organization has just released first ever guideline on digital interventions for health system strengthening. Et the European level, in June 2018 the WHO Regional Office for Europe launched the WHO/Europe initiative for Digitalization of Health Systems and in February 2019 organized the first Symposium on the Future of Digital Health Systems in the European Region. The European Commission in April 2018 published a Communication on Digital transformation of health and care in the digital single market and requested the Expert Panel on effective ways of investing in health (EXPH) to release an evidence-based opinion on how to assess the impact of digital transformation of health services. In such context, the European Public Health Association (EUPHA) has at an early stage acknowledged and understood the crucial importance of applying the potential offered by digitalization to public health. Not only its most prominent members work and research as WHO and EC experts on how to plan, implement and evaluate effective digital public health interventions, but EUPHA itself - as umbrella organization representing public health associations and institutes across Europe had: i) actively participated to the WHO Euro Symposium successfully co-organizing a session on the ‘beautiful marriage’ between digitalization and public health, ii) supported the publication of a EJPH supplement on digital health and iii) has planned to create a EUPHA Section on Digital Health. With the overall goal of positioning the proposed EUPHA Section on Digital Health in the enriching and constructive context of the European Public Health Conference the workshop specifically aims to: present a comprehensive conceptual framework for the application of digital technologies to public health in Europe;present and report on EUPHA collaborative action on digital health, aligned with European institutions;present the structure and content of the EJPH supplement on digital health;present the general aim, specific objectives, scope, mission and preliminary outputs of the proposed EUPHA Section on Digital Health, as well as its synergy with other EUPHA’s Section workPresent the results of two/three specific projects on digital public health to serve as concrete examples of the application of digital solutions to public healthEngage with the audience to promote the active participation of the broader EUPHA community to the activities of the Section, collect interests and best practices, and share ideas and projects worth scaling up at the Section-level. Key messages The ‘beautiful marriage’ between digitalization and public health has to be concretely planned, implemented and evaluated. EUPHA action on digital public health can be further strengthened through the collaborative action and work of its dedicated Section.

Skills building seminar: Making the elevator pitch work: how to convince a policymaker in less than 2 minutes

Abstract Since a number of years, EUPHA, the European Public Health Conference and other associations, have been working hard to translate the evidence in a such a format that policymakers take notice. The work by WHO Europe on ‘telling the public health narrative’ or providing factsheets and infographics is an example. EUPHA has organised several skills building workshops on translation of evidence in the past years (e.g. 2018: You say tomatoe, I say tomato). The European Public Health Conference introduced the so-called pitch presentations (at Glasgow 2014), where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), a way to learn to present key messages from research in just a few minutes. But what should you do, if you meet your policymaker in the hallway or in an elevator? Can you present your work, including key messages, without slides? And in less than 2 minutes? You should be able to. In this skills-building workshop, we will select a number of abstracts that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work? Key messages Being able to present your key messages anywhere, anytime is needed. Panelist Anne-Marie Yazbeck Chafea, Luxembourg Contact: Anne-Marie.YAZBECK@ec.europa.eu Ivan Erzen Slovenia Contact: Ivan.Erzen@nijz.si

A public health approach to imprisonment

Abstract This presentation explores the contested meaning of “prison public health”. European Public Health aligns itself with legal, ethical, political and economic principles that govern human rights, the rule of law and social justice. The UN Universal Declaration of Human Rights and the WHO Commission on the Social Determinants of Health infer an egalitarian approach towards social justice that supports rights of all citizens to have their basic needs met, unnecessary threats to wellbeing minimised, and social competence maximised. In the spirit of the WHO Ottawa Charter for Health Promotion, this means operationalising agency of individuals and communities and of the broad structural determinants of health: economic, political, legal and institutional. In contrast, the law conventionally positions criminal responsibility with the individual perpetrator who is held responsible for their ‘offending’ behaviour. In parallel, arguments surrounding responsibility for health have abounded for many decades, with the principle of collective responsibility for health forming the ethos of the Ottawa Charter. Only recently has it been acknowledged that criminogenic and pathogenic ‘determinants’ intersect, criminal risk behaviours and health risk behaviours sharing common aetiologies. This presentation will reinforce that a public health approach towards imprisonment is fundamentally egalitarian and commitment to social justice, recognising that structure and agency intersect and that the health of the prison is as important as that of the prisoner. It will argue that it is short-sighted to attend only to prisoner behaviour if the system surrounding the prisoner is failing in its duty of care and capacity to serve society. Most prison populations represent the most vulnerable or disadvantaged sectors of society. Governments must proactively facilitate sustainable human development and protection and empowerment of vulnerable groups including those in custody.