National Public Health Associations Research Articles

Strengthening public health professionals in policymaking in the Eastern WHO European region

Abstract Background The collaborative research between EUPHA and WHO aimed to explore factors impacting public health professionals’ (PHP) involvement in health policy processes in the Eastern WHO European Region, addressing barriers, enablers, and capacity-building needs. Methods Utilizing a mixed methodology, the study employed document analysis, scoping review, and interviews to triangulate data, with the document analysis focusing on 4 published Essential Public Health Operations Self-Assessment Reports, the scoping review analysing 15 key articles, and 5 semi-structured interviews providing additional insight from key country stakeholders. Results Core findings revealed significant barriers impeding PHPs' participation in policy processes. Among others, these included limited intersectoral collaboration, shortage of skilled public health (PH) personnel, financial resource constraints and inadequate governance structures. Conversely, several enablers were identified, such as a positive trend in increased intersectoral collaboration and innovative governance structures during Covid-19, the development of more trained PHPs and the utilization of International Health Organisations. The two main capacity building needs reported were the importance of modernizing PH education and promoting intersectoral collaboration. Conclusions This study offers a preliminary overview of how PHPs' involvement in health policy processes in these countries can be enhanced: More intersectoral collaboration, updated PH education curricula and trainings, and governance re-design building on positive trends seen during the pandemic. Following actions are recommended: Creation of an international platform for cross-sectoral PH communication & exchange, direct support for universities and PH researchers, development of comprehensive PH trainings, assistance in forming or strengthening national public health associations and identification & sharing of effective local governance practices. Key messages • This research identifies barriers to PHPs’ participation in Eastern WHO European Region's health policy processes, while highlighting enablers like increased collaboration during Covid-19 to build on. • Recommendations to harness the enablers include clear actions such as creating an international public health platform for interaction and exchange or build-up of national public health associations.

Sentiment towards vaccinations in healthcare workers of five European countries after the pandemic

Abstract Background Health care workers (HCWs) are a trusted source of vaccine information for patients and communities. Our aim is to evaluate the impact of the COVID-19 pandemic on European HCWs’ sentiment towards vaccination (STV), focusing on COVID-19 and influenza. Methods We designed a multilingual Knowledge-Attitudes-Practice web-survey with 4-point Likert items addressed to HCWs in 11 countries and spread through national Public Health Associations. We present a preliminary analysis of responses from France (n = 206), Germany (n = 376), Italy (n = 394), Spain (n = 549) and the United Kingdom (n = 172, UK). Results The completion rate is 81% (1,374/1,697). Respondents are mostly female (66%), with a median age of 45, mainly employed as physicians (44%). HCWs agree on the effectiveness (92%), safety (89%) and necessity (91%) of vaccinations in general, but many think that their side effects are downplayed by pharmaceutical companies (46%) and health authorities (39%). The majority received 3+ doses of COVID-19 vaccines (72%) and agree that these vaccines are effective (88%) and have a favorable benefit-risk ratio (83%). However, many have concerns about their administration in pregnancy (76%). Most HCWs agree with mandatory COVID-19 vaccine for their category (59%) and are ready to accept a further COVID-19 booster vaccination if recommended (72%). The majority agree that the pandemic increased their attention to update their vaccination schedule (62%) and their confidence in vaccines safety (53%). Accordingly, only 50% received regular influenza vaccination prior to the pandemic, whereas 67% got vaccinated in the last season and 65% plan to do so in the next one. Overall, STV is more positive in Italy and Spain, less marked in Italy has the lowest scores in Germany. Conclusions Despite persisting doubts about COVID-19 vaccines and differences among countries, the sentiment towards vaccinations in European HCWs is generally positive and has improved after the pandemic. Key messages • European healthcare workers have generally positive sentiment towards vaccination, including COVID-19 and influenza, despite concerns about side effects and about administration during pregnancy. • The COVID-19 pandemic increased European HCWs’ attention to update their vaccination schedules, with the majority agreeing on the effectiveness, safety, and necessity of vaccinations in general.

Global public health policies: gathering public health associations’ perspectives

ABSTRACT Background Advocacy is one of the core functions of public health and is a key tool for achieving Sustainable Development Goals. Public health associations play a key role in advocating for the development and implementation of strategies to prevent diseases and promote health and well-being. Objective This study aims to map out the focus of public health advocacy carried out by selected national public health associations over 4 years, between 2018 and 2021, in order to identify gaps and strengths and support associations and professionals in their advocacy efforts. Methods Twelve national public health associations participated in the study. Official policy documents produced between 2018 and 2021 were collected and analysed. The title and summary of the policy documents were examined line by line and coded into the main subject categories and themes. A qualitative thematic analysis was conducted. Policies were assessed from global and regional perspectives. Results A total of 220 policy documents were analysed. Overall, the largest number of policy documents came from high-income countries and dealt with environmental health and communicable diseases, including COVID-19, with, however, important differences among regions. In the African region, public health advocacy focused mainly on strengthening health systems; Europe and South America were mostly concerned with communicable diseases and pandemic management; and North America and the Western Pacific regions focused primarily on climate change. Limited attention was paid to international health and health as a human right in all regions. Conclusion Our study showed that, especially in high-income countries, public health associations actively engage in advocacy; however, more effort needs to be devoted to implementing a more international and intersectoral approach at the global level, anchored in health as a human right and aligned with the Sustainable Development Goals.

Workplace Violence and the Mental Health of Public Health Workers During COVID-19

During the COVID-19 pandemic, public health workers were at an increased risk for violence and harassment due to their public health work and experienced adverse mental health conditions. This article quantifies the prevalence of job-related threats, harassment, and discrimination against public health workers and measures the association of these incidents with mental health symptoms during the COVID-19 pandemic. A nonprobability convenience sample of state, local, and tribal public health workers completed a self-administered, online survey in April 2021. The survey link was emailed to members of national public health associations and included questions on workplace violence, demographics, workplace factors, and mental health symptoms. Mental health symptoms were measured using standardized, validated tools to assess depression, anxiety, post-traumatic stress disorder, and suicidal ideation. Multivariable Poisson models calculated adjusted prevalence ratios of mental health symptoms, with workplace violence as the primary risk factor. Analyses were conducted in 2021-2022. Experiencing any type or combination of workplace violence was significantly associated with an increased likelihood of reporting depression symptoms (prevalence ratio=1.21, 95% CI=1.15, 1.27), anxiety (prevalence ratio=1.21, 95% CI=1.15, 1.27), post-traumatic stress disorder (prevalence ratio=1.31, 95% CI=1.25, 1.37), and suicidal ideation (prevalence ratio=1.26, 95% CI=1.14, 1.38), after adjusting for confounders. A dose‒response relationship was found between the number of workplace violence events experienced by a public health worker and the likelihood of reporting mental health symptoms. Violence targeted at the public health workforce is detrimental to workers and their communities. Ongoing training, workplace support, and increased communication after a workplace violence incident may be helpful. Efforts to strengthen public health capacities and support the public health workforce are also needed.

Barriers to Climate Disaster risk Management for Public Health: Lessons from a Pilot Survey of National Public Health Representatives.

This study sought to examine current national disaster risk management capacities, and identify governance barriers to strengthening national preparedness for responding to public health emergencies, associated with the anticipated climate-driven intensification of natural disaster cycles. A mixed-methods online survey, assessing broader governance constraints to climate change adaptation (CCA) for public health, was distributed to representatives of national public health associations, and societies of 82 member countries under the World Federation of Public Health Associations. Specific questions relevant to disaster risk management capacities and barriers were analyzed as part of a narrowed focus on the CCA subdomain of emergency preparedness. Existence of some technology, infrastructure, and/ or human resources, necessary to develop early warning and other surveillance systems for climate-related health risks was reported by 9 out of 11 responding countries. However, 7 reported persistent limitations and/ or regional discrepancies. Most significant identified barriers to strengthening emergency preparedness at the national level included governance coordination challenges, and, in the case of many developing countries, technical, medical, and human resource shortages. The development of new frameworks for intersectoral governance and large-scale resource mobilization will prove crucial to ongoing efforts to strengthen national climate-health resiliency and prepare for disaster-associated health threats.

Understanding national barriers to climate change adaptation for public health: a mixed-methods survey of national public health representatives

PurposeTo uncover the major government constraints to enactment and implementation of public health-targeted climate change adaptation (CCA) strategies in order to equip public health stakeholders and health advocates with the knowledge resources necessary to more effectively mobilize and support CCA for public health responses at the national level.Design/methodology/approachA mixed-methods online survey was distributed to the representatives of national public health associations and societies of 82 countries. The survey comprised 15 questions assessing national progress on CCA for public health and the effects of various institutional, economic/financial, technical and sociopolitical barriers on national adaptive capacity.FindingsSurvey responses from 11 countries indicated that national commitments to CCA for public health have increased markedly since prior assessments but significant shortcomings remain. The largest apparent barriers to progress in this domain were poor government coordination, lack of political will and inadequate adaptation finances.Originality/valueThis study is unique in relation to the prior literature on the topic in that it effectively captures an array of country-specific yet cross-cutting adaptation constraints across diverse national contexts. With a deepened understanding of the major determinants of national adaptive capacity, international actors can devise more effective, evidence-informed strategies to support national governments in responding to the health impacts of climate change.

Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to intervene. We searched literature for duties to warn at-risk groups discovered during public health surveillance, but we found no directly applicable guidance or cases. Reasoning by analogy, we conclude that surveyors should contact the school’s leaders to call attention to its outlier status, but public warning is unwarranted. However, such an ad hoc decision to issue a warning, even if only to school leaders, raises significant practical, legal and ethical issues. National public health and education associations should produce guidance that clarifies ethical and legal duties owed to schools and students involved in population health-risk surveillance.

Understanding national barriers to climate change adaptation for public health - a global survey

Abstract Background Climate change has introduced a series of unprecedented threats to human health, ranging from rising food and water insecurity to deteriorating air quality, novel disease outbreaks, and intensifying natural disasters. The Paris Agreement pushes countries to develop adaptation plans that will protect human health from the worst impacts of climate change -a process referred to as climate change adaptation (CCA). Yet despite international pressure and escalating health threats, vast shortcomings persist in national CCA for public health progress. Thus, we investigated the major governance constraints underlying these trends. Methods A mixed-methods online survey was distributed to representatives of national public health associations and societies of 82 member countries under the World Federation of Public Health Associations. Results 9 of the 11 respondent countries (82%) affirmed the existence of a national CCA plan that includes an explicit public health focus. All respondees listed governance challenges in developing and operationalising their national CCA agenda. The major identified barriers to CCA for public health progress were lack of inter-government policy coordination and insufficient political will to mobilize human and non-human resources in support of public health-oriented adaptation efforts. Conclusions Climate change-driven amplification of global health risks necessitates that all nations generate clear CCA plans to protect human health. Our findings assist by highlighting the need for new platforms for organizational collaboration/networked governance and enhanced forums for CCA agenda-setting and ambition-raising. Such forms of enriched knowledge may facilitate decision-making amongst key public health stakeholders and global institutions for how best to align climate advocacy and country-wide support initiatives with cross-cutting national needs and constraints. Key messages Climate change-driven amplification of global health risks necessitates that all nations generate clear climate change adaptation plans to protect human health. New platforms for organizational collaboration/networked governance and enhanced forums for adaptation agenda-setting and ambition-raising may significantly bolster public health adaptation progress.

Dissemination of Information About Climate Change by State and Local Public Health Departments: United States, 2019-2020.

Objectives. To determine if and how state and local public health departments present information about climate change on their Web sites, their most public-facing platform.Methods. We collected data from every functioning state (n = 50), county (n = 2090), and city (n = 585) public health department Web site in the United States in 2019 and 2020. We analyzed data for presence and type of climate-related content and to determine whether there existed clear ways to find climate change information. We analyzed Web sites providing original content about climate change for explanatory or attributional language.Results. Fewer than half (40%) of state health department Web sites, and only 1.6% of county and 3.9% of city Web sites, provided clear ways to find climate change information, whether through provision of original content or links to external agencies' Web sites. Among Web sites providing original content, 48% provided no explanation of climate change causes.Conclusions. National and global public health associations have identified climate change as a public health emergency, but most state and local public health departments are not delivering that message. These departments must be better supported to facilitate dissemination of reliable, scientific information about climate change and its effects on health.

A collective voice for advancing public health: why public health associations matter today.

We reflect on why public health matters today from the perspective of Canada's provincial, territorial, and national public health associations. As independent, non-profit organizations that transcend professional roles and sectors, public health associations are positioned to play an essential role in strengthening public health, broadly speaking, across Canada. We outline three reasons why public health associations matter today. First, public health associations are uniquely positioned to champion a public health perspective. Second, they represent and connect a diverse range of roles, professions, and stakeholders involved in public health. Finally, they are positioned for advocacy, providing a platform for participation to those who may not otherwise be able to engage but who understand the importance of a collective voice. These reasons why public health associations are important are not new, but arguably carry renewed importance in the context of a contemporary public health landscape characterized by, among other things, weakened formal public health infrastructure, neoliberal agendas and individualism, and public health imperatives such as growing economic and social inequity and ecological determinants of health that require intersectoral responses.

Climate Change and Public Health Surveillance: Toward a Comprehensive Strategy.

Climate change poses a host of serious threats to human health that robust public health surveillance systems can help address. It is unknown, however, whether existing surveillance systems in the United States have adequate capacity to serve that role, nor what actions may be needed to develop adequate capacity. Our goals were to review efforts to assess and strengthen the capacity of public health surveillance systems to support health-related adaptation to climate change in the United States and to determine whether additional efforts are warranted. Building on frameworks issued by the Intergovernmental Panel on Climate Change and the Centers for Disease Control and Prevention, we specified 4 core components of public health surveillance capacity relevant to climate change health threats. Using standard methods, we next identified and analyzed multiple assessments of the existing, relevant capacity of public health surveillance systems as well as attempts to improve that capacity. We also received information from selected national public health associations. Multiple federal, state, and local public health agencies, professional associations, and researchers have made valuable, initial efforts to assess and strengthen surveillance capacity. These efforts, however, have been made by entities working independently and without the benefit of a shared conceptual framework or strategy. Their principal focus has been on identifying suitable indicators and data sources largely to the exclusion of other core components of surveillance capacity. A more comprehensive and strategic approach is needed to build the public health surveillance capacity required to protect the health of Americans in a world of rapidly evolving climate change. Public health practitioners and policy makers at all levels can use the findings and issues reviewed in this article as they lead design and execution of a coordinated, multisector strategic plan to create and sustain that capacity.

Digital technologies for population health and health equity gains: the perspective of public health associations.

Digital technology (DT) plays an increasingly important role in the health sector. This study explores how national public health associations (PHAs) use DT to achieve their mandate. The World Federation of Public Health Associations canvassed and conducted a semi-structured interview with its national public health association members about their use of DT, the challenges they encounter in using it, and their experiences and thoughts as to how to assess its impact, both organizationally as well as on population health and health equity. The study found that digital technology plays an important role in some PHAs, principally those in higher income countries. PHAs want to broaden their use within PHAs and to assess how DT enables PHAs to achieve their organizational mandates and goals, including improved public health and health equity.

A survey of the governance capacity of national public health associations to enhance population health.

BackgroundNational public health associations (PHAs) are key partners with governments and communities to improve, protect and promote the public’s health. Governance and organizational capacity are among the key determinants of a PHA’s effectiveness as an advocate for appropriate public health policies and practice.MethodsDuring 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysisResultsResponses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA’s leaders (77 %) and the competence of people serving on the PHA’s governing body (76 %). The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %). The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders.ConclusionNational PHA have a responsibility to put into place the practices and infrastructure that enhance organizational governance. This will enhance their ability to be effective advocates for policies and practices that enhance, protect and promote the public’s health. The WFPHA has an important role to play in providing the technical assistance and financial resources to assist PHAs in attaining and sustaining a higher level of governance capacity.

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 …

Civil society engagement in innovation and research through the European Public Health Association

The European Public Health Association (EUPHA) proposed and led PHIRE (Public Health Innovation and Research in Europe), with co-financing by the European Commission, to assess public health innovation and research at national level in Europe. PHIRE was also designed to promote organizational development and capacity building of EUPHA. We assess the success and limitations of using EUPHA's participative structures. In total, 30 European countries were included-27 EU countries, Iceland, Norway and Switzerland. EUPHA thematic section presidents were asked to identify country informants to report, through a web-based questionnaire, on eight public health innovations. National public health associations (EUPHA member organizations) were requested to identify their national public health research programmes and calls, review the health research system, coordinate a stakeholder workshop and provide a national report. The section and national reports were assessed for responses and completeness. Half of the final responding CIs were members of EUPHA sections and the other half gained from other sources. Experts declined to respond for reasons including lack of time, knowledge of the innovation or funding. National public health associations held PHIRE workshops with Ministries of Health in 14 countries; information for 10 countries was gained through discussions within the national association, or country visits by PHIRE partners. Six countries provided no response. Some national associations had too weak organizational structures for the work or insufficient financial resources or criticism of the project. EUPHA is the leading civil society organization giving support to public health research in Europe. PHIRE created new knowledge and supported organizational development. EUPHA sections gained expert reports on public health innovations in European countries and national public health associations reported on national public health research systems. Significant advances could be made if the European Commission worked more directly with EUPHA's expert members and with the national public health associations.

PHIRE (Public Health Innovation and Research in Europe): methods, structures and evaluation

Public Health Innovation and Research in Europe (PHIRE), building on previous European collaborative projects, was developed to assess national uptake and impacts of European public health innovations, to describe national public health research programmes, strategies and structures and to develop participation of researchers through the organizational structures of the European Public Health Association (EUPHA). This article describes the methods used. PHIRE was led by EUPHA with seven partner organisations over 30 months. It was conceived to engage the organisation of EUPHA--working through its thematic Sections, and through its national public health associations--and assess innovation and research across 30 European countries. Public health research was defined broadly as health research at population and organisational level. There were seven Work Packages (three covering coordination and four for technical aspects) led by partners and coordinated through management meetings. Seven EUPHA Sections identified eight innovations within the projects funded by the Public Health Programme of the European Commission Directorate for Health and Consumers. Country informants, identified through EUPHA thematic Sections, reported on national uptake of the innovations in eight public health projects supported by the European Union Public Health Programme. Four PHIRE partners, each taking a regional sector of Europe, worked with the public health associations and other informants to describe public health research programmes, calls and systems. A classification was created for the national public health research programmes and calls in 2010. The internal and external evaluations were supportive. PHIRE described public health innovations and research across Europe through national experts. More work is needed to conceptualize and define public health 'innovations' and to develop theories and methods for the assessment of their uptake and impacts at country and cross-country levels. More attention to methods to describe and assess national public health research programmes, strategies and structures--contributing to development of the European Research Area.

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

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

Impact of innovations in national public health markets in Europe

Social innovations can contribute to health and wellbeing. PHIRE (Public Health Innovation and Research in Europe) investigated the impacts at national level of innovation projects funded by the European Union Public Health Programme. Through the European Public Health Association, experts assessed the uptake of the eight public health projects, for 30 European countries. Their reports were assembled by country and, thereafter, national public health associations reviewed the reports. Following stakeholder workshops, or internal and external consultations, 11 national reports were produced which included discussion on the impacts of the public health innovations in national product markets. In 11 countries, there were reports on the eight innovations for 45 (51%) of the possible public health markets. The innovations contributed positively to policy, practice and research, across different levels and in different ways, in 35 (39%) market, while competing innovation activities were recorded in 10 (11%) markets. The workshops also discussed contributing factors and limitations in dissemination and timing for policy cycles. The impacts of European Union social innovations in public health markets can be identified through national discussions. Further attention should be given to understanding drivers and incentives for successful public health innovations.

Strategies for public health research in European Union countries

'Health' is an identifiable theme within the European Union multi-annual research programmes. Public Health Innovation and Research in Europe (PHIRE), led by the European Public Health Association, sought to identify public health research strategies in EU member states. Within PHIRE, national public health associations reviewed structures for health research, held stakeholder workshops and produced reports. This information, supplemented by further web searches, including using assisted translation, was analysed for national research strategies and health research strategies. All countries described general research strategies, outlining organizational and capacity objectives. Thematic fields, including health, are mentioned in some strategies. A health research strategy was identified for 15 EU countries and not for 12. Ministries of health led research strategies for nine countries. Public health research was identified in only three strategies. National research strategies did not refer to the European Union's health research programme. Public health research strategies of European countries need to be developed by ministries of health, working with the research community to achieve the European Research Area.

Competitive funding and structures for public health research in European countries: Table 1

The European Union is giving increasing emphasis to research as a driver for innovation and economic development. The European collaborative study PHIRE (Public Health Innovation and Research in Europe) investigated the funding and structures of public health research at national level in European countries. Background materials were prepared for national public health associations of European countries to hold workshops or discussions with research and policy stakeholders on their public health research systems. The reports, supplemented from internet sources for 23 EU countries (four did not contribute), provided information for framework analysis. All countries have public funding and administrative structures for research, but structures for public health research are more varied. In most countries, competitive health research funding is controlled by the Ministry of Science, with little input from the Ministry of Health. In four countries, Ministries of Health provide competitive funding alongside Ministries of Science, and in two countries there is a single health research council. There is no comparative reporting of public health research funding, and little connection with European public health research programmes. Europe needs a comprehensive picture of national and regional systems of public health research, in order to critically assess them and better adapt to changes and challenges, and to achieve a European Research Area for public health.