Public Health Research Articles

AI-Powered Post-Discharge Monitoring to Prevent Patients Readmissions and Reduce Workforce Burden

Abstract Background Patient readmission poses a significant burden on healthcare systems, straining resources, negatively impacting patient treatment, and it is often a Public Health problem. Traditional post-discharge follow-up methods, such as phone calls, often lack efficiency and personalization. Artificial intelligence (e.g., Machine Learning (ML)) offers a transformative approach that can potentially improve post-discharge care. Methods This scoping review aimed to map existing research on AI-powered solutions for post-discharge monitoring, focusing on their application in risk stratification and their potential for reducing hospital readmissions within a public health framework. Following PRISMA-ScR guidelines, a search was conducted across four databases using keywords related to AI, post-discharge, and risk stratification. Results Studies published between 2018 and January 2024 were included if they described the development and application of an ML model in a post-discharge setting for risk stratification. Sixteen studies met the inclusion criteria. Tree-based algorithms, particularly XGBoost, were the predominant ML approach, with promising performance metrics for readmission risk prediction. Conclusions However, limitations were identified, including restricted generalizability due to data source limitations and a lack of real-time implementation in many studies. This review highlights the potential of AI in post-discharge monitoring, particularly the use of ML for risk stratification, as a promising tool for public health contact tracing. While challenges remain regarding generalizability and real-world implementation, the findings suggest AI holds immense promise for improving post-discharge care, potentially reducing readmissions, and optimizing resource allocation. Future research with broader datasets and real-time applications can further solidify the role of AI in revolutionizing post-discharge care within public health systems. Key messages • This study shows the potential of AI and risk stratification in post-discharge monitoring, improving public health outcomes by reducing hospital readmissions and optimizing the healthcare workforce. • This review highlights the value of AI in public health, particularly for improving post-discharge care through effective prediction of high-risk readmissions.

Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy

Abstract Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity. Key messages • The EPHF framework as an innovative tool to strengthen public health in border regions. • Take the geographical living space of citizens in a border region into account to achieve health equity.

The Africa CDC Guidance for Strengthening NCDI-MH Surveillance Systems: The role of HIS assessments

Abstract Deaths due to NCDs, injuries and mental health conditions are expected to at least triple by 2063 in the region of the African Union. Population-based data for NCDI/MH and their determinants remain scarce in many AU MS; therefore, NCDI/MH surveillance is a flagship initiative in the Africa CDC NCDI/MH Strategy. In a survey conducted by Africa CDC and RKI in 2022 on the impact of COVID-19 on NCDI/MH in 10 AU MS, countries signaled the need for a continental guidance document. In 2023, Africa CDC and RKI performed desk reviews and facilitated peer-to-peer multi-country HIS assessment workshops, based on modified WHO and IANPHI tools. The first workshop took place in Zambia with experts from Botswana, Democratic Republic of Congo/DRC, Kenya and Zambia. The second workshop was hosted in Ghana and included DRC, Ghana, Morocco, Nigeria, Senegal and Sierra Leone. Participants came i.a. from ministries of health, national public health institutes or academia. The process included a virtual introductory meeting as well as half-day training sessions at the physical meeting for participants to familiarize themselves with the tools. Peer-to-peer assessment sessions took place on days 2 and 3. Day 4 was reserved for site visits to (public) health institutions of the hosting countries. On day 5, participants presented their findings to the plenary, which included high-level representations from host countries. The combined results from the survey, desk reviews and workshops informed the development of the continental Africa CDC Guidance for strengthening surveillance for NCDI/MH, launched at the 3rd Conference on Public Health in Africa. In four chapters, the Guidance covers recommendations on indicators, data sources and data types; surveillance system capacities; surveillance integration with existing systems; and data use. Implementation of the Guidance, including development of core health indicators, has been initiated by Africa CDC in 2024.

Application of artificial intelligence to study the causality in public health: a systematic review

Abstract Introduction In epidemiology, establishing causation requires meeting rigorous criteria beyond mere association. Traditional methodologies often struggle to provide definitive causal conclusions due to confounding variables. However, leveraging artificial Intelligence (AI) and machine Learning (ML) offers a promising solution by modeling complex interactions among relevant factors. This systematic review explores the AI techniques utilized to uncover causal relationships in public health applications. Methods A literature search was conducted in Pubmed, Web of Science, and Scopus, employing the following search strategy: (Causalit*[Title/abstract] OR Causation*[Title/abstract] OR Causal[Title/abstract]) AND (‘Machine Learning’[Title/abstract] OR “Deep Learning” [Title/abstract] OR ‘Artificial Intelligence’ [Title/abstract] OR Algorithm* [Title/abstract]). The search aimed to identify studies encompassing causal inference techniques utilizing ML and AI methodologies in public health. Results From a total of 28,230 articles published up to August 2023, after removing duplicates (11,158) and articles that did not meet the inclusion criteria (16,168 post title/abstract screening, and 856 post full-text screening), the systematic review included 48 articles. Bayesian additive regression trees, Bayesian network models, causal forests analysis, and graphical causal models emerged as the prevailing causal methodologies. AI-driven causal methodologies have been investigated across various domains within public health, encompassing disease prediction, evaluation of treatment efficacy, identification of risk factors, analysis of health behaviors, precision Public Health initiatives, and environmental health assessment. Discussion While our systematic review affirms the potential of AI-driven causal approaches across several public health domains, further research is warranted before these emerging techniques can be effectively integrated into real settings. Key messages • In epidemiology, establishing causation requires meeting rigorous criteria beyond mere association and traditional methodologies often struggle to provide definitive causal conclusions. • This systematic review explores the AI techniques utilized to uncover causal relationships in public health applications.

The corporate political activity of Portugal’s food industry: enhancing public health transparency

Abstract Background This study in Portugal aims to monitor the Corporate Political Activity (CPA) in the food industry. Portugal provides a compelling case study due to its robust implementation of public health policies. Methods A systematic qualitative approach proposed by Mialon et al., a part of the INFORMAS Module 3, was employed. This method is based on the analysis of publicly available information. Key industry actors were selected through expert consultation and market analysis using EuroMonitor data. Information sources included industry, government, and academic materials accessed via websites and news. A thematic qualitative analysis was conducted involving iterative steps: identifying CPA practices based on predefined strategies - Taxonomy of Action Strategies: access and influence policymaking, use the law to obstruct policies, manufacture public support, shape evidence, displace and usurp public health, and manage reputations -, recording methods in a database, and saving evidence. Data collection spanned October 2023 to April 2024, covering materials from 2022 to 2023. Results Twenty-five key players were identified, including processed food and non-alcoholic beverage manufacturers, fast food companies, food retailers, and national trade associations. Food retailers, notably Jerónimo Martins, Lidl, Mercadona, and Sonae, showcased a higher prevalence of CPA. Nestlé and Sumol+Compal also emerged as prominent actors. The food industry in Portugal employs diverse strategies and tactics primarily focused on shaping evidence and managing reputations. While instances of displacing public health priorities and manufacturing public support were observed, they were relatively fewer. Only APED and FIPA showed engagement in policymaking influence. Conclusions Vigilant monitoring of CPA in the food industry in Portugal reveals dominant tactics of shaping evidence and managing reputations. Understanding these strategies is vital for policymaking to safeguard public health. Key messages • The food industry in Portugal employs diverse strategies, primarily shaping evidence and managing reputations, to influence public health policies. • Monitoring the Corporate Political Activity is key to preserving the integrity of public health policymaking in Portugal’s food industry.

Fairer Training in public health, the UK FPH example

Abstract Background Public Health (PH) advocates for health equity and social justice. The UK Faculty of Public Health (FPH) is committed to tackling inequalities across the public health career pathway. The Fair Training project is a multi-phased programme which focuses on fair recruitment into PH, reducing differential attainment during PH training and postgraduate examinations. Objectives • Analyse available data from various sources; • Identify gaps in fair training culture and any biases; • Identify where support or interventions may best be focussed to minimise disadvantages; • Identify improvements in data that could be used to monitor actions; • Identify areas of good practice. Variables explored were demographic characteristics e,g, age, sex, ethnicity, disability status, professional background, candidate status (UK or overseas), place of primary qualification. Results Results show that candidates from ethnic minority backgrounds, those who are older, from international medical graduate backgrounds and backgrounds other than medicine are under-represented at the end of recruitment. Multivariable analysis of the diplomate exam shows that an attainment gap exists across increase with age, and those from black, Asian or white other ethnicity, professional background other than medicine, and overseas candidates. For the membership exam, multivariable analysis shows the attainment gap persists across those of increasing age and black ethnicity. Conclusions Recognising differential attainment as a structural problem requires organisational and individual leadership. Recommendations include an action plan to ensure: • Equality of opportunity for learning and career progression; • Collaborative working to eliminate discrimination in the design of education; • Ensure that training and the working environment are inclusive and diverse; • Inform future PH workforce planning; • Share good practice. FPH will implement the recommendations and share with other organisations and countries. Key messages • Structural causes of differential attainment during recruitment and training in public health do exist and should be mitigated. • FPH aims to promote Fair Training and excellence in public health practice.

A cross-sectional study of data linkage and artificial intelligence practices across European countries

Abstract Background The availability of different data sources is increasing with the possibility to link them with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the use of data linkage and artificial intelligence (AI) in routine public health activities and the constraints to linking different data sources. Methods A cross-sectional survey was performed across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI). Results In Europe, the use of data linkage and AI at national institutes of public health, health information and statistics varies. The use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes is common in majority of European countries. The use of AI to estimate health indicators is not frequent among these institutes. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as main constraints to routine data linkage for public health surveillance and research. Conclusions Our study showed that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system allowing to link different data sources are essential to contribute to public health research. Moreover, it supports evidence-informed health policy making processes with an overview of various aspects affecting population health and may contribute to European pandemic preparedness.

Gender and Education Differences in Mental Health in Belgium: a Bayesian Age-Period-Cohort Analysis

Abstract Background Mental illnesses (MI) constitute a growing public health problem, with reports of a higher prevalence among middle-aged adults (age effect), during specific periods such as economic crisis (period effect) and in recent birth cohorts (cohort effect). However, few studies have assessed whether these age-period-cohort (APC) effects were related to general population trends or if they are driven by changes in the mental health status of more vulnerable groups. Therefore, this study aimed to assess gender and educational differences underlying observed APC effects in the prevalence of MI in the Belgian adult population. Methods This study used data from six cross-sectional waves of the Belgian Health Interview Survey (1997-2018, ∼ 10,000 respondents per wave). Mental health was assessed using the 12-item General Health Questionnaire. Bayesian hierarchical APC models were applied on the prevalence of MI, taking into account gender and educational differences, as well as some potential confounding factors. Results Overall, this study confirmed the higher prevalence of MI in middle-aged adult, in 2013, and in more recent birth cohorts (1980-2000). Accounting for the interaction between gender and education, we found that the MI educational gradient was more pronounced for women than men. Finally, we found that APC trends were different between gender. The odds of having MI tended to be stable across age groups for women, while men showed an increased odds between 50-60 years and a decrease between 60-65 years. Regarding period and cohort effects, the increase odds in 2013 was mainly present in men, while the increase in recent birth cohorts was mainly present in women. Conclusions This study emphasizes that the age-period-cohort effects on mental health are different depending on gender and education, thus enriching our understanding on the underlying mechanisms to better guide future public (mental) health policies. Key messages • This study shows the importance of studying not only the overall trends in mental illness, but also the underlying differences in its distribution. • Insights into gender and educational differences in Age-Period-Cohort effects on mental health is crucial for the development of timely and efficient public health interventions.

‘Positive disruption’: catalysing system-wide work on health inequalities through embedded research

Abstract Background This presentation explores embedded research as an innovative model for bridging system-level knowledge to action gaps in public health. Embedded researchers (ERers) are university-employed researchers co-located in public health organisations, who work to boost capacity in these organisations to tackle inequalities by better use of evidence in decision-making, evaluation and service improvement Methods Drawing on the initial phase of the role and wider literature, we qualitatively reflect on strengths and limits of a system-level ERer model. Most ERer evidence draws on a one-to-one organisational model. This presentation explores a different model of an ERer embedded in and working across a public health system (health services, municipality, third sector) in a large city in north England Results Our focus is on catalytic features of the ERer role (1) positionality: being embedded at system-level gives fuller understanding of inter-organisational connections and of the implications of emergent system changes; (2) convening: bringing together partners improves mutual awareness and builds interest in collectively pursuing research aligned to identified population health needs and public health priorities in the city; (3) co-production to build capacity: working with a new cross-organisational partnership to collectively address issues constraining opportunities to pursue system-level research; working with the municipality to explore the production/use of research to inform decisions on approaches towards health inequalities. This includes work on links between public health and other functions focused on social determinants of health Conclusions This presentation outlines distinctive consequences of system-level embedded research in a city-wide public health system. It critically appraises the transferability of this model of knowledge production and mobilisation at the intersection of system and cross-organisational action on health inequalities. Key messages • System-level embedded research is an innovative model for helping to bridge system-level knowledge to action gaps in public health. • The model has catalytic benefits and transferability potential, although this needs to be considered in relation to the specific context for proposed system-level embedded research.

5.I. Scientific session: Epidemiological insights into vaccine hesitancy in Europe: building bridges and overcoming barriers

Abstract Vaccine hesitancy remains a pivotal challenge in public health, undermining immunization efforts and the containment of infectious diseases across Europe. This scientific session aims to dissect the complex nature of vaccine hesitancy, uncovering epidemiological trends and barriers to vaccine acceptance, particularly in diverse demographic contexts. The objective is to facilitate a comprehensive understanding among public health stakeholders and to foster actionable strategies through enriched dialogue and interaction. This session will delve into recent studies and projects that highlight the variability of vaccine hesitancy within Europe. First, an exploration of COVID-19 vaccine acceptance will reveal how sociodemographic factors influence vaccine-related behaviors across 20 European nations. This will be complemented by an analysis of targeted interventions designed to enhance vaccine uptake among migrant populations, drawing lessons from the RIVER-EU project. Additionally, a focus on national efforts to combat measles vaccine hesitancy will provide a case study on the challenges and successes in altering public health narratives. Based on the feedback received on last year’s session, the format is intended not only to provide a platform to present empirical evidence and insights but also to encourage a participatory environment where attendees can exchange ideas and propose innovative solutions. For this reason, the session will engage the audience through an interactive discussion period at the end of each of the three presentations, stimulating thought-provoking dialogues that could lead to effective and innovative public health practices. Fostering international and interdisciplinary collaboration in the field of vaccine hesitancy is key for continued monitoring and reporting on the vaccine hesitancy phenomenon and inspiring actionable solutions. Key messages • Sociodemographic factors are associated with vaccine hesitancy across Europe indicating the potential for targeted strategies. • A platform to share insights and inspire actionable public health solutions to combat vaccine hesitancy amomg European public health professionals is needed.

10.Q. Scientific session: Evolving landscape of scientific publishing practices: implications for public health

Abstract In the landscape of scientific publishing, questionable research practices pose significant threats to the integrity and reliability of health research. This is occurring alongside notable changes in both the quantity and quality of published work. This scientific session aims to dissect the implications of such changes and practices on public health, fostering a critical examination and encouraging proactive discourse among public health professionals, researchers, and policymakers. Meta-research can explore the nuances of publishing ethics and the idea behind this session is seeking to heighten awareness of these issues and initiate meaningful discussions among public health professionals on maintaining the integrity of scientific literature in the health domain. The session will delve into the complexities of contemporary publishing, including the proliferation of mega-journals, trends in retracted papers, journals delisted from scientific databases, and the disturbing trend of paper mills which produce fraudulent research papers. Each aspect will be scrutinized for its potential impact on the credibility of health research and the consequential risks to public health. Structured as an interactive panel discussion, the format of this session is designed to maximize engagement and foster an open exchange of ideas. Participants will be encouraged to contribute their experiences and perspectives after each of the three presentations, enriching the dialogue and enhancing collective understanding. The distinct topics presented will underscore the pervasive nature of publishing practices and malpractices across different aspects of health research, highlighting the interconnectedness of ethical challenges and their broader implications. This session will merge meta-research empirical evidence with practical repercussions, offering attendees a comprehensive perspective on how publishing ethics might be shaping public health outcomes. It aims to equip participants with the knowledge to identify dubious practices and advocate for higher standards in scientific publishing. Improving research integrity is a cornerstone for effective health policies and interventions. The subject matter is poised to stimulate debate, invite scrutiny, and inspire action. Through this discourse, the session will articulate key messages about the urgency of upholding ethical standards in publishing to safeguard health research, providing clear, actionable insights for attendees to implement in their respective fields Key messages • Unethical publishing practices endanger health research integrity and might have consequences for public health outcomes. • Acknowledging good publishing practices and combating malpractices will foster higher ethical standards in health research.

A Multi-Modal Approach for A Healthier Weight and More Active Lifestyle

Abstract Background Obesity and overweight has been increasing globally and in the UK over the last few years, bringing along a wide array of challenges in health and wellbeing. Not only do they take a heavy toll on those affected, but obesity and overweight-related ill-health is costing the UK National Health Service £6.1 with projected costs to run up to £9.7 billion in 2050. This project aimed to apply artificial intelligence to identify the predictive indicators for obesity and co-create an intervention with public health practitioners and stakeholders. Methods Using health and wellbeing public health population data from the 2015, 2018 and 2022 from a city in the East Midlands, we applied artificial intelligence that uses machine learning techniques to discover insights, find hidden patterns and discover relationships in the data about engaging in physical activity and a healthy diet. The data on dietary choices and physical activity preferences were further analysed using advanced machine learning techniques. Results The outcomes from our machine learning process revealed patterns of physical activity engagement and diet from specific locations, along with a range of demographic variables that influence individuals’ patterns of physical ability and dietary practices. These findings, which will be presented in detail, have been integrated into a comprehensive city map. This map not only showcases opportunities for engaging in a healthy lifestyle but also aids in prioritising interventions in areas of greatest need. Conclusions The AI technology we employed allowed us to parameterise and generalise our findings with the possibility of scaling up the machine learning approach to other similar datasets. The findings facilitated the development of bespoke training for public health officers working with underserved communities, further demonstrating the impact of applying AI to inform the design of public health interventions. Key messages • Applying Artificial Intelligence to public health data has the potential to inform the development of effective interventions and increase precision. • Using AI in public health data can generate new insights into population health and well-being and inform public health policy.

10.A. Round table: Transforming public health systems at large scale: no pain, no gain

Abstract The COVID-19 pandemic, acceleration of climate change, and geopolitical turmoil have triggered discussions about how public health systems in Europe need to transform to be adequately equipped for the so-called “permacrisis”. The challenges to policy makers, health institutions and health services have become so multifaceted, that single solutions from the health sector alone no longer work. Yet, despite the complexity, countries seek to get its own house in order whilst building on inter-sectoral and European approaches in parallel. Germany, Ireland, and Ukraine have all embarked upon ambitious public health services and institutional reforms, leading to transformative change in public health systems. WHO has been accompanying these reforms. The workshop will provide a platform to draw insights and lessons on transforming public health systems from all three countries, although their population size, their socioeconomic and political situation and their public health system design is so different. As the smallest of the three countries in population, Ireland created coherence and is aligning public health actors within “Healthy Ireland” and the Sláintecaire and the Crowe Horwath public health reforms. Germany’s “Pact for the Public Health Services” has been one of the greatest public health investment programs in Europe that was initiated following lessons from the COVID-19 pandemic. And Ukraine has undertaken important legal steps to adopt a Public Health System Law, in the middle of a war of aggression on its territory. The workshop will exhibit the process of large-scale public health system transformation in each of the three countries. The purpose is to identify the enablers that make large scale system transformation possible and addressing some of the pains and gains. The workshop will have three parts. Part one consists of three presentations on large scale system reforms from each of the participating countries. Part two consists of a moderated Q&A session. Part three will focus on the synthesis of enablers for large scale public health system reforms through interaction with the workshop participants, using a digital white board. Key messages • Disruptive times can create enabling conditions for large scale public health system transformation. • Designing and implementing large scale public health system reforms is complex, requiring passion, resilience, and collaborative leadership.

Concept of a medical and public health cancer genomics platform

Abstract Background This study aims to produce the concept of an open-access medical and public health cancer genomics platform aimed at aggregating and sharing documentation of ongoing initiatives and data resulting from the CAN.HEAL project, available for EU researchers, healthcare professionals, policy makers, citizens and patients. Methods The context (reference sector, stakeholders and research evidences), feasibility (privacy management and data processing), and platform’s end users were analysed; the CAN.HEAL project deliverables were listed and clustered; aspects related to the definition of the overall platform architecture and modules integration were studied. Results The project deliverables were catalogued into 8 categories which could be the platform’s cloud interface main labels: results from events, policy papers, newsletters, mapping results and reports, datasets, recommendations and guidelines, use cases, courses and training activities. To define the overall system architecture, the following key activities should be implemented: content management system choice, hosting configuration and setup of the development domain, content management system installation, development of HTML web pages, data entry, data visualisation and graphic layout, and test and debug. To the modules integration purposes the following items should be addressed: creation of a server analytics account; social network integration; activation of additional system for sending newsletters. Conclusions Cloud-based data platform allows to securely manage, integrate, analyse and share large datasets. Establishing an infrastructure to help researchers access, store and analyse large amounts of biological data is of paramount importance both to enable advances in research and support health policy making processes. The CAN.HEAL platform could help aligning clinical and population-based interventions for integrating the genome of Europe biobanking initiative into public health genomics for cancer. Key messages • Connecting healthcare data can support the challenge of accessing the relevant information needed for the policy and decision making processes to effectively promote population health and wellbeing. • The set-up of a medical and public health cancer genomics platform promotes the effective translation of genome-based knowledge and technologies into public policy and health services.

Environmental Public Health Tracking in England- support for Health Impact Assessments

Abstract Environmental epidemiology is a key function for the public health service with regards to investigating the public health effects of environmental hazards, monitoring the public health efforts to control the environmental risks, and providing the evidence that informs decisions making and preparedness. At the United Kingdom Health Security Agency (UKHSA), the Environmental Public Health Tracking (EPHT) Programme, initiated in 2010, has developed a number of data streams to help link environment and health data, to support Health Impact Assessment (HIA). The main aims of the EPHT programme in England are to: 1. Identify populations at risk from exposure to significant environmental and chemical hazards 2. Investigate relationships between hazard and disease 3. Inform public health policy making 4. Optimise intervention and prevention strategies 5. Generate hypotheses for further research. Such EPHT functions are based on three key components: a) by building a national EPHT program that integrates surveillance of environmental hazards, exposures and related health outcomes, to allow data linkage and assessment of environmental and health information; b) strengthening the epidemiology science, by conducting research and training of the workforce and c) developing strategies for response to immediate risks, incidents and preparing for future risks. Examples to support HIA include a) developing an air pollution exposure surveillance work programme, that has designed a pilot population vulnerability indicator; b) developing indicators for climate change impacts for public health, c) reporting regularly on the health impacts of public fluoridation water supply schemes (as mandated by Government) and d) exploring risk factors associated with elevated blood lead concentration in children, through laboratory reporting to surveillance systems. The talk will highlight some examples of practice and outline how the EPHT programme in England has supported HIA practices.

Correlates of using behavioural sciences to design health promotion interventions and programs

Abstract Background The World Health Organization highlighted the need to better integrate behavioural science in the field of public health. Based on the theoretical domains framework, this study examined correlates of public health practitioners’ use of behavioural science principles to plan public health actions aim at promoting physical activity and healthy eating. Methods This study adopted a cross-sectional design. A convenience sample of 160 public health practitioners were recruited from different public health agencies (non-profit organizations, governmental and para-governmental agencies). They were asked to complete a survey questionnaire online and self-reported their use of behavioural science to plan health promotion interventions. Regression analyses were conducted to examine correlates of behaviour and behavioural intentions. All analyses were controlled for sex, number of years of experience in public health and the type of organization they work for. Results Skills (OR = 4.1, 95%CI: 1.3, 13.5) and intentions/goals (OR = 9.2, 95%CI: 2.3, 36.1) were the two domains significantly associated with the use of behavioural science. Perceived capacity to overcome the fact that none of their colleagues rely on behavioural sciences in their organization (OR = 7.2, 95%CI: 1.7, 30.3) was also associated with behaviour. Knowledge (OR = 8.6, 95%CI: 1.9, 39.1) and beliefs about consequences (OR = 4.0, 95%CI: 1.1, 14.7) were in turn associated with intentions/goals. Conclusions This unique study provides important insights for the development of future knowledge transfer activities aim at supporting positive attitudes and motivations toward the use of behavioural science as well as developing competencies and a normative use of behavioural science. The development of a strong knowledge basis would also need to be a core component of trainings to support the integration of behavioural science in public health to design physical active lifestyles and healthy eating interventions. Key messages • Increasing knowledge and skills in behavioural sciences is a key for a better integration in public health practices. • Changes in norms and attitudes toward the use of behavioural sciences will also support a better uptake.

Bridging the gap: mapping co-creation methods for public health impact and innovation

Abstract Background Co-creation offers a promising approach to public health innovation, particularly for tackling complex issues. However, the lack of a standardized methodology limits its reliability and reproducibility, especially across diverse contexts. This study explores co-creation methods used by researchers and practitioners, aiming to shed light on their implications for public health. Understanding this methodological landscape can enhance the effective implementation of co-creation processes to address complex challenges. Methods Utilizing the Systematic Methods Overview approach, we examined co-creation methods. Data were gathered from the Health CASCADE Co-Creation Database and grey literature using an artificial intelligence-assisted recursive search strategy and a two-step screening process. We conducted textual, comparative, and bibliometric analyses to evaluate methodological underpinnings and relationships between methods. Results Analysis of 2,627 academic articles and grey literature sources identified over 900 co-creation methods. While surveys, focus groups, and group discussions were prevalent, participatory methods were underutilized. Notably, 91.3% of methods co-occurred, with a predominant combination of qualitative approaches. Furthermore, a significant discrepancy between research and practice was evident, with only 10.2% convergence. Conclusions This study revealed a critical gap between co-creation in research and practice, emphasizing the need to bridge this methodological divide for advancing co-creation as a reliable approach in public health. The over-reliance on qualitative methods raises concerns about tokenistic engagement and undermines meaningful public participation in co-creation. Addressing this trend is vital to preserve the essence of true co-creation and maximize its potential for addressing complex public health challenges. Key messages • Mapping the diverse methods of co-creation in public health reveals both richness and disparities in approach, from surveys to participatory methods. • Addressing the discrepancy between co-creation in research and practice is vital for establishing a reliable and effective approach to tackling public health challenges.

Formalizing the role of community key individuals in Utrecht, the Netherlands

Abstract Issue The disconnect between (underserved) communities and governmental bodies in Utrecht, The Netherlands, has led to uneven access to (essential) healthcare services, increasing health inequalities. This gap is often bridged by key community individuals, whose roles have historically been informal. Key individuals are often seen as volunteers who are necessary to gain access to certain communities but are rarely seen as equals in a project team, resulting in mistrust and reduced collaboration on the long term on the side of the key individuals. Description of the problem This practice describes the start of a new foundation in Utrecht that formalizes and compensates key individuals’ roles in public (health) projects. The aim was to empower them and to encourage continued participation. Effects In 2024, the foundation supported key individuals in three government projects, including a childhood vaccination awareness campaign. Interviews revealed that key individuals felt more empowered and equally valued compared to other project members. They also felt a strong responsibility for project success. However, some noted that formal structures could be restrictive. The government felt more convenience working with a formal foundation. Lessons Empowering key individuals is crucial for effective collaboration in public health. There needs to be a balance between formal structures and the flexibility of informal approaches to prevent barriers for key individuals to participate in government projects. Key messages • Formalizing key individual roles enhances public health interventions. • Fair compensation to key individuals fosters sustainable collaboration.

Public health and broader economic benefit of treating autoimmune and respiratory diseases in Greece

Abstract Background The increasing prevalence and incidence of autoimmune and respiratory diseases is a leading public health concern. This study aims to quantify the public health and broader economic gains from treating autoimmune and respiratory diseases in Greece. Methods A decision-analytic model was constructed evaluating the socioeconomic and fiscal gains of established standard of care treatments against 4 autoimmune disorders namely, rheumatoid arthritis, psoriatic arthritis, psoriasis, ankylosing spondylitis and against the respiratory diseases of asthma, and COPD. Morbidity reductions from treatment were translated into averted loss of income and absenteeism and averted tax revenue loss and prevented disability pensions. Targeted literature reviews were conducted to obtain the effectiveness of treatments on productivity-related outcomes. Economic data were obtained from official sources. Results Treating 1,000 patients for the autoimmune and respiratory conditions is estimated to generate annual gains of 196.3 productive life years (PLYs), to avert 48,547 absenteeism days and to prevent 1.2 disabilities. The annual socioeconomic and fiscal gains of treatments against autoimmune disorders are estimated at €6.5 million and €1.3 million, respectively. Preventing asthma and COPD-related morbidity, among 1,000 patients, is estimated to yield annual socioeconomic gains of €1.2 million and fiscal gains of €0.4 million. Conclusions Effective treatment of autoimmune and respiratory diseases may generate substantial public health, socioeconomic and fiscal gains, simultaneously promoting population’s health and the sustainability of the healthcare system. Key messages • It is the first study carried out in Greece aimed to assess the positive impact on public health and the broader economic value of treating autoimmune and respiratory diseases. • Therapeutic value of pharmacological interventions transcends the potential benefits to patients and public health.

Public Health In Conflict And War: A Response To An Ever Evolving Landscape

Abstract Background The bases for this proposal are the current and ongoing conflict and war situations around the world, causing turmoil for nations and hardship and public health crises for people. We can no longer ignore the critical and time-sensitive need to address issues of Public Health (PH) in conflict and war in our education and training programmes. Objectives To consider appropriate themes and topics in Conflict and War that should be included in PH education and training programmes; and to consider how and where they are best represented. Member schools of the Association of Schools of PH in the European Region (ASPHER) were asked to provide details of their curricula relating PH in Conflict and War. Submissions on this topic were received from over 10 schools. Information was collated into logical themes, to which elements of the curriculum were mapped. In a modified Delphi process, respondents were asked for their level of agreement for inclusion in a curriculum and at what level content should be delivered. Results Findings from the survey allowed identification of seven main themes from topics provided: Contextual Factors; Preventive Strategies; Emergency Preparedness; Impact and Response; Conflict Resolution and Solidarity, Rehabilitation and Recovery. Respondents had high levels of agreement that content should be included in curricula and be delivered at every level in PH education and training. Conclusions PH education and training have been deficient in not including PH in Conflict and War as a subject area in programmes. The knowledge and expertise developed of necessity in some places can be shared across the ASPHER network and beyond to increase awareness of the PH considerations of conflict and war. Key messages • Public health in war and conflict zones is critical due to unique challenges and urgent needs of affected populations. • An Integrated curriculum is vital for addressing conflict’s long-term health impact and preparing skilled workforce for health, resilience, action and laying the path to peace.