Health System Research Articles

Life course prevention - challenges for public health lying ahead

Abstract Issue/problem Demographic and epidemiological transitions have now shifted the focus from vulnerable population groups onto the active population, in particular young adults. At the same time lessons from the covid-19 pandemic taught us about missing actions on the elderly. While the latter have shown compliance and have followed most preventative activities, we observe scepticism and reluctance in the young adults. Description of the problem The covid-19 pandemic showed that young to middle-aged adults were the most reluctant group to adhere to preventative measures but in complying to the recommendations concerning vaccination. Since European activities are now focusing on addressing determinants of NCDs and are hoping to mobilise all population strata, including young and middle-aged adults, it would be important to explore how this mindset might affect the overall attitude to prevention. Results Health policy should explore specifically the needs of young to middle-aged adults (e.g. ages 30 to 44) to list their specific needs, expectations from preventative activities. On the other hand, it would be necessary to find out about the concerns, reluctance, and objections. The interplay of these will play a significant role in acceptance of present and future preventative activities. Exploration on these topics presents the following challenges: 1. Multiple sources of information on given health problems; 2. Lack of structured accessible and well-understandable explanations of advantages and benefits; 3. Inappropriate communication by health professionals or agencies on their behalf; 4. Complexity of the problem, which is then translated into complex and not easily understood messages. Lessons Learning about the specific needs of young adults, their expectations from the health systems in terms of prevention and health care as these will shape their overall attitude to prevention and have an impact on their families, particularly children. Key messages • Knowledge about expectations, needs, concerns, and reserves with respect to prevention is essential for the future activities on prevention. • Involving young and middle-aged adults in the preparation of the future preventative activities for their population groups is essential.

A source and a destination country for migrant healthcare workers: the case of Ireland

Abstract Background Ireland has a long tradition of emigration, particularly to countries such as the United Kingdom and the USA. Since 2000, Ireland has become increasingly reliant upon migrant healthcare workers. At present, 43% of nurses and 45% of physicians registered in Ireland, trained internationally. Methods This study draws on literature and available data (migration and registration data) to illustrate recent patterns of healthcare worker migration into and out of Ireland. Results The data show that Ireland depends heavily on migrant healthcare workers to staff its health system. In 2021-22, internationally trained healthcare workers comprised 71% of new entrants to the medical register and 69% of new entrants to the nursing register. In terms of outward migration, the data also indicate a consistent pattern of outward migration of physicians to countries such as Australia, the United Kingdom, Canada, and New Zealand. Conclusions A heavy (and growing) reliance on migrant healthcare workers to staff the Irish health system implies a failure to train or retain sufficient healthcare workers locally and indicates weak healthcare workforce planning capacity. It also highlights a disconnect between Irish healthcare workforce planning and the WHO global code on the international recruitment of health personnel. This study will consider some of the risks associated with high rates of inward and outward healthcare worker migration in the Irish context.

Study on access to social protection policies by homeless people during the COVID-19 pandemic

Abstract The study analyzed the access of homeless people (HP) to health and social protection policies, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of the state of Minas Gerais, Brazil. Its main objective was to provide data on the profile of HP in the municipality, in addition to evaluating existing public policies focused on HP, based on the time frame of the health emergency. Study with mixed methods design with triangulation of quantitative and qualitative data. It used official databases in parallel with document analysis, interviews and focus groups. As a result, the cartography showed that in the first months of the pandemic the municipality had difficulty reorganizing the health system, which underwent constant protocol updates, consolidating, however, over the months. Important emergency interventions in the municipality of BH involved activities that facilitated HP’s access to the provision of services, including intersectorality between health services, social assistance and the third sector. The temporary offer of various intersectoral services, simultaneously with the offer of daytime shelters by organized civil society, was considered a key factor for the expansion and intensification of care networks for HP during the emergency phase. Itinerant services were among those with the greatest positive evidence of service to HP, with emphasis on the ‘Consultório na Rua’. The study concluded that understanding the profile of homeless people in BH and the intersectoral variables that impact HP contributes to better directing investments in interventions for these individuals and increasing the effectiveness of health and social protection systems, in line with with the work carried out by the third sector. Key messages • Understanding the inter-sector variables that impact Homeless People contributes to better targeting of investments in interventions in protection social. • Knowing the profile of the homeless population makes it possible to organize more effective health care and social assistance.

Territorial health inequalities in breast cancer mortality across France from 1968 to 2017

Abstract Background Territorial health inequalities are of growing concern in countries with universal health systems. From 2003, three successive national cancer plans were launched in France, aiming to improve prevention and treatment. Regions in France are responsible for strategic and financial management of healthcare within their boundaries, which, until 2016, included up to 8 departments. In this study, we analyze the evolution of between and within-region territorial inequalities in breast cancer mortality over 50 years. Methods We used direct and indirect standardization to analyze trends in breast cancer mortality for women aged 25 to 74 years between 1968 and 2017 in each department of metropolitan France. We analyzed the evolution of relative inequalities over time using standard errors of age-adjusted rates. We used multilevel Poisson regression to estimate how much the regional level contributed to territorial variation. Results Over the period 1968 to 1992, breast cancer standardized mortality ratios (SMRs) increased (+16%) while relative territorial inequalities decreased (-21%). After 1997, SMRs decreased (-23%) but territorial inequalities remained unchanged. In 18 out of 22 regions, inequalities were lower at the end than at the start of the study period. Period proved to be the most important determinant of variation in mortality. However, multilevel models also suggested that the regional level explained most of the remaining variation in each period (from 50% to over 80%). Conclusions Over the study period in most French regions, breast cancer mortality has decreased, and so have relative inequalities. Nevertheless, there is evidence that regions have performed differently. The proportion of variation explained by the regional level suggests the continued relevance of the health system on breast cancer mortality. Key messages • Territorial inequality in breast cancer mortality has decreased in France over the 1968-2017 period. • In most regions, disparities between departments have decreased.

The NHS London Legacy and Health Equity Partnership: Evaluation of an equity lens framework

Abstract Background Disparities in COVID-19 vaccination uptake emphasised stark inequalities linked to ethnicity and deprivation, highlighting lack of trust and access barriers. London health leaders committed to create a community-centred legacy through the development of the NHS Legacy and Health Equity Partnership (LHEP); A novel 2-year programme aiming to close the equity gap in vaccinations, screening and access to health, focused on underserved communities, delivered in collaboration with London partners and communities. LHEP focused on 12 unique programmes with a key role of system leadership. Outputs included 15 reports, 6 conference presentations, 7 academic publications, 6 community workshops and 5 toolkits including development of an overarching LHEP framework aiming for long-term legacy. Methods An evaluation was designed to assess the benefits and limitations of the programme and framework through 16 semi-structured interviews and 5 focus groups delivered with key stakeholders. Ethical approval was obtained from the UKHSA Research Ethics Group. Data was coded inductively and drawn into themes. Results LHEP was said to add value through a) a dedicated team championing health equity and visible focus of leadership within the equity space b) fostering community engagement enabling dialogue between health systems and communities c) advocating co-production, building trust, focusing on communities in vulnerable circumstances d) programme innovation and agility d) drawing from COVID-19 lessons and disseminating learning. Interviewees stressed a legacy beyond vaccinations, establishing London as a blueprint for others. Conclusions Lessons were drawn into the ‘LHEP Approach for Health Equity’, a concise framework to guide partners to embed health equity, gathering 4 key tenets to ensure ‘no community is left behind’; data, evidence and learning; commitment from leaders and strong partnerships, allow for innovation and consider sustainability and communities at the centre. Key messages • Legacy and Health Equity Partnership is a 2-year multistakeholder programme aiming to tackle inequalities for the diverse communities of London that built evidence and led system change. • Evaluation stressed the impact of establishing London as a blueprint to follow and a framework to guide and support partners striving for health equity.

Governance and health system reform: a case study of new health regions in Ireland, 2018-2023

Abstract Background While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation. Methods The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis. Results Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed. Key messages • Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives. • Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.

Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer. Methods Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective. Results 20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences. Conclusions Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services. Key messages • Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services. • Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.

Preparing for outbreaks of vaccine preventable diseases: why are prisons invisible?

Abstract From 1 March 2023 to 29 February 2024, 30 EU/EEA Member States reported a total of 5 770 cases of measles, 4 864 (84.3%) of which were laboratory-confirmed. Th7e highest number of cases were reported by Romania- at the time of writing, 11,397 confirmed cases, including 12 deaths from 1 January 2023 to 7 April 2024. Measles is a highly infectious disease. The best mitigation is vaccination which is highly effective. Outbreaks in many countries have been driven by decreases in vaccine coverage with a two-dose measles-containing vaccine (MCV), especially evident since the COVID-19 pandemic. In many countries, vulnerable migrant populations, ethnic groups and communities experiencing social deprivation have been over-represented in cases and under-covered by vaccine programmes. We know that prisons contain such populations. Historic seroprevalence studies of prison populations, which themselves are scant, show that prison populations are under-vaccinated. Prisons are a setting that can cause disease amplification. Given these facts, it is perhaps surprising that many countries in Europe cannot provide specific surveillance data on either cases in prisons or vaccine coverage specifically in prison populations. Further, that prisons are not often cited as specific settings for vaccine catch-up programmes in national or regional programmes. This is despite evidence of measles cases and outbreaks historically and currently in several European countries. In the presentation we will ask why this ‘blind spot’ in national and international disease surveillance continues and what Member States could and should do to prevent the risk of mass outbreaks of measles in prisons, causing pressures on justice and health systems and risking wider community outbreaks. Finally, we will reflect on how this experience should alert us to the risk of other infectious diseases going undetected, unprevented, and under-studies in prisons, threatening our collective health security.

Eco-friendly treatment: a win-win for patients, health systems, and the planet. Rapid scoping review

Abstract Background As the fifth-largest CO2 emitter globally, the healthcare industry must act to mitigate its environmental impact. This includes de-implementing low-value care and adopting eco-friendly innovative treatment alternatives. Our study aims to explore existing research on the environmental effects of these actions and the outcome measures utilized. Methods We conducted a rapid scoping review following a pre-published protocol, searching Ovid MEDLINE® and Scopus (Elsevier) from January 2015 to June 19, 2023. Initially, dual abstract and full-text screening was performed, followed by a single review. Data extraction was cross-checked by a second reviewer. Findings were narratively described using summary statistics. Results We analyzed 182 articles, primarily life cycle assessments and modeling studies (92 out of 182), with only one study being a randomized controlled trial. The research covered various healthcare practices, including consultation methods/telemedicine (32%), surgical and medical device usage (26%), medication (25%), surgical procedures (19%), as well as diagnostic tests, screening, and imaging (13%). The main sustainability strategies mentioned were ‘Rethink’ (99%) and ‘Reduce’ (81%), with ‘Reuse’ (32%), ‘Recycle’ (19%), and ‘Refuse’ (10%) being less utilized. Environmental outcomes reported included global warming (88%), resource consumption (27%), and chemical hazards (23%). Most studies were conducted in Europe (48%), followed by the USA (37%), with 75% published after 2020. Conclusions The environmental impact of healthcare is a pivotal area for public health action and fortunately, it is also emerging as a significant research field. Utilizing methodological approaches less common in evidence-based healthcare research underscores the necessity for innovative interdisciplinary collaboration and capacity building. The most pressing research gap lies in the impact of de-implementation strategies (“refuse”) targeting low-value care practices. Key messages • Measuring the environmental impact of healthcare demands the development of novel cross-disciplinary research methods and collaborations. • De-implementing low-value care represents a future win-win scenario for patients, the financial viability of healthcare systems, and global environmental sustainability.

Climate change adaptation measures in the context of health promotion using participatory foresight

Abstract Issue/problem Climate change is regarded as a big threat to human health (WHO 2023), requiring action to prepare our health systems. Using participatory foresight approach has the potential to increase capacities of communities and to sustain future health. The process is easily transferable to other regions or countries across Europe. The work is part of the Austrian “Climate-Resilience-Check Health for regions and municipalities”. Description of the problem We present an innovative qualitative method to contribute to a climate change and health vulnerability and adaptation assessment following WHO’s guidelines. Questions answered by the project were: • What measures can be taken to shape the regions’ potential for a health-promoting lifestyle and to increase climate resilience? • Does participatory foresight represent a well-suited method to develop climate adaptation measures which address local needs? Taking place between 10/23 to 12/23, the participatory foresight process consisted of (1) a foresight-workshop facilitating development of adaptation measures through the creation of personas and (2) intervention boards, which gave the broader population the opportunity to vote for measures developed in the workshop. The aim of the approach was to identify measures that receive approval within the population. Results The participatory foresight process highlighted the local populations’ wish of revitalizing village centers to strengthen social cohesion. Particular emphasis was placed on the establishment of a community center and the expansion of daycare services. Lessons The process will be conducted in further regions as part of the Climate-Resilience-Check Health for Austrian regions and provides lessons of good practice for roll-out across European countries aiming to bridge efforts for climate adaptation and health promotion at regional levels.

Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023

Abstract Issue Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services). Problem Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area. Results In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported. Lessons Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions. Key messages • Mass gathering s events put under stress all the main areas of public health system. • Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.

Defining medical deserts—an international consensus-building exercise

Abstract Background Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe. Methods We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email. Results The agreed definition highlights five major dimensions: ‘Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers’. Conclusions The five dimensions of access to healthcare: insufficient human resources in health or; facilities; long waiting times; disproportionate high costs of services and; other socio-cultural barriers, ought to be addressed to mitigate medical deserts. The term medical deserts might not be the most appropriate term for defining areas with insufficient access to health services as it excludes essential domains, such as access to public health and preventive services. Key messages • Medical deserts directly and negatively impact the health outcomes of the people living in it. • Medical deserts might not be the most appropriate term for defining areas with insufficient access to medical services, as it excludes public health and preventive services.

Mixed-methods systematic review of shared decision-making tools for cancer screening

Abstract Shared decision-making (SDM) tools hold promise for guiding informed choices in cancer screening. However, their effectiveness among underserved people, as well as the specific characteristics of these tools preferred by this group and clinicians, remains unclear. This review aimed to synthesize evidence on the effectiveness of SDM tools for cancer screening and explored the preferences of underserved people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analyses showed that SDM tools for cancer screening are effective in reducing decisional conflict for both the general population and the underserved, and in increasing cancer screening knowledge and intention for underserved people only. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes, measured over a six-month period. Insights from the qualitative findings revealed that underserved people highly preferred SDM tools with relevant information about cancer risk, culturally tailored content, and high accessibility, both during clinical encounters and beyond. Meanwhile, clinicians highly preferred tools that can be easily integrated into medical systems, and can effectively guide SDM, while considering their patients’ values and the limited time for consultation. There is strong evidence on the effectiveness of SDM tools in facilitating informed choice in cancer screening, especially among underserved people. However, evidence on long-term outcomes remains insufficient. Additionally, considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential. Key messages • Shared decision-making tools are effective in increasing screening knowledge and intention among underserved people. • Considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential.

Public health resilience and recovery in Ukraine: Academic partnerships to improve population health

Abstract Background Strengthening the public health workforce is among top priorities for the transformation of Ukraine’s public health system. As part of the USAID Public Health System Recovery and Resilience Activity, an Academic Partnership Collaborative brought together three Ukrainian universities (National University Kyiv-Mohyla Academy, I. Horbachevsky Ternopil National Medical University, Sumy State University), two American universities (Temple University and Drexel University), and the All-Ukrainian Association of Public Health Specialists (UPHA) to enhance the competencies of public health graduates in Ukraine. Objectives The collaborative focuses on strengthening the Ukrainian universities’ public health curricula and the teaching and research competencies of the Ukrainian faculty, making the curricular changes in Ukraine better aligned with US and European academic standards. The university partners are collaborating with the newly established UPHA in building partnerships with peer organizations in the US (American Public Health Association) and Europe (EuPHA) and sharing advancements in public health education with the broader community of public health practitioners in Ukraine to enhance their competencies to improve population health and align with European systems of public health. Results We have established linkages among all partners via an initial meeting in Uzhhorod, Ukraine in April 2024. We anticipate results by November 2024 to include curriculum review recommendations, coaching on prioritized topics for the Ukrainian partners, faculty development plans, and the establishment of continuing professional development programs in collaboration with UPHA. Conclusions Through this partnership, selected Ukrainian universities will have an enhanced and sustainable capacity to train the public health workforce and will become leading examples for other public health programs to simulate and collaborate with beyond the project. Key messages • Ukraine’s resilience and recovery relies upon the strength of the current and future public health workforce; mechanisms for building public health training are essential to a healthy population. • A collaborative process of strategic activities among American and Ukrainian universities and professional associations can be effective in building a resilient public health system in Ukraine.

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

Implementation of polygenic risk scores in secondary prevention of (breast) cancer

Abstract Utilizing polygenic risk scores to inform secondary prevention of breast cancer via population screening programs is one of the pioneering applications of genomics in public health applications. Over the last decade, polygenic risk scores for breast cancer have been developed and validated in various European populations (AUC ± 0.63, OR per Z unit ± 1.6, depending on the population). In some countries, the polygenic risk score has been integrated with decision modeling tools, such as CanRisk in the Netherlands, and low-level implementation into health and care systems has started. Implementation strategies vary, but generally consider initial implementation into high-risk populations, such as breast cancer families, in specialized clinical setting, such as academic medical centres, or specialized cancer clinics, referring relatives of patients to population screening based on comprehensive risk modelling, including polygenic risk scores. This route may be followed by other disease fields as well. The presentations outlines the current evidence and considerations on breast cancer genetic risk modelling, clinical pilot studies and the outline of step-wise implementation of such models to benefit secondary prevention programs. We start from the perspective of a single hospital, to the needed steps to upscale to national populations, both in diversity of these populations, as the throughput of genetic testing and counselling, until the harmonization and recalibration of various European healthcare models. We draw from examples of the Genotyping on all patients (GOALL), building cancer health platforms (CanHeal) and Genome of Europe (GoE) consortia.

The relationship between mental health and employment: a systematic review of cohort studies

Abstract Background Knowledge on the bi-directional association between employment status and mental health is important, as it affects multiple dimensions of our daily lives, both at the individual and societal level. Given that the mental health status and employment situation of individuals are likely to change over time, there is an important need for longitudinal data to better understand causality patterns in this association and the underlying mechanisms. Methods A systematic review was carried out based on the PRISMA guidelines in 3 electronic databases: PubMed, Embase, and PsycInfo. Studies eligible for inclusion were cohort studies, involving the general population, and assessing the relationship between employment status and mental health longitudinally. Results In total, 3,733 studies were identified and 36 met the inclusion criteria. The eleven studies focusing on the social causation hypothesis highlighted the negative long-term impact of unemployment and unstable employment on mental health. Four studies observed mental health improvements upon re-entering employment, although limited and in more specific contexts. The fourteen studies focusing on the health selection hypothesis found a lower probability for individuals with mental health problems in finding and maintaining employment. Finally, the eleven studies assessing the two hypothesis simultaneously found that mental health problems were both a consequence of and risk factor for poor employment status, although some important moderating factors, such as gender differences, influence the direction and strength of the association. Conclusions This review underscores the bi-directional association between the employment status and mental health of individuals, highlighting the need to develop targeted prevention (e.g. mental health support in the workplace) and interventions strategies (e.g. supported employment programs) in both the mental health and labor market systems. Key messages • The bidirectional link between employment and mental health highlights the need for concurrent responses to break the vicious cycle between poor mental health and social exclusion. • To reduce the clinical and social burden of mental health problems, gender differences must be taken into account in mental health and employment support practices and policies.

3.Y.2. Road traffic injuries, disability burden and implications for compensation schemes in Europe

Abstract Reducing traffic fatalities and injuries is a complex challenge, but it is one that is of paramount importance for public health and safety worldwide. In recent years, there have been improvements in trauma care and injury prevention efforts, which reduced mortality rates and increased survival after serious injury. However, an increased heterogeneity in recovery times is observed with survivors of road traffic injuries differing in their adjustment compared to other traumas in terms of symptoms’ onset, variability and chronicity. The recovery trajectory seems to vary widely with a large percentage of survivors in need of extensive time periods for full recovery. Attention has now been shifted towards the adverse effects of non-fatal injuries on functional, mental health, economic and societal outcomes. The capacity of a person to continue functioning, inability to work, sickness absence and reliance on welfare benefits to compensate for loss of income are some of the injury-related long-term consequences, causing great concern for health and social security systems across Europe, as they have been shown to account for more than one third of total road traffic incident costs. These figures fail to include individuals who sustain “minor” injuries, which do not require hospitalisation, yet still impair their ability to work. Despite the rapidly growing epidemiological and clinical attention, there are still several issues missing from research, policy and practice. A universal definition of recovery after a road traffic injury is still missing, and this has been seen as critical for improved understanding of risk factors of poor recovery as well as improved identification of those in need of welfare benefits. Furthermore, long-term sickness absence and disability following road traffic injury in Europe is still understudied and evidence on the different return to work pathways and compensation schemes is scarce. Evidence is still limited on the context in which return to work occurs, the injury profiles most dependent on long term compensation schemes and the policy settings of injury compensation schemes that impact return to work outcomes post injury. Data availability and data linkage issues often cause misclassification errors when granting disability pensions and this remains unattended long after an injury. Welfare benefits are often poorly connected with the injury or other medical diagnoses and this makes it difficult to assess the contribution of injuries on disability pensions and other welfare benefits, especially in comorbid and multimorbid conditions. The current workshop aims to improve our understanding of the long-term consequences and the challenges faced by those injured in road traffic injuries and aid the development of interventions that seek to enable sustained recovery, and help inform policy and practice of healthcare and injury compensation systems. Key messages • Timely access to quality healthcare, rehabilitation therapies, and assistive technologies can significantly improve outcomes and reduce the strain on social security and compensation systems. • Ensuring equitable access to social security benefits for injured individuals, requires efficient compensation schemes that recognize the full impact of the disability on individuals’ life.

Implementing patient navigation for cancer prevention among individuals with mentally ill-health

Abstract Issue In Europe, over 80 million people experience mental ill-health and there are 4 million new cancer diagnoses each year. Individuals experiencing mental ill-health exhibit higher rates of cancer morbidity and mortality, with this excess attributed to risky health behaviors and obstacles encountered when accessing often fragmented healthcare systems. Description of the problem The aim of Co-CAPTAIN is the pilot implementation and evaluation of the Patient Navigation Model (PNM) for the improvement of primary cancer prevention in individuals with mental ill-health, adapted through participatory co-design in the European context. The project will adopt a cohort-based study design, commencing data collection at baseline and succeeded by three follow-ups (6 weeks, 9 months, 18 months). It will utilize a mixed-methods approach, combining quantitative and qualitative methodologies to assess diverse outcomes of PNM, facilitating both exploratory and confirmatory research. Qualitative data will be obtained through semi-structured interviews, while quantitative data will be collected using validated questionnaires and items developed ad hoc. The project will involve four pilot sites in Europe (Austria, Greece, Poland and Spain), where the PNM will be adapted to the specificities of national healthcare and support systems. The implementation phase is expected to begin in June 2024. Results During implementation, gathering both quantitative and qualitative data will offer valuable insights into feasibility and effectiveness, establishing a baseline for reshaping health and social care policies for individuals with mental ill-health across Europe. Lessons Co-CAPTAIN project aims to reduce health disparities for individuals with mental ill-health by improving overall health and reducing cancer burdens, leading to cost reductions in European health and social care systems. Key messages • The project aims to deliver an innovative solution based on the PNM, to address health disparities among individuals with mental ill-health by reducing cancer burden. • Combination of qualitative and quantitative methodologies to assess diverse outcomes.

Strengthening ecosystems

Abstract The mission of THCS activities with respect to strengthening ecosystems is based on the understanding that the actual transformation of health and care systems is dependent on the ability of numerous actors to align their goals and actions so that they are complementary. At the same time, it is also true that the transformation takes place at national, regional and local levels, making activities and support at these levels essential for the success of THCS. Therefore, the focus lies on connecting and supporting the broad community and other stakeholders in developing ecosystem-wide approaches and creating awareness and urgency among ecosystem layers and components, thus serving as a platform for transformation. One strand of activities for strengthening ecosystems aims at identifying, analysing, describing and disseminating key learnings from successful transformative ecosystems (TE’s). TE’s are broad constellations of interacting organisations and people who are committed, and through aligned actions, able to reach joint, explicitly defined goals in long-term. Making not only the most successful TE’s but also the dynamics explaining their achievements visible, value is being added through three main routes. Firstly, the experiences are distributed widely on European arenas and platforms as well as through national, regional and local channels to inspire ecosystem building processes in earlier stages of maturity. Secondly, collaboration between identified forerunner ecosystems is supported to enable mutual peer-learning. Thirdly, the examples are used to give guidance and inspiration to consortia that are applying for or receiving THCS project funding. As strategic partners of the ecosystem strengthening activities, other work packages of the THCS programme as well as the THCS National Mirror Groups are of great importance.