WHO Action Research Articles

Trends in access to anti\u2010malarial treatment in the formal private sector in Uganda: an assessment of availability and affordability of first\u2010line anti\u2010malarials and diagnostics between 2007 and 2018

BackgroundMalaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanisms aimed at increasing the availability and affordability of artemisinin-based combination therapy (ACT). This paper examines the availability and affordability of first-line malaria treatment and diagnostics in the private sector, which is the preferred first point of contact for 61% of households in Uganda between 2007 and 2018.MethodsCross-sectional surveys were conducted between 2007 and 2018, based on a standardized World Health Organization/Health Action International (WHO/HAI) methodology adapted to assess availability, patient prices, and affordability of ACT medicines in private retail outlets. A minimum of 30 outlets were surveyed per year as prescribed by the standardized methodology co-developed by the WHO and Health Action International. Availability, patient prices, and affordability of malaria rapid diagnostic tests (RDTs) was also tracked from 2012 following the rollout of the test and treat policy in 2010. The median patient prices for the artemisinin-based combinations and RDTs was calculated in US dollars (USD). Affordability was assessed by computing the number of days’ wages the lowest-paid government worker (LPGW) had to pay to purchase a treatment course for acute malaria.ResultsAvailability of artemether/lumefantrine (A/L), the first-line ACT medicine, increased from 85 to100% in the private sector facilities during the study period. However, there was low availability of diagnostic tests in private sector facilities ranging between 13% (2012) and 37% (2018). There was a large reduction in patient prices for an adult treatment course of A/L from USD 8.8 in 2007 to USD 1.1 in 2018, while the price of diagnostics remained mostly stagnant at USD 0.5. The affordability of ACT medicines and RDTs was below one day’s wages for LPGW.ConclusionsAvailability of ACT medicines in the private sector medicines retail outlets increased to 100% while the availability of diagnostics remained low. Although malaria treatment was affordable, the price of diagnostics remained stagnant and increased the cumulative cost of malaria management. Malaria stakeholders should consolidate the gains made and consider the inclusion of diagnostic kits in the subsidy programme.

Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability.

WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range: $61-$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from $135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations.

National food policies in the Islamic Republic of Iran aimed at control and prevention of noncommunicable diseases.

Diet plays an important role in the risk of noncommunicable diseases. In the Islamic Republic of Iran, national activities were started after release of the World Health Organization's (WHO) action plan on prevention and control of noncommunicable diseases. This study describes national food policies implemented by the government in order to reduce noncommunicable diseases in the country in line with WHO action plan. Newly adopted food standards and regulations linked to noncommunicable diseases from 2013 to 2018 were reviewed and the maximum permitted levels of salt and trans and saturated fats were compared in the old and new standards. Nutritional traffic light labelling to raise public awareness of healthy diets was evaluated. Fifteen food standards associated with eight food items that make up a large share of the daily Iranian food basket and three that make up a small share were evaluated. Policies on salt included reduction in maximum permitted percentage in bread, cheese and doogh (a fermented drink) to 1%, 3% and 0.8%, respectively. For trans and saturated fats, maximum permitted percentages were set as 2-5% and 30-65% of edible oils and fats, respectively. Nutritional traffic light labelling, which indicates the content of salt, sugar, fat and trans fat in foods, has been mandatory for all foods since 2016. In view of the polices implemented to reduce the salt and fat/oil content of foods, significant decreases in noncommunicable diseases are expected in coming years in the country. However, further studies are needed to show the effectiveness of the interventions.

Atividade física nas prioridades da OMS:

Pretende-se debater a indução internacional de políticas de promoção de atividade física no Brasil, tomando o plano de ação global da OMS, More Active People For a Healthier World, como documento norteador, o Sistema Único de Saúde como contexto, e a perspectiva da determinação social da saúde como fundamentação teórica. Advoga-se deslocar a inatividade física do combate às DCNT para integrar a atividade física às políticas de promoção de saúde na Atenção Primária, tomando as condições crônicas como processo de mediação. Reconhecemos que as orientações da OMS têm forte poder de indução, todavia, não garante resultados. Estudos futuros poderão mapear como os gestores cumpriram o plano de ação da OMS, tendo em vista o contexto de saúde brasileiro.

Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study.

Objectives: To evaluate the price and availability of medicines in China. Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018. Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector. Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.

Developing the European Health Literacy Action Plan using a transformative future scenario planning approach

Abstract Background The 53 Member States of the WHO European Region adopted in 2019 a health literacy roadmap and a resolution to develop an action plan to guide the work of the Member States. The development of the action plan builds on achievements regarding the EU funded European Health Literacy Survey and the WHO action networks on health literacy measurement and NCD related demonstration projects as well as the multiple national initiatives launched in the European region in the last decade. Methods Scenario planning is a methodology that uses the inherent human capacity for imagining futures to better understand the present regarding the development of a new strategy or action plan. In the kick-off phase of the development process of the health literacy action plan, a transformative future scenario planning approach was applied in combination with a SWOT analysis (strengths, weaknesses, opportunities, threats) of current achievements, challenges and gaps considering the development of health literate societies involving 50 experts from a wide range of sectors and disciplines. Additionally, an iterative process followed including technical consultations with experts in Europe in preparation for a governmental consultation. Results The SWOT analysis, long-sight planning and generation of complementary concrete actions served as basis for the development of the action plan highlighting its relevance, sustainability and accountability. Additionally, the health literacy plan was developed in a process of co-creation with the wider health literacy community as well as stakeholders with multiple backgrounds in research, policy, education and practice. Conclusions The European health literacy action plan is multi-sectoral, people-centred and targeted governmental actions with the aim of developing health literate societies and populations. It can serve as a model for other world regions to adapt.

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

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

Prices, availability and affordability of medicines in Rwanda.

BackgroundAccess to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda.MethodsA survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data.FindingsPrices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector.ConclusionIn Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.

Gradients in Mental Health and Health Consciousness by the Degree of Disabilities - Results from representative GEDA-Survey in Germany

People with disabilities belong to a vulnerable population group, especially with regard to their economic and health situation. In the social-epidemiological research, hardly any studies on mental health and health awareness among people with disabilities are available using representative data, in particular not differentiated according to their degree of disability (DoD). Therefore, the aim of this study is to investigate 1) differences in mental health and health awareness between people with disabilities compared to people without disabilities. In addition, the study 2) shows differences mental health outcomes and health awareness, differentiated according to the DoD. Data is used from the representative study "Gesundheit in Deutschland Aktuell (GEDA) 2012" (N=19,294). Outcomes were self-reported health, health awareness, depression or depressive mood, mental discomfort, vitality and psychological well-being. The exposure variable used was the recognized disability (DoD≥50 vs. DoD<50 vs. no disability). Univariate and bivariate analyses were conducted using cross-tables and multivariate analyses using binary logistic regression models, controlled for socio-demographic, economic and health-related features. People with disabilities often rate their mental health worse than people without disabilities. The bi- and multivariate analyses revealed a disability-specific gradient for all outcome measures according to the DoD (p<0,001). People with disabilities had a significantly higher likelihood of poor mental health compared to people without disabilities. People with severe disabilities (DoD≥50) had a more than 4,6-fold increased likelihood risk of poor self-reported health and 2,5-fold likelihood of depression or depressed mood compared to people without disabilities. A high level of health awareness was more prevalent in PWD than in those without disabilities. The study highlights that People with disabilities more frequently reported mental health problems than people without disabilities. Targeted measures are necessary, which address in particular the target group of the people with disabilities. There is further need to strengthen access to health services and programs, assistive technologies and support services, and to make health of people with disabilities to the subject of research and health promotion in line with the WHO Action Plan on "Better health for all people with disabilities" (2014-2021).

Pandemic response protocol of a non-frontline specialty in a multispecialty tertiary health care centre-a pilot model in orthopaedics.

Background3,181,642 cases and 224,301 deaths in 212 regions of the world—this is the status of COVID-19 (Coronavirus Disease 2019) pandemic as of May 1, 2020. This pandemic has managed to overwhelm the health care system of the most advanced countries in the world. As the whole of the medical fraternity stands robed as health care professionals to fight against COVID-19, specialty emergencies like trauma continue to pester the already overburdened health care community. This situation calls for the need for a pandemic response protocol (PREP) in each specialty that helps the doctors to manage specialty emergencies without chaos and at the same time allowing them to play their part in pandemic management.ConclusionPREP as an integrated pragmatic approach is essential in containing pandemics as they need international cooperation at various levels starting from knowledge sharing to monetary support. PREP which is in line with the WHO action plan, will be an essential minimum response of a non-frontline pandemic response specialty like orthopedics to combat and curtail the effects of a pandemic in a multispecialty tertiary health care centre.

Abstract P532: The Italian Pilot of the Health Literacy Survey 2019 in the Cuore Project for the Who Action Network on Measuring Population and Organizational Health Literacy (m-pohl)

Background: Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to the funds of the Italian Center for Diseases Control and Prevention-CCM of the Ministry of Health, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS. Objective: A pilot study was conducted to evaluate the feasibility of the M-PHOL international questionnaire HLS-EU using the Italian version of the short form (HLS-EU-Q16 items), during the CUORE Project-Health Examination Survey 2018-2019. Methods: One hundred people aged 35-74 years, resident in the South of Italy, were face-to-face interviewed following consecutive access to the HES. The 4 Likert-type responses were grouped in 2 classes: 0 (zero) for fairly difficult/very difficult and 1 for fairly easy/very easy. According to the HLS-EU-Q16 sum score (range: 0–16), three levels of HL were defined: ‘Inadequate’ (0–8), ‘Problematic’ (9–12), ‘Sufficient’ (13–16). HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES. Means and prevalence were age and gender standardised using the European standard population. Results: Ninety-eight persons completed the questionnaire (47 men, 51 women); HL mean score was 13.1 (SD=3.2) with no sex difference; prevalence of persons with ‘Inadequate’ HL was 11.2%, ‘Problematic’ 26.5%, ‘Sufficient’ 62.3%. For persons with the highest educational level (Tertiary) the highest prevalence was in the ‘Sufficient’ HL (20.5%); in the same HL category, only 3.4% was the prevalence of those with the lowest educational level (Primary). Hypertension was lower in the ‘Sufficient’ HL category (37.9% vs. 45.1% in the ‘Inadequate’ HL). Smoking habit decreased with increasing HL level (21.3%, 19.0%, 5.4% in the three HL categories, respectively). Conclusion: More than one third of interviewed adult population had ‘Inadequate’/’Problematic’ HL. Preliminary results from the Italian pilot of the HLS-EU-Q16 within the HES of the CUORE Project suggest that the survey is an important opportunity for the possibility of linking HL data with HES measured data. A national survey on HL will be implemented in the Italian general population in the framework of the M-POHL network.

Availability, prices and affordability of selected antibiotics and medicines against non-communicable diseases in western Cameroon and northeast DR Congo.

Access to safe, effective and affordable medicines of good quality is included into the Sustainable Development Goals of the United Nations. Furthermore, WHO has developed a Global Action Plan with the aim to raise access to essential medicines against non-communicable diseases (NCDs) to 80%, and to improve their affordability. In order to contribute to the monitoring of progress towards these goals, the present study investigated the availability and affordability of seven antibiotics and six medicines against non-communicable diseases in the northeast of the Democratic Republic of Congo and the west of the Republic of Cameroon. Data on availability and prices of these medicines were collected in 60 different sites (34 in the DR Congo, 26 in Cameroon), including government health facilities, church health facilities, private pharmacies and informal vendors, as part of a study on medicine quality. The data were analyzed using a standardized procedure developed by WHO and Health Action International (HAI). Average availability of the investigated antibiotics ranged from 62% to 98% in the different types of facilities in both countries, including the informal vendors. Average availability for medicines against NCDs in the different types of facilities showed a higher variation in both countries, ranging from 11% up to 87%. The average availability of medicines against NCDs in government health facilities was only 33% in Cameroon, and as low as 11% in the DR Congo. In contrast, availability of medicines against NCDs in church health facilities in Cameroon was 70%, not far from the 80% availability goal set by WHO. Medicine prices were clearly higher in Cameroon than in the DR Congo, with median price ratios to an international reference price of 5.69 and 2.17, respectively (p < 0.001). In relation to the daily minimum wages in both countries, treatment courses with five of the seven investigated antibiotics could be considered as affordable, while in each country only one out of the five investigated medicines against NCDs could be considered as affordable. Especially generic medicines provided by government and church health facilities showed reasonable affordability in most cases, while originator medicines offered by private pharmacies were clearly unaffordable to a major part of the population. Despite some encouraging findings on the availability of antibiotics in both countries, the availability and affordability of medicines against NCDs urgently requires further improvements.

Intrinsic Capacitiy Monitoring by Digital Biomarkers in Integrated Care for Older People (ICOPE).

The WHO action plan on aging expects to change current clinical practices by promoting a more personalized model of medicine. To widely promote this initiative and achieve this goal, healthcare professionals need innovative monitoring tools. Use of conventional biomarkers (clinical, biological or imaging) provides a health status assessment at a given time once a capacity has declined. As a complement, continuous monitoring thanks to digital biomarkers makes it possible to remotely collect and analyze real life, ecologically valid, and continuous health related data. A seamless assessment of the patient's health status potentially enables early diagnosis of IC decline (e.g. sub-clinical or transient events not detectable by episodic evaluations) and investigation of its probable causes. This narrative review aims to develop the concept of digital biomarkers and its implementation in IC monitoring.

Radon activity concentration measurements in water sources from Perak state Malaysia

Radon activity concentration in water samples from Perak state Malaysia and their possible health risk was assessed. The Samples were from lakes, hot springs, and rivers. The RAD7 Detector was used for in-situ measurement of radon concentration. The radon activity concentration ranged from 0.04 ± 0.08 — 3.98 ± 0.39 Bq l – 1, with mean of 0.69 Bq l – 1 and standard deviation of 0.92 Bq l – 1. The activity concentration ranged from 0.08 ± 0.12 — 0.45 ± 0.27, 0.04 ± 0.08 — 0.62 ± 0.32, 0.33 ± 0.23 — 3.98 ± 0.39 Bq l – 1, with a mean of 0.24 ± 0.19, 0.30 ± 0.21, 1.26 ± 0.34 Bq l – 1 for lakes, hot springs, and rivers respectively. The result was below the UNSCEAR, USEPA and WHO action levels of 11.1 Bq l– 1and100 Bq l – 1respectively. The 222Rn contribution from water to indoor air was found to be below the recommended action level . The annual effective dose for inhalation and ingestion ranged from 0.000102 — 0.009954 mSv y – 1 and 0.000102 — 0.010112 mSv y – 1, with mean annual effective dose of 0.001733 and 0.001759 mSv y – 1 respectively. The effective doses for both inhalation and ingestion were below the world average of 0.002 mSv y – 1. The 222Rn activity concentration in the study could be termed normal and without threat to human health.

WHO Action Network on Measuring Health Literacy: the Italian pilot for the Survey 2019 Title

Abstract Background Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to Ministry of Health funds, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS. Objective: The HLS-EU-Q16 questionnaire was administered to a sample of adult population during the Health Examination Survey-HES of the CUORE Project started in 2018, to verify and evaluate the feasibility of the HL survey. Methods One hundred people aged 35-74 years, resident in Reggio Calabria (South of Italy), were interviewed (face-to-face) following consecutive access to the HES. According to the HLS-EU-Q16 sum score, three levels of HL were defined: inadequate, problematic, and sufficient. HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES. Results HL mean score of 98 completed questionnaires (47 men, 51 women) was 13.0 (SD = 3.5), with no sex difference; prevalence of persons with inadequate HL was 11.2%, problematic 26.5%, sufficient 62.3%. Sufficient HL level presents the highest prevalence (72%) of high educational level. Smoking habit decreases as HL level increases. Conclusions The HLS-EU-Q16 questionnaire represents a standardised tool applicable in the general population. Preliminary results from the Italian pilot of the HLS-EU-Q16 suggest that the survey is feasible within the HES of the CUORE Project, with the opportunity to link HL data with HES measured data. More than one third of interviewed adult population have inadequate/problematic HL.

Italian participation to the WHO action network on measuring health literacy: policy implications

Abstract Issue Health literacy (HL) is recognized as a determinant, mediator or moderator of health and of use and results of health care services Inadequate HL is associated with patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. Description of the problem Few previous studies suggested that inadequate HL is a prevailing problem in Italy. As compared with the European Countries, Italy has peculiar characteristics of socio-demographic determinants of HL levels, which constitute a challenge for policy making. In so far HL has not been considered as a strategic priority for the Italian National Health Service. The Italian National Institute of Health and Ministry of Health are promoting a national program on HL by adhering to the WHO action network on measuring population and organizational health literacy (M-POHL). Main aim of the program is to propose policies that could enable all citizens to share the benefits of improved HL. A national population survey, coordinated at European level, has been planned in each participating country in 2019. Preliminary results We are setting up the survey using the questionnaire with 47 specific questions about HL and 32 about lifestyles and demographic characteristics. Updated results of this survey will be analysed in order to define a strategic line for the implementation of actions for the improvement of HL in the next National Prevention Plan. Furthermore, the national survey will be scheduled and repeated to monitor results. Lesson State Policies can be implemented at individual, community, organization or system level. Italy is at the beginning of its experience in this field. A national steering committee of experts has also been appointed to support HL policy initiatives. The comparison with existing policies in other countries within the M-POHL action will be another asset to develop HL policies and related activities to benefit citizens, patients and communities.

Workshop: Health literacy: an asset to public health policy

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

Use and patient affordability of opioid analgesics for cancer pain management in different regions of China: a retrospective analysis of data from 2006 to 2016

BackgroundLittle information is available on the need for opioid analgesics based on demographic, economic and disease spectrum data, or on patient affordability of opioid analgesics, in different regions of China. This study analysed the level of, and trends in, opioid analgesic use in different regions of China from 2006 to 2016, calculated the need for opioid analgesics based on demographic, economic and disease spectrum data from the different regions, and analysed the gap between need and actual consumption. Patient affordability of opioid analgesics for cancer pain management was also measured. MethodsOpioid analgesic consumption data were obtained from the China Hospital Pharmaceutical Audit (CHPA) database of IQVIA (formerly Quintiles and IMS Health). We assessed the clinical need for opioid analgesics by calculating the morphine use density (MUD, daily defined doses of morphine per 100 000 population) and its growth rate from 2006 to 2016 in China and its seven regions. Regional need for opioid analgesics (in morphine equivalents) was estimated based on regional cancer registration data and standard treatment doses of opioids, as defined by international guidelines for cancer pain management. The study adopts WHO and Health Action International (HAI) methods to evaluate patient affordability of opioid analgesics for cancer pain management using standardized costs in daily defined doses (DDD). FindingsThe national MUD increased from 1·45 DDD/100 000/day in 2006 to 6·93 DDD/100 000/day in 2016. Southern China had the highest MUD (9·67 DDD/100 000/day), and northwest China had the lowest MUD (3·28 DDD/100 000/day) in 2016. The actual use of morphine equivalents accounted for only 21·5% of the morphine required for cancer pain management at the national level; 26% in east, 36% in south, 11% in southwest, and 12% in northwest China. The DDD costs of all studied opioid analgesics ranged from CNY ¥10·80 to ¥848·88. Except for morphine injections, the out-of-pocket payments for a standard full course of treatment with opioid analgesics were more than the daily disposable income in all regions. Patient affordability of opioid analgesics is low according to the WHO and HAI method. InterpretationOpioid analgesic use for the management of cancer pain was insufficient relative to needs in China, and varied markedly across regions with different levels of economic development. Long-term use may pose a heavy economic burden to patients. The findings call for actions to strengthen cancer pain management, and to improve the affordability of drugs. FundingThe Peking Union Medical College Education Fund.

1637PD - Reaching sustainable oncology care via the National Cancer Control Program (NCCP)

BackgroundThe NCCP is a program of activities for efficient action in the field of cancer control adopted by our Government and based on recommendations of WHO and European Partnership Action Against Cancer. It was initiated due to high cancer incidence and mortality in our country. We report achievements of our 3 organized, population-based screening programs (SP). Methods1. Cervical Cancer (CerC) SP, started 2003, conventional cytology, 3 years interval, age 20–64, participation 72%. 2. Colorectal Cancer (CRC) SP, started 2009, immunochemical fecal occult blood test, follow up colonoscopy if positive, age 50-74, 2 years interval, participation 62%. 3. Breast Cancer (BC) SP, started 2008 in central region, countrywide in 2018, mammography every 2 years, age 50-69, participation 73%. Outcome measures: 1. Incidence for CerC and CRC for all pts diagnosed in Slovenia from SP start. 2. Stage distribution, net survival and hazard ratio (HR) of death for screen vs not screen detected cancers diagnosed with CerC, CRC and BC from 2011-2015 for all invited patients to the SPs. ResultsCerC incidence was reduced from 2003 to 2017 by 62% (from 211 cases/year to 85), CRC from 2010 to 2015 by 21% (from 1729 cases/year to 1357). A significant (p<0.0001) stage shift in screen detected vs not screen detected cancers was achieved. The stage shift percentages (screen detected/not screen detected) for the three SP are: for CerC stage I 81/41; stage II 16/30; stage III 3/19; stage IV 1/10, for CRC stage I 45/14; stage II 19/24; stage III 29/33; stage IV 8/30 and for BC stage I 66/40; stage II 26/35 stage III 8/18; stage IV 1/7. 5-year net survival for screen detected pts with CerC, CRC and BC was 92.1%, 88.4% and 100% and in not screen detected 63.7%, 57.1%, 85.3% respectively. The risk of death described by hazard ratio is in screened detected cancers 4-5 times lower: CerC HR 0.18 (0.11 – 0.28), CRC HR 0.26 (0.23-0.29) and BC HR 0.17 (0.10-0.31). ConclusionsHigh quality SPs have a significant impact on incidence, stage and survival and are the basis of sustainable oncology care. They are even more essential in countries with limited human and financial resources. Pts with screen detected cancers are diagnosed in earlier stages and have lower probability to die from cancer. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

How well do national and local policies in England relevant to maternal and child health meet the international standard for non-communicable disease prevention? A policy analysis

Objectives(1) To identify national policies for England and local policies for Southampton City that are relevant to maternal and child health. (2) To quantify the extent to which these policies...