WHO EURO Research Articles

Workshop: Alcohol policy reforms in European countries – challenges and solutions

Abstract Alcohol-related harm is a major public health concern in Europe, with levels of alcohol consumption and associated health harm among the highest worldwide. According to the European Commission, premature deaths linked to alcohol account for over 7% of all European morbidity, and alcohol is a major avoidable risk factor for neuropsychiatric disorders, cardiovascular diseases, cirrhosis of the liver, cancer and unintentional and intentional injuries. Even moderate use of alcohol raises long-term risks of certain heart conditions, liver disease and cancers, and frequent use can lead to dependence. There is extensive research on efficient strategies to reduce alcohol-related harm, alongside high-level policy recommendations. Examples are the WHO’s global strategy to reduce harmful use of alcohol and the WHO European office’s European action plan to reduce the harmful use of alcohol 2012-2020. The European Union (EU) strategy to support member states in reducing alcohol-related harm expired in 2012. Since then, the Committee on National Alcohol Policy and Action (CNAPA) has drawn up a non-binding Action Plan in relation to alcohol and EU countries have the main responsibility for their national alcohol policy. Despite strong evidence bases supporting alcohol policy, the implementation of potentially effective alcohol policy is often challenged by companies with commercial interests seeking to undermine evidence and advocate for less effective alternatives. These alternatives, such as education or voluntary industry action, are often favoured by politicians and the public. This opposition to evidence-based alcohol policy represents a challenge to public health. In this session, we will discuss recent developments in alcohol policy reform in Estonia, Finland and Scotland; reflecting on the outcomes of policies and the challenges faced in implementation. We invite commentaries from national experts and from the DG Sante and WHO Euro. Among these the French commentary will address the influence of the alcohol industry in circumventing effective public health policies, with discussions concerning the new strict French low-risk guidelines on alcohol use as one example. The objective of this workshop is to share experiences of the challenges faced in applying effective alcohol policies, to discuss ways to tackle those challenges, and to invite the EU and the WHO to share their views on ways to overcome these barriers in future policy advocacy. Key messages Commercial determinants of health are a powerful force in preventing effective public health policy on alcohol-related harm. The public health community need to work in a persistent and coordinated manner to bring in a suite of effective alcohol policy interventions across Europe.

Strengthening influenza surveillance in South East European countries

Purpose: South East European (SEE) countries presented different influenza surveillance systems based on universal surveillance for influenza, different influenza diagnostic capacities and some of them less data compared to other European countries. The aim of the study was to identify influenza surveillance systems in SEE countries and challenges related to establish sentinel surveillance systems. Methods & Materials: The surveillance of influenza and specifically influenza-like illness (ILI), acute respiratory illness (ARI), severe acute respiratory infections (SARI) and virological surveillance were assessed by using Sentinel surveillance system review tools and Sentinel SARI surveillance: Scaling implementation of WHO Regional Office for Europe guidance for sentinel influenza surveillance in humans and CDC International Influenza Surveillance Assessment Tool. The tools and questionnaires were translated and adapted into countries and discussed into focus groups of profesisonals and stakeholders. A desk review was performed by a national and international team. Data collesction were analysed based on WHO Euro Guideliness for sentinel influenza surveillance. Results: All countries had virological surveillance and had capacities to use molecular diagnostic methods for influenza diagnosis. All countries had universal ARI surveillance and influenza activity was measured by laboratory-confirmed cases. Only 50% of the countries had ILI sentinel surveillance. SARI sentinel surveillance was established only in 44% of the countries. Virus isolation and identification was missing in 44% of the countries. Baseline and epidemic thresholds to indicate a level of disease activity were developed only in some countries. Only three countries had web based ARI surveillance systems but the challenges of influenza surveillance data base management were enormous and shared by all countries. Only three countries had systems to monitor and strengthen influenza surveillance but even such systems were not well developed. Avian influenza surveillance activities were lacking in cross border areas since 2010. Conclusion: None of the countries had performed assessment of their influenza surveillance system as a crucial activity for monitoring the timing and severity of influenza and documenting the change in the epidemiology of influenza infection. The countries need to increase their capacities on ILI sentinel surveillance especially to establish and improve SARI surveillance and their database management systems.

Can mentorship improve laboratory quality? A case study from influenza diagnostic laboratories in Southeast Europe

BackgroundStrengthening the quality of laboratory diagnostics is a key part of building global health capacity. In 2015, the Centers for Disease Control and Prevention (CDC), the Southeast European Center for Surveillance and Control of Infectious Diseases (SECID), WHO European Regional Office (WHO EURO) and American Public Health Laboratories (APHL) collaborated to address laboratory quality training needs in Southeast Europe. Together, they developed a quality assurance (QA) mentorship program for six national laboratories (Laboratories A-E) in five countries utilizing APHL international consultants. The primary goal of the mentorship program was to help laboratories become recognized by WHO as National Influenza Centers (NICs). The program aimed to do this by strengthening influenza laboratory capacity by implementing quality management systems (QMS) action steps. After 1 year, we evaluated participants’ progress by the proportion of QMS action steps they had successfully implemented, as well as the value of mentorship as perceived by laboratory mentees, mentors, and primary program stakeholders from SECID and WHO EURO.MethodsTo understand perceived value we used the qualitative method of semi-structured interviews, applying grounded theory to the thematic analysis.ResultsMentees showed clear progress, having completed 32 to 68% [median: 62%] of planned QMS action steps in their laboratories. In regards to the perceived value of the program, we found strong evidence that laboratory mentorship enhances laboratory quality improvement by promoting accountability to QMS implementation, raising awareness of the importance of QMS, and fostering collaborative problem solving.ConclusionIn conclusion, we found that significant accomplishments can be achieved when QA programs provide dedicated technical mentorship for QMS implementation. Since the start of the mentoring, Laboratory “B” has achieved NIC recognition by WHO, while two other labs made substantial progress and are scheduled for recognition in 2018. In the future, we recommend that mentorship is more inclusive of laboratory directors, and that programs evaluate the amount of staff time needed for mentorship activities, including lab-based assessments and mentoring.

Assessment of the Integration between Primary Health Care and Public Health in Almaty

This article presents the results of the study on assessing the degree of integration between primary health care (PHC) and public health (PH) in Almaty. The purpose of the study is to assess the degree of integration between PHC and PH in Almaty in accordance with the European framework for action on integrated health services delivery (EFFA IHSD). The relevance of the studylies in a comprehensive analysis from the position of integration between PHC and PH in Almaty. Research team: Kazakhstan School of Public Health, with the methodological support of the European Regional Office of the World Health Organization (WHO EURO), conducted a study. The EFFA IHSD of WHO has formed the basis for its development. Methodology: We conducted an analytical review and interviews with key informants. The analytical review included an analysis of the indicators characterizing the healthcare system. In the study we used the following research methods: bibliographic, analytical and interviewing. For the interviews with key informants we used the Interview protocol for key informant interviews, developed by WHO EURO in a step-by-step guide for developing profiles on health services delivery transformations. Results: We evaluated the morbidity of the population of Almaty with priority (infectious and non-infectious) socially significant diseases: diseases of the circulatory system, diabetes mellitus, tuberculosis, oncology, injuries. Evaluating the morbidity and mortality, it should be stated that the introduction of an integrated approach with the development and improvement of PHC and PH yielded improved health outcomes in Almaty. According to the existing model of integration between PHC and PH in the Republic of Kazakhstan, we have identified and conducted several interviews with key informants on initiatives. Conclusion: This study shows trends and an overall picture in the integration between PHC and PH. The results of our study showed that PHC and PH have as a series of specific and a number of overlapping functions.

Parents’ and teachers’ attitudes, objections and expectations towards sexuality education in primary schools in Austria

The World Health Organization Regional Office for Europe (WHO EURO) and the German Federal Centre for Health Education (BZgA) published the Standards for Sexuality Education in Europe in 2010. The standards were developed to provide an overview of those sexuality education issues that should be addressed in school at various specific age levels. They were intended to guarantee that sexuality education teaching is age-appropriate and of uniformly good quality throughout Europe. In the context of the present survey, Austrian teachers and parents or guardians were asked about the importance of the topics covered by the WHO standards and about any aspects they would like to see for such sexuality education to be successful. The paper concludes that parents and teachers agree on the sexuality education topics they find important for coverage in Austrian primary schools, although teachers find sexuality education in general to be of greater importance than do parents. Teacher’ wishes for sexuality education in practice correlate highly with parents’ ideas of quality. Overall, qualifications and support for work in this field are viewed as essential, with survey respondents perceiving the need for high-quality initial training and continuing education and appropriate frameworks for implementation in school.

VACCINATION FOR ADOLESCENTS IN THE EUROPEAN REGION: CURRENT STATE OF THE PROBLEM

This article describes the peculiarities of the National immunization programs for adolescents in the WHO Euro region. A comparative analysis of the groups was conducted based on economic development. The best and the worst performing states were identified in every group. It was demonstrated that economic development is not the leading factor that determines a country’s vaccination policy.

ED12.02 Tobacco Control: The Turkish Experience

ED12.02 Tobacco Control: The Turkish Experience

10.L. Round table: Working with society: strategies and instruments addressing the governance challenge<subtitle>Organised by: European Observatory, WHO EURO and EUPHA section on Public health practice and policy</subtitle>

10.L. Round table: Working with society: strategies and instruments addressing the governance challenge<subtitle>Organised by: European Observatory, WHO EURO and EUPHA section on Public health practice and policy</subtitle>

Investigating lead poisoning in children—could surveillance help?

Lead poisoning in children (LPIC) is associated with serious health effects including neurodevelopmental problems. Population-level preventive measures have helped to reduce exposures to new sources of lead for children in high-income countries such as England. However, new LPIC cases can still occur through exposure to existing sources of lead in the environment. In this article, we discuss how development of laboratory surveillance of LPIC could aid investigation and control of environmental sources of lead. Environmental risks are a particular concern for child health due to the higher exposures in comparison to adults and also the potential effects for growth and development. In recognition of this, the World Health Organization European Region (WHO EURO) has developed The Children’s Environment and Health Action Plan for Europe (CEHAPE) to help tackle environment-related child disease among European member states. In addition to tackling morbidity related to air pollution and inadequate sanitation, a key goal of this plan is ‘to reduce the risk of disease and disability arising from exposure to hazardous chemicals (such as heavy metals)’.1 The UK is one of the EURO member states committed to CEHAPE and has a number of pre-existing policies related to environmental risks. However, a need has been identified in the UK to improve knowledge of patterns of poisoning in children and information about the settings in which children are exposed.2 High-income countries such as the UK and USA have been successful in using population-wide measures such as legal restrictions to restrict the use of lead such as drinking water pipes, toys and paint. However, children can still be exposed to environmental lead that had accumulated prior to these interventions. These exposures can be associated with a range of health effects such as headaches, fatigue and abdominal pain. The most recently published evidence for childhood lead …

'Social, innovative and smart cities are happy and resilient': insights from the WHO EURO 2014 International Healthy Cities Conference.

This paper provides a brief overview of, and elaborates on, some of the presentations, discussions and conclusions from Day 4 of the ‘WHO EURO 2014 International Healthy Cities Conference: Health and the City - Urban Living in the 21st Century’, held in Athens, Greece on 25 October 2014. The Internet of Things (IoT) is made of sensors and other components that connect our version of the world made of atoms, i.e., humans/our bodies, our devices, vehicles, roads, buildings, plants, animals, etc., with a mirror digital version made of bits. This enables cities and regions to be self-aware and dynamically reconfigurable in real- or near-real-time, based on changes that are continuously monitored and captured by sensors, similar to the way the internal biological systems of a living being operate and respond to their environment (homeostasis). Data collected by various IoT sensors and processed via appropriate analytics can also help predict the immediate future with reasonable accuracy, which enables better planned responses and mitigation actions. Cities and regions can thus become more adaptable and resilient in face of adversity. Furthermore, IoT can link atoms (humans) to other atoms (humans) (again via bits), resulting in the formation of ‘smart(er) communities’ that are socially connected in new ways and potentially happier. Cities, but also less urbanised regions and the countryside, could all benefit from, and harness the power of, IoT to improve the health, well-being and overall quality of life of the local populations, actively engage citizens in a smarter governance of their region, empower them to better care for one another, promote stronger social inclusion, and ensure a greener, sustainable and more enjoyable environment for all. Technology can also help reverse the ‘brain drain’ from the countryside and smaller towns to larger metropolises by making the former more attractive and connected, with better services akin to those found in larger cities. The article also discusses some ways of measuring and benchmarking the performance of smart cities and their impact on well-being. However, it should be emphasised that technology is not a panacea and that other factors are equally important in creating happier and healthier cities and regions.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-072X-14-3) contains supplementary material, which is available to authorized users.

D.4. Round table: Effective Action on NCD Prevention: A focus on price<subtitle>Organised by: WHO EURO Division of Noncommunicable Diseases and Life-course and EUPHA section on Chronic diseases</subtitle>

D.4. Round table: Effective Action on NCD Prevention: A focus on price<subtitle>Organised by: WHO EURO Division of Noncommunicable Diseases and Life-course and EUPHA section on Chronic diseases</subtitle>

INFLUENZA SURVEILLANCE IN RUSSIA BASED ON EPIDEMIOLOGICAL AND LABORATORY DATA FOR THE PERIOD FROM 2005 TO 2012.

Exchange of information on and sharing of influenza viruses through the GISRS network has great significance for understanding influenza virus evolution, recognition of a new pandemic virus emergence and for preparing annual WHO recommendations on influenza vaccine strain composition. Influenza surveillance in Russia is based on collaboration of two NICs with 59 Regional Bases. Most epidemiological and laboratory data are entered through the internet into the electronic database at the Research Institute of Influenza (RII), where they are analyzed and then reported to the Ministry of Public Health of Russia. Simultaneously, data are introduced into WHO's Flu Net and Euro Flu, both electronic databases. Annual influenza epidemics of moderate intensity were registered during four pre-pandemic seasons. Children aged 0-2 and 3-6 years were the most affected groups of the population. Influenza registered clinically among hospitalized patients with respiratory infections for the whole epidemic period varied between 1.3 and 5.4% and up but to 18.5-23.0% during the peak of the two pandemic waves caused by influenza A(H1N1) pdm 09 virus and to lesser extent (2.9 to 8.5%) during usual seasonal epidemics. Most epidemics were associated with influenza A(H1N1), A(H3N2) and B co-circulation. During the two pandemic waves (in 2009-2010 and 2010-2011) influenza A(H1N1) pdm 09 predominated. It was accompanied by a rapid growth of influenza morbidity with a significant increase of both hospitalization and mortality. The new pandemic virus displaced the previous seasonal A(H1N1) virus completely. As a rule, most of the influenza viruses circulating in Russia were antigenic ally related to the strains recommended by WHO for vaccine composition for the Northern hemisphere with the exception of two seasons when an unexpected replacement of the influenza B Victoria lineage by Yamagata lineage (2007-2008) and the following return of Victoria lineage viruses (2008-2009) was registered. Influenza surveillance in Russia was improved as a result of enhancing capacity to international standards and the introduction of new methods in NICs such as rRT-PCR diagnosis, regular testing of influenza viruses for susceptibility to antivirals, phylogenetic analysis as well as organization of sentinel surveillance in a number of Regional Base Laboratories. Improvements promoted rapid recognition of the appearance a new pandemic virus in the country and enhancement of confirmation tests in investigation of influenza related death cases.

Tuberculosis surveillance and control in Germany — An application of the Berlin Declaration Monitoring and Evaluation Framework

In 2007, the 'Berlin Declaration on Tuberculosis' (BD) was signed by the Ministers of the WHO European Region Member States (MS) to address the re-emerging threat of tuberculosis (TB) by fully implementing the Stop TB strategy. WHO Euro developed a Monitoring and Evaluation (M&E) Framework using programmatic and epidemiological indicators to follow-up the BD from 2013 onwards. Ahead of this, we explored the Framework performance for Germany, a low TB incidence country. We selected from a surveillance perspective on five country-specific indicators asked for all MS. Information sources included guidelines, notification data and laboratory quality assurance results. As to national TB guidelines (indicator 1.1.1), up-to-date guidance documents are available. Regarding external quality assurance (3.2) proficiency testing confirms high quality of culture and drug-susceptibility testing. M/XDR-TB prevention and control is reflected by a 1.7% MDR-TB rate in 2010 with decreasing tendency (4.1.2). As to treatment success (5), the WHO target of 85% is reached for all age groups except the elderly ≥60 years. Germany disposes of an electronic case-based surveillance providing evidence for TB policy and practices (5.2.2). The selected M&E Framework indicators proved well applicable to a low-incidence country. The results show no specific gaps in TB surveillance and control in Germany.

Targets for health in Europe: the debate continues

The WHO European Region covers three quarters of a billion people, in 53 Member States, and reaches west–east from the Atlantic to the Pacific. Under a recently joined Regional Director, WHO European Region (WHO EURO) is reviewing its health strategy. Stein et al 1 have provided an update on thinking about health targets that were first proposed (38 targets) in 1984, and again (21 targets) for the Health in the 21st century strategy in 1998. In the past decade, WHO EURO member states have used national targets for national health strategies; and although headline health indices (mortality rates) were diverging, recently there have been improvements in all parts of the region—even against the trend of the economic downturn (figure 1). But this time, following consultation, the new targets are proposed only for the WHO European Region itself (i.e. at supranational level), whereas the progress of member states will be ‘monitored’ within the entire region. Do member states disagree with the concept of national targets? Are they concerned about differences between the member states? …

European Public Health News * President's column * EUPHA office column--EUPHA 1992-2012 * Message from the World Health Organization Regional Director for Europe Healthy Ageing in Europe: Empowering More People to Remain Active and Healthy at Higher Ages * European Commission Proposes Measures to Better Protect Europeans from Serious Cross-border Threats to Health * Malta 2012 5th Annual European Public

In this European public health news, the main themes are management and leadership. Ricciardi starts with concluding that management is of vital importance, but leadership even more so. Zeegers Paget follows with discussing leadership of and within EUPHA. Jakab presents the leadership of WHO EURO in this year of healthy ageing, followed by Takki and Ryan who describe the proactive management by the EU to protect Europeans from serious cross-border health threats. It all shows that leadership and management are basic necessary skills to further European public health. # President’s column {#article-title-2} Some people, use and have used the word manager and leader as synonyms. However there is increasing agreement of the fact that leadership and management are different activities although many managers also are leaders. Perhaps one way to describe it now is to say that all leaders also have to manage but not all managers are leaders. So what is leadership and how does it differ from management? This is not an easy question to answer because, as always happens, the more widely a term is used the more meanings it acquires. One approach is to define management as primarily concerned with the running of an operation. In the excellent book called Trying Hardest Is Not Good Enough, a very important book for everyone involved in healthcare although it is primarily about education, Mark Friedman says that management is ‘the day to day a month to month running of operations’. Leadership is more than management and John Kotter, another very influential writer, distinguishes the two clearly. There are probably two features of the work of the leader that are crucial. One is that the leader has to help people adapt to bad news, to reframe their view of the world and to help them overcome significant problems. The other is that the …

European Accreditation of Public Health Education

The European Agency for Accreditation in Public Health Education (APHEA) was launched in 2011. This followed nearly two decades of efforts in a variety of programmes supported by international donor agencies, and others that provided experience and field testing of peer review systems for schools of public health in Europe. The Association of Schools of Public Health in the European Region (ASPHER) Public Health Education European Review (PEER) project, devised with the aid of WHO EURO in the early 1990s and later by the Open Society Institute (OSI) within the framework of a joint ASPHER-OSI Program from 2000–2005, helped to develop a cadre of expertise on the process of international peer review and standards that are compatible with a full accreditation process.The purpose of this paper is to provide a brief overview of the background, criteria and current pilot phase of European accreditation for the Master of Public Health degree and equivalent study programmes. Undergoing the accreditation process will help longstanding and new schools review their programmes to meet new European accreditation system standards and provide students, graduates and potential employers with confidence in the future acceptability of their credentials. The new accreditation agency was established by a consortium of European public health organisations and represents a new phase for development of standards and quality of education systems in Europe to face the challenges of workforce development for a “New Public Health” era in the 21st century.

Zsuzsanna Jakab: WHO's Regional Director for Europe

Zsuzsanna Jakab: WHO's Regional Director for Europe

Drowning Rates in the Newly Independent States & Russian Federation: A Call for Research and Action

Drowning is the second leading cause of unintentional injury deaths worldwide after road traffic injury deaths, claiming approximately 450,000 lives every year. Overall male drowning rates in the Newly Independent States and Rus- sian Federation are dramatically higher than the rates in Western European countries; the highest male drowning rate in WHO Euro region, drowning rate in Belarus, is 50 times higher than the lowest, the drowning rate in the United Kingdom. 1-4 age group male drowning rate in Turkmenistan is alarmingly high. More research is needed to determine the risk fac- tors of child and adult drowning in each of the Newly Independent States and Russian Federation.

Can the WHO Ministerial Forum lead to the eradication of TB?

The WHO EURO region's Ministerial Forum1 on tuberculosis on Oct 22, 2007, in Berlin will bring together European ministers of health, finance, justice, and foreign affairs to declare tuberculosis as a regional health threat and to announce new political and financial commitments to tackle the threat. But, as in the European framework to decrease the burden of TB/HIV,2 the perspective of the threat is from within the regional boundaries of Europe and overlooks the threat from the devastation caused by tuberculosis outside Europe.

Zsuzsanna Jakab—Director of the European Centre for Disease Prevention and Control

Zsuzsanna Jakab was the former Secretary of State in Hungary's Ministry of Health. As the most senior civil servant at the ministry she was responsible for overseeing Hungary's implementation of European Union (EU) policies and laws in her area, administering the spending of EU financial assistance, and managing Hungary's national public-health programme. She worked as a Director in the WHO Regional Office for Europe (WHO Euro) for 11 years before being invited to join the Ministry of Health by the Hungarian government in 2002.