Capacities of Literate Individuals Literacy August 19, 2011 Cecil County Public Schools.
Public Health Capacities in Europe · Public Health Capacities in Europe (preliminary results)...
Transcript of Public Health Capacities in Europe · Public Health Capacities in Europe (preliminary results)...
Public Health Capacities in Europe (preliminary results) European National Public Health Institutes Directors’ Meeting 5th - 6th November 2011, Poznań Helmut Brand, Professor of European Public Health, President elect ASPHER
Public Health capacities in Europe are…
1 …the level of organisational, human, financial and
other resources that enable actions to be taken by responsible authorities to improve health and reduce health inequalities (working definition; EAHC, 2009).
2 …the combination of available infrastructures, resources and people’s competencies to achieve the desired public health goals (PAHO, 2007).
3 …the activities or interventions which aim to change a system’s ability to address health issues by creating new structures, approaches and/or values (Bagley and Lin, 2009).
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Relevance to EU
The “Third Public Health Revolution” has confronted the European public health communities with changing goals, approaches and actors. Respective public health capacities need to be adapted and strengthened accordingly.
Need for greater capacity in public health delivery recognized in the EU Health Strategy 2008-2013
Sustainability of public health capacities threatened across Europe in times of economic crisis
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Health effects of financial crisis: omens of a Greek tragedy
www.thelancet.com Published online October 10, 2011 DOI:10.1016/S0140-6736(11)61556-0
Alexander Kentikelenis, Marina Karanikolos, Irene Papanicolas, Sanjay Basu, Martin McKee, *David Stuckler [email protected] *Department of Sociology, University of Cambridge, Cambridge CB2 3RQ, UK (AK, DS); European Observatory on Health Systems and Policies (MK, MM) and Department of Public Health and Policy (SB, MM, DS), London School of Hygiene and Tropical Medicine, London, UK; Department of Social Policy, LSE Health, London School of Economics and Political Science, London, UK (IP); and Department of Medicine, University of California San Francisco, San Francisco, CA, USA (SB)
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Kentikelenis A, et al. www.thelancet.com Published online October 10, 2011 DOI:10.1016/S0140-6736(11)61556-0
Greece compared 2007 – 2009 Cuts in hospital budgets - 40% - admissions public hospitals +24% - admissions private hospitals - 25%
Suicide-rates - 2007 – 2009 + 17% - 2009 – 2010 (inofficial) + 25% - 2010 – 2011 (inoff., 1. quarter) + 40% - “financial difficulties” mentioned
in call to national suicide helpdesk 25%
Homicide and theft + 100% HIV infections (2010 -2011) + 52 % NGO street clinic visits was 3%, now 30% Alcohol consumption down Drink-driving down
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Life expectancy at birth, in years
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Healthy Life Years at birth male 2009 (IT, UK 2008)
Eurostat 2011
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Healthy Life Years at birth female 2009 (IT, UK 2008)
Eurostat 2011
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Jagger C et al. Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 2008;372:2124-31
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Life Expectancy in Germany: 1952 - 1990
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Life Expectancy in Germany: 1956 - 2007
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Aims and objectives of the assessment
1. Carry out a detailed review of the capacity in the EU Member States to develop and implement public health policies and interventions;
2. Identify the main strengths, weaknesses, opportunities and threats (SWOT) for public health in the EU;
3. Make recommendations for action;
4. Identify key gaps in knowledge.
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Mixed methodology
Literature review to develop a conceptual model and a questionnaire for the assessment;
Assessment at country level with closed and open questions answered by national experts and validated by focus groups;
Quantitative and qualitative analysis of the national assessment;
Case studies to provide more in depth information of the capacity to develop and implement a certain policy or intervention addressing emerging or new issue for public health;
Appreciative inquiries and policy dialogues with national experts to develop recommendations for EU Member States and the EU.
Country specific context with relevance for public health
Capacity for public
health
Workforce Availability and distribution
of workforce
Training and development
Public health competencies
Professional associations
Leadership &
Governance Responsibilities for public
health
Policy making for public
health
Expertise within MoH
Leadership qualities in the
health sector
Strategic visioning and
systems thinking
Financial resources Financial resource
generation
Financial resource
allocation
Partnerships • Formal partnerships
• Joined up government
• Informal partnerships
Organizational Structures Institutional capacity for
public health
Program delivery structures
Public health aspects of
health care services
Capacity to respond to
emergencies
Knowledge Development • Health information and
monitoring systems
• Public health reporting
• Research and knowledge
infrastructures
(Very) general results
Across Member States (MS) there is a need for:
1. More “good governance” including political commitment and effective public health policy formulation, implementation and evaluation;
2. A stronger focus on “new” public health measures;
3. More financial resources and sustainability of systems (in the light of the financial crisis);
Notably:
4. „Traditional‟ country-clusters did not emerge from assessment (e.g. “old” vs. “new” MS, rich vs. poor MS, tax based vs. social insurance based MS)
National context & Leadership and Governance
+ Formal recognition that PH is important
+ National strategies formally exist
+ Many professional organisations and associations exist to advocate for PH issues
- PH Priorities often politically rather than evidence-based
- Instability over political cycles / dependence on political will
- Public health as a „soft‟ political topic
- Health care often dominates political debate
- Monitoring and evaluation of policies weak
Organizational structures
+ Infrastructures for communicable disease control, hygiene and health protection widely exist
+ Many public health related programmes and projects in MS
+ Need for collaboration between public health and health care has been recognized and some collaborations and distributions of tasks have been established
+ Well functioning PH emergency response systems
- Capacities of local institutions often weak to face population needs
- Large differences in capacities of organizations across regions and municipalities
- Health care and public health linkages still underdeveloped
- Weak collaborations between organisation
- Limited sensitivity for differences in population groups and minorities
Workforce
+ Many people (indirectly) involved in public health activities
+ Generally good training and education capacities
+ Growing number of university graduates with PH degrees
+ High quality research capacities
- No idea of size and nature of „public health‟ workforce
- Weak capacity in rural areas
- Career pathways poorly developed and few plans for PH workforce development
- Many people focused on traditional health protection measures rather than on Social Determinants (SD) or Health Inequalities (HI)
- No agreed competency framework for PH workforce
Financial resources
- Difficult to precisely identify and enumerate the financial resources for public health
- Limited financial resources for PH programmes and projects (and in some countries shrinking, although demand is likely to increase)
- Financial crisis
- Strong imbalance in favor of
curative health services is reflected in funding
+ Various public sectors make financial contributions to public health issues (and are not labelled as such; e.g. road safety campaigns)
Partnerships
- Weak links between academia and policy makers
- Intersectoral action weak
- „Public health‟ has not gained much prominence in other sectors (little acknowledge-ments of health impacts)
- Skepticism regarding partnerships for public health between the private and
public sector
+ Collaborations exist at EU and international level
+ Various public institutions are involved on specific PH issues and Ministry of health is not the only Ministry that initiates public health activities
+ Partnerships with other
sectors at local level to deliver public health
Knowledge Development
+ Good knowledge of health status (in most countries)
+ Available expertise and capacity to carry out research about effectiveness of PH policies and practice
+ Some information sharing across institutions and countries
- Funding for public health research is inadequate and research is often medically dominated
- Weak mechanisms to monitor and evaluate public health and health promotion programme implementation
- Weak links between policy makers and academia
Scoring system1
1 2 3 4 5 6
Not developed Not developed but need for
capacity recognized
In early stage of development
Partially developed
Fully developed
Fully developed
and functioning
well
There is no capacity in place in this area or it has
not been considered
There is awareness that
capacity needs to be developed in this area but no steps have been
taken
Objectives for capacity develop- ment in this area
have been set and there have been
some steps taken to develop capacity
There has been partial develop- ment of capacity
in this area
Capacity in this area is fully
developed but it is too early to
assess impact or outcomes
Capacity in this area is fully
developed and results show that it is achieving its
objectives
[1] This scoring system is adopted from Fawkes S. & Lin V. (2005), Rapid Assessment of National Health Promotion Capacity: A Dialogue-Based Tool And Manual For Use In Countries In The Western Pacific Region. WHO Regional Office of the Western Pacific Region. It is also used by Spence K. (2007). Health
Communication/Promotion Capacity Mapping Questionnaire for the UNICEF CEE/CIS Region.
Green line: capacities fully developed and functioning well Red line: EU-average
EU-average
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Leadership & Governance
Organisational Structures
Workforce
Financial Resources
Partnerships
Knowledge Development
Green line: capacities fully developed and functioning well Red line: national scores
Leadership &Governance
Organisational Structures
Workforce
FinancialResources
Partnerships
KnowledgeDevelopment
Germany Leadership &Governance
Organisational Structures
Workforce
FinancialResources
Partnerships
KnowledgeDevelopment
Greece Leadership &Governance
Organisational Structures
Workforce
FinancialResources
Partnerships
KnowledgeDevelopment
Hungary Leadership &Governance
Organisational Structures
Workforce
FinancialResources
Partnerships
KnowledgeDevelopment
Ireland
Leadership &Governance
Organisational Structures
Workforce
FinancialResources
Partnerships
KnowledgeDevelopment
Italy
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Spidergrams were built on the basis of standardized scores. The scores indicate relative strengths and weaknesses in each particular country, regardless of the country‟s absolute level of capacities
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Recommendations to the EU
Final report:
“The findings of this report reiterate the importance of on going EU / DG SANCO activities, which contribute to strengthening public health capacities in the Member States.
In the light of the economic crisis the EU activities form an important pillar of continuity.
To further strengthen and support Member States in building additional capacities for public health, the EU should maintain the current activities and, if necessary ensure their sustainability and effectiveness.”
Recommendations to the EU (selection)
Facilitation of EU Structural Funds for investments in public health infrastructures;
Creation of an integrated European strategy for public health research and innovation, with appropriate expert advisory structure and levels of funding;
Identification and development of tools and mechanisms to support translation of research into policy;
Support of the development of core competencies and definitions of roles and responsibilities for the public health and health promotion workforce;
Utilization of the existing consortium of European health organisations and key experts that responded to this study to take forward the recommendations as a dedicated public health capacities network and platform for exchange of information.
Public Health Capacities in Europe The team: Christoph Aluttis (Maastricht University), Britta Baer (EHMA), Floris Barnhoorn (EUPHA), Helmut Brand (Maastricht University), Stephan van den Broucke (Université Catholique de Louvain), Cristina Chiotan (EuroHealthNet), Caroline Costongs (EuroHealthNet), Elisabeth Jelfs (EHMA), Diane Levin-Zamir (IUHPE), Kai Michelsen (Maastricht University,) Robert Otok (ASPHER), Bernd Rechel (European Observatory on Health Systems and Policies)
The Key Experts: Roza Adany (Hungary), Tit Albreht (Slovenia), Colette Andrée (Luxembourg), Dace Beināre (Latvia), Miriam Camilleri (Malta), Teresa Contreiras (Portugal), Antonio Daponte Codina (Spain), Antonio G. de Belvis (Italy), Lieven de Raedt (Belgium), Antoine Flahault (France), Florentina Furtunescu (Romania), Anita Gębska-Kuczerowska (Poland), Ramune Kalediene (Lithuania), Zuzana Katreniakova (Slovakia), Ilmo Keskimäki (Finland), Niek Klazinga (The Netherlands), Heli Laarmann (Estonia), Tina Lesnik (Slovenia), Cristina Mattsson Lundberg (Sweden), Terese Otte-Trojel (Denmark), Constantinos Phellas (Cyprus), Anastas Philalithis (Greece), Petko Salchev (Bulgaria), Norbert Schmacke (Germany), Eva Schwarz (Austria), Martin Sprenger (Austria), Liina-Kaisa Tynkkynen (Finland), Jaroslav Volf (Czech Republic), Jenny Wright (England/UK)
The report will soon be available at: www. inthealth.eu or contact: [email protected]
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Summary of all EU recommendations • Build capacity for strategic planning, development and implementation of public health measures at national, regional and
local level and use the existing consortium of European health organisations and key experts that responded to this study to take forward the recommendations as a dedicated public health capacities network and platform for exchange of information;
• Create an integrated European strategy for public health research and innovation, with appropriate expert advisory structure and levels of funding; give relative more emphasis to public health research, compared to pharmaceutical, biomedical and biological research, and at the same time close the existing research capacity gap on public health between EU countries;
• Develop long term EU strategies for public health capacities and support Member States to follow up long term strategy planning and ensure sustainability of resources needed for design and implementation of public health policies;
• Facilitate EU Structural Funds for investments in public health infrastructures, public health capacity building efforts and measures supporting “good governance”‟; public health issues are currently still underrepresented within the EU Structural Funds process;
• Communicate better the different initiatives and outcomes from EU funded projects, networks or partnership programmes that facilitate knowledge and information exchange, in particular about those public health capacities that are required for needs oriented, effective and sustainable health systems;
• Develop, improve and disseminate use of Health Impact Assessment Tools; increase awareness and knowledge for Health in All Policies approaches to address the socio-economic determinants of health and support capacity building for partnership development
• Encourage stronger collaborations between public health and health care services to increase the role of health care services for health promotion and diseases prevention and maximise other potential benefits;
• Build leadership capacities for advancing the public health agenda among policy makers, making the economic case for public health and health promotion and to develop collaborations and partnerships with other sectors;
• Develop tools and methodologies for monitoring and evaluation of policies and programmes, including distributional impacts across the gradient, and support capacity building at Member State level for harmonized health information systems;
• Support the development of core competencies and definitions of roles and responsibilities for the public health and health promotion workforce in light of the current social, economic, demographic and health challenges; encourage the development of public health training for officials or professionals working in other policy sectors;
• Support the development of guidelines for quality assurance in public health services; • Develop research on how to balance foreseen shortages in the public health workforce e.g. by societal innovations like
home based services and community development approaches; • Support identification and development of tools and mechanisms to support translation of research into policy; promote
good practices and develop capacities for data analysis and knowledge transfer into policy recommendations and actions.
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References
• Bagley P, Lin V. The development and pilot testing of a rapid assessment tool to improve local public health system capacity in Australia. BMC Public Health 2009;9:413.
• Executive Agency for Health and Consumers (EAHC) Call for tender n° EAHC/2009/Health/05 concerning developing public health capacity. [Online] 2009.
• Pan American Health Organization (PAHO). Public Health Capacity in Latin America and the Caribbean: assessment and strengthening. Washington DC: PAHO, 2007.
• World Health Organisation Regional Office for Europe. Strengthening Public Health Capacities in Europe. A framework for action. Copenhagen:WHO, 2011.
Thank you for your attention! ... and see you in Europe