Dear colleagues,

CALL FOR NOMINATIONS PHPP SECTION PRESIDENT 2023-2025

As announced in the previous Newsflash we now invite nominees for the elections of the new PHPP section President to be installed at the Berlin conference, November 2022.

Rewards of being a PHPP section President

In our view, we have experienced these six years as very rewarding professionally and personally. To us, it is

• A way of making (policy, administration and political) science more serviceable to regional, national and EU level policymakers, managers, practitioners and other public health (sub)disciplines;
• An opportunity to set EUPHA members’ agenda for under considered issues and topics;
• A great way of expanding, advising, mobilising and enacting professional networks within EUPHA and with external collaborating partners, such as European Health Forum Gastein; WHO Europe; European Observatory on Health Systems and Policies; European Consortium of Political Research, European Health Policy group, European Health Management Association, just to name a

With currently 4329 section members across the world (doubled since  2016),  and 771 followers on Twitter, we are fully confident that there will be quite a number of applications from you to continue this work according to your own values and ambitions, mastering your talents and capacities for the  greater good of health

Rules

• There is a three-year term for acting section presidents.
• After 3 years, the president can be re-elected for a second term;
• After two terms the president must step down and organize section elections.
• The vice-president can nominate for president;
• The new president appoints the vice president.

Tasks

• Set the section’s agenda in deliberation with the vice president, the section Advisory committee and working group, develop plans and allocate tasks.
• Developing topical events such as conference workshops, satellite events, webinars etc in collaboration with other EUPHA sections as well as with external collaborative partners;
• Communicating news, events, developments and member news through the social media channels, such as the Section Newsflash (2x a year); Twitter; LinkedIn group; etc.

More information: https://db.eupha.org/public-health-policy-and-politics.

General job requirements

1. Be a EUPHA member;

The section president has:

2. an ambition and dedication to build and facilitate a growing, thriving and impactful section community;
3. clear affiliations with public health policy analysis, with a minimum of 5 years of work experience in a relevant scholarly or health policy and public decision-making environment.
4. an interest in facilitating and/or developing further health political science and policy systems analysis and evidence for effective public health advocacy and action;
5. an international and relevant network that can provide synergies with the PHPP section.

Procedure

The call for nominations will be closed on August 31. Send in your resume and short motivation letter to marleen.bekker@wur.nl.

September 2022 The nominations are to be sent to office@db.eupha.org and a first check on EUPHA membership is made. A conflict of interest form needs to be signed by the candidates.

October 2022 The nominations are then  send  to the President and the steering committee to discuss the nominations. President informs section members on the nominees and set a deadline for voting. Voting will be open from October 1 until October 15. People can vote by email to office@db.eupha.org.

Early November 2022 The office informs the president and the steering committee, who will then inform: the person elected and the section members on the election result.

We now welcome your applications!

ACCEPTED WORKSHOPS 2022

We are (co-)organizing 5 accepted workshops, and a Preconference event at EPH 2022!

1. Preconference event: Evaluating implementation of public policy for the promotion of physical activity and healthy nutrition: Why, how and what should this involve.

9 November 2022, Berlin, half-day event

Organized by the JPI Healthy Diet for a Healthy Life (HDHL) Policy Evaluation Network & PHPP section

Workshop Description:

Urban cities host over half the world’s population and their growth is projected to increase in the foreseeable future. Within these urbanised food and physical activity (PA) systems, promoting health enhancing behaviours and sustainability is challenging. Indeed, the UN Sustainable Development Goals blueprint highlights the need to ‘make cities and human settlements inclusive, safe, resilient and sustainable’. A need to move beyond the individual behaviour change to broader policy or systems-based approaches is needed. For Governments, the concept of a ‘best buy’ in public health interventions is associated with evidence of effectiveness, rationale for need and applicability to the target population. Yet, in public sector policy the concept of a ‘best buy’ is far from clear. Indeed, the ‘best buy’ indicators (from a scientific perspective) may not be politically relevant (due to context) and/or difficult to obtain.

The aim of this workshop is to share the learnings from the Policy Evaluation Network on examining public policy development, implementation and evaluation in food and PA and present strategies for improved policy evaluation. This workshop will explore the tensions that exist in identifying policy ‘best buys’, the impact of different stakeholder perspectives’ on agreeing ‘best buys’, and the associated issues of implementation and monitoring for accountability at city and national levels.

To begin the workshop our experts will give presentations from the EU Policy Evaluation Network (https://www.jpi-pen.eu/), INFORMAS (https://www.informas.org/) and others designed to advance our understanding of the potential for policy intervention to change environments and behaviour. Next, we will present strategies by which we can obtain better data for policy evaluation and how we can provide actionable knowledge for policy makers to create healthier physical activity and food environments. We will focus on policies that are good for the planet, publically acceptable and good for the economy. The team of experts will provide tailored feedback to the small groups as their ideas are flourishing, and drawing on examples from physical activity and food policy, participants: 

• Explore recent rapid developments in physical activity national and local policy development, and learn from the successes and challenges of the globally relevant food policy examples;
• Explore the tensions that exist in developing and implementing physical activity/Food policy.
• Review indicators and methods for monitoring implementation of policy and discuss the challenges in obtaining the data needed for outcome evaluation.
• Participants will discuss opportunities to influence local food and physical activity policy to follow best practice in developing a healthy, sustainable, and resilient system which underpins national and international policies.

The full programme will be published on the conference website soon.

Registration: €75,00

Conference workshops 10-12 November

1. Health in all Policies: key driver for better health still awaiting of greater governing stewardship

Organisers: EUPHA-HIA, EUPHA-PHPP, EUPHA-ECO, EUPHA-LAW

Workshop abstract

Healthy public policies are those that take accountability of all possible health impacts, acknowledging the causal pathways resulting from the modification of upstream health determinants (e.g. transport strategies, etc.), and related risk factors downstream (e.g. air pollutants). The strategy of Health in All Policies (HiAP), promoted by the World Health Organization (WHO) and adopted by the European Union (EU) in 2006, reinforced the need to reduce inequalities and improve health and wellbeing as essential pillars for a sustainable economic development. Central to HiAP is the notion that health is not only the responsibility of the health sector, but also a shared responsibility with many other sectors. In this context, Health impact Assessment (HIA) was proposed as the combination of methods to support HiAP implementation by providing scientific evidence on the positive and negative effects that any new proposal may have on health and health equity. The COVID-19 pandemic, and the climate change threat, are two of the main challenges that emphasise the need of integrated responses across many sectors to mitigate not only effects on health and inequalities, but also in the economy.

However, HiAP and HIA implementation remains almost at a conceptual level, with a few remarkable exceptions in Europe. One of the most relevant reported barriers contributing to this uneven HiAP implementation is the lack of political stewardship and commitment. The difficulties in applying the guiding principles of HiAP (and consequently of the HIA) at the highest governance level (local, region, or national), are in many cases linked to a conflict between the right to work and the mobilization of the economy, with the right to health and the reduction of inequities. This is where the role and drive of public health actors

comes across, as HiAP requires public health professionals to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity, external to the health sector. A good proxy example to HiAP implementation, facilitating local and regional initiatives with communities, is the WHO initiative of Healthy Cities.

The present panel discussion intends to analyse, from different perspectives, why HiAP has not gained a meaningful place within governing contexts, the current and future status of the intersectoral approach, and the advocacy role of public health in this context. The session is scheduled with a first overview presentation followed by a debate framed around the following aspects:

• Different perceptions regarding the concrete implementation of HiAP at the all political levels
• Perceived barriers or trade-offs for a broader implementation of HiAP
• Role of public health actors in the implementation of HiAP at a strategic, policy level, and how it could gain a more prominent role
• Level of understanding and awareness of the utility of HIA for HiAP implementation by public health actors.

Presentations

1. Health in All policies: what do we mean and where are we now?

Liz Green, Programme Director of HIA, Public Health Wales, Wrexham, United Kingdom; and Visiting Professor for ‘Healthy Urban Enviro, University of West of England, Bristol, United Kingdom

This presentation sets what HiAP is and is not, and its evolution since it was conceived. It also addresses how HiAP can be mobilised in practice via the use of tools such as HIA and the key role that enabling structures and contexts – both politically strategic and locally operational- to ensure that health, wellbeing and equity is promoted in the European region. It discusses the enabling context of Wales, with the Future Generations (Wales) Act 2015, which provides political leverage for the implementation of HiAP in practical terms, enabling addressing health considerations intersectorially by non-health policies and projects.

This Act along with supporting documents, guidance and legislation implicitly incorporates the principles of HiAP so the rest of non-health sector understand (and also have the statutory obligation) to address the health considerations of policies and plans. It does this by requiring all public bodies in Wales to strive to maximise 7 Well-being Goals – which include ‘A healthier Wales’, ‘A more equal Wales’ – and requires that they do so by working with other agencies in order to prevent negative impacts and promote participation, long-term thinking and integration to ensure that inequalities are minimised. These are key public health principles from which to have conversations. Wales also provides a good example with its advocacy and policy in respect to Economies of Wellbeing – a critical challenge for HIAP is that HiAP is, by its nature, political, and may challenge some policy proposals. Although the focus is on identifying ‘win:wins’ and co-benefits, sometimes there is a conflict between health and other outcomes. There may be a need to balance health gains against economic growth or other policy aims. The following debate intends to discuss the challenges and enablers to achieve that aim, and how public health can make its voice heard.

1. Alternative routes to HiAP implementation

Marleen Bekker, President of EUPHA-PHPP section; and Health & Society group, Center for Space, Place, and Society Wageningen University, the Netherlands

From a public health political science perspective there are alternative routes to HiAP. Besides the ‘classic’ HiAP approach seeking government internal departmental alignments, facilitating and rewarding bottom up social initiatives by communities, or marketed health innovations by commercial health-related consultancies and enterprises, and regional (socio-)economic innovation networks that after a developmental stage can start to pressure multi-level governments for action. A final route lies along the litigation path (Think of climate agreements and governments being held accountable by the judiciary to comply with agreed emissions reductions etc.)

1. Economics and health economics as a major determinant towards HiAP

João Vasco Santos, President of EUPHA-ECO section, EUPHA, Utrecht, Netherlands; MEDCIDS – Department of Community Medicine, University of Porto, Porto, Portugal; and CINTESIS, Center for Health Technology and Services Research, Porto, Portugal

COVID-19 pandemic response was an opportunity to advocate for HiAP as everyone developed opinions on how policies could affect the different dimensions, including health and economy. Health planning, from the local to the international level, is the main setting where we still need to advocate for the inclusion of all political sectors and actors in order to ensure an effective HiAP implementation.

From a more technical perspective, there is still a lot to do when it comes to implementing and improving economic evaluations, including on data on costs, valuing benefits or using cost-effectiveness approaches.

1. Reflections

Nikhil Gokani, Vice-president EUPHA LPH, EUPHA, Utrecht, Netherlands and School of Law, University of Essex , Essex, United Kingdom.

2. Workshop: Public health of the future: innovations in surveillance, communication and knowledge translation

Organiser of the workshop: SESPAS, co-organisers: PHPP section – ASPHER

Presenters: Enrique Bernal and María Gabriela Barbaglia

Panellists:

• Manuel Franco: Universidad Alcalá, Alcalá de Henares, Madrid, Spain; Epidemiology Department, John Hopkins Bloomberg School of Public Health, Baltimore, MD, Estats Units. Manuel.franco@uah.es
• Sofia Ribeiro: PHPP section EUPHA; Maastricht University, Maastricht, the Netherlands. sofiafigribeiro@gmail.com
• Robert Otok: ASPHER Director

The social, ecological, economic and health crises exacerbated by COVID-19 pandemic are challenges of extraordinary magnitude and complexity for global public health. Moreover, the context in which the pandemic emerged was characterized by underinvestment in public health and growing distrust in institutions. Public health responses were often fragmented and failed to make use of existing resources and expertise.

Nearly 3 years after the start of the COVID-19 pandemic much has been learned and much is still to be learned. Accordingly, European national public health agencies have been pushed to their limits and currently face an urgent need to be renovated incorporating innovations in surveillance, communication and knowledge translation. National agencies should network and collaborate at the EU level. EUPHA may play an important role in this effort. 

On the one hand, there is the need of improving surveillance of harmful effects of the pandemic, specifically the health inequalities aggravated at local, national and global levels; and, on the other, to improve the availability of this knowledge to policymakers. Public Health communication needs to be further developed as it has been a crucial piece of national and international efforts to protect and promote health in the pandemic and so will be in the future.

With this workshop proposal, we would like to bring up for discussion how could we further improve surveillance, communication and knowledge translation to policy makers and citizens in our European national public health agencies. Innovative and updated public health agencies will help regaining trust and strengthening public health institutions. National and European Public Health further development is essential and should be strengthened to protect and promote European population´s health.

The objectives of the workshop are:

• To discuss key innovations to implement in national public health agencies to improve surveillance, communication and knowledge transfer to policy makers and citizens.
• To reflect on supranational European coordination mechanisms that would allow for efficient surveillance and a rapid and adequate response to different public health challenges, including social inequalities in health.
• To manage public health intelligence in the European Health Data Space and the role of public health in this data lake design.

Key messages:

1. COVID19 pandemic has revealed the challenges of creating strong trustworthy national public health institutions to ensure the integrity of public health
2. Structures to facilitate timely and efficient monitoring requires national and supranational coordination mechanisms, including data and experience sharing.
3. Workshop: Breaking the barriers: gender equality and women empowerment in public health practice

Organiser: EUPHAnxt, EUPHA-PHPP, EUPHA SDG5 WG

Abstract

Gender equality is an issue in the public health arena. Though women make 70% of the healthcare workforce, there is an average 28% pay gap. (WHO, 2019). Other barriers have been identified in the literature. (Lancet, 2019) Work–life balance, gender discrimination, sexual harassment or assault in the workplace are pointed out in research studies. Consequences of poor work-life balance include insufficient time with families, difficulties in handling work and all household responsibilities, affecting childbearing decisions. Women also decline leadership opportunities, such as promotions and committee chair positions, because of family obligations. Gender discrimination included feeling inferior and discouragement from promotions or leadership positions on the basis of gender. Another identified barrier was the lack of a safe and unbiased system for seeking help following harassment or assault. Issues related to work-life balance became even more apparent during the COVID-19 pandemic, which placed a disproportionate burden in female public health workers. In the recovery phase, we have an opportunity to rethink public health delivery in order to make it a more equal, less biased, and safe place for women. This should be a concerted effort, involving men and vulnerable populations such as trans women and underrepresented ethnic groups, to ensure that no one is left behind.

As one of the leading public health organizations in Europe, the European Public Health Association is committed to join efforts to address this issue in the multiple public health arenas: public health practice, policy and research. This panel discussion is a collaboration between the EUPHA Working Group on gender equality and women’s and girl’s empowerment, the Policy and Practice section and EUPHAnxt, and is for any conference participant that is committed to reducing the gender gap in public health.

The aim of this panel discussion is two-fold. First, we aim at discussing the barriers that female healthcare workers face on an everyday basis, and their impact on their careers. Secondly, we aim at discussing how institutions and individuals can address these barriers and contribute to enhanced gender equality in the public health arena.

Following panelists’ interventions (additional speakers have been invited and will be confirmed at a later stage), the audience will be invited to participate in a discussion on gender barriers they have experienced and how those could be addressed.

Key message 1 :

Public health practice still faces several barriers to gender equality.

Key message 2 :

Identifying barriers to gender equality and discussing strategies to overcome them is a step towards achieving gender equality in the workforce.

4. Workshop: Models of care in prison: addressing infectious diseases during and after the pandemic in EU/EEA

Organiser: EMCDDA, WHO, UNIPI, EUPHA-PHPP, EUPHA-IDC

Abstract :

 According to the latest data, in 2019 about 497,000 people were held in prison on any given day in the EU. However, the number of people who pass through European prisons each year is considerably higher. Due to infrastructural and population characteristics, individuals in contact with the criminal justice system face multiple and complex health care issues, including a higher prevalence of communicable diseases than the general population, and severe clinical outcomes when infected.

The high turnover of people coming from the most disadvantaged segments of the population, together with the daily inflow/outflow of prison staff and facilities characterized by overcrowding, poor ventilation increase the risk of air-borne virus outbreaks.

People living in prison are substantially more likely to experience drug-related problems than their peers in the community. Incarceration is associated with increases in blood-borne diseases-related risk behaviour among people who inject drugs. People living in prisons, because of the scarcity or lack of availability of needles, syringes and condoms, often share injecting equipment, tattooing and shaving materials, and practice unprotected sex.

Individuals in contact with the criminal justice system often come from marginalized groups of society with a higher burden of poverty and discrimination, and with limited access to healthcare. Despite tailored preventive interventions should be implemented among vulnerable groups at the community level. Prisons can represent a point of access to integrated prison-community healthcare and social services. Delivering health protection and harm reduction programmes in prisons not only benefits the prison population but also has the potential to reduce the risk of transmission of some infectious diseases in the community, intervening earlier in the natural history of disease. The WHO has long supported the concept of prison health as an inseparable component of public health.

However, a number of challenges hampers the successful implementation of such a concept, including the need for evidence-based decision making, inter-sectoral partnerships and adequate monitoring systems. Due to structural and operational reasons, conducting solid research and monitoring activities in prison settings is challenging and often available studies are mono-centric.

This workshop will provide attendees with a comprehensive overview at European level of infectious diseases prevalence in prison populations and health services provided in detention facilities. The discussion of three European project collecting successful models of care for hepatitis elimination and implementation of vaccination services in prisons will create the context for an in-depth analysis of key challenges for prison health implementation and may help promote awareness that targeted interventions are feasible and effective in reducing infectious diseases burden among people living in prison and the community at large.

Key message 1 :

 Existing European initiatives contribute to building the evidence for tailored prevention & control interventions in prison settings

Key message 2 :

 Adequate and effective prisons healthcare contribute to achieving the UN’s SDGs through improving health, reducing health inequalities and providing a fairer and safer society for all

Presentation 1 : Burden of infectious diseases in prison settings and services offered

Presenting author : Dr Filipa Alves da Costa

Introduction

The WHO Prison Health Framework was developed to assess prison health system performance and support Member States (MS) in improving their prison health systems. Moreover, it shall enhance MS capacity to evaluate: the impact of changes in governance models, progress in service provision and improvements of the health status of people in prison (PiP).

Methods

The framework informed the 2021 data collection round of the Health In Prisons European Database Survey. Invitations were sent to all 53 MS of the WHO European Region. Those MS nominating a focal point and providing valid answers were included in the analysis.

Results

Answers were obtained from 36 MS, representing a total of 613,497 PiP. Access to immunization was very good across all MS, with the highest for COVID-19 (90% of MS provide it in all prisons). Vaccination against HBV was only available in all prisons of 25 MS. Access in all prisons to HIV post and PrEP were reported, respectively, by 78% and 58% of MS. Screening for diseases at entrance was common for HIV, HCV and HBV. In all prisons of 35 MS soap was provided for free, while needles & syringes and lubricants were only provided free of charge, respectively, in 3 and 4 MS. 5 MS did not have therapeutic spaces to tackle drug problems in any prison, in 73% of those having, accessibility was restricted to some prisons. HIV prevalence ranged from 0-16% and treatment was accessible to 55-100% of those diagnosed. Prevalence of HCV ranged from 0-34%, with access to treatment ranging from 0-91%. The most common format of health records in European prisons was paper based (44%).

Conclusions

Prison-based data collection systems resulted in limited capacity for extraction so that some countries were unable to provide any data on disease prevalence or treatments offered. Given the scarcity of data on this topic obtained from real-world and not from ad-hoc studies, this snapshot provides an important contribution to public health.

Presentation 2 : Overview of availability of harm reduction interventions in European prisons

Presenting author : Mrs Linda Montanari, S. Mazzilli  , A. Tarján , I. Hasselberg, W. Hall, L. Vandam, A. Vernooij, H. Stöver               

Introduction

Prisons are high-risk environments for the transmission of drug related infections, due to over-incarceration of people who inject drugs; often inadequate healthcare, substandard prison conditions; and others. An overview of the availability and coverage of prison-based harm reduction interventions in Europe is presented.

Methods

National Focal Points of the EMCDDA (30) collected 2019 data, which were integrated with findings from the European funded project HA-REACT (Joint Action on HIV and Co-infection Prevention and Harm Reduction).

Results

Prison based harm reduction interventions are available in European countries, but only few of them are available in most countries and often with a low coverage (e.g. less than 10% of prison population in Opioid Substitution Treatment (OST) in most countries). Interventions available in most countries (20 or more) include: HIV, HBV, HCV testing (29), OST continued from community (29), Referral to HIV treatment upon release (28), HIV treatment (27), Referral to HCV treatment upon release (25), HCV antiviral treatment (25), Testing for TB (23), HBV antiviral therapy (25), OST initiated in prison (22), Treatment for TB (21), Vaccination for HBV (20). Interventions available in 10 to 19 countries are: condom distribution (19), OST (re)initiated before release (17), prison/community guidelines for implementation of OST (13). Interventions provided in <10 countries include: distribution of disinfectant (9), condom with lubricant (9), take-home naloxone (5), needles and syringes programs (3).

Conclusion

Compared to the community, the availability and coverage of harm reduction interventions in European prisons are limited and large information gaps exist. Scaling up harm reduction in prison can achieve important individual and public-health benefits.

Presentation 3 : Viral hepatitis micro-elimination: models of care and barriers to implementation in 5 EU/EEA prisons

Presenting author : Thomas Seyler, L. Montanari, L. Ceccarelli, E. Torri, S. Mazzilli, L. Tavoschi,

Introduction

Coverage of essential prevention and control services and adequate monitoring schemes for viral hepatitis are often suboptimal in prison settings. Yet, evidence shows that targeted interventions are feasible and effective in reducing viral hepatitis burden and decreasing virus circulation among people living in prison and the community at large. To promote transferability and improvement of prison health quality in EU/EEA the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will identify and disseminate models of care for viral hepatitis elimination in prisons.

Methods

The models of care were gathered using a data collection tool that has been designed for this purpose based on the literature review and agreed with an expert advisory group. Based on the results of the data collection, a survey for healthcare staff working in 5 selected prison institutions in the EU/EEA has been developed.

Results

The following models of care were collected: HCV micro-elimination in prison; transitional care for HCV treatment or HBV prevention/treatment; HCV or HBV care services tailored to women living in prison; HBV or HAV/HBV vaccination in prison settings. Harm reduction and drug treatment services in the prison are essential at all steps of the prevention and continuum of care. Among barriers identified were: engagement of people living in prison and prison governance structure, availability of infrastructural and human resources, daily prison organisation, inter-sectorial collaboration within prison and between prison and community services, training for prison staff and lack of systematic monitoring.

Conclusion

Evidence of effective and acceptable interventions in prison to prevent and control viral hepatitis is essential to foster inclusion of prison setting within national elimination programmes. Intra-EU benchmarking may help promote awareness, to allocate adequate resources, monitor of impact and ultimately the achievement of the elimination goal.

Presentation 4 : COVID-19 vaccination in prison settings: a model to design tailored vaccine delivery strategies

Presenting author : Dr Lara Tavoschi, S. Mazzilli, D. Petri, V. Busmachiu, I. Stylianou, F. Meroueh, H. Stöver, A. Rosello, R. Ranieri, L.      Baglietto 

 Introduction

Vaccinations are one of the most powerful preventive tools discovered by modern medicine. Although expanded programmes of immunization are well established in EU/EEA, significant immunity gaps and suboptimal coverage are registered among specific populations, including people living in prisons (PLP). PLP are also at increased risk to vaccine-preventable diseases (VPD) with potential outbreak in prison, e.g. flu, COVID-19, as well as other VPDs such as HBV. The EU-funded project RISE-Vac, aimed at collecting models of care developed during the pandemic to design tailored vaccine delivery strategies that could be extended beyond the sole COVID-19 vaccine.

Methods

Through a survey to healthcare staff working in prisons in six countries of the EU/EEA (Cyprus, France, Germany, Italy, Moldova, UK) we collected information on the implementation of COVID-19 vaccination program. The following areas were investigated: challenges & barriers encountered, workload distribution, education & training activities for prison staff and PLP, referral strategies after release, immunization information system.

Results

The respondents reported that in prisons COVID-19 programs have been implemented efficiently. Strategies for optimal management of the vaccination campaign included: week-day dedicated to vaccination services when vaccines were delivered and immediately administered to overcome cold chain challenges; new staff recruitment & task shifting; administration of booster doses within prison premises for released individuals; distribution of informational material both to PLP & prison staff.

Conclusion

Our results show that universal immunisation campaigns are feasible, acceptable and effective in places of detention when there is commitment to implementing them. Evidence from the pandemic situation may inform future provision of expanded immunization programmes.

5. Workshop: Promoting health without borders: cross-border public health policy in the Euregio Meuse-Rhine

Organiser : EUPHA-PHPP, Gesundheitsamt Düren, Foundation euPrevent

For more than 20 years, different public health institutions in the German-Belgian-Dutch border triangle have been involved in cross-border public health activities. The partners in the Euregio Meuse-Rhine (EMR), as this area is called, have jointly implemented studies on COVID-19 and on adolescent risk behaviour. They have established joint health reporting for various purposes and implemented prevention measures together.

The special problems in the border regions during the Corona pandemic have once again impressively shown how important cross-border cooperation is – also for cross-border public health policy. In the health sector, orientation towards municipal, state and federal borders does not lead to the desired results. The results of the Euregional COVID 19 study of 2021 show that in this way a ‘borderless’ life – and partly also cross-border health care – cannot be adequately served. In fact, in the everyday life of a border community, there is hardly any difference between a district border and a national border. In the EMR, this is exemplary for the entire European Union, with its many national or local responsibilities. For infectious diseases, lifestyle risks, environmental toxins or climate risks, borders have no meaning. For health , however, they do. Cross-border policy and politics is the appropriate response to real European conditions.

The workshop will show the possibilities and results of cross-border policy on the basis of 3 examples from the long-standing cooperation of public health actors from the Euregio Meuse-Rhine. Finally, we will present these factors and put them up for discussion.

From these and other activities, the factors that enable or hinder policy along borders can be deduced. We will present these factors, classify their significance and present the possibility of generalisation for cross-border work for discussion.

Key message 1 :

 Cross-border policy and coordination are the appropriate responses to the current realities in the European Union.

Key message 2 :

 National differences in culture, administration and policy can be obstacles to cooperation; but are usually inspiration for new approaches and input for best practice.

Presentation 1 : Euregional Youth Survey  Structure and results of the cross border youth surveys

1. Philippsen, Dept. Public Health reporting, Gesundheitsamt Kreis Düren

The Euregional Youth Study takes place at intervals of currently 4 years since 2001. The Dutch, German and Belgian municipalities of the Euregio Meuse-Rhine (EMR) can participate. Pupils in the 8th and 10th grades are asked about various topics in an online questionnaire. These include: physical and emotional well-being, physical activity, nutrition, media behaviour, drug use and school behaviour. In 2019, 88 schools with more than 13,500 participants took part.

With its cross-border approach, the study provides the opportunity to compare the living conditions, behaviour and health situation of pupils in the three countries. Ideally, this would result in common policy and prevention approaches and best practice options. For example, there are differences between the regions of the EMR regarding drug use or overweight, while risky media use is rather universal. It is striking that the Dutch participants almost consistently show the best values. It is also important to stress the importance of insight in policy along the border. Changes in policy actions have a huge effect on border regions. Examples are:

The change in drinking age in the Netherlands: from 16 to 18 resulted in organizing their parties in the neighbouring countries.

The change in cannabis policy in the Netherlands in the 2000s, is clearly reflected in the purchasing behaviour of German young people.

Independent of the cross-border aspects, the Euregional Youth Survey provides a standard data set (also with trends over time) for the adolescents of the participating districts, which the local health offices could not realise on their own and which is not self-evident for German municipalities.On the other hand, it is certainly considered as problematic that there is no binding and uniform participation of the EMR partners in the study. This leads to a partial loss of comparability and significance of the Euregional Youth Study.

Presentation 2 : The Euregional policy impact of COVID 19 on the border region between the Netherlands, North-Rhine Westphalia and Belgium

1. Hoebe, GGD Zuid-Limburg, Heerlen, Netherlands; Dept. Social Medicine, University of Maastricht

Maastricht, Netherlands

During the Coronavirus pandemic, internal European borders were temporarily re-established with the argument to mitigate the outbreak. Also in the border region between the Netherlands, North-Rhine Westphalia and Belgium (EMR). Existing evidence on the effectiveness of border control for infectious disease control (IDC) has been dominated by studies that focused on scenarios within countries with limited attention to border regions. To address this gap, we analysed the experiences of public health professionals working in European border regions.

We conducted three studies: 1. seroprevalence and questionnaire study among 10.001 Dutch persons with and without cross border mobility, 2. analyses of incidence data in municipalities in 4 cross border regions to analyse cross border differences, and 3. we conducted 27 semi-structured interviews with public health professionals in the EMR. Participants were asked about their perspectives on border controls and the spread of Covid-19.

Four key-results: First, border regions are characterised by dynamic social life and cross-border movements. Incidence was mainly determined by country policy, Second, the impact of border control and closing on local infectious disease epidemics is likely marginal. Third, due to the dynamic social life, border control measures cannot be fully implemented in border regions, and thus their effectiveness is even more questionable. Fourth, border control measures may harm the social fabric of border regions more than they do in in-countries territories.

Our study results highlighted the ineffective role of border control measures for regional infectious disease control. Sustainable cross-border collaboration is crucial to ensure effective pandemic management in border regions. The results of our study impacted on policy makers, to be much more reluctant with closing borders.

Presentation 3: Euregional Health Atlas: how to use it for cross-border public health policy- Building a common health monitoring platform for the Meuse-Rhine Euroregion.

1. Demarest, Service Lifestyle and chronic diseases, Team Sciensano, Brussels, Belgium

Studies show that European border regions –that account for over 30% of all European citizens- are faced with more deficits. Living in a border region still means fewer possibilities in the fields of employment, mobility, care and well-being. In order to tackle this, an absolute prerequisite is to dispose of relevant and comparable data across borders.

The Euregional Health Atlas is an initiative that aims to collect and to visualize validated and comparable data for the municipalities of the Euregio Meuse-Rhine (EMR: Zuid Limburg (Nl), Zweckverband Aachen (De), the provinces Limburg, Liège, Ostbelgien (Be)). Themes addressed are: demographics (population, socioeconomic status, vulnerable groups), health care (care contacts, difficulties in daily living, chronic diseases, mortality), lifestyle (use of alcohol, smoking, weight, nutrition) and quality of life (perceived health, happiness).

Data used to feed the Euregional Health Atlas are derived from registers, health surveys and from former and current Interreg projects like the Youth Euregional Scan (YES).

During the COVID-19 pandemic, data on the daily number of cases and 7-day incidence, the number of tests performed, the hospitalisation rate and the number of reported deaths related to Covid-19 were processed and presented on our dashboard and this not only for the Euregio Meuse-Rhine, but also for other Euregios.

The Euregional Health Atlas is a work in progress: existing data are continuously being updated to improve their suitability for comparison purposes and new data are added to broaden the perspective. It contributes to knowledge-sharing, mutual understanding and cross-border policy development. The Atlas is a free, easily accessible platform, available for everybody; health care professionals, policy makers and citizens, see www.euregionalhealthatlas.eu!

Presentation 4 : Concept of cross border policy in public health: what is it and how does it

1. Van der Zanden, Foundation euPrevent , Heerlen, Netherlands

Cross-border cooperation depends on many factors. Not least because of the perception of a border and its influence. Literature shows that the perception of a border is different for different stakeholders. A citizen has a different perception of a border than a policy worker of the government. This influences the effects of cross-border policies.

The first three presentations already show this indirectly. Apart from the perception of a border, it is important to look at how cross-border policy in the field of public health is actually made in Europe. On the basis of European policy documents, it has been analysed how policy and policy issues concerning cross-border public health care in Europe are established and what can be deduced from this for policy in cross-border regions such as the EMR. Elements in this are the ‘existence’, ‘genesis’, ‘influencers’ (+/- stakeholders) of cross-border policy and the potential relation with public health.

Questions that will be addressed during the presentation are: What does cross-border policy look like? Is this also available in the field of public health? When yes how has this come about (genesis)? How is this concept of cross-border policy influencing the current way of looking at cross-border public health? Are there currently main ‘influencers’ that have impact on creating cross-border public health policy?

Best regards,
Marleen Bekker
Wageningen University & Research