Interview with Nathalie Chaze

 

Chaze N

Nathalie Chaze, Head of Unit Health Systems at DG Health and Consumers, European Commission

 

 

 

 

What has the EU done so far to empower patients? The Young Gasteiners have held a workshop on cross border healthcare, does it contain empowering measures?

The EU has taken action to empower patients in patient safety. The Council recommendations on patient safety of June 2009 contain the provision that patients should be informed and empowered by involving them in the patient safety process. The EU is monitoring progress on implementation of the recommendations and has recently published a “patient safety package”. We found out that when patients report an adverse event, in more that 30 percent of cases there is no action taken post-report. Patients have a right to complain but there is no responsiveness afterwards. Patient safety is also a priority of the Italian Presidency of the EU. The Directive on patients’ rights in Cross border healthcare is another example as it establishes National Contact Points that will inform patients about healthcare professionals, treatment options and quality standards that apply in other EU Member States.

What will the European Commission do in this new political term to ensure that empowerment and equity in health become an EU reality?

The Commission has launched a study on empowerment as the need was identified after a discussion in the Council. The aim is to increase understanding of patient empowerment through concrete good practices and examples. The Directorate General for Health and Consumers has also launched a study on health literacy which will also look at shared decision making and self-care. The EU has launched a tender on self-care, to establish a platform that will reflect on how far individuals can be empowered to treat themselves. Once these studies have reached their conclusions, the Commission will go back to the Council to discuss further steps.

This interview was conducted by Laurene Souchet (Young Forum Gastein Scholar 2014)

Laurene Souchet Gastein

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Obesity: the world’s biggest disease

In 2007, Nauru, a small island of 10000 inhabitants in the Pacific, appeared at the top of Forbes list “World’s Fattest Countries” due to 94.5% of its population over 15 years of age being overweight. In 2008, 70% of deaths in Nauru were due to non-communicable diseases. When we asked the actual Minister of Health of Nauru, Hon. Valdon Dowiyogo, about the strategies put in place to address this problem he named sport and healthy eating programs, but most important of all for this country’s situation, underlined how significant increasing commercial exchange with other countries and subsequently reducing unemployment had been. Many factors influence obesity, and of course it is not geographically restricted to Nauru; it has become an international issue.

In the WHO European region 1 in 3 11-year-old is overweight or obese; in general population it increases to 50%. WHO developed the “Global Action Plan for the prevention and control of noncommunicable diseases 2013-2020″ which aims to build on the WHO Framework Convention on Tobacco Control and the WHO Global Strategy on Diet, Physical Activity and Health. The action plans to halt the global obesity rates to those of 2010. It’s unclear whether this will be enough when food industries seem determined to get some of their most unhealthy products through to the population and especially children.

An open war seems to exist between public health policies addressing obesity and food industries. Food companies have invested heavily in marketing trying to sell products especially to younger ones: toys with fast food, apps made by fast food companies and even leading controversial sports events.

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Picture taken from Ms. Jane Martin (Executive Manager of the Obesity Policy Coalition, Cancer Council Victoria, Australia) presentation.

Since obesity is a multifactorial disease the strategies employed by local and national government are numerous. Mexico for example has decided to tax soft drinks due to their high amount of sugar and their link to obesity: they discovered people between 19 and 59 consumed around 450 calories per day in sugary drinks. A tax policy of 10% was put in place in January 2013 for non-dairy and non-alcoholic sugary beverages. But as you can see in the picture below, a lot of work is still needed in the placement of sugary drinks in food stores.

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Picture taken from Dr. Simon Barquera (Director, Nutritional Epidemiology Division, Nutrition and Health Research Center, National Institute of Public Health, Mexico) presentation.

When asked about taxing as a possible solution to obesity, Kevin Fenton, the Director of Health and Wellbeing at Public Health England, replied that even though it could work, it shouldn’t be the only option; the solution should be a mix of actions: more research and evidence has to be presented, and better choices offered, like cheaper and healthier products. An example of a multifactorial-addressing and successful program is the one implemented in the Hualien County in Taiwan.

In Hualien County, 25.6% of adults were overweight and 19.1% were obese. The regional authorities created a task force with interdisciplinary professionals who participated in the communication and design of the program. They invited leaders to join the worksites and openly support the program, and had a monthly newsletter distributed to local governments. The program included: exercise plans, design and cooking techniques for healthy diets and inviting successful applicants to participate in the media campaign. They also created a weight control registration system online and put in place 129 weight measurement and registration stations. The whole community participated and the local government even created a restaurant guideline to promote healthy food locals: famous chefs were invited to promote the idea of healthy delicious food and fashioned lunchboxes with low calorie appealing food and smaller in size. Hualien County has also worked on changing the environment by increasing the bike lanes to 117 km, increasing the number of hiking routes, organising marathons, building exercise grounds in the parks, etc. 84937.8 kg were lost in total through this program in the Hualien County.

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Picture taken from Dr. Hsiang-Ming Hsu (Director General, Hualien County Health Bureau) presentation.

Not all programs are as large as the one from the Hualien County but surely try to tackle the problem. The American Medical Association has decided, concerned by the 100 million of people in the US suffering from pre-diabetes and diabetes, to combine efforts with YMCA, a leading non-profit organization for youth development, healthy living and social responsibility, and have doctors offer their patients the possibility to join this organisation and sport programs to ameliorate their health.

And even with all these efforts sometimes it is just not enough. Hannah Brinsden, former Young Gasteiner and Policy and Advocacy researcher at World Obesity Federation, explained her work on regulatory actions: given the lack of implementation of most strategies, a legal framework has been deemed necessary. Is it possible that the only thing that could actually work to stop increasing rates of obesity is binding laws? More awareness is needed or is there a lack of participation of the population due to a paternalistic vision of health systems? Could a more patient-centred health care system help? What is the difference between the Hualien County and the rest of us?

I can’t keep from thinking that we are all in general obese: we have prioritised uncontrolled consumption giving it total control over our time and left behind our survival instincts. Obesity might be an early indication that we have started to walk the path toward extinction!

This blog was written by Yaiza Rivero (A Young Forum Gastein scholar)

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Crazy quilting or setting global (health) priorities

September 2015 is the deadline for the eight Millennium Development Goals (MDGs) the world agreed on in 2000.

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MDGs and SDGs

Based on the 2014 report, it seems several MDG targets will be met. These includereduction of extreme poverty, the fight against malaria and tuberculosis, access to improved drinking water, and the reduction of disparities in primary school enrolment between girls and boys. However, for others targets it seems unlikely that they will be met despite the progress that has been made. These targets include to reduce hunger, chronic under nutrition in infants, child mortality, maternal mortality, antiretroviral therapy access, access to improved sanitation, enrolment of children in primary school, and progress in environmental sustainability.

Although not all goals and targets have been reached, the MDGs have been exceptionally successful in uniting the world in a set of priorities and actions. As the MDGs are nearing their deadline, the “Post-2015 Development Agenda” is currently being prepared. The Sustainable Development Goals (SDGs) will be at the core, and a proposal for 17 SDGs from the Open Working Group was published in July 2014.

Process of the SDGs

The process to develop the SDGs was more inclusive than that of the MDGs. The MDG process was critiqued for not involving all stakeholders sufficiently, especially from low- and middle income countries. More voices were heard this time and not only of governments and civil society. Also people living in this world could have their voices heard for example through the “The World We Want” platform. The SDGs should therefore represent a set of (development) priorities, which includes health.

Interviews with Global Health experts

With Ding-Cheng (Derrick) Chan, fellow “Young Global Health Forum Working Group member” (as the group of Young Gasteiners and Young Taiwanese were called at the Taiwan Global Health Forum) I interviewed three (global) health experts who attended the TWGHF. Our interviews started with the same question: “If you had to choose three Global Health priorities, what would they be?”

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And guess what? We got very different priorities.

Prof. Ilona Kickbusch, Director of the Global Health Program at the Graduate Institute of International and Development Studies in Geneva, listed global health governance, global inequity, and commercialization of health. Mr. Michael Moore, Vice President/President Elect of the World Federation of Public Health Associations and CEO of the Public Health Association in Australia, prioritizednon-communicable diseases, social determinants of health and health advocacy.Dr Margaret Mungherera, psychiatrist in Mulago National Referral Hospital in Kampala, Uganda and the immediate past-president of the World Medical Association, selectedmental health, sexual and reproductive health and primary health care.

“Crazy quilt” of priorities?

In one of the TWGHF talks the term “crazy quilt” was used to describe the US health care system. After having read and heard much about the post-2015 Development Agenda process and having conducted these three interviews, I wonder if we do not face a similar “crazy quilt” of the outcomes of the Post-2015 Development Agenda and the SDGs. The current draft proposes 17 SDGs and 169 targets. Yes, you read it well: 17 SGDs, 169 targets proposed, and actually even more indicators. This is many more than the comprehensive 8 goals and 18 targets of the MDGs. Although the SDGs ambition is different from the MDGs in that it 1) is applicable to both developed and developing countries and 2) it tries to incorporate the climate change and sustainability agendas, it is a much more difficult message to communicate.

How is health faring in the SDGs?

Quite a few of the health experts we talk to during the conference were worried that health was not sufficiently addressed in the SDGs. Where in the MDGs three out of eight goals were clearly health related (MDG4 to reduce child mortality, MDG5 to improve maternal health, and MDG6 to combat HIV/AIDS, malaria and other diseases), the SDGs only have one health goal (SDG3 Ensure healthy lives and promote well-being for all). Personally, I am not so worried about “only having one goal”. If we assess the SDGs on how they link to health, “we” do not have one goal – as nearly all goals will improve the health and wellbeing of people. Poverty, hunger, (women’s) education, gender equality, water and sanitation, economic growth and employment, infrastructure, inequities within countries, climate change, peaceful societies with accountable and inclusive institutions, better land/ocean/forest/etc conservation management, and others, all have an impact on health and wellbeing. In fact, many of these are part of the social determinants of health, or the “causes of the causes” and it seems a great opportunity for health advocates to reach out, and find the connections with other sectors relevant for health and wellbeing.

I am worried, however, about the complexity of the message that needs to be communicated with the proposed SDG framework. This month the UN Secretary General’s Synthesis Report is expected in which he synthesizes all the various activities of the Post-2015 process. I hope he, and the intergovernmental negotiations that will commence after, will be able to present an ordered crazy quilt of priorities that will help the world to unite and work on the future we want.

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Joyce Browne (Young Forum Gastein scholar) is a medical doctor (2013) and studied Epidemiology at University College London (2009), with a focus on social determinants and international health. She is currently a PhD student in Global Health at the University Medical Center Utrecht, the Netherlands.

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Interview with Dr Antonio L. Andreu Periz

Dr. AntoSONY DSCnio L. Andreu Periz
is Director General of the
National Institute of Health
Carlos III (ISCIII) in Spain.

 

 

Which medical conditions are benefiting the most from personalised medicine at the moment?

Personalised medicine has been intensively developed in the oncology field, mainly related to the detection of biomarkers and its response to particular oncology treatments. But considering the advances of genomic medicine, we can be convinced that any medical condition should be approached from a personalised medicine strategy. In the last two or three years, when results on genomic medicine have become available to the public health systems and we have started having a large number of genomic sequences in other pathologies, there are clear indicators that other medical conditions in the field of metabolic disorders, neurology and cardiology can benefit from a personalised medicine approach.

Taking into account the financial situation of European countries, do you think it is possible for health care systems to finance these kind of therapies at this moment?

It is going to be difficult because the financial capacities of the system are, at this moment, in a particularly difficult situation, however we have to think in the long term. Related to this, we have a very interesting recent example in Europe which is the inclusion of antiretroviral therapy for the treatment of hepatitis C. Hepatitis C is a life threatening condition that requires enormous efforts from health care systems because it has an enormous cost for the system. Now, we have a drug, and some more drugs that will be developed in the future, that are very expensive but that may cure the patient. So we have to think carefully about it and we have to analyse very carefully the cost of implementing these actions because, in some cases, the relatively high cost of implementation will save the health care system an enormous cost in the future. In this respect, it is fundamental to do research in the field of health economics which is going to play a fundamental role in the future.

Antonio Andreu Periz plus YGs

 

 

 

 

Besides the cost, what are the main challenges to overcome over the next years in order to implement personalised medicine?

There are enormous challenges because we are talking about a change of the whole model. Issues are not only at the economic level but there are also legal issues, regulatory issues, awareness issues and training issues at all levels, from the governance structure, to the patients and the citizens, and to the whole of society. It is going to be difficult but in order to make a global change you have to face all those parallel changes. The positive element at this particular moment is that there is full awareness of all professionals involved and knowledge about how to overcome these particular difficulties. Now, we will have to talk about specific actions to overcome regulatory, ethical, patient empowerment and scientific issues that may arise.

Should personalised medicine be approached from a European or a global perspective rather than from a local level?

The European Union has given us the opportunity of creating a common framework where this thinking is functioning and we can see it at the Gastein Forum today. PerMed is the practical proof that a European perspective is possible. It is definitely an approach that has to be developed together with all countries in the European Union. But the problem is global so there are other actors that may complement the expertise and that could also be companions in the journey. A particularly important actor is the personalised medicine coalition in the US. The US has been working for a longer period than us with all the technical issues and regulatory issues and they have accumulated an enormous amount of experience. So it is important for us Europeans to establish links and bridges also with the policy makers that work in personalised medicine across the Atlantic.

Which areas of health care do you feel that personalised medicine will impact on the most, not only diseases but other health care areas?

Prevention and epidemiology will be influenced by personalised medicine development. Epidemiological studies and cohort studies, to detect and to implement prevention activities, will be a very interesting stage for the development of personalised medicine. Cohort studies need to incorporate genomic data and individualised information to obtain the most important benefit at the epidemiological level, which at this stage is still too immature.

This interview was conducted by Sonia García-Pérez and Verónica Alonso (Young Gastein Scholars 2014)

foto EHFGVerónica ALONSO_photo

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