Long-term access to vaccination across Europe (L8)

The one with housemate Rich and vaccines

When I was given my working group for Young Gasteiners and saw ‘vaccines’ on our list of sessions to attend, I struggled to think of how I could link this to my interest area of mental health. As far as I was aware they haven’t yet made a vaccine they could’ve given me when born, to stop me freaking out with professional anxiety, have they? I wasn’t sure, but I was willing to find out…

I start by taking a photo and sending it to an old house mate ‘Rich’ who is just finishing a PhD in vaccine use across the UK to make him jealous.  The room starts half empty, I put that down to fact it was the last day of 3 intense days of networking, thinking, making ‘hmmm’ noises, nodding in agreement and … well late night networking, but it soon filled up as the session went on.

Natasha Azzopardi-Muscat moderating says EU is responding to growing concerns, and people’s imagination running wild, with measles outbreaks STILL HAPPENING in our day and age. I think of Rich and how this information would rile him mad, as he is a ‘pro-vaccine’ campaigner.

Kicking off, An Baeyens from the European Commission gave us a refresh on what procurement is at an EU level.  In a nutshell, it appears to be something that ensures all services that public authorities’ commission, have to meet the EU rules.  They are there to ensure best value for money happens….NOT to force member states to privatise healthcare services, so we are told.  Maybe Rich could enlighten me on this when I get home.

Italy in 2017 created a Compulsory Vaccination Law!!  This is a brave and bold step, and a hefty 500 euro fine for non-compliance after primary school age. Since it has started, there has been an obvious increase in vaccinations being had. Carlo Signorelli said that this is constantly on-going in the political realm and looks to stay that way for some time to come. I think Rich would definitely be happy to see something similar to this in the UK…maybe.

Radu Ganescu, in a stunning suit, told us that in Romania, they’ve actually put forward a very similar framework, but this has spurred 2 years of debate to this day.  One off the big debates going on was the idea to suspend healthcare compensation to those families/children who haven’t had a vaccination. Radu finished talking about Romania having the EU presidency next year, for which he simply stated:

“We should go together and push that everyone across Europe has access to vaccine.”

I think I’ll give Rich his details…

Purchasing & awarding are phrases I normally associate with me ‘purchasing’ a chocolate bar to ‘reward’ myself after my run, not in health care. I say this, but I am aware of health economics and financial procurement with Pharma companies, which we get quick tour de force about in relation to vaccine from Tim Wilsdon.

At the start of this session, due to Rich, I did have some baseline knowledge on this topic, but learning about Compulsory Vaccination and worryingly, how the lack of access to vaccinations, due to money and other political spheres is still a thing, further peaked my interest in this topic.

Sadly they still haven’t created a vaccine that would’ve stopped me freaking out at my age (maybe Rich can make one??  He should know how to do that by now??), but what’s exciting, especially with the EU presidency being with Romania soon, is that vaccine’s will get a deserved spotlight, Rich will love it.

This blog was written by the Young Gasteiner Nicholas Morgan

Thursday Plenary (P2)

Making the case for investment in health – but what is investment?

The Thursday plenary Talking so you’re heard – making the case for investment in health focused on the question of how to ensure we get more resources to be spent on health for improved health outcomes and wellbeing of the population. As Hans Kluge from the WHO Regional Office for Europe said in his opening address, improved health systems and spending in health systems do not only lead to better individual health and wellbeing, but also to inclusive economic growth. So, how hard can it be to get what we as health sector want – a bigger piece of the budget cake?

Throughout the debate, however, it became clear that behind this question, there are certain implicit assumptions that should be acknowledged and re-examined. A diverse mix of speakers ensured that we heard both the financial and the health perspective, and figure out where they differ.  Let’s look at some of those assumptions.

You are successful if you get more money to spend. Wilhelm Molterer, Managing Director at the European Fund for Strategic Investment and former Minister of Finance and Agriculture in Austria, urged us to rethink whether it could also be a success that we spend equally or less.  However, the question remains how much room for efficiency there is if the original amount of resources is low in the first place.

We need to increase the share of resources for health in the public budget. Additionally, Mr. Molterer pointed out that the health sector too often just aims at increasing their share of the budget in the public sector, but does not think about alternative forms of financing – for example by turning to the private sector and adopting a more entrepreneurial approach.

We have not been successful in achieving investment in healthcare. Jennifer Dixon from The Health Foundation challenged us by saying that perhaps we have been too successful in achieving investment in healthcare, but not in the areas such as public health, social care and wider social determinants of health. More leadership is needed, though, in order to shift the focus away from mere treatment towards targeting factors that will promote health.

We just have to make the case about the return on investment to the finance sector. While the finance perspective (besides Mr. Molterer also Matti Hetemaki from the Finnish Ministry of Finance,) emphasized that in order to be willing to provide the resources, a clear case has to be made on return on investment. Josep Figueras, Director of the European Observatory on Health Systems and Policies and Head of the WHO European Centre on Health Policy, pointed out that often the measures of efficiency in healthcare, as set by the ministries of finance, are too simplified and not nuanced enough to capture the actual outcomes. 

Health and finance sectors are speaking the same language. Despite using the same terms, during the panel it became clear that representatives from finance and health sectors did not always mean the same thing when they said, for example, “investment” or “healthcare” or even “health”. These issues should be considered when having a conversation with people from different backgrounds. If we want to have a common understanding of our objectives and targets, we first have to make sure we are talking about the same basic concepts.

It is definitely true that it is important to think about win-win strategies for all the sides and that we have to overcome the silo thinking, as it was pointed out throughout the plenary. At the same time however, the discussion showed that we have to make sure to keep on reconsidering and rethinking the assumptions behind our reasoning, or we will not keep up with the rapidly changing circumstances.

Written by a Young Gasteiner Daša Kokole

Economic strategies for health equality (L2)

Building bridges with business and economic development

We hear a common theme at the European Health Forum Gastein – that we need greater levels of multi-sectoral work to tackle health inequalities. This includes private businesses and the “wealth generators” in society, since they too have an influence over the health of populations. Today’s lunchtime session on economic strategies for health equality emphasised the importance of engaging with businesses and economic groups if we are serious about achieving the SDGs by 2030.

Emma Spencelayh from the Health Foundation kicked off this session by highlighting some stark health inequalities from the UK. Major gaps in life expectancy and high levels of childhood poverty were cited; these are issues we may be familiar with, but cannot afford to be complacent about. Clearly, economic growth in high-income countries does not always equate to inclusive growth where everyone benefits. Having a healthy working-age population contributes towards economic prosperity, but there is an onus on us to ensure that available work is fair and decent work, which recognises the labour rights of employees. A few eyebrows were raised when some modern-day workplaces were likened to “sweatshops” and “Victorian workhouses”, particularly in zero-hour contract settings. Calling a spade a spade, perhaps…? If we truly want a healthy and productive workforce, then surely we need to do more to engage with large-scale employers, and encourage them to end unsafe and unfair employment practices.

Fabrice Murtin of the OECD convincingly argued that we could only truly achieve inclusive economic growth, and the SDG targets, if our health policies respond to “deep drivers of inequalities”. Inequitable income distribution has become more and more entrenched in recent years and has occurred in parallel with disparities in educational opportunities and social mobility. But what’s the solution? He asserted that inclusive growth needs real investment in the vulnerable groups who have been ‘left behind’, and business dynamism needs to be supported. There were nods of approval from the audience at the need to challenge the “Winner takes all” mindset that prevails in so many countries. How can we expect to see population-level improvements in health if our financial resources continue to be so unfairly distributed?

Charlotte Ersbøll of UN Global Compact emphasised the need to support businesses in a practical way so that they view the SDGs as real opportunities for growth. As public health professionals, we need to work together with businesses so they consider the health impacts of their activities. We need to encourage and facilitate them to do this, rather than pointing the finger of blame when it doesn’t happen. Although “health is everyone’s business”, it’s unrealistic to expect the corporate world to tackle health-related issues independently. We all need to play a part in “connecting the dots” between relevant stakeholders: healthcare professionals, policy makers, business leaders, economists, marketing experts etc.

A lively discussion ensued on how we can build bridges with the business world, and what practical steps we can take to ensure that politicians respond to the call for more inclusive economic growth. My highlight in this session was learning about the work done by the OECD in developing modern metrics that capture wellbeing and social progress in a more holistic way. We are all too familiar with the challenge of advocating for public health and social interventions, which we can’t adequately evaluate. The OECD has been working to capture, and quantify, what we mean by improved ‘wellbeing’ and ‘social progress’ by developing new indicators such as the Multidimensional Living Standard and Better Life Index. These metrics will allow holistic cost-benefit analyses to be undertaken when new reforms are proposed, and may help to convince politicians and multi-sectoral partners of the true value of such reforms. This year’s conference is about making “bold political choices” to achieve the SDGs… maybe these tools will help us to convince politicians to do exactly that?

From left to right: Charlotte Ersbøll (Senior Advisor, UN Global Compact), Fabrice Murtin (Economist, OECD), Emma Spencelayh (Senior Policy Advisor, The Health Foundation), Fiona Adshead (Expert Advisor, The Health Foundation).

What can be done? Framework for Action on Inclusive Growth. Slide from presentation by Fabrice Murtin (Economist, OECD).

This blog was written by a Young Gasteiner Peter Barret

All I want for summer is the ECDC Summer School

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Introductory meeting with ECDC Director Dr Marc Sprenger

Stockholm, 9-12 June 2014

I don’t know about you but the moment I hear “course” I develop an autoimmune reaction. It’s not that I don’t like learning, come on, I have a six year career, two masters degrees, four years of specialty in Public Health and I’m doing a PhD while working… So no, it’s not that I don’t like learning, but I just can’t bear to sit for hours listening to someone talk the day away. Therefore if you are like me, the ECDC summer course is your thing. It starts with a very formal meeting and then the crowd is quickly divided into groups. From the moment you enter your assigned room, you know this won’t be a typical learning environment: the chairs are organised around four tables and none of them are directly facing the front of the class. You are in here to talk and discuss, not to be talked at.

ECDC and the external experts´ mission, was to help us understand how evidence becomes health policy. If you think this is easy, let me make this clear: it is not. We started by learning how to calculate the burden of disease, analysed which factors helped or limited the evidence from transforming into public health actions, and what were the determinants of decision-making. How many times do you read an abstract and don’t understand how the conclusions can lead to a public health action? Exactly! We need to publish answers to these fundamental questions: what do you want to say and why is it important? Now of course, decisions need a public health ethics framework. The ethics workshop was definitely a workshop where the level of discussion and debate was high.

Once you have your evidence and health policies ethically disposed, you should be prepared for future threats, especially the cross border ones. We learned about existing tools for risk assessment and in no time were role-playing. Suddenly Young Gasteiners had to take decisions on how to operate during an infectious outbreak in Scan Mark, a fictional very wealthy country. We solved it by creating an island where diagnosed patients were taken for care upon entering the country, to avoid provoking an epidemic (as you might imagine we also had laser swords and a throne made of syringes…). The fact that our imaginary countries were wealthy or not was not a mere detail: money, or more precisely, cost-effectiveness, makes the world go round. Therefore our last workshop was dedicated to this fascinating topic.

At the end of the course I was exhausted due to the 4am sunrise light coming through my unblinded hotel windows every day, but I felt satisfied by the fact that I had learned… while having fun. Young Gasteiners, you will be invited next year, please don’t miss this opportunity!

Yaiza Rivero Montesdeoca
Yaiza participated in the ECDC 2014 Summer School with fellow Young Gasteiners Kolia Bénié and Héðinn Svarfdal Björnsson

Young Gasteiners hard at work!

The goal of the ECDC Summer School is to strengthen mentoring and technical skills in applied epidemiology and public health microbiology. This is achieved through a series of workshops on selected topics for prevention and control of communicable diseases and by providing an opportunity for sharing best practices within the ECDC expert networks. The International Forum Gastein would like to thank the ECDC for their generous support of the Young Forum Gastein Network in offering three places on the 2014 summer school to Young Gasteiners.

 

What’s NEW at the EHFG?

Together with our new president and secretary general, the EHFG team has begun to rethink some of our structures and procedures and in consultation with a lot of highly appreciated colleagues has embarked on a journey of gentle change based on the success of the past.

Firstly, following discussions with colleagues and partners and their suggestions we have begun to organise and co-organise events next to our main event in October. Please find below dates for some of EHFG (partner) events in Europe and Taiwan. Why not make plans now to attend?

  • European Public Health – 20 years of the Maastricht TreatyTurning past experiences into visions | 22 May 2013 – 23 May 2013 (Maastricht)
  • Primary care in the driver’s seat – The role and impact of primary care systems in Western Europe | 16 May 2013 (Vienna)
  • Resilient and Innovative Health Systems for Europe | 29 May 2013 (Brussels)
  • Global Health Forum in Taiwan | 22 – 25 November 2013 (Taiwan)

 

What else is new at the EHFG?

  • We have added NGO and government conference fees to encourage the attendance of representatives of these two EHFG pillars.
  • EHFG publications will only be in English from now on.
  • Following the suggestions of colleagues and for environmental reasons, publications will not be printed anymore and will from now on only be sent via email.
  • We have decided to shorten the programme as full attendance of the EHFG conference has not been possible for most participants. We will therefore not offer any official programme on Saturday (excluding the social programme). We would like to encourage and support closed meetings or project meetings you would like to arrange on Saturday morning, though. Please get in touch with us!
  • We have implemented a new registration procedure, which will allow you to pick services according to your needs and wishes (hotel, shuttle, social programme).
  • We are stepping up: From now on it will be a user-friendly online registration for you.
  • You will be able to pay directly via Paypal and don’t have to think about open invoices.
  • Please note that this year we will have a registration deadline: 27th September 2013, but you will be able to register at the EHFG registration desk onsite.

 

News Makers 2012

Just in case you have missed these changes:
The EHFG has a new President and a new Board, a new Secretary General, and last but not least a new Advisory Committee since 2012.