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

Health as an Asset (F8)

‘No health is an island’ – Are we trapped in an ocean of missed opportunities?

It’s day two of EHFG 2018 and we already discussed so many interesting health-related areas but are we focused on the ‘real’ issues? What really matters in all our discussions? People, it’s all about people’s health! We need to keep that in the back of our minds, always. And as individuals, we live in complex societies and we thrive for development, well-being and happiness. I would like to remind you of Maslow’s pyramid of necessities and how critical is to address basic needs within the whole population. If we want to have a healthier population, we surely need to create a salutogenic context across all sectors that affect health – which means basically everything!

While you’re reading this, just image that society as a boat in the middle of the ocean. David Linch reminds us that not only healthcare services should be considered in this equation. Actually, our ocean is full of social and economic factors that can lead us to a calm and enjoyable trip, or can also smash us with a storm of social problems and economic lightinings.

While we are crossing the waters, they don’t remain stable and quiet. Neither inequalities in health do! In fact, they keep their alarmous rising tide, threatening the sustainability of our boat as a whole. We really need fearless captains rather than short sighted pirates…I mean, politicians! Some leaders can see that reelection island really near, missing the paradisiac island that is 10 and 20 years far. Social determinants of health are (still!) an essential topic that calls for interventions, as Sir Michael Marmot highlighted in his inspirational speech!

Vesna-Kerstin Petric gave us some really nice ideas to get some gold that will allow us to build a stronger and resilient boat, capable of travelling the Bermudas’ Triangle. Slovenian ship actually looked for the financial help of other ‘armadas’ like Norway and the European Union. So why should we give it a try?

The key to this treasure might lay in having an organized kitchen inside our ship, trained navigators and a well-designed structure. In other words, planning across sectors! There is an urge to plan health around a table that brings together municipalities, academia, policy-makers, community and NGOs, at least. And around this table, we can define a strategy to conquer the seas through definitions of priorities, which would be the focus on prevention by investing real money and resources! Should we go for the basic shipments or start fishing for lobsters first?

For the further days I leave you some words to thought about, inspired by the sustainable development in health:

  • Plan
  • Prioritize
  • People
  • Partnerships

(And I would dare you to add Politics and Pirates!)

This is the time to take action and build an ‘armada of societies’ to reach this magical island where social cohesion grows, wealth is fairly distributed, and health is an asset rather than a burden. Close your eyes and imagine how wonderful that would be – now open your eyes and start playing your role!

Such a long journey will only be successful with the involvement of all sectors and an upstream intervention in the ‘causes of the causes’.

PS: An enormous thank to ‘Captain’ Tim Elwell-Sutton for setting up this session that reminded everybody about the importance of intersectoral action in health.

This blog was written by a Young Gasteiner Duarte Vital Brito

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

Policy in Evidence (L1)

Is there a best practice for policy to meet the evidence?

It is important to make good evidence-based decisions. However, researchers are struggling with politicians not paying attention to their evidence. Politicians, on the other hand, are struggling with researchers not answering their simple questions, but rather telling complicated narratives. So why are these two groups not meeting? Should it not be clear that politicians need evidence and the scientists need action based on their results?

Paul Cairney, Rob Cook, Tanja Kuchenmüller, Milojka Kolar Celarc and Brigitte Piso each took the floor and presented fascinating viewpoints, while Josep Figueras led the discussion and passionately engaged the audience. Finally, Claudia Habl wisely summed up the fruitful session.

Josep Figueras inspired the panel and the audience.

Why do policymakers seem to ignore researchers’ evidence? Because as there are many politicians, there are also many different ideas of what counts as good evidence. In addition, politicians just have to ignore almost all the evidence since there is a lot of it. Finally, they cannot control the policy process, as it is complicated, explained Paul Cairney.

Milojka Kolar Celarc added that for policymakers it is not easy to get evidence, and even if they do get the evidence, it is not readable and understandable. She stated that it was highly important for politicians and researchers to speak the same language.

What kind of instruments are there to translate evidence for policymakers? The audience used its voice and voted for personal communication, policy briefs, infographics and lobbying. The white papers, research reports and active material, such as blogs and social media, were not considered that important. There is a conflict in the usual ways of communication within the researcher groups, because, of course: they are publishing mostly the research papers! And actually, if you look further, it might be so that the researchers do not want to cross the invisible line by recommending politicians to do something – rather, they want to stay objective and let the evidence speak for itself. So, when a politician asks “what to do” or “yes or no”, the researcher explains all the nuances of everything (actually it is not that far from the “political talk” – when a journalist asks yes or no, the politician explains all the nuances of everything – maybe eventually they do have the same language!)

So, is there a secret recipe, the golden best practice rule, to improve the process of evidence meeting policy? Obviously, communication is key: the researchers must synthetize the evidence and present it in a good and understandable way. The evidence must be contextualized because otherwise it would not be helpful. Other important ingredients are the networks and the understanding that the policy-making system is complex. Finally, a bonus idea may be to think further: according to audience vote, there should be “scientific knowledge officers” in government bodies. Maybe there will be a completely new profession in the future? Or should it already be both politicians and researchers’ responsibility?

The blog was written by the Young Gasteiner Pia Blomqvist