Food for thought: We are what we eat (L6)

After an indulgent jampacked and fruitful three days absorbing all things related tohealth policy at the European Health Forum in Gastein, this session allowed conference attendees to ingest the current issues regarding food policy in Europe and digest what this means for our public health and wellbeing.

Food is a fundamental part of human society that impacts every facet of our lives. What we eat has huge effects on how we look, how we feel, and most importantly our own health. We use food to sustain ourselves but increases in food availability has indirectly led to increasing disease prevalence across EU countries. We are seeing more and more diseases such as irritable bowel syndrome (IBS), food allergies, liver disease and bowl disease in our populations. Huge societal issues around food and health sustainability are brewing and we need to act now for the health of our populations!

As food supply and delivery has developed in recent history, we have created an obesity monster that is devouring health system resources and people’s quality of life. During this session it became obvious to me there is a lack of awareness of the impact food issues have across society at both the micro and macro level.  The damage being caused to our lives by actions of the food industry is exceptionally serious. We need to start to ask hard questions of food industry practises now and introduce disruptive policy inventions to bring down the disease burden of obesity.

During this session, we found out that not only are we what we eat but that we are not alone and our own friendly microorganism’s health is also dependent on what they eat. To keep our fellow bacterial buddies healthy and happy, we need to realise core benefits of healthy eating and change supply chains and food delivery systems.

We heard about steps some countries are taking such as Israel to improve their populations health from the massive negative effects to rising obesity. It was emphasized that we need to empower people through market interventions to have the choice of changing their own eating habits.

As far as Public health in concerned we need to focus creating environments where people can eat well. We need to more to a space where we engage many areas not just health but other areas of government at all levels to design policies to change behaviour and improve life’s of our citizens. At an EU level, we need to strive to make ensure different actors in the system are involved and are aware of the importance of food in citizen’s lives.

Healthy eating choices need to be considered a basic human right, Food for thought indeed.

This Blog was written by Young Gasteiner Ronan O’Kelly.

European alcohol policy: The elephant in the room (F10)

In terms of heath, alcohol-related harms have long been a sensitive topic. However, we must understand that whenever one raises the topic of alcohol, one will inevitably get into all sorts of quagmires. Still, the harm alcohol causes is undeniable. Compared to other major non-communicable disease risk factors, such as tobacco-use, a relatively high proportion of alcohol-related harm occurs early in the life course. The WHO European region struggles with one of the highest levels of alcohol-related deaths: alcohol kills approximately 2345 people per day and that is an inevitable fact. How can we tackle this? What are the potential solutions we can take?

Carina Ferreira-Borges, who is the Programme Manager Alcohol and Illicit Drugs at the WHO European Office for Prevention and Control of NCDs, reminded us that we need to rethink and re-challenge our current direction with alcohol. The European Union region have the highest level of alcohol consumption. The WHO identified three ‘Best Buys’, actions for alcohol policy. The first Best Buy deals with increasing the price of alcohol through taxation. The second focuses on limiting alcohol availability though for example restrictions on the time alcohol is available in stores. Lastly, Best Buy suggests restrictions on marketing, either by reducing or banning it all together. Unfortunately, it has been very troublesome in getting European countries on board of these Best Buys.

Alcohol-related harm does not happen in a vacuum. Alcohol alone affects 13 of the Sustainable Development Goals and 52 targets. There is a relationship between the harmful use of alcohol and heart diseases, cancer, liver diseases, mental health disorders and other non-communicable diseases. Alcohol-related harm brings direct costs to the household in terms of poverty, loss of job or unemployment. The European Union is faced with massive costs, approximately €156 billion yearly, by alcohol alone.

Rethinking and strengthening implementation may take more than just regulations and laws. We need to rethink the concepts we take for granted. For example, more than half of the male drinkers between 15-64 years have engaged in heavy episodic drinking in 2016. We need to think about the social aspect of alcohol. During the group work sessions, one point seemed to come across in most of the tables: we need to change how people think of alcohol in terms of socializing. How can we disrupt the norm of drinking when going out with friends, when we find ourselves thinking we need that glass of wine in our hand to be a part of a group? How do we strip our minds from the social norm of alcohol being present in sports events? The groups tried to come up with solutions such as incentivizing alcohol-free events to cover their losses. It was also recognized that alcohol policies should be Europe-wide, because if it is possible, people will travel for alcohol. This is not true only in terms of bordering countries, but for example, in Scandinavia young high schoolers go on cruises to Estonia or Sweden with the sole purpose of drinking.

Coming from Finland, I cannot help but to mirror experiences in other countries to my own status quo. Even though restrictions on advertising alcohol, selling alcohol during certain hours and tax on alcohol are in place in Finland, according to the Finnish Institute for Health and Welfare, 78% of alcohol consumption in 2016 can be classified under the category of harmful use of alcohol. Personally, I do not consume alcohol for religious reasons. However, I do sense a slight change in drinking culture nowadays. Non-alcoholic drinks seem to be more available. This change would not have come if enough people were not demanding alcohol-free beverages. In other words, there is power in masses, we are the keys to the changes we need to see.

In order to reduce and eventually eliminate alcohol-related problems, we need to change not only individuals and societies, but also companies. During the panel discussion, we heard how Heineken bought Slovenian breweries, and in no less than two weeks Heineken suggested a legislation change in Slovenia. Furthermore, there is a dire need to put Best Buys in the agendas of governments. NGOs might be more willing to adopt these actions, but they need assistance from each one of us since changing how we view alcohol is certainly not an easy task.

This Blog was written by Young Gasteiner Idil Hussein

Shortage of essential decisions Shortage of essential medicines (L5)

Can patients expect short-term, effective actions to ensure availability of their medication? This was one of the last questions asked during the lunch session on shortage of essential medicines. I believe it actually was the most important question which remained largely unanswered.

In the last decade, delivery problems of medicine have increased. In Estonia and France, for example, medicine shortages for respectively 118 and 116 human medical products have been reported. During the session, all relevant stakeholders sat together in a panel to discuss this growing problem, from politicians regulators, practitioners to the industry. Euro Commissioner of Health and Food Safety, Vytenis Andriukaitis set the scene. It is important to distinguish unintentional from intentional reasons for medicine delivery shortages. Unintentional reasons relate to the global pharmaceutical supply chains. Disruptions at raw material manufacturers, quality problems or packaging issues may cause delayed delivery. Yet, it increasingly happens that pharmaceutical companies intentionally lower production of certain medicine brands because of too low profit margins or small market sizes.

Listening to the different panellists convinced me that the solutions are abundant. According EMA regulator Kristin Raudsepp, there needs to be a stronger network for governments and regulators to prevent and respond to potential medicine delivery issues. The pharmaceutical industry itself also has to do it’s homework according to Raudsepp: pharma needs to improve on manufacturing capacity planning, logistics, regional forecasting demand, multilingual packages, and importantly, transparency. Richard Bergström, having worked in the pharma sector, largely confirms this: the responsiveness and traceability within supply chains can improve a lot. Everybody from the panel and audience seemed to agree on the fact that much needs to be done and that this requires action from policy makers, the industry and above all collaboration between them.

Thinking back about the mentioned most important question, asked by a patient representative, I had an uncomfortable feeling after the session. Are all these problem analyses and solutions going to prevent patients from missing essential treatments? I am afraid not. During the Gastein Forum one issue has frequently been raised: the current way in which healthcare in general and pharma in particular is organized and financed is unsustainable. Can we expect from large pharmaceutical companies, owned by shareholders who seek a maximum short-term profit, that they will do everything to assure delivery of not so profitable medicine? Recent years seems to show the contrary as both production of old and development of new medicine is falling behind. Importantly, the regulators and practitioners are caught in the middle and are only able to manage quick fixes. Politicians on the other hand, do not have the vision or capabilities to drive real change, as expressed by soon-to retire Commissioner Andriukaitis.

Maybe after 1 November we will find out if quick fixes are enough, or that the Brexit leads to a healthcare crisis that calls for essential decisions.

This Blog was written by Young Gasteiner Bart Noort.

European alcohol policies: Rethinking and strengthening implementation (F10)

Did you know that one million deaths per year in the WHO European Region are due to harmful use of alcohol? – and that these figures vary within and between countries in the region and by social group? Evidence also shows a clear relationship between alcohol consumption and life expectancy; if you decrease the former you can increase the latter. So why aren’t countries doing more to prevent this?

Well there are a number of challenges and barriers to implementation of alcohol relate policies, such as cultural resistance, strong lobbying, lack of political commitment, to name a few. Also, don’t forget about the commercial determinants of health – which relate to marketing, global money flows, trade agreements etc.

The session started with a number of setting-the-scene presentations by several expert panellists; participants were then asked to break up into groups to discuss the following challenges and to try to come up with ideas on how to address them:

  • Challenge 1: How to overcome barriers for implementing WHO best buys – policies that have proven to be cost effective – reducing availably of alcohol, taxation, and marketing?
  • Challenge 2: How to create a fora that will not end up being a ‘talk shop’ and ‘white-washing’ that avoids conflict of interest?
  • Challenge 3: How do we mobilize public support and shift the social alcohol norms to create a transformative change for health and well-being?
  • Challenge 4: How should we enforce, monitor and evaluate process in the implementation of alcohol policies and actions?

What came out of the session was the need for better understanding of the root causes and social drivers around harmful alcohol uses – to assist to establish alternative, effective interventions. Alongside that should be the implementation other interventions such as product replacement, taxation, the promotion of healthy-lifestyles, restrictions of opening hours in pubs, alcohol bans in sports centres and events, and reducing the size of alcohol bottles etc. Also, a coalition rather than a fora could be established. But whatever is done, it needs to be packaged in a clear, strong and unified message, and supported by strong collective leadership.

Written by Young Gasteiner Lucinda Cash-Gibson

Lunch Session: Making real world data real – new methods for EU health technology assessments (L7)

Bullet points:

  1. We do not measure what matters most to patients
  2. There are economic disincentives for hospitals even if the drug is less invasive – this should not happen
  3. In the 21st century we are still trying to provide healthcare that is not working
  4. We need to think big and globally when it comes to health data to provide better care for all
  5. We need complete and robust data in order to work effectively
  6. We need large amounts of data to give us real insights, the patient is a single outcome, but the input has to be much larger

Title: Health data – a matter of safety, robustness and advancement

In healthcare we constantly need to make accurate decisions based on efficient and correct assessments of not just the short- but also long-term value and performance of new therapies and drugs for patients. We need robust and especially complete data from patients. This however poses challenges in terms of data protection, regulatory approvals to meet comparative effectiveness and value in terms of health outcomes. Experts and advocates discussed the above matters during the lunch session on Friday, 4th October 2019, titled: Making real world data real – new methods for EU health technology assessments.

Amongst the experts, Dr Anja Schiel (Senior Adviser & Statistician, Unit for HTA and Reimbursement, Norwegian Medicines Agency (NoMA)) addressed the uncertainties faced during the conduction of clinical trials often resulted from incomplete and flawed patient data. She encouraged the audience to always pose questions such as (i) what data do we need to generate in order to answer the posed questions (ii) what does the data we have exactly tell us and (iii) is the data we gathered robust and complete to draw conclusions or allow further research.

The ‘Health Technology Assessment’ was introduced to the audience as the systematic evaluation of the properties, effects and/ or impacts of health technology and a health economics model to predict future scenarios based on existing available data. Dr Schiel stressed the importance of contextualising data in order to be useful and applicable in different national health care and its finance systems. This implies that treatment and economic-based decisions are reliant on robust evidence. Dr Schiel also posed the question why what was good enough for approval is often not acceptable for reimbursement anymore.

Audience and experts also discussed the crucial aspect of patient data safety initiated by a comment from one of the participants outlining the need to especially protect data of vulnerable groups such as migrants. Participants agreed that there is the danger of data falling into hands of those using it to commercialise needs and this has to be prevented. Patients have the right to share their information with whomever they want and it is the system’s responsibility to keep the data safe.

The healthcare sector needs robust data to advance and optimise treatment for patients. This means that public health professionals and those using data for research purposes need to communicate why and how data is used to increase the willingness of sharing.

This Blog was written by the Young Gasteiner Anna Stielke