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.

Obesity in Europe – time for a new approach? (F8)

We have all heard the words chronic diseases and non-communicable diseases before. But have we ever considered defining obesity as one? In this afternoon’s session, Jacqueline Bowman-Busato, the policy lead of the European Association for the Study of Obesity, asked a controversial question: What would happen if Europe approached obesity like other chronic disease epidemic and focused on addressing the biological causes in approaches to policy along the obesity continuum?  

We have all heard someone say “just eat less and exercise more and you will lose weight.” Is that the magic formula to solving the challenge of obesity? Clearly not. Despite a set WHO target to halt the rise in diabetes and obesity by 2025, prevalence is rising globally. Across Europe alone, almost all countries have an obesity prevalence above 15%. But the worse news is that it keeps increasing, meaning that whatever we have been doing to address the problem is failing. Why is that? As highlighted by Abd Tahrani, an NIHR clinician scientist, we are failing because we are not treating obesity as a chronic, relapsing disease, but as an individual choice and despite severe long-term health, social and financial repercussions, health care systems around the world are failing those living with obesity.

Yet, the complex foresight obesity map highlights the hundreds of inter-linkages surrounding and having a direct – or indirect – impact on individuals. For the scientists and biologists in the room, Abd Tahrani also stressed that obesity meets the American Medical Association criteria to be classified as a disease, namely:

  1. It leads to the impairment of normal function
  2. It has characteristic signs or symptoms
  3. It causes harm or morbidity

While this lesson in obesity 101 was enlightening and hopefully led many people around the room to have a “Eureka” moment, I still wonder if calling obesity, a disease really is the solution. How is that going to change the number of challenges that exist such the awareness, discrimination and stigma associated with those living with obesity, or address infrastructure, health system and data challenges?

Current treatment and prevention interventions focus on directly tackling obesity but fail to address any of the underlying causes. But what about the impact of our external environments? Supermarkets are filled with products high in fat, sugar and salt. We are bombarded with advertisements that shows the consumption of excessively sugary drinks as very appealing. Cities are built in ways that promote sedentary behaviours. Does an individual approach to the treatment and prevention of obesity take into account any of these environmental factors or the different stakeholders that play a role in sustaining – and even encouraging – these environments? People living with obesity are stigmatised and discriminated against. What if we shifted our angle of attack? It is time to change the narrative about obesity and adopt a systems approach and shift the blame away from those living with obesity and acknowledge that it is the result of the complex interactions of many factors that surround us on a daily basis.

Health systems around the world are failing people living with obesity. We need to stop pointing fingers at those suffering today and start an open, non-discriminating dialogue that includes all stakeholders. This approach needs to empower individuals to leverage the system. This is everyone’s responsibility and our work start today. So now I am asking you: is it time to adopt a new narrative to address obesity?

This Blog is written by the Young Gasteiner Margot Neveux

Facts. Figures! Fiction? Who will take the power to lead the conversation?(L1)

In the era of technology and the broad availability of information, health care professionals are facing the problem of finding the relevant and accurate information in the haystack.

The Lunch workshop 1 on ‘Facts. Figures! Fiction?’, chaired by Martin McKee (LSHTM) and Claudia Habl (Gesundheit Österreich GmbH) tackled the problem of ‘fake news’, data quality and the availability, interpretation and dissemination of information – and who influences each of these. He stresses that the term is often used without a clear understanding of what it means, and that we need to be able to distinguish between ‘misinformation’ (often involuntary), ‘disinformation’ (purposely deceiving people), and ‘fake news’ (a weaponised form of disinformation spread in a way often mimicking news media trustworthy content). However, in practice is often very difficult to make a difference between the categories. For example, anti-vaccine propaganda may be spread by those who have a genuine concern (however misguided about safety) or by those who are using the issue as a tool to undermine trust in particular governments.

Fake news is not contemporary and it is not new – it can be traced back hundreds of years when fake news was used to blackmail or extract money. What has changed is the technological landscape, that allows broadcasting them wider. Fake news has a broad definition that spans anything from satire to harmful lies used for political campaigns. In the media dementia can be beaten by following some simple rules: ’Chocolate can halt dementia’, ’Red wine pill stops dementia’, ’Lose weight to beat dementia’, ’Coffee fights Alzheimer’s’, ’Spicy diet can beat dementia’, ’Stay married beat dementia’ are only some of the examples. 

To test your knowledge, ask yourself true or false?:

  • Electronic cigarettes have been shown to be 95% safer than conventional ones
  • The increase in children obesity is because children spend all day on the iPods and watching television
  • People who are very ambitious highly driven are at great risk of having a heart attack

If you are not sure. Where will you look for answers? Who drove these collective insights? In the end, we all have to know that more data does not necessarily yield useful findings and it can lead to „data fishing“. No amount of data available can help overcome poor research methodologies. We need to remember: data, information and knowledge transfer do not stand for themselves – who has the power to lead the conversation?

This Blog was written by the Young Gasteiners Zeljka Stamenkovic and Mateusz Zatonski