< Previous10CLOSING PLENARYEHFG 2020 CONFERENCE REPORT Closing Plenary Health politics beyond COVID-19 Let’s make Gastein the birthplace of the European Health Union! The Treaty of the European Union (EU) considers health to be an area of EU Member State (MS) competence, however COVID-19 has transformed the way the EU relates to health. Europe has suddenly been confronted by a number of “elephants in the room” at once, including the “elephants” of national fragmentation, lack of vision and a lack of solidarity between MS. In his EHFG 2020 closing address, Clemens Martin Auer, President, EHFG, highlighted that the conference had provided a dancefloor on which to dance with a number of “elephants” standing in the way of achieving progress on health, an economy of well-being, and promoting more social justice in our societies. He stated: “The clear answer to all this dancing is a European Health Union”. The concept of such a Union was raised most recently by European Commission (EC) President Ursula von der Leyen in her first State of the Union address on 16 September 2020. She underlined the fact that in the context of the crisis we should discuss the question of EU health competences and called for the establishment of a strong European Health Union (EHU). Leaving no one behind in the quest to achieve access to safe and high-quality care and a sustainable strategy for health in Europe are also ideas that Vytenis Andriukaitis, former EU Commissioner for Health, advocates in a draft Manifesto discussed during the EHFG that includes principles and policies on which to base a EHU. He urged “Let’s make Gastein the birthplace of the European Health Union!” So why do we need a EHU? What should it represent and how can we achieve it? Health is a fundamental human right Josep Figueras, Director, European Observatory on Health Systems and Policies, articulated a number of key arguments for a EHU: the unmet potential of the EU to impact health (obvious also from earlier crises); a human rights and solidarity rationale and a cost-effectiveness rationale. In terms of the economic arguments, he reminded us of the market power of 460 million buyers as exemplified by recent joint EU action on the procurement of medical supplies such as vaccines to tackle COVID-19. Additionally, health threats such as COVID-19 and AMR are externalities that do not respect country borders and should therefore be managed at EU level. Organised by European Health Forum Gastein Time for a European Health Union!11CLOSING PLENARYEHFG 2020 CONFERENCE REPORT Health is a human right, and the EU has a duty to ensure it. Any future strategy should build on the EU Pillar of Social Rights, ensuring wellbeing for all people of all ages, and on the Agenda 2030 goals. Policies such as the economy of wellbeing, the resilience and recovery fund, the Digital Agenda and the Green Deal should be followed by a “Health & Wellbeing deal,” said Ilona Kickbusch, Founding Director, Global Health Programme, Graduate Institute Geneva. The pandemic has shown us more than ever that protecting health is a shared responsibility between MS, EU institutions and citizens. Lessons learnt from previous crises prove that “the EU cannot have an accountant’s vision of health policy”, she emphasised. The EU should become a democratic union by including the voices of civil society, patients, professional organisations and disadvantaged groups: a EHU must empower citizens. Strengthening the current EU health mandate In an audience poll, 59% of respondents voted for the need to strengthen the EU health mandate with regulatory and financial powers to make progress towards a EHU, while 34% thought that in addition a Treaty change would be necessary. Seven percent thought we should simply apply current EU instruments more effectively. Defining the word “Union” can be time consuming. According to Thomas Steffen, State Secretary, Federal Ministry of Health, Germany, this is the right time to look at how to sharpen the existing instruments available at both national and European levels. He was convinced that we should be pragmatic and pursue secondary legislation aimed at ensuring the best health outcomes for European citizens, rather than discussing questions of Treaty change which will be time-consuming and may require referenda in some MS. The other speakers agreed, with Caroline Costongs, Director, EuroHealthNet, adding: “If strengthening the EU health mandate with additional powers as a first step does not work, we can then push for Treaty change.” Mohammed Chahim, MEP, lamented the major decrease in funding for health at EU level from 9.4 billion to 1.7 billion Euros, but Steffen pointed out that sometimes more money does not always equate to better outcomes, arguing that we need to set the right priorities and then organise efficient funding, and that ensuring synergies with other programmes like Horizon Europe and Digital Europe will be essential to maximise benefits to the EU4Health programme. Promoting transparency, trust and European sovereignty Marta Temido, Minister of Health, Republic of Portugal and a member of the current EU Presidency Trio, appealed for the need to strengthen the EU pharmaceutical strategy, have transparent pricing of medicines and ensure access to innovation. Mohammed Chahim concurred, emphasising: “Let´s be transparent about pricing and side effects and liabilities. If we are not transparent this will decrease citizen trust in these vaccines.” Speakers also called for a reinforced ECDC that should be given more power to formulate clear recommendations to MS and ensure they comply, and for MS to better utilise the European Semester process. All agreed it was also high time to reduce European dependency on nations such as India and China and strengthen the EU´s internal market for medicinal products, ingredients and protective equipment, securing local supply chains. Focus on prevention and preparedness Building a Europe where all people are as healthy as they can be throughout their lives requires a broader approach focussed on the determinants of health. Caroline Costongs called for a strategy focused on the psychosocial aspects of the pandemic, not just the biomedical ones. Mohammed Chahim reminded us that if we want to be prepared for the next crisis it is important to be aware that the world is changing in such ways that infectious diseases will be more frequent in future. There is always a hesitancy to invest in prevention, he acknowledged, but as health is a fundamental human right we must look at how to promote it from a broader perspective. Ilona Kickbusch agreed and had the final input on the topic, summarising many elements discussed in the session. She described that the EHU needs to be built with a number of key mechanisms in mind: the various determinants of health (including social, environmental and commercial determinants); strengthening the existing European institutions, and giving them more money where necessary; and co-production of health with aforementioned strategies outside the health arena. “Unless the EU finds a good way of combining these it will not be able to put this (EHU) into practice,” warned Kickbusch. Session recording Learn more Programme12TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT Health systems resilience Absorbing shocks, assessing response impacts and preparing for crisis The COVID-19 pandemic has brought into sharp focus the critical issue of how to achieve more resilient health systems. In this session, a panel of experts discussed key concepts, strategies and early lessons learnt from the experience of three countries – Austria, Germany, and Switzerland – in strengthening the resilience of their health systems while responding to COVID-19. Now more than ever resilient health systems are required The session began with a welcome speech by Rudolf Anschober, Austrian Federal Minister of Social Affairs, Health, Care and Consumer Protection, who shared his perspective on how the country is responding to the pandemic. In order to enable timely and evidence-informed decision making, the Austrian government set up a Crisis Unit in the Federal Ministry of Internal Affairs, and an Advisory Taskforce composed of virologists and public health experts, among others. Anschober highlighted the importance of having the technical capacity to deal with the pandemic and noted that hospital capacity in Austria (including beds and intensive care units) that had previously been criticised and considered excessive had now become an asset. According to him, resilience is the most important aspect in the successful management of such a crisis. But, what does health system resilience mean? Anna Sagan, Research Fellow, European Observatory on Health Systems and Policies (OBS), provided a definition of resilience from a health systems’ performance perspective: “the ability of a health system to prepare, manage (absorb, adapt and transform), and learn from shocks (a sudden and extreme disturbance)”. Sagan introduced the shock caused by the COVID-19 pandemic as a complex one, exacerbated by an overlapping global economic crisis. Such a shock necessitates resilience-enhancing strategies in relation to all functions of health systems, including governance, financing, resources and service delivery. Sagan also presented some early lessons learned from the COVID-19 response of European countries, published in a new policy brief by the OBS entitled “Strengthening Health Systems Resilience”: • Resilient COVID-19 responses are two-fold, entailing (1) enough technical capacity to respond and (2) appropriate and effective governance. • Although the pandemic has had a severe impact on disadvantaged groups and widened the equity gap, it has also shown that no one is safe until everybody is safe – a Organised by the Austrian Ministry of Social Affairs, Health, Care and Consumer Protection and the European Observatory on Health Systems and Policies13TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT chain is only as strong as its weakest link. • Countries need to collaborate to benefit from better surveillance and notification systems, joint procurement, medical research, sharing of best practices and to ensure an effective global governance response to COVID-19. • An effective response to COVID-19 is multifaceted and multisectoral: along with health system components, it incorporates social, economic, green and other dimensions, and it considers global trends such as digitalisation. What do the pandemic responses of Germany, Sweden and Austria have in common? Country representatives Hans-Ulrich Holtherm, Head of the Directorate-General Health Security, Health Protection, Sustainability, German Federal Ministry for Health; Olivia Wigzell, Deputy Director General of the Ministry of Health and Social Affairs, Sweden, and Stefan Eichwalder, Head of the Department for Diagnosis Related Group (DRG) and Health Economics, Austrian Federal Ministry of Social Affairs, Health, Care and Consumer Protection, discussed the policy interventions implemented in their respective countries for an effective and timely response to the COVID-19 crisis. A common approach adopted by all these governments was the uptake of knowledge in decision-making, either by establishing a new advisory task force (Austria); involving existing institutions in the decision-making process (Germany); or partnering with expert organisations (Sweden). The main principles followed by all three governments and described as central aspects to tackle the pandemic were fostering social cohesion, ensuring a holistic response, and promoting solidarity, trust and cooperation across different sectors. Similar to Austria, Germany stressed having excellent hospital capacity as one of the strengths of its health system response, while Sweden responded by doubling their ICU capacity in the early months of the pandemic. Furthermore, Germany´s strong primary care system acted as a means of gatekeeping patients with mild symptoms, so that only severe cases were referred to hospital. Lastly, its strong public health system enabled successful contact tracing to slow virus transmission. Sweden and Germany both utilised digital tools either to monitor ICU beds (Germany) or to enhance health professional capacity through e-learning opportunities (Sweden). Beyond commonalities, there are some key differences There were two different perspectives offered on the impact of decentralised health systems during the session. On the one hand, this feature was presented as an advantage for the German context, as it allowed federal decisionmakers to act based on local needs, for example when deciding on the adoption of stricter or milder lockdowns. On the other, a decentralised health system posed challenges for the Swedish government to coordinate national initiatives like testing and tracing and provide a joined-up response to the pandemic across the country, with 21 different regions responsible for financing, purchasing and running healthcare delivery and 290 local municipalities responsible for local services including schools, elderly care, emergency services etc. The international response The lack of sufficient international collaboration within and outside of the health sector (e.g. travel advisories, procurement, and supply chain issues) in the early stages of the pandemic was discussed by Stefan Eichwalder. It was clear before the pandemic that supply chains were vulnerable but mitigating measures had not been enacted. Nonetheless, signs of improvement in terms of international collaboration can already be seen in the context of the EU joint procurement for vaccines, he remarked. Eichwalder also emphasised the concept of trust, both between EU MS and between governments and citizens – the latter which must be sought through open and transparent communication campaigns. The pandemic has highlighted that health is a prerequisite for stable and successful societies, and that strong, solidarity-based health systems that make health promotion and prevention a key concern are an absolute necessity. Eichwalder urged policymakers not to forget treatment too however: continuing to provide hospital emergency and elective care services during the pandemic remains of paramount importance and will otherwise lead to higher levels of indirect mortality and morbidity. Connected to this, a necessary balance between the protection of health and the protection of the economy is a prerequisite for both economic recovery and health and wellbeing, and making decisions based on these factors will continue to be a tricky balancing act for decisionmakers as governments continue to tackle COVID-19. Learn more Session recording Programme14TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT COVID-19 has created a generational opportunity to place health at the centre of European cooperation. Fuelled by fragmented responses, the pandemic has laid bare the shortcomings of a European contract that incentivises national responses over cross-national solidarity. Nowhere is this clearer than in the case of the European health workforce (HWF). Plagued by competition and nationalist impulse since long before COVID-19, the development of a regional HWF has never been more critical. Setting the scene, session co-moderator Vytenis Andriukaitis, Special Envoy for the European Region, World Health Organization (WHO), articulated better health to be one of the deepest desires of European citizens. Nonetheless, it remains largely ignored by mainstream politicians. Calling for a European Health Union (EHU), he stressed “The EU is ripe to transform itself to become a Union committed to fostering well-being and health”. The impact of the EU and national borders on health workforce mobility Corinne Hinlopen, Global Health Policy Researcher, Wemos, highlighted that the free movement of workers is cornerstone to an open and integrated Europe and plays a crucial role in shaping HWF mobility. HWF imbalances and shortages are a major concern and while lack of financing is partially to blame, it is also a matter of inaction. As Hinlopen pointed out, “It’s long been known that the current HWF is not fit to face the healthcare needs of tomorrow”. Short-sighted actions to bridge the gaps, such as attracting HWF from one Member State to another results in a “waterbed effect”, leading to health labour market failures. In this scenario, panellists agreed HWF mobility to be the elephant. The challenge, but also the opportunity, is for Europe to learn how to dance with this elephant; managing it in such a way that ensures we continue to reap the benefits, all the while preventing the negative consequences. Martin McKee, Professor of European Public Health, London School of Hygiene & Tropical Medicine, argued that in times of a pandemic such as COVID-19, our open and invisible borders, defining the EU as a whole, become visible again, and now potentially decide where one is safe or at risk. In a Europe that is based on the idea of solidarity, this is simply unacceptable and illustrates further the necessity of a “Europe for health”. Health workforce trends Alex Soros, Deputy Chair, Open Society Foundations, acknowledged that despite best intentions, open borders have Universal health coverage and the role of the health workforce Building on the momentum from COVID-19 Organised by Open Society Foundations and the European Institute of Health and Sustainable Development15TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT resulted in demographic shifts and unexpected inequalities. Building on this point, Hinlopen painted a sobering picture of HWF trends across Europe: • An ageing HWF approaching pension age, and an ageing population in general with corresponding healthcare needs; • Decreased popularity in pursuing a career in healthcare, with its heavy workload, administrative burden, and relatively poor salary; • Complex push and pull factors driving health worker mobility between and within the EU Member States, creating medical deserts; • Reliance of many Member States on foreign-trained health workers, mostly leading to an exodus from South to North and East to West which was exacerbated during the accession of new Member States to the EU and the financial crisis in 2008; • Active and targeted recruitment of foreign-trained health workers, also from countries with existing HWF shortages; • An increasing number of bilateral agreements between governments that do not always benefit all parties involved, and are seen more as a “business deal” rather than having UHC in mind. Referring to a recent report from the European Commission’s Expert Panel on Investing in Health (European Commission, 2019), McKee brought forward the issue of task shifting. Often seen as a way of delegating tasks to lower skilled workers, he noted the report painted a more complex picture. Tasks should be distributed among and between different types of health workers, patients and their carers, and increasingly, machines. However, in order to facilitate change, ingrained practices must be challenged. Mitigating the unintended harms of workforce mobility Andriukaitis called on the EU to demonstrate commitment to pan-European solutions in the field of HWF mobility. Finding solutions is not only critical for convergence between current Member States, but progress is also important to win hearts and minds in countries that are considering joining the EU. In an attempt to retain healthcare workers, Salija Ljatif- Petrushovska, Director of the Specialized Gerontology Center, Specialized Hospital for Geriatric and Palliative Medicine, explained how policymakers in North Macedonia, an EU candidate state, had implemented a 40% salary increase for the HWF. Ultimately, this has been seen as a positive step, but she cautioned, in isolation would not be a sufficient incentive to remain. In agreement, McKee emphasised that the decision of health workers to migrate is often not solely due to demotivation caused by insufficient salaries, but also influenced by the poor working conditions the remaining workers face. In order to fully address the imbalance, working conditions, opportunities for developing skills and responsibilities, along with more difficult issues such as informal payments must be addressed. With many EU Member States having already developed data- driven strategies to build a resilient HWF, the question remains if and how the EU will advance coherent policy responses that ensure national strategies are not hindered by macroeconomic agreements unrelated to the health labour market. Hinlopen reiterated the importance of developing responses that amplify the implementation and effectiveness of national strategies, balancing the national interests with the collective interests of the Union. COVID-19 and strengthening EU cooperation The COVID-19 crisis, and the wider societal and systemic response, have brought health inequalities into sharper focus. Those most vulnerable have been hit the hardest due to societal, political, and health system failures that replicate inequalities and vulnerabilities. Hinlopen recognised this to be Europe’s opportunity to “build back better”, acknowledging the pandemic has resulted in increased political will to invest in health. Now is our moment to leverage that will because “what is our wealth, without health?”. Learn more Session recording Programme16TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT #healsy20 - Lessons learnt from COVID-19 Resilient Health Systems 2020 Organised by the German National Association of Statutory Health Insurance Physicians (KBV) as part of Germany´s Presidency of the EU Council While most of the larger European countries – France, Italy, the UK, Spain – famously struggled with managing the COVID-19 pandemic during its early phase, Germany stood out with early infection control and low mortality rates since the beginning. What determined Germany’s success in containing the outbreak? What lessons can be learned from the German experience during the past months? These and other questions were discussed in the opening session of the Digital Congress of the German National Association of Statutory Health Insurance Physicians (KBV), which was streamed live to the EHFG. Comparing outbreak indicators across Europe Reinhard Busse, Professor and Head of the Department of Health Care Management, Berlin University of Technology, started his keynote by giving a cross-country overview of epidemiological data and response indicators to contextualise the German outbreak response. Notably, Germany has exhibited high testing volumes with low positive rates since the beginning of the crisis. Even more importantly, however, Busse stressed that the share of COVID-19 patients treated in hospitals has been significantly smaller in Germany than in other countries. Both testing and treatment of milder cases have predominantly taken place in the primary healthcare (PHC) sector. On the one hand, this has helped prevent overcrowding of hospitals. On the other hand, it reduced the risk of virus transmission to health professionals and other patients. Germany’s fortunate situation is also reflected in mortality statistics: while all-cause excess mortality reached around 20% in some European countries, there has not been a significant increase in deaths in Germany. As Busse pointed out, this is most likely not only due to low COVID-19 related mortality, but also to the continued provision of necessary care to non- COVID-19 patients, which helped minimise collateral damage. So, Germany fared well – but why? Following the keynote presentation, a high-level panel discussed what they considered to be the major success factors in Germany’s management of the COVID-19 crisis. Jens Spahn, German Federal Minister of Health, stressed the importance of an early response: Germany was one of the first countries in Europe to provide diagnostic infrastructure and to grant reimbursement of tests by statutory health insurance. He also drew attention to Germany’s good laboratory infrastructure and network of local public health authorities. He put particular emphasis also on the importance of the health workforce, consisting of more than five million people, and explicitly mentioned professions like medical technicians, who receive little attention in normal times. Taking up the point from Busse’s presentation, all panellists agreed on the importance of a strong PHC sector that helps relieve the burden on hospitals. Andreas Gassen, Chairman of the Board, KBV, pointed out that he regarded Germany’s decentralised system of outpatient general practitioners and specialist care as crucial for its successful management of the crisis, especially for avoiding transmission within the healthcare sector. He also expressed confidence that, should case numbers rise further in the coming weeks and months, the German system would still be able to handle such an increase relatively well. Yet, there is room for improvement The panel also identified some lessons to be learned from the German crisis management so far. In this regard, Spahn stressed the need to better use the potential offered by digitalisation, including to improve the exchange of data, e.g. on test results. Electronic patient records, which have been used in other countries for many years, will be introduced in Germany in 2021. Two other aspects he mentioned were the need for greater 17TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT independence from China regarding pharmaceutical production as well as for bringing antiquated occupational regulations for health professions up to date. Doris Pfeiffer, Chairwoman, German National Association of Statutory Health Insurance Funds, drew attention to questions of financing. While spending of statutory health insurance funds in 2020 appears to remain lower than had been feared – due to lower service use in the inpatient sector and cost sharing with the federal government for reserved hospital capacities – the outlook for 2021 remains highly uncertain. The financing situation then will depend on factors that are hard to assess upfront, like the extent to which the virus will continue to spread, the economic development, and the costs related to a potential vaccine. This makes planning ahead a difficult task for payer organisations. Hans Kluge, Regional Director for Europe, World Health Organization, also highlighted the need for increased international solidarity and reforms targeting health systems resilience and preparedness at a European level. He also called for a closer alignment of public health and policy-making. The elephant to dance with in the coming months: vaccination Inevitably, towards the end of the session, the discussion turned to considerations around a potential vaccine. True to the motto “no one is safe until everyone is safe”, the panellists agreed on the importance of international solidarity in the distribution of vaccines once they are available. Mentioning the COVAX facility, Kluge drew attention to the danger of neglecting middle- income countries, as the discussion is mostly focussed on high- and low-income countries. Furthermore, there was consensus that the level of solidarity and cooperation that has arisen from the current crisis should be further capitalised upon, e.g. for health-policy related reforms at the EU level. As pressing as the need for a vaccine to alleviate the effects of the pandemic currently feels, both Spahn and Gassen insisted that vaccine candidates must fulfil high safety standards. Thus, they welcomed the decision made by the EU to only introduce a vaccine once it has successfully undergone phase three of the evaluation process. Spahn also addressed rumours spread persistently by anti-vaccine groups and made clear that vaccination would not be mandatory in Germany. Learn more Programme18TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT The future of health systems sustainability Young European Voices The COVID-19 pandemic has exposed the fault lines in health systems of even the most economically advantaged and politically stable countries across Europe. The session ‘Young European Voices’, organised by MSD and Johnson & Johnson, set an arena for discussion on the future of health system resilience and sustainability, and in fact did so with a particular and much-needed twist – a focus on Europe’s next generation of experts, leaders and community voices. The session called for more opportunities for young Europeans to get involved in the process of building a more equitable and harmonised future for healthcare in the European Union. To identify actionable steps towards this goal, the session gave the floor not only to a panel of high-level policymakers and experts, but also representatives of key youth organisations: Digital Europe, European Health Parliament, European Patients’ Forum Youth Group, EU40, One Young World, Think Young, Young European Leadership, Young Forum Gastein; and Young Coalition for Prevention and Vaccine. Hope that the COVID-19 crisis might present a moment of opportunity to (re)think what kind of future we want to create for younger generations echoed through the session – as summarised by Michele Calabrò, Policy Advisor, European Patients’ Forum: “We are certainly not starting from an ideal situation - but we should try to learn from this crisis and advance, not just repair, our health systems for better resilience.” Susana Solís Pérez, Member of European Parliament, stressed the weight of the political choices we make as we strive to overcome the pandemic: “Now more than ever, policymakers need to collaborate with young people to build a brighter and more inspiring future for Europe.” Signe Ratso, Deputy Director- General at the Directorate-General for Research and Innovation (DG RTD), European Commission, highlighted the importance of knowledge-sharing and collaboration across countries and sectors in the fight for recovery. “I firmly believe that research and innovation are critical to ensure sustainability and recovery and to boost resilience.”, Ratso summarised. Advancing digital transformation One area of innovation in which young, ‘digital native’ actors can doubtlessly lead the way is the digital transformation of health systems. Unsurprisingly, during the pandemic young people were on average better able to make the sudden technological leaps required to successfully navigate the new reality. Given the high level of digital literacy in young professionals, it is particularly important to facilitate and encourage the involvement of young Europeans in conceptualising the EUs future approach to digital health. However, digitalisation cannot succeed without the trust of citizens, and as Evelina Kozubovska, Member of the European Health Parliament, pointed out “it is crucial to ensure that citizens know what happens to their data and how it is used.” The fact that many national-level health records in the EU remain disjointed and health data sharing initiatives in the EU are still limited in scope presents a challenge to overcome, as does the creation of a safe and coherent pan-European data infrastructure that can allay fears and reliably meet data security requirements. Alongside the empowerment of citizens, investing in trainings for healthcare professionals will be crucial to make digitally transformed health systems possible. As discussed by speakers in this session, it is vital to ensure that the transition to digital health does not come at the cost of further increasing health inequities within Europe, with those less health- and digitally literate being left behind. The panelists agreed that the development of a resilient health system, and the digital transformation accompanying it, need to capitalise on the invaluable resource represented by young healthcare and public health professionals all across Europe. From good examples to best practices Among a broad agreement that COVID-19 has opened a window of opportunity for bold, transformative action on health in Europe, the challenge now will be to identify concrete next Organised by MSD and Johnson & Johnson19TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT steps to harness this momentum. While all policymakers on the panel were united in their commitment to involve young health professionals in the COVID-19 recovery effort, it proved more challenging to pin down practical actions to achieve this goal. To realise the potential of young actors for policy change, not only do young Europeans need to be proactive in their involvement, but new mechanisms need to be put in place that facilitate their engagement. Signe Ratso named several positive examples of youth participation during the COVID-19 pandemic, such as designing face masks, providing care for the elderly, and creating solutions in the digital space like organising health-focused hackathons. Despite the inspiring examples, it also became clear that much work remains to be done to channel individual innovations into a systemic empowerment of young actors for positive structural change. The session carried important take-away messages for the audience and in particular for policymakers. First, stronger intergenerational cooperation needs to be established and institutionalised to allow for a smooth transition of European public health into the digital age, and young European health professionals need to be at the helm of this transformation. Beyond that, an effort needs to be made for all European health professionals, regardless of their age, to improve their digital skills as a matter of priority. Finally, health budgets need to be improved both on the national and European level, with the recent cut in the EU4Health programme budget flagged as a particular topic of concern. United Young Voices leading the way forward The second part of the session gave the floor to young voices by bringing together a number of European youth organisations to envision Europe’s (healthy) future. The discussions were thematically divided into two groups: ‘Prevention and sustainability of future health systems’ and ‘Digital health - building today the healthcare of tomorrow’. These discussions were meant to serve as a starting point for more comprehensive action: based on the collected proposals, a youth engagement campaign on the value of prevention will be established to motivate young people to become actively involved in fight for health system resilience in Europe, while the group focused on digital health will come up with a concrete set of policy recommendations. Elisabeth Wisniewski, Editor, Debating Europe, steered the discussion in the prevention and sustainability group. The group agreed that empowering youth to embrace their role in prevention with respect to their own health will be an important stepping-stone to encouraging young people to take their engagement for health from the personal to the institutional level. Reaching young people with messages about health and health promotion must happen on their terms: one stand-out conclusions from the discussion concerned the need for clear, concise and dynamic messages tailored to young people. The discussion in the digital health group was facilitated by Joe Litobarski, Debating Europe, who led the discussion to form a common set of priorities and policy recommendations. A wide number of topics such as data security, equitable access and infrastructure were addressed, showing also that many issues in the digital space are highly interconnected. Communication and literacy stood out as priorities also in this group, stressing that citizens, healthcare professionals and policymakers need guidance and resources to navigate digital data and processes. The two groups were designed to foster an active and constructive tone of discussion, and most importantly helped the session participants come closer to answering the question on how to use the potential of young people in the COVID-19 recovery period and how to involve youth in public health in Europe in general. The involved youth organisation and session organisers will continue their work in this space, and looking forward, we will see how the recommendations that emerged will be operationalised and taken forward on the policy level. Learn more Session recording ProgrammeNext >