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Background: Many studies around the world have been carried out to establish the association between deprivation and health outcomes. Both separate deprivation indicators (income, education) and indices that include several ones are used. Deprivation indices have been actively used in public health since the mid-80s of the last century. Nowadays, there is no clear classification of deprivation indices. Methods: In order to create a taxonomy of deprivation indices, scientific publications related to the development and application of indices have been combined, analyzed, and systematized. The search was carried out in two bibliographic databases (PubMed and Google Sholar). After conducting a full-text review and searching and adding relevant papers from the bibliography, and adding papers that were already known to the authors, 61 documents were included in the study. These documents referred to 61 original deprivation indices. Original index is defined as ‘‘an index that includes a combination of deprivation indicators that is unique and not repeated in other indices’’. Results: Four key characteristics of the indices included in the classification were determined: type of deprivation, spatial scale, data source and weighting method. To create the taxonomy, an integrative approach was used that allows you to add new classes and subclasses when new information appears. In accordance with the type of deprivation 72% (44 \ 61) socio-economic, 7% (4 \ 61) material deprivation, 5% (3 \ 61) environmental deprivation and 16% (10 \ 61) multidimensional indices were identified. Conclusions: The terms and definitions introduced during the review are aimed at ensuring uniformity in the taxonomy and finding a common language among researchers and specialists who develop and use indices. We also hope that the data from the study will stimulate the use of a competent approach and will help in resolving conflicts or inconsistencies that arise during the construction and use of indices. [ABSTRACT FROM AUTHOR]

Background: Patient-reported experience measures assess patients’ experiences with processes in healthcare and hence support a patient-centred orientation of care. The aim of the study was to measure patients’ experiences in Slovenian acute hospitals in the fields of internal medicine, surgery, gynaecology and obstetrics, oncology and orthopaedics. Methods: The survey was based on a 2006 questionnaire already in use in Slovenia, which was updated after a literature and documentary review. The questionnaire included the following domains: admission to the hospital, time from arrival to the hospital to the bed on the ward, attitude of doctors, attitude of nurses, treatment, privacy, hospital environment and discharge from hospital. Mixed-mode study design was used, which involved a combination of traditional paper-and-pencil method and a web survey. Results: The national survey was conducted in autumn 2019 and included 22 acute hospitals with 49 hospital wards. The questionnaire was validly completed by 3,684 patients, with 91.8% paper and 8.2% online questionnaires. The response rate was estimated to be 32.1%. The mean value for the general assessment of hospital treatment on a scale from 0 to 10 was 9.07. The worst rated indicators were related to hospital food (only 56.9% of patients were satisfied) and doctors’ explaining the possible side effects of the newly prescribed medications (65.0% of patients agreed on obtaining such explanation). Qualitative analysis of open questions revealed that patient paid considerable attention to poor infrastructure and needs for hospital renovations. Conclusions: The surveyed patients in our study rate highly the treatment in acute care hospitals. However, there is room for improvement. Increased attention to hospital environment and infrastructure is warranted in the future, including the amendments of the questionnaire. Key messages: • In autumn 2019, a national survey on patient’s experiences in acute care hospitals in Slovenia was conducted. 76.5% of the surveyed patients rated the medical treatment with a score of 9 or 10. • Qualitative analysis of open questions revealed poor infrastructure and needed renovation of the hospitals. [ABSTRACT FROM AUTHOR]

Analyzes the motivations for and methods of four national public health strategies. Information on public health, power and governmentality; Reasons for governments to improve the health of their populations; Identification of health problems of the population.

Background: This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses. Methods: The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours. Results: A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents. Conclusion: The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses. [ABSTRACT FROM AUTHOR]

Background: There has been little research on the economic status of those with multiple health conditions, particularly on the relationship between multiple health conditions and wealth. This paper will assess the difference in the value and type of wealth assets held by Australians who have multiple chronic health conditions. Methods: Using Health & WealthMOD, a microsimulation model of the 45-64-year-old Australian population in 2009, a counterfactual analysis was undertaken. The actual proportion of people with different numbers of chronic health conditions with any wealth, and the value of this wealth was estimated. This was compared with the counterfactual values had the individuals had no chronic health conditions. Results: There was no change in the proportion of people with one health condition who actually had any wealth, compared to the counterfactual proportion had they had no chronic health conditions. Ninety-four percent of those with four or more health conditions had some accumulated wealth; however, under the counterfactual, 100% would have had some accumulated wealth. There was little change in the value of non-income-producing assets under the counterfactual, regardless of number of health conditions. Those with four or more chronic health conditions had a mean value of $17 000 in income-producing assets; under the counterfactual, the average would have been $78 000. Conclusion: This study has highlighted the variation in the value of wealth according to number of chronic health conditions, and hence the importance of considering multiple morbidities when discussing the relationship between health and wealth. [ABSTRACT FROM AUTHOR]

The authors introduce the issue, themed From Data to Public Health Actions, which features work conducted by the Population Health Information Research Infrastructure (PHIRI). Topics discussed include an overview of PHIRI, essential pillars covered by PHIRI to support strong and resilient HIS and research for evidence-based policy making across Europe, and role of PHIRI in the implementation of the European Health Data Space (EHDS).

The authors announce that beginning in January 22, the journal "European Journal of Public Health" will be published fully open access. They talk about the changes in the publishing landscape as of February 2021, the strong international momentum to increase the transition to open access, and concern on the cost of publishing.

Background: Up to now, research has focused on the effects of urban renewal programs and their impacts on health. While some of this research points to potential negative health effects due to gentrification, evidence that addresses the complexity associated with this relation is much needed. This paper seeks to better understand when, why and how health inequities arise from urban renewal interventions resulting in gentrification. Methods: A realist review, a qualitative systematic review method, aimed to better explain the relation between context, mechanism and outcomes, was used. A literature search was done to identify theoretical models of how urban renewal programs can result in gentrification, which in turn could have negative impacts on health. A systematic approach was then used to identify peer-reviewed studies that provided evidence to support or refute the initial assumptions. Results: Urban renewal programs that resulted in gentrification tended to have negative health effects primarily in residents that were low-income. Urban renewal policies that were inclusive of populations that are vulnerable, from the beginning were less likely to result in gentrification and more likely to positively impact health through physical and social improvements. Conclusions: Research has shown urban renewal policies have significant impacts on populations that are vulnerable and those that result in gentrification can result in negative health consequences for this population. A better understanding of this is needed to impact future policies and advocate for a community-participatory model that includes such populations in the early planning stages. [ABSTRACT FROM AUTHOR]

Background: Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. Methods: We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. Results: We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Conclusions: Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. [ABSTRACT FROM AUTHOR]

Background This scoping review aims to map the extent, range and nature of qualitative research on people's 'perceptions' of their own alcohol consumption. Methods A systematic search of five electronic databases was conducted. A total of 915 abstracts were screened and 452 full texts examined, of which 313 papers met the inclusion criteria (including a report of qualitative data on perceptions, experiences or views of people's own drinking in peer-reviewed journals published in English). Results This study maps the available literature assembled over approximately 30 years, which was found to be extensive and diverse. Many existing studies are focused largely on people's 'experiences' of their own drinking behaviours, particularly when they were drinking in ways commonly understood as heavy, risky or problematic. Fewer studies focused on populations whose drinking was not heavy or was risky in less obvious ways, such as older adults prescribed medications for chronic health conditions. Most studies were conducted since 2010, with the rate of publications increasing since 2014. Conclusions This review identifies gaps in the evidence regarding people's perceptions of their own drinking and opportunities for qualitative studies to make valuable contributions to alcohol research. Gaps discussed include patterns of drinking that are less obviously problematic, and in relation to consumption of alcohol in those parts of the world where overall consumption and harms from alcohol are high. Such studies could usefully be informed by existing studies in the evidence mapping. [ABSTRACT FROM AUTHOR]

Background Prevalence of overweight and obesity in Germany is increasing. High body weight can affect children's growth and development. This paper aimed to determine the association between body mass index (BMI) and visual impairment among preschool children and explore the potential role of obesity in predicting visual developmental disorder. Methods Six consecutive years of data from the School Entry Examination were collected for all preschool children aged from 4 to 6 years residing in Rhine-Neckar County and the City of Heidelberg, Germany from 2013 to 2018. Univariate and multivariate regression were used to analyze the complete data, multiple imputation was used to deal with missing data. Results Among the group with an immigrant background, children with obesity [OR = 1.20, 99% (1.02–1.42)] were more likely to have visual impairment compared to those with normal body weight (P  <   0.01) after adjusting for survey year, age, and gender of children, education and occupation of parents, screen time-frequency, whether a television was in their bedroom, and quality of preschool outdoor environment. Conclusion There were significant associations between obesity and visual impairment among German preschool children with immigrant backgrounds. Strategies to support vulnerable groups were needed across all regional schools. [ABSTRACT FROM AUTHOR]

Background: Public reporting (PR) of healthcare (HC) provider's quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider's perspective; patient experience; and unintended consequences. Methods: PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016. Results: Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients' choice, 7 evaluated the provider's perspective, 4 economic outcome, 4 service utilization, 2 purchasers' use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies--mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider's perspective and economic outcome (27%) and mainly negative on unintended consequences (68%). Conclusions: Our research covering different outcomes and settings reported that PR is associated with changes in HC provider's behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user's perception of the providers' quality of care, helping them to make empowered choices. [ABSTRACT FROM AUTHOR]

Background: The numbers of migrants living in Europe are growing rapidly, and has become essential to assess their access to primary health care (PHC). Avoidable Hospitalization (AH) rates can reflect differences across migrant and ethnic minority groups in the performance of PHC. We aimed to conduct a systematic review of all published studies on AH comparing separately migrants with natives or different racial/ethnic groups, in Europe and elsewhere. Methods: We ran a systematic search for original articles indexed in primary electronic databases on AH among migrants or ethnic minorities. Studies presenting AH rates and/or rate ratios between at least two different ethnic minority groups or between migrants and natives were included. Results: Of the 35 papers considered in the review, 28 (80%) were conducted in the United States, 4 in New Zealand, 2 in Australia, 1 in Singapore, and none in Europe. Most of the studies (91%) used a cross-sectional design. The exposure variable was defined in almost all articles by ethnicity, race, or a combination of the two; country of birth was only used in one Australian study. Most of the studies found significant differences in overall AH rates, with minorities (mainly Black and Hispanics) showing higher rates than non-Hispanic Whites. Conclusions: AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence. [ABSTRACT FROM AUTHOR]

Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making. [ABSTRACT FROM AUTHOR]

We provide a framework for assessing the outcome of community-based intervention programmes for the promotion of cardiovascular health at local level. Particular attention is therefore given to conceptual components connected with community participation in health programmes and to methodological approaches in the evaluation of cardiovascular disease (CVD)-prevention programmes. In a search of the literature covering more than 20 years (1966–1988) in 2 databases (MEDLINE and SOCA), we found that the concepts of ‘community participation’ and ‘community involvement’ have mainly been used during the latter half of the study period. The concepts were often used interchangeably and with no statement as to their precise meanings. The methodological examination of 2 well-known community-based CVO-preventive programmes revealed that most of the scientific papers from these programmes dealt with health behavioural and/or medical effects. The suggested framework presented in this study is designed as a longitudinal process analysis focusing on critical key steps along the path from input to output. The suggested research strategy is problem-orientated, inter-disciplinary and based on a multi-method approach. [ABSTRACT FROM PUBLISHER]

Background Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. Methods A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. Results Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. Conclusions The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies. [ABSTRACT FROM AUTHOR]

Background Natural disasters are increasing in their frequency and complexity. Understanding how their cascading effects can lead to infectious disease outbreaks is important for developing cross-sectoral preparedness strategies. The review focussed on earthquakes and floods because of their importance in Europe and their potential to elucidate the pathways through which natural disasters can lead to infectious disease outbreaks. Methods A systematic literature review complemented by a call for evidence was conducted to identify earthquake or flooding events in Europe associated with potential infectious disease events. Results This review included 17 peer-reviewed papers that reported on suspected and confirmed infectious disease outbreaks following earthquakes (4 reports) or flooding (13 reports) in Europe. The majority of reports related to food- and water-borne disease. Eleven studies described the cascading effect of post-disaster outbreaks. The most reported driver of disease outbreaks was heavy rainfall, which led to cross-connections between water and other environmental systems, leading to the contamination of rivers, lakes, springs and water supplies. Exposure to contaminated surface water or floodwater following flooding, exposure to animal excreta and post-disaster living conditions were among other reported drivers of outbreaks. Conclusions The cascade effects of natural disasters, such as earthquakes and floods, include outbreaks of infectious disease. The projection that climate change-related extreme weather events will increase in Europe in the coming century highlights the importance of strengthening preparedness planning and measures to mitigate and control outbreaks in post-disaster settings. [ABSTRACT FROM AUTHOR]

Background Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type. Methods Using the WHO standardized STEPS methodology, adults self-reported their smoking status. In a later stage of the survey, a subset of participants provided a urine sample, which was tested for cotinine. Using each participant's objective cotinine measurement and their self-reported smoking status, we calculated the sensitivity, specificity and positive predictive value of self-reported smoking. Next, we calculated the estimated prevalence of smokers according to the type of measurement. Results Results indicated high sensitivity (83.37%, 95% CI: 76.79–88.37%) among males and relatively low sensitivity (38.60% CI: 29.23–48.90%) among females. According to self-report, the prevalence of smokers was 26.44% (23.61–29.48%), while according to cotinine detection, the prevalence of smokers was 32.27% (29.16–35.55%). Among all subgroups, the self-reported prevalence of smoking was significantly lower than the cotinine-detected prevalence. Conclusions To the best of our knowledge, this is the first time that the validity of the STEPS self-reported tobacco indicator has been tested. Self-reported measures of smoking status may lead to an under-estimation of smoking prevalence among Georgian adults, especially women. These findings suggest that integration of biochemical measures of smoking into tobacco use studies may be an important investment. [ABSTRACT FROM AUTHOR]

The article offers information on a workshop at the 16th World Congress on Public Health 2020 on addressing the commercial determinants of health.

The article offers information on a workshop at the 16th World Congress on Public Health 2020 about vaccination challenges in developed and developing countries.

The article offers information on a workshop at the 16th World Congress on Public Health 2020 which connects health labour market data with the human face of the health workforce and brings a global approach to the analysis, with a focus on Europe.

Background Rapid infant weight gain (RIWG) is strongly related to childhood overweight and obesity, and prevention of RIWG is an approach to early years obesity prevention. This systematic review aimed to explore effectiveness, deliverers' and recipients' experiences of involvement, and key intervention components and processes of such prevention activities. Methods Key databases and websites were searched systematically for quantitative and qualitative studies covering intervention effectiveness, experiences with intervention involvement or process outcomes. After duplicate screening and quality assessment, papers were analyzed through narrative synthesis, thematic synthesis and intervention component analysis. Results Seven quantitative and seven qualitative studies were eligible for inclusion. Most intervention studies reported small, but significant results on infant weight gain. More significant results were measured on weight gain during the first compared with the second year of life. A weak evidence base made elaboration of the relationship between intervention effectiveness and content challenging. Home-delivered interventions may be more relevant for parents. Contextual factors, such as social norms, beliefs and professional identity should be considered during intervention development. Stakeholder involvement can be key to increase intervention acceptability and feasibility. Conclusions The field of RIWG prevention is new and evolving, but more research is needed before further conclusions about intervention effectiveness and intervention content can be drawn. Future interventions should take parents, health professionals and other contextual needs into account to improve chances of success. More research on long-term effects on overweight and obesity is needed. [ABSTRACT FROM AUTHOR]

Background: To describe breast cancer (BC) incidence and mortality by ethnicity in South Africa (SA). Methods: Sources of data included the South African National Cancer Registry (NCR) pathology-based reports (1994-2009) and Statistics South Africa (SSA) mortality data (1997-2009). Numbers of cases, age-standardised incidence rates (ASIR) and lifetime risk (LR) were extracted from the NCR database for 1994-2009. Age-specific incidence rates were calculated for five-year age categories. The direct method of standardisation was employed to calculate age-standardised mortality rates (ASMR) using mortality data. Results: Between 1994 and 2009, there were 85 561 female BC. For the Black, Coloured and Asian groups, increases in ASIR and LR were observed between 1994 and 2009. In 2009, the ASIR for the total population, Blacks, Whites, Coloureds and Asians were 26.9, 18.7, 50.2, 40.9 and 51.2 per 100000, respectively. For Asians, an increase in proportion of BC as a percentage of all female cancers was observed between 1994 and 2002 (11.1%) and continued to increase to 2009 (a further 4.5%). Whites and Asians presented higher incidences of BC at earlier ages compared with Blacks and Coloureds in 2009. In 1998, there were 1618 BC deaths in SA compared with 2784 deaths in 2009. ASMR between 1997 and 2004 increased but stabilised thereafter. Conclusion: This paper demonstrated that SA BC incidence rates are similar to other countries in the region, but lower than other countries with similar health systems. Ethnic differences in BC trends were observed. However, the reasons for observed ethnic differences are unclear. [ABSTRACT FROM AUTHOR]

Background: The EU directive on patients' rights and cross-border care is of particular interest to small states as it reinforces the concept of health system cooperation. An analysis of the challenges faced by small states, as well as a deep evaluation of their health system reform characteristics is timely and justified. This paper identifies areas in which EU level cooperation may bring added value to these countries' health systems. Method: Literature search is based primarily on PUBMED and is limited to English-language papers published between January 2000 and September 2014. Results of 76 original research papers appearing in peer-reviewed journals are summarised in a literature map and narrative review. Results: Primary care, health workforce and medicines emerge as the salient themes in the review. Lack of capacity and small market size are found to be the frequently encountered challenges in governance and delivery of services. These constraints appear to also impinge on the ability of small states to effectively implement health system reforms. The EU appears to play a marginal role in supporting small state health systems, albeit the stimulus for reform associated with EU accession. Conclusions: Small states face common health system challenges which could potentially be addressed through enhanced health system cooperation at EU level. The lessons learned from research on small states may be of relevance to health systems organized at regional level in larger European states. [ABSTRACT FROM AUTHOR]

Background Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix). Methods A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included. Results The current evidence includes high-income countries (USA, n  = 7; UK, New Zealand and Oman, n  = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n  = 4), state (n  = 1), county (n  = 1), school district (n  = 1) and city (n  = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors. Conclusion Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour. [ABSTRACT FROM AUTHOR]

Background The emergence of new types of tobacco and tobacco-related products on the European Union (EU) market has precipitated the possibility for both poly-tobacco use and transitions between products. In the EU, the regulatory environment has shifted with the implementation of the European Tobacco Products Directive (TPD) in May 2016, which may influence consumer transitions between products. Methods The aim of this paper was to examine trends and transitions in tobacco products from 2016 to 2018 -before and after implementation of the TPD in the EU. Data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Survey, a cohort study of adults who at the time of recruitment were smokers from six EU countries- Germany, Greece, Hungary, Poland, Romania, and Spain. D (N = 3195). Bivariate and logistic regression analyses of weighted data was conducted using SAS-callable SUDAAN Results Overall, among those who smoked factory-made cigarettes (FM) only at Wave 1, 4.3% switched to roll-your-own tobacco (RYO) only. Among RYO only users at Wave 1, 17.0% switched to FM only, however compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%). Conclusions The most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2, however this varied across countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. Conclusions Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM. [ABSTRACT FROM AUTHOR]

Background The Global Burden of Disease study has generated a wealth of data on death and disability in Europe. At a time of change for the European Union and European Region of WHO, with a new Health Commissioner and Regional Director, respectively, a review of health trends can contribute to identify outstanding needs and gaps. This paper reports a summary of the burden of disease in the European Union (EU) in 2017 (compared with 2007). Methods For the whole EU and each country, mortality by causes of death, disability-adjusted life years (DALYs) and life expectancies are reported. Results In 2017, the age-standardized mortality and DALY rates were of 452.6 and 19 663.3 per 100 000 inhabitants, respectively. The diseases contributing most to mortality were ischaemic heart disease (IHD), dementias and stroke, while low back pain and IHD accounted for the highest burden of DALYs. Conclusions Overall, there was an improvement in the state of health in the EU but substantial differences between countries remain. Cardiovascular diseases still represent the major burden, although there have been substantial improvements. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease. [ABSTRACT FROM AUTHOR]

Background The high prevalence of smoking among French women since the 1970s has been reflected over the past decade by a strong impact on the health of women. This paper describes age and gender differences in France of the impact of smoking on morbidity and mortality trends since the 2000s. Methods Smoking prevalence trends were based on estimates from national surveys from 1974 to 2017. Lung cancer incidence were estimated from 2002–12 cancer registry data. Morbidity data for chronic obstructive pulmonary disease (COPD) exacerbation and myocardial infarction were assessed through hospital admissions data, 2002–15. For each disease, number of deaths between 2000 and 2014 came from the national database on medical causes of death. The tobacco-attributable mortality (all causes) was obtained using a population-attributable fraction methodology. Results The incidence of lung cancer and COPD increased by 72% and 100%, respectively, among women between 2002 and 2015. For myocardial infarction before the age of 65, the incidence increased by 50% between 2002 and 2015 in women vs. 16% in men and the highest increase was observed in women of 45–64-year-olds. Mortality from lung cancer and COPD increased by 71% and 3%, respectively, among women. The estimated number of women who died as a result of smoking has more than doubled between 2000 and 2014 (7% vs. 3% of all deaths). Conclusions The increase in the prevalence of smoking among women has a major impact on the morbidity and mortality of tobacco-related diseases in women and will continue to increase for a number of years. [ABSTRACT FROM AUTHOR]

Policy simulation models (PSMs) have been used extensively, both to shape health policies before real-world implementation and to evaluate post-implementation impact. However, an accepted quality assessment framework for simulation models is lacking. This systematic review aimed to develop a novel quality assessment framework for tobacco control PSMs. We searched five databases to identify peer-reviewed tobacco control PSMs that projected tobacco-use and tobacco-related outcomes from smoking policy scenarios. We extracted information on modelling inputs, structure and outputs. Using our proposed quality assessment framework, we scored models on nine dimensions: representativeness of population, policy effectiveness evidence, simulated smoking histories, simulated smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. We then compared the model score with the number of cited papers using each model. The results were narratively presented. After screening 5046 candidate papers; 145 papers were included and categorised into 25 PSMs. After scoring the models using our proposed framework, we observed that seven models were given seven and more points. The higher-scored models were generally those with a higher number of publications. While all included models had been subject to sensitivity analysis, other best practices were often lacking. Nine models did not explicitly consider smoking-related diseases. Smoking histories were commonly collapsed into crude smoking status categories rather than reflecting smoking intensity or quitting history. Furthermore, only four models estimated policy equity impact. Our systematic review revealed a variety of modelling techniques used in tobacco control. Our novel quality assessment framework offers a potential quality measure for tobacco control policy simulation models. It may guide health decision modellers and inform health policymaking. Key messages: All nine framework dimensions were observed in two tobacco control PSM, suggesting the framework relevance and feasibility. However, few models achieved high scores in all dimensions. This novel quality assessment framework aims to support the development and sharing of good modelling practice and thus promote better health policy decision-making. [ABSTRACT FROM AUTHOR]

The Health Systems Response Monitor (HSRM) was established in March 2020 at the beginning of the COVID-19 pandemic to collect and organize up-to-date information on how 50 countries in the WHO European Region and Canada are responding to the crisis. The HSRM uses a structured template, focusing primarily on the responses of health systems but also capturing wider public health initiatives. The HSRM is a joint undertaking of the WHO Regional Office for Europe, the European Observatory on Health Systems and Policies, and the European Commission. The HSRM builds on the Health Systems and Policy Network of the European Observatory, which brings together an international group of high-profile institutions from Europe and beyond with high academic standing in health systems and policy analysis. The content collected on the HSRM platform has been used to enhance cross country learnings through topical snapshots, papers, webinars and more. At the end of 2020, the European Observatory initiated a Health Policy Special Issue (SI) based on the work of the HSRM containing both thematic policy papers and full comparative descriptions and analysis of country responses. Overall, work from the HSRM aims to provide coherent and comprehensive insight on lessons learned from the COVID-19 response so far to support policymakers for future waves or in case of future pandemics. This workshop aims to provide the audience with an overview of the COVID-19 HSRM and the insights gleaned from the SI. An introductory overview will briefly introduce the COVID-19 HSRM and the SI. The first presentation will compare provider payment adjustments across 20 countries. The second presentation will focus on how countries planned services for potential surge capacity, managed care provision, and maintained routine services in both hospital and outpatient settings during the first wave of the pandemic. The third presentation will zoom in on experiences in primary health care. The last presentation will feature one of the country comparison papers from social health insurance countries. The workshop will conclude with an audience discussion about the lessons learned from the COVID-19 HSRM, and future opportunities for research using the HSRM. Key messages: The COVID-19 Health System Response Monitor has tracked the progression of health policies throughout the pandemic and captures particularly policy relevant aspects. Both thematic and cross-country comparisons can illuminate how health systems have responded to the COVID-19 pandemic and provide lessons for future waves and pandemics. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of COVID-19 has created global transmission. While effective at reducing the spread, public health measures implemented may impact individuals differently leaving them susceptible to the detrimental effects on their health and wellbeing. Therefore this review aims to synthesise the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID-19 pandemic. Methods: A three-step search strategy was used to find both published and unpublished papers. The databases searched included: MEDLINE, CINAHL, EMBASE, and Google Scholar. Following the search, all identified citations were uploaded into Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed independently by two reviewers, with meta-synthesis conducted in accordance with JBI methodology. Results: Fifteen papers were included. Three synthesized conclusions were established a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID-19 including mortality; b) Gender inequalities and family violence have been exacerbated by COVID-19, leading to diminished wellbeing among women; and c) COVID-19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to healthcare, housing instability, homelessness and difficulties in social distancing. Conclusions: Vulnerable population groups have been disproportionately impacted by COVID-19, including health outcomes such as hospitalisations and mortality. The COVID-19 pandemic has highlighted the need for action on health inequalities and the social determinants of health. Reflection on social and health policies implemented are necessary to ensure that the COVID19 pandemic does not exacerbate health inequalities into the future. [ABSTRACT FROM AUTHOR]

Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the European burden of disease (BoD) studies. The SLR will provide an overview of the existing BoD studies and the computational variations used and will also help identifying ways to harmonize the approaches enhancing the comparability of BoD estimates. The SLR was split in four parallel reviews: noncommunicable diseases (NCDs), communicable diseases (CDs), injuries and risk factors. For the first three, the search strategy included terms describing the population (GBD area ‘‘European region’’) and the BoD measures (years lived with disability, years of life lost, and DALYs). We included studies published between January 1990 and April 2020, without language restrictions. The search strategy was run in PubMed, Web of Science, Cochrane, and Embase. OpenGrey, OAIster, CABDirect, WHO and targeted public health agency websites were screened for grey literature. In addition, burden-eu members were asked to supplement the list of publications with any material available within their national public health institutes. Data extraction focused on methodological information. The title, abstract and full-text screening resulted in the final inclusion of 165 papers regarding NCDs, 189 with CDs, and 124 papers regarding injuries. The final list includes peer-reviewed articles and reports showing a variability in data sources used (e.g. patient medical records, disease registries, insurance claims sources) and model assumptions (e.g. use of multi-morbidity adjustments, use of disability weights). Further data extraction and analysis is in process, and will be presented during the workshop. [ABSTRACT FROM AUTHOR]

Background: Digital sources such as Internet-based search tools have created prospects for augmenting traditional public health surveillance. These can support the identification of emerging public health concerns, intervention evaluation or policy making. Social Determinants of Health(SDoH) are key factors linked to health outcomes yet they are poorly recorded and seldom used. Scientific papers have reported SDoH impacts on various outcomes yet this data has not been explored for population trend analyses. We present an analysis of our approach to combining insights mined from PubMed with online search trends. Methods: PubMed-2019 database was used to build a knowledge graph(KG) of connected health and social concepts based on relative co-occurrences found throughout the abstracts. We then observed Google search trends for 10 SDoH concepts at the outset of the 2020 pandemic (March-May) and compared them with the previous 4 years. For concepts with increasing trends, the KG was used to identify other potentially relevant concepts. Subsequently we continued observing online trends for a further 12 months in order to examine the KG concepts’ trends. Results: Our analysis showed Food Security and Unemployment trended the highest compared to previous years. These became the seed concepts used to traverse the KG, where the top 20 relevant concepts were identified for each seed. An analysis of the 8 concepts overlapping both seeds showed 6 with increasing trends during follow-up. Correlation coefficients were computed and positive relations observed (Unemployment+Anxiety, r=.72; Distress+Food Security, r =.62). Data will be discussed. Conclusions: Positive correlations were observed between data from a 2019 PubMed KG and online search trends during COVID-19. These preliminary results suggest value in combining these digital sources to strengthen public health systems. This is important to understand the interactions between health and social factors and identify emerging trends. Key messages: Combining data from scientific research papers with online search trends yielded interesting results that may further complement traditional surveillance systems and clinical case ascertainment. Social determinants of health data should play an increasingly important part in complementing public health surveillance systems and in strengthening population trend analyses. [ABSTRACT FROM AUTHOR]

Background: In the first wave of COVID-19, the UK Government relied heavily on digital channels to provide information to the public. This disproportionately excluded older people - one of the groups with least access to (or experience of) using the internet. Approximately 11.5 million people in the UK lack digital skills and 4.8 million people never go online, with around half (51%) of these being aged over 65. The Greater Manchester (GM) response was to work collaboratively with a number of key Ageing groups to develop Keeping Well at Home, a booklet providing evidence based health and wellbeing information and advice for older people during COVID-19 restrictions. Methods: An evaluation of the booklet was undertaken during summer 2020 by the Healthy Ageing team at the Applied Research Collaboration GM. As national restrictions on movement remained in place at the time, a postal questionnaire was distributed to a sample of older adults in GM. Results: Nearly 500 questionnaires were returned. The response was overwhelmingly positive; 92% found the information helpful; 90% agreed the booklet would help older people stay healthy during lockdown; 74% had used the home exercises section; 78% found the tips for keeping their mind well helpful. Around 50% of respondents did not have internet access. Paper based resources was the preferred choice for 92% of respondents with only 6% opting for digital versions. Conclusions: The evidence from the evaluation challenges the growing trend towards communicating just through digital channels, and emphasises the need for tailored paper-based materials for older adults. The Keeping Well at Home booklet also shows the value of working with older adults to ensure the content and design are inviting to readers. Information, support and services must be made available in an offline equivalent and proactively disseminated to reach those who otherwise would not have access to it. Key messages: Print-based communications are preferred over digital for some groups; ensuring inclusivity is critical as the ‘digital by default’ approach excludes large numbers of our population. Including target group representatives as co-editors to advise on content and stylistic design is key to ensure content is relevant and useful. [ABSTRACT FROM AUTHOR]

Background As digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges. Methods We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. Results From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction. Conclusion A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level. [ABSTRACT FROM AUTHOR]

Background The reduction of soda intake in the population remains an important goal to improve population health. Concerns exist about how industry-sponsored studies in nutrition tend to favour the interest of the sponsor. We describe the scope of partnerships between Coca-Cola and health organizations in Spain, examining marketing strategies contained in scientific papers funded by Coca-Cola. Methods Funding for health organizations in Spain during 2010–2016 was retrieved of the Coca-Cola transparency list. We systematically searched research projects and publications (by PubMed) of all the recipient organizations. In addition, we characterize the research agenda and the level of alignment of sponsored authors with marketing strategies used by Coca-Cola. Results A total of 74 health organizations received funding from Coca-Cola between 2010 and 2016. Nutritional and cardiology organizations received the highest financial support. A total of 20 articles derived of two research projects were identified. Most publications (14 out of 20) were aligned with marketing strategies used by Coca-Cola (e.g. focusing on physical inactivity as the main cause of obesity). Authors identified did not disclose having previous conflicts of interest. Conclusion In Spain, numerous health organizations receive financial support from Coca-Cola. We provide evidence that research funded by this beverage company is serving its commercial objectives that, in many cases, are at odds with efforts to improve population health. Problems with transparency among authors and the recipient organizations imply that we are offering very conservative estimates about the impact of this company on public health. [ABSTRACT FROM AUTHOR]

The article provides updates on issues related to the European Public Health Association (EUPHA) as of October 2019. Topics covered include opportunity of the World Health Organization to renew its vision for health in Europe beyond 2020, a white paper published by the European Commission in March 2017 setting out five possible paths for the future of Europe, and EUPHA's statement on what European political parties are stating on health.

Background This paper examines changes in substance use, and compares the resulting attributable burden of disease in the WHO European Region between 2010 and 2016. Methods Data for 2010 and 2016 on the number of deaths, years of life lost (YLL) and disability-adjusted life years (DALYs) lost were obtained by sex and country from the 2016 Global Burden of Disease (GBD) study. Exposure data for all substances except alcohol were obtained from the same study, while alcohol data were obtained from the WHO. Proportional changes were calculated for the WHO European Region as a whole to identify trends and for sub-regions to identify which regions contributed most to trends. Results In the WHO European Region in 2016, substance use caused 2.1 million deaths, 48.6 million YLL and 57.9 million DALYs lost, representing 22.4, 29.0 and 20.4% of all deaths, YLL and DALYs, respectively. The substance-attributable burden of disease was higher among men than women and highest in the eastern parts of the WHO European Region. Changes in the number of deaths, YLL and DALYs lost between 2010 and 2016 were almost uniformly downward, with the largest proportional changes observed for men. Exposure to tobacco, alcohol and illicit drugs also decreased uniformly. Conclusions Substance use and its attributable mortality and burden of disease have decreased in the WHO European Region since 2010. However, overall levels of substance use and the resulting burden of disease in the Region remain high compared with other regions of the world. [ABSTRACT FROM AUTHOR]

Background The aim of this paper was to compare the effects of demography (population aging and the increasing fraction of tertiary educated) and behaviour (intra-cohort ageing and inter-cohort change) on long-term change in the fraction of daily smokers (FrS), using a counterfactual framework. Methods Using aggregated data on smoking prevalence, education and population size from Norway 1978 to 2017, the probabilities of smoking for men and women were calculated using a pseudo-panel approach. From these estimates, four counterfactual scenarios of FrS were constructed by holding the age effect, the cohort effect and the distribution of age and education constant over time. Results FrS decreased from 45 to 14% among men, and from 33 to 14% among women over the study period. Holding the age distribution constant did not have any substantial effect on FrS. Holding the distribution of education constant led to a five percentage points increase in FrS among women, but not among men. In the case of no intra-cohort ageing, FrS would have been 11/12 percentage points higher among women/men. The corresponding figures for no inter-cohort change were 13 points for women and 27 points for men. Conclusions If the age distribution had remained stable over time, FrS would have been almost identical to the current level. In contrast, if smoking behaviour had remained stable over the life course or between birth cohorts, FrS would have been substantially higher than it is today. These results highlight the large cumulative effect of reducing smoking uptake in successive cohorts. [ABSTRACT FROM AUTHOR]

Background: Our aim, within the collaborative study SPHERE (Strengthening Public Health Research in Europe), was to produce a bibliometric overview of public health research literature for Europe. Methods: A search strategy ('filter') was designed to interrogate the Science Citation Index (SCI) and the Social Science Citation Index (SSCI) databases for research articles published between 01/01/1995 and 31/12/2004 in any language. We analysed output for country by population, Gross Domestic Product (GDP), burden of disease using DALYs, and language. Results: Overlap between the two databases SCl and SSCI was 35%. 210433 publications were identified after duplicates were removed, a world total of about 20000 per year. Approximately 7000 papers per year were produced in Europe and 9400 by the USA. Thirteen of 28 individual European countries produced more than 100 public health papers per year. Publications per capita were highest in northern European countries. In multiple regression analyses, GDP was a modest predictor (r² = 0.53, P< 0.02) of publications for European countries, while population size and disability adjusted life years were not significantly related. Smaller countries and lower producers of public health research were more likely to collaborate with other countries. Of the publications, 3.5% were published in a non-English language, with German the most common. Conclusion: There is marked variation in public health publication by country in Europe. Eastern and southern European countries appear to under-invest in public health research compared with northern European countries and compared to relative health need. [ABSTRACT FROM AUTHOR]

This paper discusses the work of the EUHPID Project to develop a European Health Promotion Monitoring System based on a common set of health promotion indicators. The Project has established three working groups to progress this task - health promotion policy and practice-driven, data-driven and theory-driven. The work of the latter group is reviewed in particular. EUHPID has taken a systems theory approach in order to develop a model as a common frame of reference and a rational basis for the selection, organization and interpretation of health promotion indicators. After reviewing the strengths and weaknesses of those health promotion models currently proposed for indicator development, the paper proposes a general systems model of health development, and specific analytical, socio-ecological models related to public health and health promotion. These are described and discussed in detail. Taking the Ottawa Charter as the preferred framework for health promotion, the socio-ecological model for health promotion adopts its five action areas to form five types of systems. The structure and processes for each of these five systems are proposed to form the basis of a classification system for health promotion indicators. The paper goes on to illustrate such a system with reference to indicators in the workplace setting. The EUHPID Consortium suggest that their socio-ecological model could become a common reference point for the public health field generally, and offer an invitation to interested readers to contribute to this development. [ABSTRACT FROM AUTHOR]

Context/problem: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. Objective: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. Methods: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. Results: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. Conclusions: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

The paper will provide a global perspective on current public health policies to tackle the growing burden of multimorbidity both in high-income and low-resource settings. Specifically, over the past two decades, there have been multiple stepwise approaches to non-communicable diseases (NCDs), the development of a process to link the prevention and control of NCDs to health systems, the compilation of evidence linking NCDs to the global development agenda, the implementation of life-course approaches to the prevention of multimorbidity around the world. [ABSTRACT FROM AUTHOR]

Background Global threats, such as the coronavirus disease 2019 (COVID-19) pandemic, have highlighted the critical importance of robust and well-functioning health information systems (HIS) in effectively addressing public health emergencies. To enhance the understanding and the functioning of such systems, it is crucial to perform HIS assessments. This article explores key gaps and identifies best practices in the COVID-19 HIS of eight European countries. Furthermore, it provides recommendations to strengthen European systems for better pandemic preparedness. Methods Assessments were carried out in eight European countries using an adapted version of the WHO support tool to strengthen HIS and the Joint Action on Health Information assessment tool. The assessments took place between January 2022 and April 2023. Results Four main themes emerged regarding the gaps and best practices identified in the various HIS: organizational, technical, legal and resources. The results of these assessments show different approaches implemented by countries to improve their HIS and respond to the demands of the pandemic. Conclusions It is imperative for countries to draw valuable insights from the COVID-19 pandemic and strengthen their HIS. This involves the adaptation or development of pandemic preparedness plans, strengthening legislative framework for data sharing and privacy protection, promotion of data standards and international definitions and implementation of a unique person identifier. Additionally, countries will have to act in this post-pandemic era and integrate the newly developed systems and innovations into existing structures, maintain and develop trust by citizens through transparent communication and engage in infodemic management and address resource gaps in the workforce. [ABSTRACT FROM AUTHOR]

Background The application of foresight to the field of public health is limited. There is growing need to anticipate uncertain future trends and to plan for them. Foresight provides tools to experts and policymakers to discuss and plan for possible futures. Hence, the aim of this study is to illustrate how the foresight six-step approach can be applied in public health, and to provide recommendations on dealing with challenges, drawn from the Population Health Information Research Infrastructure (PHIRI) foresight exercise. Methods In this tutorial, we describe the six-step approach as part of foresight methodology and give examples of possible challenges. Step 1 comprises the formulation of study objectives. Step 2 focuses on developing a conceptual model and applying the Demographic Economic Sociocultural Technological Ecological and Political-Institutional (DESTEP) framework to identify and prioritize driving forces for the topic of interest. In Step 3, a time horizon and spatial level are defined. Step 4 discusses scenario logics. Steps 5 and 6 discuss different types of scenarios and associated tools for analyses. Possible challenges encountered whilst applying the foresight methodology at each of the steps, were drawn from experiences during PHIRI foresight exercise. Results Challenges associated with applying the foresight six-step approach included: formulating concise objectives, developing a conceptual model, understanding driving forces and uncertainty and difficulties in building scenarios. Conclusions Understanding concepts used in the six-step approach and how they relate to each other remained difficult. Support from foresight experts, conducting more foresight exercises, tutorials and guidelines can enhance understanding and support building capacity. [ABSTRACT FROM AUTHOR]

Background Before the COVID-19 pandemic, a need for a uniform approach to health information (HI) knowledge in population health analysis across Europe was evident. The Population Health Information Research Infrastructure (PHIRI) emerged as a proactive initiative to strengthen European HI capacities. This article describes the achievements of PHIRI, highlighting its capacity-building activities and their contribution towards a sustainable strategy for the implementation of the European Health Data Space (EHDS). Methods PHIRI collaboration established a work package for skill-building activities in population health in partnership with other organizations. Activities included webinars, workshops, sessions, training schools and courses for researchers and public administration workers from Europe and beyond. The primary goal of the activities was to examine the impact of COVID-19 on European health systems at both local and national levels, including healthcare facilities and policymaking entities. Results Twelve activities were organized between October 2020 and the summer of 2023. In March 2023, the Spring School on Health Information was organized to share the knowledge achieved from PHIRI and other European Union-related projects. This event also validated the European Health Information Training Programme. Conclusions PHIRI's findings emphasized the importance of equipping the workforce with core HI skills to improve health systems' preparedness and resilience. Through this research, it is possible to propose a strategy for building capacity that emphasizes the importance of providing training in human-machine dynamics. This approach will contribute to the sustainable implementation of the EHDS. [ABSTRACT FROM AUTHOR]

Background Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises. [ABSTRACT FROM AUTHOR]

Background Several studies have estimated the impact of second-hand smoke (SHS) exposure on mortality in the population of different countries. This study aimed to identify and describe studies that have estimated the attributable mortality (AM) associated with SHS exposure in the adult population. Methods A literature search was conducted in MEDLINE, EMBASE, Cochrane Library and CINAHL databases up to January 2023. Studies that estimated the AM associated with SHS exposure in the adult population and used a prevalence-dependent method were included. The main characteristics of the studies and their results were described. Results Fifty-three studies were included. Most of them were conducted in North America (n  = 13), Europe (n  = 14) and China (n  = 6) and included lung cancer (n  = 46) or ischaemic heart disease (n  = 22) as causes of death. There was considerable variety in the population under study regarding the relationship with tobacco: non-smokers (n  = 30); never-smokers (n  = 9); both non and never-smokers (n  = 2); the whole population (n  = 1) and not known (n  = 11). The age at which AM was estimated also varied between studies, ranging from 15  to 40 years and older. Conclusions Studies estimating AM associated with SHS exposure are heterogeneous in terms of the causes of death studied, the age at which mortality is attributed, or the population to which mortality referred: consensus should be reached. Despite their importance, studies assessing AM to SHS are infrequent in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. Methods The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. Results The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. Conclusions By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable. [ABSTRACT FROM AUTHOR]