Floris Barnhoorn

National action for European public health research

INTRODUCTION Research and innovation are the basis for improving health and health services. The European Union (EU) supports research through multi-annual programmes. Public Health Innovation and Research in Europe (PHIRE) investigated how European countries cooperate for action in public health research. METHODS In PHIRE, following stakeholder workshops and consultations, a national report on public health research was created for 24 of 30 European countries. The report template asked five questions, on national links to European public health research and on national research through the Structural Funds and Ministry of Health. The national reports were assessed with framework analysis, and the country actions were classified strong/partial/weak or none. There were responses to the five questions sufficient for this analysis for between 14 and 20 countries RESULTS Six countries had public health research aligned with the EU, while three (large) countries were reported not aligned. Only two countries expressed strong engagement in developing public health research within Horizon 2020: most Ministries of Health had no position and only had contact with EU health research through other ministries. Only two countries reported use of the 2007-13 Structural Funds for public health research. While seven Ministries of Health led research from their own funds, or linked with Ministries of Science in six, the Ministries of Health of seven countries were reported not to be involved in public health research. CONCLUSIONS Ministries of Health and stakeholders are poorly engaged in developing public health research, with the Horizon 2020 research programme, or the Structural Funds. The European Commission should give more attention to coordination of public health research with member states if it is to give best value to European citizens.

Civil society engagement in innovation and research through the European Public Health Association.

BACKGROUND The European Public Health Association (EUPHA) proposed and led PHIRE (Public Health Innovation and Research in Europe), with co-financing by the European Commission, to assess public health innovation and research at national level in Europe. PHIRE was also designed to promote organizational development and capacity building of EUPHA. We assess the success and limitations of using EUPHAs participative structures. METHODS In total, 30 European countries were included-27 EU countries, Iceland, Norway and Switzerland. EUPHA thematic section presidents were asked to identify country informants to report, through a web-based questionnaire, on eight public health innovations. National public health associations (EUPHA member organizations) were requested to identify their national public health research programmes and calls, review the health research system, coordinate a stakeholder workshop and provide a national report. The section and national reports were assessed for responses and completeness. RESULTS Half of the final responding CIs were members of EUPHA sections and the other half gained from other sources. Experts declined to respond for reasons including lack of time, knowledge of the innovation or funding. National public health associations held PHIRE workshops with Ministries of Health in 14 countries; information for 10 countries was gained through discussions within the national association, or country visits by PHIRE partners. Six countries provided no response. Some national associations had too weak organizational structures for the work or insufficient financial resources or criticism of the project. CONCLUSION EUPHA is the leading civil society organization giving support to public health research in Europe. PHIRE created new knowledge and supported organizational development. EUPHA sections gained expert reports on public health innovations in European countries and national public health associations reported on national public health research systems. Significant advances could be made if the European Commission worked more directly with EUPHAs expert members and with the national public health associations.

Critical discernment in collaboration with private partners

Welcome to the University of Rummidge , the fictional university campus novelist David Lodge described in the trilogy Changing Places , Small World and Nice Work . These novels are a must-read for everybody who has qualms about scholars and industries becoming bed partners. It is the 1970–80s and government urges universities and industries to collaborate. It is as if you ask a fish and a bird to build a car. Lodge humorously describes how these two seemingly incompatible worlds get to know and even appreciate each other without losing a critical distance, understanding the mechanisms that drive both worlds. The recognition of the qualities and contribution of all parties involved is possible because people meet. The ‘industry’ becomes Vic Wilcox, the ‘academic’ has a name: Robyn Penrose. Visiting the world of the University of Rummidge does not result in an unreflective embrace of financial entanglement of academy and industry but gives a discerning perspective on the intricacies of a research world where academic freedom is confined by directives from the outside world, e.g. government policies. The novels equally challenge supporters of collaboration and objectors to these types of partnerships. Four decades later, the novels have not lost any of their topicality. We continuously engage ourselves in exploring how to provide and present excellent research in a world where funding is not merely driven by academic curiosity. There is abundant evidence of how ‘he who pays the piper calls the tune’. In health research, ‘He who pays’ is usually identified to be the pharmaceutical industry or food industries (see Razum et al.). Public funding agencies seem to remain exempt of a similar scrutiny even though their agendas are not free of embracing …

European Public Health NewsPresident's ColumnEUPHA office columnMessage from the WHO regional director for EuropeThe Ebola outbreak: 1 year on8th EPH Conference—‘Health in Europe—from global to local policies, methods and practices’

In this main European public health (EPH) news, there is a clear call for the public health community to unite (Andriukaitis), combine efforts (McKee, Zeegers Paget) and to work intersectoral (Jakab). We need all of this to make the voice of the public health community visible and loud. # Presidents Column {#article-title-2} One of the most important roles of the public health community is to make the invisible visible. Frequently we find ourselves giving voice to the unheard, the many marginalized and often vulnerable groups whose needs remain unseen by our political leaders. We use our epidemiological skills to detect otherwise invisible associations, shedding light on previously unknown risk factors for disease and detecting patterns in complex data. However, increasingly we find ourselves shedding light on those powerful vested interests that threaten population health. The work of tobacco-control researchers exemplifies this, dredging through thousands of industry documents to reveal behaviour that is almost always immoral and sometimes illegal. More recently, researchers seeking to understand policy on food and alcohol have had to resort to the same tactics to understand how those industries operate, showing that they have frequently adopted the same methods as the tobacco industry. This body of work has led to the increasing use of the term ‘commercial determinants of health’, with its focus on how large corporations frame the prevailing narrative, defining what is considered possible and what is not, capture the regulators and in some cases, write the laws in ways that will advantage them. In recent months, EUPHA has sought to make two of these processes more visible. Attracting little public attention, the European Commission has been promoting a Trade Secrets Directive that would give large corporations an exceptional degree of protection from public scrutiny.1 Along with many other organizations concerned about health, the environment and transparency, we …

European Public Health NewsEUPHA president’s columnEUPHA office columnMessage from the WHO Regional Director for EuropeMessage from Vytenis Andriukaitis, EU Commissioner for Health and Food Safety9th European Public Health Conference—‘All for Health—Health for All’

In this European Public Health News, we address the need for a common approach from the individual, from the health care worker, from the politician and from the community. McKee stresses the task and commitment of the public health community to make a change, using the refugee problem in Europe as an example. Zeegers uses personal experience to emphasize the need for a common approach in health care. Jakab reiterates the importance of understanding the cultural context to deliver public health to refugees and Andriukaitis uses diabetes as an example of how we should collaborate to deal with major chronic diseases in Europe. Of course, most of these issues will be extensively discussed at the upcoming European Public Health Conference in Vienna from 9 to 12 November. Don’t miss this opportunity to get the most complete update on European public health in just 4 days. # EUPHA president’s column {#article-title-2} In January this year, I had the enormous privilege of speaking in Copenhagen at the 70th birthday celebration for Allan Krasnik, president of our section on Migrant and Ethnic Minority Health. Allan has been a remarkable champion of some of the most marginalised and discriminated against groups in our society over many years. In part, this may reflect his personal history. During the Second World War the Danish people distinguished themselves by smuggling almost all the Jewish population to safety in Sweden. A few were deported to the camps, among them Allan’s father. It was there that he met Allan’s mother. Thankfully, both made it to safety back in Denmark at the end of the war. It was a real pleasure to join with so many of his colleagues in celebrating his many outstanding achievements. Allan and I have known each other for many years. We published our first article together in 1992, on …

European Public Health NewsMartin McKee colomn9th EPH Conference—‘All for Health, Health for All’50 Years of Medicine Safety in the EU By Vytenis Andriukaitis, EU Commissioner for Health and Food SafetyMessage from the World Health Organization (WHO) Regional Director for Europe

European non-governmental organizations very often struggle with their sustainability. This sustainability is focused on two levels: financial and organizational. Financial sustainability—in times of economic crisis—is at the forefront. Next to own income, such as membership fees, most European NGOs have to find extra sources of income. Projects and grants from the European Commission are a good source of extra income, but with limited resources available and a high number of excellent quality projects, you might just miss the opportunity. The best option, which has worked really well for EUPHA, is to increase the own income and increase the number of financial sources. The reorganization of the European Journal of Public Health and the successful management of the EJPH by Peter Allebeck and his team at Karolinska Institutet have provided EUPHA with a solid second source of own income. And the collaboration with the European Public Health Conference Foundation has even provided a third source of (nearly) own income. With this financial structure, EUPHA is reasonably secure in covering the core activities, but for all extra activities, EUPHA, like most other European NGOs, is looking for other financial sources. For instance, the EJPH editorial office has been supported by the Swedish Research Foundation for numerous years. The other level for sustainability is organizational. Keeping in mind the financial situation, most of the European NGOs work with a small team of committed professionals, which does make them vulnerable. And this vulnerability can be clearly seen if one of the staff leaves the organization. At EUPHA Office, nobody has left the organization, but I have had to take a leave of absence due to illness, and this has certainly had an impact on our organizational sustainability. And even here, we see that EUPHA is up for the challenge. The small team of dedicated …

European Public Health NewsPresident's ColumnEUPHA office columnMessage from the Who Regional Director for Europe: Preparedness and Response to Health Threats8th European Public Health Conference—‘Health in Europe—from global to local policies, methods and practices’

In this European public health news, all authors reflect on potential threats and an unstable Europe (McKee, Jakab) and the impact this has on public health. All agree that a comprehensive (Jakab), collaborative (Zeegers) and global (McKee) approach is necessary to make sure that public health in Europe and in the world remains a strong partner to combat the potential threats and overcome the crisis. # Presidents Column {#article-title-2} As I write my first column as the newly appointed President of EUPHA, I am reflecting on several things. The first is the exceptionally high standard that my predecessor, Walter Ricciardi, has set. Elsewhere in this edition I pay tribute to his enormous contribution to public health and beyond. I commit to doing everything possible to live up to his standards. The second is the worrying state of Europe today. Once more we see armed conflict breaking out in our continent, in Eastern Ukraine, and in our neighbouring countries in the Middle East. We have yet to recover from a prolonged economic crisis and seem to have done nothing to address the problems in the financial sector that created it. The recent elections to the European Parliament saw a frightening increase in support for racist and neo-fascist parties. In the global arena, we face threats from international agreements that place trade above health. And we search in vain for the political leaders, at regional, national and European levels, who have the vision, charisma and ability to lead us out of this situation. Even if our political leaders lack a vision, we in EUPHA have one, set out in our recently adopted strategy for the years 2014–20. Our vision is one of improved health and reduced health inequalities for all Europeans. Our contribution to achieving this vision will be to add value to the efforts of …

European Public Health NewsPresident’s columnEUPHA office columnMessage from the Regional DirectorInformation sourcesHealth literacy in the EUMark your agendas: 6th European Public Health Conference 13-16 November 2013 The Square, Brussels, Belgium

This European public health news summarizes some of the successes achieved this year and some of the challenges remaining. Ricciardi celebrates the adoption of the new health policy framework of the WHO’s Regional Office for Europe—Health 2020; Barnhoorn describes the promising progress of the Public Health Innovation and Research in Europe (PHIRE) project, where the impact of European projects and the organization of public health research are the main topics. Jakab goes back to childhood immunization and the hope that rubella and measles will be eradicated by 2015; Ryś stresses the importance now and in the future of health literacy and being in this ‘together for health’. The theme of the 6th European Public Health Conference in Brussels next year nicely completes this news: ‘Health in Europe: are we there yet? Learning from the past, building the future’. 2013 will be an interesting year. # President’s column {#article-title-2} Last September in Malta, 53 Member States of the WHO European Regional Committee endorsed ‘Health 2020’, the new health policy framework of European Region. The policy aims at significantly improving the health and well-being of populations, reducing health inequalities, strengthening public health and ensuring sustainable people-centred health systems. Progress towards its goals will be achieved by policy action in four areas: investing in health through a life course approach and empowering citizens; tackling Europe’s major disease burdens of non-communicable and communicable diseases; strengthening people-centred health systems and public health capacities, including preparedness and response capacity for dealing with emergencies and creating supportive environments and resilient communities. A key element in achieving progress towards the goals of Health 2020 is to further the development of the evidence base on what works to promote better health and well-being, in differing contexts and at what cost. European health systems face considerable challenges in promoting and protecting health at a …