Natasha Azzopardi-Muscat

Demographic trends and public health in Europe

Demographic trends in Europe are currently being shaped by an ageing population, falling fertility rates and diverse migration flows. Fertility rates are lowest in Eastern and Southern Europe with Eastern Europe also experiencing the lowest net migration and an exodus of its working population. All regions in Europe are experiencing aging of their population with some countries having the added burden of high rates of unemployment among the working age population. The impact of these demographic changes on the current and future public health of the country depends on how countries have been preparing and adapting to demographic changes over the past years. Changes in age structure and ethnic composition will put further strain on health care and welfare systems and requires careful planning. A multi-faceted approach which goes beyond the health care system is required and countries need to look beyond their borders in search as to how countries are tackling these important issues. As Europe ages the concept of healthy aging should become an increasing priority focus for European Public Health.

Will European Reference Networks herald a new era of care for patients with rare and complex diseases

The patients’ rights and cross-border care directive is widely seen as the beginning of a new era for European action in health services.1 While cross-border care only affects a small percentage of European Union citizens, an important section of the directive provides for a series of collaborative initiatives between Member States. It is this part of the directive that is likely to be highly influential in shaping the manner future health services across the European Union. One such initiative is the establishment of European Reference Networks (ERNs). Earlier this year, the decisions regulating the setting up and management of ERNs were adopted.2,3 These decisions serve to lay down the framework within which ERNs will operate. Much preparatory work has gone into the development of the framework, and there is a general expectation that ERNs will have to meet rigorous standards both to be initially approved as well as on an ongoing basis. European citizens aspire to have knowledge about where the ‘best’ care for their condition exists within …

Health in All Policies

Health In All Policies (HiAP) has been explicitly defined as a collaborative approach used internationally to address multifactorial health and social inequalities, etc. It is complementary to the more commonly known approaches of public health and health care services and it is essential in enhancing evidence-informed policy making by clarifying for decision makers the links between policies and interventions, health determinants, and the consequent health outcomes.

Europeanisation of health systems: a qualitative study of domestic actors in a small state

BackgroundHealth systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. Yet, recent developments including the patients’ rights and cross-border directive (2011/24 EU), as well as measures taken following the financial crisis, appear to be increasing the EU’s influence on health systems. The aim of this study is to explore how health system Europeanisation is perceived by domestic stakeholders within a small state.MethodsA qualitative study was conducted in the Maltese health system using 33 semi-structured interviews. Inductive analysis was carried out with codes and themes being generated from the data.ResultsEU membership brought significant public health reforms, transformation in the regulation of medicines and development of specialised training for doctors. Health services financing and delivery were primarily unaffected. Stakeholders positively perceived improvements to the policy-making process, networking opportunities and capacity building as important benefits. However, the administrative burden and the EU’s tendency to adopt a ‘one size fits all’ approach posed considerable challenges. The lack of power and visibility for health policy at the EU level is a major disappointment. A strong desire exists for the EU to exercise a more effective role in ensuring access to affordable medicines and preventing non-communicable diseases. However, the EU’s interference with core health system values is strongly resisted.ConclusionsOverall domestic stakeholders have a positive outlook regarding their health system Europeanisation experience. Whilst welcoming further policy developments at the EU level, they believe that improved consideration must be given to the specificities of small health systems.

European Public Health NewsEUPHA Presidentrs ColumnEUPHA Office ColumnEUPHA section column: nothing about me without mema need for a new migrant health agendaMessage from the WHO Regional Director for Europe: European Member States agree to develop a roadmap to implement the 2030 Agenda for Sustainable DevelopmentMessage from the EU Commissioner for Health and Food Safety: EU action to support refugeesr and migrantsr healthFrom Vienna 2016 to Stockholm 2017

In this last European public health news of 2016, we see a change in EUPHA presidency. Muscat introduces herself by highlighting the importance of a united public health workforce in Europe. Zeegers adds to this by announcing the 25th anniversary of EUPHA next year. In our EUPHA section column, Kumar and Krasnik reflect on the successful satellite conference organised in June 2016 in Oslo, Norway, where solutions on the migrant and refugee problems were discussed. Again, a unified and strong public health workforce is necessary. Jakab emphasizes that working towards health (leaving no one behind) also includes an intersectoral approach to health. Andriukaitis specifically looks at the challenges of the migrants and refugees problem and reminds us that ensuring integration and protecting against stigma and health inequalities remain our long-term priorities. Zeegers showcases the strong voice of public health by reflecting on the Vienna Declaration, signed by many of our partners and members. # EUPHA President’s Column {#article-title-2} Sitting to write the first of my contributions as the President of EUPHA has provided an opportunity for me to reflect upon my relationship with EUPHA and public health over a couple of decades. I first came into contact with EUPHA in 1999, when as a young and an inexperienced public health doctor I sought out membership for the newly established Malta Association of Public Health Medicine. I arrived in Prague not knowing anyone other than my former professor Martin McKee who had encouraged me to write up a paper for presentation. It was then I met Dineke Zeegers Paget. Dineke has been a constant, unassuming, but ever present motor behind this organisation. Emboldened by the fact that I could speak Italian, I plucked up courage and introduced myself to Walter Ricciardi. I relate this starting point in my journey with EUPHA since it may resonate … Correspondence : Allan Krasnik, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen, Denmark, Tel: p4523321145, e-mail: alk{at}sund.ku.dk