Nicole Rosenkötter

Austerity policies in Europe—bad for health

Health protection within the EU mandate is more relevant than ever

Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities – a qualitative study

BackgroundThe European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity.MethodsSemi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs.ResultsThe ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients’ rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity.ConclusionsWhen comparing the emerging themes from the interviews conducted with the responsibilities defined in the EU health mandate, one can identify that these responsibilities were only partly fulfilled or acknowledged by the respondents. In general, the EU is a recognized public health player in Europe which over the past two decades, has begun to develop competencies in supporting, coordinating and supplementing member state health actions. However, the assurance of health protection in other European policies seems to require further development.

A concept for routine emergency-care data-based syndromic surveillance in Europe.

We developed a syndromic surveillance (SyS) concept using emergency dispatch, ambulance and emergency-department data from different European countries. Based on an inventory of sub-national emergency data availability in 12 countries, we propose framework definitions for specific syndromes and a SyS system design. We tested the concept by retrospectively applying cumulative sum and spatio-temporal cluster analyses for the detection of local gastrointestinal outbreaks in four countries and comparing the results with notifiable disease reporting. Routine emergency data was available daily and electronically in 11 regions, following a common structure. We identified two gastrointestinal outbreaks in two countries; one was confirmed as a norovirus outbreak. We detected 1/147 notified outbreaks. Emergency-care data-based SyS can supplement local surveillance with near real-time information on gastrointestinal patients, especially in special circumstances, e.g. foreign tourists. It most likely cannot detect the majority of local gastrointestinal outbreaks with few, mild or dispersed cases.

Non-infectious events under the International Health Regulations (2005) in Europe--a case for syndromic surveillance

The scope of the International Health Regulations of 2005 (IHR (2005)) has been expanded. The IHR (2005) are no longer limited to a specific set of infectious diseases, instead they prescribe detection and assessment of any event of potential public health concern regardless of its source or origin. We examine events of non-infectious origin that might fulfill the criteria of a potential public health emergency of international concern under the IHR (2005). These comprise predominately events related to food safety, but also events related to drug safety or of chemical or industrial origin. We argue that to identify these events and assess health effects related to them, existing disease surveillance systems should be augmented with less specific indicator-based syndromic surveillance strategies that use available routine health-related service data for monitoring purposes.

The influence of migratory background and parental education on health care utilisation of children

School-entry screening data from North Rhine-Westphalia (NRW), Germany from 2007 were used to investigate child health care utilisation. We focussed on the influence of migratory background and parental education on children’s (1) participation in regularly scheduled early recognition examinations, (2) immunisation uptake and (3) referrals due to a school-entry screen-detected complaint. The study sample consisted of 52,171 children out of 17 NRW districts. Bivariable, stratified and multivariable analyses were performed to identify relevant associations between social determinants and health care utilisation outcome parameters. Multivariable logistic regression showed that children belonging to families with a migratory background or low parental education were more likely to have an incomplete documentation of early recognition examinations and to be referred due to a new diagnosis. Children with migratory background were more likely to be sufficiently immunised than children with parents of German ethnicity. For all studied health care utilisation outcomes, kindergarten visit had a supportive effect. Conclusion: In general, the results of our regional study were in line with the results from national population-based studies. Additionally, a larger likelihood of referrals due to school-screen-detected deficits in children with migratory background or low parental education was detected.

Meeting the International Health Regulations (2005) surveillance core capacity requirements at the subnational level in Europe: the added value of syndromic surveillance

BackgroundThe revised World Health Organization’s International Health Regulations (2005) request a timely and all-hazard approach towards surveillance, especially at the subnational level. We discuss three questions of syndromic surveillance application in the European context for assessing public health emergencies of international concern: (i) can syndromic surveillance support countries, especially the subnational level, to meet the International Health Regulations (2005) core surveillance capacity requirements, (ii) are European syndromic surveillance systems comparable to enable cross-border surveillance, and (iii) at which administrative level should syndromic surveillance best be applied?DiscussionDespite the ongoing criticism on the usefulness of syndromic surveillance which is related to its clinically nonspecific output, we demonstrate that it was a suitable supplement for timely assessment of the impact of three different public health emergencies affecting Europe. Subnational syndromic surveillance analysis in some cases proved to be of advantage for detecting an event earlier compared to national level analysis. However, in many cases, syndromic surveillance did not detect local events with only a small number of cases.The European Commission envisions comparability of surveillance output to enable cross-border surveillance. Evaluated against European infectious disease case definitions, syndromic surveillance can contribute to identify cases that might fulfil the clinical case definition but the approach is too unspecific to comply to complete clinical definitions. Syndromic surveillance results still seem feasible for comparable cross-border surveillance as similarly defined syndromes are analysed.We suggest a new model of implementing syndromic surveillance at the subnational level. In this model, syndromic surveillance systems are fine-tuned to their local context and integrated into the existing subnational surveillance and reporting structure. By enhancing population coverage, events covering several jurisdictions can be identified at higher levels. However, the setup of decentralised and locally adjusted syndromic surveillance systems is more complex compared to the setup of one national or local system.SummaryWe conclude that syndromic surveillance if implemented with large population coverage at the subnational level can help detect and assess the local and regional effect of different types of public health emergencies in a timely manner as required by the International Health Regulations (2005).

The realisation of a European health information system—time to get the politicians involved

The 2013 European Public Health Conference (EPHC) in Brussels brought together representatives of the European Commission’s (EC) Directorate General for Health and Consumers (DG SANCO), the European Regional Office of the World Health Organization (WHO-EUR), the Organisation for Economic Co-operation and Development (OECD) and EUPHA. The aim of the round table discussion was to explore how the diverse European health information initiatives could be integrated to create an infrastructure that is comprehensive, functional and sustainable. So far, the EC has given financial support to projects to develop common European instruments …

The EU’s heath mandate after 20 years: the glass is half full

Taking stock of two decades of the European Union (EU) health policies will inevitably provide an inventory of successes, failures and missed opportunities. Yet, the current profile of the EU’s health mandate prompts optimism for the future challenges ahead: Infrastructures and institutions at the EU level have been established and sustained to add value to single Member State’s actions by regulation, capacity building and facilitating collaboration and exchange among them. However, given the shared health problems in European societies, we call for an enforced EU health mission that supports the life of the European citizen. It would not only benefit people’s health and well-being but would improve the reputation and legitimacy of the EU itself. In 1992, the EU adopted what is known as the ‘health mandate’, which stated that … ‘the EU shall contribute towards ensuring a high level of human health protection by encouraging cooperation between Member States and, if necessary, lending support to their action … ’.1 The mandate has triggered important actions to improve public health for the European citizens throughout the 20 years. The impact has been discussed in various contributions concerning health research,2, …

The Directorate-General for Health and Consumers 1999-2014 : An assessment of its functional capacities

Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. It applies the UNDP Capacity Assessment Framework and uses a literature review, a document review of EU policy documents and expert interviews to assess the capacity of DG SANCO to fulfill its mandate for public health and health systems. Our results suggest that DG SANCO has established capacities to engage with stakeholders; to assess various health issues, to define issue-specific health policies and to collect information for evaluative purposes. In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTEs (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTEs responsibilities.