European Health Forum Gastein 2009 focused on economic and financial crisis and on threat of communicable diseases

Bad Hofgastein 30 September 2009The European Health Forum Gastein (EHFG) taking place in Bad Hofgastein from 30 September to 3 October 2009 is proving to be a magnet for leading European public health sector representatives this year as well. As in previous years, 600 participants from the areas of public health administration, health policy, science, lobbies (patient advocates, NGOs), medicine and business are taking part in the 12th edition of the most important health policy conference for experts and decision-makers in the European Union.


The thematic focus of this year's programme are the numerous consequences of the economic and financial crisis for health care. The problem of declining revenues - lower social insurance contributions due to rising unemployment, declines in private health insurance - will be addressed, as will the effects on research activities and rising crisis-related lifestyle habits that are harmful to health - smoking, alcohol, nutrition.

The opening of the 12th European Health Forum Gastein (EHFG) was focused entirely on the current financial and economic crisis. 600 participants from 41 countries are taking part in the most important health policy congress for experts and decision-makers in the European Union.

"The potential effects of the economic crisis on the health care system cannot be estimated highly enough", EHFG President Günther Leiner explained. "We have dedicated a significant portion of this year's programme to this issue and have been able to obtain a series of leading experts who will present their concepts and counterstrategies here. Thus the EHFG will provide important ideas for health policy in the European Union and its member states again this year and I am certain that some of what will be discussed by experts and decision-makers in the Gasteinertal in the coming days will be reflected in health policy in Europe."

"The economic crisis also poses a serious danger to the quality and functional capacity of the European public health system", warned EHFG President Günther Leiner in his opening speech to leading representatives of the European public health system. Without rapid and systematic countermeasures noticeable negative consequences for the population of the European states will be unavoidable.

Günther Leiner demanded that the standards of health care achieved not be eradicated despite the financial problems with government budgets and the declining revenues of statutory health insurers due to the considerably higher degree of unemployment: "That would be an attack on the health of the population and in the long run economically unreasonable. In the medium term a worsening of public health services leads to more sick leave, health-related early retirements and poorer performance at work, and is consequently a strain on the economy. Thus excellent public health services for everyone are not only ethically indispensable, but also an investment in the economic location."

Yet Günther Leiner has not closed his mind to the demand for cost-cutting measures in the public health sector. "In view of the current economic situation, there must be an end to the continuing opposition to long-overdue reforms, cost-cuts and increases in efficiency. Only those who rationalise the health care system will be able to prevent the rationing of health care services."

The ramifications of the crisis on the health situation clearly extend beyond the financial problems of the statutory health insurance schemes. Experts warn that in the scope of the economic crisis behaviours that are harmful to health will be on the rise again. The number of smokers threatens to climb as much as the increase in alcohol abuse and a trend toward unhealthier nutrition is also feared. The difficult economic situation in many householders and unemployment can also lead to a rise in stress-related illnesses and depression. For this reason increased preventive and informational measures are now particularly important.

"The economic crisis presents many challenges to health and increases the need for European and international co-operation", stated Robert Madelin, Director-General for Health and Consumers. "We need to invest in health, focus more on prevention, and on the promotion of healthy lifestyles, create more dynamic and sustainable health systems. And do all we can to reduce inequalities in health and maintain our commitment to the fundamental values of solidarity, respect for human rights and protection of the most vulnerable."

The poor and the most vulnerable are likely to suffer most in crises. "Evidence shows that 16 percent of the population in the European Union is already at risk of poverty", stated Nata Menabde, Deputy Regional Director of the WHO Regional Office for Europe. Difficult choices are being and will have to be made in terms of spending and priorities, but it is vitally important that, despite the current problems, the Region and Member States remain committed to the values and principles agreed in the 2008 Tallinn Charter: promoting shared values of solidarity, equity and participation through health policies, resource allocation and other actions, ensuring due attention is paid to the needs of the poor and other vulnerable groups. Ideally the health system can and should do three things: firstly protect those most in need, secondly concentrate on areas in which it is effective and adds value, and thirdly behave as an intelligent economic actor in terms of investment, expenditure and employment.

In addition to the main theme, the economic crisis, the 20 individual events of the EHFG provide a wide range of content. This includes the especially current issue of pandemics resulting from the concern over the further spread of the New Flu - swine flu, concepts for the future-oriented reorganisation of hospitals and international co-operations for research on and therapy for rare diseases.

Furthermore, the "European Health Award" for outstanding cross-border health initiatives will be presented for the third time. In past years awards were presented to an Irish/Northern Irish project for the improved care of dialysis patients in border regions and the "European Alliance against Depression".

This year the "European Health Award" goes to the "European Patient Assessment" (EPA) project. EPA is designed to improve the exchange of knowledge and experience by practical physicians in the area of primary care. Cross-border health care initiatives are distinguished every year with the European Health Award.

"The project is well-structured and makes a significant contribution to ensuring home care can be compared in participating countries", Günther Leiner, president of the European Health Forum Gastein and chairman of the jury of experts presenting the European Health Award to EPA, explained. "Particularly remarkable is the fact that the unfortunately often neglected area of primary care is the subject of broad international co-operation. Here the European countries and therefore the patients can still expect enormous improvements as a result of the cross-border exchange of information and the adoption of best-practice models."

The fact that there are big differences in the quality and efficiency of primary care, even in countries of a similar economic situation and comparable health care, shows the enormous potential for improvement. The general lack of international comparability and insufficient adoption of best-practice models play a significant role in the dissatisfying situation. EPA can help close these significant gaps. Project partners in Belgium, Germany, England, France, Israel, The Netherlands, Austria, Switzerland, Slovenia and Wales are involved in EPA.

"Well-organized primary care contributes to better health outcomes and satisfaction in patients and lower costs", stated Richard Grol, professor at St. Radboud Medical Center at the University of Nijmegen, The Netherlands and co-coordinator of the projects. "EPA supports the improvement of practices and contributes to a high-performing health system and optimal care for patients. One of the benefits of EPA is that it focuses on primary care teams - doctors and nurses - which is crucial for achieving real improvements in patient care."

EPA prevailed over a series of excellent competitors in the presentation of the European Health Award 2009. Additional finalists were:

  • Diabetes: Best Information through Regional Outcomes (BIRO) - The aim is a European health information system with uniform parameters and indicators, data protection regulations and - if possible - the harmonisation of organisational processes.
  • The WHO Health in Prisons Project (HIPP) - This long-term project of the WHO addressed improved health care for prisoners, also in matters of HIV prevention, tuberculosis and mental illness.
  • Patient Safety Information System (PaSIS) - The objective of PaSIS is the rapid detection of the sources of error and development and implementation of effective counterstrategies through a well-functioning alarm system.
  • Pharmaceutical Pricing and Reimbursement Scheme - Health insurers and public health authorities are to obtain easy-to-compare data on the pharmaceutical market and costs of medicines. The content of the project was the creation of country profiles and indicators for comparison.
  • Rare Diseases: the Rapsody Project - Competence centres are to be established in participating countries for 16 rare diseases. The aim is to exchange information on methods throughout Europe, to compare services in various countries and to identify the best methods.

The threat of communicable diseases will become even worse in the near future. At the European Health Forum Gastein, the European Union's leading health policy congress for experts and decision-makers, experts stressed that there are a number of risk factors which contribute to a growing risk of the spread of communicable diseases into Europe, namely into the European Union.

"Open borders, changed lifestyles and eating habits make it inevitable that communicable diseases will play an even more important role in the future", stated Richard Coker, professor of public health at the London School of Hygiene & Tropical Medicine. "Since 1973 no less than 50 new communicable diseases have been identified, among them epidemics such as the West Nile Virus and SARS. And there are more to come."

Martin McKee of the European Observatory on Health Systems & Policies stressed that although potential pandemics like the New Flu - Swine Flu - deserve considerable attention, the biggest threats are at the borders of the European Union. quot;There are numerous communicable diseases in the area of the former Soviet Union, the Balkans and the Maghreb countries, and it will be an enormous challenge to keep these out of the European Union. This battle is even harder and more important than the action to be taken against pandemic threats such as the current "New Flu".

Both Richard Coker and Martin McKee agreed that the European Union has massively improved its preparedness for communicable diseases over the past few years. Nevertheless, the experts demand further improvements:

  • Better surveillance at the level of the member states: many of the member states are far from achieving the level of surveillance quality like the Scandinavian countries, the United Kingdom or The Netherlands.
  • Monitoring outside the European Union: while the European Union monitors the situation in its territory fairly well, monitoring activity outside the European Union, especially at its doorsteps in the East and Southeast, must be intensified in order to identify new threats quickly.
  • Linking the monitoring of human and animal disease: as a majority of communicable human diseases have their origins in animal diseases, monitoring and research in both fields must be better linked.

Rifat Atun, professor of international health at Imperial College London and director of strategy at the Global Fund, the largest international institution financing health programmes, demanded more than surveillance. It is action and responsibility that count. The new rise of HIV infections and multi-drug-resistant tuberculosis (MDR TB) in Eastern Europe are an especially big threat for the European Union. "The economic growth of these countries makes them ineligible for funding from the Global Fund, but there are no tools available to replace our expiring programmes. It is imminent that the European Union creates these tools for some of its new member states as well as for neighbouring countries in order to prevent major setbacks in the prevention of communicable diseases on its own territory."

The European Statistical System Network on Public Health Statistics (ESSnet PH) was presented in the scope of a workshop at the European Health Forum Gastein. The aim is a uniform basis for data in the area of health care for all European Union member states. ESSnet PH is launching in October 2009 and will build on the work of the informal Partnership on Health Statistics established in 2003.

All European Union member states as well as Iceland, Norway and Switzerland are participating in ESSnet PH. The co-operation is to result in a set of public health indicators (European Community Health Indicators - ECHI). ESSnet PH will develop guidelines for the methodology of data collection, tools on sampling as well as specifications for data quality.

With it the comparability of health statistics on the status of health, health-influencing factors and the assessment of preventive measures in the European Union member states will be improved and their analysis made easier. The indicators on which it is based include mortality rates, assessments concerning the number of "healthy life years", statistics on the causes of death and indicators on people's assessment of their own condition of health.

From ESSnet PH experts anticipate improvements in Europe-wide statistics on monitoring the implementation of European Union health policy concepts. "As long as indicators in European Union member states are not based on comparable, reliable and consistent basic data, it will be difficult to compare the results of joint policy measures in the member states in order to recognise successful approaches", Hartmut Buchow of Eurostat explained. "In contrast, reliable and solid indicators based on uniform data sets allow comparisons between countries to be made. This permits successful health policy measures of other countries to be quickly adopted in one's own country."

One particular area of attention with the ESSnet PH programme continues to lie in the improvement of statistical foundations for epidemiological and medical research.

Source: EHFG

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