An Interview with Tapani Piha, European Commission

10085829895_138d12f291_o

Tapani Piha was born in Helsinki, Finland, and educated as a medical doctor. He specialised in Public Health, and is now working at the European Commission.

PB: Where were you working/studying when you were my age?

TP: At that time I was actually working at the Ministry of Health in Helsinki, but I was just about to finish that because I went to work in Copenhagen with the World Health Organization Regional Office for Europe. In Helsinki I was working as a Chief Assistant or Senior Medical Officer for Health Promotion and I was responsible in particular for tobacco control, and then I was sent by my government to Copenhagen to work specifically on tobacco control at a European level.

PB: From your professional point of view, what do you feel should be the primary aim of a health oriented conference such as this one?

TP: It is particularly useful to support your professional development and stimulate your thinking. You obviously learn things here, but I think that what is more important is that you can listen to exceptional influencers, exceptional thinkers, who are challenging you intellectually during the seminars, but also challenging you intellectually during the breaks. Therefore for example this interaction with other participants as well as the lectures, is important both during the seminars but equally important during the breaks and evenings.

PB: The theme of this year’s conference is ‘Resilient and Innovative health systems for Europe’. What, according to your point of view, should be the main ingredients of a resilient and innovative health system trying to survive or even make use of the global economic crisis to improve its performance?

TP: There is no simple recipe, one of the things that is important is that healthcare is well organised but there is probably not only one model of organising health care, there are many good models that fit different societies. The second important ingredient is well trained personnel, doctors, nurses, everybody working in health care, they need to be well trained so that they are ready to promote innovation and embrace it when it comes. And the third thing is that personnel must have a very high professional ethic.

PB: Looking back on your life experience and career, what single lesson or message you would like to convey to Young Gasteiners and other young people (i.e. students or young professionals) attending the conference?

TP: I can give you a simple piece of advice, very simple to follow up. Never sit with your fellow country people during breakfast, lunch or dinner. Because if you sit with those people you already know you may not be learning anything, but when you seek company of people you don’t actually know, people from other countries, you may learn something special and in any case by doing so you expand your network. I have followed this advice myself.

PB: What do the European Commission offer in the way of training and career opportunities for young professionals? 

TP: There are blue blook traineeships, the official traineeships of the EC.This is a paid traineeship of 5 months that is offered twice a year, with around 1400 places available annually. Then there are also atypical traineeships, interested applicants must send a CV and letter of motivation to the HR department of their desired EC Directorate General. People can be taken on this way to gain work experience at the EC, although placements are normally unpaid.

For more information on blue book traineeships check out the site here: http://ec.europa.eu/stages/

Interview by Young Gasteiner Paula Beltrán

Picture PB

An Interview with Marc Sprenger

 

Marc Sprenger

PB: Can you tell us about your background?

MS: My birthplace is Maastricht. I went to medical school in Maastricht and after that I went to the Erasmus University to do my specialisation in microbiology, and I have my PhD in epidemiology and virology, mixed. From 1991-1993 I was Director of the WHO National Influenza Centre that was established there. Then in 1993 I went to the National Institute for Public Health and the Environment (RIVM) in the Netherlands and became Head of the Department of Infectious Disease Epidemiology, and from there went to the National Board of Health Care Insurance and was Director of Health Care from 1999-2003. In 2003 I returned to RIVM as Director General. And now I am Director of the European Centre for Disease Prevention and Control (ECDC).

PB: Where were you working/studying when you were my age?

MS: So I had finished my medical school and I was working at the National Institute of Public Health. I was in Public Health and I had finished my PhD and changed from university to the National Institute (RIVM).

PB: From your professional point of view, what do you feel should be the primary aim of a health oriented conference such as this one?

MS: That is not so easy, I think we would all like to improve our health systems, and we are all trying to do that at the national level. My personal view is that I would like to get more information about initiatives, for example “I tried to decrease in my country the price of pharmaceuticals” and I would like to share that experience with you. I think this would be a very good place to give examples, not only positive because you can learn from failures even more. I think this would be very good. Personally I would like a little bit more of an academic approach here.

PB: The theme of this year’s conference is ‘Resilient and Innovative health systems for Europe’. What, according to your point of view should be the main ingredients of a resilient and innovative health system trying to survive or even make use of the global economic crisis to improve its performance?

MS: I don’t like these words that much, they are buzz words, I would like to have an old fashioned health care system that provides all sorts of vulnerable people with health care, so that people who are in a bad condition can get health care. Of course in these times of austerity, there is more unemployment, more TB cases in big cities… That is why it is important for me that we are able to have a system that is providing care for these people. You can call it resilient, you can call it innovative, I don’t care. And of course you need to do that at a low cost. But you know health costs money. We (ECDC) have organised a workshop on hospital acquired infections because if you don’t pay attention in a hospital to hygiene because it is too expensive, the consequences can be severe.

PB: Looking back at your life experience and career, what single lesson or message would you like to convey to Young Gasteiners and other young people ( i.e. students or young professionals) attending the conference?

MS: Seize opportunities, so if there is an opportunity make use of it. I was an infectious disease epidemiologist and then I became (to my big surprise, although I applied for the job) Director of Health Care. That was a big change, but it is so important to change from time to time and to get experience in different fields. Don’t be afraid to embark on a new field even though it is very difficult because if you work in a field you become an expert, you give presentations… but if you go to another field you are nothing. But nevertheless, in the end it will pay off. That is my advice.

Interview by Young Gasteiner Paula Beltrán

Picture PB

 

 

 

Interview with Antonyia Parvanova

AParvanova

Dr Antonyia Parvanova is a Bulgarian MEP and was born in the Northeast part of Bulgaria, in the city of Dobrich. This is very close to the famous city of Varna, in the coastal area of the Black Sea.

PB: Can you tell me a little about your educational background?

AP: I did a lot of investment in education and training. First, I graduated as a Medical Doctor. Then I did a second degree, because at that time it was not possible to do only a Masters degree, but I was supposed to do a Bachelor and a Masters in Health Care Management. Then I did a third degree in Public Health in Maastricht, again a Masters degree. And then I went for training in Health Policy to University College London and started a PhD programme there. The final one was again another Master degree back in Bulgaria in Health Care Administration. I also subscribed for a Law degree but after so many years in the Parliament, I realised that it would not be that beneficial to me.

PB: And what are you currently involved in professionally?

AP: At the moment, I’m a member of the European Parliament from Bulgaria and I’m sitting on the Environment Public Health and Food Safety Committee.  My second committee is Internal Market and Consumer Protection.  And my third committee is Women’s Rights and Gender Equality.

PB: Where were you working or studying when you were my age?

AP: I was working, studying, and taking care of my two wonderful daughters.  It was a little bit hectic because at the time of your age, I had very tough exams in Health Economics, in Trade Law and Analytical Maths, all those kinds of very heavy stuff included in the first years of Management Studies. I should say it was very hard, I took maths in the first and second year of my medical studies, physics and chemistry, but at the time of the first two years in Health Care Management, I should say that I took some private lessons to catch up. This is what I was doing actually. During the day I worked as a medical doctor, in the afternoons I took good care of  family matters, then during the night, I studied Maths and Economics.

PB: From yur professional point of view, what do you feel should be the primary aim of a health oriented conference such as the EHFG?

AP: My opinion of this conference and the way it is developing (I’ve been attending since 2001 or 2002, difficult to remember, but I think I’m one of the dinosaurs here!)… it is developing rapidly in a very innovative and intensive direction. Having all stakeholders together, having Young Gasteiners and young people mixing, is incredible because there is continuity, there is a link between the generations, there is a link between industry, the patients, the decision makers with public health workers, etc. This is a very good laboratory and it’s hard to imagine a more ambitious goal than what it is now, but it would be very pragmatic and useful for everybody if this conference would have a little more implementing credibility.  Everything that is discussed here is wonderful but still in terms of conclusion, and this conclusion to be some kind of commitment from national government, there is a little bit of a gap.  At the end of these sessions here in Gastein, we have wonderful conclusions but most important to me is when all these decision makers, politicians from executives or legislative institutions, how seriously they take the conclusions and recommendations of Gastein. They may consider it.  They may learn something, which is wonderful, but to me most the important practical thing would be to implement.  So far, Gastein is a laboratory of wonderful analyses and wonderful proposals. Still we have to figure out how to make politicians more confident that they can really trust these proposals, and if they implement them they will be backed up by all stakeholders, generally speaking.  This is difficult because for decision makers, you can imagine especially during a crisis, it’s tough to make the decisions, it’s tough to balance, and if you have conclusions coming from such conference by all stakeholders, then you may say that your decision is evidence based.  And this will save your political life.

PB: The theme of this year’s conference is “Resilient and Innovative health systems for Europe”. What, according to your point of view, should be the main ingredients of a resilient and innovative health system trying to survive or even

AP: We have a very interesting saying in Bulgaria, probably other nations have a similar one, it says that “every bad thing is bringing new developments, and it’s positive to a certain extent”.  I think the crisis hit us really badly, but probably it will allow us and it’s already doing so, to reconsider our economic and social positions, and behaviour, and attitude, and connections, and commitments.  What I mean is that with the economic crisis, probably we will have the opportunity to assume that even if we invest in an enlarging and growing economy, this is not necessarily having added value towards public health.  Second thing is that whatever  the economic growth is, the elasticity of our citizens and of our society to consume is almost extended.  And thirdly is probably that we have to find a different notion of this relationship economy-consumer or citizen.

And it is the same in the medical field. Probably not in the near future, but because you asked me for a little jump ahead, let’s say in the year 2050, we will be able to realise that investing in medical services and health care services as we do so far because we tackle them as part of the economy, is not having the exact impact and the added value that is expected and especially that is expected by citizens.

And I hope that by the right investments into the reconsidered valuable priorities we will be actually able to make a shift and to reshape these priorities, and to find a solution that will actually have a better impact in terms of public health and satisfaction, citizen’s satisfaction from the health care system and from public health in general.  And it is very significant, there was a graph during the previous session about the output and input in the health care system and the productivity.  So you see the productivity is still going stable without significant improvement whatever the outputs and the inputs are, which are actually following the same pattern.  But the productivity remains the same which means that, cynically speaking, regardless of how much money we put into this, still our system is not having a significant added value in relation to the sickness trends and also, whatever money or whatever effort, people will continue being sick.

This is something that we don’t tackle in the right way but probably if we invest in a different understanding of profound medical science which will give us answers that are not leading only to a treatment to curing diseases but also to convincing people that healthy lifestyles are better for them, and saving their healthy years is much better than expecting somebody to give some money to treat them while they are already sick.  This will be a significant change and this will be a significant achievement and I hope that there is an investment that is going into this direction.  Still, of course it is difficult but I see that in 2050, we will have different understanding about the ideology of diseases and also of not just treatment but curing diseases.

PB: Looking back at your life experience and career, what single lesson or message would you like to convey to Young Gasteiners and other young people (i.e. students or professionals) attending the conference?

AP: From my personal experience and through all these years of trying to accumulate knowledge and to be able to have a vision, one thing that I’m absolutely convinced of to understand what works is to listen to what people say, take their experience and knowledge, but do not hesitate to jump over at least one generation, to imagine what is and should be in the future, and try to achieve it.

Written by Young Gasteiner Paula Beltrán

Picture PB

An Interview with Mark Pearson

“Often people who work in health don’t really know how other policies are made; there is some naivety of what goes on. You have individuals in health who have only ever worked on health policy and tax people who have only worked on tax policy. I think there is something to be said about working in different areas.”

Mark Pearson is an English Economist, and has a first degree in Politics, Philosophy and Economics from Oxford University. He also studied in London where he qualified with a second degree in Economics and Econometrics. His division at the OECD is responsible for publications including “The Economics of Prevention: Fit not Fat”.


Yaiza Rivero Montesdeoca is a Young Gasteiner and works at the Institute of Health Carlos III, Spain.

Thursday morning at the European Health Forum Gastein starts at 7:30am for Mark Pearson, Head of the Health division of OECD. He participated in the breakfast workshop and then in the forum “Investing in Health. From health to wealth.” When I approach him, some minutes after noon, he explains he has a cold but would be pleased to go on with the interview. This is how we end up chatting under the poster tent in front of the Kursaal building.

YRM: Where were you working/studying when you were in your early 30s?
MP: I was working in Paris for OECD in social policy. I worked for the first 5 years in taxation, before moving to social policy where I worked for 10 years. For the last 5 years I have been into health policy. I changed themes because “I have the attention span of a small fly” and prefer not to talk about the same subject for too long. Often people who work in health don’t really know how other policies are made; there is some naivety of what goes on. You have individuals in health who have only ever worked on health policy and tax people who have only worked on tax policy. I think there is something to be said about working in different areas.

YRM: Looking back on your life experience and career, what single lesson or message would you like to convey to Young Gasteiners and other young people ( i.e. students or young professionals) attending the conference?
MP: Interesting one! Policy is an interesting area, there are an awful lot of people working in academia and we need a strong academic foundation for all that work, but there is a disconnect between what goes on in academia and what policy makers actually act on. Finding that middle ground of how you interpret the very technical work that gets done in academia in order to help policy makers make better policies is the big gap. If you want to be an academic, think about ways to actually help policy makers and if you want to be a policy maker keep your nose rooted in academia so you can follow the new ideas.

YRM: From your professional point of view, what do you feel should be the primary aim of a health oriented conference such as this one?
MP: I would say:
• Aim to keep everybody up to date on what is the latest development in evidence and on what good policy should look like, clearly an important thing.
• Aim to review what works in terms of changing policy makers’ opinions, because it is one thing to gather evidence together and another one to package it in a way that is useful to policy makers.
• Aim to frame debates on themes like resilience.

YRM: The theme of this year’s conference is ‘Resilient and Innovative health systems for Europe’. Which, according to your point of view should be, the main ingredient of a resilient and innovative health system trying to survive or even make use of the global economic crisis to improve its performance?
MP: Primarily we need to be able to change and adapt to circumstances. We had a large amount of money to invest in health in 2000-2009 and we didn’t really change systems, we just absorbed large amounts of money. Health spending increased three times more than income per capita on average in Europe. Difficult decisions about cutting spending in certain areas which no longer provided value for money were not made because there was enough new money to be able to adopt many new technologies – choice was not necessary. Now we have a problem reducing spending in some areas, partly because we don’t have as much money as before but even when we do no country is seeing spending up at the same rate as 2000-2009.

We now need to start making choices and maybe take advantage of mHealth, for example. We have to reallocate resources from one part of the health system to another, and health systems are not good at that. One reason for it is that we are not good at getting the benefits from innovation. Health systems innovate but benefits have been captured by providers and ultimately, to be resilient, what we need is for the payers to get the money. Day surgery was a massive innovation but we ended up paying the same amount for day surgeries as we did for in-hospital surgery with two-three nights at hospital. We made people who provide cataract surgery much richer, so maybe we should be paying much less and investing the surplus in other areas.

YRM: About your work on prevention of obesity: in your economic analysis was obesity a cause or a consequence?
MP: I would see the obesity as a consequence, it comes from a set of societal institutions and incentives and the result is obesity which in turn leads to a series of other health outcomes.

YRM: Is taxing the future in tackling obesity?
MP: Yes and no. Unfortunately the attraction of taxes on tobacco is that the tax points and the effects on health are very close together, in other words if you´ve bought cigarettes and paid the tax the cigarettes is going to be smoked and poorer health is the inevitable outcome. The trouble with obesity is that the tax point on say, purchase of sugary drinks, and the actual obesity and the health consequences might be some way apart. Obviously we don’t care about someone who just ran a marathon getting a sugary drink! So the relation between the tax points and the bad outcome is weaker and therefore it means that inevitably taxation is going to be less effective than in the case of tobacco. There are other technical issues that make the tax response to obesity more difficult: the variety of goods, the number of producers involved… That doesn’t mean that taxation cannot be used, we have interesting examples from Hungary and from Denmark before they removed tax, to understand that it does have an impact on consumption. That confirms our own theoretical modelling which suggests that changing prices can have an impact on consumption of sugar and fats and finally on obesity. But I don’t think it will ever be as prominent in the anti-obesity set of policies as it is in the anti-tobacco set of policies. However, I do think that we will see more, and we are already seeing an awful lot of taxation on soda and in other very sugar-dense or fat dense products. I think we will see specific taxes but it will take longer before we see broad-based taxes though.

EC session on discrimination and healthcare

EC Workshop – Anti-discrimination in health

This session aimed to identify issues in relation to discrimination in access to healthcare in the EU, to discuss possible actions on improving access, identifying barriers and challenges and highlighting best practice.

Commissioner Borg opened the session, highlighting that examples of discrimination still exist across groups and despite recent progress we must recognise that discrimination is still rampant. In terms of health inequalities, he argued that Europe was not so ‘united’, and that there was plenty remaining for the EU to do to tackle this.

Morten Kjaerum, Director of the Fundamental Rights Agency, reported on studies carried out by the Agency. He highlighted the reduced access to quality healthcare amongst migrant groups, the variable entitlements in Member States of irregular migrants to healthcare, and other access problems such as language barriers and disabled access to medical facilities.

Michael Cashman MEP gave an overview of what the EU is doing to tackle discrimination in healthcare. He noted that whilst a Member State has competence, pressure to act can be increased at European level. He highlighted the importance of the Roma strategy but questioned the existence of the necessary political will to implement it, and argued that mutually reinforcing stigmas can affect access in the most acute ways – for example the instances of late testing and delayed treatment for LGBT people with HIV. Overall, he argued that the EU could play a role in increasing data and information sharing between Member States, and that the role of European solidarity was vital in a fiscal climate where the weakest in society were often taking the brunt.

Aurel Ciobanu-Dordea, Director at European Commission Directorate General for Justice reported on what the EC was doing on these issues, focusing on three major pillars – legal protection, mainstreaming, and concrete steps on specific issues. On legal protection he argued that protection against discrimination on the grounds of religion or sexual orientation should be extended to the provision of goods or services (this currently only exists in the field of employment). On mainstreaming, he gave a number of examples of EC action including the conditionality of anti discrimination on structural funds, to ensure that no EU money is going into projects which do not respect human rights. Examples of concrete steps on specific issues included the Roma strategy and the development of indicators to measure the status of rights for disabled people including on access to healthcare.

Following the speeches a panel discussion identified gaps and challenges and highlighted actions, evidence and best practice around three main themes: solidarity and inclusion; migration and the stigma surrounding migrants, and wider societal discrimination. The most common theme running through the discussion was the importance of prioritising solidarity, particularly in a climate of economic uncertainty and fiscal pressures that can impact disproportionately on the most vulnerable groups in society. Migration was argued to be a trend that is increasing and clearly here to stay, but is accompanied by increasing anti-migrant sentiment across Europe. A variety of examples of direct discrimination in healthcare settings were given, and the issue of mutually reinforcing stigmas creating particular barriers – e.g. for gay migrants. A number of panel members focused on the role of wider societal discrimination affecting access to healthcare and health outcomes – in addition to direct discrimination happening in healthcare. As a result, the session wrapped up by concluding that tackling direct discrimination in healthcare is a first step – and an important one – but that wider action on discrimination and stigma in wider society and culture was perhaps even more critical

Megan Challis, Young Forum Gastein