A journalist’s view on reporting on EU health policy: “I think there is a risk of getting a little bit overexcited”

Peter ODAt the 17th Edition of the European Health Forum Gastein, Young Gasteiner Paul Giepmans took the opportunity to interview Peter O’Donnell, a journalist and Associate Editor for newspaper the European Voice. The European Voice, according to its website , “provides essential, independent insight into the Brussels beltway for insiders and outsiders, both in print and online.” The main question is: how much ‘essential insight’ is there to report on when it comes to EU health policy?

Peter O’Donnell couldn’t be clearer: EU health policy is “not the slightest bit interesting” to the general public. He recognises that coverage on national health policy is a subject of interest to media, but they seldom cover EU health policy. At the European Voice a decision has been made to increase its attention to this area. Partially because there is a capacity to do so, partially because it is considered an interesting period in EU health policy. Though Mr. O’Donnell is not quite convinced that these are such interesting times as the EU health community believes it is. Continue reading

Health system performance: does the EU care and dare? (F6)

15397259016_776cb9f5b3_mThe answer to this question given by Martin Seychell, Deputy Director-General of DG Health and Consumers of the European Commission, speaking at the European Health Forum Gastein 2014 was a clear “yes”: “Yes the EU cares about health system performance!” And: “Yes, the EU can and will support member states in creating better performing health systems”. (For the record: Martin Seychell first said that the answer to the second part of the question was more difficult than the answer to the first part.)

I was pleasantly surprised by the clear answers given during this session!

Health system performance has been a buzz word amongst policy-makers and researchers for quite some time – certainly since the publication of the World Health Report 2000 on “Health Systems: Improving Performance”.

Improving health system performance is currently on the political agenda in almost all EU countries. However, it often remains unclear what people mean when talking about health system performance or about “improving performance”. Are people concerned about efficiency? About health outcomes? About patient experiences? About financial sustainability? Continue reading

The importance of person-centred care when developing future health strategies (L4)

DNVGLOn Thursday 2nd October at the EHFG 2014, DNV-GL hosted a lunch workshop on the topic of ‘Person-centred care. Towards a safer and smarter future’ in collaboration with the Young Forum Gastein network. Eva Turk, senior researcher, and Stephen Leyshon, Deputy Programme Director, represented DNV GL Norway. Hedinn Svarfdal Björnsson, Project Leader, Determinants of Health, Iceland, represented the Young Forum Gastein and Nick Fahy, Director of Nick Fahy Consulting Ltd, UK, moderated the event. The workshop started off with a discussion of a vision for healthcare, linking in with the conference theme of ‘The Europe We Want’. Workshop participants were asked to consider their own interactions with healthcare in the past year and to describe the kind of care they wanted. Answers included ‘accessible’, ‘sustainable’, and ‘person-centred’. The challenges of ensuring sustainable healthcare were then outlined, and included lack of safety, changing needs, rising costs, fragmented care pathways and unequal access. These themes had been echoed in other fora and workshops during the conference.

Discussion of the challenges painted a worrying picture. However, the speakers emphasised that one of the key points currently in our favour is that we are increasingly gaining a better understanding of why people become sick. Rather than taking the traditional linear approach of connecting a single cause with an outcome (e.g. poor diet and bad health), taking into account more of the full lifespan of a person will help us to understand how to best improve their health (e.g. what factors are impacting the person’s ability to eat well and how can they be improved?).

In conclusion, we need to consider the full picture and engage with it to improve health. Person-centred care was described as the basic philosophy and process whereby healthcare becomes more responsive to the psychology, social abilities, needs, and preferences of patients in addition to physical aspects of their health. In order to make this a reality, system change is needed.

How do we engage with patients to improve healthcare systems?

Stephen Leyshon discussed current and potential future approaches to engaging patients in healthcare design, or ‘co-creating healthcare’. It would seem that the same system failures continue to recur in healthcare as a direct result of not engaging patients in care design. If we are to learn from previous mistakes, and thereby improve patient safety, we should adopt approaches from other industries where service users are invited as co-designers and co-creators. This workshop invited participants to share in the opportunity to create a strategy for person-centred healthcare.

Participants watched videos of six patients/carers with different health conditions describing their experiences of the health system. Each table of participants then discussed a particular patient/carer and considered the current journey of the patient and how their care might look under a person-centred care system. Participants considered how we can involve patients as co-designers of healthcare systems and how we could use emerging technology and real-time feedback to improve safety and quality in healthcare. Finally each table fed back their discussions.

Current variations in person-centredness across different health systems

As participants came from many different countries, many variations in current levels of ‘person-centredness’ were found. Some participants described existing cases of ‘expert patients’ who have learned to care for their own illness and can serve as trainers to empower other patients. Also, in some healthcare systems there are staff members employed specifically to listen to patients. These can include former patients who act in ‘patient support’ roles or staff members with the title of ‘Chief Listening Officer’. However, in many countries feedback is not actively encouraged and patients are often unaware of the best ways to give feedback on their care. Where feedback is taken, often the feedback loop is not closed and patients are not shown the effects of their feedback in changing healthcare. The importance of feedback from patients as an aid to improving safety was agreed by all.

Concrete steps to enhance person-centred care

Practical steps to improve person-centredness which were discussed included the use of new technologies such as apps, which may be used to collect health data or opinions submitted by patients. However, they are cognizant that, folks with life insurance for 85 and older will lag behind with such technology. The human supports of social networking and coaching were raised as ways to help patients navigate health systems in the context of fragmentation of care. Also it was felt that more could be done to inform and empower patients about their potential as co-creators. There was some discussion of the limitations of person-centredness. For example, while it may be important to a patient to access services locally, the best quality care may not be logistically achievable at a local level. When discussing this kind of problem, it was concluded that we must ensure that patients are equipped to make their own decision on what services they avail of, rather than dictating what care the patient must receive. This means clearly highlighting the risks and benefits of treatments and ensuring patient autonomy.

Having shared perspectives from different health systems, each participant was invited to declare their pledge towards person-centred care. Further sessions at the EHFG conference, e.g. personalised medicine, reflected some of the themes which emerged during the person-centred care lunch workshop. It was clear from this year’s EHFG that the Europe we want has the patient at the centre of healthcare.

Written by Young Gasteiner Susan Spillane

Susan photo for applications etc.

Moving your body for health and well-being – creating ‘win-win-wins’ for everyone involved (F8)

F8During last week’s Gastein Forum, I participated in a forum on ‘Moving your body for health and wellbeing’, organised by DG Research and Innovation, European Commission.

To health professionals it seems almost common wisdom that non-communicable diseases account for an incredibly high percentage of total mortality in Europe. Some estimates state that up to 86% of total mortality can be attributed to non-communicable diseases – many of which could be prevented through changes in lifestyle. Interestingly, the increase in sedentary lifestyles seems to be an issue in virtually every EU-member state, making this a relevant topic for collective action and policy. It therefore makes sense to look beyond national borders and to approach these developments from a European perspective.

The session kicked off with an overview of some recent EU-activities which promote physically active lifestyles. This included some noteworthy developments such as the EU Work Plan for Sport 2014-2017, the EU Council Recommendation on promoting health-enhancing physical activity across sectors, and the introduction of the annual European Week of Sport (the next one is taking place in September 2015). To me as an observer it felt as if the Commission was stepping up its game in pursuing its physical-activity agenda.

During the session, some very interesting EU-funded projects were presented. Each of these projects offered some interesting ‘out of the box’ thinking on the promotion of physical activity. One project called “Credits for Health” (C4H) stood out for me, because it took a particularly noteworthy approach to promoting healthy behaviour in the population. The main objective of C4H foresees that citizens define personal goals in the areas of nutrition, physical activity and participation in social life. If participants then adhere to these goals, they can earn credits which they can spend. In other words: imagine buying your groceries from money that you made through exercise and through creating healthy habits. The project is still ongoing but I am very eager to hear about its final results and whether this will be rolled out to all European citizens in the near future.

Another equally interesting project focused on helping men lose weight and become active through something that men value more than anything else in this world: professional football! The so called Eurofit project focuses on involving men to become members of a weight loss team which is affiliated and working with their favourite football club. The project therefore engages men through their emotional connection with their favourite clubs in order to make sustainable improvements to their diet, activity, and physical fitness. Their website is definitely worth checking out (unfortunately my favourite club is not yet on the list of participating clubs). The third innovative project I was able to learn about was called PAPA (Promoting Adolescent Physical Activity). It is a European-based project committed to enhancing young peoples’ health and well-being through ensuring positive experiences in youth sport. The project aims to develop, deliver and evaluate a theoretically-grounded and evidence-based coach education programme that can help coaches make youth sport more engaging, empowering, and enjoyable. I think that this is certainly a project that will havesome direct and positive impact in the years to come.
What I liked most about all projects was that they took a practical and positive approach to the promotion of more physical activity and health – and it surely will be interesting to follow-up on their final outcomes in the future.

During the second part of the forum, three break-out sessions allowed for an active discussion on barriers and facilitators in enhancing physical activity. Through some lively round-table style conversations, stakeholders who worked in this field were able to engage directly with EC-staff to share their experiences in enhancing physical activity. It quickly became clear that for any health promotion related activity, contexts and environments play an important role. I think that especially across European member states, this seems to be a crucial point. Another important aspect during these discussions was that any programme and partnership should explicitly show the added value to each party, including the citizen. Creating those ‘win-win-win’ situations for all stakeholders involved was considered paramount for the effective development and implementation of programmes and partnerships.

Written by Christoph Aluttis, Young Forum Gastein
PhD Candidate
Department of International Health, Maastricht University

C Aluttis

Undocumented migrants: access to health care vs. imprisonment (W11)

Imagine what it would be like to fear arrest when seeking health care. This is the reality for undocumented migrants (UDM), one of the absolute weakest groups in the EU. This was the focus of one of the final workshops of EHFG 2014.

DSC_0012The workshop was moderated by Lilana Keith, Programme Officer for the Platform for International Cooperation (PICUM) on Undocumented Migrants (UDM). She started out by bringing us all closer, turning the workshop into an intimate interaction between the audience and the panel, consisting of Lilana, Frank Vanbiervliet from Doctors of the World and Carina Spak representing the Austrian initiative AmberMed. The introduction movie made by PICUM in 2011 gave us a view into the world of UDM in need of health care, and the altruistic people working in NGOs trying to provide this. Even though regulation and access varies between countries in the EU, it seems that all the UDM in Europe (between 2 and 4 million) face similar situations of disparity and risk of prosecution when seeking heath care. The WHO Constitution enshrines the highest attainable standard of health as a fundamental right for every human being. Therefore the current state of handling UDM seeking health care in most EU nations is in violation of human rights legislation.

Since the beginning of the economic crisis in 2008, the situation for UDM seeking healthcare has actually improved; but due to increasing unemployment and impoverishment the number of migrants losing their resident permits has increased, according to Lilana. She also pointed out that even though upgrading to a good system of health care can attract UDM, a situation many nations fear, research shows that these immigrants lack the knowledge to travel to the countries with the best legislation.

DSC_2894Carina Spak described the situation in AmberMed, a Vienna-based organisation working to support UDM with health care. Because of the fear of arrest, UDM often postpone seeking health care until the situation is very serious. Treating 2000 patients a year, the altruistic health professionals at AmberMed see the same kind of disease among the UDM as in the general population, but in a much more progressed state. Stories of children losing sensation in their ears from sleeping on concrete floors describes the human suffering we need to consider when discussing this topic.

Health tourism is a myth, according to US data discussed by Frank Vanbiervliet. His examples showed that immigrants are healthier than the local population. However UDM are more prone to become ill because of the circumstances in which they are forced to live. A major concern is mental health, where there is currently no sound data to describe the situation, but the high number of UDM suffering from psychosomatic disease is a sign of the magnitude of this problem.

Earlier in EHFG 2014, Professor Sir Harry Burns pointed out that inequality is the major contributor to premature death in Scotland; and health illiteracy is a problem of major concern according to Ilona Kickbusch. I feel certain that UDM represent the poorest and most illiterate group in Europe today; their situation needs to be urgently addressed.

by Bendik Brinchmann, Young Forum Gastein