europe - ÖGPH

healthy

N O V E M B E R 2 0 1 6

CURRENT INFORMATION ON PUBLIC HEALTH AND HEALTH PROMOTION

europe

InterviewsThomas DornerArmin FidlerAllan KrasnikThomas Plochg

30 years of theOttawa CharterHow health promotion has developed since 1986

EPH Conference2016All for Health – Health for All

IN CONVERSATION WITH

Health is political.„“

EVELYNE DE LEEUW,INTERNATIONALLY

RENOWNED HEALTHRESEARCHER

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PUBLISHING DETAILS

Disclosure in accordance with §25 ofthe Austrian Media Act (MedG)

Media owner and publisher: teamword, Dietmar Schobel, MeidlingerHauptstr. 3/5-7, 1120 Vienna, Austria

Concept:Floris Barnhoorn (EUPHA),Dr Christina Dietscher (BMGF),Assoc Prof Dr Thomas Dorner (ÖGPH),Gerlinde Rohrauer-Näf (FGÖ),Dietmar Schobel (teamword),Dineke Zeegers Paget (EUPHA)

Editorial office: teamword, Dietmar Schobel,Meidlinger Hauptstr. 3/5-7, 1120 Vienna,Austria, www.teamword.at, [email protected],Tel.: +43 1 909 33 46 (office) or +43 664 360 17 82 (mobile)

Translation/Proofreading:RBL Translation & Proofreading,Rosemary Bridger-Lippe

Graphic design:Gottfried Halmschlager

Photos:Luke Fuda, Johannes Hloch, Klaus Ranger,Moritz Wustinger, Fotolia, private

Cover photo:Luke Fuda

Printing: Ferdinand Berger & Söhne Ges.m.b.H.

Publication frequency: “Healthy Europe” 2016 is a one-off publication for the European Public HealthConference, Vienna, in November 2016 Published and produced in Vienna, Austria

Editorial policy: This issue of “Healthy Europe” was made possible by collaboration between theEuropean Public Health Association (EUPHA),the Austrian health fund Fonds GesundesÖsterreich (FGÖ) and the Austrian PublicHealth Association (ÖGPH). It is a platform forpublic health and health promotion in Europe,presenting people and conveying content from the worlds of politics and science, as well as practical issues.

CONTENTS

PEOPLE ANDPOLICIES

Three profiles: NatashaAzzopardi Muscat, Thomas Dorner and Armin Fidler4

In brief5 Knowledge exchange is important, as is networking, says ThomasDorner in an interview.6

The 16 thematic tracks of the 9th European Public Health Conferencein Vienna7

COVER STORY Internationallyrenowned researcherEvelyne de Leeuwtalks to us aboutwhat she has learnedfrom 30 years ofhealth promotion inaccordance with theOttawa Charter.8

Armin Fidler: Education ismore valuable for health than better rescue helicopters.11

The 30th anniversary ofthe Ottawa Charter forHealth Promotion12

Survey: Four experts fromSwitzerland, Slovenia andAustria on the strategies suit-able for achieving “Healthfor All” in today’s world15

IN FOCUS“Built environment” has a major influence on our health.

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The Vienna Declaration16

Allan Krasnik: Cultural diversity is an opportunity.17

KNOWLEDGE

Even though health promotion is an importantpolitical topic in all European countries, there is still a lack of practical implementation.18

Health inequality on the rise in Europe20

High-quality public health trainingprovides theknowledge to overcome the current challenges forhealthcare systems.22

Guest article by Peter Allebeck: Impact factor or impact?26

Everybody will be in Stockholm: The 10th European Public Health Conference will take place in early November 2017 inSweden’s capital city.27

ll for Health – Health forAll” is the theme of the9th European Public

Health (EPH) Conference in Vienna which is organised bythe EPH Conference Founda-tion in collaboration with theEuropean Public Health Association (EUPHA) and theAustrian Public Health Associ-ation (ÖGPH). This edition of“Healthy Europe” is dedicatedto the Vienna 2016 conference.On the one hand, the title of theconference draws attention tothe fact that all people should be able to make useof their health potential. On the other, it is aboutcreating the best possible prerequisites for ahealthy life. This requires commitment from all so-cial areas and scientific disciplines, and also fromeach and every one of us. The theme of the confer-ence is based on the Ottawa Charter, the funda-mental document for international health promo-tion. As the Charter is celebrating its 30th anniver-sary this year, one of our interview partners forthis issue of “Healthy Europe” is Ilona Kickbusch,who was responsible for the first health promo-tion conference for the World Health Organization(WHO) in 1986 which was held in the Canadiancapital. The cover story is dedicated to one of theyoungest participants at the Ottawa conference:Evelyne de Leeuw, who was 26 years old at the time.She points out that above all “health is political”.Natasha Azzopardi Muscat, who follows Martin McKee as President of EUPHA, shares this opin-ion. She explains in the article on health promo-tion in Europe that she intends to focus on thegreater integration and visibility of public healthpractitioners within EUPHA. The article on pages20 and 21 explores why the health differences between various population groups are currentlyon the rise in many European countries. It alsodiscusses the best strategies for reducing thishealth inequality. Last but not least, in this issue of“Healthy Europe” we have also included anabridged version of the “Vienna Declaration”,where the principles of the Ottawa Charter are reiterated and renewed.This magazine for the EPH Conference 2016 wasmade possible by collaboration between EUPHA,ÖGPH and the Austrian health fund FondsGesundes Österreich (FGÖ). We hope that youwill find it an informative and stimulating readand a source of inspiration for your work.

Dineke Zeegers Paget, Executive Director of EUPHA, and Floris Barnhoorn,Deputy Director of EUPHA

EDITORIALDear Readers,12

Still asrelevant today

as 30 years ago

The Ottawa Charter for Health Promotion from the year 1986 fundamentallychanged the way we think about health.

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Thomas Dorner (41) is Chairof the European Public HealthConference 2016 in Vienna.He comes from Markt St. Mar-tin in Burgenland, studiedmedicine in Vienna and completed his clinical trainingas a foundation doctor at thegeriatric hospital “Haus derBarmherzigkeit” and KaiserFranz Josef Hospital in theAustrian capital city, amongothers. Thomas Dorner grad-uated in public health studiesat the University of Viennaand the Medical University ofVienna. In 2008 he took up apost at the Institute of SocialMedicine and Epidemiologyat the Medical University ofGraz. Since 2009 he has been

working at the Centre for Pub-lic Health at the Medical Uni-versity of Vienna and has beenAssociate Professor there forthe last two years. In 2012 hewas elected President of theAustrian Public Health Asso-ciation.“I started to study medicinebecause I was interested inpeople – and everything thatmakes us what we are,”Thomas Dorner recalls, andcontinues: “The fact that I specialised in public healthmedicine later on was a logicaldevelopment for me. In thissector we really deal with aperson as a whole – and looknot just at an individual, butinstead at large sections of

the population that shouldgain advantages from ourwork. Health promotion andprevention can benefit morepeople than therapy, I am convinced of that.”

Armin Fidler was born inInnsbruck in 1958. He at-tended high school in Bre-genz and then studied med-icine in Innsbruck and Ham-burg. He trained as a generalpractitioner at Bregenz statehospital and then as a trop-ical medicine physician at theBernhard Nocht Institute inHamburg. He subsequentlyattended the master’s cours-

es on public health and alsohealth policy and manage-ment at the Harvard Schoolof Public Health and theKennedy School of Govern-ment in the USA. From 1990Armin Fidler worked for theWorld Health Organization(WHO) in Mexico City. In1993 he joined the WorldBank as a manager andworked as their chief adviseron health issues from 2007to 2015. Since March 2015he has been employed at theManagement Center Inns-bruck and teaches the Euro-pean Master in Health Eco-nomics and Managementcourse.

“I come from a family of doc-tors: my father was a GP, mymother was a paediatrician,”Armin Fidler reveals, andadds that he may have beenaware of the limits of repairmedicine at an early stagefor that reason: “I alwayswanted to focus on some-thing that would enablemore to be achieved for theentire population, and for methat was public health, healtheconomics and the topic ofhealth in all policy fields.”Armin Fidler has a partner,lives in Hörbranz in Vorarl-berg and has three childrenaged 20, 16 and two yearsold.

“Health promotion can benefit more people

than therapy.”

PEOPLE & POLICIES

Natasha Azzopardi Muscat was born in August1973 in Attard on Malta, where she also nowa-days lives with her husband and three children

Aidan (15), Sereena (11) and Nathan (6). She studiedmedicine and public health at the University of Malta,after which she graduated with distinction in healthservices management at the London School of Hygieneand Tropical Medicine and the London School of Economics and Political Science. From 2001 NatashaAzzopardi Muscat occupied various senior positions atthe Maltese Ministry of Health. She was the person responsible for the area of health when Malta joinedthe European Union in 2004. From 2011 she was theisland’s Chief Medical Officer. Since 2014 she has heldthe post of Consultant in Public Health Medicine at theDirectorate for Health Information and Research. Shehas taught the subjects of health policy and healthsystems at the University of Malta for the past 17 years.“Public health is primarily concerned with political strate-gies. This is the key message that I try to get across tomy students,” says Natasha Azzopardi Muscat, who hasbeen active in non-governmental organisations sinceher student days. Her past functions have included President of the National Youth Council and Presidentof the Malta Association of Public Health Medicine,which she helped found in 1999. As of November 2016Natasha Azzopardi Muscat is President of the EuropeanPublic Health Association.

“Public health is primarily concerned with

political strategies.”NATASHA AZZOPARDI MUSCAT,

PRESIDENT OF THE EUROPEAN PUBLIC

HEALTH ASSOCIATION

ARMIN FIDLER, LONG-STANDING CHIEF ADVISERON HEALTH ISSUES FOR THE WORLD BANK

THOMAS DORNER, CHAIR OF THE EPH CONFERENCE 2016 IN VIENNA

“I was aware of the limits of repair medicine at an

early stage.”

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PEOPLE & POLICIES

“Exactly 30 years ago the OttawaCharter was published – the fun-damental document for healthpromotion. We have beenprompted by this anniversary toprepare a concept that outlinesthe direction in which health promotion should develop in theyears leading up to 2030 andthe priorities that we want to assign,” says Nicoline Tamsma –President of EuroHealthNet, theEuropean network of health promotion organisations and

institutions, which is headquar-tered in Brussels. EuroHealthNethas therefore drawn up a clearframework entitled “Rejuvenate”which describes ten stages thatare intended to advance healthpromotion in the future. “The 17Sustainable Development Goalsspecified by the United Nationscontain many points for us tobuild on where we can incorpo-rate the values and methods ofhealth promotion. The same applies to the Pillar of SocialRights planned for the EuropeanUnion,” says Nicoline Tamsma.The EuroHealthNet future conceptfor health promotion and well-being focusses on how knowl-edge is gathered and applied,and also how the healthcare sys-tems can be designed to promotehealth to a greater degree, amongother areas. The full text can befound at eurohealthnet.eu.

Better health for everyone in EuropeEUROPEAN PUBLIC HEALTH

ASSOCIATION

Together with the European PublicHealth Conference Foundation,the European Public Health Asso-ciation (EUPHA) and the AustrianPublic Health Association are or-ganising the ninth European PublicHealth Conference in Vienna.Founded in 1992, EUPHA is theumbrella organisation for 71 publichealth associations, institutes andother members from a total of 41

European countries. Within theframework of EUPHA, 17,000 experts work together and sharetheir know-how with one another.The four pillars of the Europeanumbrella organisation’s work areresearch, policy, practice and pub-lic health workforce and leader-ship. EUPHA aims to improve thehealth and well-being of all peoplein Europe and to narrow healthinequalities. It has 21 “sections”that specialise in different thematicareas, ranging from child and adolescent public health to urban

public health. Martin McKee, Pro-fessor for European Public Healthat the London School of Hygiene& Tropical Medicine, was appoint-ed President of EUPHA in 2014.Natasha Azzopardi Muscat, formerChief Medical Officer of Malta, ishis successor as of November2016. The new President of EUPHA declares: “I would like tocarry on the commendable workof my predecessors and to focuseven more on integrating publichealth practitioners within our organisation.”

Martin McKee – Professor for EuropeanPublic Health

Nicoline Tamsma– President of EuroHealthNet.

EUROHEALTHNET

Framework for healthpromotion

The Austrian Public Health Associ-ation (Österreichische Gesellschaftfür Public Health – ÖGPH) is organising the ninth European Public Health Conference in Viennatogether with the European PublicHealth Association. Originallyfounded in 1995 by a group ofaround 30 public health experts,ÖGPH now has some 250 members. As well as researchersand academics, its members includepractitioners such as employees ofAustrian social security funds.ÖGPH has seven competence

groups: “Preventing obesity”, “Promoting primary healthcare inAustria”, “Gerontology”, “Physicalactivity”, “Public mental health”,“Screening” and “Sexual and gender diversity”. At regional level,the organisation also has its ownpublic health group in the federalstate of Styria. ÖGPH aims tostrengthen the public health community in Austria and, amongother things, works to ensure thathealth aspects are taken into account in all areas of policy. Italso aims to improve structures forresearching health and care andto encourage the sharing of health-related know-how across disci-plines. “We are also firmly com-mitted to safeguarding the qualityof public health training and edu-cation at all levels and for variousprofessions in Austria,” emphasisesGünter Diem, Deputy President ofthe Austrian Public Health Asso-ciation and a general practitioner.

Günter Diem: “We are firmly committed to safeguarding the quality of public healthtraining and education at all levels.”

AUSTRIAN PUBLIC HEALTH ASSOCIATION

Promoting the sharing of know-how

Photo: EUPHA

Photo: Moritz Wustinger

Photo: private


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PEOPLE & POLICIES

Knowledge exchange is important, as is networking, says Thomas Dorner, Chair of the European Public Health Conference in Vienna. Ample opportunities

for both of these will therefore be available at the conference.

HEALTHY EUROPEProfessor Dorner, how many partici-pants are you expecting at the Euro-pean Public Health (EPH) Conferencein Vienna?Thomas Dorner: We are anticipating thatroughly 1,600 participants will attend the scientific conference over the four days. It is avery good number of visitors compared to pre-vious events. The participants are coming fromall over Europe, and also from many non-European countries. The spectrum ranges fromresearchers in the areas of healthcare andhealth promotion, epidemiologists and healtheconomists, to civil servants on a national, re-gional and local level, and also representativesfrom social security funds.

HEALTHY EUROPEHow would you describe the EPH Con-ference programme, in brief?We have chosen “All for Health – Health forAll” as our overriding topic. As I see it, this il-lustrates that we need to overcome hurdles inorder to achieve the best possible health forall people in Europe. I am referring to theboundaries between the different disciplinesand social areas just as much as those between

sections of the population and also differentcountries. In other words, it is about promotinginterdisciplinary and intersectorial cooperationand also the international exchange of expe-riences as the basis for the best possible healthof all population groups. Specifically, there are16 thematic tracks for lectures and workshopsat the EPH Conference in Vienna, ranging from“European Public Health” to “Health at theWorkplace” (see also page 7 with informationon the “16 thematic tracks of the EPH Confer-ence 2016 in Vienna”).

HEALTHY EUROPEAt the EPH Conference 2016 in Vienna,18 skill building workshops will takeplace as well. What will actually hap-pen there?We are very pleased that the conference willbe attended by so many participants who arestill at the very beginning of their professionalcareers in public health. The skill building work-shops are designed specifically with them inmind and are intended to convey practicalknowledge: the know-how that is necessaryin order to write academic articles and theproficiency required for implementing healthpromotion in practice. A “speed dating” session

will provide an opportunity for intensive net-working. Around 60 academics will be giventime to find out information about each other.First one person, then the other, will have oneminute to introduce themselves briefly – andthen they move on to the next contact.

HEALTHY EUROPEWhat are the other highlights of theaccompanying programme for the EPHConference 2016 in Vienna?Networking activities are at the very leastequally important as pure knowledge transfer.The accompanying programme of events there-fore includes the welcome reception in ViennaCity Hall and also the gala dinner in theRathauskeller restaurant on the following day,with Vienna’s party band “graVity”. Four activityareas will offer opportunities for physical exerciseat the conference, and we have invited 80 stu-dents from schools in Vienna to come to theconference and explore the topic of healthyexercise together with the participants. Peoplewho enjoy singing can also join the conferencechoir, which will rehearse every day and performat the closing session of the conference, wherean initial energetic outlook on the 2017 EPHConference in Stockholm will be given.

HEALTHY EUROPEWhat are your expectations for theconference?By communicating knowledge and also by cre-ating opportunities for becoming better ac-quainted with one another personally, we wouldlike to give the participants fresh inspirationfor their work in the public health sector. Sothey can return home with fresh enthusiasm. Ph

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“Networking activities are as important as pure knowledge transfer.”

THOMAS DORNER, CHAIR OF THE EUROPEAN PUBLIC HEALTH CONFERENCE 2016 IN VIENNA

Returning home withfresh enthusiasm


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The 9th European Public Health Conference in the Austria Center Vienna has 16 thematic tracks that cover the broad range of public health issues in Europe.

PEOPLE & POLICIES

Photo: IA

KW-AG

The main topics of the EPH Conference

The 9th European Public Health Conference is taking place in the Austria Center Vienna.

A All for healthHealth is everyone’s concern and everyone should be concerned about health.

B Health for allAll segments of the population should have a right to health.

C European public healthCollaboration on health, especially on cross-border issues, is essential.

D Health promotionA health-promoting environment is essential for achieving health for all.

E LifestylesAn individual can and must contribute to health by adopting a healthy lifestyle.

F Chronic and non-communicable diseasesAn ever-increasing problem in public health.

G Health of migrants and ethnic minoritiesHealth for all with specific emphasis on the most vulnerable groups.

H Child and adolescent public healthEarly intervention and awareness: practice makes perfect.

I Mental healthAn increasing problem due to the economic crisis and the new fast-moving society.

K Health information and control of infectious diseasesThe importance of being informed and prepared for epidemics.

L Inequalities and social empowermentThere is an increase in inequalities among population groups. Social empowerment can be an importanttool for overcoming this.

M Health services and systems researchThe ageing population, costs and rapidtechnological development have an impact on sustaining health systems.

N Health and care: research, policy and practiceA well-trained workforce and a focus onpatients are achievable through research,policy and practice.

O Health data, methodology, monitoring and reportingA good research base remains the corner-stone for planning public health activities.

P Communication in public healthThe importance of timely, accurate and understandable communication is essential for successful public health.

Q Workforce development and the workplaceA professional, well-trained workforce is needed.


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INTERVIEW

HEALTHY EUROPEHow important is the Charter thatwas developed jointly in 1986 at theWorld Health Organization’s first everconference on health promotion inOttawa?Evelyne de Leeuw:The Ottawa Charterchanged the world. It describes a newway for people to get and stay healthy.Health is no longer viewed as something that solely concerns eachperson individually. Rather, there is anew perspective indicating a relationabove all with social and environmetal factors. This innovative concept wasexpressed so clearly and simply in justtwo pages that it was taken on boardby many people in all countries andultimately changed their way of thinking.

HEALTHY EUROPEFrom a global perspective, which de-velopments were triggered by the Ot-tawa Charter?The ideas outlined in the Ottawa Charter were embraced in many countries in the first ten years after being published – in Canada, in manyEuropean countries, and as far afieldas Thailand and Australia. We also suffered setbacks in the years followingthis, which can in no small part be attributed to the rise in neoliberal political tendencies. In some countries,health policy once again focussed onlyon medical care, stressing that peopleare responsible for their own healthchoice and behaviour. In many cases,health is again seen as being merely aquestion of lifestyle. However, the

Ottawa Charter concept has been enjoying something of a second windover the last few years. More and morepeople are once again recognising thatpromoting health involves more thanmerely aiming to change people’s be-haviour. Above all, we need to changethe circumstances that shape our lives.

HEALTHY EUROPEIs health promotion a luxury that onlyrich countries can afford?No – quite the opposite, in fact. It islow and medium income countriesin particular that can also benefit fromthis. At the WHO’s 7th conference onhealth promotion in Nairobi in 2009,it was possible to establish a clear connection between the principles ofthe Ottawa Charter on the one hand,

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Internationally renowned researcher Evelyne de Leeuw talks to us about what she has learned from 30 years of health promotion in accordance with the

Ottawa Charter and about the challenges for the future. Text: Dietmar Schobel

Health is political

Born on 25 June 1960 in HaarlemStar sign: CancerI live in two different places at the moment: in Summer Hill, a suburb of Sydney where Iwork and then around 1,000 km away inDrumcondra in the state of Victoria, which iswhere the rest of my family live – my girlfriendand my dog. Hopefully they will be moving toSydney next year.My hobby is thinking. Apart from this, I like to go for walks to experience the world in allits glorious diversity.I like to go on holiday to Provence inFrance, or anywhere with mountains.

I like to eat all kinds of cheese and reallylove cheese fondue, occasionally with a glass of Chasselas white wine.I listen to classical music, for example Chopin or Rachmaninoff. But I also love the sounds of the 70s like the Electric Light Orchestra or modern French electro like Air and Daft Punk.On my bedside table there is, among otherthings, a copy of “Letter to Father” (“Brief aan Vader”), the latest book by Maarten Biesheuvel. In my opinion, he deserves to winthe Nobel Prize for Literature. Apart from that, I have a set of radio speakers that allows me

to hear radio stations from all over the world.I keep healthy by using public transportand, as a consequence, walking a lot as well and by taking good care of myself – forexample by eating a balanced diet and gettingenough sleep.What causes illness is having to witness injustice or stupidity and not being able to doanything about it.These three characteristics describe me best:I am a thinker, a very reliable friend and sometimes impatient – with other people and with myself.

PROFILE: EVELYNE DE LEEUW


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and economic and infrastructural andhuman development on the other. Involving people is particularly important. At first glance, it may seemsimpler to invest only in vaccines,pills or doctors rather than interactingwith everyday people, but this isevery bit as important. For example,a sufficient vaccination coverage fora country can only be achieved if thegovernment implements a strategyfor this and if the vaccines are available. However, at the end of theday, people must also be convincedthat they need to be vaccinated.

HEALTHY EUROPEFive areas of action are described inthe Ottawa Charter. What experiences

increasing people’s health literacyand self-efficacy. There has also beenprogress in the area of “Creating supportive environments”. The relation between health on the onehand and living, working and leisureconditions on the other is generallyrecognised today and practical initiatives have helped to makeschools and workplaces into healthierenvironments. However, hardly anysignificant improvements have beenmade in the fifth area of action, “Reorienting health services”.

HEALTHY EUROPEWhy not?There is a lot of talk about involvingpatients in decisions but it rarely

have been recorded in each of these?The first area of action is “Buildinghealthy public policy”. At a nationallevel, only initial approaches havebeen made so far, such as the nationalhealth objectives in Austria. At a locallevel, however, this often works verywell, for instance in thousands ofcities that are involved in the WHO’s“Healthy Cities” initiative. Greatprogress has been and is still beingmade with regard to the area of“Strengthening community action”.Similarly, extensive know-how hassince been accumulated in the areaof “Developing personal skills” andthere are many good examples ofhow this can be implemented in practice. This involves above all Ph

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“The Ottawa Charterchanged the world.”EVELYNE DE LEEUW, INTERNATIONALLY RENOWNED HEALTH PROMOTION EXPERT


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INTERVIEW

amounts to more than empty buzz-words. The fact is that healthcare sys-tems are still geared towards treatingsick people in such a way that theycan leave the system again as quicklyas possible. How long they remainhealthy after that does not seem to en-ter the equation.

HEALTHY EUROPEWhat have you learned from your ex-perience to date with health promo-tion in accordance with the OttawaCharter?Knowing about health is not enoughon its own. For example, it is by nomeans enough just to tell someone thatthey should switch to a healthier dietand what such a diet consists of. Weneed to work together with peopleand with the communities they belongto. We need to listen to them, to respectthem and to get them on board at theoutset so that we can develop health-oriented community action together.As well as this, we need to structuretheir everyday environment in such away that it is easier to opt for health –the healthier choice should be the easier choice.

HEALTHY EUROPEWhat are the greatest challenges forthe future in the field of health pro-motion?Needless to say, where health is con-cerned, there is always an individualcomponent as well. But first and

foremost health is political and is directly related to systems. Becauseof this, health promotion is concernedwith systems and today we know better how we need to change thesein order to ensure a healthier population. This is by no means easy.But that shouldn’t stop us fromanalysing it very closely and communicating it to people in thesimplest possible terms. After all, lifeitself is complicated as well. But thatdoesn’t mean that we shouldn’t beable to cope with it effectively.

HEALTHY EUROPEWhat personal memories do you associate with the WHO conference on health promotion in Ottawa in 1986?Aged 26, I was one of the veryyoungest participants and I realisedonly in hindsight what a high-levelconference it was. One thing I stillrecollect very clearly is sitting for threehours in a restaurant with a group of15 women having a heated discussionabout whether the Charter met ourexpectations as women. We felt thattwo sentences needed to be added atall costs, scribbled them down on anapkin and delivered them to IlonaKickbusch, the initiator of the Charter,in the middle of the night. One of thetwo sentences was actually includedin the Charter and I am still quiteproud of this today. It read: 'This mustapply equally to women and men.'

A BRIEF CAREER RUNDOWN

Evelyne de Leeuw was born on 25 June1960 in the Dutch city of Haarlem and“grew up all over the world”. As she explains: “I have lived in many countriesand cities, from the USA and Canada toFrance, Denmark and Australia. In all ofthese places there were influences thatwere important to me and people who inspired me.” Her overriding memories ofprimary and secondary school were of being bored there. After this, she discov-ered an interest in health sciences, whichshe studied in Maastricht from 1981 to1985. Following this, she graduated with aMaster of Public Health from the Universi-ty of California in Berkeley. In 1989 shesuccessfully defended her PhD thesis.Since 1989, Evelyne de Leeuw has actedas adviser at the Healthy Cities project of-fice for the European region of the WHOand was General Secretary of the Associa-tion of Schools of Public Health in the Eu-ropean Region (ASPHER) between 1992and 1998. From 1992 to 2001, the much-travelled academic became Director of theWorld Health Organization CollaboratingCentre for Research on “Healthy Cities” atthe University of Maastricht. In 2000 sheset up the public health programme atSyddansk Universitet in Esbjerg, Denmark,which was followed by a position atDeakin University in Victoria, Australia,from 2005 to 2013.Since October 2015, Evelyne de Leeuwhas been Director of the Centre for HealthEquity Training Research and Evaluation(CHETRE) at the University of New SouthWales in Australia. Here, the work under-taken together with her 25-strong teamincludes theoretical and practical researchinto Indigenous health and socially disadvantaged people, and applying and refining health decision support systems,including Health Impact Assessment. Evelyne de Leeuw is also Editor-in-Chief ofthe renowned international peer-reviewedjournal “Health Promotion International”.

Evelyne de Leeuw:“Knowledge does not lead to

change. That is true for individual as well as political choices.”

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INTERVIEW

HEALTHY EUROPE“All for Health – Health for All” is themain topic at the 9th European PublicHealth Conference in Vienna. What doyou associate with this theme, Mr Fidler?Armin Fidler:We have known for a long timefrom numerous studies that all areas of society,such as the education system, infrastructureand the economy, have important influenceson health. In comparison, the health systemitself only makes a small contribution to keepingus healthy. Neither the population nor ourpoliticians have recognised this, however. Thereare even experts who work in public healthyet still believe that the health system is theonly health contributor. One consequence ofthis way of thinking is an inefficient use of resources. After all, it has been proven thatmulti-sector activities are more beneficial thanclinical intervention. For example, when it comesto improving health on average, then – to putit somewhat simply – every euro spent onbetter education is more usefully invested thana euro spent on an even faster rescue helicopter.

HEALTHY EUROPEWhat could help us take a step closerto this goal?Generally, it is necessary for all areas of societyto work together across the board. This meansthat all departments and policy levels must beintegrated and there must be clear targets. Inpractice, this can mean collaboration betweenthe Ministries of Education, Transport and Healthin order to reduce the number of road accidents.Another goal could be achieved, for example,if at least half of all schoolchildren were ableto either walk or cycle to school safely within

a certain time frame, to counteract increasedobesity in young people. Or we could strive toteach children at school how to shop, cookand eat healthily – this is educational contentthat is at least as important as mathematicsor other subjects.

HEALTHY EUROPEWhat influence does the economyhave on health?I am convinced that everybody’s health im-proves as a result of economic progress,which I interpret to be economic growth thatis ecologically sustainable and in coordinationwith social policy that is focussed primarilyon eliminating poverty. Targeted multi-sectorstrategies that advance the health and socialstatus of the population strata with the worstsocial position reap the greatest benefits. Itis then of marginal importance if the numberof millionaires increases or decreases by oneor two at the same time. History has shownthat absolute equality must not necessarilybe pursued.

HEALTHY EUROPEMulti-sector activities were alreadydemanded in the Ottawa Charter for

Health Promotion from the WorldHealth Organization in 1986. What hasbeen achieved since then?We have done a lot and now know in theoryhow health is generated and what areashave to be fine-tuned in order to improvehealth. At the same time, we still need tomake improvements in the same areas as30 years ago because there is a lack of thepolitical willingness that is necessary for implementing this knowledge in practice. Itis also due to the fact that the economicvalue of health is regularly overlooked. Andthe world of politics usually only thinks inshort-term results. This issue is all aboutchange, however, and the effects may onlybe felt a generation later.

The health of the population can only improve if there is cooperation between all policyareas, states Armin Fidler, one of the main speakers at the 9th European Public

Health Conference in Vienna, in conversation with “Healthy Europe”.

Education is more valuable than better rescue

helicopters

Medical expert Armin Fidler (57) waschief adviser on health issues at theWorld Bank until 2015. Since then hehas taught the European Master inHealth Economics and Managementcourse at the Management Center Inns-bruck (see also profile on page 4).

PROFILE

11healthyeurope

“We still need to make improvements in the same areas as 30 years ago.”

ARMIN FIDLER, FORMER CHIEF ADVISER ON HEALTH ISSUES AT THE WORLD BANK

p


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PEOPLE & POLICIES

The weather was ideal. At leastideal for a conference – thanksto the fog, cold and snowstorms

that held sway in November 1986, the300-odd participants at the WHO’sfirst-ever conference on health pro-motion rarely ventured outside theconference hotel in Ottawa. Instead,they devoted themselves even moreintensively to the joint meetings andworkshops that would ultimately leadto the document that outlined thefoundation of health promotion. TheOttawa Charter defined – in clear, simple language – the three basicstrategies for health promotion andthe five areas of action (see also box:“The three basic strategies and fiveareas of action for health promotion”).All conference participants in Ottawa

had the chance to make an active con-tribution to the document. “It was es-pecially important for us to have thewidest possible participation – we evenset up boxes to collect comments. Itwas quite common for notes withhandwritten comments on the latestversion of the Charter to be pushedunder my bedroom door in the middleof the night,” recalls consultant andrenowned global health expert IlonaKickbusch, who initiated the conference.A team of writers worked through thenight to produce a new, revised versionof the document every day, then cir-culate it among all participants the fol-lowing morning. At the close of thefive-day conference in Ottawa, the finalversion of the Charter was read outbefore the assembled participants. “We

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THE THREE BASIC STRATEGIES AND FIVE AREAS OF ACTION FOR HEALTH PROMOTION

According to the World Health Organiza-tion’s Ottawa Charter, health promotion is“the process of enabling people to increase control over, and to improve, theirhealth”. Three basic strategies and five areas of action are outlined in this connection. The three basic strategies are:

AdvocateEnvironmental and behavioural factors canall be either conducive or detrimental tohealth. Health promotion aims to influencethese factors through advocacy for health.

EnableHealth promotion focusses on reducing ex-isting health differences owing to socialfactors. It aims to enable all people toachieve their fullest health potential.

MediateThe health sector alone is not capable ofensuring good health. Rather, health pro-motion calls for coordinated action by allsocial areas and institutions.

The five main areas of action forhealth promotion are:

1 Build healthy public policy2 Create supportive environments3 Strengthen community action4 Develop personal skills5 Reorient health servicesThe complete wording of the Ottawa Chartercan be found online at the following link:http://www.euro.who.int/de/publications/policy-documents/ottawa-charter-for-health-promotion,-1986

The World Health Organization’s Ottawa Charter for Health Promotion was developed in 1986 and fundamentally changed the way we thought

about health. Text: Dietmar Schobel

Still as relevant today as 30 years ago


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all had the feeling of having createdsomething truly innovative,” says Gauden Galea – today, Dr Galea is Director of the Division of Noncom-municable Diseases and PromotingHealth through the Life-course at theWHO’s Regional Office for Europe,but at the time he was one of theyoungest participants, aged just 26.

A new way of thinking“The Ottawa Charter completelychanged the way we think abouthealth,” emphasises Bosse Pettersson,Vice President of EuroHealthNet, theBrussels-based European network ofhealth promotion organisations andinstitutions, who also attended the con-ference in Canada. Rather than merely

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THE SETTINGS APPROACHHAS BECOME

COMMON PROPERTY

In the Ottawa Charter of 1986, the set-tings approach was defined as a corestrategy for health promotion. “Set-tings” are distinct socio-spatial systemsin which people live and which have aninfluence on the health of individualsand groups. The aim should be to de-sign healthier overall settings ratherthan merely seeking to change individ-ual behaviour by means of health promotion. The first settings for healthpromotion were defined by the WHO as companies, schools, towns/cities, regions, prisons, colleges/universitiesand hospitals. “The settings approachhas since become common property,”explains Christiane Stock, Professor ofHealth Promotion at Syddansk Univer-sitet in Esbjerg, Denmark, and Presidentof the EUPHA Section on Health Promotion.“In Austria, we have around 30 yearsof experience in working with this concept and many new settings havebeen added as well,” explains GerlindeRohrauer-Näf, health adviser at FGÖ,the national centre of competence forhealth promotion and prevention.Among the projects supported by FGÖ,these include municipalities, child daycare centres, educational or trainingestablishments, social and healthcareinstitutions such as residential or nursing homes, consulting institutions,and families and communities, such asthose of people with a migration background. Practical experience showsthat the following conditions in particu-lar must be met in order for health promotion to be actually integrated in asetting.

• The entire setting should beanalysed to begin with – and not justthe health problems of the people inthe setting• People should be assisted in mak-ing their setting more conducive togood health; this process should beoverseen by experts if necessary• Health promotion must also in-clude improving the core functions ofthe setting, e.g. education in the caseof schools or working processes at theworkplace• Any action taken must addressconditions and also individual conductto the same extent, i.e. at several of thefive intervention levels defined by theOttawa Charter.

Sabine Oberhauser: “In many countries, health promotion has established itself as an important pillar of the health system.”

Klaus Ropin:“We are always faced withnew challenges.”

Gerlinde Rohrauer-Näf:“In Austria, we have around 30 years of experience in working with the concept of ‘settings’.”


PEOPLE & POLICIES

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This meant that the focus was nolonger merely on individual behaviourbut above all on everyday “settings”,the influence of social and environ-mental factors and the responsibilityof state and society for the health ofthe people. The Ottawa Charter statesthat health is created where people“learn, work, play and love”. Over thecourse of time, this concept found itsway into the health policies of manycountries on all continents – sometimesto a greater and sometimes to a lesserdegree, depending on the overall po-litical situation in the country in ques-tion. Bosse Pettersson: “Looking at theoverall picture, the Ottawa Charterdefinitely had an enormous influence.”

reflecting on how illnesses can beavoided, the document examined forthe very first time how health can bepositively influenced and strength-ened.

A pillar of the health systemThese sentiments are echoed by Austrian Minister for Health SabineOberhauser: “In many countries, healthpromotion has established itself as animportant pillar of the health system.Over the past decades, it has developedfrom a series of dedicated individualinitiatives into an area with extensivesupport at policy-making level.“ InSabine Oberhauser’s view, the OttawaCharter shows that people need morethan medical care to stay healthy – forexample, they also need good livingconditions, supportive social networks,safe food and drinking water, goodeducation and employee protection:“For policymakers, that means ensur-ing that all living environments offerthe best possible health opportunitiesfor the population. This can only comeabout by different departments working together.”Gauden Galea also points out that theideas underlying the Ottawa Charterhave already become common knowledge among academics in thefield: “Today, it is difficult to imagineanyone giving a lecture on publichealth without citing the importanceof social determinants such as incomeand education on health or withoutreferring to the health differences between different social groups.”Klaus Ropin, head of Austrian healthfund Fonds Gesundes Österreich(FGÖ), stresses: “Great progress hasbeen made in science and research inthe field of health promotion over thepast 30 years, and extensive practicalknow-how has been accumulated aswell. These days, we know more aboutwhich measures are effective and howthey can be implemented in practice.Which is precisely why the OttawaCharter is every bit as relevant todayas it was 30 years ago. After all, weare still a long way from achieving itsobjectives and we need to channel ournew findings into renewed efforts toachieve them now. And in doing so,we are always faced with new challenges.”

A CONCEPT FOR ALL CONTINENTS

Since Ottawa, seven more internationalWHO conferences on health promotionhave taken place and have further devel-oped, deepened and enriched the con-cept with new elements. The individualconference venues were chosen by theWHO to enable the idea of health pro-motion to be gradually “carried aroundthe world”. The host countries were usu-ally nations that had already showedcommitment to health promotion andwere regarded as pioneers in the area.This being the case, the second interna-tional conference was held in Adelaide,Australia. This was followed by Sundsvallin Sweden and the Indonesian capitalJakarta in Southeast Asia. The fifth con-ference took place in Mexico City, thesixth in Bangkok. In 2009 Kenya’s capitalcity Nairobi was chosen as the venue,followed by Helsinki in Finland in 2013.Shanghai is to host the ninth global con-ference on health promotion between 21 and 24 November 2016. This eventwill focus above all on the correlationsbetween health promotion and the 17Sustainable Development Goals that theUnited Nations has set for 2030.

Ilona Kickbusch:“It was especially important forus to have the widest possibleparticipation.”

Gauden Galea:“We all had the feeling of having created something truly innovative.”

Bosse Pettersson:“The Ottawa Charter completely changed the waywe think about health.”

Ottawa: The 1st international conference for health promotion of the World Health Organizationin 1986 took place in Ottawa.


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SURVEY

Pamela Rendi-WagnerHead of the Public Health and Medical Affairs Section, Austrian Ministry of Health

The World Health Organization defines health as a “state of complete physical, mental and social well-being”. This is naturallya utopian dream. A more realistic definition is the attempt to achieve the best possible health, depending on the starting situa-tion. A wheelchair user is faced with a different situation to that of a top athlete. We have done quite well in approaching thisgoal so far: the quality of life in Austria is high when compared internationally, and life expectancy is continuing to rise. The situation could be less optimistic for our children and grandchildren: malnourishment, a lack of exercise and the abuse ofstimulants promote an increase in chronic illnesses. Climate change, deregulation of the economy and international conflictslead to added environmental pollution, to fears, worries and an erosion of social solidarity, and also to an increase in the riskof poverty with the familiar detrimental consequences for health. In order for the goal of achieving the best possible health toremain realistic for everyone, we must address those in particular who are most affected by these developments.

Josef ProbstGeneral Director of the Main Association of Austrian Social Security Institutions

The central goal of health promotion – “Health for All” – is more relevant than ever. The fact that we witness a shift in the conditions for living, working and leisure activities within a society as the years pass is also expressly addressed in the OttawaCharter, which states that the organisation of work, working conditions, environments and leisure time should be geared to-wards participation and well-being. In Austria we developed national health targets in 2012 and coordinated them with policyareas. Nine of these ten national health targets are objectives that promote health or address determinants for health. The tenthspecifies the optimisation of medical treatment. We intend to counteract phenomena such as the erosion of solidarity and fragmentation with participation in the national health targets and their content. We advocate a general policy that promoteshealth: in other words, all policy areas must make their own contribution to the promotion of well-being and health, and direct our attention more closely to the social determinants of health.

Vesna Kerstin PetricHead of the Division for Health Promotion and Prevention of Noncommunicable Diseases, Slovenian Ministry of Health

The goal “Health for All” is still as relevant as it was 30 years ago. It is also an essential part of the national strategy for thedevelopment of primary healthcare in Slovenia in the years leading up to 2025. The bigger component of primary healthcareis supplied by 64 community-level health centres which are equipped with teams of physicians and nurses. Health promotionunits within the health centres are responsible for prevention and health promotion, including smoking cessation and slim-ming group counselling. Their services will be expanded significantly by involving community nurses and assuring collabora-tion with social services and schools, for example. By the year 2020 there will be health promotion units with these expandedservices in 25 of the primary healthcare centres, and by 2025 they will be available in all centres. Also, in all 858 primaryhealthcare practices in Slovenia there will be part-time diploma nurses who will provide assistance for patients with chronicdiseases and offer individual preventive services. Such nurses are already employed at 584 primary healthcare practices.

Salome von GreyerzHead of the Health Strategies Division in the Federal Office of Public Health, Switzerland

Yes, in Switzerland this goal is still relevant. It is all the more applicable in view of the demographic developments, the in-creasing influx of people from crisis regions, and also the pressure of globalisation with its economic consequences. In 2013the Swiss government therefore approved the “Health 2020” strategy. A total of 36 measures in all areas of the health system are intended to safeguard the quality of life, strengthen equal opportunities, increase the quality of care and improvetransparency in order to orient the Swiss health system ideally on the coming challenges while at the same time keeping it affordable. It is a matter of avoiding illnesses and the associated suffering through effective prevention, early detection andlong-term care, increasing the competence for health issues in all population groups, avoiding unnecessary treatment andcomplications, but also tapping the full potential of efficiency reserves.

Is the main goal of health promotion still relevant as described in the Ottawa Charter from 1986? We asked four experts from Switzerland, Slovenia and Austria about the strategies that are

suitable for achieving “Health for All” in today’s world.

“Health for All” – utopian dream or real world?


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PEOPLE & POLICIES

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• The prerequisites for healthThe ideas set out in the Ottawa Charter havestood the test of time. The Ottawa Charteridentified five areas of action in the area ofhealth promotion. As with so much of theCharter, these remain relevant today. However,as the world has changed, so the responses tothis changing environment should adapt.

• Build healthy public policyThe Ottawa Charter has contributed greatly tothe identification of obstacles to the adoptionof healthy public policies in non-health sectorsand the ways of removing them, with a muchgreater focus on the upstream, or social, com-mercial and political determinants of health.The public health community must now mapwhat are often hidden influences on policy,coupled with attention to policies in all sectors,from the domestic, such as welfare reform, tothe global, such as climate change and inter-national trade.

• Create supportive environmentsIn many countries, the environments in whichpeople live and work have become less sup-portive of health. In some of these, deindustri-alisation, urban decay, depopulation and pollution have led to severe degradation. Inothers, property speculation and high rentshave priced ordinary people out of the housingmarket. The public health community must engage ac-tively with those responsible for economic andemployment policies and also with the officialsresponsible for urban planning.

• Strengthen community actionDespite great progress, there have been toomany reversals since the Ottawa Charter. Inmany countries, citizens have lost trust in theirgovernments and have disengaged from thepolitical process. The public health community must now advo-cate a process of civic renewal, which supportsthe empowerment of communities rather thanundermining it.

• Develop personal skillsThe Ottawa Charter placed a high priority oninformation, education for health, and enhan-cing life skills. Faced with the explosion of in-formation provided by the Internet, the publichealth community needs to promote health lit-eracy, for people of all ages, as part of an over-all approach to developing healthy life skills.

• Reorient health servicesThose providing personal health services in-creasingly recognise the importance of preven-tion and health promotion, while the increasein multi-morbidity has made a more holisticapproach to the patient essential. The public health community must engagewith those delivering healthcare to ensure thatpreventive measures are given priority andthat the care provided is equitable and effec-tive.

• Public health functionsThe Ottawa Charter identified a set of corehealth promotion functions, which are now updated and renewed in the Vienna Declaration.

• Information: using data to give voice to the weakThe public health community must base its ac-tions on information about what works, and inwhat circumstances. Public health interventionshould thus be evaluated using rigorous re-search methods, and the results disseminated.The public health community must also arguefor safeguards in the use of such data.The public health community must ensure thatadvances in the use of data do not further ex-clude the most vulnerable in society.

• Advocating changeThe public health community has a duty to ad-vocate healthy public policies while recognis-ing that this often requires engagement withother sectors, remaining consistent with theconcept of “Health in All Policies”. The public health community must recognisethat advocacy requires specific skills in order toframe the narrative and communicate it effec-tively, as well as a commitment to rapid action.

• Good governance for the protection of healthThe public health community must promotethe concept of “Health in all Policies” at all lev-els of government. The public health communi-ty has a key role to play in holding govern-ments at all levels to account for their actions.

• Capacity for triggering changeThe public health community can only play aneffective part in improving health if it has suffi-cient numbers of people with the requisiteskills and with access to the relevant data. The public health community must call for asustained and lifelong investment in training. Join us by signing our full Declaration on:

• https://ephconference.eu/vienna-declaration-294

EUPHA and ÖGPH together with many partners at the European Public Health Conference 2016 in Vienna are

reiterating their commitment to the principles of the Ottawa Charter from the year 1986.

The Vienna Declaration - summary


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GUEST ARTICLE

Allan Krasnik in an interview on challenges in the areas of healthcare and health promotion for migrants and refugees.

HEALTHY EUROPEMigration and flight are bringing chal-lenges for the healthcare systems.How well can these challenges bemastered?Allan Krasnik: The conflicts in Syria and neighbouring countries such as Afghanistanand Iraq have forced considerable numbers of people to flee to Europe in recent years. Somecountries where particularly large amounts ofpeople have sought protection, such as Sweden,were initially overwhelmed in some areas bythe volume of asylum seekers. This was dueabove all to problems with coordination between the responsible authorities, though.When this coordination improved it was ultimately possible to take care of the refugees,especially also with regard to healthcare. Andthis is certainly conceivable in the EuropeanMember States. So far, Europe as a whole hastaken in roughly as many refugees owing tothe current conflicts as Lebanon, which is onlysmall country yet is sheltering around one million people.

HEALTHY EUROPEAre there any specific health prob-lems among the refugees – infectiousdiseases, for example?Infectious diseases are not much of a problem.However, many of those who are seeking pro-tection have had to witness the death of closerelatives or friends in wars or civil wars, or aretraumatised by fear and abuse experienced ontheir journeys or by their situation while livingin camps. Particular challenges are thereforefaced in the area of mental health. We mustattempt to recognise and treat psychologicalillness among refugees as early as possible,something which is frequently made more difficult by language and cultural barriers.

HEALTHY EUROPEHow can these barriers be overcome?People who come here from a different coun-try are unfamiliar with the healthcare systemin their new home and are usually withoutrelatives to help them if they are unsure. Thismeans we need to organise our healthcaresystems so that they are easily accessible forrefugees as well, and also in general for themuch larger group of migrants.

HEALTHY EUROPEWhat does that mean, exactly?It begins with larger organisations appointinga coordinator for the health of migrants. Inaddition, we need people who are familiarwith the cultural differences and can act asmediators when conflicts arise. And finallywe require interpreters who are present inperson or are available via video transmissionwhen necessary. In some countries – Den-mark, for example – such translation serviceshave already been established. In principle,we should see cultural diversity not as aproblem, but instead as an opportunity: ifwe learn how to handle it, then we can benefit from our experiences and also putthem to good use in the interests of patients who perhaps have been unable to make themost of the healthcare services for other reasons.

HEALTHY EUROPEShould migrants and specificallyrefugees receive education on healthpromotion?It would be wrong not to do that because it issimply assumed that migrants and especiallyrefugees have different, existential worries. Asthese newcomers have to adapt to a changedsituation in any case, this can also be a goodopportunity to familiarise them with new behaviour patterns that promote health. Thetopic of health should be given more importancefrom a social point of view as well when itcomes to the integration of migrants and inparticular refugees. It is just as important as,for example, the areas of work or education.Health promotion activities can contribute agreat deal to improving social contacts – between the migrants themselves, as well asbetween them and the existing population ineach area.

Cultural diversity is an opportunity

“Health promotion activities can contribute to improving

social contacts.”ALLAN KRASNIK, PRESIDENT OF THE EUPHA SECTION FOR MIGRANT

AND ETHNIC MINORITY HEALTH

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Allan Krasnik, (70), is Professor of Public Health and Health Services Research at the University of Copen-hagen and President of the EUPHA Section on Migrant and Ethnic MinorityHealth.

PROFILE


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KNOWLEDGE

In recent decades, health promo-tion in Europe as described in theOttawa Charter has made consid-

erable progress. Today there are relevant institutions in every country,and both scientists and politicianshave generally recognised the sig-nificance of health promotion”, saysNatasha Azzopardi Muscat, medicalpublic health expert from Malta andthe new President of the EuropeanPublic Health Association. She pointsout that there have been repeatedsetbacks, however, and specificallythe economic crisis in 2008 resultedin spending cuts that affected healthpromotion and prevention in somecountries during subsequent years.She emphasises: “There should be clearer political commitment at aEuropean and national level to thetargeted implementation of healthpromotion and prevention.”

Caroline Costongs, Managing Directorof EuroHealthNet, the Brussels-basedEuropean network of health promo-tion organisations and institutions,also calls for recognised methods forhealth promotion to be applied morefrequently within and beyond healthsystems. “In the past two years thecurrent European Commission hasnot developed any new health strate-gies,” criticises Caroline Costongs.And so she hopes that the EU initia-tive on a potential “European Pillarfor Social Rights” will give rise tonew opportunities for incorporatinghealth promotion and strengtheningthe social determinants of health at

a European level. She urges: “Theremust also be increased investmentin training, capacity building andthe development of organisations inthe public health sector,” and addsthat health promotion and publichealth experts should also step uptheir efforts on forming effective alliances with institutions and actorsin other areas.

Pioneers for better healthSome countries – according to theexperts interviewed by “Healthy Europe” – are already forerunnersin the area of health promotion andpublic health. These include, for example, Norway, Sweden, Finlandand Denmark, also England and the Netherlands, as well as currently

Slovenia and the Baltic States, specifically Latvia.

Austria is regarded around theworld as a model for the “Health inall Policies” concept. Many differentdepartments worked together to de-velop the ten national health targetsapproved in 2012 which aim to helpensure that the Austrians spend anaverage of two additional years ingood health by the year 2032. Irelandwas not only the first country in Eu-rope to ban smoking in public places,but also introduced a programmeentitled “Healthy Ireland” for theperiod between 2013 and 2025 whichaspires to achieve a greater sense ofwell-being in its population, and alsorelies on both cooperation between

For a healthier EuropeEven though health promotion is an important political topic in all

countries of the World Health Organization’s (WHO) European Region, there is still a lack of practical implementation. Text: Dietmar Schobel

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KNOWLEDGE

several ministries and maximum par-ticipation by all groups in society. InWales, the Well-being of Future Gen-erations Act was passed in 2015. Itobligates various public institutionsto work together in pursuit of sevengoals, for example to improve thefeeling of togetherness within com-munities, to reduce inequalities andto improve the health of its citizens.

More political courage is neededIn Germany, a Prevention Act waspassed last year which more thandoubles health promotion and prevention services from the healthinsurance funds, and increases theirexpenditure to around 500 millioneuros. “It is an improvement, butmore important than the question ofmoney is the issue of looking for solutions at a national level in areassuch as nutrition or alcohol consump-tion, in a similar way to the successthat has been witnessed with smok-ing as a result of relevant laws andtaxes. There is currently a deficit inthe political courage needed for this,”comments Reinhard Busse, Professorof Health Care Management at theTechnical University of Berlin.

Christiane Stock is Professor of HealthPromotion at Syddansk Universitetin Esbjerg, Denmark, and Presidentof the EUPHA Section on Health

Promotion, which has around 2,000members. A survey of these memberswas conducted recently which focussed on existing achievementsin the five priority areas of the Ot-tawa Charter for Health Promotion.Christiane Stock sums up two interesting results: “The strategy ofdeveloping personal skills is pursuedin almost every country. But on theother hand, the attempt to achievehealthier public services has gained theleast success so far.” In addition, thesurvey revealed that northern/west-ern Europe is more successful thansouthern/eastern Europe when itcomes to creating supportive environ-ments and strengthening communities.A healthy public policy, on the otherhand, is a topic that is found in allregions to the same extent, albeit ata relatively moderate level.

Perspectives for the futureHow should health promotion in Europe develop in the future?“Owing to the growing proportionof elderly people in European coun-tries, strategies and concepts for thissection of population are going toplay an increasing role,” explainsChristiane Stock. And the new EUPHA President Natasha Azzopar-di Muscat points out that an attemptmust also be made in the healthpromotion and public health sector

to find answers to the new challengesposed by the globalised economyand digital communication. She emphasises: “We must create morepolitical pressure for our concerns.This requires simple and understand-able language used in a manner thatcan be understood by everyone.”

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BENEFITS FOR THE ENVIRONMENT

AND HEALTH

In January the project entitled INHERITwas launched. It will continue until December 2019 and is headed by CarolineCostongs, Managing Director of Euro-HealthNet, the Brussels-based Europeannetwork of health promotion organisa-tions and institutions. INHERIT has beenawarded around six million euros andinvolves 18 partner organisations fromall over Europe in the areas of health,environment, equity, economics and technology. The project aims to examinehow patterns for our lives, exercise andconsumption have an effect on healthand the environment. The goal is to findout how we can change our lifestylesand at the same time enable health andthe environment to benefit as well. Furtherinformation can be found online atwww.inherit.eu

Natasha Azzopardi Muscat:“We must create more politicalpressure for our concerns.”

Caroline Costongs: “In the past two years the current European Commissionhas not developed any new health strategies.”

Reinhard Busse:“Solutions at a national levelare necessary. There is currentlya deficit in the political courageneeded for this.”

Christiane Stock:“Strategies and concepts forelderly people are going to play an increasing role.”


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KNOWLEDGE

28years. This, according to aWorld Health Organizationreport, is the difference in

life expectancy between newborn ba-by boys in two districts of Glasgow,just a few kilometres away from oneanother. While Calton is riven withpoverty and unemployment, upmar-ket commuter suburb Lenzie is teem-ing with well-heeled residents. Thehealth differences between differentpopulation groups are not as extremeelsewhere, but they do exist withinall European regions and countries.“Health differences owing to socialfactors are unfair and avoidable. Theyrelate to many factors, including income, wealth, ethnicity, legal status,and education,” says Martin McKee,Professor for European Public Healthat the London School of Hygiene &

Tropical Medicine and formerly President of the European PublicHealth Association (EUPHA).

To take just one more example, thedifference in life expectancy betweenmen in Germany with very low in-comes and those with very high in-comes is eleven years – and eight yearsbetween their female counterparts.The groups with relatively poor healthinclude financially and educationallydisadvantaged people, including mi-grants, single mothers, elderly womenliving on their own, and unemployedpeople. According to a press releasefor the EU programme “Equity Ac-tion”, the fact that socially disadvan-taged people are more frequently illand tend to die earlier costs EU coun-tries an estimated €1.3 trillion everyyear. This is more than the entire an-nual gross national product in almostall individual EU countries – with the

exception of Germany, France, Italyand the UK, the last still an EU mem-ber at the time of writing.

The gap has widened furtherHowever, in recent years and espe-cially since the economic crisis of 2008,the social gap between rich and poorhas widened further throughout Eu-rope. In many countries, there hasbeen an increase in the proportion ofpeople who are “manifestly poor”and who cannot afford everyday ne-cessities such as new clothing, chil-dren’s school supplies or adequatehome heating in the winter. Healthdifferences owing to social factorshave also increased. Meri Koivusalo,Senior Researcher at the National In-stitute for Health and Welfare in Fin-land, explains: “Seen overall, life ex-pectancy has increased on average inrecent years along with the numberof years that we can expect to spend

Health inequality on the rise in EuropeTell me where you live and I will tell you when you will die:

Social inequality based on income, education and place of residence manifests itself in serious health differences. Text: Dietmar Schobel

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DIFFERENCES IN HEALTHBETWEEN COUNTRIES

The difference in life expectancy at birthbetween the 53 countries of the WorldHealth Organization’s European Region –which stretches from Iceland in the northto Israel in the south and from Russia inthe east to Portugal in the west – is twelveyears for women and seventeen for men.This is shown by the report on health in-equality in Europe published by the WHOin 2013. Women had the highest life ex-pectancy in Spain with 85 years comparedwith 73 years in Kyrgyzstan. Similarly, menin Israel had a life expectancy of 80 yearsat birth compared with just 63 in Russia.


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in good health. However, while thischange has been quicker to take effectin socio-economically privilegedgroups, it has often been sloweramong less socio-economically privileged groups. Furthermore, forexample in Finland, life expectancyhas stagnated for the lowest incomegroup. This means that health inequal-ity associated with social factors is onthe rise.”To counter health inequality, it is firstnecessary to gather the required datacarefully in order to identify especiallydisadvantaged groups. However,opinion is often divided as regardsthe right strategy for doing so. Whilesome experts feel that the focus shouldbe primarily or exclusively on the disadvantaged groups, others are infavour of undertaking measures atpopulation level. “A mixture of theseis likely to be best – in other wordsprogrammes and projects for the population of a country as a wholetogether with additional interventionsgeared specifically towards the ten ortwenty per cent of people who areparticularly disadvantaged from ahealth perspective,” says AngelaDonkin, Deputy Director at the Institute of Health Equity, UniversityCollege London. Practical experiencehas also shown that, in many cases,these “vulnerable groups” are partic-ularly difficult to reach. Because ofthis, suitable financial funding needsto be made available.

Measures at three levels“Structurally speaking, interventionsat a number of different levels areimportant for reducing health inequality,” affirms Gudrun Brauneg-ger-Kallinger, who is a health adviserfor Austrian health fund FondsGesundes Österreich. At macro level,this could be in keeping with the“Health in all Policies” concept, forinstance measures for improving educational opportunities for children from educationally disad-vantaged households, or political interventions aiming to improve access to the labour market for vulnerable groups. At meso level,this might involve restructuring en-tire settings or environments – suchas companies or schools – to makethem more conducive to healthy liv-ing. At micro level, it is ultimately aquestion of how best to involve in-dividual people. As GudrunBraunegger-Kallinger emphasises:“The aim is ultimately to enable allpeople – and socially disadvantagedpeople in particular – to make useof their health potential as well.”

From a social perspective, studiesconducted by British researchersMargaret Whitehead and RichardWilkinson indicate that, on average,people tend to be healthier in thosestates in which the differences be-tween rich and poor are relativelysmall. As Martin McKee points out:

“This means that a policy of redis-tribution can ensure better health forall. At the same time, we should notdestroy incentives for entrepreneur-ship. What matters is that policiesare fair.”

A HEALTHY LIFE IN A FAIR SOCIETY

What is most important when it comesto making a society fairer and, in turn,healthier as well? This question was explored by the Marmot Review, a com-mission chaired by British epidemiologistand public health expert Michael Marmotfor the UK Secretary of State for Health.In a report published in 2010, the followingsix measures were recommended:

• Give every child the best start in life

• Enable all children, young peopleand adults to maximise theircapabilities and have control overtheir lives

• Create fair employment andgood work for all

• Ensure a healthy standard ofliving for all

• Create and develop healthy andsustainable places andcommunities

• Strengthen the role and impactof ill-health prevention.

Source: Fair Society, Healthy Lives – The Marmot Review,England 2010, download at: www.ucl.ac.uk/marmotreview

Martin McKee: “Health differences are unfair and avoidable.”

Meri Koivusalo:“Health inequality associated with social factors is on the rise.”

Angela Donkin:“A mixture of measures is likely to be best.”

Gudrun Braunegger-Kallinger:“The aim is to enable all people to make use of their health potential as well.”


KNOWLEDGE

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Here in Europe, we need a goodrange of professional educationand training courses on public

health and we also need healthcaresystems in which this area is of corre-sponding importance,” says JacquelineMüller-Nordhorn, Professor of PublicHealth at the Berlin School of PublicHealth and President of the Associationof Schools of Public Health in the European Region (ASPHER). Foundedback in 1966, this association hasworked to improve the quality of pub-lic health training in European coun-tries by international cooperation andknowledge exchange (see box: “50years of ASPHER”). This is also important given that the growing proportion of patients with chronic illnesses and rising cost pressure bothconstitute major challenges for Euro-pean healthcare systems. Public healthexperts can help to overcome this problem by contributing their in-depthknowledge about how to improvehealth at total population level.As early as 2011, ASPHER publishedan article outlining the core compe-tences with which public health expertsshould be equipped in order to meetthis challenge. These include problem-

oriented and in-depth knowledge ofepidemiology and demography, aswell as of statistics, sociology, socialpsychology, anthropology and health-care research. Jacqueline Müller-Nord-horn: “Above all, it is a matter of know-ing which illnesses are frequent andwhich measures are most suitable forpreventing them effectively.”

Professional education and trainingProfessional education and training isavailable in almost all countries in theWorld Health Organization’s EuropeanRegion. Some of these are still gearedmainly towards medicine, hygiene andhealthcare research, while others arein the “new public health” vein, leaningmore towards social medicine and thesocial sciences. A formal distinctionmust be made between the kind oftraining that focusses solely on publichealth and the kind in which it is justone of several important components.At universities and other higher-levelinstitutions, public health is taught atpostgraduate level as well as founda-tion courses and master’s degrees.However, public health is also a factorwith regard to training nurses and carers, for instance.

There are major challenges in store for healthcare systems. High-quality public health training provides the knowledge needed to overcome these challenges at population level.

Putting in-depth knowledge into practice

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50 YEARS OF ASPHER

The Association of Schools of PublicHealth in the European Region (ASPHER)was founded in 1966 on the initiativeof the World Health Organization(WHO). Today, 112 training institutionsfrom 43 European countries are fullmembers of the association, with a further 14 associated members fromcountries outside Europe. ASPHER worksto help develop high-level study programmes for public health – frombachelor to doctorate level – and topromote ongoing professional trainingas well. It also founded the Agency forPublic Health Education Accreditationtogether with the European PublicHealth Association, EuroHealthNet, theEuropean Public Health Alliance andthe European Health Management Association. This organisation aims tosafeguard the quality of public healthtraining at European level. Among otherthings, a list of criteria was drawn upfor this purpose, together with a self-evaluation manual. Further informationon public health training in Europe canbe found online at www.aspher.organd www.aphea.net


INTERVIEW: HEALTH PROFESSIONS NEED TO FIND A NEW ORIENTATION

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In an interview with ThomasPlochg, he explains why he feelsthat healthcare systems are fragmented and health professionsoverspecialised and in need of anew orientation.

HEALTHY EUROPEDirector Plochg, you are calling fora completely new orientation forhealth professions. Why is this?Thomas Plochg: For health professions,training and practice are still almost ex-clusively geared towards acute individualillnesses – which have been and are stillbeing treated with greater and greatersuccess. However, these have dwindledin recent years, while there has been anincrease in chronic conditions – from diabetes and cardiovascular diseases tochronic obstructive pulmonary diseaseand depression. In most OECD countries,chronic illnesses currently account forfour-fifths of the overall disease burden,with around half of these patients classi-fied as “multi-morbid”, i.e. sufferingfrom more than one chronic illness atthe same time. Because of this, we willneed more physicians and nurses withinterdisciplinary knowledge who are wellversed in treating patients with severalillnesses.

HEALTHY EUROPEWhich role should prevention playin this regard?Prevention and health promotion needto take a central role in both trainingand practice. These should no longer bethe responsibility of specialised profes-sions or institutes but should becomesecond nature to everyone in the healthsector.

HEALTHY EUROPEWhat impact do you expect thisconcept to have on healthcare sys-tems?These days, healthcare systems are in-creasingly fragmented and overspe-cialised. The growing cost pressure onhealthcare systems means that fewerand fewer specialist personnel are expected to do more and more and todo it better and better. In many cases,this in turn prompts decision-makers tointroduce a constant stream of controlmechanisms that are supposed to increase efficiency – and which oftenmean more administrative work forhealthcare professionals. Changing theorientation of health professions shouldtherefore also lead to more sustainableand future-oriented healthcare systems.

HEALTHY EUROPEHow should this be implemented?The first move should be made by politi-cal representatives and the remainingsteps regulated from within the ranks ofthe healthcare professionals themselves.

Public health is of particular impor-tance for physicians. Anita Rieder, ViceRector for Education and Head of theCentre for Public Health at the MedicalUniversity of Vienna, explains: “At theMedical University of Vienna, for example, there is a six-year trainingcourse for public health physicians,organised on similar lines as in Switzer-land and Germany. We feel that it isalso very important for public healthknow-how to be covered in trainingfor all of our students. This encouragessystemic thinking, in terms of the parameters that need to be created inorder to improve the health of the population as a whole.”

How is this knowledge put into practice?A key question is how public healthknowledge can be put into practice.Anita Rieder: “It should start with decision-makers knowing which interventions are cost-effective and ob-tain results, regardless of whether theyinvolve healthy food for schoolchildren,promoting exercise for senior citizensor measures for better emotional health,to name just a few.” People who are incharge of implementing measures forimproved health also require in-depthknow-how ranging from problem

definition to planning and ultimatelyevaluating projects and programmes.Doctors, nurses, carers and therapistsfrom various professions can pass ontheir prevention and health promotionexpertise directly to patients. Anita

Rieder: “At population level and froma future public health perspective, weneed to tackle the challenges arisingfrom the fact that the proportion of older people and of people with a mi-gration background are both growing.”

Thomas Plochg (43) is Director of the Netherlands Public Health Federation and Assistant Professor for Public Health at Amsterdam University.

Jacqueline Müller-Nordhorn:“Above all, it is a matter of knowingwhich measures are most suitable forprevention.”

Anita Rieder: “Decision-makersshould know which interventions are cost-effective.”


KNOWLEDGE

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We are constantly exposed towhat is termed ‘built envi-ronment’, i.e. the way in

which space is planned and buildingsare erected. This affects our well-beingto a great degree, and our emotionalhealth in particular. Simply put: weare what we build,” explains JuttaLindert, Professor of Public Health atthe University of Applied Sciences inEmden, Germany, and President ofthe EUPHA Section on Public MentalHealth. This is readily confirmed byStefano Capolongo – architect, publichealth expert and professor at the

Politecnico di Milano: “Built environ-ment is of central importance for bothprotecting and promoting health. Theterm refers to both urban agglomera-tions of buildings and infrastructureand to rural and natural spaces thatare connected with one anotherthrough transport routes.”

Learning from mistakesA 240-page report published by theWorld Health Organization (WHO)earlier this year deals in particularwith health in urban areas and statesthat for the first time in human history,

“Built environment” has a major influence on our health. Because of this, cooperative efforts involving planners, architects and

public health experts can be expected to yield positive effects.

more people are living in urban thanin rural areas. According to UnitedNations statistics, this figure is evenhigher than 70 per cent in Europe.During the age of industrialisationand in many cases afterwards, urbangrowth was often unplanned andtook its toll on the health of the population.

“However, we can learn from the mis-takes of the past,” says Arpana Verma,Head of the Manchester Urban Col-laboration on Health and Presidentof the EUPHA Section on Urban

We are what we build

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Health. “Countries with low andmedium average incomes in particu-lar will be able to benefit in futurefrom the way their urban spaces aredesigned.” Arpana Verma, publichealth lecturer at The University ofManchester, was also at the helm ofthe European Urban Health IndicatorsSystem, an international project supported by the European Union(see also box: “Measuring the healthof people in urban areas”).

What we knowIn 2013, a symposium in Barcelona ti-tled “Green Cities, Healthy People”examined the factors to be taken intoaccount when designing urban areasto be conducive to good health. According to the report on this specialist event, there is in-depthknowledge that indicates that havingmore green areas improves health ingeneral and emotional health in particular. For instance, there is evidence that this reduces the risk ofobesity, cardiovascular conditions andrespiratory diseases. Among otherthings, these positive effects can beattributed to the fact that having moregreen areas helps people to relax aswell as facilitating social contact andphysical exercise.

However, this subject has not beeninvestigated in any great depth so far.

For example, relatively little is knownat this stage about how individualpopulation groups use green areasand about the needs that they havein this regard. Jutta Lindert: “In anycase, it is safe to assume that it is generally more important for childrenand older people to have green areasand expanses of water within easyreach than it is for mobile adults intheir middle years.” Similarly, littleresearch has been conducted to dateon the correlations between traffic infrastructure and health, and abouthow the aesthetic quality of a builtenvironment affects people’s health.Finally, the focus of public health research should not be geared solelytowards urban areas, but also on whatis necessary in rural areas in order tocreate places for people to meet wherethey feel comfortable.

Champions for better healthIn practice, according to Arpana Verma, interdisciplinary cooperationis the key to designing increasinglyhealthy spaces: “This means that public health experts must sit downtogether with decision-makers, urbanplanners and architects and – as‘champions for better health’ – pooltheir know-how when structural decisions are on the agenda for citiesand municipalities.” For instance, itis very important to ensure that people

can walk or cycle to school or worksafely and to increase the quality ofliving in socially disadvantaged districts in order to help create increased health equity. Jutta Lindertconcludes by making reference to theresponsibility towards future gener-ations: “The spaces that we are building today will still exist indecades to come. This means that wehave to design them in a way thatwill enable as many people as possibleto feel comfortable there.”

MEASURING THE HEALTH OF PEOPLE IN

URBAN AREAS

In Phase 1 of the European UrbanHealth Indicators System (URHIS) – aproject in which over 30 European coun-tries participated – a system of 45 in-dicators for health in urban areas wasdeveloped beginning in 2006. In Phase2, the data for the indicators in variousEuropean cities were collected andanalysed between 2009 and 2012.Health profiles were also created for26 of the participating cities – fromAmsterdam (Netherlands), Kosice (Slo-vakia) and Montpellier (France) to Trom-sø (Norway). From 2014, URHIS wasalso implemented in China in a coop-eration with Fudan University in Shang-hai. Further information can be foundat www.urhis.eu.

^

THE WHO HEALTHY CITIESNETWORK

Improving health in urban areas hasbeen a key issue since as far back as1986. Shortly after the World HealthOrganization’s Ottawa Charter forHealth Promotion came into force,“Healthy Cities” was the first concreteinitiative that it launched. Since then,thousands of cities and municipalitieshave become involved – from Isle-aux-Grues in Canada with 160 inhabitantsto Shanghai, which is home to over 20million people.

Jutta Lindert:“The way in which space isplanned and buildings are erected affects our well-being to a great degree.”

Stefano Capolongo:“Built environment is of central importance for both protecting and promoting health.”

Arpana Verma: “We can learn from the mistakes of the past.”


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KNOWLEDGE

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Everybody agrees that journal impact factors are a poor indicatorof quality. But a high impact factor

is nevertheless something everyone inthe scientific community strives toachieve: scientific journals wish to attaina high impact factor, researchers wishto publish in journals with a high impactfactor, and impact factors are used inallocation of resources to universitiesand research departments. Clearly, ahigh impact factor for a scientific journalmeans that many articles are read andcited by other scholars. But this doesnot provide any information on citationfrequencies for individual articles, andit says even less about the impact of ajournal or individual article outside thescientific world.The European Journal of Public Health(EJPH), of which I am Editor-in-Chief,belongs to a category of journals withoutvery high impact factors. But what aboutour societal impact? We only have anecdotal evidence that some articlesare used by the authors themselves oron demand for policymaking, in publichealth practice, or in teaching. Sometimes our articles are cited in standard media and perhaps more oftenin social media. This area is gaining im-portance, and publishers, scholars, uni-versities and research institutes shouldalso award it greater significance. Alt-metrics provides a method that is used

to measure the impact of scientific workoutside the scientific community. It tapsinto the naming of articles on Facebook,Twitter and other social media.The number of times that papers aredownloaded also shows the importanceof scientific work in practice. We thereforeregularly check the downloading frequency for papers published in theEJPH. This has increased continuallyover recent years, specifically for the topics of mental health, socio-economicstatus, obesity and smoking.

Who pays for open access?In order for scientific knowledge to bedisseminated widely, open access to scientific publications is increasingly becoming mandatory for researchersfunded by public agencies. It is easy toagree on a policy for open access to research findings, but there is still anissue of who pays for it. We are in aprocess of cost shifting for scientific publications from subscribers (libraries,institutions) to authors (mainly researchfunders). While publishers are being accused of “double dipping”, earningmoney from subscribers as well as authors, both tax-paid money, authorsare often in a limbo with a requirementto publish on open access, but withoutbeing given the resources to pay the gen-erally high fees for open access publish-ing. Policy documents at European and

national level tend to promote a move-ment towards purely author-paid openaccess journals, and discard hybrid jour-nals. What these policies forget is therole of scientific societies. Many scientificjournals are owned, wholly or in part,by scientific societies, usually in collab-oration with a professional publisher.

Not only scientific articlesNow what does this have to do with impact? A scientific society is interestedin more than just publishing scientificarticles. Journals are used as a member-ship forum, and as a way to disseminateother types of information to a widerreadership. Hybrid journals can incor-porate editorials, news from the scientificsociety, as well as other news related tothe journal’s field of interest, sectionswith debates, letters and comments. Weknow that many of our editorials andpolicy documents are used by authorsand stakeholders in their contacts withthe media and policymakers – and thesetexts and articles in particular thereforehave a considerable “societal impact”. The debate on how scientific publishingcan be “open” and who pays for it willcontinue. But we must pay more atten-tion to dissemination and use of knowl-edge outside the scientific community.Scientists and publishers must aim forimpact with their knowledge, not onlyimpact factors.

Scientists and publishers must aim for societal impact with their knowledge, not only impact factors within the scientific community, writes

Peter Allebeck in his guest article.

Impact factoror impact?

Peter Allebeck is Professor of Social Medicine at the Karolinska Institutet, Sweden, and Editor-in-Chief of the European Journal of Public Health.

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KNOWLEDGE

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The tenth EPH Conference will take place in Stockholm’s exhibition centre.

also currently increasing: from yoga institutesto private clinics. This will be considered under the following sub-theme: “From publicto private, from collective to individual: Howcan public health systems adapt to a changing world?”

• The fourth sub-topic examines howhealth systems respond to pressure owing toan ageing population and migration yet stillretain solidarity and human rights.

• Finally, lectures, workshops and discus-

sions on the interaction of planetary bound-aries and health will also be awarded suffi-cient scope at the conference in Stockholm.

Networks and personal contacts“Naturally, the tenth EPH Conference will alsoprovide good opportunities for the public healthexperts from Europe and all over the world tonetwork and establish personal contacts, aswell as a possibility to take a close-up look atthe Swedish welfare system”, emphasises Conference Chair Birger Forsberg. And so he iscertain: “Everybody will be in Stockholm.”

The end of one conference marks the beginning of another: the tenth European Public Health Conference will take place in early November 2017

in Sweden’s capital city, Stockholm.

Everybody will be in Stockholm

T he tenth European Public Health (EPH)Conference will be held on 1-4 Novem-ber 2017 in Stockholm. The central

theme is: “Sustaining resilient and healthycommunities”. What were the reasons forchoosing this motto? “Europe and the wholeworld are currently facing major social, economic and cultural challenges,” explainsBirger Forsberg, Head of the Unit for HealthDevelopment at Stockholm County Council,Associate Professor in Global Health at theKarolinska Institutet and Chair of the 10th Eu-ropean Public Health Conference. He adds:“Local authorities and companies thereforeneed resilience, in other words the ability todeal with stress while remaining able to continue with development, in order to achievethe best possible health for all.” The word“sustaining” also indicates the strong influenceof environmental factors and establishes a con-nection between the 17 Sustainable Develop-ment Goals specified by the 193 United NationsMember States in September 2015.

Sharing our common wealthThe following five sub-themes have alreadybeen defined for the tenth EPH Conference:

• With the title “Sharing our commonwealth”, there will be deliberations on howwelfare policy can manage to maintain a balance between endeavours in the interestsof efficiency and those espousing fairnessand justness.

• “Public health in a globalised world” isanother sub-theme. In this framework, discussions will concentrate on how Europewith its large number of highly differentcountries can meet the requirement of guarding against non-communicable diseasesand preventing their increase.

• In many countries the significance of private organisations with a health focus is

“The tenth EPH Conference will also provide good opportunities for taking a close-up look at the

Swedish welfare system.”BIRGER FORSBERG IS CHAIR OF THE 10TH EUROPEAN PUBLIC HEALTH

CONFERENCE IN NOVEMBER 2017 IN STOCKHOLM.


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