Public HealthPublic health in Europe
Section snippets
Diversity and inequality
Within WHO's definition of Europe, there is enormous diversity in the basic determinants of health (table 1), contributing in part to major health inequalities between countries (table 2).5
Whereas the inequalities are apparent at the level of global indicators—such as life expectancy—for individual causes of death the contrasts are even more stark. Deaths from injuries among children are almost five times as common in the countries of the former Soviet Union than in those of the European Union.6
Tuberculous—an exemplar of the challenges
Deaths from tuberculosis in Russia have risen to the level they were 20 years ago. The reasons for this reversal illustrate many of the challenges facing the public-health community in the former Soviet Union. Although the rise in tuberculosis is intimately linked with conditions in the Russian prison system, the increase is a result of failures in a range of areas.10 The prison population has increased dramatically, to levels approaching those in the USA. This rise indicates not only
Diversity in the public-health response
Public-health responses vary enormously. The organisation of public-health activities, such as what is regarded as public health or not, and whether it is based on a predominantly medical or multidisciplinary notion or a unisectoral or intersectoral model, shows the complex mixture of cultural norms. The strong sense of individual responsibility for health in Denmark contrasts with a much greater acceptance of a role for the state in Sweden. Abuses by the prewar German public-health system14
Identification of threats to health
Emerging threats to health can be acute or cumulative. The former is typified by the outbreak of communicable or foodborne disease; the second by rising cases of certain chronic diseases. The nature of outbreaks in Europe is changing, bringing new challenges for those responsible for surveillance. Infectious agents do not respect borders and the growth in international travel and trade provides many more opportunities for spread of disease. In western Europe this threat has led to the
Design of effective interventions
Although many policies that relate to public health still bear little relation to evidence,32 there is a growing recognition throughout Europe that policies need to change, although we accept that such policies will, inevitably, incorporate prevailing values and political decisions and should take account of the local context. The International Cochrane Collaboration,33 in which many public-health professionals have been actively involved, has been an important driving force in this process.
Implementation of policies
Within the European public-health community there is a widespread recognition of the importance of intersectoral action. There is now extensive research from WHO's healthy cities39 and healthy regions movements, showing what can be achieved by building effective inter-sectoral partnerships.
There is also a growing amount of research on this model of working40, 41, 42 that has identified critical success factors. These factors are feeding into the increasing number of integrated national-health
Tensions
In many countries in Europe there are certain unresolved tensions within public health. One is the link between practice and academe. A second emerges from the competing roles of the public-health professional as a corporate manager or an advocate.
Close links between practice and academe can bring many mutual benefits. Practitioners can contribute to setting the research agenda and researchers can ensure that their findings are translated into practice. In practice, these links are weak in many
Tackling inequalities in health
Health inequalities exist in every country in which they have been assessed but action to tackle them has, with a few exceptions, been conspicuous by its absence. WHO has made strenuous efforts to define the extent of inequalities,57 but action has to be left to individual countries and governments. There are few examples of targeted policies nationally,58 one being the Dutch govern-ment's research programme on health inequality.59
The UK has attracted attention because of its long and
Conclusions
The full range of issues facing public health in Europe are impossible to do justice to. However, some key points emerge. The first is the huge diversity and inequality involved. Despite moves to greater European political integration, patterns of health—and responses to them—remain largely the products of national factors. There are, however, a growing number of initiatives at a European level that are helping public-health professionals to learn from each other and to develop common
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Cited by (42)
Causes of death among children aged 5–14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016
2018, The Lancet Child and Adolescent HealthCitation Excerpt :Increasing attention is being paid to older children,5–8 but no studies thus far have provided a comprehensive assessment of the mortality burden in the 5–14 years age group in the European Region. Substantial diversity exists between countries in the WHO European Region in terms of socioeconomic and political conditions and health risks.2,9 For example, the highest country-specific under-5 mortality rates are 25 times higher than the lowest rates.2
Usury, our history and the second post-war
2012, Cirugia CardiovascularDeath toll exceeded 70,000 in Europe during the summer of 2003
2008, Comptes Rendus - BiologiesCitation Excerpt :Our observations showed that during the summer of 2003, a series of minor mortality crises throughout Europe, occurring almost unnoticed, led to a significant cumulative number of victims in comparison to the huge number of victims due to the August heat wave. Global warming may constitute a new threat to health in an aged Europe [8,24] that may be difficult to monitor at the level of a country or of a major city only. Centralising the count of daily deaths on a sufficiently large scale, like grouping neighbouring regions across the border and countries with small populations, should improve detecting early excess mortality due to various causes.
Public health in eight European countries: an international comparison of terminology
2008, Public HealthCitation Excerpt :However, a consensus on either the organization of public health or public health terminology is non-existent. Public health in Europe is characterized by the diversity of concepts, systems and terminology.4 In some countries, the Anglo-Saxon term ‘public health’ with its underlying concept has been gaining pre-eminence over the variety of country-specific terms since the early 1990s.
Reducing inequalities from injuries in Europe
2006, LancetCitation Excerpt :The 52 countries in the WHO European Region are diverse, not only in language and culture but also in the indices of social and economic development that affect the causes and determinants of injuries.15