The future of public health practice in Europe

The European Public Health Association (EUPHA) identifies research, training, policy and practice as the four pillars for all its work. At a conference organised by the Association of School of Public Health in the European Region (ASPHER) in May 2016, an interesting session setting out a vision for these four areas for the coming years was organised. Josep Figueras and John Middelton outlined the challenges facing training and policy respectively in this session. They invited us to think outside the box and in a sense to reinvent public health in the 21st century. In this contribution, I focus on public health practice. Public health practitioners, who constitute an important part of EUPHA’s membership, are persons who typically work at the front line to translate research and policy into meaningful initiatives at local level.peer-reviewe

Malta, the European Union and the medical profession: I - EU accession ­- new frontiers for the Maltese Medical Profession

The Nationalist Party has, for the last thirty years, strongly believed that Malta's future is that of a full member of the European Union. This decision is rooted in political and economic considerations. In this paper I will discuss why the medical profession should consider Malta's accession to the EU positively. I will also provide information that should dispel some of the common myths that doctors may have heard in circulation. had never been taken up in earnest by successive governments. The EU accession process has acted as a catalyst for reform and provided an opportunity to set the ball rolling. The reforms that are being instituted have been discussed and decided upon with the medical profession. Indeed, irrespective of the outcome of the referendum, a new order has been set. We should recognise the opportunities that the accession process has provided in this regard.peer-reviewe

The European added value of health system cooperation to ensure access to innovative medicines and technologies

Between January and June 2017, Malta held the Presidency of the Council of the European Union (EU). One of its thematic priorities was Structured Cooperation between health systems. Evidence for strengthened cooperation in the areas of procurement of health technologies and delivery of highly specialised services was presented and discussed in a series of meetings. Council Conclusions were elaborated and an ambitious cooperation declaration between Southern European countries in the area of access to innovative medicines was signed. This article describes the rationale for these linked activities as a means to support European health systems in addressing critical challenges that cannot be tackled by Member States acting alone. These cooperation initiatives are important in the light of the evolving debate on the Future of Europe and the role that health policy should play in the European Union post 2020. Malta, as a small Member State with an open market, is often exposed earlier and more harshly to the impacts of market and environmental changes on its health system. It can therefore play an important role in scanning the horizon for potential impacts and proposing appropriate policy responses at European level.peer-reviewe

How will personalised medicine change public health practice?

Personalised medicine is challenging core elements of public health practice to bring about a paradigm shift. Traditional public health activities such as prevention, screening programmes, infectious diseases control, financing and planning of health systems will all be affected by developments in genomics. There is a need to move away from the traditional high-risk versus population approach debate and to engage with concepts of population stratification and public health genomics. Public health through its activities of surveillance, needs assessment, education and policy advocacy has a critical role to play in shaping the entry of personalised medicine into health systems.peer-reviewe

In European public health we trust?

It is now 3 months since the British people voted narrowly to leave the European Union (EU). The absence of any agreement on what the alternative is, or a coherent plan to achieve it means that this may not actually happen. However, the resulting uncertainty creates major challenges, not only for the UK, which has suffered immediate economic damage, but also for the rest of Europe.peer-reviewe

The evolution of life expectancy in Malta over half a decade

An overview of life expectancy in Malta over the past sixty years shows a remarkable increase for both men and women. However, gains in life expectancy were not constant throughout the period. The rate of increase as well as the attributable causes of the noted increase varied over the years. Disparities in life expectancy by gender and by level of education exist. Life expectancy in Malta has caught up with Western Europe over the past 30 years and now compares well with the average for the EU-15. (The EU-15 consists of the 15 EU member states who became members in the European Union before 2004 and on average have the best life expectancies in the EU).peer-reviewe

Europeanisation of health systems : a qualitative study of domestic actors in a small state

Background: Health systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. Yet, recent developments including the patients’ rights and cross-border directive (2011/24 EU), as well as measures taken following the financial crisis, appear to be increasing the EU’s influence on health systems. The aim of this study is to explore how health system Europeanisation is perceived by domestic stakeholders within a small state. Methods: A qualitative study was conducted in the Maltese health system using 33 semi-structured interviews. Inductive analysis was carried out with codes and themes being generated from the data. Results: EU membership brought significant public health reforms, transformation in the regulation of medicines and development of specialised training for doctors. Health services financing and delivery were primarily unaffected. Stakeholders positively perceived improvements to the policy-making process, networking opportunities and capacity building as important benefits. However, the administrative burden and the EU’s tendency to adopt a ‘one size fits all’ approach posed considerable challenges. The lack of power and visibility for health policy at the EU level is a major disappointment. A strong desire exists for the EU to exercise a more effective role in ensuring access to affordable medicines and preventing non-communicable diseases. However, the EU’s interference with core health system values is strongly resisted. Conclusions: Overall domestic stakeholders have a positive outlook regarding their health system Europeanisation experience. Whilst welcoming further policy developments at the EU level, they believe that improved consideration must be given to the specificities of small health systems.peer-reviewe

Patients’ willingness to access cross-border healthcare

European Union (EU) Member States were required to direct their health practices to ensure implementation of ‘Directive on patients’ rights in cross-border healthcare’ which provides the right for EU citizens to seek treatment abroad. This study recruited Maltese patients, consequently it identified and quantified domains constituting willingness to access cross-border healthcare. Via this analytical approach, the results and recommendations were presented to assist cross-border healthcare policy.peer-reviewe

Malta : health system review 2017

Maltese life expectancy is high, and Maltese people spend on average close to 90% of their lifespan in good health, longer than in any other EU country. Malta has recently increased the proportion of GDP spent on health to above the EU average, though the private part of that remains higher than in many EU countries. The total number of doctors and GPs per capita is at the EU average, but the number of specialists remains relatively low; education and training are being further strengthened in order to retain more specialist skills in Malta. The health care system offers universal coverage to a comprehensive set of services that are free at the point of use for people entitled to statutory provision. The historical pattern of integrated financing and provision is shifting towards a more pluralist approach; people already often choose to visit private primary care providers, and in 2016 a new public-private partnership contract for three existing hospitals was agreed. Important priorities for the coming years include further strengthening of the primary and mental health sectors, as well as strengthening the health information system in order to support improved monitoring and evaluation. The priorities of Malta during its Presidency of the Council of the EU in 2017 include childhood obesity, and Structured Cooperation to enhance access to highly specialized and innovative services, medicines and technologies. Overall, the Maltese health system has made remarkable progress, with improvements in avoidable mortality and low levels of unmet need. The main outstanding challenges include: adapting the health system to an increasingly diverse population; increasing capacity to cope with a growing population; redistributing resources and activity from hospitals to primary care; ensuring access to expensive new medicines whilst still making efficiency improvements; and addressing medium-term financial sustainability challenges from demographic ageing.peer-reviewe

Malta: health system review

Maltese life expectancy is high, and Maltese people spend on average close to 90% of their lifespan in good health, longer than in any other EU country. Malta has recently increased the proportion of GDP spent on health to above the EU average, though the private part of that remains higher than in many EU countries. The total number of doctors and GPs per capita is at the EU average, but the number of specialists remains relatively low; education and training are being further strengthened in order to retain more specialist skills in Malta. The health care system offers universal coverage to a comprehensive set of services that are free at the point of use for people entitled to statutory provision. The historical pattern of integrated financing and provision is shifting towards a more pluralist approach; people already often choose to visit private primary care providers, and in 2016 a new public-private partnership contract for three existing hospitals was agreed. Important priorities for the coming years include further strengthening of the primary and mental health sectors, as well as strengthening the health information system in order to support improved monitoring and evaluation. The priorities of Malta during its Presidency of the Council of the EU in 2017 include childhood obesity, and Structured Cooperation to enhance access to highly specialized and innovative services, medicines and technologies. Overall, the Maltese health system has made remarkable progress, with improvements in avoidable mortality and low levels of unmet need. The main outstanding challenges include: adapting the health system to an increasingly diverse population; increasing capacity to cope with a growing population; redistributing resources and activity from hospitals to primary care; ensuring access to expensive new medicines whilst still making efficiency improvements; and addressing medium-term financial sustainability challenges from demographic ageing