European support for improving global health systems and policies

The European Union (EU) is one of the world’s largest markets, aid donors, health care innovators and tradingpowers. As such, many of its policies affect global health. EU policies affect global health directly, as with overseas aid, trade policy or support for the World Health Organization (WHO). They also affect global health indirectly, as with the many internally focused policies which affect health and health policy options in other countries, such as research priorities or medicines regulation. The extensive range of policy areas that touch global health mean that the EU has a wide range of policy tools which inevitably shape global health, and which the EU can use intentionally to shape health governance and outcomes worldwide.The broad shape of any coherent strategy or approach to global health, in the complex institutional environment ofEurope, must align priorities with tools, identifying what the EU wants to achieve in the global health sphere andwhich policy tools will be best suited to have the desired effects. Alignment requires consideration of the differentways in which countries near the EU already relate to it (e.g. accession candidates) and should include anappreciation of which actors should use the different policy tools, with respect to subsidiarity as well as the advantages of joint action in some areas. The review of EU instruments clearly shows the immense scale of the impact of existing EU policies on global health, and the potential that a coherent approach could have to strengthen global health governance and improve global health policies and outcomes. The EU affects global health through many different policies; the question is how, when and by whom these policies will be used for global health.

Launching a public debate on the European Union’s future health priorities: how do we keep health on the political agenda beyond 2024?

In 2024, European citizens will vote for a new European Parliament. The ongoing political cycle has coincided with a health crisis that has reshaped the European Union’s policies and opened a window of opportunity for health and health systems. There is now a unique opportunity to assess past achievements and consider future goals in the field of health. The European Observatory on Health Systems and Policies, in agreement with the EC Directorate General for Health and Food Safety (DG SANTE), has launched a public debate. This initiative invites input from different stakeholders and the public to inform future EU health priorities. The article highlights key events and milestones planned within this public discourse.

From Health in All Policies to Health for All Policies.

Worldwide responses to the COVID-19 pandemic have shown that it is possible for politicians to come together across departmental boundaries. To this end, in many countries, heads of government and their health ministers work closely with all other ministries, departments, and sectors, including social affairs, internal affairs, foreign affairs, research and education, transport, agriculture, business, and state aid. In this Viewpoint, we ask if and how the Sustainable Development Goals (SDGs) can support intersectoral collaboration to promote health, since governments have already committed to achieving them. We contend that SDGs can do so, ultimately advancing health while offering co-benefits across society.

Centralizing and decentralizing governance in the COVID-19 pandemic: The politics of credit and blame.

COVID-19 led to significant and dynamic shifts in power relations within and between governments, teaching us how governments make health policies and how health crises affect government. We focus on centralization and decentralization within and between governments: within government, meaning the extent to which the head of government controls policy; and between governments, meaning the extent to which the central government pre-empts or controls local and regional government. Political science literature suggests that shifting patterns of centralization and decentralization can be explained by leading politicians' efforts to gain credit for popular actions and outcomes and deflect blame for unpopular ones. We test this hypothesis in two ways: by coding the Health Systems Response Monitor's data on government responses, and through case studies of the governance of COVID-19 in Austria, Czechia and France. We find that credit and blame do substantially explain the timing and direction of changes in centralization and decentralization. In the first wave, spring 2020, heads of government centralized and raised their profile in order to gain credit for decisive action, but they subsequently tried to decentralize in order to avoid blame for repeated restrictions on life or surges of infection. These findings should shape advice on governance for pandemic response.

COVID-19 pandemic: health impact of staying at home, social distancing and 'lockdown' measures-a systematic review of systematic reviews.

BACKGROUND: To systematically review the evidence published in systematic reviews (SR) on the health impact of staying at home, social distancing and lockdown measures. We followed a systematic review approach, in line with PRISMA guidelines. METHODS: In October 2020, we searched the databases Cochrane Database of Systematic Reviews, Ovid Medline, Ovid Embase and Web of Science, using a pre-defined search strategy. RESULTS: The literature search yielded an initial list of 2172 records. After screening of titles and abstracts, followed by full-text screening, 51 articles were retained and included in the analysis. All of them referred to the first wave of the coronavirus disease 2019 pandemic. The direct health impact that was covered in the greatest number (25) of SR related to mental health, followed by 13 SR on healthcare delivery and 12 on infection control. The predominant areas of indirect health impacts covered by the included studies relate to the economic and social impacts. Only three articles mentioned the negative impact on education. CONCLUSIONS: The focus of SR so far has been uneven, with mental health receiving the most attention. The impact of measures to contain the spread of the virus can be direct and indirect, having both intended and unintended consequences.

Centralisation and decentralisation in a crisis: How credit and blame shape governance

The COVID-19 pandemic led to unprecedented challengesand political creativity worldwide. In governance, this often led to unexpected centralisation and decentralisation in response to case surges. Changes in the distribution of power and responsibility throughout governments changed quickly as the pandemic progressed. Centralisation and decentralisation occurred within governments and between governments, as power shifted. The main explanation for the patterns of centralisation and decentralisation is the politics of credit and blame. Politicians at all levels seek to centralise when there is credit to be had from forceful action and decentralise when there are unpopular policies or bad news coming.

Editorial: governance strategies for building health system resilience

Governance is about making and implementing collective decisions. It is therefore vitally important to health policy and implementation and is a pivotal, yet often underestimated, enabler for leading a health system in times of emergencies, preventing them from becoming a crisis.

Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire.

WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code's principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code's principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.

What are the conditions for successful health policy implementation? Lessons learnt from WHO’s regional health policy Health 2020: policy brief

This policy brief explores the conditions that need to be in place for successful health policy implementation in the context of Health 2020. It is based on a scoping review of the literature, as well as semi-structured in-depth interviews with experts in selected WHO Member States. The policy brief identifies six key conditions for successful health policy implementation in the context of Health 2020: 1) ensure contexts are appropriate and receptive; 2) get the timing right; 3) transfer appropriate policies and innovations; 4) ensure good governance; 5) work with other sectors; and 6) move from exploration to full implementation. Identifying how these conditions can be used to maximum effect in specific national contexts and policies will help health policy-makers to increase the chances of success for the policies they develop and aim to implement. Crucially, putting policies in place is only the first step towards full implementation. Successful health reforms generally take several years to prepare and adopt, and they often take far longer to implement. A certain degree of pragmatism will also be needed, using evidence as best as possible and allowing for feedback and refinements throughout the reform process. This includes sticking to principles of good governance. They fulfil a double purpose, ensuring the required leadership for the reform process and allowing for effective implementation to take place. This publication was tabled as a background document during the Sixty-ninth session of the Regional Committee for Europe, Copenhagen, 16–19 September 2019.

It’s the governance, stupid! TAPIC: a governance framework to strengthen decision making and implementation

This policy brief’s key messages are: governance is a broad and complex topic with many overlapping definitions, frameworks and recommendations, but governance concepts and ideas found in the literature can broadly be grouped into five key domains: Transparency, Accountability, Participation, Integrity and Capacity (TAPIC); governance is crucial to successful policy-making and implementation. It affects the likelihood that workable policies are adopted, that they are implemented, and that they produce intended results. At the same time, governance may be the cause of policy problems. But it is only one potential cause of problems, alongside other causes of failure such as inadequate finance.; each of the five domains of the TAPIC framework contains many different techniques for policy and procedural change. Rigorous and context-sensitive analysis is required to work out which domains contain governance problems and what those problems might be.