Towards a Feminist Global Health Policy: Power, intersectionality, and transformation.

In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice.

Professional Characteristics of Health Promotion: A Scoping Review of the German and International Literature.

Objective: This scoping review investigates current developments in the professional characteristics of health promotion (HP) with a focus on the German speaking part of Europe. The conceptualization of HP is a prerequisite for progressing HP professionalization and clarifying the interconnectedness between HP and Public Health. Methods: The search strategy was informed by sociological professionalization theories. Original publications were included in a content-based analysis. Results: Ninety publications (37 original publications) were identified in the review. The results are summarized in categories based on professional characteristics: 1) profession, 2) ethics, 3) education/training 4) competencies, and 5) quality. The professionalization of HP regarding the professional characteristics is less developed in the German compared to the international literature. Conclusion: The mixed findings emphasize the relevance of a common HP conceptualization. The HP core competencies, which have been developed by the International Union for Health Promotion and Education must be further promoted. A strong HP workforce within Public Health strengthens the HP status in policy contexts and society and its contribution to promoting health and tackling social inequalities in health.

[Public health services in the COVID-19 pandemic: strategies and practices in selected European neighbouring countries]. / Öffentliche Gesundheitsdienste in der COVID-19-Pandemie: Strategien und Praktiken in ausgewählten europäischen Nachbarländern.

The challenges posed by the COVID-19 pandemic face different institutional structures and traditions of action in the European health systems. This article uses the example of the public health services in Sweden, France and Austria to address the question of the similarities and differences in the measures taken to combat the pandemic (status: November 2020).Among the countries presented in this article, Austria is the least affected by the pandemic and France is the most affected. In all analysed health systems there is a tension between national and regional responsibilities. France's healthcare system is particularly centralized, while Sweden's is strongly regional and municipal. Governments in the nation states are striving to obtain pandemic containment powers independent of parliamentary decisions. Sweden differs from Austria and France in that its pandemic containment strategy is based primarily on recommendations and appeals rather than directives and bans. The sequences of action during the pandemic and, apart from Sweden, the instruments used to contain the pandemic are similar. The course of the pandemic and the measures taken in Austria and France show clear parallels with those in Germany. The protection of particularly vulnerable groups has not been sufficiently successful in all countries and remains a challenge to be met.

Gender inequalities in mental wellbeing in 26 European countries: do welfare regimes matter?

BACKGROUND: Nature and extent of welfare regimes and social policies are important determinants of health and health inequalities. This study examines the association of gender and mental wellbeing in European countries and investigates whether type of welfare regime plays a role in this association. METHOD: Data of 19 366 women and 14 338 men of the third round of the European Quality of Life Survey (2011-12) was used to analyse mental wellbeing, assessed by the World Health Organization 5-Mental Wellbeing Index. Multilevel logistic regression analyses were performed to analyse the association between gender and good mental wellbeing first at country-level, and secondly the between country variation was analysed and welfare regimes were included as explanatory variables. RESULTS: We observed cross-national variation in good mental wellbeing. At country levels gender inequalities in good mental wellbeing were observed in 7 out of 26 countries. In analyses considering all countries together gender inequalities in good mental wellbeing were identified independent of further individual socio-demographic variables and independent of the welfare regimes that people lived in [women vs. men: OR = 0.76; (95% CI = 0.71-0.81)]. Gender inequalities in good mental wellbeing were not modified by welfare regimes. CONCLUSION: There are cross-national differences in good mental wellbeing between European countries. Gender inequalities with a lower prevalence of good mental wellbeing among women are common in European countries. This study suggests that welfare regimes do not modify these gender inequalities in mental wellbeing.

From heterogeneity to harmonization? Recent trends in European health policy.

In the European Union (EU), health policy and the institutional reform of health systems have been treated primarily as national affairs, and health care systems within the EU thus differ considerably. However, the health policy field is undergoing a dynamic process of Europeanization. This process is stimulated by the orientation towards a more competitive economy, recently inaugurated and known as the Lisbon Strategy, while the regulatory requirements of the European Economic and Monetary Union are stimulating the Europeanization of health policy. In addition, the so-called open method of coordination, representing a new mode of regulation within the European multi-level system, is applied increasingly to the health policy area. Diverse trends are thus emerging. While the Lisbon Strategy goes along with a strategic upgrading of health policy more generally, health policy is increasingly used to strengthen economic competitiveness. Pressure on Member States is expected to increase to contain costs and promote market-based health care provision.

Transnational migration of health professionals in the European Union.

The establishment of the European Common Market has involved the free movement not only of capital and goods, but also of persons and services. The principles of free movement also apply to the health care sector, i.e. they allow for the free incorporation of health care providers and the cross-border delivery of services. Since the 1970s, the European Union (EU) has passed numerous regulations to enforce the mutual recognition of qualifications of physicians, nurses, and other health professionals by the Member States, considered an indispensable precondition for the free movement of services. Thus far, the establishment of a European job market for the health care professions has not led to extensive migration among the EU Member States. Likewise, the accession of Central and Eastern European countries to the EU in 2004 did not cause a "brain drain" to the better-off countries of Western and Northern Europe. However, the mobility among health care professions is expected to increase in the coming years.

From heterogeneity to harmonization? Recent trends in European health policy

In the European Union (EU), health policy and the institutional reform of health systems have been treated primarily as national affairs, and health care systems within the EU thus differ considerably. However, the health policy field is undergoing a dynamic process of Europeanization. This process is stimulated by the orientation towards a more competitive economy, recently inaugurated and known as the Lisbon Strategy, while the regulatory requirements of the European Economic and Monetary Union are stimulating the Europeanization of health policy. In addition, the so-called open method of coordination, representing a new mode of regulation within the European multi-level system, is applied increasingly to the health policy area. Diverse trends are thus emerging. While the Lisbon Strategy goes along with a strategic upgrading of health policy more generally, health policy is increasingly used to strengthen economic competitiveness. Pressure on Member States is expected to increase to contain costs and promote market-based health care provision.

Na União Européia, as políticas de saúde e a reforma institucional dos sistemas de saúde têm sido tratadas principalmente como questões nacionais, levando a diferenças importantes entre os sistemas dentro da União. Entretanto, o campo da política de saúde está passando por um processo dinâmico de europeização, estimulado pela mudança recente para uma economia mais competitiva, conhecida como a Estratégia de Lisboa, enquanto as exigências regulatórias da União Econômica e Monetária estão promovendo a europeização da política sanitária. Além disso, o método conhecido como coordenação aberta, que representa uma nova modalidade de regulamentação dentro do sistema europeu com múltiplos níveis, é aplicado cada vez mais à área de política sanitária. Enquanto a Estratégia de Lisboa acompanha a melhoria estratégica da política de saúde no sentido mais geral, esta política é utilizada cada vez mais para fortalecer a competitividade econômica. A previsão é de que a pressão crescente sobre os países membros irá conter custos e promover a oferta de serviços de saúde com base no mercado.

Transnational migration of health professionals in the European Union

The establishment of the European Common Market has involved the free movement not only of capital and goods, but also of persons and services. The principles of free movement also apply to the health care sector, i.e. they allow for the free incorporation of health care providers and the cross-border delivery of services. Since the 1970s, the European Union (EU) has passed numerous regulations to enforce the mutual recognition of qualifications of physicians, nurses, and other health professionals by the Member States, considered an indispensable precondition for the free movement of services. Thus far, the establishment of a European job market for the health care professions has not led to extensive migration among the EU Member States. Likewise, the accession of Central and Eastern European countries to the EU in 2004 did not cause a "brain drain" to the better-off countries of Western and Northern Europe. However, the mobility among health care professions is expected to increase in the coming years.

A criação do Mercado Comum Europeu envolve a circulação livre tanto de capital e produtos quanto de pessoas e serviços. Os princípios da circulação livre se aplicam igualmente ao setor de saúde, i.e., permitem a incorporação livre de provedores de assistência e a prestação transfronteiriça dos serviços. Desde os anos 70, a União Européia (UE) tem aprovado várias normas voltadas para o reconhecimento recíproco da qualificação de médicos, enfermeiros e outros profissionais de saúde pelos Países Membros, como pré-condição indispensável para a movimentação livre de serviços. Até o momento, a criação de um mercado de trabalho europeu para as profissões de saúde não levou a uma migração extensa entre os Países Membros. A entrada de países do Leste Europeu e Europa Central para a UE tampouco provocou uma "fuga de cérebros" aos países mais abastados do Oeste e Norte do continente. Entretanto, a previsão é de que a mobilidade entre as profissões de saúde deve aumentar na Europa nos próximos anos.

The Free Movement of Health Professionals.

Apresentação que trata de recursos humanos na área de saúde na União Européia, apontando o histórico da criação do bloco econômico e as políticas públicas existentes. Segundo o autor as políticas sociais e da área da saúde são desenvolvidas de forma incipiente e o financiamento e o escopo do serviço de saúde é deixado para os estados membros resolverem. Mostra o movimento de migração dos profissionais de saúde pelos países da União Européia, onde desde 1975, diretrizes aprovadas regulamentam o reconhecimento mútuo de profissões de saúde.

European Health Care Policy: From Diversity to Harmonization?

Apresentação que traça um panorama do funcionamento das políticas médicas em alguns países europeus, usando como base dados de Portugal, Inglaterra, Alemanha, Suécia e Polônia. Entre as diversidades e as igualdades no acesso aos serviços de saúde fica claro que cada país entende que as políticas de saúde são recursos fortes de legitimação nos seus respectivos governos e por isso a qualidade e o bom atendimento são primordiais. Analisa o atual panorama das discussões para o estabelecimento de acesso universal para o cuidado médico de alta qualidade, além da continuidade das reformas nos sistemas para a diminuição dos gastos.