[Health Care for Refugees: Challenges and Opportunities in Hamburg]. / Medizinische Versorgung von Flüchtlingen: Chancen und Herausforderungen in Hamburg ­ ein Praxisbericht.

The massive increase in the number of refugees represents a great challenge to German cities. In Hamburg, 40 868 asylum seekers were registered in 2015, of which 22 315 remained in the city. The goal of the health administration is to provide primary medical care in response to specific health risks and needs of refugees while allowing them to be swiftly integrated into the standard health care system. Public authorities, charities and civil society are working hand in hand. In all reception centres in Hamburg, medical consultations with translation services are offered in fully equipped medical container practices. For every 1 000 refugees, a full-time doctor and a medical assistant are available. In addition to contractual staff, employees of contractually integrated hospitals are participating in the provision of medical care. Systematic collection of data on the health condition of the refugees as well as strengthening public health services are key factors in the planning and improvement of services in the future. Healthier living conditions and access to the standard health care system provide an opportunity to facilitate successful integration of refugees into society.

Defining and Assessing Public Health Functions: A Global Analysis.

Given the broad scope and intersectoral nature of public health structures and practices, there are inherent difficulties in defining which services fall under the public health remit and in assessing their capacity and performance. The aim of this study is to analyze how public health functions and practice have been defined and operationalized in different countries and regions around the world, with a specific focus on assessment tools that have been developed to evaluate the performance of essential public health functions, services, and operations. Our review has identified nearly 100 countries that have carried out assessments, using diverse analytical and methodological approaches. The assessment processes have evolved quite differently according to administrative arrangements and resource availability, but some key contextual factors emerge that seem to favor policy-oriented follow-up. These include local ownership of the assessment process, policymakers' commitment to reform, and expert technical advice for implementation.

Comparing susceptibility and contagiousness in concurrent outbreaks with a non-VOC and the VOC SARS-CoV-2 variant B.1.1.7 in daycare centers in Hamburg, Germany.

We describe two outbreaks of SARS-CoV-2 in daycare centers in the metropolitan area of Hamburg, Germany. The outbreaks occurred in rapid chronological succession, in neighborhoods with a very similar sociodemographic structure, thus allowing for cross-comparison of these events. We combined classical and molecular epidemiologic investigation methods to study infection entry, spread within the facilities, and subsequent transmission of infections to households. Epidemiologic and molecular evidence suggests a superspreading event with a non-variant of concern (non-VOC) SARS CoV-2 strain at the root of the first outbreak. The second outbreak involved two childcare facilities experiencing infection activity with the variant of concern (VOC) B.1.1.7 (Alpha). We show that the index cases in all outbreaks had been childcare workers, and that children contributed substantially to secondary transmission of SARS-CoV-2 infection from childcare facilities to households. The frequency of secondary transmissions in households originating from B.1.1.7-infected children was increased compared to children with non-VOC infections. Self-reported symptoms, particularly cough and rhinitis, occurred more frequently in B.1.1.7-infected children. Especially in light of the rapidly spreading VOC B.1.617.2 (Delta), our data underline the notion that rigorous SARS-CoV-2 testing in combination with screening of contacts regardless of symptoms is an important measure to prevent SARS-CoV-2 infection of unvaccinated individuals in daycare centers and associated households.

The governments' doctors: the roles and responsibilities of chief medical officers in the European Union.

The regular meetings of the chief medical officers (CMOs) from the European Union's (EU's) 27 Member States provide an important forum to address issues of common interest affecting Europe's populations. Yet there is no universally agreed role for a CMO. This article describes the findings of a study, based on interviews with key informants and documentary analysis that sought to describe their diverse roles. For the purpose of this article, CMOs are defined as those sent by their governments to the regular EU meetings of CMOs. Four broad categories of countries were identified: those whose CMO is the most senior doctor in the health ministry, in some cases with responsibility spanning all of government; where they are head of a division within the health ministry; head of a separate body such as a national board of health; and countries where no single individual can be identified. Although the diversity of health systems means that these roles cannot be harmonised, there is scope to explore what can be learnt from the different approaches.

Organization and financing of public health services in Europe

How are public health services in Europe organized and financed? With European health systems facing a plethora of challenges that can be addressed through public health interventions, there is renewed interest in strengthening public health services. Yet, there are enormous gaps in our knowledge. How many people work in public health? How much money is spent on public health? What does it actually achieve? None of these questions can be answered easily. This volume brings together current knowledge on the organization and financing of public health services in Europe. It is based on country reports on the organization and financing of public health services in nine European countries and an in-depth analysis of the involvement of public health services in addressing three contemporary public health challenges (alcohol, obesity and antimicrobial resistance). The focus is on four core dimensions of public health services: organization, financing, the public health workforce, and quality assurance. The questions the volume seeks to answer are: How are public health services in Europe organized? Are there good practices that can be emulated? What policy options are available?; How much is spent on public health services? Where do resources come from? And what was the impact of the economic crisis?; What do we know about the public health workforce? How can it be strengthened?; How is the quality of public health services being assured? What should quality assurance systems for public health services look like? This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe: country reports and The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance.

The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance

Growing levels of overweight and obesity, continued harmful consumption of alcohol, and the growing threat of AMR are some of the greatest challenges to the health of European populations. While the magnitude of these problems varies from country to country, they affect all countries in Europe. For each problem, it is clear that public health agencies and organizations must play a part in any response, with intersectoral action beyond the health system needed. What is less clear is what role public health organizations currently play in addressing these problems.This is the gap that this volume aims to fill. It is based on country reports from eight European countries (England, France, Germany, Italy, the Republic of Moldova, the Netherlands, Poland, and Sweden) on the involvement of public health organizations in addressing alcohol consumption and obesity and on reports from nine European countries (England, France, Germany, Italy, the Republic of Moldova, the Netherlands, Poland, Slovenia and Sweden) on their involvement in addressing antimicrobial resistance.This web edition includes Country reports – appendix to The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance (2018; ISBN 9789289051712).

The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance

Growing levels of obesity (including among children), continued harmful consumption of alcohol and the growing threat of antimicrobial resistance (AMR) are some of the greatest contemporary challenges to the health of European populations. While their magnitude varies from country to country, all are looking for policy options to contain these threats to population health. It is clear that public health organizations must play a part in any response, and that intersectoral action beyond the health system is needed. What is less clear, however, is what role public health organizations currently play in addressing these problems. This is the gap that this volume aims to fill. It is based on detailed country reports from nine European countries (England, France, Germany, Italy, the Republic of Moldova, the Netherlands, Poland, Slovenia and Sweden) on the involvement of public health organizations in addressing obesity, alcohol and antimicrobial resistance. These reports explore the power and influence of public health organizations vis-a-vis other key actors in each of the stages of the policy cycle (problem identification and issue recognition, policy formulation, decision-making, implementation, and monitoring and evaluation). A cross-country comparison assesses the involvement of public health organizations in the nine countries covered. It outlines the scale of the problem, describes the policy responses, and explores the role of public health organizations in addressing these three public health challenges. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe and Organization and financing of public health services in Europe: country reports.

Organization and financing of public health services in Europe: country reports

What are “public health services”? Countries across Europe understand what they are, or what they should include, differently. This study describes the experiences of nine countries, detailing the ways they have opted to organize and finance public health services, and train and employ their public health workforce. It covers England, France, Germany, Italy, the Netherlands, Slovenia, Sweden, Poland and the Republic of Moldova, and aims to give insights into current practice that will support decision-makers in their efforts to strengthen public health capacities and services. Each country chapter captures the historical background of public health services and the context in which they operate; sets out the main organizational structures; assesses the sources of public health financing and how it is allocated; explains the training and employment of the public health workforce; and analyses existing frameworks for quality and performance assessment. The study reveals a wide range of experience and variation across Europe and clearly illustrates two fundamentally different approaches to public health services: integration with curative health services (as in Slovenia or Sweden) or organization and provision through a separate parallel structure (Republic of Moldova). The case studies explore the context that explain this divergence and its implications. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe and The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance.

Health care systems in transition: Uzbekistan

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).

Health care systems in transition: Bosnia and Herzegovina

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).

Health care systems in transition: Slovenia

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).

Health care systems in transition: Slovenia

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).