Northern Dimension Partnership in Public Health A partnership committed to and Social Well-being achieving tangible results

e-Newsletter Issue 1/2012

Contents Dear Reader…

NDPHS Continues Efforts to It is widely recognised that health is crucial in the context of the ageing Have Health Prioritised on society and challenges posed to sustainable economic development. Yet, the Regional Agenda 1 the importance of health is not properly reflected on the regional coopera- tion agenda. One example is the Action Plan of the EU Strategy for the Baltic The Demography Challenge Sea Region (EUSBSR), where health has been listed as a sub-priority. Since in the Baltic Sea Region 2 last year our Partnership has taken several actions to address this problem Making Success Stories and our efforts will continue. This issue of our e-newsletter will give you with Russian Partners 4 some details on this. Following the above is an article about the 9th Baltic Sea States Summit rd 3 EUSBSR Annual Forum held in May 2012 in Stralsund, Germany and, more specifically, its plenary Discusses the Review of the session on the impact of demographic change. The Prime Ministers had Strategy Action Plan 5 a stimulating debate on main challenges posed by the demographic change PrimCareIT: Counteracting and discussed policies to induce win-win situations for the future. Brain Drain and Professional You will also find two articles about the 3rd Annual Forum of the EU Strat- Isolation of Health 6 egy for the Baltic Sea Region held a few days ago in Denmark. Many interest- ing events took place during it, which provided an opportunity to discuss the progress so far and the way forward. One of them was a session “Making Success Stories with Russian Partners” co-organised by the NDPHS.

NDPHS Secretariat

NDPHS Continues Efforts to Have Health Prioritised on the Regional Agenda

Last year the NDPHS embarked on the challenging task Our prosperity of the region is based on human capital. of ensuring that health would be given a more prominent Consequently a healthy population is a critical factor behind role on the regional agenda. In line with this, our Partnership sustainable economic development. Improvement of people’s is taking actions to ensure health is particularly important that health be visibly exposed in the context of the ageing among the funding priorities society, one of the greatest regional challenges in the 21st during the next EU financial century. Unless counteracted, period. The NDPHS position a decline in the working age paper (http://www.ndphs.org/ population and a higher num- ?database,view,paper,67), ber of people with chronic adopted by the Ministers re- non-communicable diseases sponsible for health during the will put an immense pressure 8th Partnership Annual Confer- on the national budgets and ence on 25 November 2011, is a will lead to loss of productiv- basis for the Partnership’s work ity in the decades to come. By towards this objective. Mr. Per Bødker Andersen, President of the Union of the Baltic Cities investing in health improve- 2

Northern Dimension Partnership in Public Health and Social Well-being NDPHS Continues Efforts to Have Health Prioritised on the Regional Agenda 1 ment and promotion, the economic gain will be two-fold: given in the EUSBSR Action Plan a status adequate to its role (i) healthy people are more likely to stay at the labour market and importance in the region’s societies. During the current longer and remain productive and (ii) reduced spending on days of austerity, some decision makers may feel tempted to treatment of ill health. focus too much on short-term gains and neglect the fact that The key role of health as a precondition for economic de- challenges such as the aging of society, the growing epidemic velopment is increasingly recognized not only at the national, of diabetes and the emerging lack of effective antibiotics can- but also the supranational level. However, this recognition not be put aside and left in a waiting room. If they are, the has so far not been sufficiently reflected when defining the future costs to our societies of today’s inaction or inadequate strategic priorities. For example, only a few European funding action will be significantly higher than what we should pay programmes currently operating in the Northern Dimension now. Being aware of this the NDPHS is taking efforts to el- area have explicitly included health among their priorities. evate the importance of health and social well-being in the Another example is the EU Strategy for the Baltic Sea Region EUSBSR and have health included as a separate Priority Area (EUSBSR) and its Action Plan. Regarding the latter, regretta- in the EUSBSR Action Plan. bly, whereas other sectors are included as separate priorities, Surveys indicate that individuals place health among the health has been listed as a sub-priority (along with education, top priorities in their life and a recent Eurobarometer survey tourism and culture). This approach undermines the value, ranks healthcare system among the main concerns of the Eu- visibility and importance of health vis-à-vis other sectors. ropeans. The review process of the EUSBSR Action Plan pro- The EUSBSR Action Plan is currently being reviewed. To vides an opportunity to recognise a key role of health in con- that end the number and content of the Priority Areas is cur- tributing to smart and inclusive growth and to demonstrate rently being discussed, which will supposedly lead to some to people that their priorities and concerns are properly re- of the areas being merged or split. The Ministerial-level 8th flected on the regional cooperation agenda. Partnership Annual Conference agreed that health should be NDPHS Secretariat

The Demography Challenge in the Baltic Sea Region

The recent 9th Baltic Sea States Summit that took place an inclusive extension of that discussion. The need to investi- in the Baltic Sea coastal town of Stralsund, Germany on the gate ways of creating a sustainable labour market that deals 30-31 May focused its second plenary session on demog- with both inclusion of senior citizens and youth in gainful and raphy. productive employment as well as creating a good work-life The Summit of Prime Ministers hosted by Dr. Angela Mer- balance, healthy lifestyles and flexible employment cultures kel differed from previous Summits by inviting a keynote are all crucial for future prosperity and health of our region. speaker for each session to provide the Heads of Government In the current times of austerity there is a risk that long- with an expert outline of the chosen subject for reflection and term sustainable demography policy will be brushed aside discussion. The issue of Demographic change – consequenc- by short term crisis management. The average age of our re- es of an ageing society was introduced by Prof. James W. Vau- gion’s citizens is increasing – but the retirement age has not pel of the Max Plank Institute for Demographic Research. The increased to off-set this upwards trend in life expectancy. topic is of course particularly relevant in the context of health. Pension systems are therefore ill-equipped to take the full Back in February of this year the Prime Ministers of the strain of longer lives with fewer average working hours over Nordic-Baltic 8 cooperation plus the United Kingdom met the entire life-cycle. The health care system as well as the in Stockholm at the Northern Future Forum hosted by the service provision for our elderly are also in need of a re-think Swedish Prime Minister, Fredrik Reinfeldt, to discuss this ex- away from its current form. People expect more flexibility act issue as well as the Forum´s other chosen topic of female and more choice, which is tailored specifically to their needs participation in the labour market. Both of these topics link but without a trade-off of possibilities for government to to competiveness and the untapped potential for economic stagger their departure from employment over a longer pe- growth and sustainability of the labour market. The Summit riod to ease the burden of the tax revenues as well as retain deliberations in Stralsund can be viewed through the lens of an active ageing policy. 3

2 Northern Dimension Partnership in Public Health and Social Well-being The Demography Challenge in the Baltic Sea Region 2 The Heads of Delegations discussed how best the coun- Social services are currently under immense pressure in tries could develop policies which would take a holistic view Europe due to the economic crises and budget constraints of the inter-relations between the different positions and pos- and cuts. In the future, as is already the case today in some sible policy options involved. parts of the world, more people will need social and health The main questions were centred upon which combina- care services for a longer time span and potentially a more tions of incentives and reforms could be introduced to induce progressively costly type of specialised care. This challenge win-win scenarios for the future? highlights a need to focus on innovation in assistance provi- A complex array of issues were discussed in detail from sion and health services. Resources must be used more effi- different country experiences of what had worked or was ciently to maintain the high quality of care from re-tooling the being tested; such as pension reform, tax incentives for the care and provision to suit new developments and techniques retention of older workers in the workforce, life-long learning as they come online. This is also a way to create new jobs in educational schemes, encouragement of an entrepreneurial the service and health sectors of our labour market with these mindset, especially innovations if we focus for older workers, hard enough - even be- pre-school system coming a source of ex- provision and paren- pertise for export and tal leave packages growth to other regions. that give flexibility This is a common chal- and enablement to lenge for all of us and it both parents to stay needs to be discussed in the workforce, on a pan-European level. fighting youth un- 2012 is the year of employment and solidarity between the social exclusion of generations and active young adults by eas- ageing after all. ing the thresholds In an age where the into the labour mar- Photo: Council of the Baltic Sea States Secretariat plasticity of longevity is ket through training fluid and extensive, these challenges should be viewed as an schemes and placements to gain experience, targeting Hu- opportunity for economic growth. The Cohesion policy pack- man Resource and Management programmes to devise spe- age proposed by the European Commission lists e-health, cial schemes for older workers for knowledge and experience health infrastructure, inequalities in health and healthy ageing retention, highlighting mentorship programmes and other policies to support women in the workplace and to focus on among other investment priorities – these areas are not only time management over the lifespan as well as healthy living. important for health in general but for productivity, compe- tiveness and overall fiscal policy. Self-monitoring tools for in- A follow up question further developed - how can innova- dividuals who want to retain a level of independence in their tion bring about an improvement in the current demographic elderly years, tele-health and remote diagnosis technologies, situation faced by the region? innovations in primary care education to boost nurse capaci- In the Baltic Sea Region as in other parts of the world the ties and develop roles for practitioners and physician assistants general conditions for growth need to be strengthened. A combined with moveability of professionals by common rec- few days ago the 3rd EUSBSR Annual Forum was held in Co- ognition of skills and fast tracking recruitments could all lead penhagen under the auspices of the Danish Presidency of the to efficiency gains across the system and the region to ease the Council of the European Union where economic competitive- ensuing burden. ness was at the front of the participant’s minds and discus- sions. But competiveness is not just about investment in in- We hope that the detailed dialogue enjoyed by our frastructure of large scale or public private partnerships for region´s Prime Ministers will clarify the value of health pro- energy production or transport super-ways. Competiveness is motion and optimization of delivery of care as one part of the crucially in the small details that enable one society or region demography conundrum in the coming years ahead. to have the edge over another. Here the ability to explore Anthony Jay Olsson one´s full potential (and productivity as a citizen) is intrinsi- Head of Media and Communications cally linked to one´s own health throughout the entire life. Council of the Baltic Sea States Secretariat

Northern Dimension Partnership in Public Health and Social Well-being 3 Making Success Stories with Russian Partners

The European Union Strategy for the Baltic Sea Region It was underlined that it is neither reasonable nor realistic (EUSBSR) aims at reinforcing regional cooperation to tackle to expect non-Member States to sign up to an EU strategy. common challenges. The EUSBSR includes objectives which Pragmatic solutions must, therefore, be sought, based on a call for constructive cooperation with non-EU partner coun- partner-to-partner dialogue and mutual benefits. To that end, tries, in particular, with Russia, in order to achieve concrete common interests have to be found and common denomi- results. Despite growing interest in cooperating with Russian nators identified for joint activities in the Baltic Sea region. partners, this effort has achieved varying degrees of success The Strategy of social and economic development of the and it is widely recognised that this cooperation should be North-West Federal District of the Russian Federation and intensified. Pragmatic solutions must be sought, based on a the EUSBSR were mentioned in this regard as good points partner-to-partner dialogue and mutual benefits. of departure in partners’ dialogue. It was also noted that the There are examples of a fruitful collaboration involving existing frameworks need to be used as much as possible in EU and Russian partners established at various levels and establishing and fostering cooperation. The NDPHS, the NCM, engaging various stake- the Turku process, the CBSS holders – national govern- and other regional organisa- ments, parliamentarians, tions were named as useful sub-regional and local au- cooperation frameworks. thorities, universities, busi- The speakers shared nesses and grass-root NGOs. experiences and lessons Some of these examples learned as well as provided were presented at the ses- examples of the established sion entitled “Making Success Stories with Russian Partners” EU-Russia cooperation along the lines of the EUSBSR Action during the EUSBSR Annual Forum held on 17-19 June 2012 Plan. Ms. Hanna Lehtinen mentioned that the Northern Di- in Copenhagen, Denmark. The session was co-organised by mension structures provided a functioning format for imple- the NDPHS and the Turku process, both of which have a track mentation of the external aspects of the EUSBSR. In particular, record of such accomplishments. It aimed to provide inspira- she noted that the NDPHS framework provides an example of tion for those engaged in the EUSBSR who would like to make pragmatic and successful collaboration between the EU and their own success stories with Russian partners, and, in this non-EU countries, including in the context of the EUSBSR. way, to help advance cooperation between EU and Russian Further examples of successful cooperation within the partners that would contribute to fostering the objectives of NDPHS were presented by Prof. Yulia Mikhaylova who stressed the EUSBSR. the importance of transnational cooperation in the field of The session was co-moderated by Mr. Marek Maciejowski health to avoid scattering resources on a fragmented approach of the NDPHS Secretariat and Mr. Mikko Lohikoski of the Turku and duplication of efforts in addressing shared challenges that process and benefited from contributions of distinguished all Baltic Sea region countries are facing, such as an ageing soci- speakers who came from a variety of institutions and organi- ety, the increasing burden of non-communicable diseases and sations operating at different levels: new health threats. She also stressed that health is crucial for economic growth and deserves to be made a separate Priority Ms. Hanna Lehtinen, Deputy Director General, Ministry Area in the EUSBSR, not a sub-area as it is now. for Foreign Affairs of Finland; The way ahead towards more success stories of coopera- Prof. Dr. Yulia Mikhaylova, First Deputy Director, Fed- tion between EU and Russian partners was also discussed eral Research Institute for Health Care Organization during the session. The speakers and participants have identi- and Information (speaking on behalf of the Ministry of fied several factors that made it possible to have the success Healthcare of the Russian Federation); stories achieved (and could be taken into account by other Mr. Arne Grove, Director, Nordic Council of Ministers In-  stakeholders interested in establishing or strengthening co- formation Office in Kaliningrad; operation between EU and Russian partners). In particular, it Ms. Sofia Rekord, Vice Rector, Head of International was mentioned that there is a willingness on both sides to Economic Relations, St. Petersburg State University of pursue pragmatic and mutually beneficial cooperation and Economics and Finance, Russia; solid cooperation platforms have already been available, Ms. Daria Akhutina, Director, NORDEN Association of covering a wide range of sectors. Also, funding provided by Russia. the NCM (approx. 20 million DKK per year) and by Norway 5

4 Northern Dimension Partnership in Public Health and Social Well-being Making Success Stories with Russian Partners 4 (through the NDPHS Project Pipeline), as well as seed money a civil society and local partners was also stressed. Among provided through the EU Delegation to Russia and the DG other complications technical problems (such as different REGIO were named as very helpful in supporting cooperation technical standards and language barriers) were mentioned. between EU and Russian partners. The session proved that the main driver for cooperation Even though the overall conclusion was that there are is the potential to achieve better results by working together. more opportunities than constraints for a fruitful collabora- It provided many inspiring examples regarding cooperation tion between EU and Russian partners, it was obvious that between EU and Russian partners as well as useful tools and a number of challenges are present that one needs to be cooperation frameworks, which can be used by interested aware of when developing cooperation. Several speakers stakeholders in their own work. We would like to sincerely stressed that more needs to be done in designing the fund- thank the speakers and the participants for an inspiring and ing programmes so that both EU and Russian partners could thought-provoking session, and we are looking forward to fu- jointly benefit from financial support. The on-going work on ture success stories made between EU and Russian partners. the preparation of the EU financial framework 2014-2020 was Undoubtedly, the session itself was an example of a success- mentioned as a good opportunity to make improvements ful collaboration between EU and Russian partners. in this regard. The need to ensure a stronger involvement of NDPHS Secretariat

3rd EUSBSR Annual Forum Discusses the Review of the Strategy Action Plan

The EU Strategy for the Baltic Sea Region (EUSBSR) was needs to be aligned with the Europe 2020 objectives and the launched in 2009. It was the first macro region strategy of the financing programmes of the next EU financial period. EU (the EU Strategy for the Danube Region was subsequently An overall analysis is currently being prepared by the Pri- ority Area Coordinators and the Horizontal Action Leaders. During the 3rd Annual EUSBSR Forum held in Copenhagen on 17-19 June 2012 two sessions were devoted to the review of the Strategy and its Action Plan. The Forum provided an excel- lent opportunity for the interested stakeholders to contribute to the drafting of the Action Plan by voicing their views and concerns. The following were the main views expressed dur- ing the event and the conclusions from it: The EUSBSR has succeeded in fostering cooperation and in finding new ways of cooperation. However, the progress among different Priority Areas has been uneven – an issue that should be addressed in an open way and reflected in ImPrim project team members discussing with Commissioner Johan- the revised EUSBSR Action Plan; nes Hahn the importance of healthy society Focusing on delivering results is of vital importance. The launched in 2011). The EUSBSR aims at making the Baltic Sea targets and indicators will be a useful tool for monitoring Region cleaner, more connected and more prosperous. It is the progress and increasing the accountability of the ac- accompanied by the Action Plan comprising 15 Priority Areas, tors involved; which represent the main areas where the EUSBSR can con- Close alignment with the Europe 2020 Strategy and the tribute to improvements. The Action Plan has been updated next EU financial period (2014-2020) is indispensable to several times, in order to take into account the relevant devel- ensure further success of the Strategy; opments in the region. Relevant stakeholders from EU and non-EU countries Almost three years after its adoption, a more fundamental should be better involved, including representatives of review of the EUSBSR Action Plan is currently being performed, civil society, business and local level; to be completed by the end of 2012 or early 2013. The most Some of the actors involved call for a reduction of a number important elements of this review will be the introduction of of Priority Areas. Others stress that the reduction should objectives, indicators and targets to enable measuring the suc- not be an aim per se. Proportionality and assessment of cess of the Strategy and to focus efforts on the most urgent performance should be applied in this respect (NB. The lat- challenges. In addition, there will also be an assessment of ter is what also the NDPHS stressed on many occasions); the number and content of the Priority Areas, to decide if they Social dimension should be stronger reflected in the EUSBSR. could be merged or reinforced. Last but not least, the Strategy NDPHS Secretariat

Northern Dimension Partnership in Public Health and Social Well-being 5 PrimCareIT: Counteracting Brain Drain and Professional Isolation of Health

The nations in the Baltic Sea Region as well as the rest The project has already had its two successful kick-off meet- of Europe face the challenges of an ageing population. This ings, one in Seinäjoki, Finland (February 2012) and the other leads to a rising demand for primary health care services. Ru- in Karlskrona, Sweden (April 2012). The partners started the ral and remote areas of the regions are affected most because project work by analysing the existing barriers to large scale of the free movement of medical professionals within the re- deployment of tele-consultation and tele-mentoring such as gions and even the whole EU. technology acceptance, work flows, daily routines or legal un- certainties. Six project work packages have started their work The PrimCareIT project is a flagship initiative part-financed efficiently: the WP3, which is led by the Flensburg University of by the Baltic Sea Region Programme 2007-2013, bringing to- Applied Sciences, is preparing a transnational literature review gether 16 institutions from 7 Baltic Sea Region countries (Be- on the current state and the challenges facing the deployment larus, Estonia, Finland, Germany, Latvia, Lithuania and Swe- of tele-consultation and tele-mentoring, as well as making ar- den). Project partners are elaborating an idea that the use of rangements for expert interviews which will tele-consultation and tele-mentoring has take place in the partner countries later this a strong potential to provide opportuni- year. Tele-consultation and tele-mentoring ties for professional networking, continu- solutions between health workers, general ing medical education and career devel- practitioners and medical specialists in pilot opment for younger and experienced sites are being designed and prepared in the doctors and health workers in remote areas. This in turn WP 4 (led by the Blekinge Institute of Technology) and the WP5 counteracts brain drain and professional isolation in sparsely (led by the Estonian Society of Family Doctors), and will be populated areas for more equal access to primary health care implemented by the end of the year. The WP6 (also led by the in the BSR. Blekinge Institute of Technology) is responsible for raising the The project is developed under the umbrella of the “eHealth awareness among the political stakeholders. The WP1, which is for Regions” network, which has been appointed by the NDPHS led by the South Ostrobothnia Health Care District, manages to coordinate the eHealth component within the EUSBSR Ac- the overall project activities, and the WP2, which is led by Vil- tion Plan. The project’s partnership is a composition of health- nius University Hospital Santariškių Klinikos, is responsible for care institutions, medical doctors associations, planning and the project communication and dissemination of the results to financing authorities, regional development administrations, the public. The project website will be launched in June 2012 health and IT research institutions. The South Ostrobothnia (www.primcareit.net). Health Care District, Finland has assumed the lead partner role For further information please contact Sami Perälä, Prim- in the project. By reusing their outputs the PrimCareIT project CareIT Lead Partner, South Ostrobothnia Health Care District also complements two other EUSBSR flagship projects also ([email protected], +358 44 332 2270). part-financed by the Baltic Sea Region Programme 2007-2013, Sami Perälä namely the ICT for Health and the ImPrim. PrimCareIT Lead Partner

The NDPHS e-Newsletter is published by the Northern While the contributions received for this issue are highly NDPHS Secretariat Dimension Partnership in Public Health and Social Well- appreciated, it should be noted that the views and opin- Slussplan 9 being (NDPHS) Secretariat in Stockholm, Sweden. ions expressed by the contributors do not necessarily P.O. Box 2010 It is published bi-annually and is available in electronic format reflect those of the publisher. SE-103 11 Stockholm, Sweden We plan to publish the next issue in late August 2012. through direct mailing to subscribers, and on the NDPHS Tel: +46 8 440 1920 Contributions are encouraged and welcome. If you are website, where you can also subscribe to it (www.ndphs.org). Fax: +46 8 440 1944 interested, please contact us at the NDPHS Secretariat. The newsletter may be freely reproduced and reprinted, E-mail: [email protected] provided that the source is cited. Website: www.ndphs.org

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