The Role of Public Health Organizations in Addressing Public Health Problems in Europe
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51 Growing levels of obesity (including among children), continued harmful consumption of alcohol, O E and the growing threat of antimicrobial resistance (AMR) are some of the greatest contemporary d R The role of public i t 51 e challenges to the health of European populations. While their magnitude varies from country to G d s y A country, all are looking for policy options to contain these threats to population health. b c e i i y health organizations N l r : o e It is clear that public health organizations must play a part in any response, and that intersectoral B I P S e Z action beyond the health system is needed. What is less clear, however, is what role public health h r t n A in addressing public l organizations currently play in addressing these problems. d a T e R I H e This is the gap that this volume aims to fill. It is based on detailed country reports from nine O c h N health problems in Europe European countries (England, France, Germany, Italy, the Republic of Moldova, the Netherlands, e l Poland, Slovenia and Sweden) on the involvement of public health organizations in addressing , A E N obesity, alcohol and antimicrobial resistance. These reports explore the power and influence of l k The case of obesity, alcohol e D public health organizations vis-a-vis other key actors in each of the stages of the policy cycle J a (problem identification and issue recognition, policy formulation, decision-making, implementation, F and antimicrobial resistance k u and monitoring and evaluation). I b N o A A cross-country comparison assesses the involvement of public health organizations in the nine w Edited by: s N countries covered. It outlines the scale of the problem, describes the policy responses, and explores k i Bernd Rechel C , the role of public health organizations in addressing these three public health challenges. M I Anna Maresso a N This study is the result of close collaboration between the European Observatory on Health Systems r t G i Anna Sagan and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It n M accompanies two other Observatory publications: Organization and financing of public health services O Cristina Hernández-Quevedo c F in Europe and Organization and financing of public health services in Europe: country reports . K e Erica Richardson P e , U E Elke Jakubowski l B The editors l e L n Martin McKee I Bernd Rechel is Research Officer at the European Observatory on Health Systems and Policies, N C o Ellen Nolte based at the London School of Hygiene & Tropical Medicine. l t H e Anna Maresso is Research Officer at the European Observatory on Health Systems and Policies. E A Anna Sagan is Research Officer at the European Observatory on Health Systems and Policies, L based at the London School of Economics and Political Science. T H Cristina Hernández-Quevedo is Research Officer at the European Observatory on Health Systems S and Policies, based at the London School of Economics and Political Science. E Erica Richardson is Research Officer at the European Observatory on Health Systems and R V I Policies, based at the London School of Hygiene & Tropical Medicine. C Elke Jakubowski is Senior Advisor for Policy and Strategy at the Division of Health Systems E and Public Health for the WHO Regional Office for Europe, based in Copenhagen. S I Martin McKee is Professor of European Public Health at the London School of Hygiene & Tropical N Medicine and Research Director at the European Observatory on Health Systems and Policies. E U Ellen Nolte is Professor of Health Services and Systems Research and was previously hub R coordinator for the London hubs of the European Observatory on Health Systems and Policies. O P E Health Policy Series No. 51 9 7 www.healthobservatory.eu 8 9 2 8 9 0 5 1 7 1 2 The role of public health organizations in addressing public health problems in Europe The European Observatory on Health Systems and Policies supports and promotes evidence- based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The European Observatory on Health Systems and Policies is a partnership between the WHO Regional Office for Europe; the Governments of Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, Switzerland, the United Kingdom and the Veneto Region of Italy; the European Commission; the World Bank; UNCAM (French National Union of Health Insurance Funds); the London School of Economics and Political Science; and the London School of Hygiene & Tropical Medicine. The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Berlin University of Technology. The role of public health organizations in addressing public health problems in Europe The case of obesity, alcohol and antimicrobial resistance Edited by Bernd Rechel Anna Maresso Anna Sagan Cristina Hernández-Quevedo Erica Richardson Elke Jakubowski Martin McKee Ellen Nolte European on Health Systems and Policies a partnership hosted by WHO iv The role of public health organizations in addressing public health problems in Europe Keywords: Public Health Government Agencies Obesity - prevention and control Alcohol Drinking - prevention and control Drug Resistance, Microbial Europe © World Health Organization 2018 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. 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The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies or any of its partners. ISBN 978 92 890 5171 2 Printed in the United Kingdom Cover design by M2M Contents List of figures, tables and boxes vii List of contributors ix Acknowledgements xiii Part I Cross-country analysis 1 Chapter 1 Introduction 3 Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte Chapter 2 Obesity 13 Cristina Hernández-Quevedo, Bernd Rechel Chapter 3 Alcohol 47 Anna Sagan, Bernd Rechel Chapter 4 Antimicrobial resistance 67 Saskia Nahrgang, Ellen Nolte, Bernd Rechel Chapter 5 Key policy lessons 93 Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte Part II Country reports 105 List of figures, tables and boxes Figures Fig. 1.1 Key stages of the policy cycle 11 Fig. 2.1 Age-standardized prevalence of overweight (defined as BMI ≥ 25 kg/m2) in people aged 18 years and over, WHO estimates, 2010 and 2016 (%) 14 Fig. 2.2 Age-standardized prevalence of obesity (defined as BMI ≥ 30 kg/m2) in people aged 18 years and over, WHO estimates, 2010 and 2016 (%) 15 Fig. 3.1 Total adult per capita consumption of alcohol (in litres of pure alcohol) in selected EU member states and the Republic of Moldova, 1990–2014 48 Fig. 3.2 Consumption of alcohol (in litres of pure alcohol) in selected EU member states and the Republic of Moldova, 2014 48 Fig. 3.3 Trends in recorded consumption of beer, wine and spirits in selected EU member states and the Republic of Moldova, 1970–2013 49 Fig. 4.1 Percentage of invasive isolates of S. aureus with resistance to methicillin (MRSA) (A) and percentage of invasive isolates of E. coli with resistance to third-generation cephalosporins (B), by country, EU/EEA countries, 2015–2016 70 Fig. 4.2 Consumption of antibacterials for systemic use (ATC group J01) in the community in eight European countries, 2016 72 Fig. 4.3 Sales, in tonnes of active ingredient, of veterinary antimicrobial agents in eight European countries, 2015 73 Fig. 4.4 Policy framework for sustainable access to effective antimicrobials 80 Tables