European Advisory Committee on Health Research: third meeting, Copenhagen, Denmark, 2–3 May 2013

European Advisory Committee on Health Research Third Meeting, Copenhagen, Denmark, 2–3 May 2013 ABSTRACT The European Advisory Committee on Health Research (EACHR) reports directly to the WHO Regional Director for Europe. Its purpose is to advise on formulation of policies for the development of health research; review the scientific basis of selected Regional programmes; advise on new findings on priority public health issues, and evidence-based strategies to address them; and facilitate exchange of information on research agendas and evidence gaps. The Committee held its third formal meeting in Copenhagen, Denmark, on 2–3 May 2013. It reviewed and offered advice on key technical work and the research implications of the agenda for the forthcoming 63rd session of the WHO Regional Committee for Europe, including the 2012 European health report; Health 2020; the social determinants of health and the health divide; vector-borne diseases; nutrition, physical activity and obesity; health and the environment; mental health; and the WHO Consultative Expert Working Group on Research and Development. It also refined its scope and vision, leading to the creation of an EACHR action plan for 2013–2014. Keywords • HEALTH RESEARCH • HEALTH MANAGEMENT AND PLANNING • HEALTH POLICY • HEALTH STATUS INDICATORS • PUBLIC HEALTH ADMINISTRATION • HEALTH PLANNING • PLANNING METHODOLOGY Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2013 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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CONTENTS Page Executive summary ............................................................................................................ 1 Introduction ....................................................................................................................... 2 The role of EACHR .............................................................................................................. 3 Regional Director’s update .................................................................................................. 5 Tackling Europe’s health priorities: from Moscow to Malta ...................................................... 7 The 2012 European health report ........................................................................................ 9 Targets and indicators for Health 2020 ............................................................................... 11 Reviews of specific WHO programmes ................................................................................ 13 Global health research and development .................................................................... 13 The social determinants of health and the health divide .............................................. 14 Surveillance and control of vector-borne diseases ....................................................... 15 Nutrition, physical activity and obesity ....................................................................... 16 Environment and health ........................................................................................... 17 Mental health .......................................................................................................... 19 Conclusions and actions agreed ......................................................................................... 20 EACHR action plan for 2013–2014 ............................................................................. 20 EACHR governance and membership ......................................................................... 21 Evaluation of the meeting ......................................................................................... 21 References ...................................................................................................................... 22 Annex 1: EACHR Action Plan 2013–2014 ......................................................................... 25 Annex 2: Meeting Agenda ............................................................................................. 30 Annex 3: List of Participants .......................................................................................... 32

European Advisory Committee on Health Research page 1 Executive summary The European Advisory Committee on Health Research reports directly to the WHO Regional Director for Europe. Its purpose is to advise on formulation of policies for the development of health research; review the scientific basis of selected Regional programmes; advise on new findings on priority public health issues, and evidence-based strategies to address them; and facilitate exchange of information on research agendas and evidence gaps. The Committee held its third formal meeting in Copenhagen, Denmark, on 2–3 May 2013. It reviewed and offered advice on overall WHO progress and priorities, including the 2012 European health report and the Regional review of social determinants of health and the health divide. It also received updates and reviewed the following key topics, offering comments and guidance: • previous meetings of the WHO Regional Committee for Europe; • the research implications of the agenda for the forthcoming sixty-third session of the WHO Regional Committee for Europe ; • targets and indicators for Health 2020; • global health research and development issues relating to the WHO Consultative Expert Working Group on Research and Development; • surveillance and control of vector-borne diseases; • nutrition, physical activity and obesity; • environment and health; and • mental health. The Committee also reviewed and refined its vision, scope and terms of reference. It created an action plan for 2013–2014 that reflects the priorities set by the Regional Committee and the WHO reform agenda and captured in The European health report 2012 and other studies. The plan is aligned with the Committee’s terms of reference and sets out goals, actions, deadlines and persons responsible. Participants commended the progress made at the meeting, its upbeat, proactive style and energy, and its focus on action. The interface between the different cultures of science and policy was a major issue in public health, and this interchange had been very useful. European Advisory Committee on Health Research page 2 Table 1. Acronyms used in this report AIDS acquired immunodeficiency syndrome ASPHER Association of Schools of Public Health in the European Union CEWG Consultative Expert Working Group on Research and Development CIS Commonwealth of Independent States DOHaD developmental origins of health and disease EACHR European Advisory Committee on Health Research EC European Commission EU European Union HIV human immunodeficiency virus OECD Organisation for Economic Co-operation and Development RC WHO Regional Committee for Europe SCRC Standing Committee of the Regional Committee WHO World Health Organization Introduction The European Advisory Committee on Health Research (EACHR) held its third formal meeting on 2–3 May 2013 at the WHO Regional Office for Europe, Copenhagen, Denmark. The Committee reports directly to the WHO Regional Director for Europe. Its membership comprises public health research experts with a wide variety of specialist expertise and experience, drawn from a range of institutions and Member States across the Region. Its terms of reference include advising the Regional Director on formulation of policies for the development of research for health in the Region, and on new findings emerging from research on priority public health issues, and effective evidence-based strategies and policies to address them. It also reviews the scientific basis of selected WHO European Regional programmes. The aims of the meeting were both technical and strategic: • review and advise on key technical work and the research implications of the agenda for the forthcoming sixty-third session of the WHO Regional Committee for Europe (RC63), Çeşme, Turkey, 16–19 September 2013; • provide feedback on progress with the WHO Consultative Expert Working Group on Research and Development; • crystallize the EACHR scope and vision in light of key priorities for Europe; and • identify key EACHR activities for 2013–2014. The Committee also agreed to review and refine its vision and scope, and create an action plan for 2013–2014. This should reflect the priorities set by the Regional Committee and the WHO reform agenda and captured in The European health report 2012 (1), Health 2020: the European policy for health and well-being (2) and other reports. Ms Zsuzsanna Jakab, WHO Regional Director for Europe, opened the meeting and welcomed all participants including new Committee members. The third meeting since she took office, it came at an opportune moment, shortly before the World Health Assembly and the Standing Committee of the Regional Committee (SCRC). EACHR input would be invaluable on the key issues to be discussed. European Advisory Committee on Health Research page 3 Committee vice-chair Professor Róza Ádány, Head of the Department of Preventive Medicine, University of Debrecen, Hungary, was elected to chair the meeting. Dr Jane Salvage, independent consultant, United Kingdom, was elected meeting rapporteur. The agenda and programme were formally adopted. The role of EACHR Presentations In her opening address, the Regional Director underlined her commitment to strengthening the evidence base of the Regional Office’s work, and ensuring that efforts to implement the Health 2020 agenda were founded on the best available research evidence, data and information. She thanked the Committee for its commitment and valuable advice, including comments on these priority areas, and for its feedback on other work including the European health report. She also welcomed the Committee’s decision, following its second meeting in 2012 (3), to take a fresh look at its role as an advisory body to the Regional Director and the Regional Office; to create an action plan for 2013–2014; and to agree its process for interaction between formal committee sessions. In her view the key roles of the EACHR were to: • provide advice on whether WHO was addressing the right priorities, particularly in Health 2020, and identify any gaps (mindful that WHO was developing one global set of criteria to guide its choices, enable better coordination of effort and reduce duplication); • advise in their early stage of development whether WHO policies were evidence-based, which required synchronising the timing of EACHR inputs with the cycle of key WHO meetings; • identify gaps in evidence that WHO could help to tackle; and • map research capacity in the Region. The EACHR had recently undergone a number of changes. Regular teleconferences were being held to discuss progress and meeting agendas; an EACHR ShareFile had been established for better communication and sharing of information; WHO procedures were being followed, including electing a new chair every three years, and rotating the membership on the basis of geographical distribution. Resources permitting, it was hoped to hold two face-to-face meetings per year. The Regional Director thanked members for their patience and active participation. Joined by members, she also thanked outgoing Committee chair Professor Martin McKee, Professor of European Public Health, London School of Hygiene & Tropical Medicine, United Kingdom, for leading its work, and commended his enthusiasm and leadership. She invited the Committee to elect a new chair to serve for three years, by the end of the meeting. EACHR members had previously been requested to meet the WHO legal requirement to provide a written declaration of any potential conflicts of interest, and specify the names of all organizations from which they received personal remuneration. Professor Ádány reminded members to give the Secretariat full written details, and invited verbal declaration, to which Professor Helmut Brand, Professor Antoine Flahault, Professor Walther Ricciardi and Professor Vasiliy Vlassov responded. European Advisory Committee on Health Research page 4 Dr Claudia Stein, Director, Division of Information, Evidence, Research and Innovation, reminded members that the EACHR reported directly to the Regional Director. She invited them to review its initial terms of reference. EACHR responses Members reviewed the terms of reference in the context of both the Committee’s work in its two years of existence, and the key challenges for Europe as set out in The European health report 2012 and other reports. A number of points were made in discussion, as follows. The EACHR needed to grasp what was happening at the cutting edge of research in order to identify the most effective interventions. This should encourage new ways of intervening to improve health, and to deliver better health care. Examples were given from social science, and also from epigenetics research. This is highlighting the developmental origins of health and disease (DOHaD), suggesting that interventions are needed at the very beginning of life, and heralding a paradigm shift in diagnosis and care. The EACHR should work to strengthen public health capacity, which would help to ensure that research developments and knowledge were translated into public health policies. It should consider its role in building capacity in evidence-based health care, with a particular focus on the eastern part of the Region. Better mechanisms were needed to transfer knowledge. Health information systems needed to focus on knowledge, not just on data and information. Monitoring policies in a more timely fashion might require different data sources, suggesting a move away from traditional epidemiology. Social as well as biomedical science should contribute to and drive policy. Social science research was crucial in tackling all aspects and determinants of health along the life course, including the inequalities agenda. The artificial boundaries between social and biomedical research should be transcended, and their approaches integrated. The divide between health care and prevention of ill health was also unhelpful. Prevention was not an agenda only for the health care system, but required a multisectoral approach. The health care system should enhance multisectoral collaboration, do more and better preventive work, and increase the proportion of resources allocated to prevention. The different backgrounds and expertise of members could help the Committee to promote inclusive interdisciplinary approaches and collaboration. It was noted that longer life expectancy is accompanied by higher levels of disability that also affect people’s well-being. Disease-related indicators of well-being might have limited value; security and safety are key indicators for some people. The EACHR could also help WHO to explore scientific developments and participate in debate, for example in journals. On the terms of reference, it was agreed that points 2, 3 and 6 suggested the clearest foci. Point 9 was not an appropriate priority for the EACHR and would be dropped. The revised terms of reference are shown in Box 1. European Advisory Committee on Health Research page 5 Dr Stein, summarizing the discussion, said the main task now was to develop an EACHR action plan for 2013–2014 that picked up on these challenges and met the revised terms of reference. It would be a living document, reviewed and modified as required during and between meetings. She proposed an action plan template to be updated continually during the course of the meeting. The contents of this plan, and other action points that arose, are summarized below under ‘Conclusions and actions agreed’. Box 1. Revised EACHR terms of reference 1. Advise the Regional Director on formulation of policies for the development of research for health in the Region. 2. Review the scientific basis of selected WHO European Regional programmes, with particular attention to their translational aspects. 3. Advise the Regional Director on new findings emerging from research results regarding priority public health issues, and effective evidence-based strategies and policies to address them. 4. Facilitate dialogue and interaction among the public health community, research bodies and funding agencies in order to exchange information on research agendas in the Region and address evidence gaps in priority areas such as noncommunicable diseases. 5. Facilitate the compilation and review of the results of major research programmes addressing priority public health problems, and assess their implications for policy at the international, national and local levels. 6. Support the development of research potential and capability, nationally and regionally, with special attention to the eastern part of the Region. 7. Pursue the harmonization of research activities in the Region with the activities of other regions and at the global level. 8. Formulate as appropriate ethical criteria for public health research activities. Regional Director’s update The Regional Director offered updates and reflections on issues that had emerged since the second EACHR meeting, and that might be taken into account during the forthcoming meeting. She highlighted progress in the work of the Consultative Expert Working Group on Research and Development (CEWG) (see ‘Global health research and development’ below for a fuller report). The Regional consultation reflected considerable interest in finding ways forward, and endorsed in principle some of the group’s recommendations, though it was premature to talk about a binding convention. The issue would be raised again at the 2013 World Health Assembly. It promised to be an interesting process, and she hoped progress could be made to allow all countries to benefit from an improved and equitable climate for health research and development. The EACHR statement on the CEWG report had featured in the technical briefing and ‘matters arising’ agenda items during the 62nd session of the WHO Regional Committee for Europe, where it was read out to Member States. The Regional Director outlined plans to reform WHO financing, using the Assembly programme budget as the basis of resource mobilization. Eighty per cent of the global WHO budget comprised of European Advisory Committee on Health Research page 6 voluntary donations. This meant many funds were earmarked, which did not always allow work on priorities. On the positive side, two thirds of Member States in the Region were developing national health policies in line with Health 2020. The five-year increase in life expectancy over 30 years was a success story, but inequalities were of great concern. Infectious diseases still needed attention, as well as noncommunicable diseases, while environment and health accounted for 20% of the disease burden. High profile events were focusing on these issues and would be reported on later. Participants welcomed the update and made a number of observations to which the Regional Director responded. It was agreed that the European landscape was very different from 10 years ago, which suggested the need for clarification of the comparative advantages of WHO and how the EACHR could best advise the Regional Director, making effective use of members’ time and expertise. She said the normative function of WHO, which it exercised in a unique and democratic way, was its main comparative advantage. Members made specific points on particular issues: • the impact of smoking on health inequalities, and the relationship between obesity, alcohol and tobacco; • the need to recognize the key role of nurses and raise the status of the nursing profession; • the continuing importance of reproductive health; • how to develop the research agenda and transfer knowledge; • how WHO could support and influence the overall strengthening of biomedical and public health research in the Region, and contribute to decisions on this in the European Parliament; • the European Union’s commitment to health research as a well funded priority in its Seventh Framework Programme; • the important role of the European Commission (EC) – the Directorate-General for Research and Innovation recently published an independent report on the future of European public health research (4); • linking studies with capacity planning; • the importance of training scientists, including public health experts; and • the need for research questions and answers to assist and influence politicians, for example on tobacco which was the biggest risk factor. The Regional Director said WHO had to influence policy-making, and asked for the EACHR’s advice to help make the strongest possible case for the renewal and revitalization of public health in today’s environment. A different type of health governance was needed. Tobacco and alcohol remained very important WHO priorities, but agreeing actions was complex as some Member States were producers of tobacco and alcohol. Public health was becoming prominent again as the need to respond to address public health challenges was more widely understood. The adoption of Health 2020 and the European public health action plan (5) had created a unique opportunity to move this on. European Advisory Committee on Health Research page 7 Tackling Europe’s health priorities: from Moscow to Malta Presentation The Regional Director gave a presentation on the role, functions and recent outcomes of meetings of the WHO Regional Committee for Europe (RC), the democratic WHO decision-making body in the Region. It comprises representatives of all 53 Member States, and meets for four days every September. At these sessions, Member States formulate regional policies; supervise Regional Office activities; and comment on the regional component of the proposed WHO programme budget. Tracing the history of previous RCs, she said the main theme of RC60 (Moscow 2010) was Setting the agenda. It addressed key public health and health policy challenges, and how to move forward in the quest for better health. These included measles and rubella elimination and prevention of congenital rubella syndrome in the Region by 2015; poliomyelitis eradication; and the future of the European Environment and Health Process. Tackling the urgent health issues was the theme of RC61 (Baku 2011). It adopted five European action plans, all now being implemented: • prevent and control noncommunicable diseases, 2012–2016; • reduce the harmful use of alcohol, 2012–2020; • combat antibiotic resistance; • prevent and combat multidrug- and extensively drug-resistant tuberculosis, 2011–2015; and • combat the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), 2012–2015. This meeting also consulted on developing Health 2020; the governance of health in the 21st century; and how to address the social determinants. It also debated strengthening health systems, with a progress report on implementation of the Tallinn Charter (6) and the way forward, and an action framework for strengthening public health capacities and services. Health 2020, developed over two years through a participatory process, was adopted at RC62 (Malta 2012), where the theme was Laying the foundation for the future. The two key documents were the Health 2020 policy framework, that addresses governments and policy-makers, and the policy framework and strategy, that addressed public health professionals and researchers. The European public health action plan was the implementation arm of Health 2020. The forthcoming RC63 would focus on implementation, and debate two proposed new action plans, on vector-borne diseases and mental health (see further discussion below). The Regional Director shared the latest draft programme and invited views. She also outlined possible agenda items for future RC meetings. The sixty-fourth session (RC64, Copenhagen 2014) would provisionally review: • follow-up to the WHO European Ministerial Conference on Health Systems, held in Tallinn, Estonia in 2008; • preventing maltreatment and other adverse experiences in childhood; European Advisory Committee on Health Research page 8 • the action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases, 2012–2016 (7); and • the 35th anniversary of the adoption of the Declaration of Alma-Ata and the way forward for primary health care. RC65, in 2015, would provisionally look at urban health and health in other settings; how to scale up the settings-based approach; modern health service delivery, including hospitals, coordination of care and health care financing; and human resources for health, including implementation of the Global Code of Practice on the International Recruitment of Health Personnel (8). Nursing and midwifery issues, already raised by EACHR members, should have prominence. RC66, in 2016, would provisionally look at the implementation of Health 2020; the Sixth Ministerial Conference on Environment and Health planned for 2016; and follow-up actions on multidrug- resistant and extensively drug-resistant tuberculosis. The Regional Director asked the EACHR to advise whether these were the right priorities; what areas needed more research; recommendations on high level guests; and finding quick wins with policy- makers. EACHR responses Much discussion focused on the social determinants of health and the health divide – politically prominent and integral to Health 2020. The approach to looking at health systems and interfaces between blocks in the system proposed by the Commission on Social Determinants of Health (9) was becoming accepted, but not operationalized. The EACHR could review the public health function. A task force on the public health workforce should be part of the discussion on modern health services (partners could include the US National Board of Medical Examiners.) The impact of aspects of globalization on health systems should be analysed. The reintegration of public health in health systems could be combined with the Tallinn process and reflection on the Alma Ata legacy, as a component of primary health care. Health systems research capacity needed building, and innovative ideas on addressing multifactorial questions. Evidence was needed on how to strengthen research capacity in the Region and develop integrated, multisectoral models of care. It was important to take account of the EC agenda and the research that was commissioned. Nursing and midwifery should receive more WHO support and attention and the Regional programme should be strengthened. It should build on the professions’ many success stories in practical implementation of policies, prevention, public health, and making things happen. They were the major providers in many parts of the Region, especially rural and remote areas. Several members expressed concern about weaknesses in health leadership and the need to understand it better through research. It was agreed that the EACHR would establish a subgroup to propose actions in this area. It was suggested that the targets on noncommunicable diseases should be more ambitious – such as a ban on tobacco in the next three years, and tougher measures on alcohol including huge tax increases European Advisory Committee on Health Research page 9 and zero tolerance. The Regional Director said there were many political constraints and it was difficult to get global agreement on alcohol, so the approach had to be pragmatic and evolutionary. Communicable diseases should continue to be a priority. Research revealed not only issues with vaccination coverage, but also serious vaccine failures, for example with pertussis, hepatitis and measles. The basis and value of vaccinations campaigns was unclear, and commercial influences were strong. Better evidence of effectiveness was needed. The eastern part of the Region had the fastest-growing HIV epidemic in the world, with the number of people living with HIV/AIDS estimated to have tripled since 2000; this needed to be understood and tackled. Much data was still needed, as literature surveys revealed few studies of causality. Recent food safety scandals in the Region indicated a gap in tackling inadequate controls on processed food, and cross-border issues. It was not clear, though, whether WHO could add value on this issue. Occupational health was another important gap that should be addressed. Members wanted a clearer sense of what was happening at WHO global level, and timescales for those projects. It was important to avoid duplication. The 2012 European health report Presentation Dr Stein explained that the European health report was the Regional Office flagship publication, issued every three years as part of its mandate to monitor and report on the health of nearly 900 million people. The 2012 report has several purposes: to give policy-makers and public health professionals the epidemiological evidence underpinning Health 2020; to analyse social, economic and environmental determinants of health; to put well-being on the agenda as a marker of social progress; and to identify key challenges for health measurement and a collaborative agenda to collect, analyse, and make use of health data Region-wide. The first section of the report sets out current European health status and trends (summarized in Box 2). It shows that people across Europe are living longer, but with changing patterns of disease, and with increasing inequalities in health and its determinants. Life expectancy has increased to 76 years, mainly as a result of decreases in certain causes of death and improvements in the prevalence of risk factors and in socioeconomic and living conditions. Yet these improvements and the conditions that foster them have not been shared equally within and between countries – substantial differences persist and in many instances are increasing. The second section of the report presents the baseline for the six overarching targets selected to monitor progress for Health 2020. In 2011, RC61 agreed that Health 2020 would set out an action framework to accelerate attainment of better health and well-being for all; be adaptable to the different realities that make up the Region; and formulate regional targets for achievement by 2020. European Advisory Committee on Health Research page 10 Box 2. European health status and trends (1) Demographic trends The Region is undergoing important demographic and epidemiological changes that are shaping future needs for health promotion, disease prevention and care. These transitions are occurring at varying speeds and intensity in different country groups and populations, creating new challenges and a mosaic of health situations that require specific approaches. This highlights the major health challenges addressed by Health 2020. The population of the 53 Member States reached nearly 900 million in 2010. Decreasing fertility rates across the Region mean that population growth will soon plateau. The proportion of people living in urban areas reached nearly 70% in 2010 and is expected to exceed 80% by 2045. As a consequence, people are being exposed to different risks and determinants of health. An estimated 73 million migrants live in the Region, nearly 8% of the population. This inflow, mostly towards European Union (EU) Member States, comprises an increase of 5 million in the migrant population and accounts for nearly 70% of population growth since 2005. Life expectancy Life expectancy at birth has increased by five years since 1980. The largest increase of 6.5 years was observed in the EU15 subregion, while the average increase was only 1.5 years in the Commonwealth of Independent States (CIS) subregion, where life expectancy is considerably lower. Data from individual countries show large inequalities in life expectancy and years gained. Mortality Overall mortality from all causes of death continues to decline, to an age-standardized death rate of 813 deaths per 100 000 population in 2010. Mortality by age tends to be low or very low up to young adulthood, then rapidly doubles in EU15 countries and triples in the countries joining the EU since 2004 (EU12) and the CIS, continuing this rapid increase into older age. Mortality trends by and within country groups show wide variations, however. Child mortality indicators have continued to decline since 1990 and are the lowest in the world at 7.3 per 1000 live births. Causes of death Noncommunicable diseases produce the largest proportion of mortality, accounting for about 80% of deaths in 2009. Cardiovascular disease accounts for nearly half (35%) of all deaths in Europe, followed by cancer accounting for nearly 20%. Cancer has replaced cardiovascular disease as the foremost cause of premature death in 28 of the 53 countries. Distribution patterns by subregion have been changing over time. Communicable diseases are less common than in other parts of the world. The main concerns are related to tuberculosis, HIV, other sexually transmitted diseases and viral hepatitis. HIV incidence trend patterns differ among subregions but Europe is the only region in the world where HIV incidence is still increasing overall. Health determinants, health systems and inequalities Health inequities are a major concern in Europe, given the widening gap in life expectancy between and within many countries. Social determinants of health – the “causes of the causes” of health inequities – contribute to 50% of health inequalities, covering political, socioeconomic and environmental factors. Global evidence suggests that at least 25% of health inequalities (differences found within a country’s population) are caused by a lack of access to effective health services. This percentage increases when adding basic public health interventions. European Advisory Committee on Health Research page 11 The third section of the report addresses improving population well-being in the context of health, a core aspect of Health 2020. This is enshrined in the definition of health in the WHO Constitution (10): a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. To date, WHO has neither measured nor reported on well-being, however. This section, in order to incorporate well-being in its work and to develop a European target and relevant indicators by 2013, lays out issues and processes needed to develop a common concept and approach that allow for valid measurement and yield information useful to policy-makers and for programme evaluation. The concluding section identifies important measurement challenges in marking progress towards Health 2020 and outlines an agenda to meet them. This reflects the support that the Region offers countries to enhance health information collection, analysis and reporting at national level, as well as its work with the EC and Organisation for Economic Co-operation and Development (OECD) on a common integrated health information system for Europe. Participants discussed the report after the subsequent presentation on Health 2020. Targets and indicators for Health 2020 Presentation Dr Stein explained that in 2012 the Regional Office established two expert groups to advise on the development of around 20 indicators for the six Health 2020 goals adopted by RC62 (see Table 2). The first group advises on the measurement of and target-setting for well-being, and the second on indicators for the other targets. These groups have met several times and proposed indicators (11, 12). The indicators were subject to a web-based consultation with Member States following the third session of the Twentieth SCRC meeting in March 2013. Their inputs are being analysed and a revision will be presented to SCRC in May 2013, with a view to being submitted to RC63. Table 2. Goals and targets for Health 2020 (2) Health 2020 area Overarching goals or targets 1. Burden of disease and risk factors 1. Reduce premature mortality in Europe by 2020 2. Healthy people, well-being and determinants 2. Increase life expectancy in Europe 3. Reduce inequities in health in Europe 4. Enhance well-being of the European population 3. Processes, governance and health systems 5. Universal coverage and “right to health” 6. Member States set national targets/goals The expert groups felt that current evidence did not support the quantification of targets, except for target 1 on reducing premature mortality, where the target and indicators are fully aligned with the WHO Noncommunicable Diseases Global Monitoring Framework (13). The targets are therefore mostly qualitative and directional. The proposed indicators were established using the following principles and criteria: • As far as possible, they are routinely available in most countries. European Advisory Committee on Health Research page 12 • The final number should be kept to a minimum. • Because of availability and comparability issues, the indicators will not be able to reflect all relevant policy areas in a balanced way. • Indicators and targets already the subject of other collections (such as the Millennium Development Goals) are important but should not be repeated here. • Some indicators can serve several targets. • All rates reported by indicators should be age-standardized. • It is assumed that basic demographic information will also be included. • Where possible and available, indicator data should be reported disaggregated by age, sex and ethnicity and by socioeconomic, vulnerable and subnational group. • Indicators should be used for monitoring (and accountability) where possible, even if rates at national level are already favourable. • There should be a set of core (level 1) indicators that all Member States should monitor – a basic minimum to facilitate regional assessments – plus additional voluntary (level 2) indicators. • Core indicators need to be comparable across the Region as they will be used for regional target monitoring. Other indicators used at national level require only “internal” comparability. • Countries may report indicators in a qualitative way when quantitative information is not available. The indicators for target 4 (enhancement of well-being) include one subjective and several objective measures. The latter require further discussion with the expert group during 2013 but will follow the same principles. The objective domains may already be reflected as indicators for other targets. The subjective well-being indicator (life satisfaction) was selected as the most commonly available indicator through surveys in many Member States (including being reported by OECD and used in the 2013 EU Survey on Income and Living Standards). It is not available in all countries, so the Regional Office is negotiating with survey providers on the collection of this information. WHO will continue to work with its expert groups and Member States to develop further innovative indicators in other areas relevant to Health 2020, including governance, the whole-of-society and whole-of-government approaches, and resilient communities. This will ensure adequate coverage of all Health 2020 areas over time. The proposed WHO monitoring framework for targets and indicators capitalizes on its existing reporting mechanisms. Member States should not have to provide additional information except where non-routine data are required (potentially targets 4 and 6). Existing platforms should be used until a single Office-wide platform is established by merging all existing databases. Joint data collection with Eurostat and OECD feeds into these mechanisms. This platform will eventually be replaced by the integrated European health information system being established in collaboration with the EC and OECD. WHO proposes to provide a synthesis every 2–3 years of all data received through the existing mechanisms, in a planned new publication provisionally called European Health Statistics. The reporting is to be complemented by an abridged annual report on the Health 2020 indicators in the Regional Director’s RC report. Major milestone reporting on Health 2020 targets and indicators will European Advisory Committee on Health Research page 13 be done in the context of the European health report. The 2012 report provides the baseline, reflecting data from 2010. The first milestone report will be in 2015, followed by one in 2018 and a final report in 2020. The revitalized Highlights on Health series of country profiles could make progress quickly visible, alongside the revived brief annual publication on core indicators for all European countries. EACHR responses Following Dr Stein’s presentations, and in view of the submission of indicators to the forthcoming Regional Committee, the EACHR was invited to comment on the indicators proposed by the expert groups – particularly their feasibility, clarity, completeness, appropriateness and usefulness for monitoring the targets – and to identify any gaps. Members described it as a commendable but difficult initiative. So many things were already measured so we should think twice before measuring, and do the right thing right. A model and conceptual framework was needed, showing how the indicators related to the model of what WHO was trying to do, and relate indicators that could be clustered. The approach should be dynamic, and build in action to help those using the indicators. Advice should be offered on how the targets could be reached. Surprise was expressed at the absence of data from some countries. One member suggested that the focus of the alcohol consumption indicator on adolescence should be broadened. The appropriateness of the indicators on universal coverage and “right to health” was questioned. Dr Stein responded that Health 2020 provided the framework and the prompts for action, a pragmatic approach using solutions that worked. Agreeing the indicators was first step before discussing what others might be added. Reviews of specific WHO programmes Global health research and development Presentation Mr Robert Terry, Programme Manager, Research, Development and Policy, Division of Department of Public Health, Innovation and Intellectual Property, WHO headquarters, gave an update on the Consultative Expert Working Group on Research and Development: Financing and Coordination. WHO established the CEWG in 2010 in response to concern that insufficient resources were being devoted globally to research and development to address treatments for diseases that principally affected developing countries. The CEWG report, Research and development to meet health needs in developing countries: strengthening global financing and coordination (14), made recommendations focused on developing innovative approaches to supporting research and development; exploring new funding mechanisms; pooling resources between research funders/donors; strengthening research and development capacity and technology transfer; and framing these activities through a binding global instrument for research and development and innovation for health. European Advisory Committee on Health Research page 14 This report was discussed at a special meeting of Member States (15), resulting in draft resolution A66/23 for the World Health Assembly, May 2013 (16). This identifies four areas for action: the establishment of a research and development observatory for health; improving mechanisms for global level coordination of health research and development; exploring new mechanisms for financing research and development; and identifying demonstration projects to test the new mechanisms identified by CEWG. WHO developed four draft working papers exploring the potential for implementing these actions if the resolution is passed. Mr Terry highlighted other publications that might inform the work of the EACHR, with its shared interest in mapping health research and development. The first was a report of a recent WHO workshop that brought together the main actors in collecting data on research and development financing (17). The second was a paper that demonstrated how the International Clinical Trials Registry Platform could be used as an indicator to measure research and development activities across countries by disease type (18). Research and development is the theme of the forthcoming WHO world health report, to be launched at the United Nations General Assembly on 19 September 2013. One aim is to ensure that health remains on the international agenda after the Millennium Development Goals. EACHR responses Members welcomed the theme of the world health report and its launch as a platform for the work of the EACHR, and requested to be kept updated on the contents of the report. It was felt that the prevalence of clinical trials was an important starting point as an indicator of health research and development in a Member State, but there was a need to go beyond it and pay due attention to other indicators, for example health systems research. A process and methodology should be developed to broaden the agenda. Ethical considerations were very important, especially in countries where controls were weak or absent. The weakness of evidence on universal health coverage was of great concern. There were many public goods that the market was unlikely to provide, and issues that it could not solve, such as antibiotic resistance, and demonstration projects were needed. The social determinants of health and the health divide Presentation Sir Michael Marmot, Institute of Health Equity, University College London, United Kingdom, gave an overview of work on social determinants of health and the health divide. The Regional Director has invited him to lead a review of the issues in the European Region. Following discussions of its recommendations at RC62, the full report is expected shortly (19). Sir Michael explained how the review built on the work of the global Commission on Social Determinants of Health. He said the knowledge, evidence, and means of closing the health gap in a generation already existed. The question was one of political will. The review established an agenda for research – there was already enough evidence for action, but more was needed, with evaluation of what was being done and what difference it made. Some countries had taken concerted action that European Advisory Committee on Health Research page 15 reduced health inequalities, and there was enough evidence to suggest where the right domains for action lay; the research agenda was to check progress. Improving monitoring was a key recommendation, as successful implementation involved getting the measurement right. The underlying values of the review were social justice and human rights, and it took a life course approach, with an interest in vulnerabilities as well as exposures, and an emphasis on empowerment. Its four main themes were the life course, the wider society, the macro level context, and systems. Asking whether health inequities could be tackled without tackling social inequities, Sir Michael said the focus was on both the social gradient and excluded groups. A concern about equity meant being concerned about health. Child development, and how to improve the quality of children’s lives in hard economic times, as well as mental health, were prime areas for research. Perhaps the most challenging finding was about the nature of the welfare state, and what difference it made to health inequalities. EACHR responses Participants welcomed the update and commended the work. Asked what was his most challenging finding, Sir Michael said the nature of the welfare state, and what difference it made to health inequalities. He questioned why inequalities persisted even countries like Sweden that had effective and well funded welfare systems (the “Swedish paradox”). Surveillance and control of vector-borne diseases Presentation Dr Guenael Rodier, Director, Division of Communicable Diseases, Health Security and Environment, described the proposed new framework for the surveillance and control of invasive mosquito vectors and re-emerging vector-borne diseases, to be submitted to RC 63 (20). Vector-borne diseases are transmitted to humans and animals by insects or other arthropods. Malaria, West Nile fever, leishmaniasis and tick-borne diseases are a growing problem in the Region, driven by the globalization of trade and travel, continuous urbanization and climate change. Potentially severe diseases such as dengue and chikungunya fevers are on the rise owing to the northwards spread of Aedes mosquito species, and are also carried by travellers from disease-endemic countries. The framework addresses the threat posed by the spread of insect vectors, with a focus on the Aedes mosquito. It is intended to help Member States to detect and respond promptly to the spread of the mosquito and to re-emerging diseases. It also aims to create a Regional platform for facilitating and coordinating activities, including cross-border actions. EACHR responses Members acknowledged the increased activity of vector-borne disease in the WHO European Region and supported the proposed framework. They discussed whether the health sector invested effectively in surveillance, prevention and control, including the importance of serodiagnosis and the need to revitalize public health functions. They supported opportunities to build intersectoral partnerships, for instance with the tourist industry whose economy is vulnerable to vector-borne outbreaks. They also highlighted the impact of media coverage. European Advisory Committee on Health Research page 16 Nutrition, physical activity and obesity Presentation Ms Caroline Bollars, Technical Officer, Nutrition Policy, Division of Noncommunicable Diseases and Life-Course, gave an overview of the Regional nutrition, physical activity and obesity programme (21). Poor diet, overweight and obesity contributed to a large proportion of noncommunicable diseases, including cardiovascular diseases and cancer, the two main killers. Most national surveys indicated excessive fat intake, low fruit and vegetable intake and an increasing problem of obesity, all of which not only shortened life expectancy but also reduced quality of life. Most Member States now had government-approved policies dealing with nutrition and physical activity. Policy developments indicated that nutrition and physical activity spanned different government sectors. A 2006 WHO European Ministerial Conference approved a European charter on counteracting obesity (22). This offered guiding principles and action areas. Action should span government sectors, be international and involve multiple stakeholders. A monitoring system was set up to collect and analyse nutrition and physical activity surveillance and policy data on topics such as salt and marketing foods high in fat, sugar and salt. The WHO European action plan for food and nutrition policy 2007–2012 presented goals and targets, and identified six areas where integrated action could be taken in individual Member States and at Regional level (23). The Childhood Obesity Surveillance Initiative provided an example of harmonized surveillance data on which policy development in the Region could be based. It aims to measure routinely trends in overweight and obesity in primary schoolchildren, in order to understand the progress of the epidemic and enable intercountry comparisons. The first data collection took place during the 2007– 2008 school year in 13 countries; in 2013 the third round took place in 21 countries. The increases in childhood obesity, marketing of unhealthy food, and consumption of processed food high in salt, sugar and fat have resulted in an explosion in obesity, diabetes, cardiovascular diseases and cancer. Confronting this required putting health at the heart of policy-making, following the principles of governance and equity set down in Health 2020. Health ministers, experts and representatives of civil society will meet in July 2013 to discuss policies on diet, nutrition and physical activity at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020. The WHO Nutrition Guidance Expert Advisory Group and WHO collaborating centres and institutions supply the evidence base of the WHO programme. Ms Bollars outlined some key research areas that should be scaled up: • integrate a focus on equity and the social determinants of health in nutritional research; • develop a set of implementation indicators to evaluate national policies; • establish a surveillance system that facilitates comparability; • identify cost-effective interventions on diet, physical activity and obesity focused on active mobility and marketing food to children; • formulating targets for reducing intakes of salt, trans fat, fat and sugars; and European Advisory Committee on Health Research page 17 • highlighting best practice on the use of fiscal and price measures to influence diet and physical activity as part of the action plan. EACHR responses Members found the presentation stimulating and raised many points. They said studies were needed of the impact of different interventions. The importance of considering socioeconomic differences and cultural determinants was underlined. Clarity was needed about what levels of policy were being addressed. Obesity could be described as an industrial epidemic. There should be no victim-blaming or stigmatization of obese people. Attention should be paid to studies of prevention at the developmental stage – for example, stem cell research was suggesting that some chemicals such as pesticides could trigger the production of fat cells. The association of overweight with morbidity and mortality was not straightforward or obvious, and more data was needed to guide large-scale interventions. There was nevertheless a clear association between obesity and disability, including long-term conditions. Most weight gain took place in adult life and more effort was needed there. There should be different strategies for physical activity and nutrition. It was suggested that the action plan should focus on simply eating less, as well as eating healthily. Undernutrition, though a feature of some parts of the Region, was not well studied, with most relevant research conducted in richer countries. The issue of working with policy-makers and the public was raised, especially when the evidence was inconclusive and trends appeared to vary. Timely, reliable data were needed to underpin advice to ministers. Members proposed taking obesity as an exemplar or case study to demonstrate how to work with evidence and policy advice. Environment and health Presentation Dr Srdan Matic, Coordinator, Division of Communicable Diseases, Health Security & Environment, described the European Environment and Health Process, a health-in-all-policies platform initiated and led by the Regional Office since 1989 (24, 25). He outlined its history, and the scope of WHO work on environment and health, in particular the WHO European Centre on Environment and Health, Bonn, Germany. Environment and health is the oldest health-in-all-policies platform led by WHO. Traditionally a cornerstone of public health, it addresses health through population-based measures that tackle 20%of the burden of disease in the Region, mostly noncommunicable diseases. The health sector itself has a large environmental footprint that should be minimized. The process tackles priority 4 of the Health 2020 agenda, “Resilient communities and supportive environments”. Outlining its governance structure, Dr Matic described the key strategic issues and focus of the recently established European Environment and Health Ministerial Board, the “political face” of the process. The key strategic issues were as follows: • setting operational and strategic priorities; European Advisory Committee on Health Research page 18 • the emerging environment and health challenges in the Region; • policy frameworks and settings in the health and environment sectors; • establishing a coherent framework of principles, values, approaches and resources that could and support action in priority areas; and • creating a portfolio of specific actions that take into account existing commitments and contemporary developments in science and policy. The European Environment and Health Ministerial Board and the Regional Office are moving towards a renewed agenda in environment and health that aims to address issues of complexity, intersectorality and competition for political attention and resources, and to remain relevant to both the environment and the health sectors. Complexity concerns the interdependence of health and well- being with the economy, society, environment and resources, and main demographic and health trends. The new direction also aims to navigate the complex policy context of environment and health, including linkages with Health 2020 and the sustainable development agendas, as well as multilateral environmental and health agreements. The renewed vision for the process, “healthy societies in a safe environment”, is to enable the development of healthy, inclusive, equitable and economically productive societies in an environment, whose systems remain within the boundaries of safe operating conditions for human life. EACHR responses It was noted that the process had been successful, although the EU had failed to implement an environmental monitoring programme. Questions remained about whether environmental issues should cross-cut every sector, rather than being the responsibility of a dedicated government department. Integrating the process in the Regional Office was a challenge. The environmental component of ill health, and the significance of environmental hazards including the impact of environmental factors on genes and on inequalities, was vastly underestimated. Many environmental hazards cause dysfunctions and adverse effects on well-being that are not easily captured by the burden of disease concept. Likewise, developmental effects are generally ignored, as the outcomes appear many years later when the link to the exposures is hard to document. Genetic predisposition means that the disease burden is unevenly shared, as it depends on both exposures and on predisposition. The programme could address issues about the disease burden in a different way. There were opportunities to inspire WHO to use new tools and develop them in new ways. Research on the impact of implementation of national environmental and health plans, for example in Portugal, should be conducted. It was questioned whether translational research had clarified the global influence of European initiatives on clean air. There was much interest in translational research and exchange of experiences, but it should be developed further. Dr Matic responded that it was important for environmental health to have a dedicated policy home as well as being mainstreamed, to maintain a knowledge centre and awareness of environmental factors in disease. The environmental determinants of disease, like health, should be everybody’s European Advisory Committee on Health Research page 19 business. Huge infrastructural investment was needed to tackle many of the issues. The returns would be long term – not measurable even after five years. Mental health Presentation Dr Matt Muijen, Programme Manager, Division of Noncommunicable Diseases and Health Promotion, described progress on updating the 2005 European Mental Health Action Plan (26). The review was demanded to respond to continuing areas of need concerning well-being and mental disorders. Member States were considering how to take effective action in the fields of promotion, prevention, treatment and psychosocial rehabilitation. It is hoped that a draft resolution on the plan will be presented to RC63 (27). Mental disorders were among the greatest public health challenges in the Region, he said, as measured by prevalence, burden of disease and disability affecting more than a third of the population. In all countries, most mental disorders were much more prevalent among the most deprived people. Rising levels of unemployment in many countries were resulting in a growing prevalence of anxiety, depression and suicide. Vulnerable groups, including young people, minority groups and people with mental disorders, were disproportionately affected. The search for financial savings meant that service provision was often reduced at a time of growing need. Yet people also expected more choice and guarantees about accessibility, safety and effectiveness of services, and patient empowerment was seen as a right. The action plan aims to address these challenges as follows: • improve mental well-being and reduce the burden of mental disorders, with a special focus on vulnerable groups, exposure to determinants and risk behaviours; • respect the rights of people with mental health problems and offer equitable opportunities to attain the highest quality of life, addressing stigma and discrimination; and • establish accessible, safe and effective services that meet people’s mental, physical and social needs and the expectations of people with mental health problems and their families. It has seven objectives, proposing evidence-based actions by Member States and WHO that would achieve measurable outcomes in policy and/or implementation. Action 7 identified research priorities, and called for ongoing evaluation and more coordinated investment. There were four core objectives: 1. Everyone has an equal opportunity to realize mental well-being throughout their lifespan, particularly those most vulnerable or at risk. 2. People with mental health problems are citizens whose human rights are fully valued, protected and promoted. 3. Mental health services are accessible and affordable, available in the community according to need. 4. People are entitled to respectful, safe and effective treatment. European Advisory Committee on Health Research page 20 Its three cross-cutting objectives are that health systems provide good physical and mental health care for all; mental health systems work in well coordinated partnerships with other sectors; and mental health governance and delivery are driven by good information and knowledge. EACHR responses Members expressed great interest in the action plan as an important Regional health priority. There were some concerns about the plan, however; it needed better substantiated statements and a strategy for moving forward, with clear explanations. In particular, the evidence base of the plan needed to be strengthened and made more explicit. There was debate about the size of the evidence base on mental health. Some members perceived a lack of evidence on issues such as rehabilitation, and called for a research agenda that would also get the mental health community on board. The life course approach could be used in research cohorts. The plan should have a stronger focus on prevention. Developmental programming and the impact of early exposures and stresses on mental health later in life were highlighted – the evidence is incomplete but suggests that emphasis on children’s mental health would be a good investment, including prevention of neurotoxic exposures and other stresses. As Dr Muijen had highlighted, many determinants of health and well-being lay outside the scope of health services and even government action, and the linkages were very complex. The challenge was how to select the right focus in such a broad, difficult area. Actions with the greatest potential for impact should be identified, that could also open doors to other actions, and engage policy-makers and practitioners using examples from translational research. Conclusions and actions agreed EACHR action plan for 2013–2014 In the final session of the meeting, the Committee returned to the discussion of its role and work plan. Discussing the criteria for setting priorities, it was agreed that the action plan should above all be supportive of the Regional Director’s priorities and the WHO agenda. Dr Stein presented the latest version of the action plan, to be reviewed by the Secretariat and circulated to all members for discussion at the next teleconference. An updated version is given in Annex 1. More detail on key points is outlined below. Mapping The mapping of national health research systems capacities with special emphasis on eastern Europe, agreed at the second EACHR meeting, remains a priority. It will be discussed at a teleconference, supported by an updated concept note with points from previous discussions. Professor Højgaard will work with colleagues from Denmark and Sweden on a pre-mapping desk-based pilot exercise. They will look at publications across the Region to see what is currently available, and report to the next meeting. Existing summaries should be summarized to obtain an overview before starting detailed work. Attention should be paid to the quality of research, as well as the number of professorial chairs and other indicators. Lessons will be learned from the similar global exercise already conducted, the raw data on the European Region, and the EC public health review comments on research capacity. WHO collaborating centres, the European Medical Universities Council, and the Association of Schools of Public Health in the European Union will be asked to help and indicate what research they are undertaking. European Advisory Committee on Health Research page 21 Reviews of evidence and policy advice The EACHR will challenge the biased use of research conclusions swayed by vested interests, and use science proactively to advise WHO in a dynamic and forceful way. A guide to the evaluation of evidence could be produced. Members could prepare advance notes and act as discussants on WHO staff presentations on emerging policies. Noting the routine cycle of WHO meetings, the optimum timing of the EACHR inputs should be determined. To test and pilot the process, the evidence base of the Regional mental health policies and programme will be reviewed. Obesity will be used as an example/case study to demonstrate how to work with evidence and policy advice to politicians and thought leaders. Partnership, communication and dissemination Attention will be paid to the branding of the EACHR work to give it greater visibility, including information on its role and definition of evidence. News articles, editorials and position papers will be submitted to important journals, and tweets could be shared. EACHR governance and membership The Committee unanimously elected Professor Tomris Turmen as its new chair, to serve for three years. A paper will be submitted at the next formal EACHR meeting clarifying how to ensure continuity between chairs and in rotation of members, while paying full attention to geographical representation. New members from other disciplines will be sought to expand the EACHR skill and expertise set to encompass social science, economics, DOHaD and biomedical research, and to strengthen its multidisciplinary, inclusive focus. Special mention was made of nursing (noting that nurses and midwives had the ability to transfer knowledge in everyday language), and of genetics. Experts from different non-health domains such as economics, social science and education science will be invited to forthcoming meetings to contribute on specific issues, in order to widen connections and learn from other domains. EACHR activities are co-funded by WHO and committee members’ institutions. Wherever possible members will seek support from their alliances to fund agreed EACHR activities. Advocacy for funding should be undertaken. It was agreed the next formal EACHR meeting will have fewer agenda items for review. It will focus on developing proactive as well as reflective methods and work processes. Members will use creative techniques as well as more conventional committee procedures. For example, each member could give a five-minute “brain drop” of their ideas on new interventions and other observations, to stimulate fresh creative thinking. Evaluation of the meeting Participants commended the progress made at the meeting, its upbeat, proactive style and energy, and its focus on action. They said the presence and active involvement of the Regional Director had been key to its success. The interface between the different cultures of science and policy was a major issue in public health, and this interchange had been very useful. The Regional Director thanked all participants, particularly meeting chair Professor Ádány, and pledged her continuing commitment to taking a close interest in the EACHR. Professor Ádány then closed the meeting. European Advisory Committee on Health Research page 22 References 1. World Health Organization (2013). The European health report 2012. Charting the way to well- being. 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European Advisory Committee on Health Research page 24 24. World Health Organization (2013). European process on environment and health (http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/european- process-on-environment-and-health, accessed 18 June 2013). 25. World Health Organization (2012). Review of the European Environment and Health Process. EUR/RC62/SC(2)/5, 29 October. 26. World Health Organization (2005). Mental Health Action Plan. EUR/04/5047810/7, 14 January (http://www.euro.who.int/__data/assets/pdf_file/0006/99735/edoc07.pdf, accessed 18 June 2013). 27. World Health Organization (2013). European Mental Health Action Plan. EUR/RC62/SC(3)/8 130162, 25 February. European Advisory Committee on Health Research page 25 Annex 1 EACHR ACTION PLAN 2013–2014 Area of Terms of Reference Detailed steps Implemented by/commissioned from Follow up/facilitator in EACHR Deadline Type of output 1. Advise Regional Director on formulation of policies for development of research for health in Region General a. Expand skill and expertise set in the EACHR (e.g. social science, economics, DOHaD, biomedical, nursing) Framework with 5–6 areas from Secretariat. Members to suggest names. Professor Grandjean Next tele- conference List of names Branding of EACHR work to give it greater visibility b. Publicise EACHR activities, e.g. in news articles, Lancet opinion piece Secretariat, members Professor Tomson On agenda for each meeting EACHR- branded articles and news 2. Review scientific basis of selected WHO Regional Office for Europe programmes, with particular attention to translational aspects Reviews of mental health; life course; reproductive health; risk factors (tobacco, alcohol) Test and pilot review process by reviewing evidence base of draft Regional mental health action plan a. Identify member to present documents as discussant b. Send detailed written comments on draft Regional mental health action plan Secretariat All members Tele- conference in good time before meeting Immediate European Advisory Committee on Health Research page 26 Area of Terms of Reference Detailed steps Implemented by/commissioned from Follow up/facilitator in EACHR Deadline Type of output Define notion of ‘evidence’ and provide guide to evaluation of guidance Use obesity as case study of how to translate evidence into policy 3. Advise Regional Director on new findings emerging from research on priority public health issues; effective evidence-based strategies and policies Define European Public Health Research for use of EACHR a. Provide concept note for the next senior officials meeting of EC/WHO Professor Leys Professor Vlassov 30 June for circulation to members Concept note for next EACHR meeting Consider establishing clearing house function in the Regional Office 4. Facilitate dialogue and interaction to exchange information on research agendas, address evidence gaps and the translation of evidence into policy in priority areas a. Apply for workshop at EUPHA European Public Health conference to facilitate dialogue Professor Ricciardi 13–16 November 2013 b. Workshop at 16th European Health Forum Gastein to facilitate Professor Brand 2–4 October 2013 European Advisory Committee on Health Research page 27 Area of Terms of Reference Detailed steps Implemented by/commissioned from Follow up/facilitator in EACHR Deadline Type of output dialogue c. Involve EVIPNet Europe focal point in Secretariat to assess how best to capitalize on EVIPNet for this area Secretariat Professor Tomson or Professor Leys d. Use Twitter to share information All All e. Consider launch of World Health Report on research as platform for visibility Launch at United Nations General Assembly, 19 September 2013 5. Facilitate compilation and review of results of major research programmes addressing priority public health problems, and assess implications for policy at all levels Link HEN to evidence results from EACHR 6. Support development of research potential and capability, nationally and regionally, with Mapping of research capacity with special emphasis on eastern Europe a. Request Professor McKee to outline his preferred mode of involvement Professor Ádány and Regional Director Immediate Deter- mine action points for next tele- European Advisory Committee on Health Research page 28 Area of Terms of Reference Detailed steps Implemented by/commissioned from Follow up/facilitator in EACHR Deadline Type of output special attention to eastern part of Region b. Pre-mapping desk- based pilot exercise Professor Højgaard con and meeting Re-circulate bibliometric global assessment of research outputs conducted by WHO headquarters Mr Terry and Secretariat Immediate Involve EVIPNet Europe focal point in Secretariat to assess how best to capitalize on EViPNet for this area Secretariat Utilize public health capacity mapping conducted in EU by Maastricht University a. Circulate capacity mapping to members Professor Brand Recommend establishment of east- west partnership between academic entities to enhance capacity in public health research a. Request response from Professor McKee to assess whether EUPHA/ASPHER can move this forward Regional Director and Dr Roberto Bertollini Create ‘leadership for health’ task force under WHO auspices, to build capacity to transfer knowledge & facilitate links between research a. Propose terms of reference and canvass for suitable people through EACHR Professor Ricciardi and Professor Tomson European Advisory Committee on Health Research page 29 Area of Terms of Reference Detailed steps Implemented by/commissioned from Follow up/facilitator in EACHR Deadline Type of output and evidence 7. EACHR governance Ensure continuity between chairs and in rotation of members, paying full attention to geographical representation Determine optimum timing of EACHR inputs to align with routine cycle of WHO meetings a. Paper to be submitted at next formal EACHR meeting Secretariat Secretariat Next formal meeting European Advisory Committee on Health Research page 30 Annex 2 MEETING AGENDA Thursday, 2 May 2013 Opening, welcome and introduction (EACHR Vice-chair) Opening address (Regional Director) Outline of meeting agenda (WHO Secretariat) Session 1: Regional update, vision and scope of EACHR (Regional Director and WHO Secretariat) • Review of the Terms of Reference • Agreement on vision and scope of the EACHR • Key priorities for Europe Formulation of action plan (WHO Secretariat) • Identify key areas of work for EACHR 2013-2014 • Propose concrete tasks to be carried out for each area of work Session 2: Update on the Consultative Expert Working Group on Research and Development (Mr Robert Terry) Session 3: The European Social Determinants Review (Sir Michael Marmot) Friday, 3 May 2013 Summary of day 1 (Dr Jane Salvage, Rapporteur) Session 1: From Moscow to Malta (Regional Director) • Review of previous WHO European Regional committees • Preview of RC 63 agenda • Advise on research implications of items proposed • Identify gaps in agenda in relation to research Session 2: Nutrition, physical activity and obesity (Ms Caroline Bollars) Review of health 2020 indicators and targets (Dr Claudia Stein) • Advice on indicators proposed by the expert groups European Advisory Committee on Health Research page 31 • Comments on the feasibility, clarity, completeness, appropriateness and usefulness for monitoring Health 2020 targets • Identify gaps in indicators for Health 2020. Vector-borne diseases (Dr Guenael Rodier) Environment and health (Dr Srdan Matic) Mental health (Dr Matt Muijen) Session 3: Review of EACHR action plan (WHO Secretariat) Conclusions and closing remarks (EACHR Vice-chair, Regional Director and WHO Secretariat) Close of meeting European Advisory Committee on Health Research page 32 Annex 3 LIST OF PARTICIPANTS Temporary advisers Professor Roza Ádány Head of Department of Preventative Medicine, University of Debrecen H-4028 Debrecen, Hungary Professor Fernando Rodriguez Artalejo Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid Arzobispo Morcillo, 28029 Madrid, Spain Professor Helmut Brand Professor of European Public Health, Maastricht University Maastricht 6200 MD, The Netherlands Professor Antoine Flahault Professor of Public Health, School of Medicine Descartes, Sorbonne Paris Cité 92140 Paris, France Professor Philippe Grandjean Institute of Public Health, University of Southern Denmark DK-5000 Odense C, Denmark Professor Liselotte Højgaard Chair, Danish National Research Foundation DK-1057 Copenhagen K, Denmark Professor Maksut Kulzhanov Director General, Republican Centre for Health Development 050000 Astana, Kazakhstan Professor Mark Leys, Vrije Universiteit Brussels B-1090 Brussels, Belgium Professor Ruta Nadisauskiene Head of Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences LT-50009 Kaunas, Lithuania Professor Jose Pereira-Miguel President, Instituto Nacional de Saúde Dr. Ricardo Jorge P-1649-016 Lisbon, Portugal European Advisory Committee on Health Research page 33 Professor Walter Ricciardi Director, Department of Public Health, Università Cattolica del Sacro Cuore 00168 Rome, Italy Dr Jane Salvage (Rapporteur) Independent consultant, Jane Salvage Limited London N5 1BN, United Kingdom Professor Göran Tomson Head, Health Systems Policy, Karolinska Institutet SE-171 77 Stockholm, Sweden Professor Tomris Turmen President, International Children's Centre 06800 Bilkent, Ankara, Turkey Professor Vasiliy Vlassov President, Society for Evidence Based Medicine 109451 Moscow, Russian Federation Dr James Whitworth Head of International Activities, Wellcome Trust London NW1 2BE, United Kingdom Observer Dr Vanessa Campo-Ruiz Science Officer to the Chief Executive, European Science Foundation BP 90015, 67080 Strasbourg, France (Via WebEx) World Health Organization Regional Office for Europe Ms Zsuzsanna Jakab, Regional Director Dr Roberto Bertollini, Chief Scientist and WHO Representative to the European Union Office of the Regional Director Ms Caroline Bollars Technical Officer, Division of Noncommunicable Diseases and Life-course Dr Nedret Emiroglu Deputy Director, Division of Communicable Diseases, Health Security & Environment European Advisory Committee on Health Research page 34 Ms Kate Frantzen Programme Assistant, Division of Information, Evidence, Research and Innovation Ms Melodie Karlson Programme Assistant, Division of Information, Evidence, Research and Innovation Dr Matt Muijen Programme Manager, Division of Noncommunicable Diseases and Life-course Mr Arun Nanda Senior Strategy & Policy Advisor, Office of Regional Director Dr Lucianne Licari Executive Manager, Office of Regional Director Dr Srdan Matic Coordinator, Division of Communicable Diseases, Health Security & Environment Ms Leen Meulenbergs Executive Manager, Office of Regional Director Dr Piroska Östlin Programme Manager, Division of Policy and Governance for Health and Well-being Dr Guenael Rodier Director, Division of Communicable Diseases, Health Security & Environment Dr Claudia Stein Director, Division of Information, Evidence, Research and Innovation Headquarters Mr Robert Terry Programme Manager, Research, Development and Policy
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