Seventieth Regional Committee for Europe: virtual session, 14–15 September 2020: progress report on the implementation of the Action Plan to Strengthen the Use of Evidence, Information and Research for Policy-making in the WHO European Region

W O RL D HE AL TH O R GAN I ZA T I ON RE GI ON AL O FF I CE FO R EU RO PE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC70/8(F) 70th session Virtual session, 14−15 September 2020 3 August 2020 200568 Provisional agenda item 6 ORIGINAL: ENGLISH Progress report on the implementation of the Action Plan to Strengthen the Use of Evidence, Information and Research for Policy-making in the WHO European Region This progress report describes the progress made in implementing the Action Plan to Strengthen the Use of Evidence, Information and Research for Policy-making in the WHO European Region, in accordance with the commitments made through the adoption of resolution EUR/RC66/R12 by the WHO Regional Committee for Europe at its 66th session in 2016. This report is submitted to the WHO Regional Committee for Europe at its 70th session in September 2020, in line with resolution EUR/RC66/R12. EUR/RC70/8(F) page 2 Background: the need for strengthened action in Europe 1. Evidence-informed policy-making (EIP) aims to ensure that the best available data, information and research evidence are used to formulate policies for improving the health of individuals and populations. EIP is a core function of WHO and is supported by World Health Assembly resolutions WHA58.28, WHA58.34, WHA60.27 and WHA66.24, and decision WHA66(12), as well as by the Thirteenth General Programme of Work, 2019–2023. Overview of the Action Plan 2. The purpose of the Action Plan to Strengthen the Use of Evidence, Information and Research for Policy-making in the WHO European Region is to consolidate, strengthen and promote the generation and use of multidisciplinary and intersectoral evidence for health policy-making, in alignment with the health-related Sustainable Development Goals (SDGs) and the Health 2020 policy framework. The adopted Action Plan includes four action areas to promote systemic changes for the achievement of the Action Plan’s long-term vision and goals. 3. Notable achievements and the way forward with regard to the WHO Regional Office for Europe’s activities to support Member States in implementing the Action Plan can be found in the Annex to the present report. Action area 1: strengthening health information systems, harmonizing health indicators and establishing an integrated health information system for the WHO European Region 4. The European Health Information Gateway and its data warehouse have been maintained, and new and updated visualizations are being developed for the data obtained in the 2018 Health Behaviour in School-aged Children survey and for 2019–2020 influenza data. 5. The European Health Information Initiative (EHII) has continued as the framework for coordinating and implementing activities outlined in the Action Plan. The health information networks of the EHII are operational, while the European Burden of Disease Network is developing a manual for countries to conduct national burden of disease studies. 6. Other activities implemented under Action area 1 include the assessment of health information systems in 12 countries1 and the publication of several health information products, such as the European health report 2018, country profiles of health and well-being, and the annual Core Health Indicators in the WHO European Region. Action area 2: establishing and promoting national health research systems to support the setting of public health priorities 7. Since 2016, in line with the Action Plan’s recommendations, the Regional Office has produced 25 peer-reviewed Health Evidence Network (HEN) synthesis reports in 1 Albania, Andorra, Bosnia and Herzegovina, Bulgaria, Ireland, North Macedonia, Republic of Moldova, Slovakia, Slovenia, Turkmenistan, Ukraine and Uzbekistan. EUR/RC70/8(F) page 3 collaboration with all other divisions of the Regional Office.2 The HEN synthesis reports have gained recognition as core evidence for public health decision-making in the European Region, with quality assurance processes centralized within the Secretariat of the Regional Office. The HEN synthesis reports have strengthened the Organization’s normative role and mandate in articulating ethical and evidence-based policy options. These reports summarize what is known about a particular policy issue, gaps in the evidence and areas under debate, with the objective of supporting policy-makers to make use of the best available evidence in their own decision-making. HEN has, for instance, collaborated closely with the Migration and Health team at the Regional Office to systematically gather heterogeneous, geographically dispersed and multisectoral evidence on the health of refugees and migrants, published in 10 HEN synthesis reports to date, which inform policy and practice. The HEN synthesis report 67 on arts and health won the 2019 Global Aesthetic Achievement of the Year award from Finland and is the most downloaded publication from the Regional Office’s website from November 2019 to April 2020 (with over 33 000 downloads), while the HEN report on the use of narrative research in the health sector received a prestigious British Medical Association Medical Book Award in 2017. HEN synthesis reports are available through the PubMed archive (NCBI Bookshelf), facilitating access, dissemination and outreach, and are published in multiple formats to ensure user-friendliness. In response to the COVID-19 pandemic, HEN has broadened its portfolio of evidence synthesis products, so that the process of collecting the best available evidence on answering an urgent policy question is tailored to shorter timelines: rapid reviews (delivered in three months) and rapid responses (delivered in 10 days). Despite shortened production timelines, both of these newly introduced products maintain a rigorous methodology to ensure that the best available research evidence is used in the Regional Office’s COVID-19 guidance documents in support of countries’ decision-making. 8. The Action Plan also urges Member States to establish and promote national health research institutes and systems to support the setting of public health priorities. The WHO European Health Research Network (EHRN), currently comprising seven Member States in eastern Europe and central Asia (Armenia, Bulgaria, Estonia, Georgia, Kyrgyzstan, Lithuania and Ukraine), was launched at the end of 2017, reconfirming these Member States’ strong commitment to the Action Plan. The EHRN promotes a systems approach in order to: align the health research agenda with health policy priorities and goals; facilitate ethical, fair and high-quality research through effective synergies across sectors and disciplines; enhance the institutional capacity of ethics review boards to promote transparency and accountability in research and the use of international clinical trial registries; and ensure the use of health research for strengthening health systems. Within the scope of the EHRN, a framework for developing or strengthening national health research systems and a process for setting public health research priority agendas are currently being developed, to be available by the time of the 70th session of the WHO Regional Committee for Europe. 9. The European Advisory Committee on Health Research is the Region’s highest-level consultative body on all health research matters, directly advising the WHO Regional Director for Europe. It reviews the scientific basis of programmes in the Region and has recently provided ad hoc operational and technical expertise to the Regional Office on topics such as big data, childhood obesity, immunization, implementation research and mental health. Three thematic subgroups provided the previous Regional Director and her Office with strategic guidance on health and migration, evidence-informed policy and implementation research, informing, inter alia, the development of new action plans and resolutions for submission to 2 The complete list of HEN synthesis reports is available at http://www.euro.who.int/en/data-and- evidence/evidence-informed-policy-making/publications/evidence-reports/evidence-reports EUR/RC70/8(F) page 4 the Regional Committee, and research agendas. With the new Regional Director having taken office in February 2020, the Advisory Committee is expected to change composition and mandate in order to be well positioned to support the Regional Director’s Office and the new European Programme of Work. 10. A guiding principle of the Action Plan is to promote local knowledge for local decision- making. The cultural contexts of health and well-being project, working with the Mental Health and Mental Disorders programme at the Regional Office and the WHO Collaborating Centre on Culture and Health at the University of Exeter, United Kingdom of Great Britain and Northern Ireland, organized several workshops in Belarus and Ukraine on the topic of early life trauma. This resulted in a collection of stakeholder essays by the participants, in which the health systems challenges in relation to early life trauma are elaborated from different perspectives, using an engaged, bottom-up research approach. In addition, working with colleagues across the Organization, the project produced a number of synthesis papers on topics including alcohol consumption, tobacco control and obesity, which sought to situate these public health challenges in the historical, social, and cultural contexts of the European Region. These synthesis papers provide important background evidence for Member States across the Region to consider when formulating polices on these topics. 11. In line with the recommendations of the Action Plan, the Regional Office has been publishing Public Health Panorama (14 issues since the Action Plan was adopted). This quarterly, peer-reviewed, bilingual (English and Russian), open access, fee-free journal aims to disseminate good practices and new insights in public health from the Region’s 53 Member States. By publishing in both English and Russian, and by accepting manuscripts in those two languages, the journal innovatively allows different parts of the Region to share their knowledge and experience. The journal has been gradually gaining in reputation: the number of submissions in response to its calls for papers has grown to approximately 150 manuscripts per year, and some issues have been downloaded more than 1500 times. Several issues of the journal were published with generous financial assistance from the Ministry of Health of the Russian Federation, and one issue with the support of the Federal Ministry of Health of Germany. Action area 3: increasing country capacities for the development of evidence-informed policies (knowledge translation) 12. The WHO Evidence-informed Policy Network (EVIPNet) Europe has, since 2013, expanded to include 23 member countries and has become the most dynamic regional knowledge translation network in the world. One of the main pillars of EVIPNet Europe in increasing country capacities for the development of evidence-informed policies is the organization of network-wide multicountry workshops aimed at improving participants’ skills and knowledge in identifying, appraising, synthesizing and using research evidence in policy development. These network meetings have also fostered regional collaboration and the exchange of knowledge and experience. Seven workshops have been organized so far, each dedicated to a slightly different aspect of knowledge translation. In addition, a series of regular webinars have been convened and a virtual EVIPNet Europe platform has been made available, with over 100 subscribers, which also supports peer learning and mentoring between Member States. 13. EVIPNet Europe supports countries in developing knowledge translation tools at country level and has published a range of guidance material. The key tool for implementing EUR/RC70/8(F) page 5 knowledge translation activities at country level is the evidence brief for policy (EBP), which offers a concise synthesis of the best available research evidence on how to address a specific policy problem. The development of an EBP by a Member State is supported by in-person or virtual training workshops, guidance and mentoring. These briefs are followed by nationally conducted policy dialogues involving a broad spectrum of stakeholders, informing and catalysing national policies and legislative changes. Recently, attention has been focused on developing capacities for rapid response synthesis. 14. EVIPNet Europe has made considerable progress at country level. Six EBPs on various national high-priority topics, such as alcohol control legislation, sugar-sweetened beverages, primary health care and antimicrobial resistance (AMR), have been published and many more are in the pipeline, and in collaboration with the AMR programme a new cohort of countries is planned to embark on developing EBPs on AMR. These EBPs have influenced policy discussions and legislative changes and are fostering the systematic use of sound and robust health information and research evidence. For instance, following dissemination of the EBP in the Republic of Moldova, changes to the country’s alcohol policies, including on taxation, have been implemented; in Estonia, the EBP on sugar-sweetened beverages catalysed government discussions; in Poland, the EBP supported the development of legislation on primary health care; and the findings of the Hungarian EBP on AMR led to changes in the medical curricula. Moreover, five countries (Estonia, Hungary, Kyrgyzstan, Poland and Slovenia) have finalized situation analyses of their particular EIP context, providing a clear baseline and options for institutionalizing EIP mechanisms. These countries have also mobilized and discussed with key stakeholders the prospects and plans for establishing a knowledge translation infrastructure in the country. In addition, Hungary has announced the establishment of a permanent structure for rapid response synthesis. 15. EVIPNet Europe is built on strong collaboration. Cooperation with technical programmes in the Regional Office has led to innovative approaches to supporting countries in the development of EBPs on AMR: two cohorts of countries are finalizing their briefs and a third cohort is being launched. EVIPNet Europe works closely with external partners such as the McMaster Health Forum, the Wellcome Trust and Cochrane, including Cochrane Nordic and Cochrane Russia. EVIPNet Europe has also continued to build relationships with other regional EVIPNet networks for improved knowledge and capacity exchange. Plans are being made to further extend the network by establishing a collaborating centre within Ben Gurion University of the Negev, Israel. The EVIPNet Europe Secretariat received voluntary contributions from the German Federal Ministry of Health in 2016–2019 to implement its activities. Action area 4: mainstreaming the use of evidence, information and research in the implementation of Health 2020 and other major regional policy frameworks 16. With its 23 member countries, EVIPNet Europe has established mechanisms for the integration and exchange of evidence for policy-making. Since 2017, a focus of EVIPNet Europe has been on scaling up evidence-informed efforts against AMR. The Secretariat of EVIPNet Europe, based in the Regional Office, and the AMR Programme have strategically joined forces with WHO country offices to assist with country led processes to develop evidence briefs for policy on AMR, which inform the development or revision of national AMR action plans and strategies in the Region. EUR/RC70/8(F) page 6 17. Volume 4, issue 2 (June 2018) of Public Health Panorama contributed to the implementation of action area 4 by featuring an article entitled “Evidence-informed Policy Network (EVIPNet) Europe: success stories in knowledge translation”.3 The article presented a descriptive study of the experiences of Estonia, Hungary, Kazakhstan, Poland and the Republic of Moldova in implementing EVIPNet Europe, and how EVIPNet membership and tools benefited them in their endeavours to improve and institutionalize evidence-informed health policy-making. 18. The development of the common set of indicators for the Joint Monitoring Framework for SDG 3 indicators, Health 2020 and the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 was a major activity under the EHII to reduce the reporting burden for Member States. Thorough mapping of the 40 indicators in the three frameworks had revealed that the indicator methodologies matched to a high degree. In a second step, in 2018–2019, the Joint Monitoring Framework indicators were matched against existing indicators in the European Health Information Gateway. 19. A Member State consultation conducted in 2018 recommended that work should be done on more qualitative methods to capture the subjective nature and experiences of concepts such as “well-being”, “resilience”, or “empowerment” and that the use of more narrative research to supplement quantitative data should be explored. Working with Member States, WHO piloted a health and well-being report template which, alongside traditional quantitative data, included narrative analysis of key themes as expressed in novels, films, artworks, and other forms of cultural output of a country. A pilot “Profile on health and well- being” is due for publication in August 2020. 20. Furthermore, WHO launched an expert group to enhance Health 2020 monitoring and reporting, which resulted in a series of HEN reports on how best to report on the following important health-related concepts, both at regional and at country levels: community empowerment, community resilience, the life-course approach, and the whole-of-society approach. The HEN reports highlighted policy considerations that Member States should be aware of when developing reporting strategies for these key concepts. Next steps 21. The Division of Country Health Policies and Systems, together with all the other technical divisions in the Regional Office and with WHO country offices, will continue to implement the Action Plan to Strengthen the Use of Evidence, Information and Research for Policy-making in the WHO European Region. Particular efforts will be made to provide the best available evidence, information and research in a timely manner to decision-makers and to strengthen the regional response aimed at mitigating and containing the COVID-19 pandemic. 3 Available at http://www.euro.who.int/__data/assets/pdf_file/0003/375078/EVIPNET.pdf?ua=1. EUR/RC70/8(F) page 7 Annex 1. Annex. WHO Regional Office for Europe activities to support Member States in implementing the Action Plan – notable achievements and the way forward Action area 1 1. The functions and use of the European Health Information Initiative should be reviewed. The terms of reference of the Initiative should be reviewed and changed in consultation with Member States to reflect current progress in relation to health information and changing needs. 2. Enhanced collaboration on the production of health information with key partners (the European Commission, the Organisation for Economic Co-operation and Development, the World Bank, the United States Agency for International Development, etc.) is needed. A high-level dialogue should be opened to coordinate and improve the Regional Office’s response to countries. A mapping exercise led by country offices of existing projects and initiatives could be a potential starting point. 3. The publications related to monitoring, analysis and forecasting (the European health report, Core Health Indicators in the WHO European Region, Country Health Profiles, etc.) need to respond to countries’ interests. WHO Regional Office for Europe’s data and health information publications should be more country oriented and more engaging (using infographics, maps and other graph types). 4. The European Health Information Gateway has substantially expanded and evolved since 2016. It currently consists of five major databases, including Health for All, four monitoring and seven reporting indicator data sets, such as Health 2020 and Health Behaviour in School-aged Children survey data, and 26 public health themes, on topics such as air quality. In addition, the health statistics mobile app provides easy, mobile access to key data for users. The Gateway is provided in both English and Russian languages and has proven to be a useful information platform for presentation of health information to professionals as well as the general public, including the media. However, in order to carry those benefits into the future it needs sustainable maintenance and innovative features so as to be able to fully incorporate the indicators of WHO’s Thirteenth General Programme of Work Impact Framework. Since usability techniques are continuously evolving, the Gateway would benefit greatly from investments in enhanced usability features, in particular in the area of data entry and incorporation of new indicator data. This would shorten the time span from the definition of new indicators to the publication of data on the Gateway, which currently can take up to two months. In the event of emergencies, daily updates would be needed for specific datasets. Concepts for rapid updating are under discussion within the Gateway team. Action area 2 5. The Health Evidence Network (HEN) synthesis reports have been recognized as an authoritative, credible source of evidence, strengthening the Regional Office’s general role as an evidence-based organization. As a response to the current COVID-19 emergency, the HEN product portfolio has been expanded to incorporate rapid evidence synthesis methods. Furthermore, and to meet the emerging needs of public health decision-makers in the Region, HEN will continue to innovate and improve synthesis methodologies, including innovative methods such as evidence gap maps and tailored summaries. EUR/RC70/8(F) page 8 6. With the WHO European Health Research Network (EHRN), the Regional Office has established an important new network focusing on strengthening national health research systems, which, particularly at times when the world is responding to a global pandemic, are key to generating high-quality and context-relevant evidence required for delivering and scaling-up safe front-line services, and for planning an effective public health response. The Network will continue expanding its assistance and technical support to Member States, in particular in eastern Europe and central Asia. 7. With a focus on using local knowledge for local decision making, the Regional Office has trialed an innovative, bottom-up methodology for co-creating insights for policy-makers. The first in this series of “stakeholder narratives” is a collection of essays from stakeholders who work with early life trauma in Belarus and Ukraine. This methodology will continue to be expanded, to explore other health challenges that would benefit from such an engaged, localized approach. Action area 3 8. The WHO Evidence-informed Policy Network (EVIPNet) has developed and made available several knowledge translation tools and guidelines to support countries in advancing evidence-informed policy-making. Further development of tools is needed and has been planned, especially in the area of supporting countries in adapting norms and guidelines to their particular contexts in order to improve the country relevance and impact of the tools, especially during emergencies. 9. EVIPNet has attracted significant country interest, and with 23 member countries is the most dynamic regional knowledge translation network worldwide. Support to eastern European and central Asian countries is expected to be strengthened. Moreover, there is potential to catalyse reciprocal learning, peer support and exchanges of experience between more advanced network members and newer member countries, irrespective of the countries’ socioeconomic development levels. 10. EVIPNet has built a strong network of collaboration with academia and various relevant organizations. However, in order to ensure the sustainability of the work and high-level methodological support, a network of WHO collaborating centres in evidence-informed health policy-making needs to be established, expanded and managed. Action area 4 11. The cultural contexts of health and well-being (CCH) project has produced several HEN reports exploring qualitative approaches to health monitoring. In order to better understand the values-based concepts that are embedded in modern health frameworks and policies, CCH completed a series of scoping reviews that examine how “well-being”, “resilience”, “empowerment”, “life-course approach implementation” and “whole-of-society approach implementation” can be better measured, both quantitatively and qualitatively. Efforts are now underway to work with countries to implement the policy considerations from these HEN reports. 12. CCH has kickstarted a new area of work to explore the evidence for how the arts can promote health, prevent ill health, manage disease and treat illness. This groundbreaking work is bringing together several Member States (including Denmark, Finland, Norway, Sweden and the United Kingdom of Great Britain and Northern Ireland) that are looking to integrate EUR/RC70/8(F) page 9 arts and health interventions into their health systems. To build on the gains made with the publication of the HEN report on arts and health, a network of partners and stakeholders is being curated to begin arts and health interventions in other countries (such as Romania). = = =