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Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis

Authors: Jacqueline Müller-Nordhorn, Christine Holmberg, Klara G Dokova, Neda Milevska-Kostova, Gratiana Chicin, Timo Ulrichs, Bernd Rechel, Stefan N Willich, John Powles, Peter Tinnemann

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

There is a major gradient in burden of disease between Central and Eastern Europe compared to Western Europe. Many of the underlying causes and risk factors are amenable to public health interventions. The purpose of the study was to explore perceptions of public health experts from Central and Eastern European countries on public health challenges in their countries.

Methods

We invited 179 public health experts from Central and Eastern European countries to a 2-day workshop in Berlin, Germany. A total of 25 public health experts from 14 countries participated in May 2008. The workshop was structured into 8 sessions of 1.5 hours each, with the topic areas covering coronary heart disease, stroke, prevention, obesity, alcohol, tobacco, tuberculosis, and HIV/AIDS. The workshop was recorded and the proceedings transcribed verbatim. The transcripts were entered into atlas.ti for content analysis and coded according to the session headings. After analysis of the content of each session discussion, a re-coding of the discussions took place based on the themes that emerged from the analysis.

Results

Themes discussed recurred across disease entities and sessions. Major themes were the relationship between clinical medicine and public health, the need for public health funding, and the problems of proving the effectiveness of disease prevention. Areas for action identified included the need to engage with the public, to create a better scientific basis for public health interventions, to identify “best practices” of disease prevention, and to implement registries/surveillance instruments. The need for improved data collection was seen throughout all areas discussed, as was the need to harmonize data across countries.

Conclusions

To reduce the burden of disease across Europe, closer collaboration of countries across Europe seems important in order to learn from each other. A more credible scientific basis for effective public health interventions is urgently needed. The monitoring of health trends is crucial to evaluate the impact of public health programmes.
Literature
2.
go back to reference Müller-Nordhorn J, Binting S, Roll S, Willich SN: An update on regional variation in cardiovascular mortality within Europe. Eur Heart J. 2008, 29: 1316-1326.CrossRefPubMed Müller-Nordhorn J, Binting S, Roll S, Willich SN: An update on regional variation in cardiovascular mortality within Europe. Eur Heart J. 2008, 29: 1316-1326.CrossRefPubMed
3.
go back to reference Rehm J, Sulkowska U, Mańczuk M, Boffetta P, Powles J, Popova S, Zatoński W: Alcohol accounts for a high proportion of premature mortality in central and eastern Europe. Int J Epidemiol. 2007, 36 (2): 458-467. 10.1093/ije/dyl294.CrossRefPubMed Rehm J, Sulkowska U, Mańczuk M, Boffetta P, Powles J, Popova S, Zatoński W: Alcohol accounts for a high proportion of premature mortality in central and eastern Europe. Int J Epidemiol. 2007, 36 (2): 458-467. 10.1093/ije/dyl294.CrossRefPubMed
4.
go back to reference Kesteloot H, Sans S, Kromhout D: Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J. 2006, 27: 107-113.CrossRefPubMed Kesteloot H, Sans S, Kromhout D: Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J. 2006, 27: 107-113.CrossRefPubMed
5.
go back to reference Zatoński WA, McMichael AJ, Powles JW: Ecological study of reasons for sharp decline in mortality in Poland since 1991. BMJ. 1998, 316: 1047-1051. 10.1136/bmj.316.7137.1047.CrossRefPubMedPubMedCentral Zatoński WA, McMichael AJ, Powles JW: Ecological study of reasons for sharp decline in mortality in Poland since 1991. BMJ. 1998, 316: 1047-1051. 10.1136/bmj.316.7137.1047.CrossRefPubMedPubMedCentral
6.
go back to reference World Health Organization: The European health report 2005: Public health action for healthier children and populations. 2005, World Health Organization Regional Office for Europe, Denmark World Health Organization: The European health report 2005: Public health action for healthier children and populations. 2005, World Health Organization Regional Office for Europe, Denmark
7.
go back to reference Powles JW, Zatonski W, Vander Hoorn S, Ezzati M: The contribution of leading diseases and risk factors to excess losses of healthy life in eastern Europe: burden of disease study. BMC Public Health. 2005, 5: 116-125. 10.1186/1471-2458-5-116.CrossRefPubMedPubMedCentral Powles JW, Zatonski W, Vander Hoorn S, Ezzati M: The contribution of leading diseases and risk factors to excess losses of healthy life in eastern Europe: burden of disease study. BMC Public Health. 2005, 5: 116-125. 10.1186/1471-2458-5-116.CrossRefPubMedPubMedCentral
8.
go back to reference McKee M, Jacobsen B: Public Health in Europe. Lancet. 2000, 356: 665-670. 10.1016/S0140-6736(00)02616-7.CrossRefPubMed McKee M, Jacobsen B: Public Health in Europe. Lancet. 2000, 356: 665-670. 10.1016/S0140-6736(00)02616-7.CrossRefPubMed
9.
go back to reference Knight TM, Birt CA, Bocsan U, Armitage LE: The public health function in central and eastern Europe. Public Health. 2003, 117: 98-105. 10.1016/S0033-3506(02)00004-5.CrossRefPubMed Knight TM, Birt CA, Bocsan U, Armitage LE: The public health function in central and eastern Europe. Public Health. 2003, 117: 98-105. 10.1016/S0033-3506(02)00004-5.CrossRefPubMed
10.
go back to reference Semenza JC, Apfel F, Rose T, Giesecke J: A network strategy to advance public health in Europe. Eur J Public Health. 2008, 18: 441-447. 10.1093/eurpub/ckn019.CrossRefPubMedPubMedCentral Semenza JC, Apfel F, Rose T, Giesecke J: A network strategy to advance public health in Europe. Eur J Public Health. 2008, 18: 441-447. 10.1093/eurpub/ckn019.CrossRefPubMedPubMedCentral
11.
go back to reference De Bono E: Six Thinking Hats. 2000, Penguin Books, Great Britain De Bono E: Six Thinking Hats. 2000, Penguin Books, Great Britain
12.
go back to reference OECD: Health at a Glance 2009: OECD indicators. 2009, OECD Publishing, Paris OECD: Health at a Glance 2009: OECD indicators. 2009, OECD Publishing, Paris
13.
go back to reference Clarke A, Gatineau M, Grimaud O, Royer-Devaux S, Wyn-Roberts N, Le Bis I, Lewinson G: A bibliometric overview of public health research in Europe. Eur J Public Health. 2007, 17 (suppl): 43-49. 10.1093/eurpub/ckm063.CrossRefPubMed Clarke A, Gatineau M, Grimaud O, Royer-Devaux S, Wyn-Roberts N, Le Bis I, Lewinson G: A bibliometric overview of public health research in Europe. Eur J Public Health. 2007, 17 (suppl): 43-49. 10.1093/eurpub/ckm063.CrossRefPubMed
14.
go back to reference McCarthy M, Harvey G, Conceição C, la Torre G, Gulis G: Comparing public-health research priorities in Europe. Health Research Policy and Systems. 2009, 7: 17-25. 10.1186/1478-4505-7-17.CrossRefPubMedPubMedCentral McCarthy M, Harvey G, Conceição C, la Torre G, Gulis G: Comparing public-health research priorities in Europe. Health Research Policy and Systems. 2009, 7: 17-25. 10.1186/1478-4505-7-17.CrossRefPubMedPubMedCentral
18.
go back to reference Perleth M, Jakubowski E, Busse R: What is ‘best practice‘ in health care? State of the art and perspectives in improving the effectiveness and efficiency of the European health care systems. Health Policy. 2001, 56: 235-250. 10.1016/S0168-8510(00)00138-X.CrossRefPubMed Perleth M, Jakubowski E, Busse R: What is ‘best practice‘ in health care? State of the art and perspectives in improving the effectiveness and efficiency of the European health care systems. Health Policy. 2001, 56: 235-250. 10.1016/S0168-8510(00)00138-X.CrossRefPubMed
19.
go back to reference Fichtenberg CM, Glantz SA: Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. N Engl J Med. 2000, 343 (24): 1772-1777. 10.1056/NEJM200012143432406.CrossRefPubMed Fichtenberg CM, Glantz SA: Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. N Engl J Med. 2000, 343 (24): 1772-1777. 10.1056/NEJM200012143432406.CrossRefPubMed
21.
go back to reference Commission E: Decision No 1350/2007/EC of the European Parliament and the council of 23 October 2007 establishing a second programme of Community action in the field of health (2008–13). Official Journal of the European Union. 2007, L301: 3-13. Commission E: Decision No 1350/2007/EC of the European Parliament and the council of 23 October 2007 establishing a second programme of Community action in the field of health (2008–13). Official Journal of the European Union. 2007, L301: 3-13.
22.
go back to reference Kramers PG: The ECHI project: health indicators for the European Community. Eur J Public Health. 2003, 13 (3 Suppl): 101-106.CrossRefPubMed Kramers PG: The ECHI project: health indicators for the European Community. Eur J Public Health. 2003, 13 (3 Suppl): 101-106.CrossRefPubMed
23.
go back to reference Wilkinson JR, Berghmans L, Imbert F, Ledésert B, Ochoa A, the Members of the ISARE III Project Team: Health indicators in the European regions: Expanding regional comparisons to the new countries of the European Union – ISARE III. Public Health. 2009, 123: 490-495. 10.1016/j.puhe.2009.05.007.CrossRefPubMed Wilkinson JR, Berghmans L, Imbert F, Ledésert B, Ochoa A, the Members of the ISARE III Project Team: Health indicators in the European regions: Expanding regional comparisons to the new countries of the European Union – ISARE III. Public Health. 2009, 123: 490-495. 10.1016/j.puhe.2009.05.007.CrossRefPubMed
24.
go back to reference Brownson RC, Fielding JE, Maylahn CM: Evidence-Based Public Health: A Fundamental Concept for Public Health Practice. Annu Rev Public Health. 2009, 30: 175-201. 10.1146/annurev.publhealth.031308.100134.CrossRefPubMed Brownson RC, Fielding JE, Maylahn CM: Evidence-Based Public Health: A Fundamental Concept for Public Health Practice. Annu Rev Public Health. 2009, 30: 175-201. 10.1146/annurev.publhealth.031308.100134.CrossRefPubMed
25.
go back to reference Smith KE, Fooks G, Colling J, Weishaar H, Mandal S, Gilmore AB: “Working the system”—British American tobacco’s influence on the European Union treaty and its implications for policy: an analysis of internal tobacco industry documents. PLoS Med. 2010, 7: 1-17.CrossRef Smith KE, Fooks G, Colling J, Weishaar H, Mandal S, Gilmore AB: “Working the system”—British American tobacco’s influence on the European Union treaty and its implications for policy: an analysis of internal tobacco industry documents. PLoS Med. 2010, 7: 1-17.CrossRef
26.
go back to reference Selker HP, Woods AJ: Industry influence on comparative-effectiveness research funded through health care reform. N Engl J Med. 2009, 361: 2595-2597. 10.1056/NEJMp0910747.CrossRefPubMed Selker HP, Woods AJ: Industry influence on comparative-effectiveness research funded through health care reform. N Engl J Med. 2009, 361: 2595-2597. 10.1056/NEJMp0910747.CrossRefPubMed
27.
go back to reference White J, Bero LA: Public health under attack: the American Stop Smoking Intervention Study (ASSIST) and the tobacco industry. Am J Public Health. 2004, 94: 240-250. 10.2105/AJPH.94.2.240.CrossRefPubMedPubMedCentral White J, Bero LA: Public health under attack: the American Stop Smoking Intervention Study (ASSIST) and the tobacco industry. Am J Public Health. 2004, 94: 240-250. 10.2105/AJPH.94.2.240.CrossRefPubMedPubMedCentral
28.
go back to reference Scott KW, Powles JW, Thomas H, Rechel B: Perceived barriers to the development of modern public health in Bulgaria - a qualitative study. Int J Public Health. 2010, 56 (2): 191-9.CrossRefPubMed Scott KW, Powles JW, Thomas H, Rechel B: Perceived barriers to the development of modern public health in Bulgaria - a qualitative study. Int J Public Health. 2010, 56 (2): 191-9.CrossRefPubMed
29.
go back to reference Kuper A, Lingard L, Levinson W: Critically appraising qualitative research. BMJ. 2008, 337: 1035-1043. 10.1136/bmj.a1035.CrossRef Kuper A, Lingard L, Levinson W: Critically appraising qualitative research. BMJ. 2008, 337: 1035-1043. 10.1136/bmj.a1035.CrossRef
30.
go back to reference Adany R, Villerusa A, Bislimovska J, Kulzhanov M: Public Health Education in Central and Eastern Europe, and Central Asia. Public Health Reviews. 2011, 33: 105-33. Adany R, Villerusa A, Bislimovska J, Kulzhanov M: Public Health Education in Central and Eastern Europe, and Central Asia. Public Health Reviews. 2011, 33: 105-33.
Metadata
Title
Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis
Authors
Jacqueline Müller-Nordhorn
Christine Holmberg
Klara G Dokova
Neda Milevska-Kostova
Gratiana Chicin
Timo Ulrichs
Bernd Rechel
Stefan N Willich
John Powles
Peter Tinnemann
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-311

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