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European Public Health > Case 8 EPH2022 > Flashcards

Case 8 EPH2022 Flashcards

1
Q

What is the European Mandate of public health?

A
  1. EU is mostly economic collaboration
  2. Do not have any jurisdiction on lifestyle
  3. Through articles, directives, incentives by trying to use internal market to promote health
  4. EU is responsible for: organ donation, food safety, medicinal products
  5. EU may work on incentives / Council recommendations to protect and improve health (incl. major cross-border health scourges & threats to health, tobacco and alcohol abuse)
  6. EU may not interfere with organisation & delivery of health services & health policy
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2
Q

How does the EU use the internal market to promote health?

A

By restricting commercials to children about unhealthy foods, not being able to sell alcohol under 18, etc. Also use incentives that if a country does something, they can get money for it.

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3
Q

What are the WHO guidelines for physical inactivity in adults?

Part of EU mandate!

A

Should do:
* 150-300 minutes of moderate-intensity physical activity or;
* 75-150 minutes of vigorous-intensity physical activity or;
* Equivalent combination of moderate + vigorous intensity activity throughout week

  • muscle strengthening at moderate/greater intensity involve major muscle groups on 2/more days a week
  • Limit amount of time spent being sedentary. Replacing sedentary time with physical activity of any intensity (including light intensity) provides health benefits.
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4
Q

*Why is no more than 300 minutes recommended for total physical activity per week by WHO?

Double check if right!

A

Doing more than 300 min of physical acitivty per week does not further reduce risk of death

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5
Q

*What are the cause-specific harms of physical inactivity?

Part of EU mandate! Correct?

A
  1. Increases risk of NCDs, inc CVD, T2D & breast & colon cancers, other cancers, dementia
  2. Separately, associated with higher mortality after being diagnosed with NCDs. Even if you were physically inactive and now have some sort of CVD, if later then become more physically active (changing lifestyle) after diagnosis, it still benefits you to reducing chance of mortality.
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6
Q

*How does physical inactivity follow a social gradient?

Part of EU mandate! check docs but smth with second bp not right

A
  • Physical inactivity more common people with lower education, non-professional & non-managerial professions, lower incomes, unemployed, & ppl renting housing.
  • Reasons for gradient are both external (area characteristics e.g. unsafe to run in neighbourhood = not going to do it, not go jogging down highway) & internal (stress, poor decision-making (related to stress), confounding, class (mimicking behaviour of people around you) → important between-country variability.
  • Varies across countries → see graph docs
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7
Q

Is there a safe level of alcohol consumption?

Part of EU mandate!

A

no safe level of alcohol consumption - every level of alcohol consumption is harmful/detrimental to health!!!

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8
Q

What does alcohol increase the risk of?

Part of EU mandate

A
  1. All-cause mortality
  2. Cardiovascular mortality
  3. Most cancers (population level lag of 7-9 years)
  4. Liver disease (cirrhosis and NAFLD)
  5. Loss of grey and white matter volume
  6. HIV/AIDS, TB and community-acquired pneumonia
  7. All types of intentional/unintentional injuries, including homicides, suicides, traffic fatalities.
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9
Q

When is alcohol consumption considered bad?

Part of EU mandate

A

Alcohol consumption not good for societies & population health but not only for people with alcohol-use disorders, people who consume large amounts of alcohol but already starts at 1-2 daily units (10-20g) of alcohol or 140g per week (light/moderate consumption)

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10
Q

What is confounding?

A

Other variables we haven’t taken into account when doing our analysis, might change the association that we observe.

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11
Q

*What is the protective effect?

A
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12
Q

What are the harms of alcohol to people other than the drinker?

Part of EU mandate

A
  1. Violence (incl domestic violence)
  2. Drink-driving
  3. Foetal injury (AFS)
  4. Resource use (absenteeism, health care, unemployment and incapacity benefits, crime and disorder).
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13
Q

Explain the equity of harm of alcohol?

Part of EU mandate

A

Harms from drinking disproportionately affect poorer people:
* Socially disadvantaged people & people who live in socially disadvantaged areas experience more harm from same dose of alcohol than those who are better off.

  • Increased spending on social welfare policies can reduce impact of economic downturns & unemployment on increased alcohol-related deaths.
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14
Q

*What is the epidemiology of alcohol consumption?

A
  • Now seeing alcohol = harmful, no alcohol consumption is good but still seeing increase in EU
  • Mediterranean, spain, france, etc drinking more but doesn’t tell us the “whole story” - take into account volume consumed & pattern of drinking
  • While Mediterranean countries engage more often in daily drinking than Central & Eastern Europe, in Central + Eastern Europe: more binge drinking. Important coz this pattern of drinking associated with more CVD’s & harmful effects than overall volume of daily drinking.
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15
Q

What is the epidemiology of alcohol harm?

Part of EU mandate

A
  • Europe: alcohol is 3rd leading risk factor for disease & mortality after tobacco & high blood pressure
  • Alcohol caused more than 220,000 NCD deaths (2016)
  • See graph docs
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16
Q

how does alcohol consumption work as a risk factor?

A
  1. Total volume of alcohol ocnsumed
  2. Pattern of drinking
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17
Q

Epidemiology of alcohol-attributable mortality (AAM/AAF)

A
  • See East-West pattern divide
  • Lowest level of AAM seen in Nordic countries, Italy, Spain, Greece.
  • Higher level AAM seen in Central Europe, parts of Western Europe, Finland
  • Highest AAM seen in Eastern Europe - associated with patterns of alcohol consumption observed above.
  • More heavy episodic drinking seen in particular country, culture = higher AAM
  • In this case, AAM ranges between 3% to 25% of all deaths being related to alcohol consumption. Means if we were to cut-out all alcohol consumption in e.g. Baltic countries, mortality rates would drop by 25%.
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18
Q

What is attributable mortality (AAM/AAF)?

A

% of total mortality associated with particular risk factor

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19
Q

What is the proportion of deaths caused by age & sex?

A
  • Highest proportion of deaths in both sexes, in age groups 15-29
  • Then plateau until late 50s then drops.
  • Not coz old people tend to drink less but coz tend to die of other reasons.
  • Young-adult middle age populations alcohol is very significant risk factor.
  • Especially men at risk but probably coz have different alcohol consumption patterns than women.

See graph

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20
Q

What is the distribution of alcohol-attributable YLL by cause of death & sex?

A

Main vector to which alcohol does cause high mortality is due to high rates of NCDs (esp cancer, CVD, liver cirrhosis)

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21
Q

What is Years Life Lost (YLL)?

A

Compared to maximum achievable life spent in a country, how many lives were lost due to premature deaths.

E.g. LE in NL = 83 yrs, if person in NL dies at 70, they contribute 13 years to YLL

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22
Q

What are the policies & regulation on physical activity & nutrition in EU?

A
  • 2007 strategy on nutrition, overweight, and obesity-related health issues
  • EU4Health 2021-2027 strategy
  • Council Recommendation on promoting health-enhancing physical activity across sectors (2013)
  • EU Physical Activity Guidelines (2008)
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23
Q

Explain the 2007 strategy on nutrition, overweight, and obesity-related health issues

A
  • encourages partnerships, involving groups working in fields of nutrition & physical activity, private sector, governments, European Commission & WHO;
  • challenges to food industry, civil society & media, by improving food products recipes, responsible marketing & labelling, & promotion of physical activity, among others;
  • sets out Commission’s plans to strengthen monitoring & reporting, in collaboration with the WHO
24
Q

Explain the strategy EU4Health 2021-2027.

A
  • Programme was adopted as response to COVID-19 pandemic & to reinforce crisis preparedness in EU.
  • Pandemic highlighted fragility of national health systems.
  • EU4Health programme will bring contribution to long-term health challenges by building stronger, more resilient & more accessible health systems.
25
Q

What interventions do not work for physical activity?

A
  • Increasing physical activity/reducing sedentary behaviours in low income groups (except children)
  • School-based physical activity interventions - likely an implementation issue
  • Behavioural interventions without alterations of build environment tend to be ineffective coz if researchers provide a facility for PA & people are highly motivated at first, but then if they keep encountering barriers to doing it in home environment, changes don’t tend to stick.
26
Q

What interventions do work for physical activity?

A
  • Community-wide public education & awareness campaign which includes mass media campaign combined with other ** community-based education, motivational & environmental programmes** aimed at supporting behavioural change of physical activity levels.
  • Public education & awareness campaigns if associated with changes in built environment that supports PA, coz people simply don’t know yet what it means to be physically (in)active. Some people think they are active if they do 5 minutes of stretching per day.
  • Physical activity counselling & referral as part of primary care via brief interventions (e.g. alcohol intervention with uni, but again more aimed at individual & want to find something that is more community-based (population level).
27
Q

Explain the Council Recommendation on promoting health-enhancing physical activity across sectors (2013)

A
  • MS should develop national campaigns & cross-cutting strategies involving different policy areas such as sport, health, education, environment & transport.
  • Governments monitor PA levels covering such issues as PE in schools, schemes to promote PA among elderly & projects encouraging active travel to work.
  • Trying to target specific groups but evidence does not support this very well, so focusing on specific groups does not stick very well.
  • National physical activity focal points are being established to help with monitoring → data transfer to WHO Europe; exchange of information & networking between MS.
  • Commission will produce a report every 3 years.
28
Q

Explain EU Physical Activity Guidelines (2008)

A

Policy recommendations for sport, health, education, transport, workplaces and senior citizens & cross-sectoral coordination.

29
Q

What are other EU intiatives of physical activity?

A
  1. European Week of Sport
  2. EU Sport Forum (high-level dialogue between sport leaders, entrepreneurs and other sport professionals)
  3. Project funding via Erasmus+ for sport specific events
  • Primarily focused on sports & high-level sports. With physical inactivity interventions aim is to try to get everybody moving a little bit (cycling, walking, etc).
  • A lot initiatives don’t have much impact, completely missing point of getting everybody to move.
30
Q

What are the policies & regulation on smoking in EU?

A
  • Tobacco products directive (2014/40/EU)
  • Council Recommendation of 30 November 2009 on smoke-free environments.
31
Q

What is the aim of the tobacco products directive 2014?

A
  • aims to improve functioning of internal market for tobacco & related products, while ensuring high level of health protection for European citizens.
  • Directive, based on proposal of Commission, entered into force on 19 May 2014 and became applicable in the EU Member States on 20 May 2016.
  • Applied only since 2016 - lot of people smoking indoors = second hand smoking
  • Saw that when free smoke spaces, etc was implemented, numbers dropped increasingly.
32
Q

What legislation exists for the tobacco products directive?

A
  1. Larger & mandatory pictures with health warnings
  2. Ban on cigarettes & RYO with characterising flavours
  3. Replacement of TNCO labelling
  4. No more promotional/misleading packages
  5. Mandatory electronic reporting on ingredients
  6. Safety & quality requirements for e-cigarettes
  7. Packaging & labelling rules for e-cigarettes
  8. Monitoring & reporting of developments of e-cigarettes
  9. Possibility to ban cross-border distance sales
  10. Measures to combat **illicit trade **
33
Q

Explain the health warnings on tobacco packages

A
  1. Directive requires large picture & text health warnings on the top edge of both sides of packets of cigarettes and roll-your-own tobacco.
  2. Must cover 65 % of the front and back of the packet & comply with minimum dimensions.
  3. Same packaging of cigarettes to make it less attractive/less branding?
34
Q

Explain the 2009 Council recommendation on smoke free environments

A

Adopted as the result of consultation & legislative process, in 2009, calling on EU countries to act in three main areas:
1. Adopt & implement laws to fully protect their citizens from exposure to tobacco smoke in enclosed public places, workplaces and public transport, within 3 years of adoption of Recommendation
2. Enhance smoke-free laws with supporting measures such as protecting children, encouraging efforts to give up tobacco use & pictorial warnings on tobacco packages
3. Strengthen **cooperation at EU **level by setting up a network of national focal points for tobacco control

35
Q

What are the policies & regulation on alcohol in EU?

A
  1. EU alcohol strategy 2006-2012
  2. Europe’s Beating Cancer Plan
  3. European Alcohol Action Plan 2022-2025
36
Q

Explain what happend before the EU Alcohol Strategy 2006-2012 was implemented

A

Development of strategy took several years because:
* Lot of resistance to mere thought of a community strategy by drinks industry
* EC commissioned several preparing studies into nature & extent of alcohol use & alcohol problems in Europe

37
Q

Explain what happend before the EU Alcohol Strategy 2006-2012 was implemented

A

Development of strategy took several years because:
* Lot of resistance to mere thought of a community strategy by drinks industry
* EC commissioned several preparing studies into nature & extent of alcohol use & alcohol problems in Europe

38
Q

Explain the EU alcohol strategy 2006-2012

A

Contained soft law, which means that doesn’t propose development of harmonised legislation.

5 priority themes relevant in all MS:
1. Protect young people, children and the unborn child;
2. Reduce injuries and death from alcohol-related road traffic accidents;
3. Prevent alcohol-related harm among adults & reduce negative impact on workplace;
4. Inform, educate & raise awareness on impact of harmful & hazardous alcohol consumption & on appropriate consumption patterns;
5. Develop, support & maintain common evidence base.

39
Q

Explain what happend after the EU Alcohol Strategy 2006-2012 was implemented

A
  • Commission presented report assessing added value of “EU Strategy to Support MS in reducing alcohol related harm”. -> Did not result in a new strategy.
  • Commissioner for Health & Food announced that Commission will not come with a separate new alcohol strategy document. His idea was that alcohol policy would just be a section of a paper on the European policy on chronic lifestyle diseases.
  • EU no longer had an alcohol policy
40
Q

Explain what the commissions plan is for Europe’s beating cancer plan

A

With regard to alcohol, the plan states that the Commission will:
1. increase support for MS & stakeholders to achieve relative reduction of at least 10% in harmful alcohol consumption by 2025;
2. review EU excise legislation;
3. review excise duty on cross-border alcohol purchases by private individuals;
4. closely monitor implementation of provisions of Audiovisual Media Services Directive, including on online video platforms & encourage self- and co-regulatory initiatives;
5. strive to reduce reach of online marketing & advertising of alcoholic beverages among young people (in cooperation with Member States);
6. review its own alcoholic beverage promotion policy;
propose mandatory ingredient & nutritional labelling for alcoholic beverages by end of 2022;
7. propose health warnings on labels by the end of 2023;
8. support MS in implementation of proven effective short-term interventions in primary care, in workplace and in social work.

41
Q

What is Europe’s Beating Cancer Plan?

A
  • Key pillar of a stronger European Health Union & more secure, better-prepared & more resilient EU.
  • Outlines substantive actions to mitigate impact of COVID-19 pandemic on cancer care & support structural improvements for a more sustainable cancer pathway.
42
Q

*What is the European Alcohol Action plan 2022-2025?

A
43
Q

What interventions/polciies do not work for alcohol?

A
  • Public service announcements & public education campaigns (particularly those focusing on low-risk drinking guidelines)
  • Media advocacy may help gain public support for policy changes
  • Warning labels
  • School-based interventions
  • Making bars and clubs safer & training serving staff
    Does prevent immediate harms from alcohol (e.g. people being overserved and getting injured as they leave)
    Just teaching not to overserve (so not giving more alcohol when clearly drunk), doesn’t decrease population level of alcohol consumption/alcohol effects. Not effective as population-level interventions
44
Q

What interventions/polcies do work for alcohol?

A
  • Alcohol taxes
  • Making alcohol less available
  • Comprehensive restrictions on exposure to advertising
  • Legal BAC levels for driving & enforcement via checkpoints and random testing → specifically for traffic fatalities, around festive activities, etC
  • Screening & alcohol brief interventions (ABIs) in primary care
45
Q

How can you make alcohol less available in a population? (intervention)

A
  • Minimum purchase age (when enforced, e.g. trial purchasers)
  • Government alcohol monopolies - when all places that sell alcohol are owned by government then if a place is doing bad/lot of alcohol harm, can shut it down. Government controls distribution of alcohol.
  • Restriction on times of sale
  • Reducing density of outlets selling alcohol - via licences, etc
46
Q

How can you make comprehensive restrictions on exposure to alcohol advertising ina population? (intervention)

A

If people in general & esp young people, are not exposed to positive messages about alcohol consumption, tend to engage less in alcohol activity. (But more evidence needed for this)

47
Q

How does screening and alcohol brief interventions in primary care work?

A

Helps more for individual level.

E.g. screening for university students where they give survey about how much, how often per occasion of alcohol consumption. If reach certain threshold, called for an ABI where ‘motivational speech’ is given and 3 things are done:

  1. Help you realise what you are doing is not healthy (some people still don’t understand this)
  2. Not a problem (from perspective that you’re not the only one who struggles with this)
  3. Offer you tools for how to change your behaviour.
48
Q

How does alcohol pricing influence the consumption of alcohol?

A
  • reduces acute & chronic harm related to drinking among people of all ages
  • Reduce alcohol consumption by young people (tend to be more responsive to prices, less cash to spend), & have a greater effect on frequent & heavier drinkers.
  • increases in alcohol prices likely to lead to increase in consumption of home-distilled beverages/illicit drugs.
  • Producers absorbing cost of increase of tax
49
Q

*Why is increasing tax prices on alcohol a problem with regards to alcohol producers?

A
50
Q

How do micro & macro level interventions work together?

A
  • Both alcohol & physical inactivity show that only focusing on individual & providing **individual interventions, doesn’t work. **
  • Must have a supportive environment in terms of policies, etc that can help this behaviour change stick.
  • For habit to really form & stick, need an environment that doesn’t create barriers towards new/healthier habits.
  • Need individual level behaviour change interventions & policy environments that can support lasting behaviour change.
51
Q

What models can we use to understand that micro & macro level interventions work together?

A
  1. Necessary & sufficient component causes
  2. Interactions
  3. Diderichsen model of health disparities
52
Q

What models can we use to understand that micro & macro level interventions work together?

A
  1. Necessary & sufficient component causes
  2. Interactions
  3. Diderichsen model of health disparities
53
Q

Explain necessary & sufficient component causes to understand how micro & macro level interventions work together

A
  • Every disease in an individual is a consequence of several things coming together
  • Necessary cause = never absent in a disease case
  • Sufficient cause = disease always follows
  • If necessary cause is present but no other factors, it’s also not sufficient for you to get disease. Need to have both necessary & sufficient - other supporting mechanisms in environment - for you to get ill.

See graph

54
Q

*Explain interactions to understand how micro & macro level interventions work together

A
55
Q

*Explain the Diderichsen Model. ofhealth disparities to understand how micro & macro level interventions work together

A
56
Q

What are the actions of policy?

A
  • Decreasing stratification - social welfare to decrease income inequalities
  • Decreasing exposure - e.g. increase alcohol taxations, decreases exposure to alcohol for everyone
  • Decreasing vulnerability to specific policies
  • Preventing unequal health harms
  • Preventing unequal economic harms
57
Q

*Would you argue for or against the one-size-fits-all approach?

A

European Public Health (7 decks)

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