“My first EuroNet meeting. In Velika Planina I had the opportunity to attend my first EuroNet meeting. My colleagues who previously participated told me some stories about EuroNet-meetings so I was really looking forward to being a part of it and connecting with new people.
Having the opportunity to meet colleagues from other countries and get to know them was definitely a great experience and my expectations were matched. I was able to meet great people enthusiastic of our work and exchange ideas, views and see first hand the commitment and the willingness to cooperate and how they can lead to a great teamwork. The work groups give the possibility to everyone to suggest new ideas and see who is on board with them or to give your own contribution to work groups that already exist and need some extra help. Of course the social programme is an important part of the meetings and fun is assured!”
“As a fresh new resident in Public health, I had the great opportunity to attend the Euronet MRPH Winter Meeting in Velika planina, Slovenia. I couldn’t imagine a better way to begin the residency and to discover EuroNet.
I would like to thank the warm and welcoming Slovenian team, everything was there to spend an unforgettable week-end: a wonderful landscape, a great atmosphere, tasty Slovenian food (and wine), cozy cottages, snowball fights and more important all the great people who were there and made this time amazing.
It was so rewarding to discover EuroNet, all the projects and workgroups in progress between different countries. There were many interesting topics discussed, demonstrating the wide diversity of Public Health residency around Europe. It was also very stimulating and inspiring to see what can be done and to hear different professional experiences and initiatives during the pitch presentations.
I came back to France with my head full of nice memories, ideas for the internship, and the aspiration to learn more about Public Health.
To conclude, thank you so much EuroNet and all of its members for this beautiful meeting and nice moments, hopefully there will be plenty of others!”
“Recently I attended my first EuroNet Meeting in Lubiana and it greatly exceeded expectations. Firstly, I had the opportunity to informally know about other public health residency programs, different directions and trajectories, new topics and interesting projects in the field. I especially liked the open organization of the working groups and now I’m very willing to participate.
Moreover, I got to know amazing people and colleagues that shifted my research horizons and my way to intend what a public health professional may potentially be. And of course, networking was fun! Snowy chalets, cozy rooms and very nice people, what else?
I would certainly recommend the experience to anyone interested in EuroNet and its activities and in networking to other public health residents across Europe. The richness of confronting with them is something I will bring home preciously.”
For a brief moment Ljubljana was the center of European public health. From November 29th until December 1st it hosted the biggest European public health conference. The EPH conference is – among other things – a meeting point for residents, recent residents and those who wished they could still remember how it felt like to be a resident.
But they are simply too far into their careers and those feelings and memories are getting harder and harder to recall. Let us all take a minute of mindful meditation to sympathize with our experienced colleagues.
Having an event of such a scale hosted by one of the EuroNet MRPH member countries made a solid case for organizing one of the regular meetings EuroNet members cherish so much in Slovenia. Many residents from EuroNet countries were attending the conference and we could feed two birds with one scone if we organised the winter meeting back-to-back with EPH.
The only problem, if we can put it this way, was that most of the residents planning to come to the winter meeting were experiencing the city of Ljubljana, listening to presentations, and sitting in lecturing halls already for at least 4 days of the EPH conference. We assumed they could use a change of scenery and so we decided to organize the winter meeting in a secluded snow-capped mountain not that far away from our green capital. And so we booked buses, funiculars, chairlifts (yes, chairlifts) to take us up to the mountain called Velika planina where chalets with wood-burning fireplaces awaited us and kept us warm for the 3 days we’ve spent there.
Programme of the meeting had a clear focus on EuroNet inner workings and projects of our fellow residents. General assembly was split in two parts this time. We started the meeting with a dinner and continued with the first part of the general assembly in the same restaurant which happened to be the only closed space on the mountain big enough for 45 people to occupy at the same time. The second day was the day when majority of work was done. First on schedule were pitch presentations where some of the work EuroNetters are involved in was showcased.
Topics covered ranged from surveillance of communicable diseases, public health advocacy initiatives to ethics of vaccine hesitancy. Afternoon sessions kicked off with working groups focusing on internship facilitation, communication and research activities. A new format of session was introduced during the meeting as we conducted the first ever EuroNet-athon (mimicking the well-known hackathon format). Three teams were tackling three challenges of further EuroNet growth identified by a committee comprised of old and new board members. Winner of the EuroNet-athon was announced during the second part of the general assembly.
Even though not everyone followed our advice on warm clothing and footwear we managed to end the winter meeting with 0 casualties. We would even go as far as to say that the winter meeting we held at Velika planina was a big success. The idyllic location and the programme of the meeting had little to do with it.
It was a big success primarily because of the people who attended. And with this in mind we are looking forward to new success stories ahead. Because EuroNet MRPH is nothing more than people that represent it.
And, to borrow a line from the great James Brown, those people look like success, smell like success, feel like success and they make success happen.
The relationship between industry and medical societies has been widely studied by the international literature and has been recognized as a potential condition for biases and conflicts of interest. A recent study analysed the relationship between industry and medical societies through the assessment of the Italian medical societies’ websites, finding some relevant correlations. Despite this scenario, little is known about the relationship between medical societies and industry in Europe.
The aim of the work conducted by Euronet MRPH is to extend the Italian research to seven European countries (Croatia, France, Ireland, the Netherlands, Portugal, Slovenia, and Spain). The study is important because it is a first such project addressing the conflict of interest between medical societies and industry in a comparative European setting. In addition to its scholarly contribution that will enhance the understanding of the nature of this relationship, the study has implications for the development of policy regulating the relationship between industry and medical societies, from disclosure requirements, to restriction on what industries can fund, among others. The working group already developed a structured flowchart to systematically produce comprehensive lists of all the medical societies in the included countries. Up to date, a significant effort has been done in assessing the differences between the national definitions of medical societies and, so far, a heterogeneous framework emerged.
The improved visibility of Lesbian, Gay, Bisexual, Trans and other non-heterosexual (LGBT+) people has not always been accompanied by advancements in the working and living conditions of those identifying as LGBT+. In medical residency programmes across Europe, there is little research analysing how challenges of the residency period align with the challenges associated with concealable identities and their disclosure. This paucity of data may be due to the notion that identity is inconsequential or irrelevant to achievement and well-being in medical studies and health professions.
EuroNet MRPH LGBT+ working group aims to better understand the daily living and working condition of medical residents identifying themselves as LGBT+. The product of this year of work (the project started in late 2016) is a questionnaire, made up of 45 questions, and organised in 6 sections, focusing on identities, acceptance both at work and home, episodes of discrimination or harassment, and emotional well-being. It will be soon disseminated after its translation in most of the languages spoken in the countries part of the network. The process of forward and backward translation will ensure semantic and conceptual equivalence between different versions and it will make data analysis reliable.
This project addresses the need for an informative survey about working environment experiences and well-being of medical residents identifying themselves as LGBT+, and could help to get an insight into the wider topic of LGBT+ acceptance in our health system. If you want to learn more or give a little help, do not hesitate to contact us.
Climate change is deemed “the biggest global health threat of the 21st century”. (1) Global warming is now unequivocal; global average temperatures have risen by 0.85°C between 1880 and 2012. (2) Global mean temperature is projected to increase by about 1.6 to 2.6°C above the preindustrial period by the 2050s, depending on the scenario used.2 Using median values, projected temperature increases for Europe and America are between 2 and 4°C for the 2050s (relative to present-day climate). (2) Higher increases are projected over much of Asia and Australia. (3) Heat waves, defined as extended periods of extreme high temperature, are regarded as one of the primary weather-associated threats to human life. (4) As increased frequency, intensity, and duration of heat wave events occurred associated with global warming, impact of heat wave on health has drawn more and more attention worldwide. (5-7) It is well-established the relationship between extreme high temperatures and human morbidity and mortality. (8)
There is also now strong evidence that such heat-related mortality is rising as a result of climate change impacts across a range of localities. (9) For instance, the excess mortality during the extremely hot summer of 2003 in Europe and the 2010 Russia heat wave, resulted in more than 70,000 and 11,000 deaths, respectively. (10,11) Much of the excess mortality from heat waves is related to cardiovascular, cerebrovascular, and respiratory disease and is concentrated in some populations groups. These groups include women, young children and older people, people with existing health problems or disabilities, and poor and marginalised communities. They are particularly vulnerable to the health effects of climate change, whether because of existing socioeconomic inequalities, cultural norms or intrinsic physiological factors.
Other risks were associated with rising temperatures and changes in precipitation pattern. For example, the modification of viable distribution of disease vectors such as mosquitoes carrying dengue or malaria. Temperature affect the range and reproductive rates of malarial mosquitoes and also affect the lifecycle of the parasitic protozoa responsible for malaria, possibly increasing the incidence of a disease that causes 660 000 deaths per year. (12) There are equally complex relationships and important climate-related risks associated with dengue fever, cholera and food safety. (13-15)
Moreover, a heat wave can be a big threat in urban area because of the “urban heat island (UHI) effect”. The UHI effect results in the temperatures being somewhat higher in cities than in suburban and rural areas, primarily because of the abundance of heat-retaining surfaces such as concrete and black asphalt, that exacerbate the negative heat effect on residents compared with reflective, transpiring, shading, and air-flow-promoting vegetation-covered surfaces. (16,17)
The events occurred in Europe and Russia and those which occurred inAustralia, 2012/2013 and 2016/2017; North America, 2012; India and Pakistan, 2015 and Europe 2015 have led to the implementation of specific policies to reduce heat-related mortality such as the National Heat Wave Plan in France, (18) and the Heatwave Plan for England. (19) Evidence suggests that effective adaptation measures would reduce the death rates associated with these heat waves. Adaptation measures also include increasing green infrastructures and urban green spaces, improving the design of social care facilities, schools, other public spaces, and public transport to be more climate-responsive. Adaptation options within health care include training of health-care workers and integrated heatwave early warning systems (HEWS). (20)
A communication and public education strategy is an essential part of the warning system, public health messages should be disseminated to all age and vulnerable groups to increase awareness of symptoms of heat-related illness.
Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change. The Lancet. 2009; 373(9676): 1693–1733.
IPCC, 2013a: Summary for Policymakers In: Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change Change [Stocker TF, Qin D, Plattner GK, Tignor M, Allen SK, Boschung J, Nauels A, Xia Y, Bex V, Midgley PM (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, pp. 1–30.
Bassil K, Cole D. Effectiveness of public health interventions in reducing morbidity and mortality during heat episodes: A structured review. Int J Environ Res Pub Health. 2010; 7: 991–1001.
Luber G, McGeehin M. Climate change and extreme heat events. Am. J. Prev. Med. 2008; 35: 429–435.
Wang C, Chen R, Kuang X, Duan X, Kan H. Temperature and daily mortality in Suzhou, China: a time series analysis. Sci Total Environ. 2014; 466–467.
Gronlund C, Zanobetti A, Schwartz J, Wellenius G, O’Neill MS. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environ Health Perspect. 2014; 122: 1187–1192.
Gao J, Sun Y, Liu Q, Zhou M, Lu Y, Li L. Impact of extreme high temperature on mortality and regional level definition of heat wave: a multi-city study in China. Sci Total Environ. 2015; 505: 535–544.
Forsberg, B. Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment. BMJ Open. 2013; 3: e001842.
Smith K, Woodward A, Campell-Lendrum D. Human health—impacts adaptation and co-benefits. Climate change 2014: impacts, adaptation, and vulnerability Working Group II contribution to the IPCC 5th Assessment Report. Cambridge University Press, Cambridge, UK and New York, NY, USA; 2014.
Robine J, Cheung S, Roy S, Oyen H, Herrmann F. Report on excess mortality in Europe during summer 2003. EU Community Action Programme for Public Health. Grant Agreement 2005114. 2007.
We have been reading ASPHER’s strategic Objectives 2016-2020. We are right now just in the middle of this period of time. Could you tell us some of the achievements ASPHER (Association of Schools of Public Health in the European Region) has accomplished so far regarding those strategic goals?
ASPHER 2020, which was inaugurated during the 50th anniversary year of the Association, presents a comprehensive and balanced agenda guiding the strategic development of ASPHER during an important period, critical in many ways for the future of Public Health in Europe and globally.
As we reach the midterm mark of this time period, several key achievements have been reached by ASPHER. These include the continued development of ASPHER’s core competences programme with the publication of the 5th edition of competences list. The list remains a core reference for the development of public health education in Europe, while also supporting public health careers and systems development.
A central project underway is the collaborative development of a series of tools for public health workforce development and professionalization in Europe. This is being undertaken as part of a groundbreaking agenda set by the WHO Regional Office for Europe within a framework of the European Action Plan (EAP) for Public Health Capacities and Services Strengthening. The tools will be presented at the European Public Health Conference in Ljubljana this November and will be made available for use by countries and other relevant stakeholders soon thereafter.
ASPHER has also made strides to bolster collaboration between keystone public health organizations. Cooperation across organizations that pool ideas, resources, and capacity can only strengthen Public Health today and brighten the outlook for the field in the future. ASPHER is maintaining historically close ties with the European Public Health Association (EUPHA), and forging new key partnerships – including those with the International Association of National Public Health Institutes (IANPHI) and the Association of Schools and Programs of Public Health (ASPPH), which is ASPHER’s counterpart organization across the Atlantic.
There are other exciting developments still to come under the ASPHER 2020 agenda. These include the launch of the Public Health Training Academy, which is meant to constitute a training platform for individuals seeking continuing professional development opportunities in public health. ASPHER is also improving the formula for its annual Deans’ and Directors’ Retreats – a major membership event of the Association.
We know one of the foremost pillars of ASPHER working is on Professionalization of the Public Health Workforce. Could you explain the ASPHER’s work in this area?
This project is primarily realized through ASPHER’s active engagement in WHO Europe’s Coalition of Partners (CoP) work on implementation of the EAP for Public Health Capacities and Services Strengthening. The relevant CoP projects include:
Development of the Road Map towards professionalization of the public health workforce in the European Region. This is a tool meant to support countries in developing policies related to public health workforce professionalization. The Road Map recognizes the diversity of public health systems in place across Europe and should act as a guide to countries to choose the path that suits their culture and needs to strengthen and professionalize their workforce. The Road Map seeks to reinforce the professional identity of the current public health workforce and help to align public health services and operations with the public health workforce development.
Development of a Handbook for managing public health professional credentialing and accreditation systems in the European Region to serve as a reference tool for the national education and health systems to ensure the competencies both required and presently possessed by the public health workforce.
Development of a core competencies Framework for the public health workforce in the European Region. This should be of use for human resources practices to enable an ongoing standardized and consistent assessment and development of public health knowledge and skills at individual, service, organizational, and country levels, thus, supporting public health professionalization and credentialing.
Does ASPHER have any plan to facilitate the application of its proposals about professionalisation to medical residency programmes in Europe? What EuroNet and public health residents in general can do to support and participate in ASPHER?
The EuroNet Medical Residents in Public Health (MRPH) plays an important role in the development and the implementation of the public health professionalization agenda. The Network already actively contributes to the work of the CoP providing a specialist workforce and fresh perspectives from a younger generation. Input from EuroNet and its individual members is critical for the success of this effort.
The specialist training EuroNet MRPH members obtain makes them also particularly relevant to ASPHER. It is no surprise then that both associations actively collaborate, share mutual understanding and friendship. Italy is an interesting example of a country where all schools providing residency and specialist training in public health became ASPHER members – such a membership context provides powerful potential for working closely together.
To learn from your experience, which are the aspects of ASPHER that led you to get involved with the association? How did you benefit from being involved in ASPHER?
ASPHER is a family, with all the baggage that it brings – both pluses and minuses. Still, what I think keeps me (and I believe not only me) with ASPHER is its unique atmosphere and the people who are part of the organization.
Over the past years, I have sought to secure its professional shape and high performance standards. Being the Association of Schools of Public Health, (i.e. concrete institutions, with staff, students and graduates), extends the impact of ASPHER through the schools’ infrastructure, the services they provide in training, research and societal contributions. It is an extremely powerful organisation – essential for the growth of the Public Health in Europe and globally. Working at ASPHER is therefore an extraordinary journey, an eye-opening experience, reflecting the complexity of the truly unique field the Public Health is.
Which do you think are the future challenges for the future public health workforce and how young public health professionals could prepare to face those challenges?
My personal take is that we are currently challenged to identify clear career options/paths and to make quality training available to enable smooth navigation through the complexity of the public health field and the choices it offers. ASPHER makes continuous efforts to address this. Young public health professionals should remain courageous and pertinacious. I would recommend that they find someone they can trust to lead them in facing their career challenges and in their turn, mentor newcomers as they move forward and gain experience.
This is a story about networks. A story about the balance between their simplicity and the impact they can bring about. My name is Miguel Cabral and I’m a Medical Resident of Public Health (MRPH), in Amadora, Lisbon, Portugal. One of the great things the Portuguese Public Health (PH) residency has is the chance for MRPH to do some of their training abroad, while still receiving their salary. Another great thing is that we have 3 months for an optional internship, which means we can pretty much choose anything we want to do in the world, as long as we work on a PH area under the supervision of a PH specialist.
In my case this was very handy. My wife was doing an internship in Rome for her residency. I wanted to find an internship that would allow us to be together and make the most out of the experience on a professional level but also on a personal level. So, I “just” had to find an internship somewhere in Rome that would not require an Italian speaking person (I can understand basic Italian but you don’t want to hear me speak).
So… networks of people. Here is where a Maltese MRPH gets into the picture. A friend of mine, that is also part of the European Network of MRPH (EuroNet MRPH), passed by Lisbon and we had a coffee and a pastel de Belém by the Tejo River. I hadn’t searched too much for internship opportunities yet, but he told me he knew the perfect guy for me to do my internship with. The next day, I had an email message from Dr. Carlo Favaretti with a general proposal of what an internship with him would be like. And boy, I was thrilled! As my wife puts it: there were many words I liked, all together.
Fast-forwarding the bureaucracy needed, some months later, I was entering the Public Health Institute of Università Cattolica del Sacro Cuore, in Rome. The institute hosts several interesting institutions. One of them is a World Health Organization (WHO) Collaborating Centre focused on Leadership in Medicine. The other one is a spin-off from the University called V.I.H.T.A.L.I. (Value In Health Technology and Academy for Leadership & Innovation). I like to think institutions reflect the people that are part of them, and the institute had several remarkable people indeed, both on professional and personal levels. But we’ll get back to that shortly.
Before my internship, I thought I would mainly deal with the topics of Health Technology Assessment (HTA) and Leadership, since Dr. Favaretti is the president of the section on HTA from the European Public Health Association (EUPHA) and is part of the Leadership Centre, on top of having extensive experience in health management. However, I got a big bonus, as I’ve also ended up dealing a lot with the topic of Value Based Health Care (VBHC), which is becoming quite trendy in Portugal (and a bit everywhere).
The most astonishing thing I’d like to point out is how much I’ve learned in so little time. I’m convinced that a temporary switch of network and work environment allows one to get in touch with so many different ideas, perspectives and methodologies that it feels like some sort of intensive course on whatever the topic dealt with. In my case, I would particularly highlight the areas of HTA and VBHC. In the classes I had about HTA they usually just addressed clinical and economical evaluation, so to find out something so schematic as the EUnetHTAmodel was very positive. And on the topic of VBHC, the discussion in Portugal is very centred on the notion of Value by Michael Porter, the author that launched the concept, by defining value as a formula that divides the outcomes of the patient by the costs used to obtain those outcomes. To me, it seemed strange to apply this to a National Health Service (NHS) type of health system. And, of course, I was not alone. During this internship I learned about Sir Muir Gray and Dr. Jani Anant’s work on the field and their notion of triple value, which is particularly more adequate, in my PH view. I was fortunate enough to even meet them in person, as the institute has very good relations with them. This is another benefit of trying out new networks as one might even get in touch with connections from that network.
As I see it, sometimes you get lucky and you grow a lot in professional terms with these internship opportunities, some other times you get very lucky and you end up also growing personally due to the relationships you build. I’ve learned a lot from the senior and junior specialists in the institute, but I’ve also learned with and because of the MRPHs in the Institute. In Italy, the PH residency is mainly based on Universities. I was able to connect with MRPH from different stages of residency and in the case of UCSC, the residents are very proactive and they even organize Global Health Courses for Medical Students in the University. How cool is that?! If they wanted to host a EuroNet MRPH meeting, I think they would probably do it without any trouble!
Besides all this, there was also Rome and Italy. There is culture around every corner and under every rock (I mean literally as during my stay they found new ruins when a bit of pavement on a road sunk due to the rain). I was able to travel around quite a lot and visit several landmarks in and outside of Rome. It is amazing how even in tiny cities I’ve visited there were some amazing monuments to be seen and the food was always good. The only travelling I didn’t enjoy was the traffic, which is quite hectic. Other than that, I have only good things to point out of my internship.
Therefore, I highly recommend every MRPH to do an internship outside their usual network of connections, as the benefits will likely out weight the costs. I was lucky enough to have someone in my network (thank you Stefan!) that was able to point out the perfect internship for me, but there are also other ways to go. For instance, you can make use of the internship program from EuroNet MRPH. Or if you are very keen on a specific place or topic that is not on the EuroNet list, you can also make use of the list of WHO’s collaborating Centres. You’ll likely have to put in a bit more effort to make it happen, but it will most likely pay off. In my case it definitely did. I’ve learned a lot, ate a lot of good food (and drank a lot of macchiato coffees as only Italy can provide), visited amazing places and enriched my network with a group of very knowledgeable, proactive and generous people. My experience would not be the same without them and I’m very thankful for them. I look forward to attending a EuroNet Meeting there very soon!
Miguel Cabral Medical Resident of Public Health (MRPH) Amadora, Lisbon, Portugal
EUPHA is an umbrella organisation for public health associations and institutions in Europe. Currently, EUPHA has 81 members from 47 countries, bringing together around 19,000 public health experts for professional exchange and collaboration throughout Europe.
EUPHAnxt was established in 2011, and has grown bigger each year. It is a free and open initiative that aims to inform and involve the future generations into the European and multidisciplinary network of public health associations.
The new team: Sara McQuinn (EUPHAnxt Coordinator), Pasquale Cacciatore (EUPHAnxt Communication Manager), Keitly Mensah (EUPHAnxt Conference Manager) and Anton Hasselgren (EUPHAnxt Partnership Manager).
We strive to further expand the network, build partnerships and strengthen the presence of students and young professionals in the European public health community. We aim to gather all young public health professionals and students in Europe. You are welcome to join us bysubscribing to our newsletter and follow our social media channels.
EUPHAnxt current projects and initiatives include:
To co-organise skill-building sessions at the annual European Public Health (EPH) conference to promote training and education. This year the conference will be inLjubljana, Slovenia Nov 28th-Dec 1st. We hope to see you there!
A fun and informative newsletter where we share our latest activities and news addressed to students and young professionals interested in public health.
The abstract mentoring programme, which provides an opportunity for young and/or less experienced abstract submitters to receive feedback from expert reviewers on abstracts that are to be submitted to the EPH Conference.
An Informal Internship Programme, where our goal is to put students and young professionals interested in doing an internship at the EUPHA office or within one of the EUPHA sections, in contact with the relevant public health professional.
If you have any queries, or would like more information regarding EUPHAnxt, please email: firstname.lastname@example.org. We also have Facebook, Twitter, Instagram and LinkedIn accounts where we share our latest activities, and interesting public health news! Come join us ®https://eupha.org/euphanxt
Worldwide, outdoor (ambient) air quality is a serious threat to health, estimated to cause millions of premature deaths due to cardiorespiratory diseases and lung cancer. Affected regions include both urban and rural areas. In 2016, the majority of the world population was living in areas in which maximum concentration of air pollutants were not met (1). In what concerns to sources, anthropogenic factors are the most relevant to negative effects of ambient polluted air (2).
Since 2013, the International Agency for Research on Cancer has defined polluted ambient air and particulate matter (PM) (separately) as carcinogenic to humans (group 1). In addition to strong evidence that polluted air cause lung cancer, there is also an increased risk of bladder cancer. Despite local variations, these conclusions are valid globally (3).
It is expected that in 2050, two-thirds of world population will be living in cities. By converging all opportunities and services in one area, overpopulated cities are also a challenge in terms of health risks and hazards. Creating and transforming sustainable cities implies intersectoral work, particularly governors and policymakers. In order to monitor and recognise success, World Health Organization (WHO) developed core health indicators for different sectors, including one in urban air quality. The indicator evaluates annual average of 2.5 and 10 concentrations in relation with WHO air-quality guidelines (4).
In 2016, Portugal had 91,3% of days classified as very good/good in terms of air quality index (IQAr) by the Portuguese Environment Agency. In the same year, Porto Litoral (coast) had 95,3% days with the same classification (Figure 1) (5). This index includes measures on five air polluted substances such as PM, ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO) (6).
Data on polluted air concentrations of 2.5 is provided by the WHO Global Observatory, including data on 190 countries. The Portuguese 2016 annual mean concentration of 2.5 was 8,1 µg/3, meeting WHO guidelines of lower than 10 µg/3 (7) (8). In the same year, the annual mean concentration of 2.5 (204 days of validated data) was 2.9 µg/3 in Porto (Sobreiras – Lordelo do Ouro station) (9). Data on both country and city levels of 10 was not available in the same sources. While Porto results are suitable so far, the predictions of research data using modelling methods are not optimistic. Even if precursor emissions and population remain constant, Porto will be the district most affected concerning 10 high concentration days and related health impact in 2100 (10).
Though in 2016, Portugal and Porto results on 2.5 met WHO guidelines, climate change and inaction specially on anthropogenic factors will be responsible for worse scenarios with serious consequences to human health.
World Health Organization. Ambient (outdoor) air quality and health [Internet]. Fact sheets. 2018. Available from: http://www.who.int/news-room/factsheets/detail/ambient-(outdoor)-air-quality-and-health
World Health Organization. Ambient air pollution: Pollutants. Air Pollution; Available from: http://www.who.int/airpollution/ambient/pollutants/en/)
World Health Organization. IARC: Outdoor air pollution a leading environmental cause of cancer deaths; Available from: http://www.iarc.fr/en/mediacentre/iarcnews/pdf/pr221_E.pdf
World Health Organization. Health Indicators of sustainable cities in the Context of the Rio+20 UN Conference on Sustainable Develpment. 2012; Available from: http://www.who.int/hia/green_economy/indicators_cities.pdf?ua=1
Fernandes AC, Guerra MD, Ribeiro R, Rodrigues S. Relatório do Estado do Ambiente 2018. Agência Port do Ambient. 2018; Available from: https://sniambgeoviewer.apambiente.pt/GeoDocs/geoportaldocs/rea/REA2018/REA2018.pdf
Portuguese Environment Agency. Air quality; Available from: (https://qualar.apambiente.pt/qualar/index.php?page=5&subpage=6).
World Health Organization. Concentrations of fine particulate matter (PM2.5); Available from: http://apps.who.int/gho/data/node.sdg.11-6-viz?lang=en
Lodgejr J. Air quality guidelines. Global update 2005. Particulate matter, ozone, nitrogen dioxide and sulfur dioxide. Environ Sci Pollut Res. 1996; Available from: http://apps.who.int/iris/bitstream/handle/10665/69477/WHO_SDE_PHE_OEH_06.02_eng.pdf?sequence=1
Portuguese Environment Agency. Station statistics; Available from: https://qualar.apambiente.pt/qualar/index.php?page=4&subpage=4).
Dias D, Tchepel O, Carvalho A, Miranda AI, Borrego C. Particulate matter and health risk under a changing climate: Assessment for Portugal. Sci World J. 2012; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361258/)
Mariana Perez Duque Public Health Resident Public Health Unit ACeS Porto Ocidental, ARS Norte, Portugal
The SAGE Working Group on Vaccine Hesitancy defined vaccine hesitancy as ‘the delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence’ (1). Indeed, it is complex and the reasons cited in the literature are varied, from fears about vaccine safety, worries about ‘overloading’ the child’s immune system, distrust of the pharmaceutical industry and collective amnesia regarding the dangers of vaccine preventable diseases (2). Many parents, unfamiliar with diseases like tetanus and meningitis, make incorrect conclusions when it comes to calculating the risk-benefit of vaccinating their children.
The current measles outbreak in Europe is the direct result of vaccine hesitancy. 13,234 cases have been reported across Europe since July 2017 (3). Sadly, there were also 18 deaths due to measles in this period (3). In Ireland, we have had 76 cases of measles in 2018 so far, with an ongoing outbreak in Dublin as I write this. What can we do to end this outbreak and prevent the resurgence of other vaccine preventable diseases?
Reviewing the current evidence on what can be done to address vaccine hesitancy is not particularly inspiring. Reminders, whether they are telephone, text or postal, and family incentive rewards have been proven to increase vaccine uptake, but there is limited evidence that they work for vaccine-hesitant individuals (4). A trusted health care professional can also have an impact on changing parental attitudes, but the evidence for the various communication tools that have been designed as aids for these professionals to use is mixed (4). More research and better measurement of outcomes is needed in this area (4). It is not enough just to measure change in attitude to vaccines, we must see if this change in attitude actually leads to increased vaccine uptake.
There are advocates for more innovative approaches. Some argue that social marketing frameworks could provide solutions (5). Others propose that children should be taught positive messages about vaccinations in school, as part of their health education, science or even citizenship classes, in order to ‘inoculate’ them against vaccine hesitancy in the future (6). A friend of mine, who teaches teenagers, created a lesson to teach her students critical analysis skills, using information on the benefit and safety of HPV vaccination. These kind of skills are vital for navigating the ‘fake news’ widespread on social media. For younger children, there are online games demonstrating how vaccines work (7). One review found 16 different games in 2016 (7). I lost 20 minutes trying to stop an outbreak with rapid vaccination at this particular link: https://vax.herokuapp.com/game
It’s a little bit addictive! Could positive attitudes to vaccines be engrained at a young age using these methods?
A mixture of targeted interventions to deal with parents in the midst of today’s crisis, as well as methods targeting future generations, will be necessary to tackle this complex issue. It is time to try new approaches. Please contact me at email@example.com, if you know of any innovative methods to improve vaccination rates that are ongoing in your country
MacDonald NE, the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015; 33:4161–4164
Marti M, de Cola M, MacDonald NE, Dumolard L, Duclos P. Assessments of global drivers of vaccine hesitancy in 2014 Looking beyond safety concerns. PLoS ONE. 2017; 12(3):e0172310.
European Centre for Disease Prevention and Control. Monthly measles and rubella monitoring report. Stockholm: ECDC; 2018
Dube E, Gagnon D, MacDonald N. Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine. 2015; 33: 4191-4203.
Nowaka GJ, Gellinb BG, MacDonald NE, Butler R, the SAGE Working Group on Vaccine Hesitancy. Addressing vaccine hesitancy: The potential value of commercial and social marketing principles and practices. Vaccine. 2015; 33:4204–4211
Wilson K, Atkinson K, Crowcroft N. Teaching children about immunization in a digital age. Human Vaccines & Immunotherapeutics. 2017; 13 (5):1155–1157.
Ohannessian R, Yaghobian S, Verger P, Vanhems P. A systematic review of serious video games used for vaccination. Vaccine. 34 2016; 34: 4478–4483.
Laura Heavey Specialist Registrar in Public Health Medicine Department of Public Health, HSE, Sligo, Ireland