Public Health in Europe: Power, Politics, and Where Next?

Abstract

Health policy in Europe is at a crossroads. Longstanding challenges, such as persisting social and geographical inequalities, ageing populations, and rising burdens of chronic diseases, are being compounded by new, global threats, such as pandemic infl uenza and crises in the world's fi nancial markets. Signifi cant improvement in the health of Europe's population has been driven by factors both inside and outside the health sector. Key obstacles to improving population health in Europe result from underlying failures to overcome political and economic issues, including those shaping healthcare fi nancing and delivery systems. How can the public health community respond to these challenges? This paper discusses three examples of how power and politics have shaped the world in which public health works. The focus on individual risk factors diverts attention from underlying determinants, such as the dominance of the market in healthcare, and the political decision to favour a rapid transition from communism in the 1990s. Effective public health policy requires addressing these political forces, seeking to understand the dominant paradigms, how they have been defi ned and shaped, and how they might be changed. Their effects are often subtle but powerful, shaping the language that is used, the assumptions that are made, and the rules that are implied. We can formulate key policy options to help improve health outcomes by reshaping the critical forces that affect public health risk factors among those populations currently most burdened by signifi cant disease in Europe today.

Cardiovascular Disease in Central and East Europe

“…Such traits as depression, anxiety, low social position, low control over one's own life and health, poor job conditions (effort-reward imbalance, job strain) are recognized as important psychosocial risk factors. 19 The evidence from CEE countries is scarce, but the clear relation between education and CVD mortality, which was confirmed in almost all CEE countries [39][40][41][42][43][44][45] seems to support that CVD risk is higher among disadvantaged groups just as it is in Western Europe. There is also confirming evidence that unfavourable working conditions are related to depression and worse health.…”

The association between family affluence and smoking among 15‐year‐old adolescents in 33 European countries, Israel and Canada: the role of national wealth

“…As smoking and inequalities in smoking among adults has been found to be related to economic development, it is important to know whether this association can be found for adolescents. This study can provide implications for future trends in inequalities in adolescent smoking, especially for less wealthy countries where economic development and prosperity are lagging behind economically advanced countries . The key objective of this study is to investigate whether wealthier countries have smaller inequalities in adolescent smoking according to family affluence, a proxy measure for SES in adolescents.…”

The Role of Social Determinants in Tackling Health Objectives in a Context of Economic Crisis

“…3 Further, other intervening factors such as prohibition and New Deal policies influenced the reductions in total mortality. 3,4 There is comparatively little research into the longerterm impacts of an economic crisis, though it appears that being born in a recession is associated with increased mortality rates in adulthood. 5 Studies into specific causes of mortality have allowed us to see more clearly the impact of recession on health.…”