The themes that proved important across the spectrum of topics discussed were the relationship between clinical medicine and public health, the need for public health funding, and the challenge of proving the effectiveness of disease prevention. In light of the latter, a need for improved data collection was identified throughout all areas discussed, as was a need to harmonize data across countries. Finally, our analysis identified areas for action that were perceived as crucial for strengthening public health in Central and Eastern Europe.
Underlying all discussions was a general understanding of the workshop participants that the main tasks of public health were to reduce risky behaviours (risk factors) in society and to prevent diseases. The general consensus was that national and supranational political will was essential to implement public health efforts and to reach set goals, making it a pre-requisite for effective public health interventions. Themes discussed recurred across disease entities and sessions.
Clinical medicine and public health
An important theme throughout the discussions was the relationship between clinical medicine and public health. Prevention programmes were perceived as being often headed by medical professionals in clinical fields. Since clinical medicine and public health have different perspectives and medicine itself is diversified, conflicts were seen to arise easily (Table , Quote 1a).
Themes of workshop discussions – direct quotations
Clinical medicine seemed the more powerful of the siblings. Its research may be influenced by industry interests and, in most countries, the social prestige and income of clinicians is higher than that of public health workers. Workshop participants perceived it as insufficient to allocate a certain amount of the time of health professionals to prevention efforts, without defining this more precisely (Table , Quote 1b).
In some countries the interplay between clinical medicine, public health and prevention was perceived as working extremely well. To achieve this, political will was thought to be as important as the willingness of different professions to collaborate on common goals (Table , Quote 1c).
Overall, the perception among the workshop participants was that clinical medicine and public health programmes are competing for funds. Results of clinical research are regularly celebrated as breakthroughs, which may be one of the reasons why political support for public health is weaker than for clinical medicine and biomedical research (Table , Quote 1d).
The pharmaceutical industry was perceived to play an important role in the predominance of clinical medicine, as it earns a lot of money through clinical approaches, but hardly anything from most public health measures (Table , Quote 1e).
Need for increased public health funding
The workshop participants could not identify ‘natural’ forces that exist to bring the public health agenda to the forefront of funding. However, the group agreed that there was a definite need for increased funding of public health activity in Central and Eastern Europe. Particularly, the breakdown of the former political and economic system was described as resulting in significant health risks, as it introduced a myriad of lifestyle changes, such as an increase in alcohol consumption in some countries and the increasing availability of ‘junk food’ (Table , Quote 2a).
Apart from lifestyle changes, there was also a breakdown of the often well-functioning public health infrastructures, such as cancer registries, screening programmes, and the surveillance of infectious diseases such as tuberculosis (Table , Quote 2b).
Accession to the European Union was perceived as offering new opportunities for strengthening public health. One of the participants expressed the hope that public health interventions could be improved by following European directives (Table , Quote 2c).
Lobbying was seen as crucial to ensure a higher visibility and funding of public health efforts. Especially the local constituency was mentioned as a valuable source to increase visibility of neglected themes. Some also mentioned the use of elections. In election times, many programmes may get funded that otherwise go unnoticed. Similarly, coalition-building with individual politicians was mentioned. In line with lobbying with local constituencies, a “bottom-up” approach was discussed as a possible avenue to initiate change.
Effectiveness of prevention
A theme discussed throughout the disease spectrum was the effectiveness of prevention efforts. Most participants believed that there was very limited data on effective interventions (Table , Quote 3a and b).
One of the most important points brought up during the workshop was that funds need to be made available for well-designed evaluations of public health interventions. This would also help to build public health research capacity. The group believed that if the effectiveness of prevention efforts were proven, political and public support would be easier to achieve (Table , Quote 3c).
Data harmonisation across Europe
Many participants pointed out that comparable information on disease and risk factor trends in Europe was limited, and that this hindered the coordination of public health programmes across countries. At the same time, creating comparable surveillance data was recognised as being difficult, as diagnosing techniques may differ across countries (Table , Quote 4a)
Collecting high-quality data was further complicated through different treatment facilities and traditions. In some countries, diseases like stroke may be treated in hospitals, while in others they were treated in local health facilities. This may even differ from region to region in a single country (Table , Quote 4b).
Developing comparable data for Europe will require careful consideration of how, where and by whom data should be collected in each country and region. This will necessitate an understanding of local health care practices within and across countries.
Areas of public health action in Europe
Throughout the discussions, group members mentioned areas for action that they found most pressing for public health in Europe. Table subsumes activities and goals of the four areas for action identified (Table ).
Areas for public health action in Europe