Selecting indicators for signalling and monitoring the wider effects of the COVID-19 pandemic

Background

The COVID-19 pandemic and the actions taken to control the spread of the coronavirus have a substantial impact on population health beyond the morbidity and mortality caused by the virus directly. To provide a comprehensive picture of the pandemic's impact, suitable indicators for signalling and tracking these wider effects should be incorporated into monitoring activities. Therefore, WHO/Euro developed a tool to select indicators for this purpose.

Methods

Based on desk research and extensive expert consultation, a framework was developed for the main pathways through which the COVID-19 pandemic influences population health. For each pathway in the framework, underlying mechanisms and related indicator areas were defined. In addition, groups that are particularly vulnerable to the wider effects of the pandemic were identified, as these require specific attention in monitoring exercises.

Results

The main pathways through which the pandemic impacts general population health as used in the tool are:

Fear of getting infected or spreading infection Impaired healthcare for non-COVID-19 conditions Direct effects of containment measures Indirect effects of containment measures through risk factors Indirect effects of containment measures through wider determinants of health

A total of 27 underlying mechanisms and related indicator areas were defined. E.g., one underlying mechanism under the first pathway involves stockpiling disinfectants and cleaners. This results in people being more exposed to dangerous substances and applying disinfectants improperly, which leads to an increase in poisonings. Identified vulnerabilities relate to people's age, gender, socioeconomic status, place of residence/living situation, morbidity/disability status, and refugee or migrant status.

Conclusions

Developing a conceptual framework provides a useful approach for structuring widespread and complex developments such as the wider health impacts of the COVID-19 pandemic.

The WHO support tool: what can you learn and how have others experienced it?

Issue and method

Health information systems (HIS) in Europe are complex and involve multiple stakeholders. To strategically assess HIS, a support tool has been developed by the WHO Regional Office for Europe.

It has been applied in nine countries by WHO Europe since October 2015. Additionally, nine countries are using the tool in a peer review format within the context of the Joint Action on Health Information (InfAct) between January and December 2019. What can you expect to find out during such an assessment? What are countries commonly struggling with? In this presentation, the wealth of experiences using the support tool will be shared and participants will learn about common strengths and weaknesses in HIS across Europe.

Results

While each country possesses a unique HIS, common strengths and challenges emerge from across assessments. A few major ones will be presented in this session. In many countries promising e-health developments are ongoing such as electronic health records, e-prescription and cloud solutions for data storage. There is a clear desire to shift towards e-health technologies which is a real opportunity. However, well-developed step-wise approaches in interaction with key players are sometimes lacking and sustainability in financing can be of concern. Central multisectoral coordination mechanisms are often lacking, leading to inefficiencies in bringing together data and information, and in the use of financial and human resources. Finally, in many cases data is available, but legal aspects (e.g. impact of General Data Protection Regulation) are limiting the exchange and linkage possibilities for research and monitoring.

Lessons

HIS assessments help to determine common strength and challenges. By sharing common experiences, participants are better prepared to face common hurdles in their country and will have been exposed to good practices on how to address these.

EUPHA strategy 2020-2025: Achieving a triple A rating for health in Europe

The challenges we face are complex in nature, and require multidisciplinary and intersectoral action at different governance levels. Therefore, EUPHA will reinforce its two-tier approach. On the one hand, we will support our members in providing high quality and efficient public health and health care services in European countries, regions and local communities. On the other hand, we will advocate for health and support evidence-informed health policy-making at the international level. Stimulating and facilitating mutual learning and the exchange of knowledge and experiences across experts, members and countries will be an essential element of EUPHA’s approach. Not only with a focus on optimal support for our members, but also with an explicit focus on overcoming health inequalities within and between European countries.

Our new vision is to enable everyone in Europe to achieve the highest possible level of health by providing independent and authoritative analysis of the evidence, combined with targeted advocacy to achieve co-ordinated action by all key stakeholders. Our vision: builds on the commitments of our governments and international agencies to achieve the health-related Sustainable Development Goals;recognises the importance of placing Health in All Policies;draws on the Vienna Declaration to embrace the entire range of health determinants, including the biological, social, environmental, occupational, political, and commercial, the health care system, and everything that influences the health of our planet.

Our mission will be: To ensure that there is a strong evidence base, built on sustained investments in data, research capacity, and knowledge translation in all parts of Europe that can inform policies that impact on health;To identify, develop, and advocate for actionable policy recommendations to improve health;andTo support capacity-building and collaborations that can achieve public health action.