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Life and Drugs, Part 1, An Overview

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Drugs //  “It is better and more useful to meet a problem in time than to seek a remedy after the damage is done” explains a Latin saying of the mid-13th Century. According to the Council of the European Union (Review August 2022):

Drugs are a complex social and health phenomenon that affects millions of people in the EU. Illicit drugs can have tremendous negative consequences, not only for the people who use the drugs but also for their families and communities. The use of drugs generates enormous costs for and harm to public health and safety, the environment and labour productivcity. It also poses security threats linked to violence, crime and corruption.

Drugs and history

Curiously, the history of drugs is linked to the existence of life on Earth, which appeared some 3.5 billion years ago, first aquatic and then on the surface. In parallel with the development of life, a fundamental problem arises: how to survive and be part of the food chain while ensuring the survival of the species.

Living organisms have therefore developed means of defence: the constitutive ones such as claws, horns, spines, etc. and the so-called inducible ones which are at the origin of the synthesis of toxic substances in the form of secondary metabolites not necessary for the life of the organism but necessary for its survival against predators. And the human being is one of these formidable predators! So there is a close relationship between survival and existing toxins or drugs.

At the origin of the times, human health was in the world of spirits, magical practices and beliefs. Traditional healing systems are back to prehistoric times and the curing traditions already included the use of psychoactive plants. In Europe, it was in Ancient Greece, in the 5th century BC, that Hippocrates laid the foundations of rational medicine and medical ethics. His oath was taken up at the world level by the World Medical Association, created in 1947, then in the Geneva Declaration of 1948 (revised in 2020) and also by pharmacists/apothecaries and dentists.

A distinction must be made between drugs and medications. The main difference lies in the purpose of use or consumption:

-The medicine has a dosage, a curative purpose, a precise and repetitive action. But the medicine is not always without toxicity. Paracelsus (1493-1541) a Swiss doctor, philosopher and theologian even said:

“Everything is poison and nothing is without poison; the dose alone makes a thing not a poison”.

-A drug is any substance, natural or synthetic, which has a modifying effect on the state of consciousness, mental activity and behavior, likely to cause addiction. Some medicines could correspond to this definition but the drug is consumed without a medical prescription and its current use does not have a curative goal. It could be to experience new or pleasant sensations, to escape from reality, anxiety, relationship problems, past traumas, by conformity or rebellion, to be efficient or withstand pressure. But, whatever the reasons and patterns, drug use is not without risk with uncontrolled consequences…

Drugs and Humanity

The history of drugs also merges with the history of humanity as for:

a) the Hemp (cannabis) that was known in Asia since the Neolithic, around 9000 BC. The seeds were used in Egypt for their anti-inflammatory properties, and in China for their nutritive richness and in 2737 BC hemp is included in the Treaty of the medical herbs of the emperor Shen Nong; the hemp canes appear in Europe imported by the Romans and with the various invasions coming from Asia. It was also the “sacred herb” of the shamans’ rituals and part of the medical practices of the monks of the 12th century.

b) the Coca leaves, from the plant Erythroxylum coca, were used since 3000 years BC in the Andes. For the Incas, this plant had been created by the Sun God to quench thirst, cut hunger and make you forget the fatigue. It was also used during religious ceremonies as in Peru and Bolivia. The West discovered the coca use and properties in the 16th century with the Spanish “conquistadores” of Pizarro (1531), missionaries and settlers. Coca leaves were then used to enslave and send the Indians to work in the silver, gold, copper and tin mines. In 1860, German chemist Albert Niemann isolated the active anesthetic substance in the coca leaves. In 1863, Corsican chemist Angelo Mariani launched the famous French tonic wine “Vin Mariani” made with Bordeaux wine and coca leaf extracts. Meanwhile, in 1886, John Stith Pemberton (1831-1888), a pharmacist from Atlanta (USA), wounded at war and using cocaine, inspired by Mariani wine produced a stimulating drink made from coca, kola nuts and soda. Then the businessman Asa Griggs Candler (1851-1929) bought the formula and in 1892  created The Coca-Cola Company. In 1902 caffeine replaced cocaine in Coca-cola.

Cocaine is a powerful stimulant of the central nervous system. After the “high” wears off (15-30 min), the person may feel anxious,  depressed, with an intense need to use cocaine again. Cocaine is one of the most difficult drugs to withdraw from.

It was in the 1960s, popularized by music and the media, that drugs became symbols of youthful rebellion, social upheaval and began to invade all aspects of society. In many ways, this was the pharmaceutical decade of the century with a plethora of new substances -and drugs- available.

Drugs classified

If we make a foray into the world of drugs, we can classify them according to their effects, such as:

  • Dissociatives: Nitrous oxide (N2O, the laughing gas) is used as an anesthetic and analgesic in surgery and dentistry.And currently used for whipped cream siphons. It is very appreciated by young people during parties for the euphoric effect but it can cause severe neurological, hematological and cardiac disorders. It destroys vitamin B12. It also includes the Ketamine, PCP (angel dust), GBL (a sedative) and GHB (a solvent), etc.
  • Delusional and entactogenic (desire for contact, empathy): Scopolamine, Atropine, etc.
  • Depressants: alcohol, barbiturates (Amytal, Pentobarbital), opium, codeine,…
  • Cannabinoids (cannabis, hashish): Delta9-THC, CBD, CBN, etc.
  • Benzodiazepines: Alprazolam (Xanax), Valium, Rohypnol, …
  • Psychiatric drugs: Fluoxetine (Prozac), Haloperidol (Haldol), Zoloft, Paroxetine (Paxil), etc.
  • Natural stimulants: cocaine, caffeine, theophylline, cocoa theobromine, etc.;
  • Stimulants: amphetamines, crystal meth, methamphetamine (WWII Pervitine), etc.
  • Pharmaceutical stimulants: Adrafinil, Modafinil, Bupropion, etc.
  • Psychedelic stimulants (hallucinogens): LSD, MDMA (ecstasy), Psilocybin, Bufotenin (alkaloid secreted by the skin of the toad that amateurs lick) and Ibogaine (from the Central African Iboga plant) are both from the family of tryptamines deriving from neurotransmitter serotonin.

Should also be mentioned The New Psychoactive Substances (NPS) which imitate traditional psychoactive substances -cannabis, cathinone (from the khat leaves), opium, cocaine, LSD or MDMA (amphetamine). But, they are more powerful and more addictive. More than 900 synthetic drugs have already been identified in Europe, uncontrolled, and illicit but sold on the Internet, and classified. (more in EMCD Drug profiles).

Examples of NPS:

1) Synthetic cannabinoids, are found in the: Spice, Yucatan, etc. as JWH-18 & 250, HU-210, CP 47 & 497, etc., having affinity for the CB1 receptors.

2) Synthetic derivatives of cathinone (an alkaloid extracted from the khat leaf, sympathicomimetic): 3-MMC (3-methylmethcathinone) and the 4-MMC (Mephedrone) which creates euphoria, blue-knee syndrome, risk of heart attack, etc.

  • MDPV (methylenedioxypyrovalerone), from “bath-salts”.
  • Overdose leads to hyperthermia, coronary heart disease, arrhythmia, episodes of psychosis and violent behavior.

3) A synthetic psychoactive opioid product: fentanyl, 100 times more powerful than morphine and more addictive, with unpredictable effects. It is considered the most lethal drug by overdose.

4) Krokodil, a Russian “flesh-eating” drug. Based on desomorphine synthesized in Germany in 1922 from morphine/codeine, a powerful sedative and analgesic that has since been abandoned. Solvents, gasoline, HCl, etc. are added to produce the drug with irreversible necrosis.

2022 European report on drugs

The European Drug Report 2022 of the EMCDDA (European Monitoring Center for Drugs and Drug Addiction), noted that Europe had 83.4 million people aged 15-64 using drugs, 29% of the population. This represents:

  • 22.2 million for cannabis, the most consumed drug (7% of Europeans), of which 16 million were aged 15 to 34;
  • 3.5 million for cocaine, including 2.2 million aged 15-34;
  • Ecstasy or MDMA concerns 2.6 million people;
  • 2 million for amphetamines, mostly aged 15-34;
  • 1 million for heroin and other opioids, with 514,000 receiving substitution treatments.

The biggest cannabis smokers are young people in the Czech Republic with 23% of aged 15-34, followed by France (22%) and Italy (21%). The Netherlands and Belgium with 110 tons of cocaine seized in the port of Antwerp in 2021, are currently the drug hubs in Europe.

EMCDDA reports that in 25 European countries, 80,000 people are in treatment for cannabis use, representing 45% of all drug treatment entrants in 2020.

The increased availability of a wider variety of illicit drugs including NPS has led to different poly-drug use practices which complicate the clinical picture. The number of illicit drug overdose deaths in the EU is estimated to be in 2019 a minimum of 5,150 and 5,800 including Norway and Turkey. The age group most affected is 35-39 with double the number of deaths of the general average.

*In the State of Washington (USA), a study of 2021 shows that deaths by suicide increased by 17.9% among 15-24-year-olds after the legalization of cannabis.

To protect the physical and moral health of humanity and based on the Conventions of 1925 and 1931, three international Conventions on Drug Control of the United Nations Office on Drugs and Crime (UNODC) were signed. These are the 1961, 1971 and 1988 Conventions against the illicit traffic of narcotic drugs and psychotropic substances.

Children, drugs and decriminalisation

In 1989, the Convention on the Rights of the Child was also ratified. Its Article 33, too often forgotten by governments, stipulates that:

States Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties.

In Europe, several countries have decriminalized cannabis use. This is particularly the case in Spain, Portugal, Italy and the Netherlands, where consumers are not liable to fines or imprisonment if for personal use.

Only Malta has fully legalized the recreational use of cannabis following a law passed in December 2021 that allows not only consumption but also cultivation.

In Germany, the Minister of Health intends to follow this pattern and legalize the recreational use of cannabis by 2024. His purpose by decriminalising cannabis is to ensure better protection for children and young people and also to provide better health protection!

France considers that the decriminalization/legalization results are still not conclusive and that the legalization of cannabis has led to a trivialization of the product, without reducing drug trafficking, and without preventing dealers from continuing to sell other illicit products.

In the Czech Republic, the Report 2022 on Illicit Drugs mentioned that

“the topics of political, professional and public discussions included cannabis used for  both medical and non-medical purposes, the inadequacy of penalties for cannabis-related offences and the use of psychedelics for treatment of mental disorders and for self-development” .

In Hungary cannabis is illegal but a personal quantity (1 gram) is tolerated.

The above justifies the successive EU Drugs Strategies as 2021-2025 of the Council of the European Union aimed ” to protect and improve the well-being of society and of the individual, to protect and promote public health, to offer a high level of security and well-being for the general public and to increase health literacy” and in its point 5: Prevent drug use and raise awareness of the adverse effects of drugs.

Drugs, celebrities and education

Since the 1960-70ies, starting with the Beat Generation, and then with celebrities (many having subsequently faced an unexpected tragic destiny), young people with a lack of factual data and information on the drug subject, became easy and vulnerable targets. Currently, the youth are exposed to drugs earlier than ever due to the easy availability of drugs, the aggressive promotions in the media and on the Internet, and due to the constant innovations in the digital illicit drug market.

It is crystal clear when talking with youth and even with parents that they are eager to know more about the drug’s harmful effects to be able to have facts to make the right decision and for the parents to dialogue efficiently with their children. So, facing the drug problem, the master word is Education! Indeed:

Education is a progressive discovery of our own ignorance wrote the philosopher Will Durant (1885-1981). This is the best prevention and basic action to oppose the pressure and lobbying of the drug industry.

The single most destructive element present in our current culture is drugs said the humanist L. Ron Hubbard (1911-1986). In Europe, cannabis  (marijuana) is with alcohol the most used drugs by 15,5% of the 15-34 years old. And cannabis appears to be the entrance gate into the destructive universe of drugs.

This is why the actions of the Foundation for a Drug-Free Europe and its hundred of Say No To Drugs associations and groups of volunteers across Europe, aware that every year drugs destroy thousands of lives and hopes, are actively contributing through The Truth About Drugs campaign, to preventively educate the youth and the public at large with factual data on the harming effects of drug use.

More in:

https://www.emcdda.europa.eu/publications/edr/trends-developments/2022_en

https://www.europol.europa.eu/publications-events/publications/eu-drug-markets-report

https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2022.html

Get informed on drugs on: www.drugfreeworld.org or www.fdfe.eu

Discover soon in The European Times, the next part of this article: Life and Drugs: (2) The Cannabis.

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Health & Society

How To Build Resilient Health Systems – Coordinated European Responses

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Many individuals and communities rely on effective health systems, particularly during crises. To ensure maximum efficiency and better outcomes, you must focus on developing coordinated responses across Europe. This approach not only strengthens your local health infrastructure but also fosters collaboration among nations, enabling a more robust response to public health challenges. In this guide, you’ll learn the necessary steps to enhance resilience in your health system, paving the way for a healthier future.

Understanding Resilient Health Systems

To truly comprehend what constitutes a resilient health system, you must acknowledge its ability to respond effectively to various challenges while maintaining necessary health services. A resilient health system can withstand shocks, whether they stem from public health emergencies, such as pandemics, or other systemic pressures like economic downturns. The resilience of such systems is not merely in their robustness, but in their agility and adaptability to changing circumstances, allowing them to bounce back swiftly from disruptions while continuing to deliver high-quality care to all.

Key Characteristics of Resilience

Assuming you want to identify the key characteristics that define resilience in health systems, you will find that flexibility, adaptability, and resourcefulness are paramount. These characteristics enable health systems to adjust to evolving needs, manage unpredictable demands, and deploy resources efficiently in response to crises. Furthermore, an emphasis on collaboration within and between health services enhances the ability to share knowledge, skills, and resources, significantly strengthening overall health system resilience.

Importance of Coordination in Health Responses

While addressing health emergencies, you must understand that coordination plays a vital role in the effectiveness of responses. The integration of efforts across various health sectors ensures a unified approach that maximises the use of available resources and minimises redundancies. This coordinated effort not only fosters better communication among stakeholders—such as health officials, government entities, and non-governmental organisations—but also enhances your ability to implement interventions swiftly and at scale, ultimately saving lives and preserving health infrastructure during crises.

Another key consideration is that effective coordination facilitates the alignment of objectives and strategies across different organisations and regions, allowing for a more focused deployment of efforts. This integration can lead to improved health outcomes by ensuring that the right resources reach the right places at the right time. By establishing clear communication channels and protocols, you can greatly enhance the synergy between health services and stakeholders, creating a robust framework that fosters not just immediate responses, but long-term improvements in health system resilience.

Factors Influencing Resilient Health Systems

Now, the resilience of health systems is shaped by a myriad of factors that hold significant importance in fortifying their ability to withstand shocks and respond effectively. You must consider several key elements that play a vital role in shaping these systems:

  • Governance
  • Policy Frameworks
  • Financial Sustainability
  • Resource Allocation
  • Collaboration

This multifaceted approach to understanding resilience allows for a comprehensive strategy in health system development.

Governance and Policy Frameworks

If you want your health system to be resilient, you need to ensure that robust governance and sound policy frameworks are in place. Effective governance involves not only strategic oversight but also the empowerment of local health authorities to make decisions that best serve their populations. The policies that underpin health systems must be flexible enough to adapt to emerging challenges, including pandemics and economic crises.

Additionally, transparent decision-making processes and stakeholder engagement are integral to building trust within the community. Your governance structures should promote accountability and encourage feedback from both health workers and the public, ensuring that policies remain relevant and effective in the face of unforeseen circumstances.

Financial Sustainability and Resource Allocation

Assuming financial sustainability is a foundational pillar for resilient health systems, it’s crucial that adequate resources are allocated to meet both current and future healthcare needs. You should scrutinise funding modalities and ensure that they are directed towards vital areas that enhance system strength, such as infrastructure, human resources, and technology. An effective resource allocation strategy can determine your health system’s capacity to respond to crises and maintain crucial services.

To succeed in financial sustainability, it is imperative that you prioritise investment in preventive care and community health initiatives. Underfunding these areas can result in significant long-term costs for your health system. Additionally, consider exploring diverse financing options, including public-private partnerships, which can bolster your system’s financial base. An effective allocation of resources not only promotes equity and access but also enhances the overall resilience of your health framework, allowing you to better navigate challenges as they arise.

How to Build Resilient Health Systems

Clearly, building resilient health systems is paramount for ensuring a responsive and robust healthcare environment capable of withstanding various challenges, including pandemics, natural disasters, and sudden shifts in population health needs. A resilient health system not only effectively manages immediate health crises but also lays the groundwork for long-term sustainability and adaptability, fostering an environment where health services can continue to operate under stress. This involves a multi-faceted approach that integrates resources, technology, and human capital, all while maintaining a clear focus on the health outcomes of the population.

In achieving an effective health system, the coordination of various elements such as policy-making, financing, and service delivery is vital. Thus, it becomes imperative to ensure that health systems are designed with flexibility in mind, enabling them to evolve according to the changing needs and expectations of the communities they serve. By promoting collaboration between public and private sectors and engaging a broad array of stakeholders, resilient health systems can be established that prioritise equitable access and quality care.

Engaging Stakeholders Effectively

You play a pivotal role in engaging stakeholders to create a robust health system. Effective stakeholder engagement means identifying key partners including healthcare professionals, policymakers, community organisations, and the public. It is vital to communicate clearly and frequently, establishing trust and fostering teamwork throughout the entire health landscape. Regular dialogue allows for the sharing of ideas and concerns, ultimately leading to shared ownership of health priorities and strategies. Involving stakeholders in decision-making processes ensures that the systems developed reflect the true needs and nuances of the communities they are intended to serve.

Moreover, cultivating strong relationships with your stakeholders enhances the sustainability of initiatives aimed at improving health systems. Engaging in active listening and collaborative problem-solving fosters a culture of inclusivity and respect. You can benefit from leveraging local knowledge and expertise, and in doing so, catalyse innovative solutions that are both creative and effective, ultimately leading to a better health system.

Implementing Evidence-Based Practices

Stakeholders are responsible for implementing evidence-based practices, which are vital for driving improvements in health systems. It is vital to integrate the best available research evidence into clinical decision-making and healthcare policies. By using data-driven strategies, you can ensure that interventions are not just implemented but are also evaluated for their effectiveness, allowing for ongoing improvements and refinements to service delivery. This provides a structure for moving away from anecdotal practices towards more scientifically validated approaches that can significantly enhance patient outcomes.

Effectively utilising evidence-based practices requires a strong commitment to continuous learning and adaptation. Health professionals and organisations should prioritise up-to-date training and education, encouraging them to seek out and apply new findings from research and clinical studies. Establishing a culture of inquiry within your health system enables quick adoption of successful practices while simultaneously identifying and mitigating potential risks, all of which contribute positively to the overall health landscape.

Tips for Coordinated Responses in Health Systems

Keep in mind the following strategies to enhance the coordination of your health system responses:

  • Focus on establishing clear roles and responsibilities.
  • Encourage ongoing training and capacity building.
  • Promote inter-sectoral collaboration.
  • Share data and insights regularly across stakeholders.
  • Engage the community to foster trust and support.

This approach will not only improve your health system’s effectiveness but also build a foundation for sustained resilience.

Establishing Effective Communication Channels

If you want to facilitate a smooth and efficient health crisis response, establishing effective communication channels is imperative. Clear and concise communication ensures that all stakeholders are informed, reducing the chances of miscommunication and enhancing the overall operation of your health response. Regular updates, shared among all participants, can help in synchronising actions and keeping the focus on the common goals of your health systems.

In addition, adopting a multi-channel approach—utilising emails, instant messaging, and formal reports—can help cater to the varying preferences of stakeholders. Make sure to gather feedback to adjust your communication methods accordingly to fit evolving needs. This proactive approach will not only strengthen relationships but also prepare your health system for future challenges.

Leveraging Technology for Enhanced Collaboration

An effective way to improve collaboration within your health system is by leveraging technology. Utilising digital platforms and tools can significantly streamline communication, foster teamwork, and enhance information sharing among professionals. Tools such as collaborative project management software or data-sharing platforms facilitate transparency and enable real-time updates, ensuring everyone is working with the latest information.

Collaboration through technology allows your health system to effectively connect various stakeholders, streamline processes, and quickly adapt to changing situations. For example, virtual meetings and telehealth solutions allow for comprehensive discussions and consultations without geographical hindrances. The potential to share critical data across borders can improve your capacity to respond to health crises even faster. Additionally, security features in modern technologies should be prioritised to protect sensitive patient information, mitigating risks associated with data breaches. Always ensure that your technology choices enhance accessibility while maintaining robust security protocols in your health system.

Evaluating Resilience and Adaptability

Your ability to evaluate the resilience and adaptability of health systems is vital for ensuring that they can withstand and respond to crises. Resilience in healthcare implies a system’s capacity to absorb shocks, adapt to challenges, and drive recovery efforts effectively. To build a robust health system, it is important to focus on both qualitative and quantitative measures that underscore operational efficiency, stakeholder engagement, and the system’s capacity to learn from past experiences.

Your approach should incorporate feedback mechanisms that facilitate continuous evaluation and adjustment. Through simulations, scenario-based assessments, and stakeholder interviews, you can gain insights into how well the system has performed during stress events. This conscious back-and-forth process ultimately leads to a healthier and more prepared health system that safeguards public wellbeing.

Metrics for Assessment

With various metrics available, it is imperative to utilise a combination of both performance indicators and qualitative assessments to gauge resilience effectively. Key performance indicators such as patient outcomes, resource allocation efficiency, and healthcare service accessibility are important metrics to consider. Additionally, qualitative factors, including stakeholder satisfaction surveys and community engagement levels, provide a deeper understanding of the health system’s adaptability and trustworthiness.

With the right metrics in place, you can benchmark progress over time, identifying areas for enhancement and ensuring that health systems are not only responsive but also capable of evolving in the face of emerging challenges. This data-driven approach empowers you to instigate informed policy changes that can significantly improve health system resilience.

Continuous Improvement Strategies

Some effective strategies for continuous improvement include fostering a culture of open communication, encouraging innovative practices, and implementing training programs focused on crisis management. By prioritising ongoing education and professional development, you strengthen the capabilities of healthcare professionals, ensuring they are equipped to tackle unforeseen challenges effectively.

The key to developing a more adaptable health system lies in integrating lessons learned into everyday practices. This might involve establishing dedicated task forces to analyse past incidents, soliciting feedback from frontline employees, or leveraging technology for data analytics. By focusing on continuous improvement, you ensure that your health system not only survives crises but also flourishes in its aftermath. This proactive stance is instrumental in building public confidence and promoting a healthier society overall.

Future Directions for Health System Resilience

Despite the challenges faced during recent health crises, there remains a significant opportunity to enhance the resilience of health systems across Europe. You may find it insightful to explore the Building a European Health Union initiative, which aims to coalesce efforts among member states, strengthening not only the capability to respond to future health emergencies but also ensuring a consistently high standard of care throughout the continent. Emphasising collaboration and unity among countries is imperative as health threats know no borders, requiring a unified approach to healthcare delivery. Understanding these future directions will equip you with the insights necessary to navigate evolving health landscapes.

Innovations in Health Care Delivery

Now, the integration of innovative technologies in health care delivery is swiftly transforming the way services are provided. From telemedicine to AI-driven diagnostics, these advancements enable you to access healthcare more efficiently during challenging times. Innovations like remote consultations can significantly reduce the burden on physical healthcare facilities while providing timely medical support, enhancing patient outcomes. As such technologies continue to develop, you will likely see a shift towards a more patient-centred healthcare model, empowering individuals to take charge of their own health.

Strengthening International Collaboration

An imperative component of building resilient health systems is the enhancement of international collaboration. This involves sharing knowledge, resources, and best practices among nations to tackle shared health challenges effectively. As you consider the importance of such partnerships, it becomes evident that collaborative efforts can lead to more rapid responses in times of crisis, and ensure that there is a collective approach in maintaining public health. Strengthening these ties is vital, especially as globalisation continues to influence health dynamics.

It is imperative to recognise that effective international collaboration not only supports immediate responses to health emergencies but also paves the way for long-term strategic planning. By pooling resources and expertise, countries can identify emerging public health threats, thus preventing potential future crises. This global solidarity is not just beneficial but necessary, as it strengthens your local health systems while ensuring a resilient response to health challenges faced worldwide. Ultimately, reinforcing international connections will allow you to contribute to a more stable and healthy future for everyone.

To wrap up

Taking this into account, you should recognise that building resilient health systems is not just a goal but a necessity in the face of evolving global health challenges. By fostering coordinated responses across Europe, you can ensure that resources are optimally shared, knowledge is effectively exchanged, and best practices are implemented to enhance your health sector’s robustness. It is vital that you actively contribute to these collaborative efforts, whether through local initiatives or wider networks, to create a more united and prepared healthcare system.

Your role in this process involves advocating for policies that support integration, investment in health infrastructure, and strengthening partnerships across borders. By prioritising these aspects, you can help cultivate a health system that adapts swiftly to changing circumstances, ultimately safeguarding the wellbeing of your community and beyond. Engaging with policymakers, healthcare providers, and fellow citizens will empower you to influence the direction of health system resilience, ensuring that your voice is part of the collective endeavour towards a healthier Europe.

FAQ

Q: What are resilient health systems?

A: Resilient health systems are those that can effectively respond to a wide range of challenges, including emergencies, pandemics, and changing health needs. They maintain crucial services during crises while being adaptable to recover from disruptions. Key components include strong leadership, efficient resource management, and integrated health services that ensure continuity and accessibility for all populations.

Q: How can European countries improve their coordinated response to health crises?

A: Improving coordinated responses in Europe requires enhanced communication and collaboration among countries. Establishing common protocols for data sharing, aligning public health guidelines, and creating joint training programmes for healthcare professionals are crucial. Additionally, fostering strong partnerships between governmental agencies and public health organisations can help streamline efforts to address health emergencies across borders.

Q: What role do technology and data play in building resilient health systems?

A: Technology and data are vital for building resilient health systems as they enable real-time monitoring of health trends and facilitate rapid responses to emerging threats. Advanced data analytics can help in predicting outbreaks and understanding public health needs. Moreover, telehealth services can improve access to care, especially during crises when physical access to healthcare facilities may be limited.

Q: How can community engagement contribute to health system resilience?

A: Community engagement is crucial for health system resilience as it fosters trust and encourages local populations to participate in health initiatives. Involving communities in decision-making processes enhances awareness about health issues and ensures that services are tailored to meet local needs. Strengthened community ties can also facilitate better compliance with health measures during crises, ultimately enhancing overall public health outcomes.

Q: What are the main challenges faced by European countries in achieving coordinated health responses?

A: European countries face several challenges in achieving coordinated health responses, including disparate healthcare policies, varying levels of funding, and differences in public health capacities. Cultural differences and language barriers can impede effective communication among nations. Additionally, the varying degrees of commitment to collaboration at political and organisational levels can hinder unified efforts to build resilient health systems across the continent.

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Socioeconomic inequalities drive significant gaps in access to mental health care across the European Union

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A study presented at the European Psychiatric Association Congress 2025 reveals deep socioeconomic inequalities in reported need for mental health care across the European Union. The research highlights how financial barriers disproportionately affect lower-income individuals, with significant disparities also linked to education level, whether the person lives in a city or in the countryside, and geographic location.

Led by Dr. João Vasco Santos, a public health physician, health economist, and professor at the University of Porto, the cross-sectional analysis used data from the 2019 European Health Interview Survey (EHIS), covering 26 EU member states. The survey among others asked participants whether they had gone without needed mental health care in the previous 12 months due to financial constraints.

Measuring Unmet Needs: A Financial Lens

The EHIS captures self-reported experiences, focusing specifically on financial reasons as a barrier including to accessing mental health services.

Across the EU, the proportion of self-reported unmet needs for mental health care varied widely — from as low as 1.1% in Romania to as high as 27.8% in Portugal, with a median of 3.6%.

Dr. Santos emphasized that while many European countries have moved toward mixed health systems — blending elements of Beveridge- and Bismarck-style models — financial protection remains inconsistent. Even in countries with universal coverage, out-of-pocket costs for medications, therapy, diagnostic testing, or medical devices can create substantial barriers.

“This is not just about whether care is public or private,” explained Dr. Santos. “Even in systems that are largely public, co-payments can be a burden. And sometimes, vulnerable groups—like migrants or asylum seekers—are excluded altogether.”

Cultural Perceptions Shape Reporting

One of the most striking findings was the stark contrast between Romania and Portugal. Dr. Santos cautioned against interpreting these figures at face value.

“It’s not just about the availability of services — it’s also about awareness and cultural perception,” he said. He noted that in Portugal, “we’re increasingly open about mental health and the mental health service.”

Portugal has been one of the countries that is spearheading the new perception of mental health care. “The UN Convention on the Rights of Persons with Disabilities laid the foundation for the much-needed paradigm shift in mental health. From an exclusively medical approach to one based on the respect of the human rights of persons with mental health conditions and psychosocial disabilities,” Ms Marta Temido, Minister of Health of Portugal told during a United Nations consultation meeting in 2021.

Ms Marta Temido stressed that “In Portugal, we have been making significant efforts to align our laws, policies and practice with human rights.”

She specifically pointed out that “We have clearly made an option for community-based mental health services instead of institutionalization. We have been improving access to outreach care, through the launching of community teams for adults and for children and adolescents.”

In countries like Romania, stigma remains high, and is influenced by a long history of institutionalized care that fails to meet basic human standards. It should be obvious that if the psychiatric system hasn’t evolved much beyond large psychiatric institutions with reported human rights violations, one might think twice before reporting need of help.

Dr. Santos noted that in countries where mental illness is stigmatized or misunderstood, individuals may avoid reporting symptoms altogether. In some cases, people may not perceive a need for care because of limited exposure to mental health education or fear of discrimination.

Education and Inequality

The study also revealed a strong correlation between educational attainment and unmet needs. In 15 out of 26 countries analyzed, individuals with only primary education were significantly more likely to report going without mental health care than those with tertiary education.

“In Bulgaria, Greece, Romania, and Slovakia, this disparity is especially pronounced,” Dr. Santos noted. The pictures across the European countries however is quite complex, as exemplified with France where the opposite is the case. In France people with tertiary education showed a higher unmet need of mental health care. This indicate that further studies may be needed which could look at adjusting for income and other factors. The study conducted only considered the educational related inequalities.

Pandemic Impact and Future Trends

Although the study drew on pre-pandemic data (from 2019), Dr. Santos warned that the pandemic likely exacerbated existing inequalities.

“We know that mental health deteriorated during the pandemic — there was increased violence, isolation, and trauma,” he said. “At the same time, access to care was disrupted. I suspect the next wave of data will show a rise in unmet needs, particularly among lower-income and marginalized groups.”

However, he stressed that longitudinal comparisons must be made carefully, noting that changes in survey design over time can affect results.

Dr. João Vasco Santos. Credit: THIX Photo

“The goal must be to leave no one behind,” Dr. João Vasco Santos

Policy Recommendations addressing socioeconomic inequalities

To address these systemic challenges, Dr. Santos outlined a series of priorities that require coordinated action at both national and regional levels.

First, he emphasized the importance of expanding universal coverage to ensure that all individuals — including migrants and asylum seekers — have access to essential mental health services without facing financial hardship. He called for reforms that would exempt low-income and chronically ill populations from co-payments, even in systems where care is otherwise publicly funded.

Second, he advocated for a shift toward community-based care models, which improve accessibility, reduce stigma, and foster integrated, person-centered treatment approaches.

Third, Dr. Santos underscored the need for national and regional mental health strategies that incorporate public education campaigns aimed at improving health literacy.

“The goal must be to leave no one behind,” he concluded. “Health is an investment — not just in individuals, but in the resilience and equity of society as a whole.”

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Health & Society

More than 30 years of difference in life expectancy highlights health inequalities

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The study of the World Health Organization (WHO) reveals that they can be responsible for a Spectacular reduction in life expectancy in rich and poor countries.

For example, People living in the country with the highest life expectancy will live on average 33 years more than those born in the country with the lowest life expectancy.

An unequal world

“Our world is uneven. Where we were born, grow, live, work and age considerably influence our health and well-being, “said Director General Tedros Adhanom Ghebreyesus.

Health inequalities are closely linked to the degrees of social disadvantage and the levels of discrimination.

“” Health follows a social gradient by which the area in which people live more disadvantaged, the more their income is lowWho said.

Inequalities are particularly exacerbated in populations faced with discrimination and marginalization, such as indigenous peoples, who have lower expectations of life than their non -Aboriginal counterparts.

This is the case in high -income and low -income countries.

Key targets at risk

The study is the first to be published since 2008, when the WHO Social Health Determinants of Health Declines published its final reporting objectives for 2040 to reduce gaps between and within countries in life expectancy, childhood and maternal mortality.

It shows that these objectives are likely to be missed, and despite a rarity of data, there is sufficient evidence to show that health inequalities have often expanded.

For example, children born in poor countries are 13 times more likely to die before their fifth anniversary than in richer countries.

In addition, modeling shows that the life of nearly two million children per year could be saved by filling the gap and improving equity between the poorest and richest populations of the population in low and average income countries.

In addition, although maternal mortality has decreased by 40% between the 2000s and 2023, the majority of deaths, 94%, still occur in low and lower income countries.

Appeal to action

Who calls for collective action to deal with economic inequalities and invest in social infrastructure and universal public services.

The agency also recommends other stages, in particular on the survival of structural discrimination and the determinants and impacts of conflicts, emergencies and forced migration.

Originally published at Almouwatin.com

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