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									                                             EUROPEAN JOURNAL OF PUBLIC HEALTH VOL. 13 2003 NO. 4                                              SUPPLEMENT


        Conclusion                                                                        Identify the means employed by politicians to bring together
        Certain essential principles, grounded in social values, should be                disparate political perspectives,
        recognized by governments and policy makers in the setting and                    Balance the public concern for quality acute health services with
        implementing of health targets.                                                   the political difficulties of promoting health targets for health
                                                                                          equity and addressing the determinants of health,
                                                                                          Look at the process of setting targets to break down barriers within
        Key Questions to Answer before Implementing Health Targets                        and between organizations delivering the care, and
     Stipe Oreskovic, Croatia                                                             Evaluate the roles that performance management plays in respect
        Issue                                                                             to health targets implementation.
        Participants are asked to translate the policy into action. However,            Lessons learned
        the major issues in considering the choice, implementation and                  Mapping values in health targeting is a continual process that
        future development of health targets entail a defining process before           requires refinement and enhancement at various stages of develop-
        action at the national and subnational levels.                                  ment.
        Description                                                                     Conclusions
        Participants are asked to define the major issues that need to be               Prior to the implementation of health targets it is crucial to engage
        considered when implementing targets. For example, they are to:                 the community of stakeholders. Therefore, identifying answers to
          Describe how local citizens will be engaged in deciding what is               key questions about health can help translate policy into action.
          important and worth doing,                                                    Here we define the questions that draw us back to the framework.


                                 Workshop 27: UEMS Workshop:
                Challenges in the harmonisation of the public health medicine name
                                 and in competencies and practices




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                                                                        P. Bonanni, C. Garbelli

        One of the most challenging issues for the development of education             fore, the advice given by the Public Health Section of the UEMS to
        and practice of public health medicine in Europe is the harmonisa-              political bodies in the issuing of directives regarding public health
        tion of specialty names in different countries and a common                     training and continuing medical education can be of great help in
        definition of competencies and abilities for the public health                  such harmonisation. Furthermore, one of the main aims of UEMS is
        medicine doctor. As a matter of fact, other medical specialties find            the possibility that each Member State shall recognise the diplomas,
        a reason of strenght in their evident common contents in each state             certificates and other evidence of formal qualifications in specialised
        (no one has doubt that, for instance, neurology is the same as to               medicine, awarded to nationals of Member States by the other
        contents to be learnt and to competencies throughout Europe, but                Member States by giving such qualification the same effect in its
        the same is not self-evident for public health medicine). Such                  territory, as those which the Member State itself awards (European
        difficulty is reflected by the variety of denominations that specialties        Union. Directive 93/16/CEE). The work of the Public Health
        referring to the contents of public health have in all countries: public        Section of the UEMS (started in 1997) has up to now included the
        health medicine, hygiene, preventive medicine, social medicine,                 definition of standards for specialisation training (chapter 6 of the
        community medicine, etc. Also the role of the public health medical             Charter on Training of Medical Specialists in the European
        specialist is intended differently among countries. In some of them,            Community) and the definition list of competencies for a public
        for instance, his/her role is limited to territorial health services, while     health specialist medicine doctor. The list (April 2001).represents
        in others they have a key role also in hospital organisation. The               our formal advice to the UEMS Council and to the national
        European Union of Medical Specialists (UEMS) is one of the eight                authorities. At present, focus is on common standards and possibility
        major medical groupings or committees officially recognised for                 of exchange of credits for continuing medical education (CME) of
        political representation of medical interest at European level. There-          public health medicine specialists across Europe.



            Workshop 28: Climate and Health: the Impact of Heat Waves in Europe
                                           Chair: Guido Bertolaso, Head, Department of Civil Protection, Italy

        Record high temperatures were observed across Europe during the                 minimise adverse health effects, and to define guide-lines for public
        summer of 2003. Although a definitive estimate of the impact on                 health interventions in Europe.
        mortality in the European countries is still being elaborated, tens of          Session Programme / Presentations
        thousands of excess deaths are expected. The World Health                         The PHEWE project-Assessment and Prevention of Acute Health
        Organisation (WHO) considers global warming to be one of the                      Effects of Weather conditions in Europe / Paola Michelozzi
        main threats to health in the 21st century. The increased frequency               Evaluation of the health impact of heat waves in Italy / Luigi A.
        and intensity of heat waves may lead to an increase in heat-related               Bisanti, Ennio Cadum
        deaths with the greatest impact on urban populations and principally              Evaluation of the health impact of heat waves in France / Philippe
        affecting the elderly and the ill. Although interest on the impact of             Pirard
        heat on mortality is increasing, data from this summer shows that                 Excess mortality associated with heat waves in Athens, Greece /
        most of European countries were unprepared to cope with this                      Klea Katsouyanni
        emergency.                                                                        Preliminary Evaluation of the 2003 Heat Wave in Germany / Gerd
        This session will focus on the impact on mortality of the 2003 heat               Jendritzky
        wave in Europe with various presentations from those countries most               Epidemiologic Study of Mortality During the Summer of 2003 in
        affected. Epidemiologists and meteorologists from different                       Italy: Preliminary Results / Susanna Conti
        European countries will discuss the data available from the heat wave
        of 2003 and its impact on public health. In addition, the largest EC            The PHEWE project-Assessment and Prevention of Acute
        funded project on climate and health (Assessment and Prevention                 Health Effects of Weather conditions in Europe
        of Acute Health Effects of Weather conditions in Europe-PHEWE)                Paola Michelozzi1, Ursula Kirchmayer1, Glenn McGregor2,
        will be presented. The principal aim of this collaborative project              Annibale Biggeri3, Bettina Menne B4, Klea Katsouyanni5,
        which started in 2002 and involves partners from 16 European cities             Pavlos Kassomenos6, Jordi Sunyer7, Hugh Ross Anderson8,
        is to evaluate the acute health effects of weather, both during the             Sylvia Medina9, Anna Paldy10 and the PHEWE
        warm and the cold season in Europe. One of the main objectives of               collaborative group
        the project will be to implement heat/health watch warning systems              1) Department of Epidemiology, Local Health Authority Rome E, Italy
40      in a subgroup of pilot cities, to develop preventive strategies to              2) The University of Birmingham, School of Geography and Environmental
  SUPPLEMENT                                              11th Annual EUPHA Meeting: Workshops


  Sciences, Birmingham, UK                                                          living in cities have an elevated risk of death when the temperature
  3) Department of Statistics, University of Florence, Italy                        (and humidity) are high, compared with those living in suburban
  4) WHO – Regional Office for Europe, Rome, Italy                                  and rural areas; this phenomenon is known as the “urban heat island
  5) Department of Hygiene and Epidemiology, University of Athens Medical           effect”. Additionally, it has been documented that the mortality is
  School, Athens, Greece                                                            highest in those areas which normally have more temperate climates
  6) University of Joannina, Laboratory of meteorology, Department of               and are usually located in the northern parts of individual countries.
  Astrogeophysics, Ioannina, Greece                                                 Studies of heatwave related mortality have further demonstrated
  7) Municipal Medical Research Institute, Barcelona, Spain                         that the greatest increases in mortality occur in the elderly.
  8) Department of Public Health Sciences, St. George’s Hospital Medical            Following the unusually hot summer this year and the social concern
  School, London, UK                                                                that was raised in response to the dramatic news from neighboring
  9) National Institute for Public Health Surveillance, Saint Maurice, France       countries such as France, it was decided to investigate whether there
  10) Jozsef Fodor National Center of Public Health, National Institute of          had been an excess in deaths this summer compared with the same
  Environmental Health, Budapest, Hungary                                           period during the previous year, with a particular focus on
                                                                                    determining changes in mortality to the elderly population. The
  Evaluation of the health impact of the 2003 heat waves in Italy                   Minister of Health thus requested the Istituto Superiore di Sanità’s
Ennio Cadum1, Paola Michelozzi2, Luigi A. Bisanti3,                                 Office of Statistics in the National Center for Epidemiology, Sur-
  Daniele Agostini4, Francesca de’Donato2, Valeria Fano2,                           veillance, and Disease Prevention to undertake an epidemiologic
  Antonio Russo5, Stefano Bovo6, Carlo A. Perucci2                                  study of mortality in Italy during the summer of 2003.
  1) Environmental Epidemiology Unit, Regional Environmental Protection             Methods
  Agency of Piedmont, Grugliasco, Italy                                             A study was undertaken in which the number of deaths that had
  2) Department of Epidemiology, Local Health Authority Rome E                      been registered in the 21 capitals of the regions and autonomous
  3) Department of Epidemiology, Health Authority Milan, Italy                      provinces during the period 1 June – 15 August 2003 and during the
  4) Health Authority Bologna, Italy                                                same period during 2002 was obtained from the communal offices




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  5) Department of Epidemiology, Health Authority Milan, Italy                      that maintain vital statistics for each of the capitals. For analytic
  6) Meteorological and Hydrographic Unit, Regional Environmental                   purposes, the period was divided into five 15-day sub-periods (1–15
  Protection Agency of Piedmont, Grugliasco, Italy                                  June, 16–30 June, 1–15 July, 16–31 July, 1–15 August).
                                                                                    Results
  Evaluation of the health impact of heat waves in France                           Compared with the previous year, there was an overall increase of
Martine Ledrans1, Denis Hémon2, Eric Jougla3                                        2,222 deaths (from 17,493 in 2002 to 19,715 in 2003). The greatest
  1) National Institute of Public Health Surveillance, Saint Maurice, France        increases occurred during the last two sub-periods for which data
  2) Institut National de la Santé et de la Recherche Médicale, Villejuif, France   were collected (16 July–15 August) : overall in the 21 capitals, the
  3) Institut National de la Santé et de la Recherche Médicale, Le Vésinet,         number of deaths increased from 6,241 deaths in 2002 to 8,485 in
  France                                                                            2003, an increase of 36% (2,244 units).
                                                                                    The greatest increase (2,127 deaths; a 40.2% increase) was seen in
   Excess mortality associated with heat waves in Athens, Greece                    those ≥65 years of age; the increase was even greater in the subgroup
Klea Katsouyanni1, Giota Touloumi1, Antonis Analitis1                               75 years and older (1992 deaths; a 49.1% increase). The increase in
  1) Department of Hygiene and Epidemiology, University of Athens Medical           mortality was greatest in the cities belonging to thr Northwest
  School, Athens, Greece                                                            portion of the country (81.4%), followed by the Center (43.8%), the
                                                                                    Northeast (33.8%) and the South (25.6%).
  Preliminary Evaluation of the 2003 Heat Wave: the Situation                       With respect to individual cities, the greatest increase was observed
  in Germany                                                                        in Turin, where deaths more than doubled (a 108% increase),
Gerd Jendritzky1, G. Pfaff2, C. Koppe, C. Dreweck,                                  followed by L’Aquila, which experienced a 105% increase, Genoa
  S. Brockmann                                                                      (79.4%), Perugia (75.4%), Milan (69.3%), Bologna (54.5%), and
  1) German Meteorology Service, Freiburg, Germany                                  Rome (51.5%). By contrast, the cities of Campobasso, Aosta, and
  2) Regional Health Authority, Baden-Wurttemberg, Germany                          Catanzaro experienced declines of –25%, –21.7%, and –15.2%
                                                                                    compared with the previous year.
  Epidemiologic Study of Mortality During the Summer of 2003                        For the cities that had the greatest increases of mortality in persons
  in Italy: Preliminary Results                                                     75 years of age and over (Turin, Genoa, and Milan), the relationship
Susanna Conti1, Donato Greco2, Paola Meli1, Giada Minelli1,                         between deaths during the 5 sub-periods and the mean maximal
  Renata Solimini1, Virgilia Toccaceli1, Monica Vichi1                              daily temperatures (provided by UCEA) were examined. A clear
  1) Office of Statistics, National Center for Epidemiology, Surveillance, and      observation was observed between the mean temperatures and
  Disease Prevention, Istituto Superiore di Sanità, Roma, Italy,                    mortality.
  e-mail: susanna@iss.it                                                            Conclusion
  2) Director of the Center                                                         Finally, based on the data from the 21 capital cities of the regions
  Aim                                                                               and autonomous provinces and the age structure of the population,
  It is widely recognized that extreme climatic conditions during the               it was empirically estimated that 4175 excess deaths occurred among
  summer months can constitute a major public health threat. Persons                Italian persons 65 years and older between 16 July and 15 August.




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