European monitoring of excess mortality for public health action (EuroMOMO)

Abstract

types of evidence and barriers and facilitators for the use of research evidence and other types of knowledge. Results Research evidence was used mostly for justification of policies and mostly implicitly. Triggers for the HEPA policies were international and national commitments, international policies and recommendations. Various types of stakeholders on national, regional and local levels had focal role in policy making. In addition, policy processes included work on experts groups, advisory boards, complementary background reports and public consultations. Stakeholders had key roles in supplying research evidence for policy making processes. Communication and familiarity of policy making processes facilitated the use of research evidence in physical activity policies. Nevertheless, media, networks, communication styles and access to internet resources seemed to interact seamlessly with 'hard' research evidence in policy making. Accountability, monitoring and evaluation of HEPA were weakly covered in the policies. Conclusions Policy making requires interaction between policy makers and researchers, development of communication skills and timely supply of information in relation to the policy making process. The international REPOPA program aims to increase understanding of different cultural and political contexts and their impact on HEPA policy making in six EU member states. The knowledge of policy context is utmost important to all who would like to influence and/or increase use of research evidence in policy making. L.2. Workshop: Improving public health information systems across Europe: which contribution of syndromic surveillance? Organised by: European project consortia of EuroMOMO (The European Mortality Monitoring project), TripleS (Syndromic surveillance systems, towards guidelines for Europe), and SIDARTHa (European emergency data-based syndromic surveillance system) Contact: alexandra.ziemann@maastrichtuniversity.nl Chairperson: Thomas Krafft, The Netherlands From SARS to H1N1, from heat wave to volcanic ash cloud, from G8 summits to Olympic Games, from Lampedusa to Cyprus, Europe faces diverse concerns for its population's health. Decisions need to be taken soon, rumors need to be controlled early, cross-border comparisons are desired, but the necessary information flow can take too long or there are information gaps for unexpected events. We call for the integration of syndromic surveillance (SyS) information to enhance preparedness of European health information systems for various public health threats and for European countries to meet the requirements of the International Health Regulations (IHR) and the European Commission's (EC) health security initiative. SyS comprises the art and science of providing timely information on any event of potential public health concern based on existing real-time data ranging from web searches to electronic patient records. Over the last five years, three EC co-funded projects have gathered evidence on the use and usefulness of SyS in Europe. EuroMOMO developed a monitoring system currently collecting all-cause mortality information from 15 European countries on a weekly basis. SIDARTHa developed a framework for real-time regional emergency medical care data-based SyS enabling generation of comparable information across Europe. TripleS inventoried SyS activities in Europe, developed guidelines for implementing SyS for future users and proposed a European strategy for SyS. The workshop aims at identifying concrete possibilities to collaborate and integrate syndromic information into existing health information systems at regional, national and European level. The workshop starts with five presentations updating on SyS based on morbidity, mortality, and animal health data, and giving evidence on SyS for risk assessment which all led to the development of user guidelines and a proposal for a European SyS strategy. The following discussion aims at finding answers to the questions: 1. How can SyS be used for decision making beyond communicable disease control? SyS proved its value for communicable disease surveillance and more recently for risk assessment of events such as mass gatherings. Can syndromic data also provide timely information on the health impact of climate change or the financial crisis, for evaluating interventions, e.g., the smoking ban, or as additional source for chronic disease reporting? 2. How can SyS be integrated into European health information systems? We argue that common case definitions and coding principles are not feasible for many syndromes against the backdrop of diverse health systems and data collection principles in Europe and suggest comparing results instead of raw data across borders. How can this information be incorporated into the existing European health information landscape of member states and European institutions? The presenters represent the three European projects and active SyS systems in different European countries. Key messages Specific surveillance systems do not adress events that are off their radar or unexpected. We call for complementing existing health information systems in Europe by integrating syndromic information. Standardisation is not the only solution for comparability of health information across Europe. Syndromic information can be compared across borders in Europe based on analysis results, not raw data. European monitoring of excess mortality for public health action (EuroMOMO) Kå re Mølbak Background The objective of EURO-MOMO is to develop and operate a coordinated approach to real-time mortality monitoring across Europe. This will enhance the European capacity to assess and manage serious public health risks such as pandemic influenza and other emerging infections as well as environmental conditions with an impact on public health, e.g., heat waves and cold snaps. Methods The 3-year project started in 2008 has 24 partners from 21 European countries. The main actions include an inventory of existing mortality monitoring systems; definition of minimal requirements for a mortality monitoring system; retrospective analysis of mortality data; identification of a uniform analytical approach and piloting of a consensus system for real-time mortality modelling in several European countries. As a response to the 2009 H1N1 pandemic, EuroMOMO implemented already in June 2009-a common mortality monitoring test system in four countries (Belgium, Denmark, Ireland and Israel). The outputs were validated and interpreted by an internal risk assessment forum before they were made available on a restricted EuroMOMO website. More countries joined in autumn 2009 to monitor the impact of the pandemic. Results The key output is a robust, simple consensus model to monitor all-cause mortality, which was piloted and is ready-to-implement and applicable all over Europe. The project increased the European capacity to monitor the spread of the 2009 H1N1 pandemic and measured the impact on mortality. Outputs included a weekly bulletin, maps and graphs of weekly total and age-specific all-cause mortality using standardized indicators (z-score) that allowed comparison of impact between countries. Conclusions The EuroMOMO approach supports risk managers to target interventions and to prioritize resources. The use of a common mathematic model will ensure that figures on excess mortality are timely collected and comparable across member states. The collection of data across several member states supports risk assessment if a health threat is unique to a country or common for several states. Discrete changes in mortality may not be visible in small countries, but when added up, important patterns may be recognized allowing for early countermeasures.