EUPHA president column: The Lisbon 2008 Conference and EUPHA's Presidency * EUPHA office news--our collaboration with the Open Society Institute * The second joint European Conference on Public Health 26-28 November 2009, Lodz, Poland * Mental health care in Europe: diversity and progress, and need for further action

The European public health association (EUPHA) is going thorough an important transitional period, leading to the full implementation of its new Constitution and Strategy by 2011. The 2008–09 EUPHA Presidency will continue to support and facilitate this process. During the 16th European Public Conference, in Lisbon (November 2008) an import step was accomplished towards making these annual conferences an occasion where all major European public health initiatives can come together and more effectively cooperate for improving European public health. In Lisbon, the Association of Schools of Public Health in the European Region (ASPHER) joined in. In Lodz (November 2009), this cooperation will continue, and hopefully will further expand in Amsterdam (2010). This is an exciting challenge. It is important that appropriate cooperation models are developed to this effect. The support and collaboration with European Commission and with the WHO has been of fundamental importance for the success of the European Public Health Conferences and other EUPHA initiatives. European public health is part of a global health context. This was highlighted during the Lisbon Conference at least in two occasions: a workshop on Public health in the United States, organized by our colleagues from CDC, Atlanta, and a lunch-time briefing on Global Health. It will be interesting to pursue this public health dimension in future conferences. During the opening session of the Lisbon Conference, the Portuguese Minister of Health, stated that there is no such a thing like a context free-public health. Europe is now amidst a serious global finance and economic crises. Its is important that EUPHA and its membership play a relevant role in minimizing the public health consequences of this crises and in taking advantage of this opportunity to further underline the importance of Public Health today. One possible response to this situation is a more innovative public health. ‘Health and Innovation’ was the main theme of the Lisbon Conference. One of the novelties here, was to link more lively plenary sessions with an Innovation Village, an interactive space where participants could further explore, discuss and plan to cooperate with specific innovative public health initiatives, made accessible in the Village and through a virtual ‘Innovation Bank’. There are plans to make the Innovation Bank a broader Europe-wide project. During the Conference, two books on health innovation where launched: ‘Policy Innovation for Health’ (Springer, 2008) and ‘Lisbon, Health, and Innovation’ (Gradiva, 2008, now only in Portuguese, an English translation now been prepared). The European public health conference ‘visits’ a different European country every year. It might be possible to have the preparation and follow up of the European Conferences playing a stronger role in reinforcing national public health strategies and infrastructures. In Portugal, a considerable effort was made to have the European Conference more easily accessible to public health students and young public health professionals. Also taking advantage of the stimulating climate provided by the European Conference, the Portuguese Public Health Association, the Ministry of Health and the National School of Public Health, decided to launch, during the first trimester of 2009, the 1st Portuguese Public Health Congress. Since the EUPHA conference in Paris in 2000, EUPHA has had a good and continuous partnership with the Open Society Institute (OSI). The collaboration mainly concerns the funding of conference participation from Central and Eastern European countries. Since 2 years, this funding is combined with the organization by OSI of workshops at the EUPHA conference. In 2008, a workshop was organized by Eva Foldes of OSI Hungary on Roma rights in health care. The session was chaired by Tamsin Rose and Marleen Foets. Directly after the session, a meeting was organized with representatives from DG Sanco and later on with the president of the EUPHA section on child and adolescent public health, Auke Wiegersma. The objective was to put the Roma health issues on the agenda for the coming years. The combination of workshop to raise attention and informal meetings to continue putting the Roma health issue on the agenda confirmed the facilitating and networking role of EUPHA conferences. Before and at the 2008 conference, I was kindly reminded that the official name of OSI is indeed Open Society Institute and not—as we like to call it—the SOROS foundation. OSI, a private operating and grantmaking foundation, aims to shape public policy to promote democratic governance, human rights, and economic, legal and social reform. OSI was created in 1993 by investor and philanthropist George Soros to support his foundations in Central and Eastern Europe and the former Soviet Union. You can see the start of the confusion between OSI (organization) and SOROS (founder). In our years of collaboration, the mix of OSI and SOROS increased. In 2003–04, we had both the SOROS participants at the conferences as well as the OSI projects to support national public health associations. We do apologize for this confusion and promise to do better in our future collaboration with OSI. In 2009, the second joint European Conference on Public Health will be organized in Lodz, Poland. The conference is jointly organized by: EUPHA—The European Public Health Association. ASPHER—The Association of Schools of Public Health in the European Region. The Polish Association of Public Health. The Nofer Institute of Occupational Medicine. The Faculty of Health Sciences, Jagiellonian University. Seventeenth EUPHA Conference on Public Health: Human ecology and public health—promoting social and environmental conditions conducive to health. Thirty-first ASPHER Annual Conference: Transcending the borders—intercultural and transdisciplinary public health education to promote social and environmental well-being—promoting innovation. Abstract submission will start on 1 January 2009. The WHO Regional Office for Europe has published a report on the state of mental health activities in 42 countries across the WHO European Region,1 as mandated by the Mental Health Declaration for Europe, adopted in Helsinki in 2005.2 The report covers many areas, ranging from mental health promotion to specialist services. The progress and policy convergence in many European countries are striking. Nearly all countries now have mental health policies and legislation, supporting the move towards community mental health services. Most countries adopted these policies in the last 3 years. Some countries have implemented impressive community-based services, where primary care has a key role in the identification and treatment of common disorders, such as anxiety and depression, and networks of specialist services that take responsibility for the treatment and care of complex cases. The involvement of service users and carers in the planning and monitoring of care is also progressing. Nevertheless, such developments are not yet uniform. In only 14% of countries do the majority of people with mental disorders have access to home treatment, and many countries still rely heavily on hospitals for their mental health services, as reflected by the high proportion of mental health budgets still dedicated to psychiatric beds. The inclusion of users and carers in external inspection is still exceptional. This variation is probably unsurprising, given the diversity across the European Region. It is difficult to find any significant variable without major differences between European countries. The number of beds varies from 8 to 185, psychiatrists from 1 to 30 and nurses from 3 to 163 per 100 000 population, and the proportion of the health budget spent on mental health care from 2% to 13.8%. Intriguingly, most of these and other variables seem to have a low correlation with each other, suggesting considerable differences in type and style of service delivery. Some key challenges emerge from this report. First, some countries reported degrading practices in institutions, and stigma and discrimination are still ubiquitous. The human rights message that everyone has the right to the highest attainable standard of physical and mental health is still in need of strong action for people suffering from mental illness. Second, community service implementation is still very haphazard and too often reliant on single isolated initiatives by non-governmental organizations. Third, the numbers and competencies of the workforce are at present inadequate in many countries to implement reform. And finally, the inability of so many ministries to provide some core data about the state of mental health in their countries, and the difference in meaning of some widely used concepts, such as ‘nurse’ or ‘crisis service’ mean that progress in some key areas is difficult to monitor and compare. This report offers a first insight into the state of mental health. It is also a call for action.