EU ZMK's Diary

“It’s hard to beat a person that never gives up.” ~Babe Ruth

(source of the photo © Mentalhealthhumor.com)

“Mini Public Health Day – 19 June 2012”

Introductory comment: On the 19th June I faced an inconvenient situation which may occur quit frequently in the life of EU professionals in Brussels due to the high intensity of networking events: at least 2 health related workshops took place simultaneously (at the same building of the EP!).

1. Workshop: ‘EMERGING AND RE-EMERGING INFECTIOUS DISEASES: A CONTINUOUS CHALLENGE FOR EUROPE’, 19-06-2012, ASP 5G2, EP, Brussels, 14:30-18:30

2. Workshop: ‘MENTAL HEALTH IN TIMES OF ECONOMIC CRISIS’, 19-06-2012, ASP A1E1, EP, Brussels 16:00-18:00.

What should I have done? As a wise person once said “If you don’t like something, change it. If you can’t change it, change your attitude.” That’s why I tried to realize as much benefits as I could: I simply attended the 1st workshop as long as the 2nd has started.

Mental health as part of the public health agenda
(Event held under the auspices of the European Parliament’s Health Working Group and the chairmanship of Glenis WILLMOTT MEP)

Since the crisis isn’t over, yet, its negative impacts on the whole population become as visible as more statistic data are available. According to the most recent statstics: the suicide rate in Greece emerged by 40% and the youth unemployment rate in Spain is as high as 50% (remember the tragic example of a Greek man’s public suicides having fiscal woe). Having regard to these circumstances, the need for alarming the bell of the danger of a hidden public health disaster is of utmost importance. This second workshop examined the links between the economic crisis and one of the most important components of public health: the mental health.

Short summary on this workshop is available on the EP’s website here.

There is an evidence base linking debt to poor mental health

The perturbing debt ratio in state budgets is at the very centre of current public debates. However, debt is also imminent part of private households’ everyday life. It is important to note that not the pure existence of debt may concern mental well being (since in economic sense, debt is natural part of financial management) but if it becomes unmanageable. If you have financial difficulties, you’re 2-4 times more likely to have major depression. This cruel correlation works vice versa: living in poor mental health may result higher risk to have unmanageable dept and increasing debt rates may cause poor mental health which implies other physical health problems. Nevertheless, if there is an economic case for investing in measures to tackle/prevent unmanageable debt (such as debt advice and consulting services) it could be beneficial from a public/mental health point of view. Experiences show that benefits (including public health benefits) overweight the costs and a common work with the financial sector is inevitable.

Europe is facing a suicidal crisis the exact magnitude we don’t know of

The most massive form of mental disorder is obviously the suicide which is a complex phenomenon since people making suicide often have mental health problems. Suicide doesn’t mean “only” the lost of an irreplaceable human life but it has also measurable negative impacts on GDP. Moreover, every 1% rise in unemployment correlates to a 0,8% rise in suicides. Europe is facing a suicidal crisis the exact magnitude we don’t know of. And the fresh, probably terrific post-crisis suicidal data are becoming available in the very soon future…

Useful links:
List of countries by suicide rate
Current Worldwide Suicide Rate
Suicide rates per 100,000 by country, year and sex (Table)
Happiest Places Have Highest Suicide Rates
Table 1343. Daily Tobacco Consumption by Country and Sex: 1990 and 2009

Top 10 Countries With Highest Suicide Rates – 2011
10 : Finland Annual suicide rate per 100,000 is 24.3
09 : Kazakhstan Annual suicide rate per 100,000 is 28.7
08 : Ukraine Annual suicide rate per 100,000 is 29.4
07 : Slovenia Annual suicide rate per 100,000 is 30.9
06 : Hungary Annual suicide rate per 100,000 is 32.1
05 : Estonia Annual suicide rate per 100,000 is 33.2
04 : Latvia Annual suicide rate per 100,000 is 34.3
03 : Belarus Annual suicide rate per 100,000 is 35.0
02 : Russia Annual suicide rate per 100,000 is 37.4
01 : Lithuania Annual suicide rate per 100,000 is 42.0

La duplication de l’âge intermediaire: l’adolescence et la jeunesse

Dans notre société moderne, on peut costaté la duplication de la période entre l’enfance et l’âge adulte : d’une part, l’adolescence (l’âge entre 12-18 ans) et d’autre part, la jeunesse (l’âge entre 18-30 ans) dont la fin est devenue de plus an plus incertain. L’enjeux de l’adolescence et la jeunesse est complex : l’integration des changements physiques et mentales et la création d’une espace d’autonomie au sein de la famille et de la société. L’élément le plus important de ce changement est le conflit entre la déconstruction et la réconstruction des jeunes. Les jeunes qui vivent dans une monde imaginaire dans la famille doivent regarder en face les réalités : des enfants roi devient des vrai individues dans le monde des adultes. Ce processus peut impliquer la déconstruction : dépression, phobies, toxicomanies. Lorsque le statut social se change, il y a un besoin d’une réconstruction : l’aide de la société adulte pour surpasser ces défis.

L’impact de la crise financière : une génération perdue ?

Néanmoins, les effets negatifs de la crise financière sur les parents fragilisés peuvent toucher les jeunes aussi : leur dépendence familiale s’allonge et ils peuvent perdre la crédibilité dans les institutions et des instances de régulation. Dans une société sans valeurs et sans projects et dans un monde sans pitié, il faut que la déconstruction soit empêchée. Le clivage entre les jeunes et les adultes devient encore plus compliqué si on tiens compte les differences entre les pays « riches » et pauvres, de familles peu touchées par la crise et les familles précarisées ainsi que les adolescents et jeunes « performants » et les adolescents et jeunes « flottant ».

Des solutions possibles : des espaces différents

Qu’est-ce que pourraient être des solutions possibles ? La création des différents espaces de régénération à retrouver : des espaces de déconstruction pour canaliser la violence, des espaces d’enchantement pour re-créer la réalité et des expaces intermediaires pour réduire la dualisation.

The WHO Europe’s approach: Social protection, the Tallinn Charter and the 3 dimensions of well-being

Populations well being is dependent on many social factors (health/marital/employment status, ethnicity, relative income, country and social class). The difference is amazing between countries of northern Europe where the crisis had no real impacts on suicide rates and countries of southern Europe where there is a strong correlation between an economic turmoil and the number of suicides. What kind of solution can WHO put forward? As it is included in the Tallinn Charter: social welfare system can protect the 3 important dimensions in that regard: health, wealth, and health systems. Some other actions can be implemented in order to influence health determinants (alcohol, smoking, diet, obesity, physical activity), improve mental wellbeing and prevent mental disorders.

Psychosocial Factors – Depression – Suicidality

Suicides (most of them) occur within psychiatric disorders. Psychosocial factors (such as stress unemployment) can lead to depression and suicidality, but depression has also an impact on suicidality and those factors. Depression can also have a hidden impact on economy: people with depression can still work but their performance is much more lower than before the illness. And data prove that economic progress do not necessary mean progress of mental health, in some cases in the contrary. Therefore, there is a need to understand how the crisis truly hit the economic and mental health (unemployment is just one of the factors). Monitoring is essential since a viable policy response cannot be based only on estimations. A targeted reaction of the society is advisable to protect people from these negative impacts by social protection.

The example of GAMIAN, a patient driven pan-European NGO clearly shows that a strong representation of the mental illness hit patient can influence in a positive way the European decisions.)

Magyarország és a Szomorú vasárnap (Gloomy Sunday in Hungarian)

Az öngyilkosság és a mentális betegségek (mint a depresszió) témájának vizsgálata során nem hagyhatjuk szó nélkül a magyar viszonyokat. Nem véletlen, hogy a világ leghíresebb, öngyilkosságot középpontba állító dal szerzője Seress Rezső, és az sem az, hogy az ihlet a 29-33-as gazdasági világválságban gyökeredzik (Szomorú vasárnapGloomy Sunday).

Az a tény, hogy Magyarország hosszú időn át világelső (!) volt az egy főre jutó öngyilkosok számában, és etekintetben még mindig „előkelő” helyen szerepel, további óvatosságra int bennünket. Pont Seress Rezső dalának sikere (és az ő személyes sorsa) is azt igazolja, hogy itt mélyebb jelenségről van szó, semmint hogy ezt pusztán a szocialista Magyarország önpusztító életmódot eredményező viszonyaira vezessük vissza. Az országot, és az egyes egyéneket ért kudarcok lecsapódásaként értékelhető a kiugró öngyilkossági ráta lényegében az egész XX. század folyamán, amely megerősíti az egyes népek, kultúrák szerepét és egyben kötelez is minden népegészségüggyel foglalkozó magyar szakembert a kérdés alapos vizsgálatára és megfelelő megoldások kezelésére.

Ennek, és a pozitív hozzáállás fontosságának szemléltesésére a művészetet hívom segítségül, és ajánlom mindenki figyelmébe az alábbi linket: így is fel lehet dolgozni igényesen a témát: Bijou – Depresszió.

Discussion and Conclusion

Politicians are fighting the undefinied monster of public debt but in policy decisions, long term (health) effects shall be taken into account respectively not only the short term economic benefits. Behind the numbers, there are people. Since the EU isn’t a confederation of states, the Member States preserved a large autonomy in respect of public health. Therefore, the Commission and Member States shall handle the current situation hand in hands. The above presented problems are well known by the health professionals and the next step should be finding the appropriate channels to target the financial sector, in order to find complex solutions not only for financial but also mental health problems.

Mental Health as an occupational disease?

The binding law of the European Union obliges employers to monitor risk factors affecting employees at their work place. Having regard to the fact that in some cases, there is an obvious link between stress at the workplace and depression, why couldn’t mental disorders be regarded as an occupational disease?. In that regard, the relating ILO recommendations have to be taken into account.

ANNEX

Further information about invited speakers and special guests:

Invited Speakers

Prof. David McDAID, Mental Health Economics European Network

Dr. Jean-Paul MATOT, Member of Action for Teens, Psychiatrist

Roberto BERTOLLINI, Chief Scientist, WHO Regional Office for Europe

Prof. José Luis AYUSO-MATEOS, Department of Psychiatry, Universidad Autónoma de Madrid

Pedro MONTELLANO, board member of Global Alliance of Mental Illness Advocacy Network (GAMIAN)

Special Guests

Jurgen SCHEFTLEIN, DG SANCO

Jorge COSTA-DAVID, DG EMPL

Last but not least, the detailed presentations are available here.

I remain at your disposal.

the compressed URL of this blog entry ► http://bit.ly/10dxngc

Related earlier EU Hemicycle updates:

27. Mini Public Health Day – First Part (1/2): ‘EMERGING AND RE-EMERGING INFECTIOUS DISEASES’ impressions from the STOA-AVIESAN workshop

23. Restructuring Health Systems: How to Promote Health in time of Austerity

21. The EU Health Strategy (2008-2013) reviewed by MEPs, the Commission and the Civil Society in order to make some useful remarks to the new Health Strategy (2014-2020)

18. Last But Not Least: Strategy for Strengthening the Rights of Vulnerable Consumers and the Democratic Function of the EP

16. Improving Patient Outcomes through Intensive Care Medicine (ICM) – Lessons Learned after the Policy Debate in the EP on 16/05/2012

13. Legal Framework for Public Health Policies and Financial Viability of Lifelong Disease Prevention

10. How Healthy is Our Way of Thinking about Healthcare Cost Cuts?

9. The Choice is Yours: either You Drink or… Re-think the EU’s Alcohol Strategy

Zoltán MASSAY-KOSUBEK

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