Europe Without Frontiers: The Implications for Health, Chichester: John Wiley & Sons, Ltd, 1993. Price (US) $79.50, (UK) £49.50 (hardback); (US) $23.95, (UK) £14.95 (paperback)

✍ Scribed by Bradford Kirkman-Liff; Charles E. M. Normand; J. Patrick Vaughan (Eds)

• Publisher: John Wiley and Sons
• Year: 1993
• Tongue: English
• Weight: 174 KB
• Volume: 8
• Category: Article
• ISSN: 0749-6753
• DOI: 10.1002/hpm.4740080208

✦ Synopsis

The London School of Hygiene and Tropical Medicine showed a great deal of foresight in planning its Second Annual Public Health Forum on the topic of Europe Without Frontiers: The Implications for Health. The concerns over new waves of intra-European migration, communicable disease control, trans-border environmental health issues, and illicit substances in the 'new' Europe are growing, and the publication of the papers and workshop reports of the conference is very timely. One important question is: which Europe? The Europe of the 12 nations of the European Community (EC)? The Europe of the European Economic Area of the EC and the FTA nations? Or, the Europe of the European Region of the World Health Organization (WHO), covering 850 million persons from the Atlantic to the Pacific? Fortunately, the papers and workshop reports used multiple definitions of Europe, and this volume contains reports ranging on such topics as the need for harmonization of health policy within the EC to the need for broader and deeper public health collaboration within the entire WHO region, as well as country-specific papers, such as those on the current state of reforms in the Czech Republic, Poland and Italy.

The range of mortality and morbidity rates in Europe is very broad, as demonstrated in the papers by Klim McPherson and by Ferenc Bojan, Piroska Hajdu and Eva Belicza. On the same topic, Lenore Kohlmeier analyses the differences in health status between West and East Germany prior to unification, which conjectures interesting relationships between nutrition, social support and some health status measures. The legal complexities of harmonization and collaboration of public health programmes is reviewed in the paper by Paula Kokkonen and Martii Kekomaki and by Reiner Leidel. These papers make it clear that there are a variety of barriers to overcome before variations in health care and health status can be reduced in Europe.

The movement of health professionals+specially physicians and nurses-is explored in depth. Despite more than a decade of laws permitting the movement of health professionals from one EC state to another, the professional migration is low, and there is lack of effective health workforce planning, as reviewed by Karin Poultin. The analysis by Alastair Gray and Victoria Phillips of factors leading to the immigration or emigration of nurses within the EC is especially thorough and should be read by policy-makers concerned with nursing compensation policy.

Communicable disease control is a serious issue as frontier controls are reduced and movement of people increases. Rafael Najera presents a clear argument for improved standardization of communicable disease surveillance methods and coordination and communication across states. He presents a proposal for the minimum requirements for coordinated and efficient communicable disease control, which should be seriously considered. The workshop discussion report for this section of the conference went beyond the usual summarization and developed an eight-point action that calls for EC-WHO collaboration: bureaucrats, take note!

The chapters on environmental protection and nutrition, food and diet standards are very useful, both for their data and for their policy perspectives. The papers on pharmaceutical policy demonstrate the lack of harmonization within the EC, let alone the rest of Europe, and the need for the development of policy that balances the interests of the many players in this sector: pharmaceutical manufacturers, pharmacists, physicians, patients, insurers and government (both at the State level and Brussels). The