Going Public in the European Union: Action Repertoires of Western European Collective Political Actors

As a result of the Europeanization of politics and the increasing role of the public sphere, political actors in Western Europe are currently facing a double strategic challenge. Based on data from seven West European countries and the European Union, the authors analyze how state actors, political parties, interest groups, and social movement organizations cope with this double challenge at both the national and the supranational level. Results indicate that the classic repertoire of inside strategies at the national level is still the most typical for all actors, but media-related strategies are also prominent at the national level. The Europeanization of repertoires is mainly determined by institutional factors and by the actors' power, whereas the public arena plays an equally important role for all types of actors, in all countries and at both the national and the EU level.

Workshop: Capacity building for national public health advocacy: case studies from national associations

The first statement of the EUPHA on the Future of Public Health in Europe refers to the need for going 'to policymakers, politicians and practitioners in all sectors of society and advise them on how to promote public health throughout society'. WHO-EURO Director General Marc Danzon, quoted in the second EUPHA statement on the responsibility of policy makers indicates that 'learning is not systematically applied in health policy development in our continent'. Statement 3 calls for the integration of public health into the political agenda in all sectors. The first EUPHA president, Louise Gunning-Schepers, quoted in Statement 10 called on EUPHA to become 'a powerful advocate of the public health community'. In addition to the above, the EU is now actively seeking ways to build capacity to implement its health strategy. Learning and building the capacity to achieve our aims The aims and objectives to promote the public's health as reflected in EUPHA's 10 statements are also mirrored in the national public health associations. However, many of EUPHA's national associations have little or limited experience in promoting public health policy at the national level. To assist in the learning of advocacy for public health policies, case studies presenting experiences of national public health organizations in lobbying for national public health policy will be presented and discussed. In addition to sharing experiences, the presentations will identify successful approaches to public health advocacy as well as lessons learned from unsuccessful attempts.

Structure du temps de travail des infirmières de santé publique: effets de l'âge des patients, de la nature des prestations fournies et du lieu du contact. [Structure of work times of public health nurses: effect of the age of patients, nature of care given and location of contact].

In the framework of health services research sponsored by the Swiss National Science Foundation, a research was undertaken of the activity of the large majority of the public health nurses working in the Swiss cantons of Vaud and Fribourg (total population 700,000). During one week, 130 nurses gathered, with a specially devised instrument, data on 4165 patient visits. Studying the duration of the contacts, one has distinguished contact duration per se (DC), duration of the travel time preceding the contact (DD), and total duration in relation with the contact (DTC-addition of the first two). It was noted that the three durations increased significantly with patient age (as regard travel time, this is explained by the higher proportion of home visits in higher age groups, as compared with visits at a health center). Examined according to location of the visit, contact duration per se (without travel) is higher for visits at home and in nursing homes than for those taking place at a health center. Looked at in respect to the care given (technical care, or basic nursing care, or both simultaneously), our data show that the provision of basic nursing care (alone or with technical care) doubles contact duration (from 20 to 42-45'). The analyses according to patient age shows that, at an advanced age (beyond 80 years particularly), there is an important increase of the visits where both types of care are given. However, contact duration per se shows a significant raise with age only for the group "technical care only"; it can be demonstrated that this is due to the fact that older patients require more complex technical acts (e.g., bladder care, as compared with simpler acts such as injection). A model of the relationships between patient age and contact duration is proposed: it is because of the increase in the proportions of home visits, of visits including basic nursing care, and of more complex technical acts that older persons require more of the working time of public health nurses.

"Public on the outside, private on the inside": the organizational hybridization, sense of belonging and identity strategies of the employees of a public unemployment insurance fund in Switzerland

A number of studies show that New Public Management reforms have altered the current identity benchmarks of public officials, particularly by hybridizing values or management practices. However, existing studies have largely glossed over the sense of belonging of officials when their organization straddles the concerns of public service and private enterprise, so that the boundary between public and private sector is blurred. The purpose of this article is precisely to explore this sense of belonging in the context of organizational hybridization. It does so by drawing on the results of research conducted among the employees of a public unemployment insurance fund in Switzerland. On the one hand, the analysis shows how much their markers of belonging are hybrid, multiple and constructed in negative terms (with regard to the State), while indicating that the working practices of the employees point to an identity that is nevertheless closely bound with the public sector. On the other hand, the analysis shows that the organization plays strategically with its State status, by exploiting either its private or public identity in line with the needs related to its external image. The article concludes with a discussion of the results highlighting the strategic functionality of the hybrid identity of the actors.

Paper 2: EUROCAT public health indicators for congenital anomalies in Europe.

OBJECTIVE: The purpose of this article is to present the specific public health indicators recently developed by EUROCAT that aim to summarize important aspects of the public health impact of congenital anomalies in a few quantitative measures. METHODS: The six indicators are: (1) congenital anomaly perinatal mortality, (2) congenital anomaly prenatal diagnosis prevalence, (3) congenital anomaly termination of pregnancy, (4) Down syndrome livebirth prevalence, (5) congenital anomaly pediatric surgery, and (6) neural tube defects (NTD) total prevalence. Data presented for this report pertained to all cases (livebirths, fetal deaths, or stillbirths after 20 weeks of gestation and terminations of pregnancy for fetal anomaly [TOPFA]) of congenital anomaly from 27 full member registries of EUROCAT that could provide data for at least 3 years during the period 2004 to 2008. Prevalence of anomalies, prenatal diagnosis, TOPFA, pediatric surgery, and perinatal mortality were calculated per 1000 births. RESULTS: The overall perinatal mortality was approximately 1.0 per 1000 births for EUROCAT registries with almost half due to fetal and the other half due to first week deaths. There were wide variations in perinatal mortality across the registries with the highest rates observed in Dublin and Malta, registries in countries where TOPFA are illegal, and in Ukraine. The overall perinatal mortality across EUROCAT registries slightly decreased between 2004 and 2008 due to a decrease in first week deaths. The prevalence of TOPFA was fairly stable at about 4 per 1000 births. There were variations in livebirth prevalence of cases typically requiring surgery across the registries; however, for most registries this prevalence was between 3 and 5 per 1000 births. Prevalence of NTD decreased by about 10% from 1.05 in 2004 to 0.94 per 1000 in 2008. CONCLUSION: It is hoped that by publishing the data on EUROCAT indicators, the public health importance of congenital anomalies can be clearly summarized to policy makers, the need for accurate data from registries emphasized, the need for primary prevention and treatment services highlighted, and the impact of current services measured.

Peut-on faire confiance à l'administration ? Une analyse du concept de confiance, appliqué au secteur public

D'une manière générale, la confiance est un « lubrifiant » (Arrow, 1974) facilitant les relations sociales (eg Luhmann, 1968, Giddens, 1984, Zucker, 1986). D'un point de vue économique, un environnement institutionnel bénéficiant d'une confiance élevée serait corrélé avec la performance de l'économie nationale (eg Dyer and Chu, 2003). La confiance, en tant que capital social, permettrait et engendrerait des comportements altruistes et coopératifs impactant et soutenant la prospérité économique d'une communauté (Fukuyama, 1995). Dans un cadre organisationnel, la confiance engendre une communication plus ouverte et facilite l'échange d'information (eg Smith and Barclay, 1997, Currall and Judge, 1995), facilite la gestion des conflits (eg Blomqvist, 2002), l'apprentissage commun (eg Bijlsma-Frankema, 2004) ou diminue les coûts d'intégration (eg Bidault and Jarillo, 1995), par exemple.