A new monitoring tool, developed by WHO and the Public Health Center of Ukraine (UPHC), is revealing how the different regions in Ukraine responded to COVID-19. Launched in October 2020, the Public Health Response Monitor (PHRM) was developed based on a regional tool, WHO/Europe’s Health System Response Monitor (HSRM).

The PHRM allows Ukraine to systematically monitor the policies and epidemiological situation across the different regions of the country. Using the findings, national and regional authorities can adjust the country’s COVID-19 response.

“We welcome tools that facilitate coordination and help us to respond effectively to the virus,” said Ukraine’s Deputy Minister of Health, Viktor Liashko, who added, “We are discovering the opportunities of regional monitoring, which we will consider integrating into the daily work of emergency coordination centres to support our public health response”.

Providing insights into new outbreaks

Several rounds of data collection began in the regions in May 2020. The WHO Representative in Ukraine, Dr Jarno Habicht, highlights the importance of this information in helping national and regional authorities to coordinate health-related interventions, policies and messages to support Ukraine’s COVID-19 response.

“The tool could also be a useful resource to help investigate a new outbreak in a given region,” he adds, “illustrating, for instance, how relaxing public health measures and allowing people to congregate, results in high infection rates in subsequent weeks”.

Emergency coordination centres at the Ministry of Health and the UPHC can also use the tool to compare governance and financing arrangements by region, and see whether these differ from national standards and policies.

Reflecting capacity and leadership

The PHRM consists of a questionnaire with six blocks of questions covering areas including regional management and coordination, funding, planning of services, case management and supporting essential health services during the pandemic. Public health data is supplemented with data on the epidemiological situation in each specific region.

The findings so far show a considerable variation in the implementation of COVID-19 measures in the regions of Ukraine, reflecting regional capacity and leadership. The next step will be a detailed study of the measures taken by the regional authorities in critical areas, such as school reopening and ensuring access to basic medical services.

The tool facilitates in-depth analysis of public health information alongside epidemiological data. It builds on a joint initiative between WHO/Europe, the European Commission, the European Observatory on Health Systems and Policies and the HSRM.

In collaboration with Uppsala University, WHO/Europe has published new technical guidance that outlines why and how Member States should collect refugee and migrant-specific health data through their national health information systems (HIS).

As a result of increased mobility, societies have become more diverse – as have their health needs. The principle of leaving no one behind in the Sustainable Development Goals (SDGs) and the advancement towards universal health coverage, one of the European Programme of Work’s core priorities, promote the inclusion of refugees and migrants in public health goals.

Progress towards these goals cannot be measured without systematically collected data on both health and health-related indicators for refugees and migrants.

Inclusion of core variables promotes effective public health programmes targeting refugees and migrants

The new publication suggests integrating a set of core variables into HIS, which will facilitate disaggregation of data by migratory status, offering insights into the health status of refugees and migrants, which can then be translated into evidence-informed policies. These core variables include:

• country of birth
• country of citizenship
• year and month of arrival
• country of birth of both parents.

The publication is an important example of WHO/Europe collaborating closely with partners including the International Organization for Migration (IOM) Global Migration Data Analysis Centre, the United Nations High Commissioner for Refugees (UNHCR), the European Centre for Disease Prevention and Control (ECDC) and members of academia, to develop evidence-based documents that can guide Member States’ efforts to ensure the right to health for all.

Statement by Eva Åkesson, Vice-Chancellor of Uppsala University

“The International Maternal and Child Health (IMCH) Unit of the Department of Women’s and Children’s Health at Uppsala University, is a leading research and education division committed to disseminating knowledge that can contribute to creating a more just and equitable society. Translating knowledge into strategies and practical action for global health and migration is one of IMCH’s goals.

“Recently, IMCH has been working with WHO/Europe to promote the health and well-being of refugees and migrants. The latest output of the current collaboration is the development of the ‘Collection and integration of data on refugee and migrant health in the WHO European Region. Technical guidance’.

“Reliable and good quality data is essential to reduce health inequality among all, including refugees and migrants, and to achieve the SDGs. Consistent data is needed to ensure policies are sound and that operational and legislative responses effectively reach those they are intended to help. The publication aims to assist decision-makers in developing evidence-informed policies and actions to ‘leave no one behind’.

“The technical guidance highlights the current status quo and offers practical solutions to address the gaps related to migration health data and HIS in the European Region. It provides practical guidance to integrate migration health data into national HIS, which present a valuable mechanism and offer information to develop targeted health interventions not only for refugees and migrants, but for the entire population, including other vulnerable groups.

“Uppsala University is honoured to support WHO/Europe in its efforts to safeguard and promote the health of refugees and migrants.”

A recent analysis of results from the WHO Childhood Obesity Surveillance Initiative (COSI) provides a unique overview of the physical activity habits of children in the WHO European Region. The study shows that more can be done to increase physical activity, reduce screen time and ensure quality sleep among children in the Region and that there are clear differences in the prevalence of these behaviours between countries.

Across the Region, Portugal had the lowest levels of children cycling or walking to school, with nearly 80% being driven by their parents or using public transport – compared to just 6% in Tajikistan, where the vast majority actively travel to class.

Stephen Whiting, one of the authors, said that the “Physical activity, screen time and sleep” report could help guide policy-makers, schools and parents to improve the well-being of children.

“The findings are interesting as they show clear differences between countries in the ways that children are active. Governments can use these results to guide their efforts to increase physical activity levels of children, to set them up for an active and healthy future.”

Active children become active adults

Physical activity is an important determinant in the prevention and management of childhood obesity, which is associated with many serious health problems during childhood and increases the risk for noncommunicable diseases.

Our physical and socio-cultural environments largely determine where and how we can be active. Physical activity habits during childhood tend to track into adolescence and adulthood; establishing physically active behaviours early on can reap dividends in later life.

One pattern highlighted in the study is that children in central Asian countries are more likely to walk or cycle to school, but less likely to be a member of a sports club than those from northern or southern Europe.

“There is a big gap in the understanding of parents and the community of the importance of including physical activity as a natural part of their children’s lives,” says Shynar Abdrakhmanova, the Principal Investigator for Kazakhstan.

Ana Rito, the study’s Principal Investigator for Portugal, who has 3 teenage boys herself, says that this is a different world from the one she knew as a child.

“When I was growing up, we didn’t have any screens to distract us. We would naturally look to go outside and play with our friends. This is a different environment now, but it doesn’t mean that because it is different that it can’t work. There are new ways of being physically active.”

The challenge of addressing sedentary behaviour and screen time

Active play (unstructured, outdoor physical activity in children’s free time), active transport (cycling or walking) and participation in sports, are the major contributors to total physical activity among children.

It is important that as children grow and develop that, in addition to high levels of physical activity, they also achieve low levels of sedentary behaviour and sufficient sleep each day.

Time spent using screen-based devices increases sedentary behaviour, which has been linked with a higher intake of energy-dense snacks, drinks and fast foods, and overall higher energy intake.

The lure of screens and devices is a particularly difficult one for parents to overcome. Shynar Abdrakhmanova, who has 4 children, points out that simply restricting them might not work. Rather, children need something more exciting to replace them with.

“Children should be doing something more interesting than, for example, merely being outside or just doing something active that isn’t on a screen. Something should attract them to do physical activity. This could involve doing something in the community, or organized physical activity. But schools are crucial – they spend a lot of time there and more lessons should be based around physical activity, and more time given to organized sport.”

Ana Rito says that while modern life has meant there are fewer ways for children to get physical activity as part of a normal daily routine, simply finding the right solution can overcome the problem – and even make them more physically active than previous generations.

The differences in the prevalence between countries shows that there are opportunities for national policy-makers to learn from experiences across the Region and to adopt what works.

Countries can use these findings to guide the development of policies and interventions to increase physical activity, reduce screen time and stop the rise in childhood obesity.