February I

EU leaders focused on three immediate priorities: jobs, especially for young people, completion of the single market and opportunities for small and medium-sized enterprises. They called for stronger structural growth, enhanced competitiveness and job creation combined with fiscal consolidation. Wherever possible, efforts made at the national level will be supported by EU action. EU funds could be redirected towards support for getting young people into work or training. The EU will also support enhanced mobility for both students and cross-border workers.
 

For more information, click here
 

To access the statement of the members from the European Council, click here
 

To access statement by President Barroso, click here
 

The European Commission has taken a range of actions to enhance growth through the use of structural funds, to counter the crisis and ensure a quicker delivery of available funding. Particular attention has been given to Member States which are currently receiving special macro-economic assistance, the so called programme countries (Ireland, Romania, Latvia, Portugal and Greece). For some other Member States a re-programming of funds has taken place, to be able to invest EU funding in sectors where a quick absorption of investments can take place.

For more information and for an overview of the taken measures, click here
 

The IUHPE’s European Conference on the 27-29 September 2012 in Tallinn, Estonia is the 9th conference with several prominent speakers from across Europe including EuroHealthNet.  This conference aims to highlight the latest innovations in health promotion development internationally. This year, the conference will focus considerable attention on the impact of recent economic changes on population health, and address the issues of stimulating health promotion interventions and investment.

The Registration and Call for Abstracts are now open through conference web-site, here
 

For any further information, email IUHPE Secretariat, here
 

The EuroHealthNet Equity Week, including a major open conference on sustainable health systems in times of economic problems, plus our General Assembly and a seminar on health in all policies will take place from 29 to 31 May 2011. Please save the dates in your agenda, and more information will be sent later.

For more information, contact EuroHealthNet Director, Clive Needle or EuroHealthNet Deputy Director, Caroline Costongs

Learning through life can impact positively on levels of social engagement and generate more cohesive, safer and healthier societies and individual benefits. However, a substantial body of international evidence shows that those with lower levels of education are more likely to die at a younger age and are at increased risk of poorer health throughout life than those with more education

To access the EuroHealthNet policy information, click here or contact John Considine, Policy and Advocacy Officer or Stecy Yghemonos, Policy and Advocacy Coordinator.
 

Gradient is a research project which has received funding from the EU's Seventh Framework Programme. It addresses health inequalities among families and children with the aim to influence policy-makers in taking necessary steps to reduce the health gradient. Health inequalities are currently regarded as one of the most important public health challenges in the EU. However, we do not have sufficient knowledge of which actions are effective to level up the gradient in health inequalities. The Gradient (March 2009 – 2012) aims to address this knowledge gap, to ensure that political momentum is maintained and that operational strategies can be developed to make progress on this issue. The focus of the research project will be on families and children, since the greatest impact on reducing the health gradient can be achieved through early life policy interventions and by creating equal opportunities during childhood and adolescence.

To access the Gradient Evaluation Form, click here or contact Giorgio Barbareschi.

Because of the significance of housing, transport, food, health and society, the report focuses on these key domains. It aims to better understand the relationships between lifestyles, the conditions that frame those lifestyles, and the resulting sustainability impacts in Europe today and into the future. In addition, it identifies promising practices from across Europe that have the potential to be examples of sustainable ways of living of the future. Existing visions, scenarios and roadmaps for more sustainable futures – from policy, research, business and civil society perspectives – are also examined in detail.

To access the report, click here

For more information, contact EuroHealthNet Senior Research Officer Cristina Chiotan

EuroHealthNet co-organised a forum on pan-European macro drivers in relation to work, worklessness and social protection, their impact on health inequalities, and futures scanning. The event was held in the context of the progress-funded project “Working for Equity in Health” led by the Scottish Government and Health Action Partnerships International (HAPI). It was aimed at developing a fuller understanding of the current and future impact of pan-European macro drivers, which lie outside the control of individual member states, but which impact on work, worklessness, social protection and, consequently, on health inequalities. The event brought together an interdisciplinary group of experts from across sectors, including policy makers, academics, representatives of international organisations and EU-level NGOs.

For more information, please contact Linden Farrer, Project and Policy Officer, or Stecy Yghemonos, Policy and Advocacy Coordinator.

All presentations, reports and pictures and available in the section of the Equity Channel community group devoted to “Working for Equity in Health”, here
 

• The opening negotiations of the Commission’s proposal for a Health Threats Package will take place during the Danish Presidency of the Council of the EU. The Purpose of the proposal is to achieve a cross-sectorial approach to health threats in order to link initiatives in the health sector to already existing EU policies in other areas. The proposal is thus to ensure better coordination of crisis responses and crisis handling of major cross-border health threats.
• In the context of the Antimicrobial resistance, the Presidency will focus on promoting a more rational use of antibiotics and on strengthening and improving the surveillance of the use of and resistance to antibiotics.
• The Danish Presidency will also give a special focus on the amendment of the Directive on Tobacco. At present the Commission is preparing an amendment of the present directive on tobacco from 2001.
• The directive aims to ensure a well-functioning Internal Market for tobacco products as well as to ensure a high level of health protection. EuroHealthNet is involved in discussions with other health networks on this important dossier as part of its new initiative on tackling non-communicable disease priorities.

To access the programme of the Danish Presidency, click here
 

For more details about the EU health Policy programme, click here
 

Reports at EU level are a synthesis of public health information and statistics from all EU countries, and contribute to creating the European Health Information and Knowledge system.

• health and health-related behaviour of the population (e.g. data on lifestyles and other health determinants)
• diseases (e.g. incidence of, and ways to monitor chronic, major and rare diseases)
• health systems (e.g. indicators on access to care for everyone, on quality of care provided, on human resources for health, and on the financial viability of health care systems)

To access the reports, click here
 

Within the context of the Community Statistical Programme (2008-2012), Eurostat responds to this key priority of the public health programme by developing its databases and publications. Through its cooperation with the statistical authorities in the Member States, more data are now available directly from Eurostat in its Online database.
 

To access the statistical reports, click here
 

The EU Platform for action on diet, physical activity and health met in the context of a workshop on communication and information. The discussion focused on the development of a comprehensive approach towards external communication in order to define key messages aiming at showing the importance of healthy diets and physical activity.
The platform also updated the list of its members.

To access the members, click here
 

To access the meeting report, click here
 

The European Commission published an update of projects carried out under the Public health programme. The selection can be done through a search by project, by year or by issue.
 

To access the list of projects, click here
 

The European Commission published an update on national focal points for health programmes. 
 

All contact details in the 27 Member States are available here.
 

The European Commission provided the rules for the establishment, the management and the functioning of the network of national responsible authorities on eHealth.
 

The network of national responsible authorities on E health is available here
 

For John Dalli, it is crucial to adapt healthcare systems to the needs of an ageing population, while remaining financially sustainable. To help citizens age in good health, live active and independent lives is essential to the European economy and sustainability. This is why potential of innovation for active and healthy ageing and promotion of smart investment in health systems are key.

For Commissioner Andor, the crucial balance between the active and the retired members of society will start changing very fast as more and more people retire and fewer and fewer come onto the labour market. While population ageing is a huge achievement — the inevitable consequence of people living longer and reducing mortality significantly — it also holds a threat for the welfare state, for economic growth, for solidarity between generations, for the very cement binding society together.

• In the context of the 2012 European Year on active ageing and solidarity between generations, EuroHealthNet launches its website devoted to healthy ageing. This website is dedicated to raising awareness of healthy ageing within the context of the EY 2012, especially the important role health promotion plays, in contributing to healthier and more active EU populations. The new website will highlight key factors such as promoting healthy diets, physical activities, social relations and meaningful activities necessary for ageing healthily throughout a person’s life. It will showcase a number of local, regional and national projects dedicated to promoting older peoples health while also identifying a number of EU policy initiatives and instruments that are available to promote healthy ageing.  
• EuroHealthNet, commission by the Federal Centre for Health Education in Germany (BZgA), has produced a new report on Health and Active Ageing. The report  identifies programmes, good practices and other resources for promoting and sustaining the well-being of “younger” older people, with a specific reference to socially deprived and migrant groups in Europe. 

To access Commissioner Dalli speech, click here

To access Statement by Commissioner Andor, click here

To access EuroHealthNet Healthy Ageing Website, click here

EuroHealthNet report on health and active ageing can be found on the home page of EuroHealthNet’s new Healthy Ageing website.

EuroHealtNet is looking to include all relevant projects and initiatives promoting older people’s health on its new www.healthyageing.eu website in the section “health ageing in action”. If you would like to feature your project, please contact John Considine.  

The new "Erasmus for All" programme, proposed by the Commission for 2014-20, aims to support innovation and quality at all levels of education across the EU, including projects and partnerships focused on early childhood education and care. Later this year the Commission will launch a new expert policy group that will look into ways of improving the quality and accessibility of early childhood education. Set up at the request of EU Education Ministers, the group will report back in the first half of 2014.

For more information, click here
 

There are recent signs of a weakening trend in labour demand particularly in the public sector. Recent figures on job vacancies for temporary agency workers show a decline in labour demand since July 2011. Growth in job vacancies was strongest in the manufacturing sector (+39%) and the trade and repair sector (+26%).
 

For more information, click here
 

The latest technological tools are helping elder to sustain their health while staying at home. The European therefore published several success stories showing how technology can help elder in their daily life, while they face diseases or any other handicaps.

To access the article, click here
 

The results of the INTERHEART study, published in the European Heart Journal, come from a case study of over 29 000 people in 52 countries in Asia, Europe, the Middle East, Africa, Australia and North and South America.

To access the study, click here
 

Commissioner Dalli underlines that the health inequalities portal is one of the activities of the "Joint Action on Health Inequalities: Equity Action" supported through the EU Health Programme. The Joint Action involves 23 associate partners from 15 EU Member States and Norway. It began in December 2010 and will run for 3 years. Its objectives are to help reduce health inequalities by developing knowledge for action on health inequalities; and supporting the engagement of Member States, regions and other stakeholders in action to tackle health inequalities. Responsibility for the joint action and ownership of the deliverables rests with the partners. The Commission evaluates regularly the activities and deliverables of all expenditure relating to the EU health programme, including this web portal, to ensure compliance with the terms of the EU contribution and value for money. In this context, comments have already been provided on this web portal with the intention of helping it to improve further.

EuroHealthNet runs this portal, although it was not mentioned in the Commissioner’s reply. For information contact Yoline Kuipers.  

Commissioner Dalli underlines the Commission supports national laws to prohibit the sale of tobacco to minors and encourages Member States' efforts for their enforcement. The Commission is also engaged in EU wide awareness raising and communication campaigns to draw particularly the attention of youth to the dangers of tobacco use and encourage them to quit smoking or not to start in the first place. The Commission is not planning awareness raising measures targeted specifically at tobacco retailers.

Comissioner Šemeta replies that the Commission (Eurostat) publishes every year annual data on poverty or social exclusion. Data are disseminated at the end of the year and cover the previous year. The number of people at risk of poverty or social exclusion was estimated in 2010 by the Commission (Eurostat) at about 115 million. Data are available by many breakdowns, including sex and age.

Directorate-General 'Employment, Social Affairs and Inclusion' also produces quarterly reviews of the social situation in Europe. The Social Protection Committee (SPC) will also adopt a report in January 2012 on the 'social impact of the economic crisis', an update to the 2008 and 2009 report. It will analyse the evolution of key poverty and social inclusion indicators in the light of recent policy developments in Member States. Lastly, the Social Situation Observatory, established by the Commission in 2005, monitors social trends across the EU, providing in-depth analysis of underlying factors and specific thematic focus work

Commissioner Reding replies the proposal on common provisions on the Community Support Framework (CSF) funds provides rules for the translation into actions for these funds of the Union's objectives, including those directly relevant to persons with disabilities: on employment, education and poverty. The proposed CSF framework doesn't explicitly set disability indicators but the draft ESF regulation includes the number of disabled participants as an output indicator. However, common provisions require each priority defined by the Member States' Operational Programmes to set "result indicators relating to the priority". Thus, individual Programmes with relevant objectives should have disability indicators. The Proposal on common provisions sets non-discrimination objectives with regard to disability at all stages of programming as well as in Communication strategy. The ESF Regulation proposal foresees a specific investment priority on combating discrimination and requires Member States to take actions to promote equal opportunities, including accessibility. The Regulation also clarifies that specific actions "shall target people at risk of discrimination and people with disabilities".

For Commissioner Dalli reminds that the Commission has no information available about the funding for associations that deal with treatment and care of people experiencing mental disorders, because this is a matter falling under responsibility of Member States. The Commission is therefore not able to provide an overview of the situation. Under the Progress Programme for Employment and Social Solidarity the Commission however provides funding to EU-level NGO networks in the fields of, among others, social inclusion and the integration of persons with disabilities. Mental Health Europe is one of the beneficiaries of this scheme under the social inclusion strand. Funding covers operational costs with the aim to reinforce organisational, advocacy and campaigning capacity at European and national level, also in support of national members and partner organizations. The Commission's action on mental health builds upon the European Pact on Mental Health and Well Being which concentrates on developing and disseminating good practices and generating action across society on key priority areas related to mental health and mental disorders

Commissioner Dalli replies that The Commission itself has no systematic information available regarding the protection, care and assistance available for people experiencing mental disorders in the EU Member States. However, the Commission has co-funded under the EU Health Programme a 2008 WHO report on "Policies and practices for mental health in Europe-Meeting the challenges". This report provided an overview of mental health services in the 42 Member States of the WHO European Region, and examined issues such as social inclusion, the empowerment of service users and the representation of their families. The Commission has also fostered exchange of good practices on mental health related issues through five conferences organised under the European Pact for Mental Health and Well-being between 2009 and 2011. The best practices from Member States, identified through these conferences, are available in the database EU-Compass for Action on Mental Health and Well-being.
 

Information about the conferences and the database is available here
 

Commissioner Cioloş reminds that the consultation related to the EU school milk scheme gave rise to useful suggestions for improving the overall efficiency of the system that the Commission took on board when reviewing the scheme, notably consisting in an extension of the list of eligible products. An evaluation of the scheme is planned to be launched in 2012. The European Parliament and the Member States will also have the opportunity to discuss important aspects of the scheme, including its coverage in terms of products, educational infrastructure and beneficiaries, financing, accompanying measures and the opportunity for synergies with the Fruit School Scheme during the discussion on the reform of the CAP. In the direction pointed out by the Court, the reform proposal includes already an obligation for Member States to draw up a national strategy for the implementation of the scheme and the possibility for the Commission to set targeting criteria.

Commissioner Dalli replies that the Commission has no evidence that reduced ignition propensity (RIP) cigarettes increase the risk of addiction. With regard to health risks, studies have shown that RIP cigarettes are not more toxic than non-RIP cigarettes. The Commission underlined that there is no safe cigarette and that tobacco is the largest avoidable health risk in Europe. This message was covered in at least 700 media instances, reaching an estimated maximum of 90 million Europeans. The European Union is a full Party to the WHO Framework Convention on Tobacco Control and fully supports its implementation with the aim to reduce tobacco consumption, which remains a major risk factor for non-communicable diseases in the EU. The Commission is also currently preparing a review of the Tobacco Products Directive.

For Commissioner Andor, given the demographic challenges facing the European Union, promoting active ageing is crucial. In line with the Europe 2020 Strategy, the Commission and the Member States committed themselves to improving the employability of older workers. The EU also prohibits direct and indirect discrimination on the grounds of age, as well as harassment and instruction to discriminate on this ground. Access to training for elderly people to ensure that their skills meet the needs of working life is important. Jobs for older people also need to be brought more closely into line with individual needs with a view to longer working careers and easier transitions from unemployment to re-employment. Those were political messages in the Joint Employment Report drafted in connection with the 2011 and 2012 Annual Growth Surveys. With a view to exploring further practical ways of supporting active ageing, the Employment Committee and the Social Protection Committee will draft common principles for active ageing, covering employment, participation in society, living independently and ageing in dignity, for adoption by the Council by the end of 2012. More generally, the European Year for Active Ageing and Solidarity between Generations in 2012 will aim to raise awareness of the importance and usefulness of older people’s active participation in family, social and economic life and to combat negative stereotypes of older people.

The aim of this public hearing is to hear the views of stakeholders and interested parties, especially from Research and Innovation industry as well as related consumer, patient, healthcare organisations, as well as organisations for elderly people.

For more information, click here
 

Good examples for promoting active and healthy ageing will be showcased and discussed by a panel of experts including representatives of European Institutions and NGOs. The best practices will address different challenges in promoting active participation of older people, including accessibility issues, migrant elders who have limitations in their second language, the opportunities of older workers on the labour market and the possibilities for the elderly to stay in their own homes and continue to live an independent life as long as possible.

For more information, click here
 

Research from Eurofound shows that the proportion of workers in the EU27 who think they will be able to do their current job at the age of 60 has risen marginally from 57% in 2000 to 59% in 2010. Also, over the past five years, work beyond retirement has become more common in almost all Member States. Currently, around 10% of 65- 69-year-olds are employed in the EU27, compared to 8.7% five years ago. The continual decline in physically demanding work, as well as improvement in health, will contribute to increasing employment rates for older workers in the future. There is no macro-level evidence that older workers sacrificing jobs would benefit the young. There are, however, a number of issues to overcome in relation to the retention and re-employment of older workers, among which updated skills inflexibility versus experience is one, and the short payback time for the human capital investment is another.

To access Eurofound's campaign website on all issues related to active ageing and solidarity between generations, click here
 

Because universal policies are usually applied to whole populations, and are often complex in nature with long causal chains, this precludes a true experimental design, and other approaches to evaluation are required. This report presents arguments and case studies from an expert group meeting convened to clarify the importance and challenges of evaluating universal policies, and to outline potential approaches to assessing the impact of universal policies on health inequities.
 

The report also identifies key research and policy questions that need evaluating as a matter of priority, and sets the agenda for partnership working to develop these methods further.

To access the report, click here
 

WHO published a report where it highlights that physical inactivity is a significant public health problem. Cycling and walking can be more readily integrated into people’s schedules than leisure-time exercise. Transport is an essential component of life and a basis for providing access to goods and services µ. Different modes of transport are associated with specific effects on society, including health, environment and social effects.

To access the study, click here
 

The OECD published reports analysing the major underlying forces behind the three decades prior to the recent economic downturn, wage gaps widened and household income inequality increased in a large majority of OECD countries. This occurred even when countries were going through a period of sustained economic and employment growth.
 

To access the reports, click here
 

Over 700 European stakeholders have helped to formulate the Manifesto for Integrated Action on the Gender Dimension in Research and Innovation through their input to the public consultation and the discussions at the European Gender Summit. This Manifesto is a work in progress to be advanced through evidence based actions and cooperation between scientists, policy makers and gender research scholars. It represents the knowledge and ideas of European organisations & individuals who believe that concrete actions are needed to enhance research and innovation in Europe by addressing gender equality issues.

To sign the manifesto, click here
 

These challenges are shared by health systems the world over, many of whom are pioneering innovative solutions. The World Health Care Congress Europe has been designed as a unique forum to present these global innovations in health care. The Congress presents the best and latest ideas in modern healthcare and features the World’s leading providers, payers and policy makers. EuroHealthNet Director Clive Needle will participate and will be part of the session related to the promotion of health prevention.

For more information, click here
 

The report challenges some of the myths around mental health and concludes that policymakers need to look for new solutions. Most people with a mental disorder work, with employment rates of between 55% to 70%, about 10 to 15 percentage points lower than for people without a disorder. Increasing job insecurity and pressure in today’s workplaces could drive a rise in mental health problems in the years ahead, says the OECD. The share of workers exposed to work-related stress, or job strain, has increased in the past decade all across the OECD. And in the current economic climate, more and more people are worried about their job security. To help sufferers, a new approach is needed, especially in the workplace, says the OECD. This includes good working conditions which reduce and better manage stress; systematic monitoring of sick leave behaviour; and help to employers to reduce workplace conflicts and avoid unnecessary dismissal caused by mental health problems.

For more information, click here

To access the summary and conclusion report, click here
 

The International Training Centre of the ILO Social Protection Programme will organise a course aiming at  identify inequities in effective access and main causes, review the importance of universal access to health care in crisis and post crisis situations, issues related to the feasibility of introducing a scheme and planning for implementation; designing the appropriate contribution levels and benefits, monitoring the provision of services and ensuring the sound governance and financing of the scheme.
 

For more information, click here
 

ILO published a report related to work-related stress. This is one of the most important issues in many countries. The negative impacts of stress are multiform and can include circulatory and gastrointestinal diseases as well as physical, psychosomatic and psycho-social problems. These in turn can lead to poor work performance, high accident and injury rates and low productivity.

To access the study, click here
 

Presentations include examples of how the UK and South African governments are working with businesses for society’s benefit as well as examples from America, Slovenia and the UK on how NGOs and companies
have worked. The programmes will include:
• Corporate Social Responsibility Managers
• Social Marketing Managers
• Public Health Practitioners
• Corporate fundraisers
• NGO Service Delivery managers
• Donor Programme Managers from Charitable Foundations

For more information, click here or email Patrick Ladbury
 

The aim of the seminar is to voice and discuss the research findings and to explore pathways to arrive at an indicator of HLY by SES of good quality, which can be regularly updated. The seminar also intends to support the use of the indicator in different policy domains like health and long-term care, social inclusion and pension policy, by elucidating current developments and the state of play concerning the status of the indicator.

For more information email here or contact Rudi Vandam
 

The Greek health-care system has been accumulating structural problems for a decade that have been exacerbated by the economic crisis. In terms of expenditure, a failure to contain costs, in part due to an absence of explicit funding criteria, created budget deficits for sickness funds.

To access the article, click here
 

The Ministry of Health in Greenland has signed an agreement with the European Environment Agency (EEA). The two organisations committed to exchange personnel, and share knowledge, data and other expertise on environment-related health issues.

For more information, click here
 

The KAM module is the successor to the Health Education Population Survey, which ran in two waves annually between 1996 and 2007 (and was intended to monitor progress in the process of achieving change in health behaviours through a health education approach. The KAM module is embedded within SHeS so can draw on a much wider pool of information about health-related behaviours, experiences and characteristics expanding the possibility for analysis and for a robust examination of the links between knowledge, attitudes, motivations and actual behaviour.

To access the report, click here
 

Professor Carol Tannahill, director of the Glasgow Centre for Population Health, which funded the research as part of an ongoing public health study known as pSoBid, said: “The association between deprivation and ill-health is well established, but the pathways through which deprivation leads to poorer health outcomes are less well understood. Previous findings from the study have confirmed that people with relatively low income, living in poor circumstances, have more miles on their biological clock than people of the same age in better circumstances.

“The new findings add evidence that people in poorer socio-economic circumstances may face an uphill health challenge from before birth.

"Health inequalities are a reflection of wider inequalities in society. We are now learning that these inequalities have direct epigenetic effects. If we are going to improve health in Scotland, we need to keep a focus on action to address poverty and regenerate poorer neighbourhoods, and to support all children to have a good start in life.”

For more information, click here
 

The Swedish National Institute of Public Health published with the aim of providing an overall view of prescription of physical activity. It also aims to support the implementation of the method in healthcare services.
 

To access the book, click here
 

The “Regional and local initiatives promoting healthy and active ageing” conference, organised by the thematic working group Active contribution and social inclusion, aims to focus on the health promotion aspects of active contribution and social inclusion and will look to discuss each of the following challenges: Quality ageing in urban environments, Elderly Immigrant’s Well-Being and Integration in their Second Home, How can older people actively contribute to their communities? and Active Participation – giving the elderly a voice.
 

For more information, email Ms Linea Svensson.
 

• Life expectancy at birth in England has continued to increase for both males and females, reaching 78.4 and 82.4 years respectively in 2008-10. Cancer: The mortality rate from cancer at ages under 75 in England has continued to decline, at 110 deaths per 100,000 population in 2008-10, a decrease of 14% since 1999-01.
• Circulatory diseases: The mortality rate from circulatory diseases at ages under 75 in England has continued to decline, at 67 deaths per 100,000 population in 2008-10, a decrease of 41% since 1999-01.
• Suicide: The mortality rate from suicide and injury of undetermined intent in England was 7.9 deaths per 100,000 population in 2008-10, a fall of 15% since 1999-01, but having remained around 7.9 since 2005-07.
• Accidents: There has been little change in the England mortality rate from accidents since 1999-01; however, in 2008-10 the rate fell by 2.8% compared with 2007-09, from 15.7 to 15.2 deaths per 100,000 population – this was mainly due to a fall in the rate for males.

The full statistical release can be found here
 

A new public health outcomes framework will measure the work of local authorities, which will take on responsibility for public health from April 2013. Ministers will assess efforts to reduce inequalities between regions and to improve 'healthy life expectancy' - the number of years lived in good health as well as overall length.
Local authorities will be given £5.2bn of ring-fenced funds, taking much of the responsibility for public health away from the NHS for the first time in decades. Councils will also be paid a health premium if they improve the public's health.

To access the article, click here